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173 DEL MAR AVE - Building Permits
> CITYOF COSTA MESA ` BUILDING DIVISION i'k•J z,;,_�,.; ,i - DEVELOPMENT SERVICES DEPARTMENT PERMI NUMBER 1 ...._..-r I 4ik PERMIT Taro ,ms# 04-00006 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,C STA MESA,CA 92626 ' - t PLUMBING PERMIT Job Address: 173 DEL MAR AV Status: ISSUED Suite No Applied: 01/06/2004 Issued: 01/06/2004 Vicinity: Parcel Nunmber: 43916125 ISSUED BY: Applicant: FARAHAN, AFSHIN Address: 3419 VIA LIDO , Phone: 714-420-6986 " _ - NEWPORT BEACH,CA _ Zip: 92663 Owner: FARAHAN, AFSHIN Address 3419 VIA LIDO' - _ Phone: - NEWPORT BEACH,CA Zip: 92663 . 6{. Contractor: OWNER-BUILDER . • r: ' Address: ' Phone: Zip: License: 000000 , ' . Arch / Eng : - Address: Phone: • __ _ __ _ _ Zip: _ " _ - - " License: - - SCOPE OF PERMIT • INSTALL DRAINAGE SYSTEM FOR 173 AND 175 DEL MAR AV. (ON SITE ONLY)REF.:B03-01029 .` PLUMBING TO INCLUDE: 1 RAINWATER DRAINAGE. , , " FEE SUMMARY AMT QTY - AMT QTY - AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 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 0Process 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 Drain, Rainwater $9.80 1 - Sewer Private Line $0.00 - 0 ' Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 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-code Das all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiratio this•permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6422) 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 workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ,,aCiaertify 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. App licantSlgnature= rOet l4 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND Dim 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 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.N Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). CI em exempt under sec.-" Business and Professions Code for this reason: at // 6/69' -Owner ID verified by driver's license. ❑Yes 0 No 1Oiiver's License:No. Expires:"' DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no axcavation 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,Op 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 apemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? (J Yes 0 No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 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 pe it until final inspection. LSignature.Of.LegalOwn_er(s) And/Or Authorized Applicant Date RODE I INSPECTION TYPE RAil ltMDALS ;Mk INSPECTION TYPE Reil MELB 1616 Fixed System Final Fire Prevention 206 Final Mechanical �1 1288 Pool Spa Final 208 Final Plumbing rr[-19 -O`i L\IY 200 Final Re-Roof _ 210 Final Electrical 201 Final Block/Retaining Wall _ 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition _ 250 Final Building/Occupancy 4 r CITY,OF COSTA MESA • BUILDING DIVISION P. %l DEVELOPMENT SERVICES DEPARTMENTPERMIT MBER t PERMIT Stbeonorsolit 03-00561 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us - 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 173 DEL MAR AV Status: ISSUED Suite No Applied: 08/29/2003 Issued: 08/29/2003 Vicinity: _ l M. Parcel Nunmber: 43916125 . - - ' " . _ ISSUED BY: Applicant: DEL MAR PART. - ' • . Address: 3419 VIALIDO' _ ' /j- Phone : 714-420 6986 � NEWPORT,BEACH CA t " - Zi 92663 / / `-�` / /L / \✓ r,--7v---- -- -\ ' �� / .A . // �`�� Own&:-'2 FARAHAN,AFSHIN- _v���N , / „/ ,\�.. Address `3419 VIA LIDO-• Y' '-,:\N \<'/ ,--/ \L.\ 7/ . 7/��,�7 Phone: " :�''. . :� V��y. -,r �� / NEWPORT BEACH,CA Zip: 92663 , Av, k �‘ ��,� Contractor ,'OWNER-BUILDER Address - - A. '- - . 'i __r ;/ � _ -' _ ;) Phone: ' 1 ,v Zip: ,.' License: 000000 N v ` 1 Arch / Eng:j - ` " Address:,', - - - - - .,• - Phone: , ,; ,- • i ,� „-Zip . , / •,. - .. License: 0. _ r�, SCOPE OF PERMIT " ‘ - N — ` ,' 2 SHOWERS 1 KITCHEN SINK 2 WASH.BASINS'?TOILETS. /7/" C- / /„ \ '',C.,\ ��,• , 'FEE SUMMARY --. ,-;:".// 7 '.`' //',// VA - AMT v .QTY - - - AMT OTY :��� / •. '''';AMTT QTY ISSUE FEE N <,','' $23:50 — - - 'Laundry Tub/Washer ' $0.00 0 ..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 C /%✓ $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) .\x$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 $19.60 2 Drain, Floor $0.00 '0,:<-•':. - Sewer Connect. , \\'.. -, ,$0.00 - 0 '`Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 ' _ Sewer Private Line$ 0.00- „ .0-.,, --' Water Closet(Toilet) $19.60 2 Drain,Roof $0.00 0 ' Shower ' c _ - - ,_1$19.66_,T,2 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar' . - ---- - - - $0.00 0 Water Piping(Inst or Rep.) $0.00 0 • . NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California i tas and related - regulations.(Ord.No.92-28,§1, 12-21-92) yr! 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 thereipiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 / / 2446-46(6/00) r DECLARATIONS ,1 WORKERS'COMPENSATION DECLARATION: I hereby kffimm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND Dor ACF($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.Lie.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: _ 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 mason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of DIvision 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.It,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑� I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(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: SiSignalise?: 4 Owner ID verified by drivers license. CO-Yes-0 No Drivatstloense•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-slx(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: - 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 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 p 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. an _.._l_...._ 4 If an RMPP is presently required,has Section 25534 of the Celifomia Heelth and Safety Code been fully complied with? ❑Ves 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? 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 ba within 1000 feet iron 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 Net 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: CERRFICATE 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 propertyfor inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this rrpit until f al inspection. I/ e3 Signature Of.lega`TS7twner(s) — -palet' And/Or Authorized Applicant Date LODE f, INSPECTION TYPE PATE m1AL5 LODEI INSPECTIONTYPE DdTE =ALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical y (] 1268 Pool Spa Final 208 Final Plumbing -. M-19 -o ` RW 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign 222 Final Site - 204 Final Demolition 250 Final Building/Occupancy - 4 +Yw2 . 64 V ,I✓ mkt Pactdia, �W V {' • • V i V-=%`y OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I. I personally plan to provide the major labor and materials for construction of the proposed property improvement. ❑ Yes ❑ No I (have/have not) At vet INS144011.1signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone ( ) Contractor's Lic. No. 4. I plan to provide portions of the work, hut I have hired the following person to coordinate, supervise and provide the major work: Name X L I M P r' a3 r-k Address 3'4 VA V\R Lea City ta •t1. Phone (IN ) it Co Contractor's Lic. No. '1 b6 tri 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work 1042-46 (REV.99B) • az I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my personal knowledge, in compliance with this State law. 'Signed: Q 1 Date: � a� 3 ,Name: Atnaa as14e.'-1- (Printed or Typed) �.D.L. #ORS.S.# For more information call City of Costa Mesa Building Division at(714)754-5273. 1042-40 (REV.9:98) r t [ lb CITY OF COSTA MESA 4 .qq BUILDING DIVISION F • «• ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT %trm p 603-01477 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.g2UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 173 DEL MAR AV BUILDING Status: ISSUED Suite: Applied: 08/29/2003 Vicinity: Issued: 08/29/2003 Parcel Number: 43916125 Zoning: I //..o.. Applicant: DEL MAR PART. ISSUED BY: S Address: 3419 VIA LIDO - , ` Phone: 714-420-6986 NEWPORT BEACH,CA Zip: 92663 Owner: FARAHAN, AFSHIN - - `� Address " 3419 VIA LIDO . . , - - Phone: •‘,..�.\ , NEWPORT BEACH,CA Zip: 92663 - -- - Contractor: OWNER-BUILDER , Address: - Phone: -. - ,. Zip: ' License: 000000. Arch : 4 - - Eng: Address: .. -Address: Phone: Phone:. . Zip: License: - License: ' , - , - - j, - SCOPE-OF PERMIT - REMOVE EXIST.WOOD SIDING ANb INSTALL 7/8"STUCCO.REMOVE EXIST.WINDOWS ANb REPLACE WITH SAME SIZE,REPLACED BEDROOM WINDOWS SHALL COMPLY WITH SEC 310.4 OF THE UBC. 11/14/03:2 SHOWERS TO BE TILED IN EXISTING BATHROOMS. - " - - , FEE SUMMARY - . . Plan Check: $0.00 Calc Valuation: $1,500.00 Permit: $54.00 • Claim Valuation: .` S1,5o0.00 SMIP Res:' - .$0.50 - SMIP Com: ; $0.00 . - Other: $0.00 „ ; � • Inspection: $0.00 ,` Total: $54.50 - - • PLANNING &ZONING SETBACKS - - ' MAIN STRUCTURE Front 0-0 Rear 0-0 - ,Left - 0-0 c Right 0-0 - ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required:” 0 Proposed:" 0' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) 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) I • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: r Carrier: V Policy Number: (This section need not be completed if the permit is valued et one hundred dollars($100)or less.) ('certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, agree that if I should become subject to the workers'compensation provisions of Seatloq 3700 of he Labor Code,I shall forthwith comply with these provisions. / Applicant Signature: Date: r 02 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under 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.Lio.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ 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.). • fiti)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. r Business and Professions Cale for this reason: Signature: � - Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. /✓ Expires: ' / Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes ❑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 Califomia 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 pe t un t I inal inspection. Signature Of Legal Bwner(s) Date ) And/Or Authorized Applicant Date ;ODE I. INSPECTION TYPE 2&IE MINA CODE INSPECTION TYPE PAg 11I AL5 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 c( �� 204 Final Demolition 250 Final Building/Occupancy Z'�/ Odf r"/.41-` -, . CITY OF COSTA MESA - +d o , BUILDING DIVISION• i; F 1 •._w I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 3PERMIT "-``**�waa��rw� B03-01477 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.caus BUILDING PERMIT 77�FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 173 DEL MAR AV Status: ISSUED Suite: Applied: 08/29/2003 Vicinity: Issued: 08/29/2003 Parcel Number 43916125 Zoning: Applicant: DEL MAR PART. ISSUED BY: Address: 3419 VIA LIDO - - .- r Os i - Phone: 714420L6986 - - _ i C NEWPORT BEACHA Zip: 92663 . i Owner: FARAHAN; AFSHIN - . - , - • Address 3419 VIA LIDO t_ - N,�.,�• /V, A Av -Phone _ - ': N, N / •�.\ >> NEWPORT BEACH CA' Zip 92663 -- ��� �v �.. ., \ Contractor. NOWNER-BUILDER ,.. ...7.'J` i /Address: ‘ Vii; / `\'�\\' / \�\ %, Phone: -`-� ,---. '1 • Zip: i ,,�: ' License: 000000 ' ` �r� - ^�,-•! - Eng: } " t/ ' N Address: `• f - i . Phone:. - -. - - - -.- - 'I. Phone: \Z p: .- ' License: - 'License`: 1 - j - - - - SCOPE OF PERMIT r /� .r f /. 'y :;r ' : ;-,REMOVE EXIST.WOOD SIDING AND INSTALL T/8' STUCCO.REMOVE EXIST.WINDOWS AND REPLACE WITH SAME SIZE;REPLACED i 'BEDROOM WINDOWS SHALL COMPLY WITH SEC 310.4 OF THE UBC. x. y,,; , C I , ( �. -- - - -FEE SUMMARY`." ' t , Y ' . 'Plan Check:"•' $0.00 1 // alc Valuation ' ` 11,500:00 `, 1%Permit: $54.00 , , Claim Valuation: ,;/r /, `-$1,500.00 ,SMIP.Res. $0.50 - _ ; r SMIP`Coms \ ,'$0.00 .i7,' ' - r /ti/ `,\Other,:.% ''$0;00 �.joj`'t'' j j:�' .,�(�J'�J Inspection: $0 00 , 6 . V �- , 6"/ ',,,/ Total: $54.50 . �'. .. ;' / `/ VA:: % PLANNING&ZONING- "� SETBACKS \ MAIN STRUCTURE Front";0-0 `Rear - 0-0 Left 0-0 — - ‘ Right.4- OTO • '4,,,"V . - • ACCESSORY Front 0-0` . - _ --Rear.- 0-0 - ,Left 0-0 " ' Right ,,,=0-0 • � N_, -. 1 • ., - - � ';"c...2-- PARKING Existing: 0 '-Requiredi;. 0 Proposed:. l) ,�i ... ii 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 lcodes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expirationloflthis permit. FOR INSPECTIONS CALL: (714)754-5626 ' Il 2448-46(8100) DECLARATIOIIIS, , rm ;'1 WORKERS'q)MPENSATION DECLARATION: ' ' ' I hereby/Man tinder 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 perfolaiance orVe work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carer. Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS(ElCO,CCO),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION Sl ba 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.N Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there''is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Seaton 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 i..{{ 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.). ❑-/�'dm exempt under sec. Business and Professions Code for this reason: _ / re: te: r/- Pld3 ✓ Owner ID verified by drivers license. Yes 0 No :nse No. / � Verification of Ownership by(type of document,i.e.-property tax bill or deed): G� 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Titie 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 Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future builtling occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0N (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 e0ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? D 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? 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--it ___..I _...._._f.. ..._ _..t. .__....— __. _ _...__.r _._ _ _ _ ._ _.... 7 application,a icatioit from the South isclos res prescribed bygement Healthal or other air pollution control 303 t been made? is r Yes for the work which La the subject of Evia . nave all of the disclosures by Californiaia and Safety Code Section 42303 made? ❑Yes 0 No • _S(I_.e�w.. .__..._—..._—___._..._.propria__ ir..pol ._ _._ 8 (If yes',mach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penally 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.,a not to occupy or allow occupancy of any building authorized by this perm' until F�l inspection.g Signature Of :!- • er(s) .----//gte And/Or Authorized Applicant Date RODE I DISPECHON TYPE DAIS DTITWS CODE L INSPECTION mg ' ' DAM ' =ALP 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final PI bing -. 200 Final Re-Roof /� / 21.1 Alf ,Inalr ctdcal 41 er 201 Final Block/Retaining Wall 0 %. 12 ire Pr--= lion • 202 Final Factory Fire Place / 220 Final Plan :Approval 203 Final Sign 222 Final Site • 204 Final Demolition 250 Final Building/Occupancy ssp &tq eitaa /I Aft Vicc4.C4n� OWNER-BUILDER 11 . T VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner: An `owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I. I personally plan to provide the major labor and materials for construction of the proposed property improvement. ❑ Yes ❑ No I (have/have not) ALS'eJ AS 4 .&Isigned an application for a building permit for the proposed work. • 3. 1 have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone ( ) Contractor's Lic. No. 4. I plan to provide portions of the work, but 1 have hired the following person to coordinate, supervise and provide the major work: Name )[ L I9%qIto yese 3 Address 3•41.k Y\Pt LNG O City p4 6. Phone (1'4 ) y 24— Le\if Its Contractor's Lic. No. -1 b 6 Pei 5. 1 will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work 1042-46 (REV.9/98) • I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my personal knowledge, in compliance with this State law. Signed: Sz Date: deli 3 ,Name: A c !-2% aJ$4A.*--Z— (Printed or Typed) �.D.L. #OR S.S.# For more information call City of Costa Mesa Building Division at(714)754-5273. • 1042-46 )REV.9/98) • • • FINAL GRAZING CERTIFICATION Project Address: /73 OEC /142, A eevac— Lot Number: PaNTI oN r '--D- a c 772*CT 376 Permit Number: f oq — 0000° L47v0 o PE By Civil Engineer. • I certify to the satisfactory completion of grading in accordance with the approved plans, specifications, local and state codes. All drainage devices required by the grading permit, grading plan and grading ordinance have been installed. Adequate provisions have been made for drainage of surface water from each building site. • The minimums are: 2% Fall from structures within 5 feet from exterior walls. 1% Fall for asphalt surfaces and landscaped areas. 0.5% Fall for concrete surfaces to approved disposal areas. • . - . - - . • . • • • • - • • • -• - •• • • •' . All final grading eleva- tions are within ± 1/10 of the designed Supervising-evil-Engineer S' Reg. No. --s 2 g (Signature) L 4N©SY,- E W /?e$ O� Date ESP. /2/3 /l o� Wit)730 39le-7 • • n 23 f`43 ti 1 1 a:72410 CALIF0- STAMP and SIGN . 1691+6 CITY OF COSTA MESA BUILDING DIVISION ROOF COVERING CERTIFICATION Permit No.Ic 3-ol y 16/80 3-013/O Property Address /7 01001 $4 All �v Owner 2 Moaa \Th3TJU Pasty.) Contractor t — r f ei1/4— State Contractor License Number Classification 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. X. I further certify that I am the owner of the property. (Owner-Builder permittee only). ❑ I further certify that I am: o Owner of sole proprietorship company O Full partner of the company o Limited partner of the company o 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. Company or Corporate Name Address Received by Building Division // By: J q Signature Date 21Z3/ Vc A� 3 As 1-V; - I iat ate Printed or Typed Name 096446 MW 6/00 White-Building Div.;Canary-Contractor:Pink-Owner INSULATION CER FICATE IC-1 /7 7)e t ri a2 4‘/ ec,cre, M?Tics* Number Pv- Number and Street City oma Cc:c 3r After 314 County Subdivision Lot Number Description of Installation 1. ROOF _ Material eaN 90 S t t svritx,(v- Brand Name C' R 1- Thickness (inches) Thermal Resistance (R-Value) 2. CEILING Batt or Blanket Type B q VS Brand Name ctaya,3 i MR.af v l l,ll Thickness (inches) 1 " Thermal Resistance (R-Value) 13 Loose Fill Type Brand Contractor's min installed weight/ft2 lb Minimum thickness inches Manufacturer's installed weight per square foot to achieve Thermal Resistance(R-Value) • 3. EXTERIOR WALL Frame Type 1,.1 o p 0 A. Cavity Insulation Material 1 Brand Name SaH+Si MP JSY"tvt,Z Thickness (inches) Ir Thermal Resistance (R-Value) I • B . Exterior Foam Sheathing Material Brand Name Thickness(inches) Thermal Resistance (R-Value) 4. RAISED FLOOR Material Brand Name Thickness(inches) Thermal Resistance (R-Value) 5. SLAB FLOOR/PERIMETER Material Brand Name Thickness (inches) Thermal Resistance (R-Value) Perimeter Insulation Depth(inches) • 6. FOUNDATION WALL Material Brand Name Thickness (inches) Thermal Resistance (R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Energy Efficiency Standards for residential buildings(Title 24, Part 6,California Code of Regulations)as indicated on the Certificate of Compliance, where applicable. 1 t2 • — Y/2-4q vlJe.CIL Item #s Signature, Date Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner 1I64 6 tie—tch Item #s Signature, Date Installing Subcontractor(Co. Name)OR General Contractor(Co.Name)OR Owner Item #s Signature, Date Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner Revised March 1, 1996 61- T • • ' CITY OF COSTA MESA -/. ,iii". BUILDING DIVISION > %�,:,,,. ," DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER Irk* • PERMIT E03-00780 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 173 DEL MAR AV Status: ISSUED Suite No Applied: 08/29/2003 Vicinity: Issued: 08/29/2003 Parcel Nunmber: 43916125 • 7 V i Applicant: DEL MAR PART. - - .. /`l% ISSUED BY:/ Address: 3419 VIA LIDO - = - II t- , '� /�1� -�. - , Phone: 714-420-6986 - - NEWPORTBEACH,CA. . - ' . .Zip: 92663 ` ;,1 , . / ' / i - L '? ,\ N Owner ' FARAHAN, AFSHIN --- - • - \ ` \ Addressn 3419 VIA LIDO ' A i `�. v �`'-s ' f/ N Phone: �A -'/ /,' V. NEWPORBEACH,CA Zip: 92663 V� �. / �V i NEWPORT i \\ , I!Contractor: -2 OWNER-BUILDER t \ 2 / �, ' ' '\ \. ' ! r Address: ,/',% DECLARATIONS r1 i'M WOIO(ERS'COMPENSATION DECLARATION: I • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier end policy number are: Carder: Policy Number: (This section need not be completed ii the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARMNO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE LS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOI I ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37C6 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.Lk,If Class R Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting 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 cMl 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.). Tam exempt under sec. Business and Professi s Code for this reason: e: 9-,j • /•"/ ale: in21:/// 1 Owner ID verified by drivers license. (3* 0 No D' er's Linen o. ares: �/ • 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,wilt 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? ❑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 D❑s o or willusiYesnapplicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? 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 epermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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 thir 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 properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this pe til final ins 11111a 7iYi ? Signatur ner(s) ate And/Or Authorized Applicant Date BODE 1. 21SPECTIONTYPE IME 91TmM4$ LODE! INSPECTION TYPE DUE =ALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -. X71 200 Final Re-Roof • 210 Final Electrical 2&I frig4 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 eziatel Neat Eu r Divai a • Ldmf- ea, OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I. I personally plan to provide the major labor and materials for construction of the proposed property improvement. ❑ Yes ❑ No I (have/have not)_ALc AS4AtttTsigned an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone( ) Contractor's Lic. No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name YL 1.-0t9rt.o✓tr-tcuS'� Address 3'1 tv tP, Loo City N •f�. Phone ll t`1 ) `11.d— 6'1 fr (o Contractor's Lie. No. 1 b 6 Fri 5. I will provide some of the work but 1 have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work 1042.46 (REV.9/98) • I hereby affirm that 1 have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my personal knowledge, in compliance with this State law. Signed: Q ) Date: rind t) 3 /Name: A vJ J as 14P,%---1-- (Printed 4A+-1(Printed or Typed) C.D.L. #OR S.S.# ► For more information call City of Costa Mesa Building Division at(714)754-5273. • • 1042-46 (REV.696) • • �lilSj CITY OF COSTA MESA BUILDING DIVISION ' ). •J ,,,,, ,I _`- DEVELOPMENT SERVICES DEPARTMENT PERMIT MBER I.0. 'SlitPERMIT # 03-01476 r. (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 173 DEL MAR AV Status: ISSUED Suite: Applied: 08/29/2003 Vicinity: Issued: 08/29/2003 Parcel Number: 43916125 Zoning: eiV — Applicant: DEL MAR PART. - - ISSUED BY: l/ Address: 3419 VIA LIDO - Phone: 714420-6986 NEWPORT BEAC :CAl.. Zip: 92663 . i H, /./r - Owner: FARAHAN, AFSHIN N ' Address 3419 VIA LIDO/ - _ = Kt'NEWPORT BEACH,CA Zip: 92663 Contractor: OWNER-BUILDER ` \ \\ '' / ' `\\\ /Ad ress: , \ \ \ ,,. /_ / Phone: 'A, _•. ,�A v• / ,. .1 • c,1 \` 7 A� A2 \ \‘ \ \,\ r - Zip ././/1 • License." 000000 . - - �Arch.- Eng: ..-- 1/4, ' . . , \ \ Address: - Address ` r . 5-Phone:. _ ,C , • � t 'Zip: License: 'License: , 7 V ` . . , SCOPE PERMIT 1 TEAR OFF EXIST COM. SHINGLES;INSTALL 2=15LB FELT.AND 20 YEAR COMMMP:SHINGLES.' N- ✓.. moi. _. .!_ _a .. FEE SUMMARY ; .t ! Plan Check:, $0.00 _ 1, r. - Calc Valuation ,$4,000.00, l '� Permit: ‘'.' $97.25 — - - - - ` Claim Valuation: ' '-'$4,000.001 SMIRRes: ,' $0.50 ,j • , ySMIPCorn $0.00 �`/ Other $0.00 , . ‘: - \Inspection 1 . $0.00 • "/ \' , l r '"c,i� A iif�� r /r� \ Total: $97:75 /1,0 1 'V ^\ _ , �� ;4r ,4 / /' 1,/ \\2\A N PLANNING &ZONING / /;, i"i i • SETBACKS/, ,; ' MAIN STRUCTURE-Front 0-02., Rear 0.0 " ' Left, .0-0 - = Right, • /0-0, ' , . r-_ ACCESSORY \•Front. 0=0 • .-Rear 0-6 Left 0-0 Right 0-0 PARKING Existing:,-- 0- Required:_ , 0, Proposed: 0 NOTES: �,, . �� - , • • • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended/ or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. -FOR INSPECTIONS CALL: (714)754-5626 2446+6(WOO) • &CLARATIONS ;l fl WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations:' - ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the . work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance-of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed If the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100p00).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COOE,INTEREST,AND ATTORNEYS 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.I Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit 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 •mpt under sec. Business and Professions Code for this reason: _ - aloilr-Aufrik-gemm. _ • ner ID verified by drivers license 0 No Driv:es License No. . - — Explr=•. ,_ Verification of Ownership by(type of document,i.e.-property tax bill or de-• • 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,Tide 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: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? Q Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 D�r will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?u 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 permit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Li 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 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). _ —,...._._.r.__ ___ __. irfo iac _ 7 application,If a perofhmll South Coast res prQescribed ed Management Healtheal or other eir pollutiondecontrol 4 district03been agency? is required Yfor the work which is the subject of this have all of the disclosures prescribed by Californiaia and Safety Code Section 42303 made? 0 Yes 0 No • __.._..__.es'',a....bh certificate ce from. _ _ 6 (If yes',attach certificof 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.l agree not to occupy or allow occupancy of any building authorized byt his pe it until final inspection. Sign er s) bd ate And/Or Authorized Applicant Date al. IN2FSIBBEIn QA¢. 1Ntmelfl PODSt INSPECTION TYPE 2AIE emma 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 20 Final Plumbing 200 Final Re-Roof � /i4 �J - - 210 Final Electrical 201 Final Block/Retaining Wail '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 1 z ts 'Y asst A",l.-t ' j &al Neat �` �i V� alUt VV ; A, OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I. I personally plan to provide the major labor and materials for construction of the proposed property improvement. ❑ Yes ❑ No I (have/have not) Auzeo AS4Palisigned an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City cam Phone ( ) Contractor's Lic. No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name )I L 1 WO(Love H cu 3 Address NIA Y\R LAO O City to qt. Phone ( r`4 )_ y to- V1/41- L Contractor's Lic. No. "j le b t l 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work 1042-46 (REV.9/98) 1 • I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my personal knowledge, in compliance with this State law. 'Signed: 9..--- —> Date: Maid 3 /Name: A vJ a (Printed or Typed) C.D.L. #ORS.S.# /For more information call City of Costa Mesa Building Division at(714)754-5273. 1142-48 (REV.9/99) CITY OF COSTA MESA BUILDING DIVISION ` ROOF COVERING CERTIFICATION Permit No. '303— 0 I Lt 76 Property Address / 1 3 C 0,51_ M F,C (A-✓ C°•M • Owner DEL MP,& V. u 't ACSJE.-J Contractor XL .Lr-NP2uJCt.tv —)i State Contractor License Number ') L ktr I Classification 13 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. g I further certify that I am the owner of the property. (Owner-Builder permittee only). I further certify that I am: O Owner of sole proprietorship company NI 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. r0eC. reset. ✓e jUa .e ev,2.1- &t J Company or Corporate Name 113 c O MPS Or Address Received by Building Division C Pm- e.p, °a-. C.).-� By: • t( 7/4)-103 Signature Date O /�•�—�� '1f' I1- LLEa A.s uAits InitDate `lPrinted or Typed Name 0990-46 MW 6/00 White-Building Div.;Canary-Contractor;Pink-Owner • OWNER _ CRF.00, FLOYD L MAY 1 3 1957 DATE 2-18-57 JOB ADDRESS 173_11p1 Mpr - -- BUILDING PERMIT NO. #4368 GENERAL CONTRACTOR Ted F. Merrill & Sons VALUE $ 1,000.00 AP119-070-13 35 BLOCK TRACT 376 Repair fire Damage I1I GROUP 1 TYPE V ZONE R!4 FIRE DISTRICT µµµ2 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Footing Trench Foundation Forms and Grade to Garage A n Rough Framing i& ,,.L/f-.. /3.:4-CLA, }'°I Plumbing,Rough to Slab _ v Plumbing, Rough Complete Temporary Pole ,,,-� G Wiring, Rough FEB 1 957 V : /� V �°il/ 2-/�/'S� 3 7 P-9 Heating,Rough Heating, Final Sewer, House Sewer, St. Septic Tank or Cesspool I Ig, In Out F .eying_ Plumbing,Final,Fixtures Complete Plumbing,Final Gas Test Wiring,Final Occupancy ar,L /$ts- - L FOgM 210 3M 10 vy 4368 c�4442 FEE RCEIVED � . 'COSTA MESA BUILDING DEPARTMENT ,4- / ---s-7 --- . -- `1 P.O. BOX 317 . FINANCE DEPT. COSTA MESA, CALIFORNIAL ������iyy TInFF rr(n���jpp �����$pp FOR APPLICANT`' TO FILL IN APPIL'�CATRS F"9 PERMIT BUILDING ADDRESS \ \ ti \�-�_� ��� ' BUILDING COSTA MESA. CALIFORNIAFOR OFFICE USE ONLY RECEIPT NO. PERMIT NO O NE CQT.- Co 936 MAIL a- • RECEIVED BY DATE RECEIVED DATE ISSUED ,_ ADDRESS ��� �_ V .1 . �AQL _ al- /F-31 -/d' 47 EL- BUILDING CITY C VSA IN In� S TNO. ADDRESS ARCH-F L IO. IE OR ' LEER NO. COSTA MESA. CALIFORNIA FIRE ADDRESS ZONE ' p ZONE NO.OF TYPE GROUP .h �`---CL,S G �S CITY LIC. �V(. /� /� LANS CONTRACTOR NO {i gTAPPROVED ADDRESS ' �`O�Q .sC \CNO- • Ac)' BY VS- DATE - _ LEGAL DESCRIPTION NO. 95 BLOCK TRACT 7 t .n;�a, e. ,a ',I9 ` TS; r ,v. t i 'I . A.P. NO. / --- C) 7 0 -1 - - SIZE !� • OF LOT ./ 5-/%_ g h 0 L A X i USE OF SUBJECT TO ,SEG. DEPT. REG. - EXISTING BLDG. ■ SETBACK LINE FROM , p CENTER OF STREET REAR YARD ,r 3 - "/ ikl tin411i a SIDE YARD RIGHT LEFT PLAN T .Qiy1, c CH � DESCRIPTION OF WORK �,A. i NEW I ALTERATION ■I ADDITION REPAIR . I MOVING ■I DEMOLISH BUILDING NO.OF SIZE ROOMS STORIES* EXTERIOR WALL ROOF _COVERING Cu .+O G7 COVERING ‘,.J--I bo.9 ' USE OF NEW _ T BUILDING '-,' -"\ QOt'N‘ C .. SrQvCISV'CR Nr-- ti, `r•Mt C : ,1/. . // I HEREBY ACKNOWLEDGE THAT I HAV REAP HIS AP- (CATION A": STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH L CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRDG . SIGNATURE OF� i\ .J VALUATION - IMIN +- PERMITTEE ``33 �/ "-4� ALAN CHECK $ $ LS b AUTHORIZED AGENT \\� TOTAL FEE S ‘ " "°ME OWNER CHRLCOAT, MKAUDE DATE 4-3-59 JOB ADDRESS 173 Del Mar Ave. BUILDING PERMIT NO. 8937 GENERAL CONTRACTOR Owner - Builder VALUE $ 3214.00 3(45.9No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK Add Bath r-nue J TYPE V ZONE RLt PLAN NO. 8937 I. PECTIONS DATE SUBCONTRACTOR PERMITS ISSUED . DATE NUMBER Trenches Forms Steel _ • Floor System • Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil W/Ps.*Pipe Tes . 5 Top Ou Furnace Gas Vents , Rough Plumbing -240-55/ AIMNar- r'-7• 7_ , Cesspool Septic Tank Prop. Swr, Line House Con. St. Swr. Sprinkling System Heating Final V bin. Fixtures, Final �2 I Gas Test Construction Pole Underground Power ' Rough Wiring / ?trta �� Fixtures, Final OCCUPANCY l%Form 210-5M-1-57 210-5M-1-57 8937 . I. 8939 COSTA APR -3-59PfNesi; 284D. arta*2.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 317 COSTA MESA, CALIFORNIA fOR APPLICANT TO TILL IN COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING . �/ ( / ; ry � ^,/� ADDRESS ` V COSTA MESA, CALIFORNIA FOR OFF/CE USE ONLY • I Y/ -4--• RECEIPT NO. PERMIT NO. OWNER C.7 VV.;l Ac (1) f I •i11 / I+ 0;7 4 . I W3 7 MAIL ARC•- -CT . / I- 2JI -� 1-7.� FI. RECEIVED BY DAT rREE1VW'. . DATE ISSUED ° ADDRESS , 1 . � . ......-"7.4----•- e2 I' i4,-.3._ S -9 BUILDING CITY eU-)` m ✓�? (ai..f NO.G-2 I ADDRESS _ - LIC. COSTA MESA. CALIFORNIA OR (EER NO. i ADDRESS FIRE �E Jv OUIJ ZONE Air or .w //]] J STATE APPROV / � , CONTRACTORaWnp,t ho.74.IC.NO. BY li/"�! DATE ADDRESS . III ZONING LEGAL ' I LOT 1/_ • vl� •• ZONE I NO.OF I USE OF NEW - , DESCRIPTION NO. 2, BLOCKY) TRACT/ LV `I) PLANS BUILDING //�//) '[�j A.P.NO. )/9-a-a V 7 0 --. APPROVED DATE �!'i� / . OELOT 6.-CAO d v NO.OF BL /NOW ON LOT YARDS REQUIRED ru EVES ALLOWED USE OF (CENTER LINE ST.) EXISTING BLDG. .hA FRONT .Co 71" FT. ../......."...-. IN. SETBACK LINE FROM /- CENTER OF STREET ,JF)O REAR YARDRDetc- L. R.SIDE T� FT. : IN. SIDE YARD LEFT L%� RIGHT R71 (J L.SIDE FT. IN. DESCRIPTION OF WORK REAR FT. IN. NEW I II ALTERATION ( ADDITION .e{1-71j �) ---la) REPAIR I II MOVING I II DEMOLISH I �, ,/.,_eOza� BUILDING44A NO.OM �� SIZE '4441 J^. B NOOF STORIES ` //f ` EXTERIOR WA4L.'11�/1 D"""""""`��y��y. ROOF °I` ilt 114 COVERING J';( /,'1 t COVERING ' USE OF BUILDING AND RK TO BE PERFORMED I Add 13hth , - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTION. /://,may ,f {� �,1{` VALUATION . SIGNATURE OQ,�5�'f--0/ aK-(CGtY'` PERMIT FEE $ �✓� B'0 PERMITTEE S ,/ `�) $ 3�/je PLAN CHECK $ • AUTHORIZED AGENT !lIJJJC� TOTAL FEE $ -0 -----