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HomeMy WebLinkAbout1218 DORSET LN - Building PermitsUNITEDST/ATES POSTAL SERVICE iORM 3547 fee due 50 Reslricicd Dula /•7rxl ,lass nail Postage and fic``Paid USPS Pernlil No. GIC) CITY OF COSTA MESA • ' ': ai,.,2m�.i.2 va aw voa - /� j DO IO LOSTAMESrtGLIF0.9NIP'J:L'.&1RC0 ADDRESS SERVICE REQUESTED J LS POST-" BOULDERSCAPEINC 149 AVENIDA GRANADA SAN CLEMENT CA 92672 B0tj1,1 EItSC1IPEINC)RIVI1L477:D OLD: 149AVEN1174 GR4N,41)A S4NC/./;MEN'/'li Cil 9267'-4051 NEIN: 330X I CALLS PERI, TC"1'U S'l'IT A S.4N./C4N Cil /Y) CI 93675-4761 TO TIIE POSTMASTER Of PO BOX 1200 COSTA MESA CA 92628-9998 b?:^'bn: ..•:11:'I;9EII cI I p,,2f, f1; 11 cl'I: Iw l'/()915 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa-SWLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 .lob Address: 1218 DORSET LN Status: ISSUED Suite: Applied: 03/03/2006 Vicinity: POOLAREA Issued: 03/03/2006 Primary Occ:' R3 Type of Construction: Parcel Number: 14115301 Zoning: R1 Applicant: ALLEN, MARK _ Address: 149 AVENIDA GRANANDA .t $136.01 Phone: 949-661-5087 ISSUED BY: SAN CELMENTE, CA Zip: 92672 Owner: BROMMERS,'ERIK D Claim Valuation: $12,000.00 Address 1218 DORSET LN - Phone: SMIP Com: COSTA MESA, CA Zip: 92626 Contractor:BOULDERSCAPE INC'— Other: $0.00 Address. " i49 AVENIDA GRANANDA ' Inspection: Phone: 949-661-5087 - SAN CELMENTE, CA Total: Zip: 92672''% License: 444828 Arch Eng: Address: Address: Phone:. - Phone: Zip: License: License: SCOPE OF PERMIT ADD A THIGH WATER SLIDE W/ROCKWORK AND A 36" WATERFALL W/GRATTO TO AN EXISTING POOL. 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) ,r/ 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 consideredlegal, 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 ILMIi= _ FEE SUMMARY Plan Check: $136.01 Calc Valuation: $12,000.00 Permit: $209.25 Claim Valuation: $12,000.00 SMIP Res: $1.20 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $346.46 PLANNING & ZONING SETBACKS ! MAIN'STRUCTURE Front ,0-,Q Rear 0-0 Leff 0-0 Right 0-0" ACCESSORY Front 0-,0, - "rRear , 0-0 Left 0-0 Right 0-0 PARKING� 0 �`-Required: •'0. Proposed: 0. NOTICE: The work authorized by this permit shall comply with all applicable handicap access 'requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) ,r/ 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 consideredlegal, 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 ILMIi= DECLARATIONS WORKERS' CQMPENSA710N DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: bave and will maintain a certificate of consent to self -Insure for workers'compensation, as provided for by section 3700 of the Labor Code, far th, performance of the rk for which this permit is issued. ave antl will maintain workers'compensation insuranceas required by section 3700vttha he performance of the work for which this Permit isissued. workers'compensation Ins�uranccee ccarrierantl_policy number are:/ S (�J.:" !-'1�"r' Policy mber. (O(Otion need not be completetl if the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of th orn(hist is issued, I shall not employ any person in any manner so es to become subject to the workers' corn n laws of Califomiaa Ihme subject to the workers' compensati provisions of Section 3700 of the Labor Code. I shall forthwith ply with t e Pro licent Signatur ' te: 3—-4-06 W E TO SECURE RKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJE,. RTO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED -THOUSAND DOLLAR9($100,000). XADDMON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSE TRACTORS DECLARATION: 1 h a licensed under pro sir f Chapter 9 (commencing with Section 7000) of D' ' n 3 of the Business and Professions Code, and my license is in full f d effect. . N L q Cc slur Dater 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 subjects the applicant to a civil penalty 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 (Sec. 7044, Business and Professions Cade: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 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, falsewerk, 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 hazardous material? ❑ Yes ❑ No (Section 25506 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 Califomia Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials aquas 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 th 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..........anR.M.................................. -................. ........ -................................................... -.................................................................................................................................-................................................................................. ............ PP 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 aMplicetion apernit 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 658502 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .......................................I.............................................................._..................................................... fi Will any part of the facilityto be constructed under this permit be within 1000 feet from the outer boundaries of a school? p ❑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 Cade Section 42303 been made? ❑ Yes ❑ No ....................................................................................................................................................................................................................................................._......................................................................_............................................................ 8 (If "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature. Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state lawd city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for ins n pur s. I agree not to Occupy or allow Occupancy of any building authorized by this permit until final inspection. S' uto a a1 Owner s - O c' -'Date And/ orized Appli t to CODE I INSPE0914 r2l DATE _�-_INTM��LL$�� MDE INSPECTION TYPE 2611 *rrmRLS 1616 Fix ystem Final Fire Prevention 206 - Final Mechanical p 1266 Pool Spa Final 7 �%t- 208 Final Plumbing 200 Final Re -Root 210 Final Electrical 201 Final BlocklRetaining 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 Mar' 24 tIB 09: 53a Brommers 7149509233 p.1 1218 Dorset Ln Costa Mesa, CA 92626 Phone: 714-850-9233 Send to/An/Pour: FrornNon/De: City Of Costa Mesa — Building Division Erik Brommers Attention/Zu Minden von/A 1'attention de: Date/Datum/Date: Mary Sane Weidenkeller 3/24/2008 Fax number/Fax nr./N° de fax: Phone number/Telefon/N' de t81.: 714-754-4856 714,754-5273 M M M 11 El Urgent/ Reply ASAP/ Please comment/ Please review/ For your information/ Dringend/ RtIckantwort/ Erledigung/ Uberprilfung/ Kenrimisnahme/ Urgent Reponse urgente Commentaires A vdrifier Copie pour attendus information Total pages, including cover sheet: 2 Anzahi der Uberinittelten Seiten inkl. Deckblatt Nombre de pages (Page de garde incluse) Re: Notice of Permit Expiration rec'd 3/22/08. Please note final approved inspection date of 9/21/07. Thank you. y. C11 .° COSTA MESA, BUILDING SAFETY DIVISION POST IN CONSPICUOUS PLACE ON THE JOB NOTICE Schedule inspection one workday in advance. To schedule inspections, call (714) 7545626. Provide the following information: 1) Permit number, 2) Job address, 3) Inspection item number. Building Address: 121 g _S)o f5; V Owner: yd Cit M ec `; Building Permit a: Electrical Permit b: C Cii ' OU u Contractor: Mechanical Permit Ir Plumbing Permit k: Job Descdplion NEW ADD ALTER REPAIR MOVING I DEMOLISH ISSUE DATE PERMITS EXPIRE 180 DAYS (6 MONTHS) FROM ISSUANCE OR LAST INSPECTION APPROVALSCONSTRUCTION eam M STRUCTURAL— � -Date Inspector Iteme POOL &SPA Date - Inspector 3 Job Site Consult 94 Pool & Equipment Location 4 Footings I Ufer Ground 96 Steel Reinforcement Zj 6 Slab 100 Electrical Bonding P 8 Structural Floor 102 Rough Plumb & Pressure Test 4- 11 Pre -Inspect Roof 104 Approval to Cover - Gunite e -o" 12 Roof Sheathing 106 Elec Conduit - Underground rj c�.,vti 14 T -Bar Ceiling -Structural 108 Gas Pipe/ Underground Test 16 Shear Panel 110 Backwash Lines, P -Trap, Z$YaS Underground 18 Frame & Flashing 20 Lathing & Siding 112 Approval to Deck rj 22 Insulation 116 Pool Plumbing System - Final 9 2 Nailing 118 Pool Electrical - Final 1 ) Plaster Brown Coat t22 Fencing I Access I Alarms ApproPre-Grout A24Drywall 124 Approval for Plastering Disabled Access 126 Pool I Spa Systems - Final N4,r1S/RMP __.�__- _ • = ° — _: — FIRE DEPARTMENT APPROVAL 1610 Overhd Hydro / Overhd Rough 1612 Dry Chemical ELECTRICAL 1614 Dry Standpipe 36 UferGround 1616 Final - Fixed System 38 Elec Conduit - Underground 44 Rough Elec - Wiring FINAL INSPECTIONS (Must be completed prior to requesting occupancy.) Call (714) 754-5626 for the following: Date Impactor 200 Final Re -Roof 46 Rough.Elec. Conduit 48 Elec T -Bar Ceiling 50 Elec Power Final I Meter Release 51 Temp Power Final 201 Final Block/ Retaining Wall 203 Final Sign 204 Final Demolition 206 Final Mechanical PLUMBING & MECHANICAL 208 Final Plumbing 52 Soil Pipe - Underground 210 Final Electrical 5,4 Shnwer CITY OF COSTA MESA, BUILDING SAFETY DIVISION POST IN CONSPICUOUS PLACE ON THE JOB NOTICE Schedule inspection one workday in advance. To schedule inspections, call (714) 754-5626. Provide the following information: 1) Permit number, 2) Job address, 3) Inspection item number. Building Address: 121 W __;bp , s o4LPN Owner: ',� c in m Lr J //'_ Building Permit #: Electrical Permit A: E V AD .— QO `(y . Conl aclor. Mechanical Permit Y: Plumbing Petmil C: Job Description NEW I ADD ALTER REPAIR MOVING I DEMOLISH ISSUE DATE PERMITS EXPIRE 180 DAYS (6 MONTHS) FROM ISSUANCE OR LAST INSPECTION APPROVALSCONSTRUCTION Nem d STRUCTDFiAL` Date Inspector Item w POOL &SPA Date Inspector 3 Job Site Consult 94 Pool & Equipment Location b Footings I Uter Ground 96 Steel Reinforcement j 6 _ Slab 100 Electrical Bonding 1� rj� 8 Structural Floor 102 Rough Plumb & Pressure Test L{ 11 Pre -Inspect Root 104 approval to Cover - Gunite 17 12 Roof Sheathing 106 Elec Conduit - Underground 5uv� 14 T -Bar Ceiling -Structural 108 Gas Pipe I Underground Test 16 Shear Panel 110 Backwash Lines, P -Trap, Underground Z$ YJ6 18 Frame & Flashing 20 Lathing & Siding 112 Approval to Deck cj 22 Insulation 116 Pool Plumbing System - Final 9 2 24 Drywall Nailing 118 Pool Electrical - Final 26 Plaster Brown Coat 122 Fencing / Access / Alarms Approval - 30 Pre -Grout 124 Approval for Plastering 33 Disabled Access 126 Pool / Spa Systems - Final 34 1610 DEPARTMENT Overhd Hydro / Overhd Rough APPROVALFIRE (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 1218 DORSET LN Suite No Vicinity: Parcel Nunmber: 14115301 Applicant: MARK ALLEN Address: 149 AVENIDA GRANANDA Phone: 949-661-5087 Zip 92672 Phone:- .. Zip: 92626 Phone: 949-661-5087 Zip: 92672 License: 444828 Status: ISSUED Applied: 03/03/2006 Issued: 03/03/2006 SCOPE OF PERMIT REF B06-00359. FOR WATER SLIDE. 1 PUMP AND I CONDUIT - SAN CELMENTE, CA FEE SUMMARY Owner: BROMMERS; ERIK -D Address i 1218 DORSET LN - � :COSTA MESA, CA: -- Contractor: BOULDERSCAPE INC Address: 149 AVENIDA GRANANDA SAN CELMENTE, CA Phone: 949-661-5087 Zip 92672 Phone:- .. Zip: 92626 Phone: 949-661-5087 Zip: 92672 License: 444828 Status: ISSUED Applied: 03/03/2006 Issued: 03/03/2006 SCOPE OF PERMIT REF B06-00359. FOR WATER SLIDE. 1 PUMP AND I CONDUIT - ISSUED BY: Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0/ $0.00 01, . $0.00 0 ; $0.00 0 $0.00 0 $0.00 0 $18.20 1 $0.00' '" 0 $0.00 0 $0.00 0 $0.00 0 $0.00: 0 $0.00 $0.00 $0.00 $0.00 Sign Circuits $0.00 0 Temp Pwr Pole ��_ $0.00- 0 NOTAL CALCULATED FEES $46.45 Intermed Pole $0.00 0 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 workfis 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 2""6 (WOO) FEE SUMMARY - Quantity ISSUE FEE $23.50 - - Temp Dist System / Lighting Temp service test $0.00, Busway /100 ft . Res. a/c package $0.00 Standing Section. New Res (1-2 units) $0.00 0 Misc Electrical Equipment New Res (3+units) $0.00 0 - Transformers up to 1 kva/kw Pool / Spa ', $0.00 _ ---- --- _ _ _ _ ......up to 10 kva/kw Lighting,Fixts $0.00 ...{0 0 ...............:up to SO kva/kw Recept Outlets " $0.00 0 .................up to 100 kva/kw Switches $0.00 0 ..................over 100 kva/kw Non Res Appl $0.00 0 Low Voltage Equipment Res Appl '. $0.00 0 _ Low Volt Wiring System / Ckt Service to 200a $0.00 0 ',.Misc. Conduit Service to' -1000a $0.00 0 Misc. Conductor Service over 1000a �-$0.00 0 Circus ( gen or ride) Motors to lhp :$4.75 1. - Circus (meth ride or lights) Motors to 100, " $0.00 <' _ - '0 = - Christmas Tree Stand Motors to 50hp, $0.00 ; �� 0 Fireworks Stand - Motors to 100hp-� !, '� $0.00��_�> _0,. _- - - - Other Electrical Fee ._ Motors over 100hp, �. $0.00 - `;0�, Communication drops., ` -$0.00' - 0 .' Investigation Fee Sub panel to 200a '$0.00' 0 Plan Check Fee Pole Light Pkg - $0.00: 0 , - Reinspection Fee , ISSUED BY: Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0/ $0.00 01, . $0.00 0 ; $0.00 0 $0.00 0 $0.00 0 $18.20 1 $0.00' '" 0 $0.00 0 $0.00 0 $0.00 0 $0.00: 0 $0.00 $0.00 $0.00 $0.00 Sign Circuits $0.00 0 Temp Pwr Pole ��_ $0.00- 0 NOTAL CALCULATED FEES $46.45 Intermed Pole $0.00 0 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 workfis 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 2""6 (WOO) 11 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 rk for which this Derrnit is issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. workers'compensation InsCura-nce cALrier and policy number are: �+ prder 9 (�"T ( G ! ✓Ny — cy Number. 7 action need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the penornance oft o wh' this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' com Ion laws of California, a e het' hould become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall forthwith om I as pro "sions. Ap rat Sign e: Be 3 --0,6 A AILURE TO SECURE ORKERS' CCMPENSA ON COVERAGE IS UNUWFUL AND SMALL SU6JECT AN EM YER CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED SAND 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 affir m licensed under provisions of Chapter 9 commencing with Section 7000) of Divisio of the Bush sions Code, and my license is in full tolce Ic. N C—Z Cl CC._ C r s Signature. Date: CONSTRUCTION LENDING AGCY: ❑ 1 hereby a firm that (here is 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).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 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 cenity 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) teat 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 feel of compressed gas at standard temperature and pressure). 2 Deor will the applicant or p'ras..e..nt. or1U*1`u­re buildingm--cu ant needloflea a"gisiratfon Corm fov*a�ulely hazer dous­matedels?.....❑..Yes' ......No� (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .. ...._..._......................................................................................................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ........................................................................_.......................................................................................................................................................................................................... ............................................................................................ 4 If an RMPP is presently required, has Section 25534 . f the California Health and Safety Code been fully complied with.? ❑Ves ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject ofthis a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control distract or agency? j� Yes � 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? ❑ Ves ❑ 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 AUTHORVAT10N 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. gree not to occupy or allow Occupancy of any building authorized by this permit until final inspection. Si re a er(s) Date Zg,6 An utho Applican D I;gp_. �. P - INTRIAL CODE I INSPECTION TYPINTITIALS 1616 Fixed System final Fire Prevention - 206 Final Mechanical 1266 Pool Spa Final 200 Final Plumbing V" 200 Final Re -Roof - 210 Final Electrical 201 Final BIOCIORelaming 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.OLY1MBING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1218 DORSET LN Status: ISSUED - Suite No Applied: 03/03/2006 AMT QTY Issued: 03/03/2006 Vicinity: POOLAREA AMT Parcel Nunmber: 14115301 $23.50 - Applicant: .,$0.00, 0 ISSUED BY: Address: 0 '.Backflow irrigation o $0.00 0 - Phone: 0 Swimming Pool $0.00 Zip: Backflow Preventer Owner: BROMMERS„ERIK.D $0.00 Address' - --1218 DORSET LN- `� $0.00 0 Bathtub`s $0.00 Phone: , " COSTA MESA, CA -.. Zip: 92626 $0.00 0 Clarifier System $0.00 0 Contractor: $0.00 0 Vacuum Brkr Bkflow(1-4) Address. - Connect (Ice,Sod`a,etc)'�, ; $0.00 0 Receptors - Phone: 0 Vacuum Brkr BkBow(5+) - Zip: '. $0.00 - License:. " 0 Wash Basin $0.00 0 Dishwasher - $0.00 SCOPE OF PERMIT Sewer Cap for Demo- $0.00 PLUMBING PERMIT FOR 1 PUMP FOR A 7' HIGH WATER SLIDE W/ROCKWORK ANDA 36" WATERFALL Wash Basin Set W/GRATTO TO AN EXISTING POOL. 0 Drain, Floor - $0.00 1 PUMP. Sewer,Connect $0.00 REF#: B06-00359 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 FEE SUMMARY - AMT QTY - AMT QTY AMT QTY ISSUE FEE $23.50 - Launcl yTub'/ Washer, .,$0.00, 0 Sump Pump , , . $0.00 0 '.Backflow irrigation o $0.00 0 - "Landscape Irrigation' - -P-Trap $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 - $0.00 0 Trap Primer $0.00 0 Bathtub`s $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) - $0.00 0 Connect (Ice,Sod`a,etc)'�, ; $0.00 0 Receptors - $0.00 0 Vacuum Brkr BkBow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher - $0.00 0 Sewer Cap for Demo- $0.00 0 Wash Basin Set $0.00 0 Drain, Floor - $0.00 0 Sewer,Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00, 0 Water Closet (Toilet)- $0.00 0 Drain, Roof , $0.00 0 ._ . -Shower _ $0.00" 0 Water Healer / vent $0.00 0 Drinking Fountain $0.00 „` 0, "� ' "� -Sink, bar, - $0.00 � 0- � Water Piping (Inst or Rep.) ; $0.00 0 Expansion Tank'. //,,$0.00, $0.00 `-, `:0 - ` Sink, commercial $0.00 0 Water Re, -pipe " $0.00 0 Gas Earthquake Valve ' 0 � ;", '" Sink,' Floor , $0.00 0 ' Water Service $0.00 0 Gas (1-4 outlets), ; ,�.• 1, $0.00 0 "� . Sink, kitchen -. $0.00 0 Water Softener , $0.00 0 Gas (Over 4 outlets). ` $0.00 ` 0 - Sink, service/mop $0.00 0 OTHER $9.80 Gas Repipe 1,$0.00, 0 Spa (private) - - $0.00 0 VIOLATION $0.00 Gas Service. $0.00 0 Spa (public) $0.00 0 . PLAN CHECK $0.00 Interceptors (Grease, Oil)•.. $0.00 `0` - REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 .0- - • TOTAL CALCULATED FEES: $33.30 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 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 Cade, for the performance of the work for which this permit is issued. ave and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. M workers' compensation Insu�r n_ce ca�rrxier and policy number are: 7 Carder, t' V�" ✓ Wicy Num r o A need not be comp/e ed if the permit is valued atone hundred dollars ($100) or less.) ❑ Ice the perform2fa,;�r�n, of w Ich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' - ensati0n s of Calia th if should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall Forthwith comply with lh a pro5i ? Applicant S' f : - Data: ��J �i 6 NG: FAILURE TO SECURE ORKERS' COM SATICN COVERAGE IS UNLAWFUL AND SHALL SUBJE CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000 , IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: - I her t I am license ptpvi io of Chapte 9 mmencinq with Section 7000) of ivision 3 of the Busine �dd; yrsions Code, and my license Is in full s 1 7 Contractors Si re: Date: ��� � D h O�UCTION LENDING AGENCY: - I ❑ 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 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 to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner Of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No 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 live (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 tiled 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 tM1a 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 Yes 5r will thhee applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? (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 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 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? Li Yes 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 an.................._............................................................................... y part 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). ........................._........._..................................................................._........................................... ...................................................................................................................................................................................................... ............ .._................ 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 _........................................I...... .............................. .................. ........................... ........................ .................................... ............ ................. _................................................................................................................................................_................. 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection pu oses. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Own s) Dalle Or Authorized Appint to CODE I, INSPECTION TYPE DATE LN rLIA,$L - CODE �INSPECTION TYPE 2AII jNTIDAL 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 BIMIORelaining 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 CITY OF COSTA MESA BUILDING DIVISION � DEVELOPMENT SERVICES DEPARTMENT PERMIT P98-00466 PERMIT NUMBER (714) 754-5273 • Fax (714) 754-4656 PLUMBING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1218 DORSET LN Status: ISSUED Suite No Applied: 06/10/1998 Issued: 06/10/1998 Vicinity: ' Parcel Nunmber: 14115301 Applicant: GULLITTA, MIKE Address: SCOPE OF PERMIT P{` PLUMBING FOR ADDITION:. NEW GAS LINE.. " Phone: ' ''AMT/ QTY AMT QTY 0 Swimming Pool $0.00 . y Zip:- , $0.00 Laundry Tub / Washer _QTY = $0.00.0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Backflow Preventer t 0 Owner: BROMMERS, ERIK D & SUSANA G' 0 Bathtub Address 1218 DORSET LN A Pressure Regulator," `, ,$O.00 0 ., , ; i" - . .. --Phone: Process Piping (per 10 ft) $0.00 COSTA MESA,CA,, Zip: 92626 .$0.00 -..0, Receptors', ,-,-° '- ' $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 OTHER Dishwasher Contractor:, BARTWOOD CONSTRUCTION Sewer,Cap forDemo, d,/,:$0.00 0 Drain, Floor $0.00 0 ':,Sewer Connect ,$0.00 Address: 11101 CONDOR $0.00 0 "Sewer Private Line ` ; - $0.00,'. •0�--'- Phone:,,: $0.00 0 . Shower' "FOUNTAIN VALLEY CA Zip 92708\ Drinking Fountain $0.00 '0 - Sink, bar -'' License(592681---� -' Expansion Tank $0.00 0 Sink, commercial $0.00 0 Arch I Eng $0.00 . 0 Sink; Floor `. 0 Gas (1-4 outlets) $5.50 1' Sink, kitchen Address: .,0 ' Gas (Over 4 outlets) $0.00 0 - Sink, service/mop - $0.00 Phone:- Gas Repipe $0.00 0 - Zip: 0 ' Gas Service $0.00 0 License`., '$0.00 0 SCOPE OF PERMIT P{` PLUMBING FOR ADDITION:. NEW GAS LINE.. Interceptors (Grease, Oil) $0.00 0 Interceptors (Sand Auto ) $0.00 0 COMMENTS / SPECIAL CONDITIONS ''AMT/ QTY AMT QTY 0 Swimming Pool $0.00 ISSUE FEE $22.00 , $0.00 Laundry Tub / Washer _QTY = $0.00.0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Backflow Preventer $0.00 0 P -Trap 1, -- ,^ $0.00 0 Bathtub $0.00. 0 Pressure Regulator," `, ,$O.00 0 Clarifier System . $0.00 < 0 Process Piping (per 10 ft) $0.00 0 Connect(Ice,Soda,etc) .$0.00 -..0, Receptors', ,-,-° '- ' $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 OTHER Dishwasher $0.00 0, Sewer,Cap forDemo, d,/,:$0.00 0 Drain, Floor $0.00 0 ':,Sewer Connect ,$0.00 _ :,a0' Drain, Rainwater $0.00 0 "Sewer Private Line ` ; - $0.00,'. •0�--'- Drain, Roof $0.00 0 . Shower' - $0.00'- 0'' Drinking Fountain $0.00 '0 - Sink, bar .- _. $0.00 0 - Expansion Tank $0.00 0 Sink, commercial $0.00 0 Gas Earthquake Valve $0.00 . 0 Sink; Floor -, '$0.00 - `. 0 Gas (1-4 outlets) $5.50 1' Sink, kitchen $0.00' .,0 ' Gas (Over 4 outlets) $0.00 0 - Sink, service/mop - $0.00 0 - Gas Repipe $0.00 0 ' Spa (private) a -" '$0.00 0 ' Gas Service $0.00 0 Spa (public] '$0.00 0 Interceptors (Grease, Oil) $0.00 0 Interceptors (Sand Auto ) $0.00 0 COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: $27.50 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. 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 -1�AMT' QTY Sump Pump! ,- $0..00 0 Swimming Pool $0.00 0 Trap Prime'; , $0.00 0 _ Urinal:. � $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 ,Vacuum Brkr Bkfl6w(5+)i `$0.00 0 Wash Basin - $0.00 0 "- Wash Basin Set ,�,";' -' $0.00 0 Waste and Vent System $0.00 0 Water Closet (Toilet) $0.00 0 Water Heater / vent $0.00 0 Water Piping,(Inst or Rep.) $0.00 0 Water Re -pipe $0.00 0 Water Service $0.00 0 Water Softener $0.00 0 OTHER $0.00 VIOLATION $0.00 PLAN CHECK $0.00 REINSPECTION $0.00 0 TOTAL CALCULATED FEES: $27.50 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. 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 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. ❑ 1 have and will malntain workerscompensation 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 completed if the permit is valued at one hundred do/iars ($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 o1 California. ajid agree that P1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply withw p , these ro – re iApplicant.Signature: J, �� Date:— WARNING: FAILURE E ( SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL PSUWECTROVIDED FOR I N EMPLOYER 6O CRIMINAL PENALTIES AND EST, FINES UPN ONE HUNDRED THOUSAND DOLLANE (E100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under pro ns 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. Uc. N i r Class a rConuactors,Signature: 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 em 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 dvil 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 Cade: 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 Cade: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 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 then 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 ocoupant meati to file a registration to= for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mese 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 Dces 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 (Socffon 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. ............................................y....................................................................ia........................................................................ith?................................................................................ 4 If an RMPP Is presently required, has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑ Yes ❑ No .................................................................................buil............................uire........................hich.................ject.....this ....plIc. tion...................................stud i............. diff ...tion. 5 Does or will the applicant u present or future building Occupant a require for the work which is the subject c this a plication a8p 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 L.1 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 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). ..............................................................................................................................................................................................................................................................I..................... 7 If a Permit from the South Coast Air Quality Management District or other air pollution control district or agency is reGwired 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 Materiels and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity 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 abov"escribed property for inspection purposes. I agree not to Occupy or allow Occupancy of any building authorized by this permit until final inspection. Signet eOf -Iw5 Date 'An—did-r.'AuBwnzed'Applicant ate. 00—L INSPECTION TYPE gAIE IfiID1ALS CODEC INSPECTION TYPE gA1E INTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical c1 1266 Pool Spa Final 208 Final Plumbing O_n 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 SUBJECT PROPERTY INFORMATION 1) Property: 1218 DORSET LN, COSTA MESA CA 92626-2725 C036 IMPROVEMENTS LAST SALE APN: 141-153-01 Use: SFR County: ORANGE, CA Tax Rate Area: 15045 Total Value: $180,000 Census: 639.02 Prop Tax: $2,004.58 Land Value: $127,027 Map Pg: 27-D3 Delinq Tax Yr: Impry Value: $52,973 New Pg: 859 -AS Exemptions: HOMEOWNER Assd Yr: 1997 Phone: FSO—,)2-33 (hd- 2-50—/364) %Improved: 29% Owner: BROMMERS ERIK D & SUSANA G Junior TD's: Mail: 1218 DORSET LN; COSTA MESA CA 92626-2725 SALES INFORMATION IMPROVEMENTS LAST SALE PRIOR SALE Bldg/Liv Area: 1,178 Transfer Date: 01/15/97 03/23/93 # Units: Sale Price/Type: $202,500 FULL $193,000 VERIFIED # Bldgs: Document #: 22809 192523 # Stories: 1 Document Type: GRANT DEED GRANT DEED $/SF: $171.90 1stTD/Type: $161,800 VARIABLE $173,700 VARIABLE Yrblt/Eff: 56 Finance: Total Rms: 5 Junior TD's: Bedrms: 3 Lender: NORWEST MTG INC Baths(F/H): 2 Fireplace: 1 Seller: GEHRMANN DAVID W Pool: POOL Title Company: COMMONWEALTH LAND TITLE CO. Bsmt Area: Transfer Info: Construct: SITE INFORMATION Flooring: Air Cond: Improve Type: Lot Size: 69 X 113 Heat Type: FORCED AIR Zoning: Lot Area: 7,797 Quality: AVERAGE County Use: 1 Parking: ATTACHED Condition: GOOD Bldg Class: Park Spaces: 2 Style: TRADITIONAL Flood Panel: 060216-004GE Site Influence: Other Rooms: Phys Chars: PATIO;AVERAGE FUNCTIONAL UTILITY; Legal: L182 TR2671/N Comments: Copyright ©1996-97 Experian Page: 1 of 1 1 ADDRESSOPSUILDING: 1218 DORSET ALN DHT: pow7ixSNAME1FIDicalah. GEHRMANN, DAVID W ADmm: 1218 DORSET LN COSTA OS A4 ESA CA 92626 Afp87 I.MMINID ADDRESS: . ARDNITECT ON ENGINEER: UC. NO, INCH. OR ERG'S ADDRESS: UNIT: CONTRACTOWS NAME: CONLRACTOWS MNUNG ADDRESS: UD. NO.: IMT: LICENSED CONTRACTORS DECLARATION: I hereby affirm under peaky of perjury dust I am licemed under pwisiaro of Chapter S (commencing with Section )000) of GNaon 3 of the Business and Professions Code, and my license is in full for, end effect. CITY UC. NO.: UC. CLASS: LIC. NO.: EXP: Dale: Connector OWNER BUILDER DECLARATION: I hereby affim under peneEy of parjury treat I an e.empl from the Contractors License Lew for the ldowkg moon (Section 7031.5 Business and protrusions Code: Any city a county which requires a permit to consNa1, spar. empress. gbmd'sh, or repair any structure, prior to as issuance, she requires the applicant for such parmd to fib a signed su rearmt that M or end Is licensed Imperial to IM provisions of the Contractors License Lew (Chapter S (eommendrp with Section ]OW) of Canadian 3 of the Business and Professions Conal or that M or etre is exempt therefrom and the Mea for the alleged exemption. My violation of Seclim 7M1.5 by any eppliwtl for a permh subjects the applicant to a coal penalty of rat more than fine hundred dollars rS IOD. ❑ I. as owsar of the pmpanya any employees with wages as Ihei sole compensation, WI do the work, end the structure a not intended or offered for sale (Sedan 70a4, Sao. and profession. Cade: The Contractors Liomse Lew does net apply loan owmrd property who Wilds or inaovea thereon, and who does such work herself or hereeff or through his or her own ampkrlaes, provided thad such impovemeda ere w intended or offered for was. N, however, the Wilding a impressment a sold within one year of complelan, this owwLugder will hew, the Wrdsn of prism, M w she did not build or improve for the purpose of rale). ❑ I. as owner of IM propend, we exdrmely contrwng with ficerwd contractors to construct the prged (Section 0a<, Guinness and Profs. Code: The Correct. Lxarea Lew does rat apply to an owner of property who Wilds or improves thereon and who contrana b win projects with a ContractoNs) (caned carouser to the Commissars Licence Law), amepepmp andsrdi/on/:BP7044 B.AP..... this rearon:9h�jJfN�ER�fD9°ING WORK Date L O 'La Ovmen way that I am... of and Understak the requirements of Coliamie Health and Safety Code Sections 25505. 25533, end and Net I or any Mum Wilding encu sure will I will nor (dole one) need to comply with eek doe coder end the requirements ler a plant formnstrudkn ormodifcationhanlMAi uamy WWW"emed Grand. Resideraw construction appica omam swept been pave Dale: ApPloem: WORKER'S COMPENSATION DECLARATION: I hereby atfim under penalty, of perjury one of the following declensions: ❑ I have end peri mains a certificated moment to self-im m ler workere'r pamdon, w prwked fa by Semon 3700 d the Labor Code, for the I»do mance d the work for which this parm4 is im ed. ❑ I have and ail this e r workere' ed. My wdion s. compensation m rsquired by Swim 3ust pthe labor Code ler the pedamaras d the work la whkA this pemd'u lecusd. MY waken' ompansdian irdurenoe radar ark pdicy number are: Carrier: Policy Number. M. sedan need ria be completed I the permlt as b one, hundred ddlers /51001 or len.) ❑ I mnM rho in the pe wo los d om work ler whc r puha Pamrb a ame,d. I shell id employ ant Prem su any mama m ore to become pebject Io Ion workers' n 37th of the lees C CelI m all and agree thea ff I dauk bacorne pebptl to the workers' compradon pmdaons d Section 3700 d the labor Code, I mall forthvdlh eornpN was those prenaom. Data: Applicant: Wenals, FaNuro m securo wodrra'rompsmNon coveropa h un/awNA end shall stsllact an employer ro MMrW psnaMp end ch,11 H. W m one hundred thousand dollam (5100,000), In aAl/pcn W Ma cwt of rorrponaatlori damages as pro~ ler In Became 3705 of Me Labor Cods, Interwar, and aMmey's fees. CONSTRUCTION LENDING AGENCY: I hereby o fins under IoM of perjury thin there I, e mnslnalion Nedirg a9 mo, MIM perfmmenoa of the peck for which IM permit is mued (Section 3067. Cm C). LENDER'S NAME: LENDERS ADDRESS: I redly thd I have road this application end etre IMI Me above infamatkn a comed. I spree to comply with all city end county adineraes end elle levee retying to building cenmudion and hereby authorize relaenntelivee of this dry to enter upon the shoos-memomd properly far inspection lrpoaea.DAVID GERHMANN Dd.: 1 LD (5151daImp) Whhe4luildinp A Solely; Green-Fle; Cmruy- ppllowr: Pink-Revanw; Gake rraHAssenor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 079437. PERMIT NO: E 079431 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH JOB DESCRIPTION : ELECTRICAL WORK IN GARAGE AREA SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: U-1 COMMENTS: ONLY ELECTRICAL WORK IN THE GARAGE AREA dE ii ii lit iElE1E**♦EIFlEiE*dE**dE iE dH iH ib dE dE dE dE*iE RE iE NE dF iE iE lit iE kfE 1E*if iilHdH*iE dE IE dE dh RE if iH df iFRE iE dE dE iE IE dE dE ii lF ii iE RE*dE iE fF dE dE iE iE did RE lit Ir, Z O N I N GS E R T E B Q A U C I K R S E M E N T S (� ------------ MAIN BUILDING ---------- U A L F E E --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 14115403 ZNE: REF NO: PLANNING NOTES> END OF FEES 9 iE dE dE♦E iE RE dE iE*♦E**dF iE dE*iE 1E*1E*1E 1E***RE RF iE db RE irk dF.if♦E dE dE dE dE dE dE iE*1F dE dF dH iE***irk df iH irk dE**ib iF iilE dE 1F*iE**RE dE*dE iE*IFdFdElEdf- D E V E L O P M E N T S -E -R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY '-_: DATE: APPLICATION ISSUED BY: DATE: �dE� iE 1F 1E 1E dE dE*♦F lit 1F lF**lit*df lit dE Si*#iEiF iFiFiF�FTF7F�F�F�F iF����E3f����f 3F3F7FitiFiFifTFTF3F***♦E dE*1E iE** LEGALIZATION:N F E`E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 18.00 50% SMIP/NON—RES PLAN ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 18.00 22.00 0.00 40,00 40.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 40.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 40.00 1E iE dH irk * * *!Flit lit dE irk di iF dE dE k dE RE * dE dE iE fit ♦f iE dE dE dE IF dE iE iE iF dE if iF if SH 1F if irk di 1E 1i irk * dE iE dE SE iE RH iF dF 1E dE dE * it lit 4 fit RE iE lit db RE * * lit dE 1E * dIF di * 1E 1E I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 15 RECEPT/OUTLET 1 ST 20 EA. 1.00 15.00 ELE 3 RECEPT/SWITCH 1 ST 20 EA. 1.00 3.00 END OF FEES 9 01 00214656-00214656 TOT 40.00 iv_�DATE: 09/10/95 TIME: 10:10 CONS:.RUk10N AND PLANNING = Date APPROVALS Permit # .. or Inspector _ POC SPA 1 - APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52.. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53- Steel Reinforcement r - 3. Electrical Conduit Utility -Undr9md. 54. Forms - 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding' ' Steel Reinforcement - 56. Rough Plumbing & Pressure Test _ r '.6. Electrical LIFER Grnd, 57. APPROVAL TO COVER-GUNITE _ T. Footings 58. Electrical Conduit-Undrgrnd. 8, Foundation 59, Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. _ 1 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 65. Electrical -Final - - 15. Rough Electrical -Conduit 6, Solar System -Final 16, Rough Electric Wiring/j Q ![ / 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 * ` - ^ Y 20. Rough Factory Fireplace 21. Oucis, in. Structure 70.-UndUg[otind Hydro 22. Ducts, Ventifoting. ,.. _ - ' + - 71. Product Piping -glias 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush ` 24. Roof Framing - 73. Undergrnd.StorageTank 13Gas 004 25. Roof Sheathing 74. Overhead Hydro - 26. T -Bar Ceiling (Structural) & Monocoat _ 75. Dry Chemical - - 27. Frame and Flashings -' _ 76. Dry Stagd`pipe 7,,-• ' r• 28. Lathing & Siding' ..: - _ 77. FIXED SYSTEM'FINAL 29. Insulation ;'; - 78. FIRE PREV. FINAL _'s 30. Drywall Nailing :. l r ,-:HEALT14 DEP.T."REQUIR-EMENT 31. Plaster Brown Coat ~ 79. FINAL INSPECT_UON - - - 32. Electrical Power Meter -Final p FOOD CERTIFICATE ISSUED 33.'Finarl'Electric c. _1 _.l - otes:�Z 34. Fina'I Heating:& Air"Cond.itioning'.'-- - K �- z 7 35.'Final Gas�Pipe-Tess 36. Hood or Canopy - 37. Final Factory Fireplace -- -•" = 38. Final -Plumbing - _ -- :c ++• 39. Water Service -Final'- "T - 40. Gas Service -Final 41. Solar Domestic -Final - 42. Backflow Preventers •" ,' .. - `, r ' 43. Backflow Irrigation• - _o 44. Landscape Irtigation System :45. Sound Attenuation - r - - - -=r�- -46. Handicap• Regulations - '• .__ ';,. 47.,FINAL STRUCTURE & BUfLDING UT. - 48.'FINAL PLANNING,. 49. -Electric Release to Edison - �50. Gas Release to Southern California Gas Co _ 51. CERTIFICATE OF OCCUPANCY' No Date _ - r r k H. V. LAWMASTER & CO., INC. s' 7940 MAIN STREET — STANTON, CALIFORNIA 68CM5-191T-002 828-8040 XXX Field Data on Test Specimens Core Concrete Gunite Grout/Mortar_ Project Parker Swimming Pool Permit No. Project Location 1218_.Dorset Lane Costa Mesa Contractor „_,._, n__,_ Architect 1 Shallow end Location in Structure ., A___ _,,,t _ 7 �;: - Engineer Date Moulded Sy7gy(n No of Specimens Slump Specimens Marked "- " Specified Strength at 28 da s 2000 p g y P.S.I. Mix Designation Age to be tested__days 28 days—clays—days READY MIX PLANT AGGREGATE SOURCE 11 Weather Condition 1 Yd. —Yd. Batch Cement Type Cement, lbs. 7 Day Test 28 7 Day Test 28 Admix Sand 6/5 6/26 6/5 6/26 Specimens made by Hansen #4 — .49X 5.61X12.3 12 5.65X 5.57X12.5 11.75 Data by n ,"-3 RECEIVED 24.36 25.07 Delivered by Hill n2 BUILDING DEPT. Date Delivered 6/1/68 REMARKS:/�r/-Z',4 7� # Water, Gals. JUN AM t$LQl�rlll 27 1968 I�I�r.�t y, i� Lab. No. Date of Test Specimen Dimensions Area Ultimate Load Lbs. per sq. in. H/D Corrected ❑® 1 2 3 FOR LABORATORY USF ONI Y 5672 5673 5674 5675 5676 5677 7 Day Test 28 7 Day Test 28 7 Day Test 28 Day Test 6/5 6/26 6/5 6/26 6/5 6/26 33X 5.45X12.25 11.7 — .49X 5.61X12.3 12 5.65X 5.57X12.5 11.75 _2333 24.02 24.72 23.67 24.36 25.07 -A6+ 80,500 44.000 60,000 30,000 49,000 1,993 3,351 1,780 2,535 1,232 1,955 7 day average 1, 68 - 28 day test verage 2,614 RCE,46207 T Co-� CITY OF COSTA MESA CALIFORNIA 92626 P.O. BOX 1200 FROM THE OFFICE CF THE PLANNING DEPARTMENT September 17, 1968 Reginald Parker 1218 Dorset Lane Costa Mesa, California Dear Pool Owner: The Costa Mesa Planning Department has been notified of the completion of your swimming pool. So that your pool will be a safe one and for the purpose of advising you of your responsibility regarding the requirements of the Costa Mesa Municipal Code, we quote Section 9298.9: 1. No swimming pool shall be constructed closer than five (5) feet to any property lines, measured from water line of pool. 2. No swimming pool shall be constructed under any electric power lines or on any electric power easement. 3. No swimming pool shall be constructed unless the yard surrounding such pool is completely enclosed by a fence six (6) feet in height and has a self-closing and locking type gate or gates. This courtesy letter is directed to you so that you will be aware of our ordinances and can make a complete safety check of your pool area. Sincerely yours, William L. Dunn Director of Planning CITY OF COSTA MESA BUILDING DIVISION � DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER B98-01305 >/ (714) 754-5273 Fax(714)754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1218 DORSET LN Status: ISSUED Suite: Applied: 07/21/1998 Vicinity: Issued: 07/21/1998 Parcel Nunmber: 14115301 Zoning: R1 R1 Applicant: GUTTICCA, MIKE Address: - r Phone: -714:97934,73-. - J- _ Zip: -� Owner: BROMMERS, ERIK D.& SUSANA G ;! f Address 1221188 DORSET LN Phone:, - COSTA MESA,CA i '-:-'. - Zip 92626 Contractor: BARTWOOD CONSTRUCTION Address: 11109 CONDOR' Phone: \ \ N / FOUNTAIN VALLEY CA Zip:R 92708 License, 592681 �r / BArch BEng JI Address /�''�. � ' L ✓ �;..� ,} i. J �A ,, / 0", --Phone:,- Zip: P-hone l�li` �_--� �,,'/I ,X l,�'• Zip: License: ��f iA 1 t !7 •.cid I� \ �. ._ \ . �� i. t _SCOPE OF PERMIT NEW ROOF FOR SFR ADDITION AND REROOF O,Fy18 SQUARES OF THE; EXIST RES. SUPPLEMENTAL TO rte,.-� , I�B98-00839 l' iI o� i. _ , I i�, UiV. FEE SUMMARY t Plan Check tctr, 1$0.00 r a-- ,, ,� _1 , , _ _ - r _ -Calc Valuation ; So.00 � V 'Permit �`� ? $0.00 Claim Valuation , ?�$1 SMIP Res \V"}x$0.50 J// \SMIPCom.-� v��t$0.00 4 Othe6: ,l\$0 00 Inspection: $0.00 \TOtal: <7$0.50 \� � 1� _, ����,.`., - �� S.1 � .���!� ��_ ,A t !.,'i. prod , i // �✓ / P,LANNING'& ZONING SETBACKS MAIN STRUCTURE Front 0-0.I 'Rear 0-0 Left- 0-0 Right- 0 0, ACCESSORY Front Rear 0-0 -`,'Left"` - ` Right -%'0 0 ;0-0--,, PARKING Existing: 0 Required: 0 Proposed: o , NOTES: 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 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 rk for which this permit is. issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this Permit is issued. My workers' CoSnsatjprrinsurflnce carder and policy number are: Carrier. ��--�- Policy Number: (This section need not be completed if the permit is valued atone hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the workers compensation laws of Califomia, a8 gree rat if I sh Id become subject to the workers' compensation provisions of Section 3700 of the Labor Cade, I shall forthwith comply with these provisio plicant Signature: --� Date: WARNING: FAILURE TO SECURE WORKERS' GYMIPE ON COVERAGE 1$ UNLAWFUL AND SHALL SUBIECT 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 3105 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed un r vi ion of he ter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. N Class N ontractor'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: 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 perrnit 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 o1 completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivel's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 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, All 2, Sec. 341, Tltle 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 neetl to file a regisiratlon forth 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). ....................*%...................... ....................cr'i............................................................................................an"a,.................................................................................................al's.)... 3 Does or will the applicant or present or future huilding occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................................................................................................................................................................................................................................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully Complied with? ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ppermit 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 Government Code requires that the requested information be fumished 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 (It "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................................................................................................................................................................................................................................................................... 7 11 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 Cade Section 42303 been made? ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... 8 (If'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.. Date An r AuthorceigNApplicant ` Date CODE I. INSPECTIONTYPE DATE INTITIAIS CODE# INSPECTION TYPE Deg iITRIA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 1 �' L� 210 Final Electrical 201 Final BlockiRelaining 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 244Fii6 r Erik and Susana Brommers 1218 Dorset Lane Costa Mesa, CA 92626 January 19, 1999 City of Costa Mesa Building Division 77 Fair Drive Costa Mesa, CA 92626 To whom it may concern: I would like to request a one month extension to building permit number B98-00839 issued 6/10/98 and due to expire around 2/11/99 (6 months after the last inspection on 8/11/98). We are in the process of constructing the landing outside the family room addition. Since we (the owners) are undertaking this portion of the project ourselves, it is taking a little longer than we anticipated. Thank you for your assistance. Sincerely, ��/j-q0. r 0 "�� ^•.,w�n/� Susana Brommers RECEIVED CITY OF COSTA MESA BUILDING DIVISION !JAN R 6 1999 CITY OF COSTA MESA ' BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT B98-00839 PERMIT PERMIT NUMBER (714) 754-5273 • Fax (714) 754-4856 BUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1218 DORSET LN Status: ISSUED 0,6 Suite: Applied: 05/14/1998 Vicinity: Issued: 06/10/1998 Parcel Nunmber: 14115301 Zoning: R1 R1 Applicant: GULLITTA, MIKE Address: Phone: Zip: . Owner: BROMMERS; ERIK D & SUSANA G Address 1218 DORSET LN Phone:- COSTA MESA,CA -Zip:- 92626 Contractor � �1�'FSa2�WoctD Address. AIRWAY -AVE If(OI Co#4ll02- Flr'CA °fzlos Phone: tl114) q7q-(-3¢7?5 COSTA'rotESA;-efr Zip: 92626 License:' C7748 Arch Eng ROB.PATTERSON- Address: �" r• i - - �� '� Phone:,,,' ��` •. � - - -Zip: License":-C7748� - -� , SCOPE OF PERMITS '402 square foot, single -story room addition, located 29 ft from right p/I, 14 It from left p/l, between garage and main- ' house. Addition is a family room. Relocate existing washer & dryer -to garage �- FEE SUMMARY Plan Check: $274.14 -- - -- i''''-- �� .t., — Calc Valuation: $32,763:00 __ �_.. 'Permit: $421.75 Claimed Valuation. $30,000.00' ` SMIP Res: $3.28 / SMIP Com: $0.00 Other:. $0.00 Inspection: $0.00 Total: $699.17 , " PLANNING & ZONINGS, SETBACKS MAIN STRUCTURE Front 20- 0 - _ Rear 5-0 - left 5-0 Right 20-0 , ACCESSORY Front 0-0 . Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 2 Required: 2 Proposed: - 0 NOTES: 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. IINSPECTIONS: 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. 1 FOR INSPECTIONS CALL: (714) 754-5626 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 penult 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: Cartier: I Policy Number: (This section need not be completed if the permit is valued et 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 th i1 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these _plonYsrions. /f pry Applicant Signature; %` r"` Deteiii /d �— WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHAH SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business aV Professions Coda, and my license is In full torce.and effect.Uc. #S27 S // Class 4— Contractors Signature: ' [� L'(1 , �te:� l /i1 4 I 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 afflml 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 Ucense 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 _-- - - - ❑ I, as owner of the property, or my employees with wages as their sole compensation. WILL 00 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, W60 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. 14 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 gale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sac. 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 Cade 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 lax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity 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 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 ❑ 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 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 pertment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................................................................................................................................................................................................................................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication ape"it 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 Government Code requires that the requested Information be furnished on applications for non-residential building permits). ................................................................................................................................................................................................................................................................................. e WIII any pert 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 ppeermit from the South Coast Air Quality Management District or other air pollution control district or agency is regwired for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safely Code Section 42303 been made ❑Vas ❑ No .................................................................................................................................................................................................................................................................................... 8 (Ii yes', attach certificete of compliance from the appropdate 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 Emlss ons. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. aturea neds) ate And/Of Authorized Applicant z__Liate�- glig" INSPECTION TYPE TYPE 2AM IKiITALS COGEN INSPECTIONTYPE DAM gQmALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ` 2"6.46 R CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT J •�� PERMIT (714) 754-5273 • Fax (714) 754-4856 Job Address: 1218 DORSET LN Suite No Vicinity: ELECTRICAL PERMIT, E98-00544 L-�// PERMIT NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUEDv Applied: 06/10/1998 Issued: 06/10/1998 Parcel Nunmber: 14115301 \\ Contractor: BARTW00D'CONSTRUCTION Applicant: GUTTILLA, MIKE Address: 11101 CONDOR Address: Quantity - .'_ _ Quantity ISSUE FEE $22.00 Phone: $0.00 0 , - FOUNTAIN VALLEY CA Zip: 92708 L ,Zip- Busway /100 ft �',, .. .. .. License 59288'1 Res. a/c package $0.00 •ice.-, 1�-.��'I` Owner: BROMMERS; ERIK D & SUSANA G, New Res (1-2 units) $0.00 Address 1218 DORSET LN $0.00 0 - New Res (3+units) $0.00- 0 -- Transformers up to 1 kva/kw $0.00 0Y Pool / Spa ,' $0.00 :Phone ..<� $0.00 0 ', COSTA MESA,CA -=Zip 92826 "up.to 50 kva/kw $0.00 '0." Recept Outlets, $14.00 14 ..............?.:up to -100 kva/kw $0.00 ;i;0: Switches-.' $6.00 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 SCOPE OF PERMIT''' ^ �� ELECTRICALWORK FOR ADDITION: 14 REC., 6 SW., 3 LIGHTS, 1 PANEL �;' \\ Contractor: BARTW00D'CONSTRUCTION • - / ��'• Address: 11101 CONDOR �- Quantity - .'_ _ Quantity ISSUE FEE $22.00 Phone: J $0.00 0 , - FOUNTAIN VALLEY CA Zip: 92708 L --1`��, \`.. Busway /100 ft �',, .. .. .. License 59288'1 Res. a/c package $0.00 •ice.-, 1�-.��'I` i. i - 0 '-^ New Res (1-2 units) $0.00 __.0 --_ -- _- '^-Mist Electiical'Equipment -' 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 SCOPE OF PERMIT''' ^ �� ELECTRICALWORK FOR ADDITION: 14 REC., 6 SW., 3 LIGHTS, 1 PANEL �;' ` '• - FEE SUMMARYA. , L,}: i;' !i• -....- Quantity - .'_ _ Quantity ISSUE FEE $22.00 Temp Dist System'/ Lighting $0.00 0 , Temp service test - $0.00 Busway /100 ft �',, $0.00 0 Res. a/c package $0.00 k^;,.�--Standing'Section ���_--�^ $0.00 0 '-^ New Res (1-2 units) $0.00 __.0 --_ -- _- '^-Mist Electiical'Equipment -' $0.00 0 - New Res (3+units) $0.00- 0 -- Transformers up to 1 kva/kw $0.00 0Y Pool / Spa ,' $0.00 0 ..........._...� up to 10 kva/kw $0.00 0 ', .Lighting Fixts $3.00 3 "up.to 50 kva/kw $0.00 '0." Recept Outlets, $14.00 14 ..............?.:up to -100 kva/kw $0.00 ;i;0: Switches-.' $6.00 6 ..........^..... over 100 kva/kw $0.o0 Non Res Appl -'$0.00 0 ,'',Low Voltage Equipment $0.00,,//", ^0 I. Res Appl - -1$0.00 0 . n . Low Volt Wiring System / Ckt $0.00;' "- 0 ,,.. Service to 200a $27.25 1 t "'' Misc. Conduit _ $0.00 i" 0 ' _ Service to 1000a $0.00, 0 �a MISC: Conductor $0.00 0 Service over 1000a $0.00 0 • `�^ `� `Circus ( gen-or"ride)`-. "- �; $0.00- 0 Motors to 1 hp , $0.00 _ ',_o '. _ , .Circus (meth ride or tights) > ; $0.001, 0 Motors to 10hp $0.00 - - 0 - _ 'Christmas Tree Stand $0.00, �, 0 Motors to SOhp $0.00 -0 Z "� - Fireworks Stand : ,- $0.00, - 0;�, Motors to 100hp $0.00 . 0 - . Other Electrical Fee - $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee' - -$0.00 Sub panel to 200a $0.00 0 Plan Check Fee Pole Light Pkg $0.00 0 Reinspection -Fee $0.00 Sign Circuits $0.00 0 ' Temp Pwr Pole $0.00 0 - -- - TOTAL CALCULATED FEES $72.25 Intermed Pole $0.00 0 - - - COMMENTS / SPECIAL CONDITIONS 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 DECLARATIONS _3 M 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 insurerae, 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: Cardec Policy Number: (This section need not he completed it the permit is valued atone hundred dollars ($1 670) or lass.) ❑ 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 Celifomia, an gree that if ould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these prov //•// Appllcant'Signettre: —, IA/ 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 DOILARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E 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. "4. Class a Contractors Signature: . � r u: r 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: 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 sale compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License taw 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 drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, Le. - property tax bill Or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certlty 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 allthoflzed by this permit, and that no building structure, scaffolding, falsework, or demolitlon or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California AdministratNe 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 California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................................................................................................................................................................................................................................................................................... 4 If an RMPP Is presenlly required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yss ❑ No .................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plicallon aaPermit 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 U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ........................................................................................................................................................................................................ .................................................................. 6 WII any pen of the facility tmit be wiriehoo o be constructed under this permit 1000 feet from the outer boundas of a scl? ❑ Yes ❑ No (It 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 ........................................................................................................tu.......lut-1-........................................................................................................................................................... 8 (II yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow Occupancy of any building authorized by this permit until final inspection. SI ature /'I nor s) �And/OcAuthoriza Applicant (r--- —Date—"-�✓J COUE L INSPECTION TYPE DAIS INIMALS CODE d INSPECTION TYPE lim yNTITIAl$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Flo -Roof 210 Final Electrical Z.' 0 _" 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 2x46-46 OWNER pAIUM, REGINALD DATE ;JOB ADDRESS 1218 Dorset Lane BUILDING PERMIT N0.28554 LOT lb2 TRACT 2b'(1 FIRE ZONE VALUE $2 CTIONS Si nature Date GROUP J TYPE III ZONE R SUBCONTRACTOR PERMITS ISSUED GAS-,, .mac Date Nvm ber Si nature WATE aA H - / Plumbin ROUG PLUMBING PROP. SWR. LINE E] HOUSE CON. Iq SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR S UNOERG ROUND POWER - Q• ROUGH WIRIN Heating and Vent. TRENCHES [D FORMS ❑ STEEL REINF. FLOOR SYSTEM r unt BOND BEAM STEEL REINFORCE i� fa pµna rtp dInE S HEATH I NG OtdlndwI FRAME AN lk-c-c LATHING — IN OUT PLASTER, BROWN COAT S" TUBAL, FINAL I F. G, VENT., REFRIG. AND A.C., FINAL — PLUMBING, FINAL AND GAS TEST _ (J 5--2— ZELECTRIC, ELECTRIC,FINAL 0 -2- BUILDING, FINALf BUILDING, F28554 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 32326 For Applicant to Fill In Completely TYPE OR BRINT „ MESA. CALIFORNIA ARCHITECT SETBACK LINK FROM APPLICATION FOR PERMIT BUILDING For Office Use Only ® DESCRIPTION OF WORK r PUNS SHALL BE LESS THAN YARDS ROVED YARDS APPROVED MAIN BUILDING I ACCESSORY BUILDING I VAR. * DATE COVERING COVERINGIAPPLICATION� R[C[IPT NO. DATE I PERMIT NO USE OF BUILDING AND WORK TO B8 PERFORMED W R[C D FOR SPECIA RE s ? DATE 1BBs180 BUILDING ADDRESS FIRS Bo. Fr. 5, 1 HEREBY ACKN DO AT i HAV[ READ 8 ZONE TYPE GROUP OP ESTABLISHING A PERMIT FEE ONLY.PLV ® DESCRIPTION OF WORK r PUNS SHALL BE LESS THAN YARDS ROVED YARDS APPROVED MAIN BUILDING I ACCESSORY BUILDING I VAR. * DATE COVERING COVERINGIAPPLICATION� DATE I USE OF BUILDING AND WORK TO B8 PERFORMED W D FOR SPECIA RE s ? l Bo. Fr. 5, 1 HEREBY ACKN DO AT i HAV[ READ 8 AMOUNT BMOWN UNDER VALVATION 18 POR THBAND RTATB T T TNK ABO 18 CORRECT D OPOSE OP ESTABLISHING A PERMIT FEE ONLY.PLV WITH AL CITY OR 1 CEG AND ■ T WSBUILDING TIONSIGNATUR OP q� PERMITFEEPERMITTEAUTHORIZED ^ Cb AGENT MR M TOTAL FEE $ O OWNER COLLEGE MESA COMPANY DATE 10-11-56 JOBADDRESS BUILDING PERMIT NO. GENERAL CONTRACTOR The Hale Company VALUE $ 10i2L8.00 1. 182 BLOCK TRACT 2671 Single dwelling v�det. gar. GROUP T Rr J TYPE V ZONE RI, FIRE DISTRICT 3868 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER T Footing Trench Foundation Forms and Grade to Garage _ev, Rough Framing Plumbing, Rough to Slab s,_,�-v�.�L�-��-a•YG - d' /0 -306 Plumbing, Rough Complete `221 ,a- fj Temporary Pole Wiring, Rough �li,..� ��. ray- �� 3 ei I/ ✓ Heating, Rough /rl (�' S %,L• •Ste Heating, Final /31 S[/� r--/y-s� ��Y,.,/ /✓.]` C� J Sewer House Q Sewer, St. ��'%/T� i'- /I���-�-q1�4�-�I O% "-G X 7/ Sentic Tank or Cesspool Ig, Int/ OutJ F._—erin9 Plumbing, Final, Fixtures Complete AV $ a _14 - S'/N-S7 - •� Plumbing, Final Gas Test/� Wiring, Final ncrtun�nov L/L�i L /%� C FORM 21O 3M 10.55 � - � 3838 Costa Mesa Building Department APPLICATION FOR PERMIT P. O. Box 317 6154"g BUILDING + COSTA MESA. CALIFORNIA 'FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY Receipt No. Permit No. 3�' .3 Building Address 1 Dorset Lane Costa Mesa, California Received by Date Recd. / Date Issued Nearest Cross St. Fairview Road Building Address Owner College Mesa Company Costa Mesa, California Mail Address 1777 W. Lincoln Avenue Nearest Cross St. Tel. City Anaheim No.KEY 3-3161 zone No. of I Plans Type '/ Grou I !/ ✓ Architect or Lie. Engineer Davis & Quigley No. C-1790 Approved by Date Address43 Malaga Cove. Plaza Palos Verdes CORRECTIONS tractor The Hale CompanyNoY L10' 3422 Address 1777 W. Lincoln Ave., Anaheim Legal Description Lot I No. 182 I Block I Tract2671 (Attach Metes and Bounds) No. of Bldgs Size of Lot 69-'k 113 Now on Lot None 4se of No.of No. of Existing Bldg. I Families I Rooms O 9 0 Z Setback Line from ! Rear Yard 64.8 Center of Street 50 Side Yard > DESCRIPTION OF WORK r - New X I Alteration Addition Repair I Moving Demolish Building 1181 No. of - Size Rooms 5 Stories 1 'erior Wall ering Stucco I Roof Covering Rock APPROVALS ..tee of New Building Single family dwelling with Foundation Location Forms, Materials, Under -Pinning Inspector Date detached Sgragp. Frame: Fire Stops, Bracing, Bolts 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 THE HALE CMANY Authorized Agt. Lath. Int. Lath. Ext. Plaster, Int. Plaster, Ext. Valuation Permit Fee $ 26.00 Plan Check $ $ 10,248.00 total Fee $ 39.00 Masonry Reinforced Bond Beam FINAL FORM 204 1055 D. P. & S. INco : r, ti.nF ., pr VO Prop. Line c: m Prop. Line �1 • L _ U 1-i 4: C It f'. .. f - .. Prop. Line w m Prop. Line a U f 4: It f'. .. - .. L C7 a U f