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Home My WebLink About206 DEL MAR AVE - Building Permits ::Costa Mesa Building Department ✓ APPLICATION FOR PERMIT 111 EAST 20th STREET 1444 BUILDING '•• ► COSTA MESA, CALIFORNIA 7. > -AM 0FrICE USE ONLY FOR APPLICANT TOFILL IN _ __ __Receipt No - Permit No, Building j / Address v 061 42-e-P 7k�/4a 'Cc-• 4 // a; Receive by., Date Rec'd. Date Issued I . Costa Mesa, California -7--11-� 'JI i. Nearest ,(� 6 -77-S s I ei '/1-.t] Cross St. (%yLC2��-Q Building !/. 4l/YAt-�, Address Owner,-°.-2�V Costa Mesa, California • Mail (� pp ---11,..., n `,- Address Q 6 aaa atea. , Nearest Y1n' Tel, 4 Cross St. City A-• Lz oo- No-L/, lige Zone /J No.of Type I Group • Architect or Lic. /� I .. Plans / �1 Engineer No. Approve by ' Date tress CORRECTIONS �' C"ity Lic. :ractore2L,(y i- c, ��e& cno. Address s 4 :‘,. _ .: . . LLegalLot �- Description I No. I BlockcjjI Tract• / � (Attach Metes and Bounds) ,4!�� f/ / - It/- 7 ; \ ( - No.of Size of Lot 7 z )( /00 I Now onLots. tldg� f �O� Use of � �J No.of No.of C -- - - - 77 Existing Bldg. 7 1-1/n2i I Families/I Rooms ✓ UI �, Setback Line from i � ` Rear Yard ..2-7—.�J (� .e.-:. ,Z Center of Street o2/',etc Side Yard a 41.fV - - ' CI D DESCRIPTION OF WORK „l r New I V I Alteration I I Addition Repair I I Moving I I Demolish I Building _( No.of Plze ' Rooms i 1.2 ( R YStories / rior WallRoof :ring ,•0�`i.�x-c I Covering APPROVALS use of New BuildingFoundation Location Inspector Date \/ � v) Forms,Materials, • Under-Pinning Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application Lath. Int. and state that the above is correct and agree to comply Lath.Ext. with all City Ordinances and State Laws regulating building constru '.n. Signature of Plaster, Int. Permittee /� .' / 7.. .s.�- Plaster, Ext. Authorized Agt. Masonry Reinforced Valuation .-- Permit Fee $ ei, e 0 $ // 0 Plan Check$ !/ ,s eTBond Beam �J Jam' r Focal $ /• d d FINAL > Ortl 1_Itr C4 FORM 204 G-H 2M 5-54 F- - (7 OWNER MA KRT'(t RUSSELL et CAROL DATE 6-11-55 '1' IJOB ADDRESS 206 Del Mar Ave. BUILDING PERMIT NO. 1424 GENERAL CONTRACTOR Owner-Builder VALUE $ 1,056.00 L APf119-121.-2 BLOCK TRACT Garage GROUP J TYPE V ZONE R4 FIRE DISTRICT 1444 - PERMITS ISSUED INSPECTIONS t� C DATE V SUBCONTRACTOR DATE NUMBER (/ Footing Trench (4- 6 a O , Foundation Forms andrade to Garage / Rough Framing 1 � , �' -de- /A- Plumbing,Rough to Slab Plumbing, Rough Complete • Temporary Pole • Wiring, Rough I. • Heating,Rough . _ '7.. Heating,Final Sewer, House Sewer,St. 1 Septic Tank or Cesspool b..,,,,// / fL---ing, In Out _ J1 I :ring C n 4—y Plumbing,Final,Fixtures Complete . - das-rYz_- Ce--72-4. , Plumbing,Final Gas Test / Wiring,Final —ccupancy . irt it -'' 1 Form 210 0-1-1 1500 1-55 15584 COSTA MESA BUILDING-SAFETY DEPARTMENT FEE RECEIVED 1P. O. BOX 317 COSTA MESA. CALIFORNIA (. SEP291�1 For Applicant to Fill In Completely APPfIC.4flg�7�TRIW� 1��1PERMIT TYPE OR PRINT CITY g ,kiiagESA ADD EIS: ;�O6 -Pei/(/fcrr 71a p• jV1 L! 1NtlV COSTA MESA. CALIFORNIA For Office Use Only ��r� // I RECEIPT HO. PERMIT mt./ OWNER V /5-4-e MAIL ��J Ra9.7./YD BY DATE REC IVEf DATE ISSUED ADDRESS //--" ,6�,1 /'GA/.77,ar "O(2.-• (� l!' lJ• '- -(�/ I C- �•� I CITY &' dr/a' A/ fQ NOX/p-JO60 BUILDING // / / �^ ADDRESS 7<� E /L.�eC'> A1y (-L.�+Q1• ARC'--ECT TEL. COSTA MESA. CALIFORNIA OR NEER — NO. ADDRESS FIRE BY DATE �f� ZONE � _-_,TYPE 12 GROUP CONTRACTOR (/ /(L 1�J` APPRO� 9 /yq -./ ADDRESS I. ZONING 20N O.OF 8 OF NEW 1ny-_-0--A- y� CITY f1I PLANS BUILDING I'Z•I\pl Ai STATE TEL LEGAL C /` '/ /3 4.o r- '7 1-- LIC.NO. NO. DESCRIPTION { V L� SIZEi7 NO. OF BLOCS. doi ./� 1 OF LOT / )( J 6 0 NOW ON LOTS A.P.NO /`�— 1 ~O z— USE OF (��J �j(/� YARDS EVES EXISTING BLDG. ileta • 1L" - APPROVED ALLOWED ' SETBACK LINE FROM (CENTER LINE ST.) __ CENTER OF STREET REAR YARD FRONT 14-TTT. . r0 �t5J; - SIDE YARD I LEFT RIGHT R.SIDE 27 FT. IN. DESCRIPTION OF WORK ,5'J FT. N. L.SIDE NE' 1 II ALTERATION II ADDITION I V REAR r}Fy\�'JryFTT.. (�l . �I`N.L REPAIR MOVING I ( DEMOLISH APPROVE DATE 7 �/ w, SIZIELDING1,:6 X NO. OF �O ROOMS 3 STORIES / rt- L-----: WALK " ROOF /1/46914an . COVERING • (CLa I COVERING .SAeinc/E'. US��..gqF BUILDING AND WORK TO E PERFOR D JJ ,c edrrn. •Fhm• ,r'n.r aTh -...- 'Ae a ' - odd. T 'j es. 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. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRU N. VALUATION O-F PERMIT FEE / - SIGNATURE OF Q A��ttle, $ / PERMITTEF ��((( } gO. �y e $ J - PLAN CHECK $ S� gh AUTHORIZED AGENT I TOTAL FEE $ 2 r 0 OWNER MADLY, RUSSELL DATE 9-29-61 . II JOB ADDRESS 206 Del_ Mar Avenue BUILDING PERMIT NO. 15584 GENERAL CONTRACTOR owner VALUE $ 5,980.00 & bath to re AP No. 119-121-02 LOT TRACT FIRE ZONE DESCRIPTION OF WORKAdd bdrm. ,fam,r \ INSPECTIONS Signature DATE GROUP T TYPE , ZONE 11_3 F _- __. ,41— - PERMITS ISSUED t A 14/ - e SUBCONTRACTOR DATE NUMBER Water ,(,.G!/ 1.2.1-C1 - Rough Corn. Refrig. ❑ Air Cond. 0 Rough Heating Sc-' alto Rough Plumbing kik, /.9../- te o v.,1-e r IO-7,o-/of—._ S'J_Ip -. Miscellaneous ,_ d� 7� _ 'Prop.Swr.Line L7 ouse Con. 0 St.Swr. 0 :0 Y GI 6�/-t-r-r--- /o/ 14114 3 /6 E.-tr. Sprinkling System Construction Pole _ Underground ❑ Power ❑ Rough Wiring _ 3 °s.,`.� _ i/-(4-61 ,/_3.11 �- Trenches Forms fs, tleefHeinf. 0 /q' ]6- .W Floor System S-- t o / ra-- 4 / Bond Beam 0 Steel Reinforce 0 • ( _ Sheathing • (342. �Mz f�oSL Frame and Flashing i 0. - - 6/ Lathing — In 0 Out ❑ / C- " / ...r— 6 2., Plaster, brown coat /3 `nom .2 r-Z — C - Ref rig. 0 Air Cond. ❑ Final ng, Final '�` I .oing Fixtures, Final it H r/r7%,rFinal Gas Test Ot*4 f....av� �[u�Electric Fixtures, Final Z�/ / I Building, Final An , ,ll 971 4r/ OCCUPANCY �/ r ,+Cpt')8µ FORM BIM•5M — 7-61 1J is a a CITY OF COSTA MESA ow RestBUILDING DIVISION Fµ �. www.ci.costa-mesata.us FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaa.us wili FOR INSPECTIONS CALL: (714)754-5626 "t''•° fi PERMIT NUMBER: BC11-00001 PERMIT TYPE: B_COMBO STATUS: ISSUED Sub Type: RES ALT DATE ISSUED: 01/03/2011 ISSUED BY: CAC JOB ADDRESS:r206iDEL MARAV-CMA - Suite/Unit: APN: 43921102 Zohing: - - Vicinity: - . . '• . Primary.Occ: .. Const Type: SQ. FT: . . 0 : Valuation: $15,000.00 SCOPE OF WORK: TWO BATHROOM AND KITCHEN RREMODEL ' 2 TOILETS 2 WASHBASINS 2 BATHTUBS 1-SHOWER 1 GAS EARTHQUAKE 1 LAUNDRY 3 P TRAPS 1 KITCHEN SINK 1 GAREBAGE DISPOSAL . 10 LIGHTS 30 OUTLETS 15 SWITCHES 1 SUBPANEL. • 2 VENT FANS OWNER: SPENCER,LANCEAddress: - . - Unit: COSTA MESA, CA Phone: 310-663-8057 • City/State/Zip: 206 DEL MAR AVE Vit.;{,} ; G • APPLICANT: SPENCER,LANCE • . Address: . • - •Unit: :COSTA MESA, CA • Phone:' 310-663-8057 City/State/zZip: 206 DEL MAR AVE CONTRACTOR: OWNER-BUILDER . . License No. 000000 - • . Phone: Address: Unit: Cell: . • City/State: ZipCode ARCHITECT: License No. PHONE: ENGINEER: . - License No. PHONE: COMBINATION PERMIT FEE SUMMARY.- Building Plan Check: '$0.00' - _ Building Fees: - _ Electrical Fees: $80.30 Mechanical Fees: Plumbing Fees: - $181.50 _ SMIP Residential: $0.00 - ...- ,,..:,::s_,, SMIP Commercial: $0.00 Bldg Std Admin Fund $1.00 TOTAL FEES: $552.05 "Refer to fee receipts for all fees paid for project ,:: ,.. .:L3:1,,, .• HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibited all hours-Sundays and the following Federal holidays: New Years Day,Memorial Day, Independence Day,Labor Day,Thanksgiving Day and Christmas Day 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. -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. CODE X. INSPECTION TYPE DATE INITIALS CODEX INSPECTION TYPE ':PATE:,'I, I INITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof Vy Is x311 ElfNO 210 Final Electrical 201 Final Block/Retaining Wall - 212 Final Fire Prevention202 Final Factory Fire Place 220 Final Planning Approval �1� 77 t 203 Final Sign 222 Final Site �y1 20 'yr 4 Final Demolition 250 Final Building/Occupancy L.c 0'�L„ [[[ Ll/ 'N WORKERS'COMPENSATION DECLARATION. Owner le - • driv e. es ❑ I hereby affirm under penalty of perjury one of the following declarations: dr. o. Expires ❑ I have and will maintain a certificate of consent to self-Irisure for workers' _ Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor-Code, far 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: 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 Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp finis sedibn need not be completed dlheperrq,is valued at one hundred dollars($100)or less) 2 Art 2Sec.341,Title 8,California Administrative Code). Policy Number: ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code,I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number: Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑ No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑ No Lic.# _ Class# (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 Contractor's Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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, Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications fix non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for - sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). , . information given above is correct. I agree to comply with all state laws and • rj,��Q I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.. "LICENSED CONTRACTORS to construct the project(Sec.•7044, Business and • Professions Code:The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ am exempt under sec. • the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 aut, e• • .. rmit until final inspection. - _\— = 1 , \ -,'nature of Legal Owner H \,Date slgnatur• 305746(3l07) • And/or Authonzed Applicant Date • • __,..............1 City of Costa Mesa Building Division 77 Fair Drive, Costa Mesa, CA 92626 Costa Mesa714-754-5273 I Fax 714-754-4856 OWNER BUILDER VERIFICATION 13 i i- 6o0 0 1 Permit # ' C it- Oaoo • Disclosures & Forms for Owner- Builders Applying for Construction Permits . IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit- has been submitted in your name listing yourself as the builder of the., • property improvements specified at ,.a n C cO.1 Mar . We are providing you with an'Owner-Builder Acknowledgment and Information Verification Form to make you . aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of., each provision, signed, and returned this form to us at our official address indicated. An,agent of the . • owner'cannot execute this notice unless you, the property owner, obtain the prior approval of'the permitting, . authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION • . DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. \ y3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. . I understand Contractors are required bylaw to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. :::-..... 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2 --s 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. — 9. I understand I may obtain more information regarding my obligations as an "employer' from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. .. 10. I am aware of and consent to an Owner-Builder building permit applied for in my name,.and understand that I am the party legally and financially responsible for proposed construction activity at the following address: ?.O Cb DPA f`I\Uvr 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. `- . I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may.be unable to assist you with any financial loss you may sustain-as a result of a complaint..Your only remedy against •. unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held • liable for damages. If you obtain a permit as Owner-Builder.and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. • Signature of property owned—\ Date: )"3 I Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents • necessary to obtain an Owner-Builder Permit for my project. Scope of.Construction Project (or Description of Work): .i,�Q Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. • Property Owner's Signature: � Date: I %- I 3148-30 CALBO Jan 1, 2009 013 Packet template 2 of 2 . , a .. as CITY OF COSTA MESA oQ BUILDING DIVISION cµ r% :I ..�'�!a,,,"t0 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us t. FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER: B11-00001 PERMIT TYPE B_ROOF2 STATUS: ISSUED APN: 43921102 DATE ISSUED: 01/03/2011 ISSUED BY: CAC JOB ADDRESS: 206 DEL MAR AV CM.• - •Suite/Unit: Vicinity: Squares: 0 - Valuation: • :•$8,000.00 SCOPE OF WORK: TEAR OFF INSTALL 1-30 LB FELT AND 30 YEAR COMP. SHINGLES.. . DETACHED GARAGE INCULDED " . OWNER: SPENCER,LANCE . Address: Unit: COSTA MESA,CA - - • PHONE: 310-663-8057 City/State/Zip: 206 DEL MAR AVE ', APPLICANT: SPENCER,LANCE Address: - •. . °4 Unit:..:COSTA MESA,CA - - - 4^',ies.:. 4 PHONE: 310-663-8057 City/State/Zip: 206 DEL MAR AVE ' - CONTRACTOR: OWNER-BUILDER License No. 000000 Address: Unit: PHONE: City/State/Zip:... . CELL: _ ARCHITECT: License No. . ' • PHONE: ENGINEER: . License No. • PHONE: FEE SUMMARY Reroof Plan Check: $0.00 . • - Reroof Permit Fee: $153.25 Reinspection Fee: $0.00 - . • - -1i,,: ,*:-,r,, • Bldg Std Admin Fund $1.00 TOTAL FEES $154.25 . . ., HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010-PER CMMC Sec. 13-279 . -.i..:i..;...:U , . Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibitied all hours-Sundays and the following Federal holidays New Years Day, Memorial Day, Independence Day, Labor Day,Thanksgiving Day and Christmas Day 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODE P. INSPECTION TYPE DATE INTITIALS • CODE II INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention :202 Final Factory Fire Place 220 Final Planning Approval --. '203 Final Sign 222 Final Site ' 204 Final Demolition 250 Final Building/Occupancy i WORKERS'COMPENSATION DECLARATION Owner I • drive.jYes ❑ No I hereby affirm under penalty of perjury one of the following declarations:. D ense No. () ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 DIVISION OF.INDUSTRIAL SAFETY PERMIT CERTIFICATION:" permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffdding,falsework,o-demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp (This section need not be completedn the pewee is valued at one hundred collars(3toO)orless.) 2,Art 2Sec.341,Title 8,California Administrative Code). Policy Number: ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Dale the Labor Code,I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No ($100,000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions.Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No Lic.# Class# (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 Contractor's Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes ElNo (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑ No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑ No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No (hereon,and who does such work himself or herself or through his or her own 8. (If'yes',attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and /✓ y� I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code:The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). - certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city • ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 _` aut ,'z:.. Augermit until final inspection. ' \ _ `�3-A\ Signal • '•a a er(s) Date •nature ate 3057-4613/07) And/or Autnonzed Applicant Date w , �_„�1 City of Costa �l�lesa Bui�ding Division Costa77 Fair Drive, Costa Mesa, CA 92626 Mesa 714-754-5273 I Fax 714-754-4856 OWNER BUILDER VERIFICATION 73 I I- 600 0 Permit # $( /(_ 000o I Disclosures & Forms for Owner- Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at aOC, O'.\ (Aar We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. NA). I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. . I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. R- 6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. . I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 3148-30 CALBO Jan 1, 2009 08 Packet template 1 of 2 —<s 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. ,. 10. I am aware of and'Consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: DNO G Oe ,1 1'A or 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abideab>id� by"� all applicable laws and requirements that govern Owner-Builders as well as employers. X12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Signature of property owne Date: I"3-j Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder.- AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my proj t. Scope of Construction Project(or Description of Work): Project Location or Address: ,,--Mt..- Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: S_ Date: 1-3-I 3148-30 CALBO Jan 1, 2009 OB Packet template 2 of 2 PROJECT ADDRESS: 206 DEL MAR AV UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: .P _ 047606 OWNER'S NAME: RUSSELL L . MAKELY • - ' - ADDRESS: 206 DEL MAR AV PERMIT NO: P 047606 PLAN CHECK NO: N GOVT: N SUPP: N • -• • COSTA MESA CA 92626 CONSTRUCTION TYPE: 5-N PERMIT TYPE: PLU PURPOSE: OTH •• ARCH/ENGINEER: ( 714 ) 645-2302 REG.NO.: ' JOB DESCRIPTION : ADD GAS LINE & OUTLET TO EXISTING SYSTEM SQ FT: ' • ADDRESS: UNIT: CLAIM VALUE: CALC-VALUE: GROUP :OCC : R73 /' t4 PERmua RUSSELL L. MAKELY ( 714 ) 645-2302 • ADDRESS: 206 DEL MAR AV ICOMMENTS: ' COSTA MESA - CA 92626 **�E�r�r�r�r�r*+r�r****�F�e�ex***xdr****�H�H*�r�t�r***�E�H*�E *�r**********�r**********gr************ LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING REQUIREMENTS _ 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS _ . CITY LIC.: • STATE LIC.: CLASS: Date: Signature: MAIN BUILDING ACCESSORY ' BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR : FT IN FRNT: FT IN REAR: - FT IN Compensation Insurance,or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN' POLICY NO.: ' EXP.DATE: COMPANY: • PARKING REQ• ' PROV: PARCEL : 43921102 ZNE: ' REF NO:' • Certified copy'is hereby furnished. ❑ Certified copy Is filed with the city Building Division. PLANNING NOTES> . > .. . . _ ••- ._. ._ Date: - - Applicant ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permits for one hundred(5100)or less). ' DEVELOPMENT SERVICES R -Et Q U I R E M E N T S • 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. ZONING APPROVED BY ' I DATE: ' • Date: - Signature: - - . - ' NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : • •./- DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. •• • CONSTRUCTION.LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED H Y: • 'r '�i'� DATE: C-1.5—=—/i!". , which this permit is issued(Section 3097,Civ.C). ************************ *** * .)F** ** **********,********************* **** LENDER: ************************************ ** **************************************. _ ' ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N • • • OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from theContractors',State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 2 , 00 - repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed • 25% SMIP/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business I and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by 'PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE • ;3 . 00 - • I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID 'DUE • ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 2 , 00 3 • 00 f 0 . 00 5 ,00 5 . 00 ' ' . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If, however the building or improvement is sold within one year of completion,the owner wit have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 5 . 00 OVER/SHORT: . 00 for the purpose of sale). - I BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT .GRADING PLAN-CHECK I,as owner of the property,am exclusivelycontracting with licensed contractors to construct the project(Section 7044,Business 5 , 00 • ❑ 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 vith a contractor(s)license pursuant to the Contractors'State License Law).I am aware ******************************************************************************* that proof of their Worker's Compensctlon insurance should be provided to me. I N D I V I D U A' L F E E BREAKDOW N 1 m I am exempt under Section: Bp 7 0 4 4 B.&P.C. I ' for this reason: ALL WORK BY OWNER 1/ / ' TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: •r0 --r-fo • Owner: .lA4 r : I do hereby certify that I am aware of and understand the requirements of Ca dornia Health and Safe ode sections 2551. ;and PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 2 . 00 2 • 0 0 25534 and that I or any luture building occupant willhwill not(circle one)neetl to comply with saptl to codes antl the req ements for a - END O F FEES • I permit for construction or modification from the Air Quality Management District.Residential co tinction applications are exempt from ! , these provisions. , 1 Date:• Applicant: • - ' I hereby certify that I have read this application and state that the above information is correct agree to comply with all city and county ' ordinances and state laws relating to building construction and hereby authorize repress t ryes his t me upo a above-mentioned - • i�O property for inspection purposes. •f Date: b'5— signature: / •• 01 00062419-00062419 1-071 ' Lrivei s License or Social Security A: i 5.00 0 DATE:• 06/05/90 TIME: 11:10 164146 White—Building;Green—Code Enforcement;Canary—Applicant:Pi —Revenue:Goldenrod-Assessor ' CONSTRUCTION AND PLANNING .. - POO SPA ' APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector • ,-s • 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement . 3:Electrical Conduit Utility-Undrgrnd. 54. Forms , ,( - 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding , '-5: Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grad. 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 - 63.63. ,Heater & Vent-Final 13. Roof Drains • ' 64. Plumbing System - Final - 14. Rough Plumbing - 65. Electrical-Final 15. Rough Electrical-Conduit - 66. Solar System-FinaI - 16. Rough Electric Wiring 67. Fencing & Access Approval - ' 17. Rough Wiring Sign 68.'APPROVEDFORiPLASTERING • 18. Rough Electrical-T Bar Ceiling " 69. POOL/SPASYSTEMSFINAL - 19. Rough Heating & AirConditioning FIRE DEPT. REQUIREMENT. 20. Fireplace Factory :' _ - - .. • • :APPROVALS. ,'Permit# - 21. Ducts, in Structure '• • - s. 70. Underground Hydro 22. Ducts, Ventilating- , -- ' 471. Product-Piping O 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 - ' 1. - 27. Frame and Flashing, - - r, • 76. Dry Standpipe - - - ?8. Lathing& Siding "- • w 77. ,FIXED SYSTEM"FINAL • 29. Insulation 78 -FIRE PREV. FINAL L - 30. Drywall.Nailing -;, • . -; , -.HEALTH'DEPT..REQUIREMENT 31. Plaster Brown.Coat rl' 79. FINAL INSPECTION • 32. Electrical Pov'er Meter Final , - I ;'' :" , 80.EFOOD CERTIFICATE ISSUED _ _ -33. Final;Electric' -• •• _ - • Notes: s' - 34. Final Heating & Air ponditioning _ �' ' , - - 35. Final Gas Pipe-Test • y ,�. , - 36. Hood or Canopy - ' -_ - . � -- - - . r,- z . . . . • 37. Final:Factory Fireplace r • _. _ ' ' - 38. Finir Plumbing _ -- , 39. Water Service-Final • . - , _ - . 40. Gas Service-Final - 7 o7" /A* ' ' . 41. Solar Domestic-Final - v . 42. Backflow Preventer - r it ' ' 43. Backflovo'trrigation • '- > - a !. -.� - 44. Landscape Iriipation System _ .. - 7` ,` : y -' • 45. Sound Attenuation :r, - -, "46. Handicap•Regulations ` _ _ - .,iz. v n • -FINAL STRUCTURE & BUILDING " - - _47. .i, . 48.'FINALPLANNING- "- '' " _ t 49. Electiic Release to Edison ,y, : , . 50. Gas Release to Southern California Gas Co '. 51. CERTIFICATE-OF OCCUPANCY , - No. Date • LIMITED STATEMENT OF RESPONSIBILITY Bldg. Permit # / / TO WHOM IT MAY CONCERN: This Permit /t> F`7 7vc--6 o DSI MAK y39 ,27/ oz. Street Address AP Number I, r Ad > C Y IA G /r "ty.„. , as Owner in Title of the above referenced • property, do hereby authorize: • kus5e (1 4 P44 /67 1YS-2 o Name / Telephone No. t& 6 psi / AL .i Street Address City State Zip to obtain permits in my behalf, as owner/builder, for at the above referenced property. Should any person become an empfoyeP engaged in the improvement of the property, I shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties. 1U.sce /? tin� / /`�-/9v Printed Na e Date L. __ igna ur- -- • JUN 5 1990 0779-46,rev.6187 •