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1869 ELBA CIR - Building Permits
4"%j-a-1t' �L ., . , CITY OF COSTA MESA• ` BUILDING DIVISION ` 4 . ,I DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER % PERMIT 'Art Ramos° 604-00981 (714)7`54-05273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1869 ELBA CI Status: ISSUED Suite: Applied: 05/27/2004 Vicinity: Issued: 10/26/2004 Parcel Number: 13942108 Zoning: R1 R1 Applicant: FETHER, KENNY ISSUED BY: At, ` Address: Phone: 714-751-6409 Zip: Owner HARTWELL, BRADLEY J Address 1869 ELBA . .Phone: COSTA MESA,CA Zip: 92626 Contractor: FETHER CONSTRUCTION Address: 'P 0 BOX 3551 " Phone: 714-751-6409 . • COSTA MESA,CA Zip: 92628-3551 License: 357301 Arch : ULTIMA'DESIGN GROUP Eng: Address: 9462 WATERFRONT DR Address: Phone: 714-968-1640 Phone: HUNTINGTON BEACH,CA Zip: 92646 License: C23684 License: SCOPE OF PERMIT CONSTUCT 854 SF ADDITION TO AN EXISTING 2-STORY SFD.WORK TO INCLUDE EXPANSION OF THE FAMILY ROOM BY 347 SF AND 507 SF ADDITION OF TWO ADDITIONAL BEDROOMS ON THE SECOND FLOOR.A 56 SF GARAGE EXPANSION WILL ALSO BE CONSTRUCTED. ZA-03-80 - - . . .-. ' FEE SUMMARY ' - Plan Check: $568.59 _ - Calc Valuation: $82,270.40 Permit: $874.75 Claim Valuation: $0.00 SMIP Res: $8.23 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 , • Total: $1,451.57 • . - - • PLANNING &ZONING SETBACKS '- ' MAIN STRUCTURE Front 25-4 Rear 56-9 Left 5-0 - Right 16-11 ACCESSORY Front-, 0-0 Rear 0-0 . Left 0-0 Right 0-0 PARKING Existing: 4 - Required: 4 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) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754.5626 < • 2446-46(6/00) . //JJi/////�/ WORKERS'COMPENSATION DECLARATION: - " I hereby affirm under penalty of perjury one of the following declarations: '. . - 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the . work for which this permit is Issued 1 have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'1om_pensa'on Insurance carrier and policy number are: /� Carder: JTLt&- £O sal-IO" ,thsviance ry✓+d Policy Number: ' '-3 g.—OW 1 1 1 (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the Work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that' I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. /��Z��� Applicant Signature: Date: • WARNING:FAILURE TO SECURE WORK R PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND Deli i ARE($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 licen, a under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business1� and Professions Code,and my license Is in full force and effect.Lic.#' .')`730 Class#- V Contractor's Signature: - '_' Date: I 0'Zb—O`/" CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑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 end 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 then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. =�� ire Of Legal Owner(s) i/7_��O to -An.,Or Authorized Applicant Date ODE# INSPECTION TYPE PEE INTITIALS CODE I INSPECTION TYPE PAH 20111!LH 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical • 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place • - 220 Final Planning Approval - 203 Final Sign 222 Final Site 9 r 204 Final Demolition - /� -i.,250 Final Building/Occupancy In l 4'1S we l• F CITY OF COSTA MESA • • BUILDING DIVISION )4%�`n,aamn,. �_tp DEVELOPMENT SERVICES DEPARTMENT PE NUMBER Ft ..^..� 4 .; PERMIT E04-01134 4tokpo RaIP mo • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1869 ELBA CI Status: ISSUED Suite No Applied: 10/26/2004 Vicinity: Issued: 10/26/2004 Parcel Nunmber: 13942108 Applicant: FETHER, KENNY ISSUED BY: ..10"...0.01/A/ Address: P 0 BOX 3551 _ / Phone: 714-751-6409 COSTA MESA,CA Zip: 92628-3551 Owner: HARTWELL, BRADLEY J , Address ' 1869 ELBA . Phone: COSTA MESA,CA Zip: 92626 Contractor FETHER CONSTRUCTION Address: P 0 BOX 3551 Phone: 714-751-6409 COSTA MESA,CA Zip: 92628-3551 License: 357301 SCOPE OF PERMIT CONSTUCT 854 SF ADDITION TO AN EXISTING 2-STORY SFD.WORK TO INCLUDE EXPANSION OF THE FAMILY ROOM BY 347 SF AND 507 SF ADDITION OF TWO ADDITIONAL BEDROOMS ON THE SECOND FLOOR.A 56 SF GARAGE EXPANSION WILL ALSO BE CONSTRUCTED. 15 LIGHT FIXTURES,20 OUTLETS,20 SWITCHES, 1 SERVICE TO 200A, 1 MOTOR TO 10 HP REF: B04-00981 FEE SUMMARY Quantity _ Quantity' - - ,' ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0, Temp service test , $0.00 Busway/100 ft - $0.00 0 ' • Res..a/c package ,', ' $0.00 .Standing Section $0.00 • 0 ` New Res(1-2 units) ' . , $0.00 0 Misc Electrical Equipment $0.00 0 ' . ," New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 '', 0 Pool/Spa. ' . ' $0.00 0 up to 10 kva/kw, __ $0.00.-- ' 0 • - - , Lighting Fixts' $16.50 15 . up to 50 kva/kw.. $0.00 0 Recept Outlets' $22.00 20 up to 100 kva/kw " $0.00 0 , Switches ' '$22.00 , 20 over 100 kva/kw $0.00 ' 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 ,: 0 ' ' ' 'Low Volt Wiring System/Ckt $0.00- 0 Service to 200a " , $30.50 " 1 Misc.Conduit $0.00 0 ' Service to 1000a ' $0.00 0' - Misc.Conductor • " $0.00 ' 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00- 0 Circus(meth ride or lights) $0.00 0 Motors to 10hp $12.30 1 Christmas Tree Stand ' ,$0.00 0 Motors to 50hp $0.00 ' 0 , Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee - $0.00 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 / 2448-46(6/00) G/ ClillialaillaMIPSIMMIIIM WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: O 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 jrYwork for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers�'compensation Insurance carper and policy number are: Carrier: ' 46,-ii, i CO.-nj .74yit-/Oil Z.-S✓raf1fc 11-the- �j Policy Number: 4 "--00D/)21 (This section need not be complefeelldd if the permit is valued at one hundred dollars($100)or less.) O I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions /ob // ' / Applicant Signature: fi�) Date: )V/L�/��' WARNING:FAILURE TO SECURE WOR ER PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lice se under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Businr and Professions Code,and my license Is in full force and effect.Lic.M 7 3^0�/ Class N contractors Signature: ��/ C Date: I D lab/o y- CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: 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 tile 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.). ' O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes IJ 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? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ign u f L 10 r(s) Date LO/I670 Lf r r d pplicant Date CODE# INSPECTION TYPE PAIS INTmALS ;ODE. INSPECTION TYPE - PATE INTrRALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 . Final Plumbing 200 Final Re-Root 210 Final Electrical - M/. a v i 201 Final Block/Retaining Wall 212 Final Fire Prevention ,1_z ilft_ _ A 4 • 202 Final Factory Fire Place . 220 Final Planning Approval 203 Final Sign 222 Final Site - . 204 Final Demolition 250 Final Building/Occupancy 4 • �' 6 CITY OF COSTA MESA 4'� BUILDING DIVISION >:f•.,,,. .-s, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F I '' PERMIT 1 / be•on rip ffr* M04-00564 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1869 ELBA CI Status: ISSUED Suite No Applied: 10/26/2004 Issued: 10/26/2004 Vicinity: Parcel Number: 13942108 ISSUED BY: Applicant: FETHER, KENNY Address: P 0 BOX 3551 Phone: 714-751-6409 COSTA MESA,CA Zip: 92628-3551 Owner: HARTWELL, BRADLEY J Address: 1869 ELBA Phone: COSTA MESA,CA Zip: 92626 Contractor: FETHER CONSTRUCTION Address: P 0 BOX 3551 Phone: 714-751-6409 COSTA MESA,CA Zip: 92628-3551 License:357301 SCOPE OF PERMIT CONSTUCT 854 SF ADDITION TO AN EXISTING 2-STORY SFD.WORK TO INCLUDE EXPANSION OF THE FAMILY ROOM BY 347 SF AND 507 SF ADDITION OF TWO ADDITIONAL BEDROOMS ON THE SECOND FLOOR.A 56 SF GARAGE EXPANSION WILL ALSO BE CONSTRUCTED. 1 INST FAU> 100K BTU, 1 GAS PIPING(2 OUTLETS) , REF: B04-00981 • 12/6/04:SUPPLEMENTAL PERMIT TO ADD FACTORY FIREPLACE(WARNOCK HERSEY#3025178 MEETS ANSI Z21.50A. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $18.20 1 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler - $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping • $6.15 1 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $10.65 1 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust, $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) ` / DECLARATIONS WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: • ' ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑, I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workee 'compensafion Insurance carrier andgslicy number are: 2 p Carrier: J'ILN4e (�UMpe,i54fii on -LhSvta,tr £✓h,.i. Policy Number: 23S BOO 1 )31 (This section need not be completed if the permit is valued at one hundred dollars($I00)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree t I' should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. '7 / / Applicant Signature: Date: 'Z-U-071 WARNING:FAILURE TO SECURE WORKERS M SA ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the BusinAs and Professions Code,and my license Is In full force and effect.Uc.x ' �/) z,S7.301 Class a' Contractor's Signature: {( `�j/� Date: 12_—b'a171-- CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: 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 the 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 properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document.i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,talsework,or demolition or dismantling thereof,will be more than thirty-six(36)1 eel high.(Chap,3.2,Grp 2,Art 2,Sec. 341,Title 8,California AdmInistrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. • Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a$ermit for such construction or modification from the South Coast Alr Quality Management District or from any other air pollution control district or agency? D 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 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 end 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (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. ej /04gnature Of Legal Owner(s) 12-6-Ott Date And/Or Authorized Applicant Date CODE 9 INSPECTION TYPE ME ItfID1AL5 LODE! INSPECTION TYPE / PATE ,,L 1616 Fixed System Final Fire Prevention 206 Final Mechanical 4+ ,0 5 `Y 1266 Pool Spa Final 208 Final Plumbing _ 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place • - 220 Final Planning Approval 203 Final Sign 222 Final Site — 204 Final Demolition • 250 Final Building/Occupancy r- .• CITY OF COSTA MESA• 4 . BUILDING DIVISION e>• t,,,t ..4r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER :sw:� / + • PERMIT -le'#o"rtari tle M04-00564 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1869 ELBA CI Status: ISSUED Suite No Applied: 10/26/2004 Issued: 10/26/2004 Vicinity: Parcel Number: 13942108 ISSUED BY: 4c__ Applicant: FETHER, KENNY Address: P 0 BOX 3551 Phone: 714-751-6409 COSTA MESA,CA Zip: 92628-3551 Owner: . HARTWELL, BRADLEY J Address: 1869 ELBA Phone: COSTA MESA,CA Zip: 92626 Contractor FETHER CONSTRUCTION Address: P 0 BOX 3551 Phone: 714-751-6409 COSTA MESA,CA _ Zip: 92628-3551 • License:357301 SCOPE OF PERMIT CONSTUCT 854 SF ADDITION TO AN EXISTING 2-STORY SFD.WORK TO INCLUDE EXPANSION OF THE FAMILY ROOM BY 347 SF AND 507 SF ADDITION OF TWO ADDITIONAL BEDROOMS ON THE SECOND FLOOR.A 56 SF GARAGE EXPANSION WILL ALSO BE CONSTRUCTED. 1 INST FAU>100K BTU, 1 GAS PIPING(2 OUTLETS) REF:B04-00981 FEE SUMMARY Quantity - - - Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $18.20 1 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator - $0.00 0 Refrig Sys<100 k BTU $0.00 0 - . 'Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU \ $0.00 0 _ • ' ' Compressors/Absorption Systems . Gas Piping $6.15 1 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 - 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 - 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box • - $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct - - - $0.00 . 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers . Fire Dampers - $0.00 0 Up t63 hp ' - $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm - $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00, 0 Other Mechanical Fee Floor or Suspend Heater $0.00- 0 Investigation Fee $0.00 Plan Check Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS a 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. VI 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 wo rs'pmpensation Insurance carder abs_l policy number are:r� I 23 ryry Carrier. *RTI Cowipe 'I3,'11I'011 1.-visa-Ante, rV nA- Policy Number: O-Oon1 13 (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) 0 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 Califomia a d agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. , //- Applicant Signature: Date: I0—7-6-0 7 WARNING:FNLURE TO SECURE WORKERS' PENSA ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOU.ARE($100,000),IN ADDmON 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,nbier rovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Businesspnd Professions Code,and my license is in full force and effect.Lic.# ' 3 1 Class# �j] Contractor's Signature: Date: 10--2-fi'0+' CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly 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 properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare en RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). _ 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of r to 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 in.•- tion. Sign'? : Of..egal • ner(, 07 e / Date , I An.t•r • th."e• •pir Date / ' CODE NS/EG ON TY' I GATE INTmAL4 ••. ..Y' I.. s' /-' I ' rat t - 1616 Fixed st' 'final Fire//``'ver • _ Final Mechanical 1266 Pool Spa - , I• _ ' ' ja �fr208 Final Plumbin. I 200 • o• 210 FiieI ElCiriGal ..201 I loo._:airing Wall j_ • 212 F' .1 re a ,•enilen I 202 Fin: -:Glory Fire Place 4 - it •Tanning Approval 4 1 203 Final Sign ,_ 1 Final Site 204 Final Demolition `' 250 Final Building/Occupancy F CITY OF COSTA MESA 4 'D@ BUILDING DIVISION :j 8 DEVELOPMENT SERVICES DEPARTMENT PERM T NUMBER F t y /ti :!d PERMIT J PO4-00822 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1869 ELBA CI Status: ISSUED Suite No Applied: 12/06/2004 Issued: 12/06/2004 Vicinity: Parcel Nunmber: 13942108 ISSUED BY: Applicant: FETHER, KENNY Address: P O BOX 3551 Phone: 714-751-6409 COSTA MESA,CA Zip: 92628-3551 Owner: HARTWELL, BRADLEY J Address 1869 ELBA Phone: COSTA MESA,CA Zip: 92626 Contractor: FETHER CONSTRUCTION Address: P O BOX 3551 • Phone: 714-751-6409 COSTA MESA,CA Zip: 92628-3551 License: 357301 Arch / Eng : Address: Phone: Zip: License: SCOPE OF PERMIT CONSTUCT 854 SF ADDITION TO AN EXISTING 2-STORY SFD.WORK TO INCLUDE EXPANSION OF THE FAMILY ROOM BY 347 SF AND 507 SF ADDITION OF TWO ADDITIONAL BEDROOMS ON THE SECOND FLOOR.A 56 SF GARAGE EXPANSION WILL ALSO BE CONSTRUCTED. 1 GAS OUTLET OVER 5(ORIG 4 OUTLETS ADDRESS WITH MECH PERMIT), 1 LAUNDRY TUB/WASHER, 1 WASH BASIN, 1 WATER PIPING(INST/REP) - REF: B04-00981 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 • 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. r' 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 inspection's and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 / 2449<8(WOO) ,. r V WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'c penssationInsurance carrier and policy number are: 23g-000113 Carrier: cul c COW1 l Saf10✓t IhSV CP,R 1a Policy Number: (This section nee not be completed if thb permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,a d agr e th If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. 17.16/04t- WARNING: 2//f6/0 Applicant Signature: Date: WARNING:FAILURE TO SECURE WORK 5'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOUARE($1000001,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 witr 9 commencing with Section 7000)of Division 3 of the Busin. and Professions Code,and my license is in full force and effect.Llc.p • 301 Class It Contractor's Signature: Date: I Z/6/n/- CONSTRUCTION LENDING AGENCY: ' ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health end Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ul 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? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 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. S' Lure Of Legal Owner(s) l 2/6/61f Date And/Or Authorized Applicant Date CODE4 INSPECTION TYPE PATF INTITIALS YOU I IBSPECRON TYPE PAIL INIIDEL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical / 1266 Pool Spa Final 208 Final Plumbing l4' 23t5 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 CITY OF COSTA MESA 4a BUILDING DIVISION ,,' e_ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t S _ I PERMIT y101-00268 Itbkr•eaarN (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.usNG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDIJob Address: 1869 ELBA CI Status: ISSUED Suite: Applied: 02/27/2001 Vicinity: FLAT PORTION OF ROOF Issued: 02/27/2001 Parcel Number: 13942108 Zoning: R1 R1 Applicant: FONSECA, EDUARDO ISSUED BY: ----- Address: 126 COMMERCIAL WY Phone: (949)548-5569 COSTA MESA,CA Zip: 92627 Owner: HARTWELL, BRADLEY J Address 1869 ELBA Phone: COSTA MESA, CA Zip: 92626 Contractor CRANK BROTHERS ROOFING CO Address: 126 COMMERCIAL WY Phone: (949)548-5569 COSTA MESA, CA Zip: 92627 License: 408677 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF FLAT PORTION OF EXISTING RESIDENCE.TEAR OFF EXISTING ROOFING&INSTALL NEW BUILT-UP ROOF SYSTEM. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $1,865.00 Permit: $66.20 Claim Valuation: $1,865.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $66.70 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No. 92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) • DECLARATIONS 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. O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollirs($700}or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with � c`ant Signatthese pr viviissions. AppOure: % _raw_Ge- Date: /2/0 7/3 1 v' WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect..Lic.# r�` Class# Contractor's Signatuure,1/. ..r - .7/11. /cC fl t-ec-<� Date: i 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). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? . ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ 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? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Callfomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances • regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si ature Of Le Ownerate C 99s) c CAnd/Or Authorized-Applicent Date CODE I INSPECTION TYPE gdIE INTITIALS CODE r INSPECTION TYPE EMU 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 7—r_ en cr,h6K 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 CITY OF COSTANMESA • BUILDING DIVISION ROOF COVERING CERTIFICATION Permit No. t ' o0 26 v Property Address 1869 ELBA CIR. Owner BRAD HARTWELL Contractor CRANK BROS. ROOFING CO. State Contractor License Number 408677 Classification C39 I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the above address in conformance with Chapter 15, and Appendix 15 of the latest adopted edition of the Uniform Building Code, and the installation instructions of the manufacturer. ❑ I further certify that I am the owner of the property. (Owner-Builder permittee only). ❑ I further certify that I am: a Owner of sole proprietorship company ❑ Full partner of the company ❑ Limited partner of the company ❑ Officer of the corporation I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this certification, which shall be binding on all successors or assigns of the company or corporation. I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building Division for acceptance. CRANK BROS. ROOFING CO. Company or Corporate Name 126 COMMERCIAL WAY Address Received by Building Division COSTA MESA, CA 92627 By: 2—27--0 / igna ure Date 2 Z1 . 0 I JAMES H. CRANK - CEO Initial Date Printed or Typed Name 099646 MW 6A0 WNte-Building Div.;Canary-Connaclor;Pink-Owner J PROJECT ADDRESS: 1869 ELBA CI UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NU: a OJbtlib , ) , ' Owf'ER'SNAME: HARTWELL, BRADLEY J muss: HARTWELL, CATHERINE A PERMIT NO: B 056887 PLAN CHECK NO; 01272-92 S GOV'3 : N Sl7PP: N 1869 ELBA COSTA MESA, CA 92626 CONSTRUCTION TYPE: PERMIT TYPE; STR PURPOSE: OTH 641-0941 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : 135LF-6FT HIGH MAX CITY STANDARD BLOCK W SQ FT: 135 ADDRESS: UNIT: CLAIM VALUE: �_ 700 . 00 CALC—VALUE: 2,700 .00 GROUP OCC: R-3 / PERMITTEE: BRAD HARTWELL ( 714 ) 641-0941 ��� y ADDRESS: 1869 ELBA CI COMMENTS: X W20),— ,y (Am-- shun. ¢r .c.a..0�i ,(.e•f2L1ri • �Y-A,(,(_ 111. C.M. CA 92626 ************* . . . . *** . . ** . *** . . ** .- .** - ***************** • uCENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions al Chapter 9(commencing with Section * MINGG REQUIREMENTS SURVEY OF L0 E 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS U IRED CITY LIC.: STATE UC.: CLASS: Ss4 IRE REQ Date: Signature: FRNT: FT MAIN NBREARING FT IN FRNT: FTCESSINYREARR1L: I G FT IN WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). POLICY EXP.DATE: PARKING REQ• PROV• PARCEL: 13942108 ZNE• R1 REF NO: COMPANY: I Ce ified copy u hereby furnished. ❑ CeNlied copy 5 filed with the cityBuilding D son. PLANNING NOTES> FOR A 135 FT. LONG > PROPERTY LINE, ONLY6 FT. HIGH BLOCK WALL ALONG SIDE ', ******************************************************************************* JEXaEeMPTION FROM WORKERS'COMPENSATION OEACLA ppltTION: seam need not be completed if the permit is for one hundred(5108)or less). DEVELOPMENT SERVICES R E Q U I R E M E N"'T S I certify that in the performance of the work for which this ermitiis issued.I AI not employ any per any manner so as to become ZONING APPROVED BY DATE: A� subject to' the Workers'Compensation taws of California. / 6 t c. . 1 h C G re: `'tr�"q • Signature: /`S� - e — // NOTICE:II.alter making this declaration.ygu should be subject to the Workers'Compensation provisions of the labor BUILDING APPROVED BY : DATE Code.you must lorthwith comply with such provisions or this permit shall be deemed revoked. w CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• J\1e1 - DATE. F which this permit is issued(Section 3097.Civ.C). - ******************************************* *********************** ** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 54 . 00 50 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON—RES pursuant to the provisions of the Contractors'Slate license Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business p LAN 35 . 10 and Professions Code)or that he/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). ISSUE FEE I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE •PLAN—CHECK TOTAL PAID DUE 113 structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS— > 54 . 50 0 , 0 0 35 . 10 8 9 , 6 0 89 . 60 0 0 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale. II.however the building or REVENUE DIVISION TOTALS--> COLLECTED• 89 . 60 OVER/SHORT: . 00 improvement of sale).oflswithin one year of completion.the owner will have the burden of proving ne/stre did not build or improve foror the purpose BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK i. I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 . 00 5 0 35 . 10 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon *****************.*************,*******************.*******.*_*****************.*,**** and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Slate License Law),I am aware that proof of(heir Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.6 P.C. tones reason: TYPE QTY DESCRIPTIO S C R I P T I O nN UNIT COST TOTAL COST Date: 4/CA Owner: SFR 135 RES—CONCRETE BLOCK WALL / FT. 20 , 00 2, 700 . 00 I do hereby certify that I am aware of and understand the requirements of Canto Health and Safety Code Sectrons 25505,25533.and /END OF FEES 25534 and that I or any future building occupant will/will not(circie one)need to comply with said state codes and the requirements for a , permit for construction or modification from the An Duakty Management Dist'I.Resldenlul construct' applications are exempt from these proviisiioons, k n Sate: `t—" �'1 �- AppOnnt: (�7/y//y/� I hereby certify that I have read this appficadon and state that the EbOve information is correct.I agree to comply with at city and county 414 ordinances and state laws relating to building construction and hereby authorize rept entatives of this city to enc upon the above-mentionedproperty fforriinspector purrppposes. 7 ,, .,..._.—Sate: `•t Signature: n —C, _ ^_i• ,--1 ;— _ - • Driver's License or Social Security e: "„'f: i -? ;_ . , 1641-46 White—Buildino:Green—Cade Enforcement:Canarv—AooticanC Pink—Revenue:Goldenrod—Assessor • CONSTRUCTION AND PLANNING P001 PA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 1-2/142_- a(6 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER•GUNITE 7. Footings L(-2t•(.r.�t_ /Qiu 1,--18. Electrical Conduit•Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, O 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 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval • 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS - Permit # 21. Ducts, in Structure 70. Underground Hydro • 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74: Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL -- 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE� ISSUED � 33. Final Electric Notes: f z_ 0-t--�`�0A=A�Vat- 34. Final Heating & Air Conditioning ��`lll 35. Final Gas Pipe-Test . 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40, Gas Service-final 41. Solar Domestic-Final 42. 9ackflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48: FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _ _ C-'OF COSTA MESA • CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. . UNIT NO. � 7440- 2/13/65 Gpw d TL - /75/3 I�roject Address i 9‘q' E.�(5A C.1 fL.�LI�, I Applicant's Mailing Address 2200 'Sc' W 0. v01 MT 'Sr, TYPE OF CONSTRUCTION -H NEW U ADD LJ ALTERATION LI REPAIR _ '- `. LOA Ms-a't-L. LA w Ren.Cfl. Phone b4+••9oyy CI CONVERSION CI DEMOLISH El OTHER - A,P•# Zone - Owner's Name DESCRIPTION OF WORK/USE OF BLDG. Address. +afn of Q.L•Bq C. 404t KQ _ - S Main Building: . Accessory Building: Arch/Eng. - - License No. TYPE OF PERMIT ' ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL E Front - ZO Address ❑ TENANT ® ELECTRICAL LI PLUMBING ❑ MECHANICAL I B Rear _ - N Contractor's Name MC SetDE • E.la-CT(,.L.Phone 7SI.flC9 LI OTHERC N Address(mailing) 2Z-ob :`3C3 - W2.9 P.T• 'st• 5)q. PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Right _ G 3,3ee UO -CON ST RUCTION TYPE ' VALUATION $ $ Left R City License No. 9 ZONE GRADING CU.YDS. ACRES - LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# • Parking Req./Provided - E I hereby affirm that I am licensed untler provisions of Charter 9 (commencing Remarks: Planning Note's: M with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force antl'ef tett. • l T ( License Class - tic No. 1432 S 1 - _ S Date 11.27' 64 • Signature - - PLUMBING FEES •WORKERS'COMPENSATION DECLARATION t Bar Sink Showers I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL - FEES of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer - • Service Sink - 800, Lab. C.) : _ Automatic Washer Transformer 0 15-50 KW , Jolicy No. C. 1 'I SS I'41 cj company ACS h11% • Cap Construction Pole Sub. Backflow Irrigation Sewer • ❑ 50+ KW l Certified copy is hereby furnished. , I - Certified copy is filed with the city Buil ng sion Bathtubs Sewer Connection Cooking Unit , / Meter Our)to.100 amps j Date II • 17- V Applicant L EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers _ Solar_ Collectors - Dishwasher _ - Meter ❑over 100 amps __- , (This section need not be completed if the permit is for one hundred ($100) or less): I Dishwasher Solar Piping' , Dryers ❑Gas ❑Electric 'Sub Panel I certify that in the performance of the work for which this pern d is issued, I -shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank • Fan Motors❑0-1 HP ❑1%-8 WOrkers5Compensation Laws of California. _ Date Signature • Floor Drains, Swimming Pool w/Spa - NOTICE: If,after making this declaration, you should become subject to the _ - F.A.U. Inc.$Olar ❑9-15 HP ❑16-15+ Workers' Compensation provisions of the Labor, Code, you must forthwith Floor Sinks - Urinal ' Fixtures • ' comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service . Outlets Water Closet Device Boxes • ' I hereby affirm that there is a construction lending agency for the performance Pole'Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors - Water Heater Outlets • ' Lender's Name • - - Range Lender's Address ' • - Kitchen Sink • Water Service OWNER BUILDER DECLARATION -- - •-- -- - _• Switches Sign I hereby affirm that I am exempt from the Contractor's License Law for the - LavatoriesAuto-Wash Garbage ' following reason (Section 7031.5 Business and Professional Code: Any city or Disposal ;Standing Sections county which requires a permit to construct,alter,improve,demolish or repair LaundryP—TrapTrays any structure, prior to its issuance, also requires the applicant for such permit y Generator 00-5 KW 05-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's,License Law (Chapter 9(commencing with Section 7000) of ' Division 3 of the.Business and Professions Code) or that he/she is exempt _ therefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil • ' ,alty of not more than five hundred dollars($500). I, as owner of the property or my employees'with wages as their sole Reinspection'Fee $15' Issue Fee . ..• $ 3 ' Compensation will do the work,and the structure is not intended or offered - ' - Reinspection Fee I $15 ,Issue Fee $ 3 • for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL ' FEES License Law does not apply to an owner of a property who builds or improves ' _ _ • __ thereon, and who does such work himself/herself or through his or her own _ - - I DEVELOPMENT SERVICES REQUIREMENTS: ' employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ , sale. If, however, the building or improvement is sold within one year of com- _ Canopy Type II ❑ ' - • Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground •• • Building Approved By - Date ' Love for the purpose of sale). �- 1, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat: - ' tractors to construct the project (Section 7044, Business and Professions Code: - The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU • SUMMARY OF FEES builds or improves thereon,and-whocontracts for such projects with a con- - tractor(s) Ilcense pursuant to the contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT ' $ • SMIP' $ ' • proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT ' ❑ rem exempt under Section B.& P.C.for this reason ' Firepl/Fact.Bit. ICBO# Fire Dampers _. PLUMBING $ ISSUANCE ' $ Date • Owner Heating System& Ducting Registers ENERGY P.C. ;$ ' - PLAN CHECK 25% $ /-� I hereby certify that I'have read this application and state that the above 0o-100,000 BTU 0100,000 BTL= - - - ELECTRICAL $ /�/-� GRADING $ information is correct. I agree to comply with all city and county ordinances - and state laws relating to building construction,and hereby authorize repre- - $ MICROFILM $ I ' • sentatives of this city/te enc r u o the above-mentioned pr per y for - PLAN CHECK 50% inspection purposes/ r � Z iS - � MECHANICAL $ TOTAL FEE ,$ L7 �� Drivers'Sure u�'�" Date�/- Reinspection Fee $15 Issue Fee $ 3 ' PLAN CHECK 25% $ ' I' / License or SS--# � • - CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor L.,'" �k.cONSTRUCTION AND.PLANNING r POOL 'A - .r APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector a 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location • :2. Soil Pipe-Undrgrnd. - • 53. Steel Reinforcement 3:7 Electrical Conduit Utility-Undrgrnd. 54. Forms ,4. Electrical Conduit-Undrgrnd. (-), - 55. Electrical Bonding ' 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test. - . 6.' Electrical UFER Grnd. • 57. APPROVAL TO COVER-GUNITE - , 7. Footings 58. Electrical Conduit-Undrgrnd. . . 8. Foundation 59. Gas Pipe:0 Undrgrnd.,Test ' ' . 9. Water Pipe-Undrgrnd. - 60. Backwash Lines,P-Trap, 0 Undrgrnd. ;10. Structural Floor System 61: APPROVAL TO DECK 11..Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap - 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System: Final • 14. Rough Plumbing 65. Electrical-Final • 15. Rough Electrical-Conduit 66. Solar System-Final - - 16. Rough Electric Wiring # 67. Fencing & Access Approval 17. Rough Wiring Sign. 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL , 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating • 71.' Product Piping 0 Gas 0 Oil 23. 'Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL • 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT • _ ' 31. Plaster Brown Coat 79. FINAL INSPECTION • 32. Electrical Power Meter-Final 80 . FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning , 35. Final Gas Pipe-Test , - 36. Hood or Canopy - 37. Final Factory Fireplace' - - 38. Final Plumbing ' 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation . 44. Landscape Irrigation System ' ' 45. Sound. Attenuation , 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING • 48. Special Requirements Completed • • . . 49. Electric Release to Edison - - 50: Gas Release to Southern California Gas Co I 51. CERTIFICATE OF OCCUPANCY . ' ... . . . . 1No. - Date - - - . _ - -. I ' CALIF e ; -- , a UMBER INSPE ,. 1ION SERVICE OFFICE r_ f ,,p • 1190 Lincoln . ' '4 19$3 t p�' � No BH 046 San Jose, Cali � is Mall I ��11 'C ' 31 Jan. 1963 CYpress 7•Brro awkiite, O l/ `�,t- Date TIFICATE OF INSPECTION l/elk Lumber herein listed has been inspected and tallied under the Grading and Dressing rules of'the W•C.•L•I.B ...Rul.es....# 15 as of 19...0.1..., paragraphs..# 123 thru 123c, 222 thrll 222c. ... in accordance with the order and specifications furnished the Inspector by the shipper at time of inspection at plant of: 18256 ,1 B 260, 1 B 26 1, (// Name Housing Tract ,f4,f ,_Permits-18262, 18263 Address Clubhouse Rd. & Elba. Circle Shipped Via Truck Costa. Mesa, California Brand WCLA, PLIB The California Lumber Inspection Service provides competent and reliable inspections, but assumes no liability for loss or damage due to erron of inspectors. SPECIES GRADE SIZE LENGTH FEET W.C.Hemlock Std. & Btr. 2 X 4 (S4S) Studs 10 M. Doug. Fir Std. & Btr. 2 X 6 ( S4S) (Rafters) Random 20 M. Inspected, in place, as per agreement between the K. & M. Lumber Co. , Pomona, California and the California Lumber Inspection Ser- vice, Los Angeles , California. This inspection to determine if above noted stock conformed to the provisions governing the grades of "Standard & Better" as listed in the W.C.L.I.B. Rules # 15, as of 1961 , now in force. Lumber found to be below the grade of "Standard" was plainly makk- ed with "blue kiel". Rafters, so marked, with a. mark on the floor section as to make the position of defective rafters easily noted, defective lumber to be corrected in the manner prescribed by the Building Department, Costa, Mesa, California. Grading lumber is not as exact science , therefore there must al- ways be bound, a 'certain amount of lumber on which inspectors do not agree. (CONSIGNEE) Facts and findings, noted in this certificate, are true and correct, to the best of my knowledge and ability. This is to certify that I Wi.11iam._liurm.e a certified inspector of the California Lumber Inspection Service have personally examined each piece of lumber covered by this Certificate of Inspection, and that the lumber conforms to the specifications sat forth. • CERTIFICATE REFERS TO CONDITION OF MATERIAL AT TIME OF INSPECTION By Inspector William Hurme, upervisor. (ORIGINAL) �/''`� 20350 FEE RECEIVED - COSTA MESA BUILDING-SAFETY DEPARTMENT AUG 5 1963 P.O.BOX 317 COSTA MESA.CALIFORNIA FINANCE DEPT. ',,^` For Applicant to Fill In Completely CIY OF COSTA MESP °_ APPLICATION FOR PERMIT TYPE OR PRINT BUILDING /7G y 474 / For Office UseO. Only BUILDING C" RECUR NO. 2tin C„ COSTA MESA. CALIFORNIA "'LGJ/UU 11�� 1V1 RECEIVY DA ECJ VIISSSUE/c . OWNER 4(4 NS t( MAIL r a r BUILDING ADDRESS • /•• -/;"-e - ADDRESS FIRE �,/ TEL. _ ZONE • TYPE' I1� . GROUP CITY(/'as 7‘ ///es4 NO.. V - / ARCHITECT TEL. BYPROV E'-f'/ E //' DATr YJ!3 OR ENGINEER NO. � ZONING AL SS Zp� / I PPLDA.HOP BUEEOPNNEW edit/ll,44 CONTRACTOR ALS/ S ‘5 CO T/ 4/3 �T /�/� LEGAL Lot 12 { r\ q( ADDRESS /2 Icy 3 r/ .1 h O/L C 4 DESCRIPTION '� �/ /Sin /'L7' CITY Con es Cl. • A.P.NO. - NOTE: NO EAVE STATE / O2 / /- TEL 80'TO SIDE @ REAR P.OVERHANG SHALL BE LESS THAN LIC.NO. �-/ v ..-r7, /i72x / ^ze ( / EAVES SIZE (s NO.OFeLDGS. ALLOWED (U.B.C.REQUIREMENT) OF LOT NOW On LOT YARDS APPROVED YARDS APPROVED USE OF �y MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. .7 ) �1� (FROM C/L STREET) SETBACK LINE FROM FR•NT FT. FT. CENTER OF STREET 3 NEAR YARD SIDE YARD LEFT / I RIGHT /J / R.SIDE FT. /D - DESCRIPTION OF WORK L.SIDE Fr. ...-C.±Fre NEW ALTERATION ADDITION REAR FT. FT. DISTANCEBET. BET.MAIN @ Sr-. MAINBLIDGB. ACCESS.BLOCS. REP... . _MOVING DEMOLISH VAR.# DATE _�� BUILD FNG�NO-OPS SIZE ROOMS STORIES C.U.P.S APPROVED EXTERIOR-WALL ROOF------_____ APPROVED COVERING COVERING BY •/ /(/ /-. DATE) ?�/ 63 USE OF BUIL NGA��+D WORK TO BE PERFgf�MHD /� 7 iy'e/a,/ni/�cr)/ et.. . 1e!et/4 .t /t /O//L'/ . N SO.FT. G I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE i AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. G PLY WITH ALL CITY ORDINANCES AND gYSTE LAWS REGULATING VALUATION m BUILDING CONSTRUCTION. / N ♦ PERMIT FEE $ SIGNATURE OF FERMITTEP • //n • i r/ PLAN CHECK $ p AUTHORIZED AGENT v •- > ' TOTAL FEE $ �_ V • 21504 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT JAN 2 9 1964 P.O.BOX 917 COSTA MESA,CALIFORNIA �M77FIN�rA�ccN�C��EE1c�TTDEP�Tl.4a ,) For Applicant to Fill In Completely APPGIEATI&1 CaTIMAYlwi' TYPE OR PRINT BUILDING Far Office Use Only BUILDINGcOM9 /6/ 9 GIB4 G)RCI C I BUILD) S F1 l; rl RECEIPT NO. PERMIT NO`/ COSTA MESA, CALIFORNIA 0--- / • L/A RECEI ED BY D rE R c?VIZ 2ATe SUED OWNER L O m ,q/I/ J A LORetvcc � k / MAIL / /�� BUILDING ADD R ESB L I fie4 G/RChe ADDRESS / f FIRE TEL. ZONE TYPE� ROUP CITY CD,STFE �J NO. I /// APPROVED J / 4 /// OR ENI6INEHR L t TF R 1 t TEL, qq BY (3 /moi/ •� J� NO.NO d/�d A. SS 3 / 7/2- d. V E2 ZO II�G ih��, I °' �C ZO 1 POOP F W UUE or NE I PLANS I BUILDING Y2 (O CONTRACTOR 4 I R..- `G Q A / f{W u IN c CO . ../. re- LEGAL tot- l7 / �\ t/3 IN ADDRESS / 3�3// e s , 4 rlar4 Ti c Aka,.d. DESCRIPTION p Q CITY Lo RIJCEr s 2 y A.P.NO. /3 / -�Z� --- ©V AA) pp' NOTE: NO EAVE OVERHANG SHALL BE LESS THAN LIC..NO. / 7C1 i/ NOA . 33 S/ SO'TOSIDE e REAR P.L. SIZE I NO.OF OLDOc. /1 EAVES ALLOWED W.B.C.REQUIREMENT) OF LOT NOW ON LOT (/ YARDS APPROVED YARDS APPROVED USE OP A!1 nn 1` MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (A A2 Ac/7 -St [- I•AMN 111, LJ43(-// (FROM ( nR,�'f 1 � � s SETBACK LINE FROM FRONT IT-- CENTER Ff t FT. OP STREET REAR YARD SIDE YARDI LEFT I RIGHT R.HIDE /� FT. FT. DESCRIPTION OF WORK L.SIDE /L FT. FT. rt NEW I ALTERATION ,ADDIT� REAR yQ -FT. FT.�.T DISTANCE BET. BET.MAIN H MAIN SLOGS. ACCESS.BLDOS. REPA.. MOVING DEMOLISH BUILDING NO_OF VAR.# DATE SIZE ROOMS STOFtTCJ— C.U.P.# APPROVED / EXTERIOR WALL----- I ROOF APPROVED dd DATE /T �P/IT r COVERING V'l USE OP BUILDING AND WORK TO BE PERFORMED i g/, ,A,a,n y79 /-)D _ 0o1/Eiz ac/c/e to Res SQ.FT. 7 DO N B I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION d m BUILDING CONSTRUCTION. ' N PERMIT FEE - SIGNATURE OF 12i nu WI . �Q PERMITTED '^"lam I ir! S d $ // • C.EC. - rc AUTHORIZED AGENT o . TOTAL FEE / 1 $ 8256 PnenTA G+ I*1'211:75 COSTA MESA BUILDING-SAFETY DEPARTMENT nT23-.r I m 5Q3z P. 0. BOX 317 COSTA MESA. CALIFORNIA • For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING ADDRESSBUILDING I Jj�J(0 d; -( (U COSTA MESA. CALIFORNIA For Office Use Only C - an,,,, 1 RECEIPT NO. I f 8 Fy 5 NO. OWNER 6 E- I 75 MAIL RECEIVED BY 1 O R2CEIVED DATE I UEG ADDRESS //4 573 rea tas � 7 CAY NOV 2 3 162 /. TEL. BUILDING CITY �_j�:tr-9- / t F/- NO //0"j%A ADDRESS ARCHITECT / � / p TEL.-7n., g COSTA MESA. CALIFORNIA OR ENGINEER (,:i.. ��// yvy/1i N0//1/.J3/p/ f� ADDRESS 7772 ti'ry GL1/ N .ea ZONE TYPE V GROUP J / / CONTRACTOR ^"-JAzr' 6Si ( a. APPROVED BY DATE /may/, �y ADDRESS ///%(f3 /P0e---S1/27 ///'Ye en' ‘19/e. $� ZONING a,�,�2 USE OF CITY l�,..,�^} %/E-3 v' '/G / ktil Z07`l — ( ( PLANS v/II BUILDING f LIC.TNO./%/�j NO.J�//Caf) DESCRIPTIONLEGAL RIe20-r- // AC l/�c 'q 6 SIZE /, NO. OF BLDOS. OF LOT / /.t I /d aNOW ON LOT A.P.NO. /Th..----C USE OF YARDS EVES EXISTING BLDG. APPROVED ALLOWED SETBACK LINE FROM (�'/ -/ (CENTER LINE ST•) CENTER OF STREET V '� REAR YAR4`S / FRONT ✓v FT. 7 IN. SIDE YARD I LEFT et I RIGHT /o , R.SIDE / OFT. IN. DESCRIPTION OF WORK KFT. IN. L.SIDE I NEW I I ALTERATION I I ADDITION I REAR �/j(FST. �/IN. II MOVING II DEMOLISH I APPROVED r f ' DATE I(' I / v REPAIRI -,/ ` L f1 �� /� BUILDING �3 Y NO. OF ROOMS 7 STORIES / "I/✓-// SIZE J EXTERIOR WAL - I ROOF COVERING (L�L'i ROOFRIN USE OF BUILDING AND WORK TO BE PERFORMED LGc�t, rc yaw 2-14 C �7c_d ti J - 07'391 c HOE— hi 2°' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN R VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PLY WITH ALL CITY ORPIK.NCES AND STATE,LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTION,/ ( �' ---yyy VALUATION L SIGNATUREITOF, � —" icz ' PERMIT FEE 5 1D JO N PERM 0,25--85-C2 - R j / $ J PLAN CHECK $ 94. 5 '� AUTHORIZED AGENT ' ( _ ILLrIm'- E . . r'TOTAL FEE � Is a PAIL 38244 'R -3-71 -00 ,Iiz� ****::*7.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 A' IC'TION FOR BUILDING PERMIT For Applicant to Fill in Completely REC- • :Y DATE RECE E• DATE ISSUED i -- 3--- 4BUILDINGjf6CF/ / t'� 4l f /rADDRESS OWNER',uni971F//^/�qc. ?enec.— A.P.NO. - ' I O it MAILADDRESS 'D C1 /eAi L=!ride/` BUILDINGDRS ,./g#5 _p ^ w {yw u; qd'-//"///Af [Jp ADDRESS (4j/+ /` 0. 0 CITY 057' Mem NO.-0-1 n�) , TRACT • /• LOT BLOCK ZZ< CONSTRUCTION ,—� N W • •• •LTER REPAIR MOVING DFMOLISH O LENDER , 0_ cu J 7 BRANCH y� ^'� JN OWNER 1 L. 1 LA (,1)12aIcs CO J ADDRESS /�'`' /y Li-t iz VALUE / win- . J Q OARCHITECT R ENGINEER .Sr/( NO. use I NT I^) (D C/ U to FIRE W cc ADDRESS ZONE TYP GROUP U-W APPROVED / mO CONTRACTOR net// ).•••/ `_ y' •r BY .z . �t DATE ,;J- .s Z J cc ADDRESS WZOj NO.OF USE OF NE O w //� / PLANS BUILDING / Z I— • % ' W O YARDS APPROVED YARDS APPROVED to • • MAIN BUILDING ACCE WRY BUILDING DO SIZE • • e •� (FROM CA.STREET)' r V OF • NOW • FRONT FT. FT. USE EXISTING• •' R.SIDE T N8� 4' / FT. 1- SIZE OF NO.OF _ Z NEW BLDG. ROOMS STORIES L.SIDE F V yflV FT. U EXTERIOR WALL ROOF �) COVERING COVERING REAR F . FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& a a MAIN BLDGS. ACCESS. BLDGS. Q T �( t VAR.+ DATE O J'LI t s O r /7:e rt. T r rC - C.U.P.# APPROVED i— APPROVE/ %'1 (3‘16" �7 / zDATE �'S —Jx O / (~.1 I hereby acknowledge that I have read this application and state tri;41 D that the above Information is correct and agree to comply with CC all laws regulating building construction, and 1 shall not employ . I_ any person in violation of the workman's compensation laws of N the State of California. e ? I hereby certify that I am properly licensed as a contractor under SO. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR i Chapter 9. and th -such licenses are in full rce and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0 am exempt fro tl e provisions of th i of California Business VALUATION and Profossio C ,Division 3,Ch t (&--- N 0,4, PERMIT FEE S Signature o �//j (a Permittee .�7' __C3$s ( i �`V PLAN CHECKS E �(� �� o LL Authorized Agent TOTAL FEE $