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Home My WebLink About1968 RAYMOND AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 1968 RAYMOND AV status: ISSUED Suite No Applied: 06/10/2005 Vicinity: Issued: 06/10/2005 Parcel Nunmber: 42630302 Applicant: CEFALIA, JOE - - - -_ - ISSUED BY: Address: 1625 IRVINE AVE- UNITB �,-%�-' Phone:.949-293-3787 - COSTA.MESA,.CA-•. Zip ..92627 Owner: IA III, JOSEPH: Address /1625 IRVINE AVE- ' 'COSTA MES ";C Phone: 949-293-3787 - UNILB' Zip: 92627 - Contractor. OWNER -BUILDER r_ �V` A'ddre'ss ,!%�/ ��,`. _��'��,? ,>• �; ��`�� , .: Phone 1 , _ Zip: - License: 000000 •` '�. .� ',�'ry SCOPEOF,PERMIT v •,-,;�.r ;'. . ' - ELECTRICAL PERMIT FORTEMPORARY; POWERjPOLE IN CONJUNCTION WITH THE CONSTRUCTION OF A NEW SFD. _ REF: B05-00627 4 UMMARY -- —_ =FEE SUMMARY,--- Quantity -" - — - /�� - Quantity Quantity .,' t ' ISSUE,FEE ' ., $23.50 i Temp Dist System / Lighting $0.00 0 , 1 Temp service test -,�� $0.00 Busway /100 ft, $0.00 0,� Res. a/c package i\, �� $0.00 '� Standing Seetionc-- $000 0.9; New Res (1-2 units)1 V t $0.00 ' 0 Misc Electrical Equipment $0.00 New Res(3+units) / �� $0.00 0 .J; � ✓ Transformers up to 1 kva/kw ° ��$0.00 $0.00 lir Pool / Sipa �� 0 s . a. up�,to 10 kva/kw .., .-.• $0.00 / "/ 0 Lighting Fixts A; �$0 00 0 a,��.t"` / �'� up to 50 kva/kw $0 00�// 0 � Recept Outlets: $0:00 J 0�, �•,y; �., ......up to 100 kva/kw , , -$0 00/ 0 ' Switches �� \ - _ i $0 00�; �� , 0 .......... over 100 kva%kw \ ' . -$6'601 0 Non Res Appl $0.00\��0 ` Low Voltage Equipment " -$0.00 .o�� Res Appl V�`V $0.00 •LA0 `Low Volt Wiring System / Ckb��$0.00' C/, 0, Service to 2006 $0.00, oMisc. Conduit.$0.00 0 - Service to 10006 �� '$0 00 % 0 - Misc.-Conductor;, -$0 00 ;i 0 Service over 10006 $0.00 i 4 /i ,0 �- - -�- -Circus (gen dr ride) _ ;��-$0 00" 0 ;, - Motors l0 1 hp Motors lol0hp c$0.00 �.,`M,l f 0 J Circus (meth ode orllighls) $0.001,, C.�O,�',��-r�IF,_-Chnstmas Tree;Sland�� $0 00 0 - $0:00��/ 0 `- Motors to 50hp $o:00t:.= 0 lr'� ! f+ Fireworks Stand=-,�.� 0 Motors to 1 00h $0.00 ='__o___ =� 0__- `---i z; 1, OthenElectri6l Fee .;��$0.'00' ,$0.00 Motors over 1 00h $0.00 0 Communication drops $0.00 0 - - -- >, 1Investigation Fee` - - - $0.00 Sub panel to 200a $0.00 0 - -- - Plan Check 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 244646(6/00) DECLARATIONS C-) WORKERS' COMPENSATION DECLARATION: I hereby all inn under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a cerBTicats of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensatlon 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 p9grul is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws Celifomla, and agree that If I s t coma bjecl to the workers' compensation provisions of Section 3700 of the Labor Code, I shell forthwith _. tnpy with these p inions.Applicant-Sign WARNING: FAILUR O CURE WORKER DMPENS N COVERAG S IN WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND 100,0001, IN ADD To TOFCOMPE ION, DAMAGES AS PROVIDED FOR IN SECTION 31060E THE LABOR OODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 o1 the Business and Professions Code, and my license Is in full force and effect. Uc. N Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code), Lender's Name: Lenders 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. It, 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 (Sac. 7044, Business and Professions Cale: The contractors License Law does not appy to an owner of property who builds or Improves thereon, and who contracts for such project with a contraclor(s) license pursuant to the Contractors License Laws.). / �1 ❑ 1 am exempt der sec. Busines and Profe ions a for this reason: 8lgnatu L+Dete�� Own ler D vfi by driv icense. ❑ Yes No (6rwe`rs'Cidenw Na' Exp( ues; Verification o 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 B. California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 5D0 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .........._........_......._........_........_........._......................__.............. _........................................... _...... .... ___._._............................................................. _............................................................... _......................... _............................... _ 3 Does or will theapplicant 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 en 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 gpplication apermit 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 California Health and Safety Cale). ........._..........—........__......_........__.............—.........._..................... _......._..—._...—..__...........___......_......................................................_...............__................................... __.................. _....... .._.......... ._........... _.. 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 Celifomla Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ........._........._........................ _............. _..........._...................................____._..........................._............................................................................ _.........................._.................... _.................. _................... _.......... _........................... __ e (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 ordin Des relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-describe roperty for inspeclio uto to oco py or allow occupancy of any building authorized by this 'per`nit`until fin-al inspection. Sf� f.Le Owner(s) `/ —D t—�� And/Or Authorized Applicant Date CODE Ir INSPECTION TYPE un IIQIIIALS CODE d INSPECTION TYPE 2AU INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final Bloc lRelaining 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 Bullding/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.101-DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1968 RAYMOND AV Status: ISSUED Suite: Applied: 04/15/2005 Vicinity: NEW SFR & ATTACHED GARAGE Issued: 07/13/2005 Primary Occ: R3/U1 Type of Construction: V -N Parcel Number: 42630302 Zoning: Applicant: CEFALIA III, JOSEPH --_. ISSUED BY: Address: 1625 IRVINE AVE - - - UNIT Phone: .949-2933787 COSTA MESA CA - Zip: 92627 -- j -- / ,;-' SCOPE OF PERMIT 7. CONSTRUCT NEW 3775 SF 2 -STORY SF_R (1ST FLR - 1986 SF & 2ND FLR-1_789 SF) WITH 52g SF 2 -CAR ATTACHED GARAGE & 145 SF FRONT PORCH AND 192 SF REAR PORCH. - -. - PREF: ZA-05-01,& G05-00012 PLANNING'&ZONING _ FEE SUMMARY SETBACKS 'Plan Check: Owner: CEFALIA III, JOSEPH — Calc Valuation: $380,309.64 V `Permit: Address A6251RVINEAVE- MAIN STRUCTURE Front `�:0- 0 '- Claim Valuation: �;;',' $0.00 I'SMIP Res , j COSTA MESA, CA Phone 949,293 3787 /j SMIP Com: 'UNIT B `" " ' Zip: 92627- 'Other: $0.00 7 ;".� PARKING Existing: 0 ✓d" j' 1n,Spection: ,';�� i Contractor: OWNER -BUILDER Total: $4,274:1 i Address:, > Phone: - Zip: ., -License: 000000 - ;Arch : - VOCBEDA, P,,ETE'` " "�. Eng: " Address: - 615 N: BENSON AVE _; - - - -- Address:,, - - - " UPLAND; CA- y Phone: _ _Phone: - SUITE C• Zip: 91786 - �' License: t License: j -- / ,;-' SCOPE OF PERMIT 7. CONSTRUCT NEW 3775 SF 2 -STORY SF_R (1ST FLR - 1986 SF & 2ND FLR-1_789 SF) WITH 52g SF 2 -CAR ATTACHED GARAGE & 145 SF FRONT PORCH AND 192 SF REAR PORCH. - -. - PREF: ZA-05-01,& G05-00012 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 240646 (600) PLANNING'&ZONING _ FEE SUMMARY SETBACKS 'Plan Check: $1,668.78 Calc Valuation: $380,309.64 V `Permit: '� $2,567.35 MAIN STRUCTURE Front `�:0- 0 '- Claim Valuation: �;;',' $0.00 I'SMIP Res , 0$38.03 _ -;'Left, /j SMIP Com: x;$0.00 0 0�-"" Righter 'Other: $0.00 7 ;".� PARKING Existing: 0 ✓d" j' 1n,Spection: ,', $10:000 Total: $4,274:1 i > 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 240646 (600) PLANNING'&ZONING _ SETBACKS MAIN STRUCTURE Front `�:0- 0 , Rear 0-0 - Leff 0- 0 1 ' Right, O O j _ -;'Left, '0-0 ACCESSORY Front 0 0�'c - Rear 0-,0-- 0 0�-"" Righter PARKING Existing: 0 Required: =. 0-_.,- --Proposed:- 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 240646 (600) DECLARATIONS , 0 F) WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' 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 carder and policy number are: Carder: Policy Number: (This section need not be complefed if the permit is valued atone hundred dollars ($160) or fess.) Mcertify that in the ante of Ne JJyyod for hich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' ompensation le of Ca fon ogre th if I shoultl become subject [o the workers' compense8on provisions of Section 3{X^00 of the Labor Code, I shell forthwith omply with th rovisi . -711 U 4t ,`Applica�F,S7gnewfe: f,. -„,Date: WARNING: FAILURE TO SE WORKERS' 0OENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EN"ER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (S100 )�IN ADDITION T0/111E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECRON 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 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. q Class x Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code), Lenders Name: Lenders 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).): 9k( 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 Profeuions Code: The contractors License Law n t apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license put to thq. nrracro Laws.). ❑ I am exp un r sec. Business and Professions Code for this reason: S gnatui ["”- DwmOf ID veriu drivers license. ❑Yes ❑ No Ddvats'L7celue No.`s=z ' 6-p 07 Verification of;/ership by (type of ment, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby comfy 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 pernit 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 marshal? ❑ 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 aDPlicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 2DO 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 end 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. ................._...........p....................__........._............._..........._...._...................................................._.__......... _._........._........................................................._....................._.........................._................................................. .._....................... a II 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 Rplication apemit 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 LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..................... ......... ._........................................................................................................................................................................................................................................................ .......................................................................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cade). .................................................................................................................................................................................................................................................................................................................................................................................... ........ 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- f 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 intonation given above is correct. 1 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 cartify under penalty of perjury that I have read this application and state that the inforrabon given Is correct. I agree to wmp{y'G i all state laws ty o dmances relating to building construction, and authorize representatives of the City of Costa Mase to enter upon the above-described prope for i rs ecti n pu e I s e not to occupy or allow occupancy of any building authorized by this permit u) II Bnal inspection. / /�� SiggqauraatiltegillOwners) I.Dat" And/Or Authorized Applicant Data CODE I INSPECTION TYPE 2AU Ui(Il19CODE�L INSPEcnoNTYPE RAM g([ITAUS 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 BulldinglOccupancy To: Applicant: Address: Telephone NEWPORT -MESA UNIFIED SCHOOL DISTRICT CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AS 1600 AND AS 181 N° 5469 (yCity of Costa Mesa District Receipt No. ( City of Newport Beach ' , ( ) County of Orange Plan Check N . r /�� Tract/Parcel and Lot Number(s): Location of Project: %:;> U c I Number of Square Feet of: 3 77 r S r - 1170 S1= Residential Space Cpe ) x $1.84 Commercial and industrial Space x $ .30 CommercialAndustrial Project is: (Check One) Warehouse R&D Movie Theater Mini -storage Heavy Industrial Regional Shops Light Industrial This project is exempt because Motel Bank Neighborhood Shops Racquet/Health Hotel _ Medical Office Office Park Total 'g't� . 2D Total Preschool Auto Repair Hospital Large Office Office Bldg. Restaurant Fast Food This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport -Mesa Unified School District. By The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not true, then this certificate ?shall automatically terminate and the appropriate City/C7unsall benotified. Date: �aL� FINAL GRACING CERTIFICATION Project Address: 1968 Raymond, Costa Mesa. Lot \umber: 0 Permit Number: �� S coo I -z— By By Civil Engineer: I certify to the satisfactory completion of grading in accordance with the, approved plans, specifications, local and 'state codes. All drainage devices required by the gradin permit, grding plan and grading ordinance have been installed. Adequa[e provisions have been made for drainage of Surface'uater from each'building site. ' The minimums are 25--c Fall from s!ructures within 5 feet fr= exterior walls. 1 �, Fall for asphalt surfaces and landscaped areas. 0.5t Fall for concrete surfaces to approved disposal areas. The final rnonu, ,ents as shown on the recorded tract map %ere set. All final grading eleva- tions are Flo of the desig ed E ztions. Supervising Civil Engineer ` Reg. No. 31720 . �:crc) Date 3/9/06 I S-,A!•T and sIcN INSULATION CERTIFICATE IC -1 1968 RAYMOND AVENUE COSTA MESA Num er and Street ty ORANGE County Subdivision Lot Number Description of Installation 1. ROOF Material _UyFACr:n RATT.$� Brand Name CERTAINTEED Thickness (inches) 12" Thermal Resistance (R -Value) Et -30 2. &-OVERHANGS Batt or Blanket Type UNFACED RATTS Brand Name CE TR AINTEED Thickness (inches) 6 114" Thermal Resistance (R -Value) R-19 Loose Fill Type Brand Contractor's min installed weightfit, ylb Minimum thickness vlches Manufacturers installed weight per square foot to achieve Thermal Resistance (R -Value) 3. EXTERIOR WALL Frame Type A. Cavity Insulation Material UNFACFD_BATT$ Thickness (inches) ,j 112" B. ExteriarFoam Sheathing Material Thickness (inches) 4. RAISED FLOOR Material Thickness (inches) 5. SLAB FLOORIPERIMETER Material 'Thickness (inches) Perimeter Insulation Depth (inches) Brand Name CERT I TEFO Thermal Resistance (R -Value) R-13 Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) 6. GARAGE CEILING Material UNFACED BATTS Brand Name CERTAINTEED Thickness (inches) 6 114" Thermal Resistance (R -Value) R-19 Declaration I hemby certify that the above insulation was installed in the building at the above location in conformance with the current Energy Wiciency Stondordas for residential buildings (Cale 24, Part 6, California Cade of Regulations) as indicated on the Certificate of Compliance, ere apap lic 1,2,3,6 3123106 OJ INSULATION, INC. Item 03 ignatare: Dau Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Ilam Os Sigoawra, Dene Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR owner Item As Signature, Date InsWlIng subcontractor (Co. Name) OR General Contracur (Co. Name) OR Owner Revised March 1, 1996 Wd :[[ 9004 SUBCONTRACTOR LIST City of Costa Mesa/- P13oning Div. --,n C P. O. Box 1200, Costa Mesa, CAS 92628-120[0 BuildeeC%5P0�/ cltC�l�tla �jAddress S4ML Phonebq l/id-766 Job Site l¢ U �. � � ' 1 Ue , Date Z) )0(, Permit # TRADE SUBCONTRACTOR ADDRESS PHONE STATE LIC. NUMBER ASPHALT CA13INETS CARPETS CARPENTRY / i0 COn (.YC �)��. Ec�naP�ace Covet / `iU-4291 lo6 9s ^ CEMENT CONT., CEMENT TRANSIT qrAwA Ccyv-re�t a a Ana 921 S -S 2(p '295- ISSO CLASSIFIED SPEC. ,. CLEANUP/HAULING DOORS (GARAGE)lil Z Pv hope, blfe 1 2947 DRAPERIES DRY WALL f-\, vo i bI 114 clq'c4)% Q& Pc09lvefa 0(04,0 Z-2(¢ 50'1 ELECTRICAL ry (-- ELEVATOR EXCAVATION 9YtC, 'C44 Ca SlraZn�oG�l, �12(nZ� 4 -I(0 q� FENCING 0yJtieC FIRE EXTINGUISHER FLOORING/DECKING FORMICA FOUNDATIONS 0 U e f GLAZING HEATING eam ea i ZnGs Yfu39 SSI i o v3d-si INSULATIbN05lt&�tiGvu meSQzA G . a170Z ?i - 0 14V-%iiq LANDSCAPING CY LATHING /Vv I G0.fG 0. �Cri S- iQi(n �Z9��3 LINOLEUM/ASPHALT TILE/GUNITE ot.rrlev MASONRY- . PAINTING L�s '/y Ii i &-llt x$12 Nevin AJt. ni' Z LVI, - .0 Z PLASTERING PLUMBING Mlke f u NU t� S) r'1F kS Qelp C SiN,E $ C� POOL REFRIGERATION nea�( �nL, S4 AE A 601/F ROOFING SANDBLASTING SEWER h16 6f0 Ah Plvmbin 'pTll�5 •'`5 H. Q. 6.4gwLyo 71ZA -'ii3s �� SHEET METAL Q Ylf j SHOWER DOOR SOLAR SPRINKLERS STEEL REINFORC. STEEL STRUCT. STUCCO , 64r o. ern Z - s� `b Z`1 '-S,43 TRUSSES/GLU-LAMS 1� LVrn�2r �0. of ararnOvYaov. v i ''I143 TV ANTENNAS WALL COVERINGS WEATHER STRIPPING OTHER SPECIALTY 1 CMF 0701-30, rev. 10/95 CITY OF COSTA MESA DEVELOPMENT SERVICES DEPARTMENT PLANNING DIVISION OWNER BUILDER CERTIFICATE OF EXEMPTION I am fully aware of the responsibilities as owner builder. The persons named below are my employees and I agree to withhold the following required deductions: Federal and State Income Taxes, Social Security payments, and Workmen's Compensation Insurance Premiums. My employer's number is Further, I hold no objection to a copy of this certificate being forwarded to any governmental agency upon their request for same. Employee's Name Address Social Security No. Under penalty of perjury, I declare that the above statement is true and correct to the best of my knowledge and belief. Signature 0 Date 3 /,?n /Q ` (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa9teCTRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1968 RAYMOND AV Suite No Vicinity: NEW SFD Parcel Nunmber: 42630302 Status: ISSUED Applied: 09/14/2005 Issued: 09/14/2005 Applicant: GLEBOVICH, JOE Address: 12951 DROXFORD STREET ISSUED BY: Phone' 562;402 3021 ;= CERRITOS, CA Zip 90701 p ¢.. Owner: CEFALIA III, JOSEPH'' Address 1625 IRVINE AVE - :.COSTA MESA, CA :Phone:. 949-293-3787 UMT B - Zip: 92627. Contractor: SOUTH SEA ELECTRIC ,`Xd&ess: 12951 DROXFORD STREET Phone: - 562-402-3021 - -?:- CERRITOS, CA Zip: 90701 License: 408563 SCOPE OF PERMIT CONSTRUCT NEW 3775 SF iSTORY SFR (1 ST FLR - 1986 SF & 2ND FLR-1789 SF) WITH 529 SF' i' 2 -CAR ATTACHED GARAGE & 145 SF FRONT PORCH AND 192 SF REAR PORCH -�- -REF B05-00627 & G05-00012 1 NEW 3775 SF SFD TO INCLUDE A/C ELEC PKG - - --> - - GARAGE: 2 LIGHT FIXTURES, 3 OUTLETS, -2 SWITCHES L FEE SUMMARY " _ - Quantity - - �. Quantity, = , ISSUE FEE .f `$23.50 _ _ - Temp Dist System /Lighting $0.00 0 " Temp service test - $0.00 - ;-: Busway /100 It - $0.00 - 0 Res. a/c package$0.00" ' ' " Standing Section - " , $0.00 • 0 - New Res (1-2 units) $211.403775 Misc Electrical Equipment ' $000 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 ','I 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 Appy- _ $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, _1 $0.00 _-- 0 ' Service over 1000a: '$0.00 0-F . Circus ( gen or ride) - $0.00 - _:- _0. Motors to 1 hp $0.00 - 0 - - - Circus (mech. ride or lights)`, ' $0.00 0 - - Motors to 10hp ' $0.00 ___ 0 , r „ Christmas TreeStand .. $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 x..$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 $242.60 Intermed Pole $0.00 0 - - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit, FOR INSPECTIONS CALL: (714) 7545626 2446-48(6/00) Z I DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. ❑ 1 have and will maintain workers' compensa0on 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 carder and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) 71 certify that in the perfornance 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' / compsnsatlon laws of California, and agree that if I should become subject to the workerscompensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pro" elo s. >41q Appflt�n`t Signature: Date: 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 31060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licens d 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 [1 7� YQ ,P Jr_6 3Class# C— If O Contractors=nature: ed J9-4 6—=_s=ue Data CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a constmction 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 Cade: 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 t0 the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) 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 perrilt 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 Of improves thereon, and Who contracts for such project with a contrador(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 Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 6, California Administrative Cade). ❑ 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 WIII 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 Q No (Section 25505 of the Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time 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 stantlartl temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ......................_............................................_............-..............................................................................................................._..............................................................-.................-.................-........................._................................................. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..........................................................-........................................................................................................................................................................................................................... ............................................................................................. 4 If an RMPP is presently required, has Section 25534 of the California Health end 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 .3.Eplication ag8armit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or age nc/7 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 sch. ool?❑ 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 ❑ No .......................................................................................................................................................................................................................................................................................................................... .............................. ............... I.................... B (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 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 oaupy or allow Occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) /yI ate O's, �And//OrrAAu�thorized Applicant nDate CODE f. INSPECTION TYPE PAL INTITALS CODE INSPECTIONTYPE 2M tNTITIALg 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Raaf 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 I (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 1968 RAYMOND AV Status: ISSUED Suite No Applied: 09/29/2005 Issued: 09/29/2005 Vicinity: Parcel Number: 42630302 " ISSUED BY: Applicant: DAN REAMS Address: P O BOX 639 - Phone: 562 -430 -5755 - SEAL BEACH, CA Owner: CEFALIA III,JOSEPH_ Address: - 1625 IRVINE AVE COSTA MESA;, CA UNIT B Contractor: REAMS HEATING CO INC Address:.;;. P O BOX 639 Zip: 90740 Phone: 562-430-5755 SEAL BEACH, CA Zip: �%;90740 - - - License. 162995 - SCOPE'OF PERMIT ` - CONSTRUCT NEW 3775 SF 2 -STORY SFR (1ST FLR - 1986 SF 8 2ND FLR-1789 SF) WITH - --'1,,529 SIF 2 -CAR ATTACHED GARAGE & 145 SF FRONT PORCH AND 192 SF REAR PORCH. REF.: - -` B05-00627 4 h a MECHANICAL TO INCLUDE: INST 2 FAU < 100K BTU AND 2 REFRIG SYSTEMS < t00K BTU 'e'Al - FOR A/C UNIT LOCATED AT REAR OF PROPERTY. Smoke Dampers $0.00, 0 - �'; FEE SUMMARY $0.00 0 Inst or Relocate Appl Vent - , $0.00 Quantity - - - _ Quantity ; - ISSUEFEE.� ,y $2350 O" ` - - Repair/ Alt Absorbtion Unit $000 „0 In`sl FAU`<<100 k BTU,., -" $29.60 2 - Repair/ Alt Refrigeration Unit I. $000 0 Inst FAU:>100 k BTU ;. $0.00, 0"' Ventillation System `' - ` i =� $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 �' '' $0.00 110 Refrig Sys <100 k BTU r $29.60 2 Domestic Incinerator #" $0.00 0 Refrig.Sys >100 k BTU"i „" ;$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 3 To 15 hp 1500 k BTU ^i$0.00 0 Hood w/Meth 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 $0.0.0 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 1 $0.00 0 Inst or Relocate Appl Vent - , $0.00 0 , -' 15 to 30 hp $0.00 0 Air Handlers < 10000cfm $0.00 O" ` - - -30 to 50 hip ,$0.00 0 Air Handlers> 10000cfm- - _ - $000 0 - --Over 50hp ',i"�'`' $0.00 0 Floor Furnace $0.00 0,. , Other Mechanical Fee' ` Floor or Suspend Healer $0.00 ' 0 _ Investigation Fee . $0.00 Plan Check Fee- - $0.00 ' - Reinspection Fee -' $0.00 TOTAL CALCULATED FEES $82.70 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 160 days. , -1. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codas, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratig11 1 this permit. FOR INSPECTIONS CALL: (714) 754.5626 244846 (6400) _ .... ... _.-. 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. - nave and will maintain workers' ocmpensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this pernit is issued. My workers' compensation Insurance carder and policy number are: i� Carrier.=.r-xPolicy-Number: / Sf— r(Tfils section need not be completed it the permit is valued at one hundred dollars ($100) or less.) ❑ 1 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: _ AJ �_—�- r-Date:`t _�z WARMNO FFILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDFION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31060F 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 Cade, and my license is in full farce and ettect.;LJc;N--- Class fl, ContractoYs;Signalure: ° Date:--T" 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 Cade). Lenders 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.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by 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: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, The, 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Coda 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). ........._...................................—..................................................................ildi................._.._......................................................._................................................................ t"e"..............................._.................................. ..... ......................._... 2 Does or will the applicant or present or future builtling occupant need to file a registration forth for acutely hazardous matenals7 ❑Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........_........... ............. ._.............. _.............. _................ ,................................................. .........._.... _._.............. __............. _................ _... _.......................................................... ................................. ........... ............................................................. ... 3 DDes 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 en RMPP is presently required, leas Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No ._........._..........._..........._............_.....................es"'e......................_....6"I'din,..................an't........._......__.._._._............................................................................................................._..........._............r, m.......................... 5 Does or will the oast Air or present or future building occupant require for the work which is the subject c this a plication appe No 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 California Government Code requires that the requested information be furnished on applications for non-residential building permits). ............................................................................................................................................................................................................................................................................................................................................................................................ 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? []Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ... ..._.........._....................._...........................................,......................._._......_.................................................................................-._................................................--._...................................................._............._........................................_.... 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. l 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 Owners) Date i1 C , t— r lul4NTe�App Icanl�„ _ Dates .L ^ CODEC INSPECTION TYPE BATE INTMAL CODE. INSPECTION TYPE Q 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 Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy J 2� `6 G APPROVED CITY OF COSTA MESA PLANNING DIVISION SUBJECT TO BLDG. DEPT. REG. NOTE: ADDITIONS, DELETIONS, OR CORRECTIONS SHALL BE APPROVED BY THE PLANNING DIV. mW 19G 8 R c'-jo (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 1968 RAYMOND AV Suite No Vicinity: NEW SFD Status: ISSUED Applied: 07/21/2005 Issued: 07/212005 - "•AMT QTY .-_-_ AMT - QTY -. ...,' _ ''.�.., , -AMT _• ,QTY ISSUE FEE • ---- '$23 50 Laundry Tub /Washer $9.80. 1 -Sump Pump :' $0.00 ' i" 0 Backflow, irrigation • '$0 00 0 Landscape Irrigation $0.00 0 Swimming Pool ,$0.00:- ,; 0 Backflow Preyenler $0.00 . = 0� P -Trap -'- $0.00' 0 Trap Primer "- , , x$0.00 0 Bathtub "..:$28.40 >3 Pressure Regulator $0.00 0 Urinal' -' $o.00' 0 Clarifier System $o.0o.. ; o Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(T-4), . $0.00 0 Connect (Ice,Soda etc) $000 0- Receptors '� „":.$0.00 0 Vacuum Brkr Bkflow(5.) . -$0:00 0 Dental Units' $0.00 ,0 Septic Tank $000" =0 Wash Basin $29.40 3 Dishwasher , $9.80 1 ,. Sewer Cap for Demo -. $0.ob,' o Wash Basin Set - .$19.60 2 Drain, Floor -:, $0.00 -"0, ; -: Sewer Connect < < --: $24.65 - 1 e :; , __'Waste and Vent System, " $0.00 0 Drain, Rainwater "`0 Sewer'Private Line <"` $000 -, °, 01A - Water Closet (Toilet) �� _= $58.80 6 Drain, Roof- ,,,$0.00 y '10.00" 0 `Shower.-' - - - $19.60 i• =; 2 _ Water Heater/ vent ` $12.30 1 Drinking Fountain �' $0 00 =- 0 .:Sink, "r-',' - '$9.80 , " 1 y" -� Water Piping (Inst or,Rep.) $0.00 0 Expansion Tank $0 00'0 :.Sink, commercial �' $000 =:0 _ Water Re -pipe, ;; $0.00 0 Gas Earthquake Valve." $0.00 . 0 Sink, Floor � : _, $0 00 =1,' 0 '• Water Service '� '' $9.80 1 Gas (1-4 outlets) `" $6.15 -•1 3:"': -Sink, kitchen -� -" $19.60 2-,- Weter Softener'- 'OTHER-- $0.00 0 Gas (Over 4 outlets) `$0,00.. 0 • ; -Sink, service/mop $9.80-, °:Y ',`' - `::' $0.00 Gas Repipe $0.00 .' 0 `Y' - Spa(Private)$0.00,,. '0 VIOLATION $0.00 Gas Service $9.80 ". 7'" " "Spa (public). _ $0.010 • . 0 ,�" n PLAN CHECK -^'',REINSPECTION $0.00 Interceptors (Grease, Oil) $0.000 .t - _ -. - - $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $301.80 r.r1UUPKITC I QDGCIAI Rf KInIT1n AIC 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) 754.5625 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. - ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carrier and policy number are: Carder: Policy Number: (This s tion need not be completed if the permit is valued atone hundred dollars ($100) or less.).. certify that in the erformance o he No for Which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation Califoml nd' gr a that if I should become subject to the workers' compensation provisions of SgggChan $$$700 of the Labor Code, I shall forthwith comply with t se pr 's s./ /G //� )v t ` ApjSTfC'9firSlgmatOre: / Date: / / J W ING. FAILURE TO ECURE WO ER COMPENSATIgJ COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOME HUNDRED THOUSANDDOLLARE 100,000LIN ADDIT TO THE COST OF COMPENSATION, DAMAGES A$ PROVIDED FOR IN SECTION 906 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. k Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). 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 Oh,slon 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. 7 , 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 mself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, 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.).' `as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors Licens tl not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) I icense pu suant to the Cantr 1 or Li se LAws.). ❑ I t under ec. Business and Professions Coda for this reason: Si` naI=a-+Y r`oal6l. l0 I ( Owner D venfi d1by driver's tic se. ❑Ves ❑ No —_; 409 Verifcan a Ownership by (type of ment, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby codify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Cade requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ._...... .............. _...... ................................................. ._............................................................................................................. ................................. ............... ........................................... ................................. ..... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomla 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 compressedgas at standard temperature and pre . ._......................................................................................................................................... .............................................................. ............................................. ......... 3 Does or will theavvDlicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes 13W (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. ........................................................................................................................................................................................................................................................................................ Y:;......................................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No .............................. .. .......................................-............................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes [] No (Section 65850.2 of the California Goverment Code requires that the requested information be furnished on applications for non-residential building permits). ......................................................................................................ithi.......................................................................................................................-e-s....................................................................................... 6 Will any part of the facility to be constructed untler this permit be within 1000 feet from the outer boundaries of a school? ' ❑Ves ❑ No (It 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 California Health and Safety Code Section 42303 been made? ❑Ves ❑ 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 slate laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF POMFICE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that 1 have read this application and state that the information given is correct. I agree comp) with all state la s?an dt ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above -describe pe f i action ryo, s. gree not to ocoupy or allow occupancy of any building authorized by this p rmit un'I final inspection. io ,�9 ros_ Signature _ - LDate_d� And/Or A orized Applicant Data COD 161E .. FixedINSPETION TYPSystem 1?AI� INTRIALS 206 . INSPECTION Mechanical . gdg INITIALS - 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 2S 200 Final Re -Root 210 Final Electrical 201 Final Block/Retaining Well - .212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval - - 203 Final Sign 222 Final Site 204 Final Demolition 250 - • Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 1968 RAYMOND AV Suite No Vicinity: NEW SFD Status: ISSUED Applied: 07/21/2005 Issued: 07/21/2005 Parcel Nunmber: 42630302 - -- ISSUED BY: Applicant: MIKE GROGAN"�� ` - - ^- Sewer Connect - - -___- $24.65-" 1 Address: 307 16TH ST'%�-� i ,, Private Line APT -5 =;i �%--. `-"-� ,- 'Phone: X714-206-41351 $O.OQ''`� r, CA - --_Zip: $19.60 HUNTINGTON BEACH, -92648 0� Sink, bar - - ( 1$9.80 1 _--' $0.00 -0 .' -- Sink, commercial, `. Owner:/CEFALIA III; JOSEPH - 0 . - - Address 16251RVINEAVE- Sink, Floor - 1 COSTA -MESA; CA Phone: 949-293-3787 0 UNIT B/� / Zip: 92627 2 -' $0.00 0 Sink, service/mop - - --- $9:80- 1 0 Water Service $9.80 1 Water Softener $0.00 0 )rContractor: MIKE ,GROGAN PLUMBING- •,� Address: `•307 16TH ST - v �- APiT"5 - - Phone: 714-206-4135 HUN TINGTON.BEACH, CA Zip: 92648 l i ��' License_ 853540 -- 11 SCOPE OF PERMIT - -- I CONSTRUCT NEW 3775 SF 2 -STORY SFR (1ST FLR - 1986 SF & 2ND FLR-1789 SF) WITH 529 SIF 2 -CAR ATTACHED GARAGE & 145 SF FRONT PORCH AND 192 SF. REAR PORCH. 3 BATHTUBS, 1 DISHWASHER, 1 "GAS SERVICE, 1 -LAUNDRY TUBM_/ASHER ; 1 SEWER CONNECT; 2 - SHOWERS, 1 BAR SINK, 2 KITCHEN -SINKS, 1 SERVICE/MOP SINK, 3 WASH BASINS, 2 WASH ` • - �, �. BASIN r SETS, 6 WATER CLOSETS, 1 WATER•HEATERNENT"'1 WATER SERVICE p /rr 7 ,\• ` PREF: B05-00627 ISSUE FEE'., / Backflow irrigation _ Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda etc Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) FEE SUMMARY AMT QTY ,�., `"rtt° ;�,` AMT QTY $23.50 LaundryTub'/ Washer • $9.80 1 $0.661-, 0 LanCscape Irrigation ' $0.00 `e0- $0.00 0 1;^ ,aS,P-,Trap'- �. ` $0.00, "o �_ ,7. $29.40 X13 - ;•Pressure Regulator = $0.00 0 -- /$0 00 O -Process Piping (per 10 ft)•• $0.00 '0 ` ,$0.00 . 0 Receptors $0.00 0 $000//,^0 $000-0 �,� 1$9.80� � \XV$0.00\�> 1/, `� ~ 'SewerCap.for Demo- ,_-;c �r$0.00=0"-- �A AMT- 0 ' ^- Sewer Connect - - -___- $24.65-" 1 \'$0.00, , 0 --,Sewer Private Line $0.00 0"'. A $O.OQ''`� 0. Showed; , --� ;- $19.60 -2 ) � $0.00 0� Sink, bar - - ( 1$9.80 1 _--' $0.00 -0 .' -- Sink, commercial, `. _. - $0.00 - 0 . - $0.00 0 Sink, Floor $0.00 0, /-, $0.00 0 Sink; kitchen., -J,-,. - - _$19.60 2 -' $0.00 0 Sink, service/mop - - --- $9:80- 1 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements. under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2"646(61M) AMT- QTY Sump Pump; $0.00 0 Swimm1n9 'Pool r = $0.00 0 Trap Pimer i `$0.00 0 ��' Urinal' ✓!' -$0.00 0 vacuumBrkr Bkflow(1-4) $0.00 0 Vacuum' Brkr,BkfloW(5+)/ $0.00 0 ,WasliBaein�-' f�% $29.40 3 Wash'Basin Set $19.60 2 Waste and -Vent System $0.00 0 Water a6set(Toilet) $58.80 6 Water Heater / vent $12.30 1 Water -Piping (Inst or Rep.) $0.00 0 Water Re -pipe $0.00 0 Water Service $9.80 1 Water Softener $0.00 0 OTHER $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements. under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2"646(61M) DECaRAfIONS 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. ❑ 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 Nis pernil is issued. My workers' compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need not be Completed if the permit is valued atone hundred dollars ($100) or less.) C—'ll,oarlify 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' �jjf compensation laws of Califomia, 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. • / r7 -7 '1 p cant ure:z /),� .�.6%�/,%Y 'Date: / � g "' V \6 IN FAM; TO SECURE W ERS' P NSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYE TO O CRIMINAL PENALTIES ANDIC VIL PINES 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 II u e rovi ns of Chapter 9 (commencing with Section 7000) of Division 3 of the Business qand Professions Code, and my license is in full force and effect.:' am ass N C, R! / Co%� n:5nkectODat C, 51g to e: " e'--.�_ CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Cade). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty o1 perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the fallowing 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 contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or dead): 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 B, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...._........_.........._......._.......__........._...................._.............._...................................-........................................................................................................................................ _.................. _............ _...... ................... _......... _............................. 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Masa 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). ..................._............................ .............. _.............. ......... ..........................................................._.............................................................................................. _............................ _................. _............. _......................................... I........................... 3 Does or will theappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes 11No (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 en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ................................................................-..............-............................................_............................................................................_................._.__..................................................-..................-............................................................................. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aPennit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ...................................................................................... .................. __..........................................................................._................_.._._...................................................................................._....................................................................... 8 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.........)..........._.........._............................_._......... _...............___............................_....._................._._................................... ..._................. ......................... ......................................................................... ( yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certity, that under penalty of perjury the intonation given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1 certify under 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 A _...0 onzedApplicanl , D2T-A� CODE f. INSPECTION TYPE gAjE IIS CODE t INSPECTION TYPE PAIF. INTITLyg 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 F al Plumbing 200 Final Re -Roof 210 nal ElecInCe 201 Final BlocWRetaining Well 2 'nal e P tion 202 Final Factory Fire Place 220 Flnel Planning App e 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BulldinglOccupency (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1968 RAYMOND AV Suite: Vicinity: NEW SFR Parcel Nunmber: 42630302 Applicant: CEFALIA III, JOSEPH Address: 1625 IRVINE AVE � _ UNIT 8 COSTA MESA, CA Owner: CEFALIA III, JOSEPH " Address , 1625 IRVINE AVE', "- COSTA MESA, CA UNIT B i % Contractor: OWN ER=BUILDER '. '.Address: GRADING PERMIT Zoning: Phone: 949-293-3787 ' Zip: 92627 Phone: 949-293-3787 Zip: 92627 r Phone:, Status: ISSUED Applied: 04/15/2005 Issued: 06/02/2005 ISSUED BY: �. Zip: _ "License: 000000 Eng: HAMERS, ROBIN Address: 234 E. 17TH ST " COSTA MESA, CA,,., Phone: 949-548-1192 SUITE 205 Zip:' 92627 - - - ---License:- - SCOPE OF PERMIT ' CUBIC YARDS GRADING FOR NEW SINGLE FAMILY RESIDENCE'& ATTACHED GARAGE. 200 CUBIC YARDS OF CUT/FILL.' REF: B05-00627 &2A-05-01 200 - J � _ 4" FEE SUMMARY Plan Check: $33.00 Calc Valuation: $3,600.00 $0:00 Permit: $54.50 - - Other: $0.00 Inspection: $0:00.,��.- _ $0.00 _ Total: $87.50:. - ,r PLANNING & ZONING 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 vold 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 (&W) DECLARATIONS A WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: l ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation; as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' 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' compersatlon Insurance carder and pollcy number are: Carder: Policy Number: (This section need not be completed if the pertNf is valued atone hundred dollars ($100) or less.) " I cortity that in the pert nco of the work)6} hi this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' /ccmpensat on laws Cali I and agr 4$I If should become subject to the workers' compensation provisions of Secon 37 00 of the Labor Code, I shall forthwith comply with these Pro Isi i0ms 15. Y -Appl4Signeture: \ rDate:,, /Z / `Gt� WARNNIG:.FAILURE TO SE WORKERS' COMP SAMON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UP TO ONE HUNDRED -THOUSAND DOLLARS ($100 ), IN ADDITION TO COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aMrtn 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. a Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders 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 su 'acts the applicant to a civil penalty of not more than five hundred dollars ($500).): il, 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 w does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursue Torn o nse Laws.). ❑�I am exam and se Business and Professions Code for this reason: Signature: c F_� - r --Date:- Z/015 1 -Owner'IDverifi� drivers livens . ❑Yes ONO Drivers License.No.�" '' tExpires� - 05 Verification of ership by (type of document, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, 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 has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII 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 hazarlous 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). ..................-............_............_.......cant_...........sent......_.._.........ildi................_—._._..._..........._......_......istr.........................................._...._..................................................... ............................................................................ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous matenels7 ❑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 theaappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? 13 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 willt applicant or present or future building occupant require for the work wnich is the subject of this application apeNo for such construction or modMicotlon from the Southh Coast Air Quality Management District Or from any other air pollution control district or agency? Y" No No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ._..........__......_........__...... __.......... _........... _......... _....................__..... __........................................................................................................................................................ ....................... 6 Will an ry pe ........................................................._............ y pert of the facility to be constructed under this rmit 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 apereit 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 _........__......._......._........__........_._..............._............................................................................11ut...................o-l"..........................................._................................._.__..................._............__..:__............._....................._............._..... B (If yes', attach certificate of compliance tram the approprfete air pollution control officor). CERTIFICATE OF COMPLIANCE: I vanity 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 AgHORIZATION OF ENTRY: I vanity under penalty of perjury that I have read this application and state that the information given is correct. I agree 4 �mpy witfflm ty ordinances relating to building construction, antl authorize representatives of the City of Costa Mesa to enter upon the above -describe rope for iagree not to occupy or allow Occupancy of any building authorized by this pe it un it final inspection. � �z %5 Signature f Legal Owner(s)""�-=mac ti,,,,, . Date , And/Or Authorized Applicant Date 000E f. INSPECTION TYPE pAIF Its CODE# INSPECTION TYPE 2AM pgyjLg 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/Retaming Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 260 Final BulldinglOccupancy (714) 754-5273 • Fax (714) 754-4856 • www.d.costa-mesagUft-DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1968 RAYMOND AV Status: ISSUED Suite: Applied: 05/12/2005 Vicinity: Issued: 05/12/2005 Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V -N Parcel Number: 42630302 Zoning: Applicant: CEFALIA III, JOSEPH Address: 1625 IRVINE AVE ' "°'"{-- .Y ,:,� ty „� ISSUED BY: UNIT B /,¢r-7. 1 Phone sas 293 3787 CELt1- COSTA MESA? .f ��'�; �`?� 1[x.3 _ _� l� x� �,P%?i r I 1 i•/ %� �! .`} �\~, Owner CEFALIA III:JOSEPH s �, Address 1625 OVINE AVE fi O tcES ice° .1�.^ .a ,n { �' COSTA MESA CA a ✓ Phone. 949 293-37 87 5t- �Fw UNITB`�t]',,gxct�fr,W+:?'' Zip: 92527 �� ` `;i y✓ya Contractor: OWNER,BUIL^DER r&r ess . , 1 � Addr. Phone: ?,. Zip License.,,000000 •; - ��`� -�_� �i ,i�Afch�- Eng. �/� - ti- - 1 / Address:, � � yf � p i ; s. � i ,.S _ - - - - __:Address:.; Une Phone.)01 Phone: y ' iP u., �`� ', fr'�Icense: License:' SCOPEOF-PERMIT,— il� •r- , „ t 1 L? 'DEMOLITION OF A 1170 SF SFR INICONJUNCTION WITH,THE FUTURE CONSTRUCTION OF'A NEW 3775 SF 2 STORYi SFR (.1ST FLR -11986 ;SF 8'2ND FLR-1789 SF) WITH 529 SF 2 -CAR ATTACHED GARAGE-&7145`SFFRONT^PORCH: AOMD,NOTIFED BY PROPERTY OWNER. 'a_ FEE.SUMMARY / ��/ Plan Check t,., a $0100*' ` — S ? Calc Valuation I/ / $2',000 00 1 `Permit. <<r$69.25:z % Claim Valuation. ; / ` $2,0o 00 SMIPyRes �� '$0,00 n� SMTP Com u1 7��$0 00 s j I?, s Other. $0 00 fi F- � I m z �a ts/! `-• / t, � Inspection: $000 P � rd wnt<;ri � ��. t � r � � , LIQ �.�iw � }✓{ � t�. Total $6925\'' lku '�PL'ANNING+& ZONINd-_5 {�C,�'t SETBACKSs�(� 1t 1 MAINS R CTU EFront ;�.0- 0i� k r/yRear 0 0 'Left 0 0 - Righty r,.0%0 ACCESSORY Front 0= Rear[ 0-,-O' t i Lift �0-0 �C`-�.% RighL/,�0=I 'r PARKING Existin : eoui}ed:- .- 0 Proposed:, NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 z 2"649 (&W) DECLARATIONS 9 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the, work for which this permit is issued. ' ❑ 1 have and will maintain workers' compensation insurance, as required by sectiori 3700 of the Labor Code, For the performance of the work for which this permit is issued. My workers' compensation Insurance canner 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 pernit is issued, I shall not employ any peison in any manner so as to become subject to the workers' compensation l",O�DO,INADDITION a that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cods, I shall forthwith comply w8 ith.the II ADP�i7YSignature: alatet:• JZ /OS WARNING: FAILURE TOPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMFL&i TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M 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. u¢ # Class # Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY:. ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). 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 Fsub' cis the applicant to a civil penalty of not more than five hundred dollars ($500).): 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 puns nt to the Contracryrs i nse Laws.). ❑ er se . Business antl Professions Code for this reason: Owner ID ve ' I by ver's license. ❑Ves ❑ No Driver's cense � `'J Evpi' re"5 CS Verification wnership by (type o tlocument, i.e. -property tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, 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 has a permit to do such work from the division. Signature: Date: Division of industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....................................................................................................................................................................................................................................................................................-..............................................................-...................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................... ................................. ......................... ......................................... ............................. ....................... ................................. ............................................ ..................................._............................. ................... _I ................ . 3 Does or will the plicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑;TI (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 compiled with? ❑ Yes ❑ No ............................................................ ......................................................................-................................................................................................................................................................................................................................................_...... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency. Li 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). ............................................................................................_......................................................................................................................................- ........................................................... I.............................. 6 Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No (If yes-. the facility must meet the requirement of . . . . Sections 25534 and 42303 of the California Health and Safety Code). if . .... .............-....................................................................................................................................................................................................................................................................................... ...................................................... - .................. 7 t 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 ............................... ................ ........... .... ..........................................................................-................................. ... ...................... ................................. ....................................................... "........................ -............................. .... .......... .... .................... B (If yes , attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agre amply with all stajjQ and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-desc ed p party far nspec6nges. agree not to occupy or allow occupancy of any building authorized by this permityntil fin inspection. T - s 2,105 Signal Of.LagallOw r(s) ( Dare And/Or Authorized Applicant Date CODE .. ' INSPECTION TYPE • ' ' QdIE "" INITTIAL,4 " """ CODE.' INSPECTION TYPE •- - ... QAIE 1NTMAL5 ' 1616 Fixed System Final Fire Prevention - 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 , Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202Final Factory Fire Place - "`' 220' Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy May 7" 2005 Cal State Lic 509785 Lead, Mold and Asbestos Abatement Commercial, Industrial, Residential Insured - Bonded E-mail: enkayeng@aol.com Joe Cgfalia 1968 Raymond Ave. Costa Mesa, CA 92627 RE: Job ? 7453 @ Above address. 1639 Monrovia Ave., Costa Mesa. CA 92627 (949) 548-5088 (800) 540-5088 FAX (949) 574-8348 www.enkayengineermg.com RE: COMPLETION OF ASBESTOS PICK UP AND DISPOSAL DEAR CLIENT: the purpose of this letter is to confirm the completion of the asbestos pick up and disposal at 1968 Raymond Ave., Costa Mesa CA and that Enkay Engineering has picked up, re -bagged into asbestos marked bags, and disposed approx. 05 bags. the waste material was disposed ofat an E.P.A. approved disposal site at Azusa Land Reclamation, Azusa, CA and has passed all air clearances in all functional spaces. All the above work was performed in accordance with all rules and regulations gfA.O.MD., E.P.A., and CAL -OSHA. If there are any questions concerning the project please don't hesitate to call us. Thank you. for choosing Enkay Engineering. .Sincerely, - Charles Baur Jr. Enkay Engineering Costa Mesa Building Department 1 APPLICATION FOR PERMIT 111 EAST 20th STREET ✓ 1 ."Oo BUILDING COSTA MESA, CALIFORNIA - F v FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY Receipt No. Permit No. Building Address 1968 RAYMOND Costa Mesa, California Received by Date Recd. Date Issued 5-5-55 Building 1968 RAYMOND Address NearestPEG Cross St.ESTHER ST. Owner bVE STVu I ND BUILDERS Costa Mesa, California Mail Address 105 E18TH ST. Nearest- Cross St. ESTHER ST. Zone No. of Type I Group R4 Plans V 1 Tel. City C, mi. No.L 1 87182 Architect or Lie. Engineer No. Approved by Date Address CORRECTIONS City Lie. Contractor DOVERSPIKE No. 1552 Address Legal Description Lot No. 10 Block Tract 249 (Attach Metes and Bounds) No. of Bldgs. Size of Lot 50XL22 Now on Lot y yr O Use of No.of No. of Existing Bldg. I Families I Rooms , a f)`) Setback Line fromt Rear Yard Center of Street 50 Side Yard y DESCRIPTION OF WORK New I X I Alteration I I Addition ((`` 11 11 h Repair I Moving I Demolish I 1 Building No. of Size 45x26 Rooms 6 Stories L Exterior Wall Covering STUCCO Roof Covering WOOD APPROVALS Use of New Building Foundation Location Forms, Materials, Under -pinning Inspector Date NG & DETACHED GARAGE I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply with all City Ordinances and State Laws regulating building construction. Signature of - -- Permittee Authorized Agt. LValuation Permit Fee $ 2 Plan Check $ 23; 8,500.00 Total $L Fee $ 25.00 Frame: Fire Stops, Bracing, Bolts Lath. Int. Lath. Ext. Plaster, Int. Plaster, Ext. Masonry Reinforced Bond Beam FINAL FORM 204 G -H 2M 5-54 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 1968 RAYMOND AV Suite No Status: ISSUED Applied: 05/12/2005 Issued: 05/12/2005 Vicinity: Parcel Nunmber: 42630302 ir, +?"'',L`" •x,as,. '��1-v' �AQ ISSUED BY: �[ r?i Y,At'j a s °.r P�-,.,, ids' r•. Applicant: CEFALIA III�,JOS�EPFi � zjr '{' t� Address: UNIT IBfIN¢E'AVE �j k 3 \ \, �n S " Phone ` 949 293 3787Jr COSTAMESArCA - Zip 92627c 1;.. ��,\`. ( �� -..?•. Owner ,CEFALIA III JOSEPH Address 16251RVINE AVE'% ', 1" COSTA .MESA['CA Phone: 949-293-3787 r.r v r ,' UNIT/B� y Zip / 92627 , 01 rContractor OWNER -BUIL ER ' �� '....... f 'Address ! J',d fn ( r / ° Phone: _ J, : �'�1 \ rl /' .•;ter UA C� -'r - Zip:�� rn, f1 - • 13}' e r _ . ; _ License 000000 rt"r a��^^• If P 114 1 �' -SCOPE OF -PERMIT' r i�i?rDEMOLITION OF A 1170 SF SFR IN CONJUNCTION WITH THE FUTURE CONSTRUCTION OF A NEW r...-'.` X3775 SF 2 -STORY SFR (1ST FLR 1986 SF & 2ND "FLR 1789 SF) WITH 529 SF 2 -CAR ATTACHED._ \ t {, GARAGE & 145 SF FRONT PORCH N t!1 "SEWER CAP c '0,SEWER B05-00767 P % ISSUE FEES -`-�-- Backflow irrigation Backflow PreJgnter ?+ Bathtub �,,'�� ?T` Clarifier Systems r� Connect (Ice ISoda etc) Dental Units' Dishwasher"'�-R, Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe FEE SUMMARY I'AMT - QTY �.: AMT �OTY f )AMT, �r T 23 50 Laundry Tub,/ Washer' ump� -r(r' ,,$0 00 0 Sump Pi� �� $0.00; $0.00`'?p 0 Landscape,lmgahon - -$0.00, ,.,� 0 SwimmmgP0o1 $0.00 $000 \'Y`.� 0 P Trap 4i ,, 1 ° `t�, '$0.00 '0 _ Trap Primer a -At-, /�$0;o0 $000 ``��0 iS._ oy"Pressure`Regulator ,.� J� $000:��'0 '0 y Unna_�il LTJ �'�$0.00 $000 ��0� - Process Piping (per 10 ft)31 $0 00 0 Vacuum Brkr.Bkflow(1-4)f/ ,$0.00 suv 'O\�'`�"s�,SePho Tank �{• rl't ; $000 °0 �- Wash BaBn�/ow(/0 $0.00 / �� $0.00 $0.00,�� 0 > Sewer Cap for Demo $9 60 a•1'-/� Wash Basin Sete $0.00 $0.00 vO ff" Sewer Connect L >`�_�- $0.00 �0 (Waste and Vent System $0.00 $0 00 0 (�- `4�"Sewer Private Line ----$0-00---0 � >>\Water Closet (Toilet) $0.00 $0 00 0` Y -Showa}•t $0.00--o- �l i Wafer H640 vent $0:00 $0 00 0 ../ ' `Sink bar, i ", E !,- �$0 0011 I 0\ v Water O ping (Inst or Rep.) $0.00 $0.00 V`"t�0�, , Sink, commercial " '-� $0 00 --0 I Water.Re pipe $0.00 $0.00 0`-' Sink ,Floo`r--`(-�.,.�."'��$0.00 0✓!%/ -Water Service $0.00 $0.00 0 \ Sink„kitchen _--$0.00- --0 i -Water Softener $0.00 $0.00 0 Sink,service/mop0� OTHER $0.00 $0.00 0 Spa (private)— - - --'$0.00 0 VIOLATION $0.00 .moi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-26, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 , 244646 (6=) DECLARATIONS WORKERS' COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for, workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ' . I - ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 ofthe Labor Code, for the performance of the work for which this permit is Issued. , My workers' compensation Insurance carrier and policy number are: - Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars ($ f 00) or less.) -- C I certify that in the pedomri of the work for which this permit is issued, 1 shall not employ any,person in any manner so as to become subject to the workers' compensation California, and a p tat if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with the eprCIAsions. �[[� i AppRanrSlgmlbm ;;a- CDale1 U /) L IOS- WARNING: FAILURE TO URE YORKERS' COJJ! ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER�TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE000), IN ADDITION T�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. x Class » Contractors 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). Lenders 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 t0 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 5su reds the applicant to a civil penalty of not more than five hundred dollars ($500).): 71, 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. ��i777777 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. It, 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 iant to the Conlr r L' nse Laws.). ❑ e mppincer s - Business and Professions Code for this reason: Siggat re:~'ra:''" j e o—,,� � �YI i as Owner ID rifled by rivers Iicens [I Yes ❑ No F0 7r Expi[ae "WS�iYEAS� C� Verificeti of Ownership by (type of document, i.e. -property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). - .......'...... ...... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials. ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 Pounds, or a volume of 55 gallons, Or 200 cubic feet of compressed gas at standard temperature and pressure). ............................ ................................................... .......................... _...................................... ............. ................. ....................................................................................................................................... -................ ... ............................................... . 3 Does or will the a plicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ PPo (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 [I No . .......................................................................................... ...................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication 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? 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). .._........................................................................................................................................................................................................................................................................................................................................................................................ 8 Will any pan 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 Qty with all slate I d city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-describe roD IrY for in aaction It asr roe not to occupy or allow occupancy of any building authorized by this pe it un I final inspection. Signature f.Legal�0ivner M='- �Dgle/ And/Oo Authorized Applicant Date CODE ,#. INSPECTION TYPE "' 17iTE ' 'f1�LS "'-- COPE! INSPECTION TYPE 196a IINTFLAL$ 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 Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy RBH ROBIEI\GINEERSRASSOCIATES, CIVILPLANNERS SURVEYORS July 13, 2005 City of Costa Mesa Building Dept. 77 Fair Drive Costa Mesa, CA 92628 Attention: Grading Inspector, Subject: Rough Grade Certification Reference Project: 234 E. 17TH ST., SUITE 205 COSTA MESA, CA 92627 (949)548-1192 phone (949)545-6516 fax 45�5-zf"6 Z 7 465--e:�001Z Address: 1968 Raymond, Costa Mesa The building pad was surveyed by this office on 7/12/05 and the pad elevation is in substantial conformance with the Grading Plan. Sincerely, 6�" Robin B. Harriers RCE 31720 �� EW 12031I4t706 March 24, 2005 CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENT SERVICES DEPARTMENT Joseph Cefalia 1625 Irvine Avenue #B Costa Mesa, CA 92627 RE: ZONING APPLICATION ZA-05-01 1968 RAYMOND AVENUE, COSTA MESA Dear Mr. Cefalia: ( U ply Review of the minor design review and minor modification for the above -referenced property has been completed. Based on the following project description and findings, the application has been approved, subject to the conditions set forth below. PROJECT DESCRIPTION The applicant proposes to demolish the existing single-family residence and construct a 3,871 square -foot, two-story, single-family residence with an attached, 528 square -foot, two -car garage — totaling 4,399 square feet. A minor design review is required because the second floor will result in a 62% second - to -first floor ratio, which exceeds the 50% threshold established by the City's Residential Design Guidelines; however, it is less than the 80% maximum recommended ratio. The proposed second floor will have a nine -foot average left side setback and a nine - foot average right side setback. The minor design review is also required because both side setbacks do not average 10 feet, as recommended by the design guidelines. Although the proposed second story does not meet specific criteria of the design guidelines, the project satisfies the intent of the design guidelines by providing interesting building mass with offsets and building projections. Various building planes, roof forms, and transitions between the first and second floor have been incorporated into the design to minimize long, unbroken building facades. Additional building setback from the front property line (27 feet proposed; 20 feet required) is also provided to relieve visual impacts to the predominantly single -story residences in the immediate vicinity. Privacy of the adjoining neighbors will not be significantly impacted because of the proposed second -story window setbacks and locations. Except for one bedroom Building Division (714) 754-5273 • Code Enforcement (714) 754-5623 • Planning Division (714) 754-5245 FAX (714) 754-4856 • TOO (714) 754-5244 • v .ci.costa-mesa.ca.us ZA-05-01 March 24, 2005 Page 2 window, windows along the north (left) elevation are small, clerestory bathroom windows. The bedroom window is set back 10 feet from the left property line and is offset from the left neighbor's windows. To provide additional privacy protection to the left neighbor, a condition has been included restricting the bedroom window to the minimum size necessary for emergency egress. Other than the laundry room window, windows along the south (right) elevation are clerestory. Since emergency egress is not required for the laundry room and to provide additional privacy protection for the right neighbor, a condition has been included requiring the laundry room window to be clerestory. Five feet of the first floor building wall will have a 4 -foot right side setback. A minor modification is required to allow a one -foot encroachment into the required five-foot side setback. The encroachment, which is to accommodate television and stereo equipment, is located at the rear of the residence, adjacent to the fireplace, is limited to only the first floor, and does not have any windows. As a result, allowing the encroachment would not impact surrounding properties. FINDINGS A. The information presented complies with Costa Mesa Municipal Code Section 13-29(g)(6) in that the minor modification will not be detrimental to the health, safety, and general welfare of persons residing or working within the immediate vicinity of the project or to property and improvements within the neighborhood. Specifically, the one -foot encroachment into the required five-foot right side setback is five feet in length, is located at the rear of the residence, is limited to only the first floor, and has no windows; therefore, it will not impact surrounding properties. The proposed project is compatible with, and enhances the architecture and design of the existing and anticipated development in the vicinity. B. The information presented complies with Costa Mesa Municipal Code Section 13- 29(g)(14) in that the minor design review meets the purpose and intent of the Residential Design Guidelines, which are intended to promote design excellence in new residential construction, with consideration being given to compatibility with the established residential community. This minor design review includes site planning, preservation of overall open space, landscaping, appearance, mass and scale of structures, location of windows, varied roof forms and roof plane breaks, and any other applicable design features. Specifically, the second -to -first floor ratio is 62%, which is below the recommended 80% maximum. Various building planes, roof forms, and transitions between the first and second floor have been incorporated into the design to minimize long, unbroken building facades. Additional building setbacks have also been provided to relieve visual impacts from the street. Privacy of the adjoining neighbors will not be impacted because of the proposed second -story window setbacks, sizes, and locations. C. The proposed project complies with Costa Mesa Municipal Code Section 13-29 (e) because: 1. The proposed development and use is compatible and harmonious with uses both on-site as well as those on surrounding properties. ZA-05-01 March 24, 2005 Page 3 2. Safety and compatibility of the design of the buildings, parking areas, landscaping, and other site features including functional aspects of the site development such as automobile and pedestrian circulation have been considered. 3. The project is consistent with the General Plan designation. 4. The proposed development complies with the City's Residential Design Guidelines. 5. The zoning application is for a project -specific case and does not establish a precedent for future development. 6. The cumulative effect of all the zoning applications for the proposed project has been considered. D. The project has been reviewed for compliance with the California Environmental Quality Act (CEQA), the CEQA Guidelines, and the City environmental procedures, and has been found to be exempt from CEQA. E. The project is exempt from Chapter XII, Article 3, Transportation System Management, of Title 13 of the Costa Mesa Municipal Code. CONDITIONS OF APPROVAL Ping. 1. The residence shall not be closer than 27 feet to the ultimate front property line. 2. The bedroom window on the north (left) elevation shall not be larger than the minimum window size required for emergency egress. 3. The laundry room window on the south (right) elevation shall be clerestory or relocated to the front elevation. 4. The subject property's ultimate finished grade level may not be filled/raised in excess of 30" above the finished grade of any abutting property. If additional fill dirt is needed to provide acceptable onsite stormwater flow to a public street, an alternative means of accommodating that drainage shall be approved by the City's Building Official prior to issuance of any grading or building permits. Such alternatives may include subsurface tie-in to public stormwater facilities, subsurface drainage collection systems and/or sumps with mechanical pump discharge in -lieu of gravity flow. If mechanical pump method is determined appropriate, said mechanical pump(s) shall continuously be maintained in working order. In any case, development of subject property shall preserve or improve the existing pattern of drainage on abutting properties. 5. Demolition permits for existing structures shall be obtained and all work and inspections completed prior to final building inspections. Applicant is notified that written notice to the Air Quality Management District may be required ten (10) days prior to demolition. 6. It is recommended that the applicant contact Comcast (cable television) at 200 Paularino Avenue, Costa Mesa, or call (888) 255-5789 prior to issuance of building permits to arrange for pre -wiring for future cable communication service. ZA-05-01 March 24, 2005 Page 4 7. Construction, grading, material delivery, equipment operation, or other noise -generating activity shall be limited to between the hours of 7 a.m. and 8 p.m., Monday through Friday, and between the hours of 8 a.m. and 6 p.m. on Saturday. Noise -generating activity shall not be allowed on Sunday or Federal holidays. Exceptions may be made for activities that will not generate noise audible from off-site, such as painting and other quiet interior work. 8. The conditions of approval, ordinance or code provisions, and special district requirements of Minor Design Review ZA-05-01 shall be blueprinted on the face of the site plan. 9. The applicant shall contact the Planning Division to arrange for an inspection of the site prior to the release of utilities. This inspection is to confirm that the conditions of approval and code requirements have been satisfied. Eng. 10. Maintain the public right-of-way in a "wet -down" condition to prevent excessive dust and remove any spillage from the public right-of-way by sweeping or sprinkling. CODE REQUIREMENTS The following list of federal, state and local laws applicable to the project has been compiled by staff for the applicant's reference. Any reference to "City" pertains to the City of Costa Mesa. Ping. 1. Approval of the zoning action is valid for one (1) year and will expire at the end of that period unless building permits are obtained and construction commences, or the applicant applies for and is granted an extension of time. A written request for an extension of time must be received by Planning staff prior to the expiration of the zoning action. 2. Street addresses shall be visible from the public street and may be displayed either on the front door, on the fascia adjacent to the main entrance, or on another prominent location. Address numerals shall be a minimum 6" in height with not less than Y2" stroke and shall contrast sharply with the background. 3. Development shall comply with all requirements of Chapter V, Article 1, of Title 13 of the Costa Mesa Municipal Code relating to development standards for single-family residential projects. 4. Any new mechanical equipment such as air-conditioning equipment and duct work shall be screened from view in a manner approved by the Planning Division. Any roof -mounted equipment is prohibited. 5. The paving under required covered parking spaces shall be Portland Cement Concrete (PCC). 6. Any on-site utility services shall be installed underground. 7. Installation of all new utility meters shall be performed in a manner so as to obscure the installation from view from any place on or off the property. The installation shall be in a manner acceptable to the public utility and shall be in the form of a vault, wall cabinet, or wall box under the direction of the Planning Division. ZA-05-01 March 24, 2005 Page 5 8. Two (2) sets of detailed landscape and irrigation plans for the front yard shall be required as part of the project plan check review and approval process. Plans shall be approved by the Planning Division prior to issuance of building permits. Bus. 9. All contractors and subcontractors must have valid business licenses to License do business in the City of Costa Mesa. Final inspections, final occupancy and utility releases will not be granted until all such licenses have been obtained. Bldg. 10. Comply with the requirements of the California Code of Regulations, Title 24, also known as the California Building Standards Code, as amended by the City of Costa Mesa. 11. Prior to or concurrent with the submittal of plans for building plan check, the applicant shall prepare and submit documentation for compliance with the State Water Resources Control Board (SWRCB) Water Quality Order 99-08-DWQ; National Pollutant Discharge Elimination System (NPDES) Permit No. CAS000002 for Storm Water Discharges Associated with Construction Activity (General Permit); the California Regional Water Quality Control Board (RWQCB) Santa Ana Region Order No. R8-2002-0010 and NPDES Permit No. CAS618030; and, the City of Costa Mesa Ordinance No. 97-20 for compliance with NPDES Permit for the City of Costa Mesa. Such documentation shall include a Storm Water Pollution Prevention Plan if over 1 acre (if over 5 acres if submitted prior to March 10, 2003) and a Water Quality Management Plan (WQMP) identifying and detailing the implementation of the applicable Best Management Practices (BMPs). Fire 12. Provide approved smoke detectors to be installed in accordance with the 2001 Edition of the Uniform Fire Code. Eng. 13. At the time of development submit for approval an off-site plan to the Engineering Division and grading plan to the Building Division that shows sewer, water, existing parkway improvements and the limits of work on the site, and hydrology calculations, both prepared by a civil engineer or architect. Construction access approval must be obtained prior to building or engineering permits being issued by the City of Costa Mesa. Pay offsite plan check fee to the Engineering Division. An approved offsite plan and fee shall be required prior to engineering/utility permits being issued by the City. 14. A site access permit and deposit of $500.00 for street sweeping will be required by the Engineering Division prior to the start of any on- or off- site work. 15. Submit required cash deposit or surety bond to guarantee construction of offsite street improvements at time of permit per Costa Mesa Municipal Code Section 15-32, and as approved by City engineer. Cash deposit or surety bond amount to be determined by the City engineer. 16. Obtain a permit from the Engineering Division, at the time of development and then construct P.C.C. residential sidewalk per City of ZA-05-01 March 24, 2005 Page 6 Costa Mesa standards as shown on the offsite plan, including four (4) feet clear around obstructions in the sidewalk. 17. Obtain a permit from the Engineering Division at the time of development and then construct P.C.C. driveway approach per City of Costa Mesa standards as shown on the offsite plan. Location and dimensions are subject to the approval of the Transportation Services Manager. A.D.A. compliance is required for all driveway approaches. 18. Obtain a permit from the Engineering Division, at the time of development and then remove any existing driveways and/or curb depressions that will not be used and replace with full height curb and sidewalk at applicant's expense. 19. Dedicate a 3 -foot public utility easement behind existing right-of-way line on Raymond Avenue. 20. Private on-site drainage facilities and parkway culverts or drains will not be maintained by the City of Costa Mesa; they shall be maintained by the owner or developer of the property. Private lateral connections to City storm drains will require a hold harmless agreement prior to issuance of permit. 21. An encroachment permit is required from the Public Services Department prior to any work within the public right-of-way. Trans. 22. The driveway shall be a minimum of 19 feet deep as measured from the sidewalk easement. SPECIAL DISTRICT REQUIREMENTS The requirements of the following special districts are hereby forwarded to the applicant: Sani. 1. It is recommended that the applicant contact the Costa Mesa Sanitary District at (949) 645-8400 for current district requirements. CDFA 2. Comply with the requirements of the California Department of Food and Agriculture (CDFA) to determine if red imported fire ants exist on the property prior to any soil movement or excavation. Call CDFA at (714) 708-1910 for information. School 3. Pay applicable Newport Mesa Unified School District fees to the Building Division prior to issuance of building permits. AQMD Applicant shall contact the Air Quality Management District (AQMD) at (800) 288-7664 for potential additional conditions of development or for additional permits required by AQMD. Once again, the above conditions, Code requirements, and Special District requirements must be printed on the face of the site plan prior to submittal of the working drawings for building plan check. Upon receipt of this letter, your project has been approved. A copy of the conceptually - approved plans are enclosed. The decision will become final at 5 p.m. on March 31, 2005, unless appealed by an affected party (including filing of the necessary ZA-05-01 March 24, 2005 Page 7 application and payment of the appropriate fee), or by a member of the Planning Commission or City Council. If you have any questions regarding this letter, please feel free to contact the project planner, Hanh Tran, at (714) 754-5640 between 8 a.m. and 12 noon, Tuesday through Friday. Sincerely, R! MICHAEL ROBINSON .Zoning Administrator Enclosure: Conceptually -approved plans cc: Gary Wong, Engineering Fire Protection Analyst Water District Building Division Wayne Johnson 339 Walnut Street Costa Mesa. CA 92627 CITY OF COSTA ME C N U f10 PE IT 'Project Address ,Applicant's Mailing Address ' /' Owner's Name Phon.&&" -�-f//�,,�,�1 Address Arch'/Eng. License No. Address Contractor's,Nzme Phon Address (mailing) 1 City License No. 777 LICENSED CONTRACTOR DECLARATION I. hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code„and MY license is in to tl. fort nd ffect. iicensy CC�IassLi Dale �sL ^ b 'S-..g'nature `No RKERS' COMPENSATION DECLARATION ereby affirm that I have a certificate of consent to self -Insure or a certificate' 1 Workers' Compensation: Insurance, or a certified cel Y inereof (Section Cnn iL_ .dOo, Lab. / // /s, 7Y /y— y ' PoliC No. k/d`/” d� Company rtifled copy is hereby furni ed. ertif'{etl copy s til ith t e city eul di g Isio ate ! ^ - licant EXEMPTION FROM WOR ERS' COM�AT ON DECLARATION (Thissection need not be completed if the permit is for one hundred ($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. Date Signature 'NOTICE: If, after making this declaration, You should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with Such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1. ' I hereby affirm that there is a construction lending agency for the performance Of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason .(Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed. Statement that he/she is licensed pursuant to the provisions of 'he Contractor's License Law (Chapter 9(commencing with Section 7000) of ,ision 3 o the Business and Professions Code) or that he/she is exempt -efrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a, permit subjects the applicant to a civil' enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's - License Law does not apply to an owner of a.property who builds or improves thereon, and who does such work himself/herself or through his or her own embloyees, provided that such improvements are not intentled or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prgva for the purpose of sale). ' IJ I, as owner of the.property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: I The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's Licea Se. Law). I am aware that Proof of their Worker's Compensation insurance should be provided to me. 0-1 am exempt untler Section B. & P. C. for this reason Date Owner ' 1 hereby certify that I havereadthis application and state that the above) Informatiomis Correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon to, above-mentioned property foy inspection purposes. ��/(� Signature .� ! Dale'„_" to fill in all spaces except those within heavy border lines and sign all TYPE OF CONSTRUCTION El NEW EJ ADD ❑ CONVERSION ❑-DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. I ALTERATION. declarations. REPAIR TYPE OF PERMIT - FJ GRADING FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICALS ❑ OTHER PROJECT, DESCRIPTION SO.FT. OCCUPANCY_ -'CONSTRUCTION TYPE ' VALUATION $ GRADI^NG.CU. YDS. ACRES— Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas'Service Outlets Kitchen Sink Lavatories - P—Trap _ Roof Drains - f . Reinspection Fee. $15 Boiler Duct - Under Ground Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting 110-100,000 BTU 1:1100,000 BT Drivers' License or SS # Reinspection Fee $15 CMF 0865-46, rev. 10/84 hite - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor .5214 12/03/85 5400 11 A.P. # I I I Zone $ Main Building: Accessory. Building: - E I ' Z T Front :'`-O ELECTRICAL FEES B A Rear `'I I -C Right _ N K Sewer Connection G S Left '' Fi Ping. Ref. # Parking Req./Provided E Planning Notes: - 0 M Meter EI over 100 amps T S LUMBING v I FEE I I ' Showers- ' '_ ELECTRICAL FEES Service Sink - - Automatic Washer Construction Pole Sub. -- Transformer ❑ 15-50 KW ❑ 50+ KW Sewer Cap. Sewer Connection Cooking Unit Meter ❑up to 100 amps Solar Collectors' Dishwasher Meter EI over 100 amps Solar Piping Dryers ❑Gas ❑Electric Sub Panel Solar Tank Fan Motors 00-1 HP ❑ 134 - B Swimming Pool w/Spa F.A.U.- Ino,Solar 09-15 HP 016-15+ Urinal Fixtures - Microwave Water Closet Device Boxes Pole Light Water Heater Q= Outlets Range Water Service Switches Sign Auto -Wash - _ Garbage Disposal Standing Sections Laundry Trays - Generator 1-10-5 KW 05-15 KW Trash Compactor Issue Fee $ 3 Reinspection Fee ' $15 Issue Fee $ 3 :CHANICAL - FEES" DEVELOPMENT SERVICES REQUIREMENTS: ' Zoning Approved By Date Building Approved eyDate Application Issued By n' Dat Hood or Type El- I Canopy Type If ❑ - Refrigeration System � 110-100,000'BTU 0100,000 BTU sC BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $. $ $ $I $ $ $ $; OF FEES 1 - SNIP $ PERMIT ISSUANCE $ 1 - ENERGY P.C. $; GRADING $' I I MICROFILM $ : TOTAL FEE $1 ' System Repair/AlterationI ^ Fire Dampers i? Registers I Issue Fee $ 3 I CONSTRUCTION AND PLANNING APPROVALS - Permit # Date Inspector POC SPA APPROVALS Permit # - Date ` Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - r '2. Soil Pipe -Undrgrnd. (t 53. Steel Reinforcement 3. Electriml Conduit;Utility-Undrgrrid. - 54. Forms 4. Electrical'Conduit=Undrgrnd. 55. Electrical Bonding 5: Steel Reinforcement - 56. Rough Plumbing & Pressure Test ; 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE :tea --7.:-Footings 58. Electrical Conduit-Undrgrnd. i 8: Foundation / 59. Gas Pipe, 0 Undrgrnd., Test • 9.' Water Pipe-Undrgrnd, + ' - •• 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System '- 61. APPROVAL TO DECK 11'. 'Property Sewer Line & House Connection 62. Backwash & Receptor-Final ". 12. Sewer.Cap '.-�" %� 63. Heater & Vent-Final 13. Roof Drains en _64. Plumbing System - Final ' 14. RougOlumbingL 65. Electrical-Final 15. Rough Electrical:Conduit 66. Solar System-Final _ 16. Rough Electric Wiring 67. Fencing & Access.Approval '17. Rough Wiring Sign' 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19.. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro _22. Ducts-, Ventilating 71. Product Piping'0 Gas - 0Oil 23. Gas Pipe-Rough & Test • 72. Underground Flush - - 24. Roof Framing ., - 73.- 3 Undergrnd. Storage Tank 0 Gas 0 Oil " 25. Roof Sheathing 74. Overhead Hydro 26.•T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe ' 28. Lathing & Siding 77: FIXED SYSTEM FINAL - 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat " - 79. FINAL INSPECTION -- - 32. Electrical Power Meter-Final '80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:,5/4,W 64nM.C, 4s I6C aaa UPC. L.EO 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test I 36. Hood or Canopy - - c 37. Final Factory Fireplace - - 38. Final Plumbing 39. Water Service-Final -- 40. Gas Service-Final 41. Solar .Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation .f - 44. Landscape Irrigation System' •+ 45. Sound Attenuation 46. Handicap Regulations • • L - - 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to-Edison - - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date - - ' A a CITY OF,FOSTq N/1 q CP,[N TRUCTION PERMIT Project Address _/ 62 J,AVI'L76XTn1 � O. M Applicant's Ma/il•in/g/ Address Owner's Name/,/S9—Z in4 Eb/Eb �7��p Phone 6� 7' /fi /J��- Mi, a 1) t . f'it Arch/Eng: I License No4 Address `, _ Contractor's Nam JInlm r=S 7--2! h! A". Phone Address (mailing) / �-% t!6 -R TNS/hL r)['-1.7-'`5 City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencin with section 7000) of Division 3 of the Business -and Professions Code, an my license is injull force and effect. _ , ,• , �_ _, Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations PERMIT NO. (, I TRACT NO. LOT NO. UNIT NO, 1 0 -b%v� TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR -�• a •t' ! hKT / ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # _ DESCRIPTION OF WORK/USE OF BLDG. S Main Building: �,hI E �! TYPE OF PERMIT It -y/ GRADING ❑FOUNDATION STRUCTURAL T Front- 11 ront ! ❑ TENANT N ELECTRICAL ❑PLUMBING ❑ MECHANICAL B Rear q�� ❑ OTHER, A 5/Gn PRO JECTDESCRIPTION SQ.;FT. OCCUPANCY C Right K Left CONSTRUCTIONT,YPE VALUATIONS :$ ZONE GRADING CU. YDS ACRES Ping. Ref. # 9 Remarks: ' Planning Notes: tl WORKERS' COMPENSATION DECLARAVION rpereby affirm that I have a certificate of consent to self -insure or a certificate 1%Workers' Compensation Insurance, or a certified copy thereof (Section 00, Lab. C.) Policy No. Company ❑ Certified copy is hereby furnished. - ❑ Certified copy is filed.with the City Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Th is section need not be completed if the permit is for one hundred ($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 becom subject to the Worker o nsdil9p-Laws of Calif - Data p 1( LSignat Calf NOTICE: If, after making -this d eclarationtion, y become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work f ,.whlc hip rms[�is ued (Se tign 3092 plv. C.) Le der's Name -_�//tet Ot- !^�1• MT ^1T7L/f� iLl" N/l//�/.O4 FIATt Lender's Address /� F/3y IS )mow !j 7 T- OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure,.prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Sine Contractor's License'Law'(Chapter 9 (commencing with Section 7000) of vision 3 of theBusinessand Professions Code) or That he/she Is exempt ;;..reflom and the basis for the alleged exemption. Any violation of Section , t'81.5 by any applicant for a permit subjects the applicant to a civil 6a, lty of not more than five hundred dollars ($500). 4 LJ I, as owner of the property or my employees with wages as their sole compensation will do the work, and the structure is not intended or offered for, sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within onelyear of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1-, as owner of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section 0 4- B. & P. C. for this reason Date - Owner I hereby certify that I have read this application and statethatthe above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter' uodtGBl above-mentioned orooerty for Zone Parking Req./Provided Z O N I " 'N G R E Q M T S Reinspection Fee, 1 $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System -0 Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting 1:10-100,000 BTU ❑ 100,000 FITi Drivers' License or SS'- �- I - I Reinspection Fee CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type ❑ , Canopy 1 Type I1 ❑ Refrigeration System DO- 100,000 BTU. ❑100,000 System Repair/Alteration Registers + Issue'Fee $ 3 FEE Reinspection Fee ' $15 I I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved'8y Application Issued By $ 3 - BUILDING PERMIT PLAN CHECK PLUMBING - PLAN CHECK '25% - ELECTRICAL PLAN CHECK ' 50% MECHANICAL PLAN CHECK 25% $ $ $. $, $ $ $ $ - SUMMARY OF FEES SMIP$ -PERMIT ISSUANCE '' r ENERGY P.C. GRADING - - MICROFI LM TOTALFEE - $ _ '$ - $ $ $ $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit Date Inspector POOL & SPA „APPROVALS Permit Date- Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location, 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Nest 6. Electrical LIFER Grnd. - 57. APPROVALTO COVER-GUNITE 7. Footings 1 i 58. Electrical Conduit-Undrgrnd. -C 8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. - 60: Backwash Lines, P -Trap, 0 Undrgrnd. " 10. Structural Floor System 61. APPROVAL TO DECK ' 11. Property Sewer Line & House Connection _" 62. Backwash & Receptor -Final 12. Sewer Cap - 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final ' 14. Rough Plumbing I 65. Electrical -Final 15. Rough Electrical -Conduit ;s1 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas El Oil 23. Gas Pipe -Rough &Test 72. Underground Flush ' 24. Roof Framing - 73. Undergrn& Storage Tank. 71 Gas OOil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat .: 75. Dry Chemical .27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing. HEALTH DEPT. REQUIREMENT ' 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical,Power Meter -Final 80. FOOD CERTIFICATE ISSUED - 33. Final Electric y Notes: , 34. Final Heating & Air Conditibning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plumbing 39. Water Service -Final - 40. Gas Service -Final 41. Solar Domestic -Final- ' 42. Backflow Preventer 43. Backflow Irrigation , 44. Landscape Irrigation System " 0.5. Sound Attenuation - 46. Handicap Regulations. _ -47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison i 50. Gas Release to Southern California Gas Co l -51. CERTIFICATE OFOCCUPANCY. No. - - Date - _ \ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. , , .90'68 3/'I-I /85 24.'50 TL- f - - - e 1 - q,ry 01 COSTA MESA .CON� RUCTION PERMIT '-- - - �; ) , .. �� 8 Gl i✓IONO fir%-: Pro V, Adrb ss 'L '� r Applicant's Mailing Address - - �- F-,-/y Owner's Name "O� ho�nJ�1__ /'76,9 Atldrass, /r �, i-��,s/� -y Arch/Eng. - License NO. /YfJ l %�/• / - Address - ��.� Contractor's Name JOS/'/U f1�NOU Phone 15? 10 16P I a.�•s 1"� Address (mailing)-/7 C�+7N OCi City License Vo � �.� CICENSEO CONTRACTOR DECLARATION Ihereby'affirm that I am iicensod�untler provisions of Charterj9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full fo aM effeit. $ License Class — O icergys No Dale Signature - C p GgC. -^ P RMIT N _ - p�j �t /e� TRACT NO... i - LOT NO. ,• , , . i UNIT-NO. ... - , - TYPE OF CONSTRUCTION_ NEW ADD' ALTERATION REPAIR' , - , - '❑ CONVERSION '❑ DEMOLISH ❑OTHER LDG: S?'�l/G'L� ��/1'� N��•T •DESCRIPTIO OF WOR,�K(USE OF BLDG- G'Lf1�('� '��yy .E•�-'L�OO,C -. A.P. � - r- ., Zone. S Main Budding.' Accessory Building, - TYPEiOF PERMI�RADING ' ' 'FOUNDATION STRUCTURAL - ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑-MECHANICAL ' El OTHER �p n (�- - - PROJECT DESCRIPTION G. FT OCCUPAS CY - CONSTRUCTION TYPE ,ALUATION 'F Z 4? ::" ZONE ' - • GRADING CU. VDS. ACRES T Front C - r'. . _ Z O B - Rear; _ I - N A C , Right - : ' N G R ' 'Left' ' , PI g: Ref. # Parking Req./Provided - E Q Remarks: I , Planning'Notes: I - '" i M • ' ' T S i PLUMBING • ' FEES i - -. WORKERS' COMPENSATION DE ARATION ' hereby affirm that I have a certificate of consent to self-insur r a certificate Bar Sink ' i Showers i i ' ELECTRICAL FEES I i if Workers' Compensation Insurance,�or a certified'copy thereof_ (Section . '3800, Lab.' C;) - " -� i Backflow Preventer .-._ , - _, _ Service Sink _ - - - - - - - - Automatic Washer .Transformer ❑ 15-50 KW Backflow Irrigation Sewer Ca P Policy No. I 1 ' Company 8 Certified copy is hereby furnished. Certified copy ii filed witn'the city Building Division. - ❑ 50+KW Construction Pole Sub. Bathtubs Sewer Connection! 'Cooking Unit ' Meter ❑up t0 100 amps ' Date' Applicant i EXEM PTIO N'F ROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred'($100) or less). i $ I certify that in the performance of the work for which this permit is issued, I . shall not, employ any person in any man so to become subject to the Workers' om nsal1yyoo jaws of Calif Date'-��- YJ�ro Signature _ic� 'NOTICE: If, atter making this declara n, you should become subject the Workers' Compensation' provisions of the Labor Code, you must for ,`with 'comply with r such provisions or this permit $shall be deemed revoked. i Clarifiers Solar Collectors _ _ ( - ,Dishwasher _ _ _ .Meter ❑over 100amps Dishwasher Solar Piping I Dryers ❑Gas ❑Electric Sub Panel' Drinking Fountains- Solar Tank - ,Fan Motors [10-1 HP ❑1'/x'8 Floor Drains Swimming Pool w/Spa I F.A.U. Inc. $Dior 09.15 HP ❑ 16-15+ Floor Sinks - - Urinal' - - i - ' "' - Fixtures-! Microwave _ Gas Service - Outlets Water Clo Set' ) ,Device Boxes Pole Light CONSTRUCTION :LENDING AGENCY; • •• i -I I hereby affirm that there is's construction lending agency for the performance Interceptors' - Water Heater _ Outlets Range i ofthe work for: which this permit is issued .(Section 3097 Civ. C.) 1 n c Le tler's' Name - Kitchen Sink Water Service ' to Switches Sign LentlI is Address- - ' OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's 'License Law for the 1 following reason (Section .7031.5' Business and Professional lCode: Any city or. county which requires a permit to construct, alter, improve, demolish.or.repair any structure; prior to its, issuance,-also requires the applicant for such permit ,to file a signed statement that-he/she is licensed pursuant to the provisions of. the Contractor'S•Licen Se Law (Chapter 9 (commencingwithSection 7000) of livision 13 of the Business and Professions Code) or that he/she is' exempt- ierefrom and the basis for the alleged exemption. Any violation of Section 03L5 by- any. applicant for "a' permit-.subjects the -applicant to a civil' nnalty of not more than five hundred dollars ($500). LJ I, as owner of the$property or my employees with wages as their sole Lavatories', Auto-Wash Garbage Disposal Standing Sections ' P_Trap ' -Laundry Trays - _ Generator ❑0.5 KW 05-15 KW Trash Compactor Roof Drains - Reinspection Fee :$15 _ t Issue Fee - $ 3 Reinspection Fee $15 Issue Fee $ 3 ' compensation, will do the work, and the structure is not intended or offered for sale '(Section 7044, Business' and' Professional Code: : The' Contractor's - License Law does not apply to an owner of a property who builds or improves thereon, and who does; Such work himself/herself or through his or her own i employees, provided that such.Improvements are•not Intended or offered for sale. 11, however, the building Or improvement is sold within one year of com- , pletion, the owner will have the burden of proving he/She did not build or im- r�ro ve for the purpose of sale). - ra I, as owner tr the property, Se tion 7044, contracting with licensed con- ' tractorsto construct the project (Section 7044, Business and Professions Code: The Com actor's License Law does not apply to an owner of property who builds or inioroves ,hereon; and who contracts for Such projects with-a con-•' 1 tram..,:) licecse ours Lam to tiie Contractor's License 'Law). I am aware that : proof or, their `;Jorker's Compensation insurance should be prov$detl to -me. I ❑ em exumi t under SectioA B. a P. C. for this reason - MECHANICAL - I - FEES DEVELOPMENT SERVICES REQUIREMENTS: ' Zoning Approved By Date Building'Approved By Date j AppliWtion Issued By Dat Boiler -' - Hood or Type I ❑ Canopy Type I1 ❑ _ : Duct - Under Ground _ Duct -Structural Refrigeration System - ❑0.10 'I000 BTU_ 0100,000 BTU - Duct --Ventilating i 1 SUM ARV F FEES - , BUILDING PERMIT '$ SMIP, $ PLAN CHECK $ PERMIT i PLUMBING' $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. '$ GRADING $ LIELECTRICAL$ MICROFILM $sentatives.o PLAN CHECK 50% •$ .$ TOTALFEE$re CHECK 25% $ Exhaust ❑ Multiple ❑ .- System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers' f • Date owner I hereby'. certify-that that Ilhave read this:a ' . v application all City information incorrect. tLp roe di comply with all city and county ortlina otos and co that rdi a nce$ an are state laws ing t building construction, and hereby authorize repro- hi cit o upo the above-menticoed property for n urp s__-MECHANICAL DateryS ' cense or 5S Heating System & Ducting i ❑0.100,000 BTU ❑t00,0008T ! Registers ` •' - ""' ';" "" - '" ` Reinspection Fee $15 Issue Fee i $ 3PLAN CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 11 . - CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POC . SPA APPROVALS Permit# Date Inspector Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. LI Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms _ 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test - 6. -,Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - H. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System !. 61. APPROVAL TO DECK 11. Property Sewer U4,& House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final , 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. ,Rough Factory Fireplace 21. Ducts, in'Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas El Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing - 73. Undergrnd. Storage Tank D Gas 0 Oil 25. Roof Sheathing . is 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 3 IS ``Sr Vo -1 4^0 - / •lONfP"r 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final ' 41. Solar Domestic -Final , 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System ,45. Sound Attenuation 46. Handicap:Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed - 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines andsign all appropriate declarations. CITY -OF COSTA MMESSAS/ C STRUCTIO PERMIT Project Address le -71,Q . Applicant's Mailing Ad ess Owner's Name Phone Address o%, Arch/Eng. License No. Address Contractor's Name ! Phone Address (mailing) 'City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensetl under provisions of Charter 9 (commencing with sectian'7000) of Division 3 of the Business and Professions Code,'and my license is in ful foV a d effect. License Class License Date � S'g t /� �r WOR�COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate Df Workers' Compensation Insurance; or a certif'reo ccun, th reofco th (Se n 3800, tab. C.) ^ , Policy No. Company 8 Certified copy is hereby furnished. Cert 'etl copy is filed with the city Building J,)iyis, iqn. Date 'Applicant ul �c[^Z/ EXEM IOf FROMI ORKERS' COMPENSATION DECLA ATION (This section need not be completed if the permit is for one hundred ($100) or less). certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date 4Signature 'NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this 'permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name' Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any,city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such.permit - to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of 7ivision 3 of the Business. and Professions Code) or 'that he/she is exempt lerefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit Subjects the applicant to a civil' end lty'of not more than five hundred,dollars ($500). 1. as owner of the property or my'employees with wages as their sole' compensation, will do the work, and the structure is not intended or offered t for sale (Section 7044, Business and Professional Code: The Contractor's, License Law does not apply to an owner of a property who builds or improves . thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this applicati information is correct. I agree to comply with a and state laws relating to building construction sentatives of this cit to enter u n the ab inspection purpose . Signature Drivers" License or SS # P6(i MIT NQ TRACT NO. , LOT.NO. UNIT NO. 0I 40 TYPE OF CONSTRUCTION NEW LJ ADD Ll ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A P # S Main Building: Acce TYPE OF PERMIT GRADING ❑ FOUNDATION STRUCTURAL ❑ TENANT' ❑ELECTRICAL ❑ PLUMBING ❑MECHANICAL ❑ ATHER T Front B A Rear PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION'TYPE VALUATION$ ZONE GRADING CU.YDS. ACRES C Right K- S Left Ping. Ref. # Parki Remarks: Planning Notes: Sink <flow Preventer <flow Irrigation nubs t ifiers 1, Dishwasher Drinking Fountai Floor Drains ' Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories P—Trap Roof Drains ler ' Outlets Fee 1 I $15 Duct - Under Ground Duct -Structural ' Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting El 0-100,000 BTU ❑100,000 Reinspection Fee I $15 CMF 0865-46, rev, 10/84 White -Building; Canary --Applicant; Pink - Accounting; Goldenrod - Assessor Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w. Urinal Water Closet Water Heater Water Service ' Auto -Wash Laundry Trays Issue Fee IANICAL Hood or Type ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee 5.00 TL A,nn TI Zone . Z' O N I' N G R E Q M T S FEES ELECTRICAL FEES Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50+KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter El over 100 amps " Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑0-1HP❑1'/:-8 F.A.U. Inc. Solar 09-15 HP 1-116-15+ Fixtures Microwave - Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections Generator ❑0-5 KW 05-15 KW Trash Compactor Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: j Zoning Approved By Date Building Approved By Date Application Issued By "` / Det BTU SUMMARY OF FEES BUILDING PERMIT $ SMIP ' $ ' PLAN CHECK $ PERMIT PLUMBING $ , ISSUANCE $ PLAN CHECK 25% $ ENERGYP.C. $- ELECTRICAL $ 'GRADING $ PLAN CHECK 50% $ - MICROFILM $ MECHANICAL $ TOTAL FEE . $S'D PLAN CHECK 25% $ - $ 3 • _ CONSTRUCTION AND PLANNING - APPROVALS Permit # - - Date Inspector - POC . SPA APPROVALS Permit # Date Inspector - 1' Temporary Electrical Service or Pole 52. Pool & Equipment Location + 2: Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3:' Electrical Conduit Utility-Undrgrnd..; 54. ,Forms - 4.'Electrical Conduit-Undrgrnd. 55. Electrical Bonding -_ 5. Steel Reinforcement 56. 'Rough Plumbing.& Pressure Test - - - --6. ElectricalUFBR,Grnd. 57. APPROVAL TO COVER-GUNITE ` . 7. 'Footings - .. - 58. Electrical Conduit-Undrgrnd. - 8. Foundation - : I 59. Gas Pipe,.0 Undrgrnd:, Test 9. Water Pipe-Undrgrnd.L.. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. ,10. Structural Floor System - 61. _APPROVAL TO DECK - 11. Property Sewer Line & House Connection 62. Backwash & ReceptorFinal 12. Sewer Cap 63. Heater & Vent-Final . 13. Roof Drains -. 64. Plumbing System - Final 14. Rough Plumbing -65. Electrical-Final 15. Rough -Electrical-Conduit 'Rough 66.-Solar System-Final, - - 16. Electric Wiring 67. Fencing & Access Approval - 17. Rough Wiring Sign 68. APPROVED FORPLASTERING 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL - 19''Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough-Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71' Product Piping OGas_ OOil r'23. Gas Pipe-Rough & Test 72. Underground Flush - 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75: Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION - - 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34.'Final Heating & Air Conditioning 35. Final Gas Pipe-Test _ 36. Hood or Canopy. - - 37. Final Factory Fireplace <_ - 38. Final Plumbing /& G� - 39. Water Service-Final - 40. Gas Service-Final , 41. Solar Domestic-Final 42. Backflow•Preventer - ''• rrigation 43. Backflow Irrigation- 44..Landscape Irrigation System 44. - 45. Sound Attenuation - 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING T r 48. Special Requirements Completed' 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations PE I I NO. TRACT NO. LOT NO. UNIT NO. 9OQB 8IQ]IBE ygQQ j'� ' CITY OF COSTA MESA C NJS UCT O RMIT j, ��-f I I I C� / ' Project Address Applicant's Mailing ddre55 TYPE OF CONSTRUCTION NEW J- ADD ALTERATION REPAIR 1 ❑ CONVERSION ❑O DEMOLISH ;❑ OTHER ' _ A P: #-' - - - --._ - - - - - Zone Owner's Name Phone ' DESCRIPTION OF WORK/USE OF BLDG. Address S Main Building: i Accessory Building: Arch/Eng. License Na TYPE OF PERMIT El GRADING ❑E UNDATIOryT OSTRUCTURAL E Front - i O El TENANT ❑ ELECTRICAL PLUMBING El MECHANICAL B N Address ❑OTHER i _ - - ( .A Rear ' I Contractor's Name Phoe n PROJECT DESCRIPTION ' C Right N Adtlress (mailing) SQ. FT.I OCCUPANCY , K Ca CONSTRUCTION -TYPE I VALUATION$ S Left I R City License No. i ZONE - GRADING CU. YDS. ' ACRES - - Ping. Ref, # Parking Req:/Provided E LICENSED CO NTRACTORD EC LA RATION - I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: .• Planning Notes: - M with section 7000) of Division 3 of the Business and Professions Code, and- ' my,license is inffull move and effect. / IS Li �ense�Clas / L¢en No. s I I I - , Date R/• ^ sa at re /lila PLUMBING' I - FEES - „JORKERS' C MO PENSATION D CLAARATION o-nereby affirm that I have a certificate of consent to self -insure or a certificate Bar Sink _i Showers ' _ -� ELECTRICAL ? FEES ' f Workers' Compensation ,Insurance; or a certifie co n f'(Secti Backflow Preventer ' Service $ink - Automatic Washer •. Transformer 0-15-50 KW ' 3600, Lab. No. Company - Backflow'Irngation , 'Sewer Cap I :i ❑' 50,+ KW - Construction Pole Sub. rP'ollicy y.1 Certified copy i5 hereby furnished. ' _ •` I - . i f IITH Certs fed co Is filed with the city Buil mg is n D Bathtubs $ewer Connection Cooking Unit I .Meter ❑upto 100 amps Date Applicant - EXEMM TIONFROM RKERS'•COMPENSATION DECLARATION Clarifiers ? r ' -Solar Collectors Dishwasher Meter ❑Over 100 amps (This section need not be completed if the permit is for one'hundred ($100) or less). ., Dishwasher — - _Solar. Piping, l r - - Dryers ❑Gas' ❑Electrio- - Sub Panel less). eq I that ,in the performance of the work too Which this permit sect - ` shall not employ any person in any manner so as to become subject to the t Drinking Fountains Solar Tank � Fan' ' _ ❑0-1 HP ❑1 Y. Workers' Compensation Laws of California. M010f$ Date Signature Floor Drains Swimmirig Pool'w/Spa _ F.A.U. I Inc. Solar 09-15 HP X16-15+ NOTICE: If,after making this declaration, you should become subject to;the _ _ - - -- - ' - Workers' Compensation provisions of the Labor Code, you must forthwith 'with' Floor Sinks' Urinal 1 Fixtures) Microwave ' comply such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service, Outlets Water Closet Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors WHeater I Water eater 2 Outlets Range ' Lender's Name 1 d I - • Lender's Addiess - - - - Kitchen Sink - - Water Service Switchesi - I -- gigs' - -- ' OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto -Wash ' Garbage Disposal Y, Standing Sections I ' following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair ' P Trap i I Laundry Trays l Generator ❑0-5 KW ❑5-15 KW Trash Compactor P any structure, prior to its issuance, also requires the applicant for such permit to file a.signed statement that he/she Is licensed pursuant to the provisions of Roof Drains `le Contractor's License Law (Chapter 9 (commencing with Section 7000) of vision 3 of the Businessand Professions Code) or that he/she is exempt ' l erefrom and the basis for the alleged exemption. Any violation of Section I I /031.5 by any applicant for a permit subjects the applicant to a civil i- - ' penalty of not more than five hundred dollars ($500).' 'I, Reinspection Fee $15 : 1 Issue Fee $ 3 ' -y as. owner of the' property' or my employees with wages as their sole I 1 -� 1 i _ compensation, will do the work, and the structure is not Intended or offered Reinspection Fee - $15 Issue Fee $ 3 . for sale (Section '7044, Business and Professional Code: The Contractor's _ MECHANICAL I FEES - License Law does not applylto an owner of a property who builds or improves thereon, and who does such work himself/herself orrthrough his or her own 1 Boiler - Hood Or Type 1 ❑' _ DEVELOPMENT SERVICES REQUIREMENTS: - • employees, provided that such improvements are not, intended or offered for sale. If, however, the building or improvement Is sold,within one year of com- I t CdriO Type I I, ❑ _ - C Zoning Approved By I - Date pletion, the owner will have the burden of proving he/she did not build or im- Duct - Under Ground py Building Approved By - - - -Date l prove for the purpose of Sale). I El 'i,as owner of .the.property, am exclusively contracting with licensed con- Duct - Structural : ", ' Refrigeration System 1 Application Issued By I ' �Z > Oat l tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License laW,does. not.apply to an owner of property who P - Duct -Ventilating ' '" 00-1000OOBTU ❑100,0008TU - - i I -- ` SUMMARY OF FEES. - ' builds or improves thereon; and who .contracts for. such projects with aeon- ; - - _ I - tractor(s) Ilcense Pursuant to the Contractor'si License Law). I am aware that the Exhaust System ❑. Multiple'O'% System Repair/Alteration•' BUILDING'PERMIT ' $ SMIP - '$ { pro ofrof their Worker's Compensation insurance should be providetl to me., I S P. - PLAN'CHECK --- $ '• 'PERMIT s - I `- ' I am exempt under Section B. C. for this reason . - Firepl/Fact. Bit. ICBG# Fire Dampers �` $ ' - S r • : I PLUMBING - ..' $ .ISSUANCE Date'- Owner - Heating System & Ducting i - '.Registers- - - - Registers--..' - t pl-,qN CHECK 25% $ � $ - I hereby certify that I have read this application and State that the above 006100,000 BTU 17100,000 BT - 1 I ' " GRADING $-' information ,s correct. I agree to comply with all city and countyordinancesELECTRICA L� .. $ - ; and state laws relating to building construction, and hereby authorize repre- 'above-mentioned, - - - ' .P LANCH ECK', 50%' $ - MICROFILM $, sentatives of; this ci to eller poo the property,for , inspection purp s 1 - 1 - l • MECHANICAL $ J •. 1 �_ (_ Siqnat ure `Date -. - - c/ ' TOTAL FEE. $ / Drivers' License or 55 Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25%. $ CMF 0865.46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit# Date - ,Inspector - - POOL &-SPA APPROVALS Permit # Date Inspector 1. -Temporary Electrical Service or Pole _ . 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. ' 60. -Backwash Lines, P -Trap; 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap _ 63. Heater, & Vent -Final i 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final ' 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit . 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping El Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing - 73. Undergrnd.Storage Tank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and, Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation - 78. FIRE PREV. FINAL 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION " 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy. 37. Final Factory Fireplace `• i 38. Final Plumbing 39. Water Service -Final - 40. Gas Service -Final 41. Solar Domestic -Final , 42. Backflow Preventer J ' 43. Backflow Irrigation - ,44_ Landscape Irrigation System - 1 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING - 48. Special Requirements Completed - �•; _ 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No. Date - - - f OWNER WESM JOBADDRESS 190E GENERAL CONTRACTOR RDIID T INC. DATE 5-5-55 JBUILDING PERMIT NO. ke VALUE s8.500.00 BLOCK TRACT 2h97 Dwelling & Detached Garage TVPF v ZnNF Rh FIRE DISTRICT 1100 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE _ NUMBER/\,I Footing TrenchS n Foundation Forms and Grade to Garat�E� �� Sf 1 Rough Framing _ b& Plumbing, Rough to Slab et— - .,y3 4r, 'n(l.n•„�Q^�1 j% S�� /f \ l Plumbing, Rough Complete ; �e Temporary Pole Wiring, Rough ]Ij . �[',,Q�,)i,,,¢�/ ��vS—S � 94{S r` C Heating, Rough _ (/ V Heating, Final liti _Z%� J 11 Sewer, House W Sewer, St. �.� 1 y �• pj Septic Tank or Cesspool ,�� Lathing, Inx Out " Plastering Plumbing, Final, Fixtures Cc lete Plumbing, Final Gas Test $ Wiring, Final Occupancy Form 210 G -H 1500 1-55 'Costa Mesa Building Department APPLICATION FOR PERMIT III EAST 20th ET COSTA MESA, CALIFORNIA 4300 BUILDING FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN Receipt No.._ . _ Permit No. 'Building `Address 1968 RAYMOND Costa Mesa, California Received by Date Recd. Date Issued Nearest PEG I. 5-5-55 JCross St. ESTHER ST. Address 1968 RAYMOND Owner WE STW I ND BUILDERS Costa Mesa, California Mail Address 105 E18TH ST. Nearest Telt' Crossst. ESTHER ST. City C. M. No. L-1 87182 Zone No. of Type Group Arrhitcntnr Lin" R4 Plans I V FORM 204 G -H 2M 5-54 O A O Address CORRECTIONS City Lic.1552 Contractor DOVER SP I KE No. Address Legal Lot Description I No. 10 Block Tract 249 I - - , (Attach Metes and Bounds) FAX nN No. of Bldgs. Size of Lot 50XL22 I Now on Lot Use of No.ofI No.of Existing Bldg. F.amllies Rooms I Setback Line fromf Rear Yard 50f Center of Street Side Yard DESCRIPTION OF WORK New x. I Alteration I Addition - Repair I - I Moving I Demolish Building No. of Size 45x26 Rooms 6 Stories L Exterior Wall Roof Covering STUCCO Covering WOOD APPROVALS Buuiildingof Foundation Location Inspector Date g Forms, Materials, DwEum & DETACHED GARAGE Under -Pinning Frame: Fire Stops, Bracing, Bolts I hereby acknowledge- that I have read this Application Lath. Int. ' and state that the abo a is correct and agree to comply Lath. Ext. with all City mices and State law regulating building constru%0ofi . Signature of Plaster, Int. 3 Permittee 4 1 /d Plaster, Ext Authorized Agt. /�;�4P n i - Masonry Reinforced Valuation Permit Fee $ z Plan Check $'�"-23' a Bond Beam $ 8,500.00 Total 25.00 Fee $ FINAL FORM 204 G -H 2M 5-54 O A O