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Home My WebLink About215 DEL MAR AVE - Building PermitsCOUNT7 OF ORANGE _, � p ` BUILDING DEPT. � 7Oa Permit No. - ---- - ------ ------ ssecvo.s�o�awaY Application for Building Permit ' Santa Ana� CaG[ornia Phone:KI2-6211 AND FOR A Certificate of Use and Occupancy ��/ �, �/LG ov�� Jvh e / 9J�� Da[e ...........................------------'-- -'----- --------..._. , i�4r�d�� OWNER'S NAME - �2.UFn- � s__.�t: ..°.-.-"-_`.-'r%/rQ�----- -�---.... PHONE:. ..��..CP�r3- .� MAILING ADDRESS- - -,-��..L✓1'r:.h1...�..--/T �r/_e.-- - ..._... - CITY.....L of_ohP--de./.l.!_4/� Name ---�.G.L1.C�2._�. ./..�---------........_-------'------=--�-----� (Architect or Engineer) . Address------------- -----�-----------------�-- -------------------------'------ IQame -'------0._Gf.�A-e�-------�Uf/�F.....L-�...��...-'-------'-.. (Contractor) Address------'-----------------------'---.-"-"'-'-------`-'-"------------"----.'_ C.cy -- - - - - - - - - - -- - - - - City - -..........- --- -- ...:... - - -- ....------- -��--- ------ -- SYate S[aYe � Lic. No.----------------------------------- Phone---------�--..__..-------------- Lic. No.--.............-------------.............. Phone--�--------�-----.._------------� PROPOSED USE: /.1..__�,z�rC-.P../t G-� /�J - - - -- - -- /- '...... ------....' �/ --� -- -- -- - 2. JOBLOCATION ��l.�.�/�. - .............�%.�.L.4/� -- - --� c_'S_�G�.- � F �,5�-_ -•/ (Ho�se No.) (Name of Street) / Town or School Distr' t) 3. LEGAL DESCRIPTION: -bc+t..�r'��.t�2�loc�r �f _�o�-:�"� T�`�`��--'3�9 �X�T/�T - --� ---...... <-�.- -- � ( r �t3-c-/�/Sv- a�:rrri r9' � e''.3"� F�" '�/l r.Sv.sr�r,. fe�� d,�"r �ne.�'� Me:es and Bounds Des<ri tion—Us reverse =� c o( (orm f �/ 4. CORNER LOT ( ) INTERIOR LOT ( v) THROUGH LOT ( ) SLOPE OF LOT ( L� v e� i. SIZE OF BLDG.:..eZ(a..iY...�So_..AREA:......,�O.o%.iT".......SIZE OF LOT:... a��I_ri .f�S.J.___.AREA:....7J�-�:�C%... o / G. HEIGHT. OF $LDG.:......___��_ CEILING HGIGHT:.......0......._....____.NO. OF STORIES.._.__. / ..................... 7. NO. FAMILIES....._..__ .... _...._.._Sizc of Smallest Bedroom:.___�Q.r.Y...l�._......... Size of Kitchen__.._�..X. �.�_. / - �'7 � , R. EXTERIOR WALL CONSTRUCTION:.,..F.Y..4Cn_�.:....�.j�C�:_INTERIORWALLCOVERING____..!_.�1��c / .. - (Frame, Stu<co, Etc.) t' .Qa � � (Plaster•Drywall, Ere.) - � - -- - --.. . J. SETBACKS: Frbnt Yard From Center Line of Sueet `-.��--�% - - -- -- - - ---...,_...- -- -� -- ---- ---- --------------- i � � Nearest Sidc Yard.......�..�........___Rear Yard._�.5�_.Distance in Fee[ Between Bldgs. on Same Lot____1_YA.!°t._�__.......... 10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. I1. For (a) Footin�: Width_.__._....lY...~....__.Dcpth in Ground___..._..l..�.'/......WidthofWal]___��`o.t.l.� Accessory --- ---- Bldes. and � ' � ) � - - P &------.��.._----��CC Material of Floor------S.l._Q'... .....__-_------- Similar 6 Si�e of Studs:....�.�.�.........S adn Structures: ,� / (c) Size of Floor Joists:--......./ �Q h-��-------Spacing ................---------.._-..._....: `CC i ,�r d Size of Rafters:..3X �...._�._.��' G......5 acin �.....T ............."CC � ) .- P g..... -- -�- I2. VALUATION OF PROPOSED W'ORK: Includinp all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and sewage disposal $...._.�SQ�._-_----__---.... 13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APP,LICABLE THERETO. Signed: cc_��/i_� t�-ui- ic--=:v� igiri<�i�ce,.-., ----- -..... / / S// . (Owner) / Plans Filcd:....---•---.....U�--: �ri------------------------- . ...----By:-��----------------------'---_....-'--'--------------------------------....- / ---------------... (Authorized Agenc) � FOR DEPARTMENTAL USE ONLY Bldg. Pcrmit Plan Check Tota] - - Receipt No. Paid to • Dace ------' FEES: �� - /" � --- - e 7.� GROUP....:��`� TYPE---- - -�-- .iSA... -...... DIST. MAP-- ... �..: � - SHEET NO............�...... APPLICA PLANS AND SPEC'S-----------, V ERIFIED....__-._......_... 1G BY HEAL' FIRE STATE._..-' - -.._....... ENGINEER � PERMIT ISSUED BY: / �, �i �� DATE. ...:._._ /n ....�'�..�/...?./ - -��-'� - - - - - /��y-��•-�PJ�/-- � - -- 51A-2..1 / -'� September 26, 2005 CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENTSERVICES DEPARTMEN7 To: Building Safety Division Code Enforcement Communications County Clerk County Planning and Dev. Services County Registrar of Voters County Tax Assessor Engineering Division (2) ESRI Fire Admin. - Training Officer Fire Admin. Fire Prevention Irvine Ranch Water District Mesa Consolidated Water District OLD ADDRESS 215 Del Mar Avenue Building Safety Comcast Cable' Newport-Mesa Unified School. Dist.(2) Pacific Bell Police Dept. - Planning & Research Sanitary District Engineer Sanitation Division Office So California Edison Company Southern California Gas State Board of Equalization U. S. Post Office - AIS U. S. Post Office, Adams Thomas Brothers File (2) NEW ADDRESS 215 Del Mar Avenue #A 215 Del Mar Avenue #B Your cooperation in this matter is appreciated. Sincerely, `�iC�u,ll.�`C�Z c,o -�t-.�Q1�P,c.-�. Willa Bowens-Killeen Principal Planner c: Kim Brandt Greg Gosselin 215 Del Mar Avenue�6 Costa Mesa, California 92627 Vi Pham A. P. NO 439-181-32 Building Division (714) 754-5273 • Code Enforcement p14) 754-5623 • Planning Division p14) 754-5245 FAX (714) 7544856 • TDD (774) 754-5244 • w,w,�.ci.wsta-mesa.ca.us (714) 754-5273 • Fan (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 .lob Address: 215 DEL MAR AV Suite: B Vicinity: Parcel Number: 43918132 Applicant: GOSSELIN, GREGG L Address: Owner: GOSSELIN, GREGG L Address 215 DEL MAR AVE Contrector: Address: Zip: Arch : Address: COSTA MESA, CA Zoning: Phone: 949-650-6247 Zip: Phone: 949-650-6247 Zip: 92627 Phone: License: Eng: Address: Phone: ISSUED BY: Status: ISSUED Applied: O6I18/2001 Issued: 07/11/2001 Phone: Zip: License: License: , SCOPE OF FERMIT CONSTRUCT NEW 1157 SQ. FT TWO STORY DWELGNG. iST FLOOR IS 717 SQ. FT:, SECOND FLOOR IS 440 SQ. FT. , TWO BEDROOM, TWO BATH DWELLING W/ GAS FIREPLACE. REF: DR-01-26. .- � ' Plan Check: $160.35 Permik $98675 SMIP Res: $9.89 SMIP Com: $0.00 Other: , $0:00 Inspection: � $0.00 FEESUMMARY . Calc Valuation: . Claim Valuation: � r�' ' $98,923.50 So.00 tt �. � �' ' Sotal: 51,156.99 ,' ' � �. - �. - � , " " � " � . , � � '; , PLANNING'& ZONING � ' � i � SETBACKS � � � ` ` - _- ,"" `� � MAIN STRUCTURE Frout 31-0 Rear 10- 6 Left 5- 0 , Right �'6- 0 ,� ACCESSORY Front 0- 0� _ Rear 0- 0 Lek 0- 0- Right 0- 0 PARKING Existinq: 1� Required: 5 Pr000sed: 6 " 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, 12-27-92) 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 780 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 requlred Inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this parmi�. FOFi INSPECTIONS CALL: (714) 7545626 2446d616/00) WORKERS' COMPENSATION DECLAHATION: — ' � — I hereby eMirm untler penalry ot perjury one of the following declaretions: ❑ I have end will meintflin a certiticata ot consent to self-Insure for workers' compensation, as provided for hy section 3700 ot Ihe Lebor Cotle, for the peAormence of the work for whlch t�i5 permit is issuetl. ❑ I heve aM will malntan workers' compensation insurance, as required by section �00 of.Vr> labor Code, tor ihe perfortnance of ihe work tor whi� h this pertnit is issued. My workers' compensatio Ins a ce wrrier antl policy number ere: n. Cerrier: � Policy irumber: �� (This non need no( be completed i! fAe permit i�al etl et one huntlretl tlollers ($100) or less.) I cenity that in the pe mance of Ne work id ich this pertnit is issued, I shall not employ any person in eny manner so as ta 6ewme subjed to Ihe workers' compensatlon laws of a a, end agree that i uld beco e sub�ect to the workere' compensation provisions ot Section 3700 of the�abor Cotle, I shall fort�with comply with t�ese provi iana �'l � I ApplicaNSlgneWre: Date: / � I WARNINO: FAILIIRE TO SECURE WORKERS' SATION COVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED TFIOUSAND DOLURE (5100,000), IN ADOITION T0 T OF COMPENSATION, DAAMGES AS PROVIDED FOR IN SECTION 31060F THE LABOR CODE, IMEREST, AND ATTORNE`f5 FEES. LICENSED CONTRACTORS DECLARATION: I hereby effirtn that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business antl Professions Code, and my licanse is in full force end eflect Lia a Class a Contrectofs SlgnaNre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aMirm that there is a wnstruciion lentling agency tor Ihe pertortnance of the work tor which this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lendefs Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby efflrtn Ihat un0er penalry of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions Code: Any ciry or wunry which requires a pertnit to construct, alter, impmve, demolish, or repair any structure, prior m its issuenca, also requlres the appliwnt for suc� permit to ille e signetl statament Ihat he or she is licensed pursuent ta the pravisians of the Camrectors License Law (Chapter 9(commencing with Sectlon 7000) of Division 3 oi the Busin s end Professions Code) or thet he or she is eaempt thereirom end the besis for the elleged exemption. Any violation oi Section 7031.5 Dy any applicant for e permit ubj s Ihe applicant to a civil penalry ot nm more ihan five hundred tlollers ($500).): I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the siructure is not intandetl or oflered tor sale (Sec. 7044, Business and Protessions Code: The Coniractors License Lew tloes not apply to an owner of properry who builds or improves thereon, antl who does such work himsetl or �emaN or through his or her own employees, provided ihat such impmvements are not intended or otteretl tor sale. It, however, the building or impmvement is sold within one year of completion, ihe owner-builder will have the burden of proving that he or she did not build or improve tor purpose of sala.). ❑ I, as owner ol the property. am EXCLUSIVELV CONTRACTING WITH LICENSED CON7RACTORS to construct the prolect (Sec. 7044, Business and Professions Cotle: T� contrectars Llcense w does not apPN �o en owner of pmperty who builtls or improves thereon, and who contrects for such project with a contracwr(s) license puT�nt to tha Coniract License Laws.). ❑ I am exemp ntle c. _ Signawre: Owner ID venfietl by rivefs license VeAfication ol Ownership by (type of �� Busineu end Prolessions Code lor this reason: - y�ty+_y� Date: ( ❑ Yes ❑ No Drivers License No. Expires: i.e. - property tax bill or deetl): DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION: ❑ I hereDy cerlify thai no excavetion fiva (5) or more feet in depih into which e pereon is requiretl to descend, will be made In connection with work euthorized by this pertnit, and Ihat no building structure, scattolding, talsework, or demolition or dismantling Ihereoi, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Celifomle Adminisirative Gode). ❑ As owner-builder, I will not employ enyone to do work which would require e permit from the Division of Industnal Safery, es noted ebove, unless such person has e permit to do such work irom the division. Signature: Date: Division oi Industrial Safery Permit Number. CER71A TE OF COMPLIANCE AND AUTHORIZATON OF ENTHV: I cenify under penalry of perjury that I have read ihis application and state t�at the information given is correct. I comply wiih ell st @laws end ci dinances ralating to Cuilding consiruction, and authorize representatives of ihe City of Costa Mesa to enter upon ihe above-des 'bed pr tor inspecti p oses. I r not to occupy or allow occupency of eny building authonzed by t is permi umil final inspection. ---� %�/ % � ! Si re f Legal Owner(s) ' Date AnNOr Authonzed Applicant Date COUE t. INSPECTIONTYPE 1616 Fixed System Final Fire Prevention 7266 Pool SOa Final 200 Final Re-Rool 201 Final BIceWRetaining wall 202 203 Final Factory Fire Place Final Sign Final Demolition o"� INi1TIAL5 CODE I INSPECTION TYPE 206 FinalMec�aniWl 20B Final Plumbing 210 Final Eleciriwl 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy QdjE IMftI�LS '�/�N,Ub �. C�i � �� `�� '� D�� OWI�F�R-BUILDER VERIFICATION . : � . ;.. . A city or county, which is required to give notice pursuant [o Section.1983Q shall attach to such notice, and, as a condition precedent to issuing a building permit,,�require the compl"eUon and require [he�return of, an owner-builder verification. , Attention Property Owner: M`owner-builder' building permit has been applied for in your name and bearing your signa[ure. Please complete and re[urn this information in the emelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No buildine perntit will be issued until Ihis verification is received. 1. 1 personally plan to provide the major labor and materials for construction of the proposed property improvement. ['Yes ❑ No 2. I ave ave not) � C__.� signed an application for a building permit for [he proposed work. 3. 1 have contracted with the following person (firm) to provide the proposed construction: Name (o ,L�t.iCs �—vc�se�L_/iv Address z �c [��w„� �e.� City ��rw-�/l,�.o{J Phone�jq�> �57� - �24-7 Contractor's Lic. No. 4. I plan to provide portions of [he work, but I have hired the following person [o coordinate, supervise and provide the major work: Name �r�� Address City Phone ( ) Con[rac[or's Lia No. 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 tOd2d6 (REV. 95B) 1 hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of Califomia Health and Safety Code and have completed the above information [o the best of my personal knowledge, in compliance with this State law. Signed: • Date: �� 1� � Name: (Printed or Typed) C.D.L. # OR S.S. # For more intormation call City of Costa Mesa Building Division at (714) 754-5273. �. � �� . _�...�. . � e �J�.. • v' 1 •�• •. . ..�: �i� � ��...• i.`. . l .' ' _ ' � ( . 1062d8 (REV.B/98� To NEWPORT-MESA UNIFIED SCHOOL DISTRICT CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 N° 3916 ( City of Costa Mesa Oistrid Receipt No. ( ) City of NewpoR Beach � n ( ) Counly of Orange Plan Check No. I'"(�(f ~ Applicant: Address: Telephone Number: TracUParcel and Lot Number(s): Location of Project: ..� Number of Square Feet ot: Residential Space Commercial and Industrial Space CommerciaUlndustrial Project is: (Check One) _ Warehouse _ R8D _ Movie Theater _ Mini-storage _ Heavy Industrial _ Regional Shops _ Light Industrial _ This project is exempt because ��_x 51.84 z $ .30 _ Motel Bank _ Neighborhood Shops _ RacqueUHeaHh _ Hotel Medical ONice Oifice Park Total Total . i . i i. I � _ Preschool _ Auto Repair _ Hospital _ Large Office _ Otfice Bldg. _ Restaurant _ Fast Food This certifies that the above-named DevelopedApplicant has paid school faatity fees in comptlance with Government Code sections 53080 and 65995. The Building Pemils for this square footage in this proposed denelopment may now be issued by your jurisdic6on. Checks are to be made payable to NewpoR-Mesa Unified School Disfict. Aulhotiiad The above representation as W square footage is We. AppBcant a� true, then this certificate shall automatically terminate and the apF Date: � � Applicant s that fi it is later determined that such representations are not ' t�e CilyfCounry hal� I be noUfy�dti 2��1/8:13 HNlt ?ico.6� \ \ itCPid.61-��NiS�a \) i15sA7 (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 215 DEL MAR AV Suite No B Vicinity: UNIT B Parcel Nunmber: 43918132 - ' � - � Status: ISSUED Applied: 11/73/2001 I ssued: 11 /7 3/2001 ISSUED BY: � Applicant: GOSSELIN, GREGG L � Address: 275 DEL MAR'AVE; � ' . , ' ;� � � � ', i :. �� i. _ . Phone: 949-650-6247 ' � , . , � • ," � COSTA MESA, CA - , - � Zip_ 92627 � _ ' _ ��, � .A , i / , Owner. GOSSELIN, GREGG L �, , Address 215 DEL MAR AVE COSTA�MESA, CA Contractor: OWNER-BUI LDER Address: , � ' . Arch / Eng : Address: Phone: Zip:� 92627 Phone: Zip: License: 0 � _ , ; � - � ��` � . �;: . , , � . � . �' . -. - � � � � - - - � ' _ - f: . . . ,- Phone: Zip: � License: � SCOPE OF PERMIT � - � . CONSTRUCT NEW TWO-STORY 1157 SF SFD. 2 BATHTUBS, 1 GAS OUTLET (1-4), 1 GAS SERVICE, 1�SEWER PRIVATE LWE, 1 KITCHEN SINK, 3 WASH BASINS, 2 WATER CLOSETS, 1 WATER��' " HEATER/VENT. , . ,' ;, �� - � � REF:B01-00915 � � �AMT �( ISSUEFEE � - �$23.50 � Backflow irrigation � $0.00 , i Backflow Preventer , � $0.00 � i BathWb -� $19.60 . . Clarifier System $0.00 i Connect pce,Soda,etc) $0.00 � i Dental Uniis $0.00 , i Dishwasher $0.00 i Orain, Floor $0.00 i Drain, Rainwater $0.00 i Drein, Roof $0.00 i Drinking Fountain $0.00 i Expansion Tank $0.00 i Gas Earthquake Valve $0.00 i Gas (1-4 ouUets) $6.15 � Gas (Over 4 outlets) 50.00 i Gas Repipe $0.00 i Gas Service $9.80 � Interceptore (Grease, Oip $0.00 I Inierceptors (Sand Auto ) $0.00 I FEE SUMMARY AMT Laundry Tub / Washer � $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 70 ft) $0.00 Receptors $0.00 Septic Tank " $0.00 Sewer Cap for Demo , $0.00 Sewer Connect $0.00 Sewer Private Line $24.65 Shower � � $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $9.80 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTY 0 0 0 0 0 0 0 0 0. 1 0 0 0 0 1 0 0 0 AMT Sump Pump , , � $0.00 Swimming Pool, - 50.00 Trap Primer ' � $0.00 Urinal . � $0.00 Vacuum 8rkr BkFlow(1-4) $0.00 Vacuum Brkr Bkflow(5+) $0.00 Wash Basin $29.40 Wash Basin Set $0.00 Waste antl Vent System $0.00 Water Closet (Toilet) $19.60 WaterHeater/vent $12.30 Water Piping Qnst or Rep.) $0.00 Water Re-pipe $0.00 Water Service $0.00 Water Softener $0.00 OTHER $0.00 VIOLATION $0.00 PLAN CHECK $0.00 REINSPECTION $0.00 TOTAL CALCULATED FEES: 5154.80 QTY 0 0 0 0 0 0 3 0 0 2 1 0 0 0 0 NOTICE: The work authorized by this permit s�ie(I��r�i� ��e �� requiremenis under California staiu es an re a e regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 1 BO 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 requlred Inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446381�) WORKERS'COMPENSAnON DECLARAnON: — � — ' I hereby aflirm untler penalry ot perjury one ot tha following daclarations: ❑ I heve end will inaintain a certificate oi wnsent to self-Insure tor workers' wmpensation, es provided for by section 3700 ot the Labor Cotle, for �he pedortnance of Iha work for which this pertnit is issued. � ❑ I have flnd will mainiain workers' compensation insurance, as required by section 3700 of ��e Lebor Cotle, for the peAortnance of the work for which this pertnit Is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (Tbls section need nof be comp/efed il fhe perm/f !s velued et one hundred dollars (5100) or less.) � I ceM1ity ihat in the pertormance of t�e work for w�ich this permit is issued, I shall not employ any person In eny manner so as to become subject to tha workers' wmpensetlon laws at Califomia, ana egrea thet II I shoultl become suDiect to ihe workars' compensatlon pravisions of Seclion 3700 at the Lebor Code, I shell forthwith comply with these provisions. Applicant Signature: Date: WARNINO: FAILURE TO SECURE WORKERS' COMPENSAiION CAVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CFIMINAL PENALTIES AND CIVIL FlNES UP TOONE NUNDRED TFIOUSAND OOILAHE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, OAMAGES AS PfiOVIDED F9R IN SEGTION 3lOfi OF THE LABOR CODE, IfJrEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm that I am licensetl untler provisions of Chapter 9(commencing with Section 7000) oi Division 3 ot Ihe Business and Professions Cotle, and my license Is in full force anC eflect. Lic. q Class a Comrectors Signature: Date: CONSTRUC710N LENDING AGENCV: ❑ I �ere6y attirtn ihat Ihere is a conshuction lending agenty tor iha peAormance of iha work tor which this Dermit is issued. (Sec. 3097, Civil Code). Lender's Neme: Lendets Address: Signature: Date: OWNER-BUILDEH OECLARA710NS: I hereby aHlrtn Iha� under penalry of perjury that 1 em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Busineu and Professlons Code: Any ciry or counry which requires e permit to consirucL alter, improve, demolish, or repair any structure, pnor to its issuance, also requires the applicant for such permit to tlle e signetl stetement that he or she is Ilcensed pursueN to the provisions of Ihe Contractars License Lew (C�epter 9(commencing with Sec�ion 7000) of Division 3 oi ihe Busines -and Profeuions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation o� Section 7031.5 by eny epplicant for e pem+' suble the epplicant to e civil penalry of not more than flve huntlred dollars ($500).): � I, as owner oi Ihe property, or my employees wl�h weges as t�eir sole compensation, WILL DO THE WORK, and ihe structure is not intended or oHereO for sale (Sec. 7044, Business and Protessions Code: Tha Contractors License Law dces not apply to an owner of DroPerty who builds or improves ihereon, and who tloes such work h' self or herselt or through his or her own employees, provided Ihat such improvemants are not in�endetl or otfered for sale. If, however, ihe builtling or improvement Is old within ona year of completion, ihe owner-builder will have ihe burden of proving ihat he or she did not build or improve for Ourpose of sale.). I, as owner of t�e property, am EXCLUSIVELV CONTRACTING WITH LICENSED LON7RACTORS to construct the project (Sec. 7044, Business and Profeulons Code: The wntractors License Law does nm epply to an owner oi proparry who builtls or improves thereon, and who coniracts tor such projact wit� a comractor(s) license Oursuay-b the Comractors License Laws.). � I em exe un0er sec. Signature: Owner ID v ' ietl Verificetion ol Ownership by Business and Professians Cotle for this reason: ves ❑ No oi tlocument, i.e. - propeny tex bill or deed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: Drivers License No. Expires: ❑ I hereby certify Ihat na ezcavation Me (5) or mora teet In depth into which e person is required to tlescend, will be made in connection with work authotlzed by this permit, end that no building sWcture, scaffoltling, telsework, or tlemolition or dismantling thereo( will be more than thirty-six (36) teet high. (Chap. 32, Grp 2, Ar12, Sec. 341, iitle 8, Calilomia Adminisirative Cotle). ❑ As owner-builder, I will not employ anyona to do work which would require a permit from ihe Division of IndusMal Sefety, es notad above, unless such person hes e pertnit to do such work from the tliWsion. Signatwe: Date: Division of Industrial Satery Permit Number: COpE I, INSPEGTIONTYPE Qaj� �l$ 1616 FixeG System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 204 Flnal Sign Final Demoli�ion GO�E� INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Elec�rical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 FinalBuilding/Occupency P� II�L@ ' L-Z -0 � (714) 754-5273 • F� (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 215 DEL MAR AV B 43918132 Applicant: GOSSELIN, GREGG L Address: 215 DEL MAR AVE - - COSTA MESA; CA " - - , Owner % GOSSELIN, GREGG.L �, ' � . i . . Addreas �215 DEL MAR AVE , . � . ' COSTA MESA, CA � Contractor: �:01NNER-BUILDER Address: .Phone: 949-650-6247 Zip: 92627 . Phone: Zip: 92627 _.Phone: Z1P License: 0 Status: ISSUED Applied: 11/13/2001 Issued: 1 i/13/2001 ISSUED BY: SCOPE OF PERMIT . CONSTRUCT NEW TWO-STORY'1157 SF�SFD i NEW RES PKG. . � . � REF: BOt-00915 " -' -- ' . . .- . . . - . --, � � � � "FEE�SUMMARY � � � � � ' ' Quantity - . - -� � . . puanlity � ,� � � ISSUE FEE , $23.50 Temp Dist System / Lighting $0.00 0 '' � - . � Temp service test $0.00 , Busway /100 ft $0.00 0 � ' Res. a/c package $0.00 Standing Section $0.00 0 � New Res (1-2 units) ', � $64.79 1157 Misc Electrical Equipment $0.00 Q.� � � New Res (3+units) ' , $0.00 0 ' �Transformers up to 1 kva/kw $0.00 ',0 � , � � Pool / Spa . � , $0.00 0 � ��"� t � ............:...up to 10 kva/kw $0.00 - ' 0 � � � � Lighting Fixts ., $0.00 0 . � � ..............::.up to 50 kva/kw $0.00 - � .� 0 , . � � ` Recept Outlets � $0.00 .. 0 . . �� .................up to 100 kva/kw.,, $0.00 � 0 Switches � . $0.00 ' - = -• 0' . . ..................over 100 kva/kw � $0.00 0 � � Non Res Appl ,$0.00 . 0 .. Low Voltage Equipment $0.00 � 0 ' Res Appl � $0.00 � , 0 Low Volt Wiring System /.Ckt - , $0.00 � 0 , Service to 200a � � . � $0.00. � � ��0 ' " � Misc. Conduit � $0.00 � 0 � Service to t000a � $0.00 , -0 Misa Conductor � $0.00 0 � Service over 1000a '- $0.00 0 Cirws ( gen or ride) � $0.00 " 0. , Motors to 1hp $0.00 0 Circus (mech ride or lights) -$0.00 . 0- Motors to 10hp - $0.00 � - 0 - Christmas Tree Stand $0.00 -, 0 Motors to SOhp $0.00 0 � Fireworks Stand $0.00 -" 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole $0.00 � � 0- � � � - $0.00 -0 , � , Investigation Fee � . - $0.00 $0.00 0 ' Plan Check Fee $0.00 $0.00 0 Reinspection Fee $0.00 $0.00 0 $0.00 0 TOTAL CALCULATED FEES $68.29 $0.00 0 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period ot 180 days. � � INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspections and (Inal approval must be obtained. Failuie to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � zaasas �sioo� WORKERS'COMPENSAnON DECLARAnON: — �' I hereby eHirtn under penalry of perjury one of Ihe following declarations: ❑ I have end will mainWin a certificate of wnsent to self-Insure for workers' compensation, es provided tor by section 3700 of the Lebor Code, tor the pertormance of the work tor which t�is pertnii is issuetl. � ❑ I have antl will maintain workers' canpensatlon insuranca, as requiretl by sectlon 3700 of the Labor Code, for the perfortnance of t�e work for which this pertnit Is issued. My workers' compensation Insurance cerrler end policy number are: Cerrier: Policy Number: (Thls secNon need nof be completed i/ the permit /s ve/uetl at one hundred dollers ($f 00) or Iess.J ❑ I certity that in the pedormance of t�e woAc tor which this permit is issued, I s�all not employ any person in any manner so as to become subled to the workers' compensetlon laws of CalHomla, entl egree that If I should become sublect ro Ihe workers' compensation provislons of Sectlon 3700 oi the LaDor Cade, I shall torthwith comply with these pravisions. Applicant SiBnewre: Date: WARNINCi: FAILURE TO SECURE WORKERS' WMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIEGT AN EMPLOVER TO CRIMINPL PENALTIES AND GVIL FlNES UP TOONE HUNDRED TVIWSAND DOLLARE (5100,000), IN ADDRION TO THE WST OF COMPENSATION, DFMAGES 0.5 PROVIDED FOR IN SECTION 37060F THE LABOR COOE. IMEREST, AND ATTORNEI"S FEES. LICENSED CONTRAC70RS DECLARATION: I hereby aHirtn that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business end Professions Code, antl my license Is In tull torce and ettact. Lia k Class A Contrectors SignaWre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aNirm that there is a constmction lentling agency for tha pertormance of the work for which Ihis permit is issued. (Sec. 3097, Civil Gode). Lentlels Name: Lenders Address: Signeture: Date: OWNER-BUILDER DECLARATONS: I hereby efllrm Ihat under penalty at perjury thel I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Profaulons Cotle: Any ctiry or counry which requires e permit to construct, alter, improve, tlemolish, or repair any strucNre, pnor to its issuance, elso requires Ihe applicant for such permit to file e si eC statemem that he or she Is Ilcensetl pursuant to the pmvisions of the Conirectors License Law (Chapier 9(commendng wlth Sedion 7000) of DlWsion 3 of t�e Busine end Pmfessions Code) or thet he or she Is exempt theretrom and t�e basis for the allegetl ezemption. Any violation ot Section 7031.5 by eny applicant for a pema'. sub' s Ihe apD�iwm to a civil penalry of not more than five hundred dollars ($500).): � I, es owner of the property, or my employees with wages as iheir sole compensatlon, WILL DO THE WORK, antl the structure Is not Intended or oftered tor sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of properry who builds or improves ihereon, and who does such work hi�se If or hereelt ar through his or her own emplayees, provided ihat such improvemenis ere not intentletl or oNered lor sale. If, however, �he building or improvement Is �e61d within one year of completion, the owner-builder will have the burden of proving thet he or she did not build or improve for purpose of sale.). �a� I, es owner of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consWct the project (Sec. 7044, Business antl Professians Cotle: The coniractors License Law tloes not apply to en owner of pmperty who builds or Improvas theraon, antl who contrects for such project with a contractor(s) license pursuant �he Contractors License Wws.). ❑ I am evem der sec. � Business and Professions Code for this reason: Signeture: � Owner ID venfietl 6y drivers license. ❑ Ves ❑ No Drivels License No. � Vedlication of Ownership by (typa of documem, i.e. - pmperty ta+c bill or tleetl): DIVISION OF INDUSTRIAL SAFETV VERMIT CERTFICATON: Expires: ❑ I hereby cenify that no excevation tive (5) or more feei in depth into which a person is required to descentl, wiil be made in connection with work euthonzed by this permit, and ihat no building siructure, swffoltling, falsework, or tlemolition or tlismantling thereof, will be more ihan thirty�six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec, 341, Tltle 8, Calitornia Adminisiretive Cotle). ❑ As owner�builder, I will not employ anyone to do work which would require a permi� from the Dlvision of Industnal Safery, as noted ebwe, unless such person has e permit ta do such work irom the division. Signatura: Date: Division o1 Indusinal Safety Permit Numbec COOE I, INSPEGTIONTYPE 1876 Fized System Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Roof 201 Finel BIocWRetaining Wall 202 Final Feciory Fire Place 203 � Final Sign Final Demolition Q� IMITI�L CO�E 1 INSPECTION TYPE 206 Final Mechanical 20B Final Plumbing 210 Final Eleclrical 212 Final Fire Prevention 220 222 250 Final Planning Approval Final Site Final Building/Occupancy �� f► ��'I (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 215 DEL MAR AV Suite No A Vicinity: UNITA Parcel Nunmber: 43918132 Applicant: GOSSELIN, GREGG�L � Address: 215 DEL MAR�AVE� � COSTA MESA, CA, � . , - \ � Owner. � GOSSELIN, GREGG L Address � 215 DEL MAR"AVE� COSTA MESA, CA PLUMBING PERMIT 0 Phone: 949-650-6247 � Zip: 92627 � . . Phone: Zip: 92627 Contractoi: 'OWNER-BUILDER Address: . � � . , � -- „ _ - � � - Phone: Zip: � License: 0 � � Arch / Eng : - �, , -. , -�� -' - � . � Address: ' Phone: Zip: �. , - License: Status: ISSUED Applied: 11/13/2001 Issued: 11/13/2001 ISSUED BY: � ;'�'- �' .�� .', ,. ADDITION/REMODEL OF AN EXISTING DWELLING. 1�BATHTUB, 1 SEWER PRIVATE LINE, 1 WASH BASIN, 1 WATER CLOSET. � REF:.BOt-00918 _ . - . , � � FEESUMMARY - AMT QTY Laundry Tub / Washer $0.00 0 Landscape Irrigation $0.00 0 P-Trep � � $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 � 0 Septic Tank � � $0.00 0 SewerCapforDemo $0.00 0 Sewer Connect , . $0.00� 0 Sewer Private Llne $24.65 7 - � � ShOwer . . � , $0:00 � � 0 � Sink, bar $0.00 0 Sink, commercial $0.00 0 Sink, Floor $0.00 0 Sink, kitchen $0.00 0 Sink, service/mop $0.00 0 Spa (private) $0.00 0 Spa (public) $0.00 0 AMT ISSUE FEE � $23.50 BackFlow i«igation : $0.00 Backflow Preventer - � $0.00 Bathtub � �$9.80 Clarifier System $0.00 Connect(Ice,Soda,etc) �$0.00 Dental Units $0.00 Dishwasher $0.00 Drain, Floor $0.00 Drain, Rainwater $0.00 Drain, Roof $0.00 Drinking Fountain $0.00 Expansion Tank $0.00 Gas Earthquake Valve $0.00 Gas (i-4 outlets) $0.00 Gas (Over 4 outlets) $0.00 Gas Repipe $0.00 Gas Service $0.00 Interceptors (Grease, Oiq $0.00 Interceptors (Sand Aulo ) $0.00 QTY� 0 0 1 0 0 0 0 0. 0 0 0 0 0 0 0 0 0 0 0 9 AMT Sump Pump � $0.00 Swimming Pool . � $0.00 Trap Primer $0.00 Urinal - $0.00 Vacuum Brkr BkFlow(1-4) $0.00 Vacuum Brkr BkFlow(5+j $0.00 Wash Basin $9.80 ' Wash Basin Sel $0.00 Waste and Vent System $0.00 Water Closet (Toilet) $9.80 Water Heater / vent $0.00 Water Piping (Inst or Rep.) $0.00 Water Re-pipe $0.00 Water Service $0.00 Water Softener $0.00 OTHER $0.00 VIOLATION $0.00 PLAN CHECK $0.00 REINSPECTION $0.00 TOTAL CALCULATED FEES: $77.55 QTY 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 NOTICE: The work authorized by this permit s� equirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) � EXPIRATION: This permit shall automatically expire and become vold if work is not commenced within 180 days, or if work is suspended or abandoned tor 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 codas, and all required Inspectlona and tinal approval must De obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � zaas-ae �sroo� WORKERS'COMPENSAnON DECLANAnON: � — I hereby aHirm under penalry oi perjury one of the Following declarations: ❑ I have and will maintaln e certificate o1 consent to seN-Insure tor workers' compensation, as provitled for by section 3700 0l ihe Labor Coae, for the peAortnance of the work for w�ic� ihis pertnit is issuetl. � 1 have and will maintain workers' compensation insurance, as repuiretl by section 3700 ot the Labor CoOe, For Ihe pertormance of Ihe work for which this pertnit Is Issued. My workers' compensatlon Insurenca carner end policy number ere: Cartier: ��% PolicyNumber: (7his section need nof be complefed /llbe permit is va/ued et one hundred dollers ($100) or less.) ❑ I cerlify Ihet in Ihe peAormance of the work for which this permit is iuued, I shall not employ any person in any menner so as to become subject to the workers' compensatlon laws ot Celitomie, end agree that it I should Decome subJect to the workers' compensation provisions ot Seclion 3700 ot ihe Labor Cotle, I shell forthwit� comply wit� these provisions. Applicent SlgneNre: Data: WARNIN�: FAILUFE TO SECURE WOFiKER$' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SIIBIECT AN EMPLOVER TO CRIMINAL PENAITIES ANO CIVIL FINES UP TOONE HUNDRED THOUSAND OOLLARE (5100,000�, IN ADDRIIXJ TO THE COST OF COMPENSATION, DAANGES AS PROVIDED FOR IN SECTION 370fi OF THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm ihat I am licensed under provisions of Chapier 9(commencing with Section 7000) of Division 3 of �he Business antl Professions Cotle, end my license is In tull brce and ettecL Lic. a Class q Contractofs SlgnaNre: Date: CONS7RUC710N LENDING AGENCY: ❑ I hereby aHirtn that there is e conslruc�ion lending agency for the pedormance ot the work tor which Ihis pertnit is issued. (Sec. 3097, Civil Code). Lentlers Name: Lendefs Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aHlrm that under penelry of per�ury that I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Business entl Professions Code: Any ciry or counry which requires a permit to construct, elter, improve, tlemolish, or repair any sirucwre, pnor to its Issuance, also requires Ihe epplicant for such pertnit to tile e signed statement Ihet he or she is Ilcensad pursuant to tha prodsions of t�e Coniractors License Lew (Chapiar 9(commencing with Section 7000) of DlNslon 3 ot the Business and Prolessions CoOe) or t�et �e or she is exempt theretrom end the basis for the alleged exemption. Any violetion ot Section 7037.5 hy any epplicant for a pem+. s�ub/jects�the applicant to e civil penalry o1 not more than five hundred dollars ($500).): L7 I, as owner of Ihe properry, or my employees with wages as their sole compensa�ion, WILL DO THE WORK, antl the structura is not intentle0 or otteretl for sale (Sec. 7044, Business and Professlons Code: The Contractors License Law does not apply to an owner ot property who builds or improves ihereon, end who Ooes such work himsetl or hersell or through his or her own employees, provideC �hat such improvemenis are not intentletl or oHered for sale. If, however, �he building or improvement is �oM wit�in one year oi com0�etioq Ihe owner-Duiltler will have the burtlen ot Oroving that he or she did not builtl or improve for purpose of sale.). ��I, as owner oi the property, em EXCLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to wnstruci the project (Sec. 7044, Business end Professions Code: e conirectors Licen Law tloes not appy to an owner ol property who builtls or improves theraon, and w�o contracts tor such project with e contrector(s) license�rsuant to the Contrac 5 LicBnse Laws.). ❑ I am exem er sec. Business and Protessions Code for this reason: Signature: J� � Owner ID veritied er s icense. ❑ Yes � No Driver'S License No. �'� �� Verificetion of Ownership by (type of document, i.e. - properry ta< bill or deed): DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I hereby certity that no excavation five (5) or more feet in depih into which e person is required lo descend, will be made in connection with work authorized by this pertnit, and that no building structure, scattolding, falsework, or demolition or dismantling thereof, will be more ihan thirty-si: (3fi) feet high. (Chep. 3.2, Gry 2, An 2, Sec. 341, Tiile B, Calitomia Administrative Code). ❑ As owner-builder, I will noi employ enyone to do work which wauld require e pertnit from the Division of Intlusiriel Safety, es notetl above, unless such person �es e pertnit to tlo such work from the division. Signature: Date: Division ot Industnal Satery Permit Numher: CE CATE OF COMPLIANCE AND A ORIZATON OF E V: I cenity under penal�y of peryury ihat I have read this epplica�ion antl state that ihe information given is corre . ae to comply with ell state lew iry ortlinan s r lating lo building constmction, and authonze representetives of ihe Ciry of Coste Mese to enter upon ihe ebove- escribe rty tor inspection purpo s. I a noi U oc upy or el`ow occupancy of eny buiiding authonzed 6y th� p9rmit until fin I inspection. O i t e Of Leoal Own I I �� a�te -` CODE �. INSPECTIONTYPE 1616 Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Root 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 204 Final Sign Final Demolition �� It� SrOpE 1 INSPECTION TYPE 206 Final Mechaniwl 208 Final Plumbing 210 Final ElecMcal 212 Final Fire Prevemion 220 Final Planning Approval 222 Final Site 250 - Final Building/OCcupency Data � It� LiL\L J�JJL (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: 215 DEL MAR AV C UNIT C(GARAGE FOR UNIT A) 43918132 Applicant: GOSSELIN, GREGG L Address: 215 DEL MAR AVE - � COSTA MESA; CA �; ", � . �.�� ;. . � . _ � .. , Owner: �GOSSELIN, GREGG L � Address " 215 DEL MAR AVE- � � COSTA MESA; CA . Contracror: ,� OWNER-BUILDER Address: e ELECTRICAL PERMIT Phone: 949-650-6247 Zip:� 92627 , Phone: Zip: 92627 -Plione: Zip: .. License: 0 Status: ISSUED Applied: 11 /13/2001 Issued: 11 /13/2001 ISSUED BY: � �\ ��\ � � � � �� , .. � _ . � - �� • �� =�-z, . i. . � , � '- SCOPE OF PERMIT � ' CONSTRUCT NEW 427 SF DETACHED GARAGE FOR UNIT A!2 LIGHT FIXTURE, 5 OUTLETS, 2 � SWITCHES, 1 SUB PANELT0�200A.�REF: B01-00916� � - ` - ' � - �- , � i � � �` � FEE SUMMARY - .� . " � - ' Quantity ISSUE FEE ' Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa � _ Lighting Fixts Recept Outlets� Switches �� Non Res Appl � Res Appl Service to 200a � � Service to 1000a Service over t000a " , Motors to 1 hp Motors to 10hp Motors to SOhp Motars to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole $23.50 $0.00 so.00 $0.00 0 $0.00 0 _ � $0.00 0 - '"- $220 2 $5.50 5 . �$220; ti'-�-: 2�-��`. - . , $0.00=. ; - 0 � . " $0.00 ...�0 . $0:00 , 0 $0.00 0 $0.00 0 $0.00 , 0 $0.00 0 . $0.00 0 $0.00 0 $0.00 ' �� 0 $0.00 0 $30.50 1 $0.00 0 $0.00 0 50.00 0 50.00 0 Temp Dist System / Lighting Busway /100 ft Standing Section Misc Elect[ical Equipment Transformers up to 1 kva/kw ................up l0 10 kva/kw .............:.:.up to�50 kva/kw .................up to400 kya/kw.-., ..................over 100�kva/kw Low Voltage Equipment Low Volt Wiring System / CkJ . Misc. Conduit Misa Conductor � � . Circus ( gen or ride) , Cirws (mech ride or lights) Christmas Tree Stand � Fireworks Stand Other Electrical Fee Investigation Fee � � Plan Check Fee Reinspection Fee Quanlity ` � $0.00 0 ,' � $0.00 0 $0.00 0 $0.00 0 $0.00 ,�0 , � $0.00 - 0 $0.00 ,',' 0 $0.00 , 0 , $0.00 0 $0.00-,'0 � $0.00, - 0 $0.00 0 $0.00 0 $0.00 0, $0.00 0 $0.00 - 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES $63.90 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremants 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 1 BO days, or if work is suspended or abandoned for a period of 1 BO 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 inapectlone and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaas�ae (voo� WORKERS' COMPENSATION DECLAFiAT10N: � � - � — I hereby effirtn under penalry ot perjury one oi the following declarations: ❑ I heve end will maintein e certiticate ot consent to sel4lnsure for workers' compensation, as provided for by section 3700 ot the Lebor Cotle, for Ihe pertortnance of the work tor whlth lhi5 permit Is issuetl. ❑ I heve entl will meintay� workere' compensation insurence, as requiretl by section 3700 oi Ihe Lebor Code, for t�e peAortnance of the work for which this permit Is Issued. My workers' camper�Cation Insurance cerder and policy number are: Carrier: Policy Number: (Tiiis sectlon need not be compleretl i/ the permit Is valued ef one hundred dollars ($100) or Iess.) ❑ I certity that in t�e paAortnance of Na work lor which ihis permit is issued, I shell not employ any person in any manner so es to become suDject to the workers' wmpensatlon lawg of Calitomia, and egree that Ii I shoul7 become su6jecl to the workars' compensation provislons o1 Sactlon 3700 of [he Labor Cotle, I she0 torthwith comph/ with Ihese D�o�sions. Appliwnt Sipneture: Date: WAqNING: FNWRE TO SEWRE WORKERS' CAMPENSAiION COVERAGE IS UNLAWFUL rWD SHALL SUBIECT AN EMPLOYER TO CFIMINAL PENALTIES AND pVIL FlNES UP TOONE HUNDRED TIOUSFND DOl1ARE (5100,000). IN ADDfTION TO THE COST OF COMPENSAiION, OAMAGES AS PROVI�ED FOR IN SECiIIXJ 3]O6 OF THE IABOR CODE, ItJrEREST, AND AT70fiNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eflirm thet I em licensed under provisions of CheD�er 9(commencing with Section 7000) ot 0lvision 3 af the Business end Professions Catle, and my license is In tull farce end effect Lic. q Class u Contractofs Slgneture: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby eMirtn that there is a construciion lending agency for the pedortnance of the work for which this pertnit is issued. (Sec. 3097, Civil Cotle). Lenders Name: �entler's Atltlress: Signature: Dete: OWNEP-BUILDER DECLAFiA710NS: I hereby atllrtn ihat untler penelry at perjury Ihet I em EXEMPT FROM TME CON7RACTORS LICENSE LAW for iha tollawing reeson (Sec. 7031.5, Buslneu end Pratesslons Code: Any clry or counry which requires e permit to construct, alter, improve, tlemolish, or repair any structure, pnor to its issuance, elso requires ihe appliwnt tor such parmit to tile e signeC stetement thet he or she is licensetl pursuant to tha provisions of tha Conirectars License Lew (Chapter 9(commendng with Sec�ion 7000) of Dlvislon 3 ot the Busine tl Professions Cotle) or that �e or she is exempt tharefrom and the basis for iha alleged exemption. Any violation of Section 7031.5 by eny applicant for e pem+. sub' t�e applicant to e civil penalry ot not more then five hundred dollars ($500).): I, es owner oi Ihe proPerry, or my employees with wages es their sole compensation, WILL DO THE WORK, and the siructure is not intended or offeretl for sale (Sec. 7044, Business antl Professions Code: The Contractoro License Ww dces not apply to an owner ot property who builtls or improves thereon, antl who does such work h self ar herselt or through his or her own employees, provided ihat such imprwemenis ere not intended or oHeretl for sale. If, however, �he building or improvement Is soltl within one year of wmpletion, the owner-builder will have Ihe burden ot proving that he or she did not build or improve for purpose of sale.). I, es owner ol the property, am EXCLUSIVELY CONTRAC7ING WRYi LICENSED CONTRACTORS ro construct the prolect (Sec. 7044, Businass entl Professions Cotle: The wntractors License Law tloes not apply to en owner ot property who bulltls or Impmves thereon, end who contrects tor such pmject with e contrector(s) license Dursuaryt�il�e Conir}GWr2License Laws.). ❑ I am exam unde c. Business and Professions Cotle for this reason: Signature: Y � _� Da� Owner ID ventied b dnver's licensa. ❑ Ves � No Drivef5 Licen50 No. Verifica�lon ot Ownershlp by (type of tlocumem, i.e. - property taa bill or deed): Expires: DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify that no exwvation five (5) or more leet in depth into which a person is required to tlescentl, will be made in conneciion wilh work euthorizetl by Ihis permi�, and that no builtling structure, scattolding, falsework, or demolition or dismantling thereof, will be more ihan Ihirry-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, 71t1e 8, Califomia Adminisirative Cotle). ❑ As owner-builder, I will not employ enyone to tlo work which would require a permit from the Division of Industnel Selery, as notetl ebove, unless such person hes e pertnit to do such work irom Ihe divisian. Signature: Date: Division of Industrial Satety Permit Number: COOE I, �NsvecnoNTvve 1676 Fixetl System Final Fire Preven6on 1266 Paol Spe Final 200 201 202 203 204 Final Re-Roof Final Block/Retaining Well Final Fectory Fire Place Finel Sign Final Demolition Qejf, I R1R �QQEd INSPECTIONTYPE 20fi Final Mechaniwl 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Finel Building/Occupancy �iE u�s (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address 215 DEL MAR AV D UNIT D(GAR4GE FOR UNIT B) 43918132 GOSSELIN, GREGG L 215 DEL MAR AVE �. i: � COSTA MESA; CA.--- �. � � � �. , � � � ": � GOSSELIN, GREGG L 215 DEL MAR AVE " � COSTA MESA, CA Contractor: O W N ER-B U I LDER Address: , ELECTRICAL PERMIT Phone: 949-650-6247 � Zip: 92627 Phone: Zip: 92627 Status: ISSUED Applied: 11/13/2001 Issued: 11/13/2001 ISSUED BY: . -� Phone: � � � � � Zlp: - � . , � �` License: 0 � � - � SCOPE OF PERMIT CONSTRUCT NEW 427 SF DETACHED GARAGE FOR UNIT B' 2 LIGHT FIXTURE, 5 OUTLETS, 2� '. SWITCHES, 1 SUB PANEL�T0200A: REF: 801-0091�� -' '� -_. � � � Quantity ISSUE FEE . $23.50 Temp service test . $0.00 . Res. a/c package $0.00 New Res (1-2 units) $0.00 0 New Res (3+units) , , $0.00 0 Pool / Spa ,` . � $0.00 0 Lighting Fixts . � $2.20 2 Recept Outlets. $5.50 5 , Switches �� ' $220 ; ` `'` 2` Non Res Appl. , $0.00 � 0 Res Appl . $0.00 � � � � -0 Service to 200a A � , $Q00 � 0� � Service to t000a � „$0.00� • - . �0-.- - Service over 1000a � $0.00 � 0 Motorstolhp �� $0.00� � �•�0�� Motors to 10hp , - $0.00 � �` � �. j, 0 � Motors to 50hp - $0.00 � . � 0 Motors to 100hp $0.00 0 Motors over 100hp $0.00 � � 0 Communication drops $0.00 0 Sub panel to 200a $30.50 1 Pole Light Pkg $0.00 0 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 Intermed Pole $0.00 0 �FEE SUMMARY - - � . . � � Quantiry ,' Temp Dist System / Lighting $Q00 0 .�. � Busway7100k $0.00 0 Standing Section � $0.00 0 ' � . Misc Electrical Equipment $0.00 0 � - -�. Transformers up l0 1 kva/kw $0.00 � -0. � - • .•� ............:..:up to 10 kva/kw $0.00,. ." 0 ,� .._._........_upto�50kva/kw $0.00 -� �0 � �` .................up,to 700 kya/kw -. $0.00 " ' 0 � , � � ' � .........:........over100�kva/kw�.. � $0.00 0 � � � . ' Low Voltage Equipment $0.00 0 � - Low VOIt Wiring System / Ckt �. 50.00 ' i, 0, .� , , Misa Conduit $OAO � 0 - ' Misc. Conductor � � , �. $0.00- 0 �' �� Circus-( gen or ride) ..,� "$0:00 .'0, j Circus (mech ride or lights) '��$0:00 ��,G 0-" . . Christmas Tree Stand � �$0.00 �� !0 �Fireworks Stand � ,. � $0.00- � 0 , Other Electrical Fee � $0.00 InvestigationFee �_ $0.00 Plan Check Fee $O.OQ Reinspection Fee $0.00 TOTAL CALCULATED FEES $63.90 COMMENTS I SPECIAL CONDITIONS p 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, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within 780 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 Inapeetiona and final epprovel must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � zaaeae �s�oo� WORKERS'COMPENSATION DECLAHATON: — � ' � � I hereDy aflirm under penalry of perjury ona oi ihe following declarations: ❑ I have end will maintein e certificate of consent to selbinsure far warkers' compensation, as provided tor by sedion 3700 otthe Lebor Code, far the peAormance of �he work tor which IhlS permit is Issued. ' , ❑ I have and wiil maintain workers' compensation insurance, as required by section 3700 oi the Lebor Coda, for the peAortnance ot the work for which this pertnit is issued. My workers' compensatlon Insurarice wrrier antl policy number ere: Cerrier: Policy Number: (lhis section need not be completetl i/ the permit is va/ued al one hundred dallars ($100) or /ess.) � I certify ihat in the paAormance of tha work for which this pertnit is issue0, I shall not employ any person in any manner so as to becoma subject to the workers' wmpensation laws ol Caliiamla, end agree that if I should become subject to the workers' compensatlon provisions of Section 3700 oi the Lebor Cotle, I shall forthwith wmpty with these pravisions. Applicant Signature: Dete: WARNING: FAILURE TO SECURE WORKERS' COMPENS/TION GUVERAGE IS UNLAWFUL AND SFULL SUBIECi AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOIXJE HUNDRED TqUSAND DOLLARE (E100.000). IN NDDITION TO THE WST OF COMPENSATIqJ, DAMAGES AS PROVIDED FOR IN SECTION 31O60F THE LABOq CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTOFS OECLARATION: I hereby atfirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Divislon 3 of ihe Business antl Protessions Coae, end my license Is in full torce and ettaa. Lia a Class a Coniractors Signalure: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirtn that ihere is a construction lentling agency tor Ihe pedortnance of tha work for w�ich ihis permit is issued. (Sec. 3097, Civil Cotle). LenCers Name: � Lendefs Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn that under penalry of perjury Ihat I am EXEMPT FROM THE CONTRACTORS IICENSE LAW for Ihe following reason (Sec. 7037.5, Business and Professlons Cotle: Any ciry or counry which reQuires e permit m construct, alter, improve, demolish, or repair eny sWcture, prior to its issuance, also requires t�e epplicant tor suc� pertnit to flle signed statement that he or ahe Is licensetl pursuant b the provisions of tha Contractors Llcense Lew (Chapter 9(commencing with Sectlon 7000) ot Division 3 of tha Bus' ess and Professions Code) or that he or she is exempt therefrom and the basis for ihe allegetl exemption. Any violation of Saction 7037.5 by any applicant for a pem+' su ects the appliwnt to a civil penelry ot not more ihan tive hundred dollars ($500).): I, owner of Ihe properry, or my employees with wages as their sola compensation, WILL DO THE WORK, anC ihe sWCWre Is not intendetl or ottered for sele (Sec. Business and Professions Cotle: The Contraciors License Law does not apply to an owner of property who builds or improves Ihereon, end w�o tloes such work himselt or hersetl or through his or her own employees, proviCed t�at such improvemenis ara not Iniended or oHeretl for sala. If, however, t�e building or improvement is sold within one year ot wmpletion, the owner-builder will heve ihe burden of proving ihat he or sha did not build or improve for purpose of sale.). ❑ I, as owner of Ihe proDerry, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTFiACTORS to consiruct the project (Sec. 7044, Business and Pmtessions Code: The coniractore License Law does not appty [o an owner oi property who builds or improves t�ereon, and who coniracis for such projec� with e contrector(s) license pursuan�e Cont�ors License Laws.). ❑ I em eaemp� nder sec. Business and Pmfessions Coda tor ihis reason: Signatura: Owner ID verifie er's ' se. ❑ Y85 ❑ No Dnvefs Licen50 No. Vedtication of Or.nership by (rype of document, i.e. � properry tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: Expires: ❑ I hereby certify that no excevetion five (5) or more fee� in depih inm which e person is requiretl lo Cescend, will be made in connection with work euthorized by this pertnit, and that no building structure, scallolding, falsework, or demdition or dismantling thereoi, will be more Ihan thirty-si: (36) feet high. (Chep. 32, Grp 2, ArI 2, Sec. 341, Title 8, Califomia AOministrative Code). ❑ As owner-Duilder, I will not employ enyone to do work which woultl require a permit irom the Division of Industrial Safery, as noted above, unless such person �es e permit ta do such work from the division. Signature: � Date: Division of Indusirial Satety Pertnit Number: COOE I, INSPECTIONTYVE 1618 Fixetl System Final Fire Prevention 1268 Pool Spa Final 200 Finel R8-Roo1 201 Final BIocWRetaining Well 202 Final Faciory Fire Place 203 Final Sign 204 Final Demolition ILSI�I:Yi11rIFj GODEI INSPECLIONTYPE 20fi Final Mechaniwl 208 Finel Plumbing 210 Final Elactrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 FinalBuiltling/Occupancy �g �� (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 275 DEL MAR AV Suite: A Vicinity: FRON7 RESIDENCE Parcel Number: 43918132 npp�icant: GOSSELIN, GREGG Address: Owner: GOSSELIN, GREGG L Address 215 DEL MAR AVE COSTA MESA, CA Contrector: Address: Zip: Arch : Address: Phone: Zoning: Phone: 949-650-6247 Zip: Phone: Zip: 92627 Phone: License: Eng: Address: ISSUED BY: Status: ISSUED Applied: O6/18/2001 Issued: 07/11/2001 Phone: Zip: License: License: SCOPE OF PERMIT ADD 42 SQ. FT. LAUNDRY ROOM�TO FRONT DWELLING. CONVERT EXISITING LAUNDRY ROOM TO A NEW BATHROOM. SINGLE CAR GARAGE ATTACHED TO FRONT DWELLING TO BE DEMOLISHED. REF: DR-01-26: � Plan Check: Permit: SMIP Res: SMIP Com; Other' Inspection: Total: $22.63 $13925 $0.61 $0.00 $0.00 $0.00 $162.49 SETBACKS ' � MAIN STRUCTURE Front 0- 0 ACCESSORY Front'.0-0 PARKING Existinq: 1 NOTES: Rear 31-0 Rear 0-0 Required: �5 � FEE SUMMARY Left 10- 0 Left 0- 0 Proposed: Calc Valuation: Claim Valuation: ,�; ,' JG_�.�.� ��j� .. Righf '-22- 0 . . � Right ,-0-0 � 6 � _ � ss;osi,00 , so:oo NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access iequirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 780 days. INSPECTIONS: In order for the work authorized under this permit to be considered le9al, such work must comply with all applicable codes, and all required inspectlons and tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446-46(fi/00) WORKERS' COMPENSATION DECLAFiAT10N:/ — I hereDy aKrm untler penalry oi perjury one ol the followinq dedarations: ❑ I heve and will maintain e cenificate o1 wnsent ta self-Insure for workers' compensetlon, es pravided tor by section 3700 ot Ihe Lebor Code, tor Iha pertormance of the work for whiCh Ui5 permit 15 i55ued. ❑ 1 have and will maintein workers' compensation insurance, as required by sectlon 3700 of ihe Labor Code, for the pedortnance of ihe work tor which this pertnit is issueC. M workers' com ensatlo'a1 Insu e carrler a oli number ere: /� Certier.Y P . Y�� P� PolicyNumber. V/ � rs sectlon nee0 nof be comp/efe i�permif s v lued et one hundred dollars ($f 00J or less.) cenify that in ihe pert r ce oi the work for whi his pertnit is is ed, I shall not employ eny person in any mannar so as to 6ecome subject to Ihe workers' compensation laws of Ilfor end egrea t�at if I ho ecome u ct to t�e workers' compensation provisions of Sectlon 370 ot Ihe Labor Cotle, I shall fart�wlth wmply with these provi 'ans. --7 /� Applicant Signature: � Date: ( �� l) � WARNINO: FAIWRE TO SECUFE WO ' COMPEI A IXJ COVERAGE WFUL PND $HALL SUBIECT AN EMPLOVEP i0 CRIMINAL PENAL IES AND GVIL FlNES UP TOONE MUNDRED T10USANDOOLLFPE(5/00,000),INADDRIONTOTHE yOFCOMPENSATION,DAhUGESASPROVI�EDFORINSECTION7/O60FTHELABORCOOE,IMEREST,ANDATTORNENSFEES. LICENSED CON7RACTORS DECLARATION: I hereby attirtn that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot Ihe Business antl Professions Cotle, and my license is in full lorce and ettect. Lic. M Class a Contrectofs Signatura: Da�e: CONSTRUCTION LENDING AGENCY: �❑ I hereby aNirtn ihat Ihere is a consWction lending agency for the pedormance of the work for which ihis pertnit is issued. (Sec. 3097, Civil Coda). i, LenOers Name: Lendefs Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby aflirtn that under penalry of perjury thel I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following rea5on (Sec. 7031.5, Business end Protessions Code: My ciry or counry which repuires e permit to consiruct, alter, improve, tlemolish, or repair eny siructure, prior to its issuance, also requires the applicant for such pertnil to file e signed statemeN Ihat he or she Is Ilcensed pursuant to the provisions of ihe Conirectors License Lew (Chapter 9(commencing with Section 7000) ot Division 3 of the Busin end Professions Code) or that he or she Is exempt [herefrom and ihe hasis for the alleged exemption. Any violation of Section 7031.5 by any applicant tor e pertnit su ' is Ihe apD�iwnt to a cNil penalty of not mora than five hundred dollars ($500).): I, es owner oi the pmperty, or my employees with wages as iheir sole compensatlon, WILL DO THE WORK, and the sirucWre is not intended or oHered for sale (Sec. 7044, Business and Professions Code: The Coniractors License Law dces not apply to an owner of properry who builds or improves thereon, and who does such work himsell or herself or Ihmugh his or her own employees, pmvitle0 ihat such Improvements ere not intendetl or ottered for sale. If, however, ihe 6uiltling or improvement is sold within one year ot comDletion, Ihe owner-builder will have ihe burden of pmving that he or she did not build or improve tor purpose of sale.). ❑ I, as owner at the propeny, em E%CLUSIVELV CON7RAC71NG WI7H LICENSED CONTRACTORS to consiruct the projecl (Sec. 7044, Business end Professions Code: Th ontrectors Licen50 Lew doe not epply ro an o�yQer oi property who bulld5 or Improves thereoq and who contrects for suth prolect wlth e contractor(s) licensa p to the Cantractors Lice�ws.). I f ❑ I em e:em�t untler se . Signe�ure: � Ov.ner ID venfied by drivefs license Vedticatlon of Ownership by (type oi Ves ❑ No i.e. - properry ta�c bill or deetl): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATON: Professions Code for this reason: Da�e: ' Driver's Licensa No. Expires: ❑ 1 hereby certity ihat no excavation fve (5) or more teet in depth into which a person is required to descend, will ba made in connection with work authonzed by Ihis pertnit, and that no building structure, swffoltling, talsework, or tlemolition or dismantling thereof, will Ce more than thirty-siz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Ttle 8, Califomia Administrative Cotla). ❑ As owner-builder, I will not employ anyone to do work which would require e permi� from ihe Division of Industnal Safety, es noted above, unless such pereon hes e pertnit to do such work from the diNsion. Signature: Date: Division of Induslrial Safety Permit Number: CERTI �COMPLIANCE ANU AUTHORIZATON OF ENTAY: I cenity under penalty of perjury ihat I have read ihis application an0 state that the infortnation given is correct. I to comply with all @te laws end rt ordinances relating to building constmction, end authonze representatives of Ihe City of Costa Mesa to enter upon the ebove-des ib�rry for inspec di uryoses I ree not to occupy or allow occupency of eny building authorized by his pe mit until finel inspection. ' 7 /�l� %DI onaWr Of C9 wner . Date CODE L IMSPECTIONTYiE 1618 Fiaed System Final Fire Prevention 7266 Pool SDa Final 200 Final Re-Roof 201 Final BIocWRe�aining Well 202 final Factory Fire Place 203 Final Sign 204 Final Demoli�ion Qlyj� IN�ITA��j �Qp� INSPELTIONTYPE 206 Final MeChanical 208 Final Plumbing 210 Final Electrical 212 Flnal Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtlin<yOccupancy QSjF INTIfIALS (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 215 DEL MAR AV Suite No B Vicinity: UNIT B Parcel Number: 43918132 Applicant GOSSELIN, GREGG-L'`"� �� Address: 215 DEL MAR�AVE . � � � � -:�. " ', -- � � Phone: 949-650-6247 � COSTA"MESA, CA, - ' Zip: 92627 ' � Owner /GOSSELIN, GREGG L Address: 215.DEL MAR AVE � � � Phone: . COSTA MESQ; CA Zip: 92627 Contractor: `OWNER-BUILDER Address: � ' ' . . Phone: ` 2ip: - License: 0 0 Status: ISSUED Applied: 11/13/2001 Issued: 11/73/2007 ISSUED BY: � SCOPE OF PERMIT �. CONSTRUCT NEW TWO-STORY 1157 SF SFD. 1 INST FAU < 100K BTU, 1 FACTORY FIREPLACE, 2 VENT FANS/SINGLE DUCT-< . - . • � - � . - � REF: B01-00915' _ � _ _' _ _ _ .. _^ s .. . . : � ISSUE FEE Inst FAU <700 k BTU Insl FAU >700 k BTU Repair / AI[ Cooling/Heat Inst / Rep. Recess Wall Htr Refri9 Sys <700 k BTU Refrig Sys >100 k BTU Gas Piping � � . Factory Fireplace � � Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct '� Appliance � �� Fire Dampers ' � � Smoke Dampers . � ' � Inst or Relocate Appl Vent Air Handlers < 10000cfm �. AirHandlers> 10000cfm ' Floor Furnace � Floor or Suspend Heater Quantity $23.50 , $14.80 1 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $10.65 1 $0.00 _0 $0.00 0 $14.50 2 $0.00 0. $0.00 0 $OAO 0 $0.00 , 0 $0.00 0 $0.00 �� 0 $0.00 0 $0.00 0 FEE SUMMARY , Repair/AltAbsorbtion Unit - Repair / AII Refrigeration Unit Ventillation System Evaporative Cooler Commercia l I nci ne rato r Domestic Incinerator � � � Compressors / Absorption Systems " Upto3hp/100k8TU . 3To15hp%SOOkBTU - 15 To 30 hp,/�1,000 k BTU - - 30 To.50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU � Boilers ' ' - _ - � , � Upto3hp � � - -� - � 3To15hp � . � � 15 to 30 hp �. ;'- � 30 to 50 hp , . ' � Over 50 hp � . � Other Mechanical Fee � ' Investigation Fee . Plan Check Fee Reinspection Fee $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES $63.45 COMMENTS / SPECIAL CONDITIONS � Quantity , O. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 72-21-92) � 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 ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspactions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 , zans-<e �erao� WORKERS'COMPENSAnON DECLAFiAnON: I hereby eHirtn under penalry oi perjury one of the tollowing declaretions: � ❑ I have antl will maintain e cenificete of consent to seH-Insure tor workers' compensation, as provided tor by section 3700 of the Labor Cotle, for the pertormence ot Ihe work for which this Dermit Is Issuea. ❑ I have antl will maintain workers' compensation insurance, az requiretl Gy seIXion 3700 ot Ne Labor Code, for tha pedortnance ot the work for which Ihis pertnit is issuetl. My workers' compensatlon Insurence carner end policy number are: Carrier: Policy Number: (11iis section neetl nat be comp/eted il the permit is valued et one hundred dollers ($100) ar IessJ ❑ I certity that in Ihe pertortnence of ihe work for which this permit is issued, I s�all not employ any person in any manner so es to become subject lo Ihe workers' wmpensa[lon laws of Celifomle, entl agree Ihat if I shoultl become sub�ect to the workers' compensation provislons oi Sectlon 3700 o11he Labor GoOe, I shell torthwith compty with Ihese provisions. Applicent Signature: Date: WqRNIN(3: FAILURE TO SECURE WORKERS' WMPENSAiION COVERAGE IS UN(AWFUL PND SHPLL SU�ECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED TVIOUSAND DOLLARE (5100,000), IN ADDRION TO THE COST OF COMPENSATION, OAMAGES AS PFOVI�ED FOF IN SECiION 3%O6 OF THE LABOR ODOE, INrEREST, AND ATTOflNEY'$ FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm that I em licensetl under provisions ot Chapter 9(commencing with Section 7000) oi Division 3 of the Business end Professions Cotle, end my license is In full lorce and ettect. Lia k Class u Comradofs Signamre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hareby aHirm ihat there is a consWction lending agency for the pedormance of the work for which this pertnit is issued. (Sec. 3097, Civil Code). Lenders Name: Lentler's Address: Signeture: Date: OWNER-BUILDER DECLARA710NS: I hereby aNirtn that under penelry of per�ury t�ai I am EXEMPT FROM THE CONTRACTOHS LICENSE LAW tor the tollowing raeson (Sec. 7031.5, Business antl Protessions Code: Any ciry or counry which requires e pertnit to construc6 alter, improve, demolish, or repair any structure, Onor to its issuance, also reqWres the applicant tor such pertnit to file e signetl statement ihat he or she Is licensed pursuant to Ihe pravisions at ihe Contrectors License Law (Chapter 9(commencing with Section 7000) 01 Divislon 3 ot the Busine and Proteuions Cotle) or t�et he or sha is exempt iherefrom end the basis for ihe alleged azemption. Any vloletlon of Section 7037.5 Dy eny applicent for e Dertr+' sub s the applicant to e clvll penelty of not more Ihan five hundred dollers ($500).): I, as owner oi the properry, or my employees with wages as iheir sola compensation, WILL DO THE WORK, and the structure Is not intentletl or oflerad tor sale (Sec. 704d, Business and Pmfessions Cotle: The Contrecmrs License Law does not apply m an owner oi properry who builds or impmves thereon, end who aoes such work h' selt or hereeN or ihrough hls or �er own emplayees, providetl ihat such impmvements are not intentled or ottered tor sale. It, however, the building or improvement Is old within one year of completion, the owner-builtler will have ihe burden oi proving ihat he or she tlitl not build or improve for purpose ot sale.). I, as owner of Ihe property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo construct the projact (Sec. 7044, Business and Professions Code: The wntractore Llcense Lew does not appy to an owner ot property w�o builtls or improves thereon, and who comracts tor such project with e contrector(s) license Dursuar�yl�iFB ComreMqre4icense Laws.). ❑ I am eaem ntler s Business and Professions Cotle for this reason: SignaWra: i �� Veritication of Ownership by (rype of daumen�, i.e. - property tan bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: Expires: ❑ I hereby ceriify that no eacevatlon tive (5) or more faet in depth inro which a parson is raquired m descentl, wlll be mede in connection with work euthonzetl by Ihls permit, and that no building sWCWre, scaflolding, falsework, or demolition or dismantling ihereof, will 6e more than ihirty-slx (36) feet high. (Chap. 32, Grp 2, Atl 2, Sec. 341, Title 8, Calitomia AtlmlNsiretive Coda). ❑ As owner-builder, I will not emplay anyane to do work w�ich would require a permit trom ihe Division of Industnal Selary, as noted ebove, unless such person has e pertnit to tlo such work irom the division. Signatura: Date: Division ot Indusirial SateTy Pertnit Number. COpE 1, INSYECTIONTYPE 2�L IMRIALS 1616 Fizetl System Final Fire Prevention 1286 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Well 202 Final Factory Fire Placa 203 Final Sign 204 Final Demolition CODE 1 INSPECTION TYPE 206 Final Mechanical 208 Final Plum6ing 270 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy �.1. PII_ � i ��/ • f , (714) 754-5273 • Fax (714) 754-0856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 215 DEL MAR AV Suite: D Vicinity: Parcel Number: 43918132 npp�icant: GOSSELIN, GREGG Address: Owner: GOSSELIN, GREGG L Address 215 DEL MAR AVE Contractor. Address: Zip: Arch : Address: COSTA MESA, CA Zoning: Phone: 949-650-6247 Zip: 92627 Phone: 949-650-6247 Zip: 92627 Phone: License: Eng: Address: ISSUED BY: Status: ISSUED Applied: O6/18/2001 Issued: 07/11 /2001 Phone: � Phone: Zip: License: License: . SCOPE OF PERMIT CONSTRUCT 427 SQ. FT. DETACHED GARAGE FOR NEW BACK DWELLING UNIT. REF: DR-01-26. � . � Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $29.45 - $18125 $0.96 $0.00 $0.00 $0.00 $211.66 F SETBACKS �.�� MAIN STRUCTURE �Front � 104- 0 ACCESSORY Front 0- 0 PARKING Existinq: o NOTES: FEE SUMMARY � ��' . Rear . 1-0 Rear 0- 0 Required: 0 - = Calc Valuation: ' Claim Valuation: , , PLANNING & ZONING '�. . _ .'�' � . .' Left 6- 0 Right 2- 0� - ." Left 0-0 ' Right 0-.0 � i Proposed: 0 . $s,so�so $o.00 ' I; NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 raqulred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244fi-46 (N00) WORKERS'COMPENSAnON DECLAHAnON: — � ` I hereby eflirm under penalry of perjury one of the tollowing tleclarations. .. , ❑ I have end will maintain a certiticete ol consent to self-Insure tor workers' compensetion, es provided for by section 3700 of the Labor Code, for ihe paAormance ot ihe work tor which l�is pertnil is issued. ❑ I have and will maintain workers' compensation insurance, a5 required by secGon 3700 of the Labor Cotle, for Iha peAortnance of cpaworrr��fffor which Ihis pertnit is issued. My workers' compensation Insuran� cayieiand qolicy�ber are; / �/� Cartier. L � � y �`� PolicyiJumDer. �J� �(This s ctlon need not be p/efetl il Ne pe /t is velued t one ndred dollars ($100) or less.) � certity that in the peA ce oi Ihe work for whic� this permi 's ued, I sh not amploy eny person in eny manner so as to become subject to the workers' compensation lews of C ito ' nd egree thet II I should beco su t to t workers' compensation provisions o1 action 3700 of the La6or Cotle, I shell fonhwith comply with �hese Orovisi 5. �� I-�� Applicant Signature: � Date: —�- WARNINO: FAILURE TO SEIXIRE WO ERS' COMPENSATIO CA ERAGE IS UNLAWFUL PND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUNORED iiN%15AND DOLIARE (5100,000), IN ADDITION TO THE WST PENSATION, DMNGES AS PROVIDED FOR IN SECTION 3]OB OF THE tABOR COOE, IMEREST, AND ATiORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hareby ettirtn Ihat I em Iicensed undar provisions ot Chapter 9(commencing with Section 7000) ot Division 3 of the Business end Professions Cotle, end my license is in full f'o/rge' a/r�/ e'/Xgtt.�UC. M Cless A yOn�eq�oyS/Slg2emre:_ Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirm ihat Ihere is a consiruction lending agency for the peAormance ot the work for which ihis permit is issuetl. (Sec. 3097, Civil Code). Lentlels Name: Lender's Address: Signatura: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirtn thal untler penalry oi perjury thei I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Busineu end Profeuions Code: My ciry or county which requires a pertnit to construct, elter, improve, demolish, or repair any siructure, pnor to its issuance, also requires ihe applicant for such permit to file a slgnetl statement ihat he or she is licensed pursuant lo the provisions ot the Contrectors License Law (Chapter 9(commencing wit� Section 7000) ai DIvlSion 3 oi the Business end Protessions Code) or that he or she is exempt therefrom and Ihe basis for the alleged esemption. Any violation oi Section 7031.5 by eny applicant for e permit ubjec t�e appllcan� �o e civil penal�y of not more Ihen five hundred tlollars ($500).J: I, es owner of Ihe properry, or my employees with wages es iheir sole compensation, WILL DO THE WORK, and the s�ructure Is not intended or otteretl lor sala (Sec. 7044, Business and Professions Code: The Contractors License Ww does not apply to an owner of properry who builtls or improves ihereon, and who Coes such work himself or herself or through his or her own employees, provided that such improvemen�s ere not intended or otteretl for sale. If, however, ihe builtling or improvement is sold wit�in one year oi completion, the owner-builder will have ihe burden ol pmving ihat he or she did not build or improve for purpose of sale.). ❑ I, es own f the properry, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Sec. 7044, 8usiness end Pwfessions Code: The acrors License Law dces not epply�an owner of propeny who bullds or improves thereon, and who contracis for such projed with a conirector(s) licensa our ant e Contractors Li�$ase Lews. ❑ I em e:emp unaer sec. SignaWre: Owner ID veritietl by dr'rvers licen� Veritication of Ownership Dy (rype Business and Professions Code for this reason: ❑ Y85 ❑ No i.e. - properry tax bill ar deetl): Drivels Licensa Na. Date: Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � ❑ I hereby certify ihat no evcavation tive (5) or more feet in depth into which a person Is required to descand, will be mede in connec�ion with work euthonzed by Ihis permit, entl Ihat no building struclure, scaHolding, talsework, or demolition or tlismantling thereof, will be more than ihirry-six (36) taet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Title B, Califomia Adminisirative Cada). ❑ As ownerhulltlar, I will not employ anyone to tlo work which would require a permit from t�e Division ol lndustnal Safery, as noted abrne, unless such person has a permit to do such work from the division. Signatura: Date: Division oi Industnal Selery Permit Number: [d7 ]�7<fZFi7�nd•P.i1"l9� 1616 Fized System Final Fire Prevention 1266 Pool Spa Final 200' 201 202 203 204 Final Ra-Roof Final BIacWRetaining Wall Final Factory Fire Place Finel Sign Finel Demolition QLg �MIi1RL5 COOE I INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Preven�ion 220 Final Planning Approval 222 Final Site 250 Final Building/Occupanry L�� ►Z�i3�6L- I[�fi (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2'IS DEL MAR AV Suite: C Vicinity: REAR OF PROPERTY Parcel Number: 43918132 npplicant: GOSSELIN, GREGG L Address: Owner: GOSSELIN, GREGG L Address 215 DEL MAR AVE Contractor: Address: Zip: Arch : Address: COSTA MESA, CA Phone: Zoning: Phone: 949-650-6247 Zip: Phone: Zip: 92627 Phone: License: Eng: Address: ISSUED BY: Status: ISSUED Applied: O6/18/2001 Issued: 07/i t/2001 Phone: Zip: License: License: � SCOPE OF PERMIT CONSTRUCT 427 DETACHED GARAGE FOR UNIT A. REF: BOt-00915. DR-01-26. ' � �- , Plan Check: $29.45 Permit: $181.25 SMIP Res: $0.96 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 FEE SUMMARY Calc Valuation: Claim Valuation: �$9,607.50 so.00 Total: $211.66 �� . � . � • � � ' :'>�:' ` ., - � ,, j � , , , , PLANNING-&ZONING-, �.,y .� � SETBACKS -�� , � MAINSTRUCTURE�Front 6-0 � Rear 10-6 Left 1-6 " - Right �29-0 ' ACCESSORY Front � 6-0 � Rear 6-10 Left 1-6 Right': � 29-0 PARKING Existin : o - Required: 0 Proposed: 6 � .., �. NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 244&a8(&00) WORKERS' COMPENSAnON DECLAFiAnON: � � I hereby affirm under penalty ot perjury one ot the tollowing Ceclarations: ❑ I have end will meintain e certificate of consent to self-Insure tor workers' compensation, as provided tor by section 3700 ot the Lebor Code, for the pertormance of the work for whlch t�ls pertnit Is Issued. ❑ I have and wlll meinWin workers' compensation insurance, as required by section 3700 oi the Labor Catle, for ihe peAormance of tha work i r whicli this pertnit is issued. My woBers' wmpensation Insura rtier a Q policy number ere: Carrier: - E��v Policy ivumber: . . is ctlon nee�p fed i/ he permit valuetl et one hundred tlWlers ($f 00) or less.) I certify thet in Ihe perfarmance oi the work f which this Oe it is issued, I shall not employ any person in any manner so as to become subjaa to t�e workers' wmpensatlon le i Celitomie, and agree tha shoultl D e sub�ect to tha workere' compensation provisions ot Section 3700 oi the Labor Code, I shall torthwlth comptywiththese ov � . %f II I�l I Applicant Slgneture: ' Date: WAqNINp: FNLURE TO SECURE WORKERS' T1dJ COVERAGE IS UNLAWFUL AND SHALL SIIBJECT AN EMPLOYER TO CRIMINAL PENALTIE�L FlNES UP TO IXJE HUNDRED TlIOUSANO �OLLARE (E100,000), IN ADDfiIIXJ TO E COST OF COMPENSATION, DMUGES AS PROVIDED FOR IN SECiIIXJ 3]O60F THE L4BOR CODE, IMEREST, AND AiTORNEI"S FEES. IICENSED CONTRACTORS DECLARATION: I hereby aHirm Ihat I em licensed under provisions of Chapter 9(commencing with Section 7000) oi Division 3 of Ihe Business and Professions Code, and my license is in full force end aflect Llc. q Class N Coniractors Signeture: Date: � CONSTRUCTION LEN�ING AGENCV: ❑ I hereby aNirtn that there is a wnsWction IenCing agency for the pertortnance of ihe work tor which ihis pertnit is issued. (Sec. 3097, Civil Coae). LenOer's Name: Lendels Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirm thet under penalry of perjury Ihat I am EXEMPT FROM THE CONTRACTORS IICENSE LAW for the following reason (Sec. 7031.5, Business antl Protessions Code: Any ciry or county which raquires a pertnit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance, elso requires the applicant tor such permit to file e signetl statement ihat he or she is licensed pursuant to the provisions of tha Contractors License Lew (Chepter 9(commencing with Section 7000) of Divislon 3 of the Business end Professions Code) or ihat ha or she is eaempi therefrom end the basis tor the alleged exemption. Any violation of Saction 7031.5 by any applicent for a permit ubj s ihe epplicant ta e civil penelry ol nat mora than five hundred dollers ($500).): I, as owner of tha properry, or my employees with wages as iheir sole compensation, WILL DO TME WORK, end the siructure Is not intendetl or oXeretl for sele (Sec. 7044, Business and Professions Code: The Gontractors License Law does not apply to an owner of property who 6uilds or improves thereon, and who tloes such work himself or herseN or through his or her own employees, provided ihat such improvements are not intended or ottered for sele. If, however, ihe builtling or improvement is sold within ona year of completion, the owner-builder will have ihe burden of proving that he or she did not 6uild or improve tor purpose of sale.). ❑ I, as own of t�e propany, am EXGLUSIVELV CONTRACTING WITH LILENSED CONTRACTORS to construct ihe project (Sec. 704a, Business and Professions Code: The rectors License Law dQes not app�/lp an owner ol propeny who builtls or improves Ihereon, end w�o comrects tor such pmlect with a contrector(s) license purs an the Contraaors Lij�q,e Wws�1 � ❑ I am ezempt tler s Signature: Owner ID veritied by dnvers license. Verification of Ownership Dy (rype of �Business and Professions Code for Ihis reason: Date: ( Ves ❑ No Drivefs Licanse No. Expires: i.a. - pmperty tav 6ill or tleed): DIVISION OF INDUSTRIAL $AFETY PERMIT CER7IFICA710N: ❑ I hare6y certity ihat no eacavation frve (5) or more faet in depih into which e person is required to tlescend, will be made in connection with work authorized by this pertnit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereot, will be more than thirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 347, Title 8, Califomia AtlmlNstretive Cotle). ❑ As owner-builder, I will not emplay anyane to do work which would require e permit imm ihe Division af IndusMal Salety, es noted ebove, unless such person has e pertnit lo do such work from ihe division. Signawre: Date: Division of Indusirial Sefety Permit Number: CODE �. INSVECTIONTYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Rool 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition D�TE �� 1 INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSite 250 Final Building/Occupancy �ATE INTRIALS ✓ PFOJECT RUOflE55: 2 S S DEL i"1� �iV OWNEBIS NFME: MODELL S aooness: z 15 DE� MAR AVE . COSTA MESA,CA 92627 646-5933 pPCHIENGINEEP: - flEG.NO.: IINIT: ADOflE55: ' ' UNIT: PEflMITTEE: NOCK PLUMBZNG ( 714 ) 895-1246 nooness:' 11610 SEABOARD CIR STANTON CA 90680 LICENSEU CONTBACTOB OECIAflRTION: I hereby aifirm �ha� I am Iicense0 untler pmvisions ol Chapter 9(commencing with Section 7000) oi OiNsion 3 oi Ihe Busness and Pmiessions Code, antl my license is m fulliorce and eilec�. ' cirr uc.: O50 STRTE LIC.: S S i 9.% S� 36 ne: 5ignaiure: — _ _ — JflREFS' COMPENSPTION �ECLABATION: I hereby a��irm that I have a ceni�iCaie of Con5enl Io Self-insure or a tetlifitate ot Workers' .,ompensalion Insuran c rtifie copy �hereof (Sec�ion 3804 Lab. , voucv No.: 11 ��/� ��19 S E%P. OATE: 3 I O S I9 i comvnNw STATE • ❑ Cenihetl copY is �ereby lumishetl. LI Cemhetl copY is liled v h t�e ciiy Building Oivision. Oale: � � D �� ' qpplicant: � �� D ENEMPTION FBOM WOXHEBS' COMPENSATION OECLAFBTION: Qhis section need na� �e campleted il lhe permit is tor ane hunAred (5100) or less). I cetlily thal in Ihe perbrmance o� t�e work lor which Ihis permit is issued. I shall not employ any person in any manner so as to �ecome SuDlec� to t�e Nlorkers' Compensalion LawS oi Califomia. Oate: - 'Signature: - " NOTICE: II, alter making Ihis declaratioq you shoultl become subject to �he Workers' Compensation pmvisions oi �he Labor Catle. you mu5i lotlhwith compty wiih such provisions or �his permi� shall 6e deemetl revoke0. CONSTPOCTION LENDING AGENCY: I hereby a��irm �ha� Ihere is a cons�mc�ion lentling agency tor the petlormance o� the wark �or �I which Ihis permii is issued �Sec�ion 3097. Civ. C�. LENUEN: ROUHESS: - ' ' OWNEH BOILOEfl DECLAflPTION: I hereby aflirm ��at I am exempi trom ��e Contrac�ors' State License Law for the �ollowing reason (Sec�ion 7031.5 Business and Pmtessional Cotle'. Any cily ot coun�y w�ich requires a permii �o constmcl, atle�, impmve, demolish, or re0air any stmc�ure. prior lo iis issuance, also requires Ihe applicant for suc� permi� to tile a signea sia�ement ��at he/she is IicenS¢tl , nursuani io Ihe pmvisions o� the Comrat�ors' S�ate License Law (Chapter 9(commencing wiih Seclion 7000� oi Oivision 3 0l �he Business ::'.Pmfessions CoOe) or Iha� he/she is e�empl thereirom antl Ihe basis tor Ihe allegetl exemplion. Any viola�ion ol Sectian 7031.5 by "-��i0�licanl br a permi� suble��s ihe applicant �o a civil penalry of nol more �han five hunOretl Oollars ($500). � �„ � I, as owner oi the pmpetly or my employees wi�h wages as ��eir sole compensation, will Oo Ihe work, and Ihe ❑ stmcmre is not inientletl ar offered far sale (Section 7044. Business anU Pmtessional CoOe: The Contmcrors' Stafe License Law tloes not apply to an owner of a pmpetly who builds or improves I�ereon, and who does such work himself/he�selt o� �Amugh �is or her own employees. pwvidea �ha�'suc� impmvements are not imentletl or o��ered lor sale. I�, however �he huilAing or improvemeni is sold wi�hin one year ol completioq the owner will have the burtlen ol pmving he/she aia noi huild or impmve for ihe purpose of sale�. ' ❑ I, as owner o� ihe pmpetly. am exclusively canVacling wi�h licensed conUac�ors to constmcl the pmlect (Sec�ion 7044.�Busine55 antl Pmlessions Cotle: The Conirac�ars' S�a�e License Law tloes nat apply lo an awner al pmperty who huilds or impmves thereon and who con�mcls for such prolec�s wi�� a coniraclor�s�license pursuant to �he ConVac�ors' State Licens¢ Law�.l am aware Ihai pmof of �heir Worker'S Compensation insurance shoultl be providetl to me. , � I am ezempi un0er Sec�ion: B. 8 P. G. lor Ihis reason: , �aie: ' Owner I Oo hereby cenily Ihai I am aware ol antl untlers�and the requiremems of Calilomia Heal�h and Sale�y Cotle Sections 255Q5, 25533. an0 2553a antl ihat I or any lulwe building occupanl wiil/will not (circle one) need to comply wilh saitl s�ate cotles an0lhe requirements for a permil lar consVuction or motlifica�ion �mm �he Air Oualily Management Disiriq. Re5i0eniial con9mc�ion applicalions are exemp� Iwm Ihese pmvisions. , Dale: Applicani: I here6y cer�ity t�at I have rea0 this applicalion an0 s�ale Ihal ihe above informalion is correci. I agree �o compty wiN all cily an0 coun�y ortlinances ad0 Slalelavrsrelaiinglo �uiltling conslmclion an0 here�y authorirerepresentatives ollhis cityto enleruponihe above�meniionea properiy brinspection purposes ///�yyp�� Oale'. ��_Ie��1=1_'___ Signaiure: � � � Driver's License or Social Security a: ' ' � t60L06 While—Builtling; Green—Code Enlorcemem: Wnary—Applicanl: Pmk—Revenue: Goltlenratl—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO:,P 051074 ' PERMIT NO: P 051074 , PLAN CHECK NO; N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE:' PLU � PURPOSE: OTH JOB DESCRIPTION ; CHANGE OUT WATERHEATER ' SQ FT:�'�: '' CLAIM VALUE: CALC—VALUE:• ' � -GROUP OCC; R-3 / COMMENTS; CHANGE OUT OF WATER HEATER • �e�t*�t***+��tre�t**�t�t�t*�t*�t�t�e�t�**�t��e*�t�t�t��t**+t�t*�t****�r**�tx �r*�r***�t***��tx�**+t**�t+t**+��t� ** � Z O N I N G R E Q U I'R E M E N T S S E T B A C K S � _ ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ------'--- FRNT; FT IN REAR: FT IN FRNT; FT IN REAR:, _ FT. IN LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV; PARCEL: 43918132 ZNE; REF NO: � • PLANNING Nt51'ES> , � . � ' "� . . . ' . • .�. . �f it 1F �f if 1F iE if if 1f M iFlf if iF dF 3F if iF 1E iF it 1F iF M �f if iklf M iF i! if !f iF 1F if iflE iF�E ik if �f �E 1E;If iklf if if 1E iflk iF iF 3E if aF1F iE if ik If if iF If iF if iE if if iE df if� �k�f # k D E V E L O P M E N T S E R V I C'E S�.', R E Q U I R E M E N T S ZONING APPROVED BY � �DATE: � .. 7 � , . BUILDING APPROVED BY': �. DATE; r, y . APPLZCATION ISSUED BY: DATE• L Z Vr ' 1EiFiFiEiE�F.IFlfifiFitlllFiFiFkMiFMlflEiF'�FR"R�7F7 3F'iF' ikiFlFlEiE�fifMiEiE iEiE 3EiFiEiFiFiEifjFiFiFMiF�EiFaElfiF±fk�FaE�F�fIfiFlfk�E3FifiFififiF�E%MiF �FlfifKlFIFlEkifiEiFiEifiF�fiflE�EiFif1E1f1E1f1E1EkifiFMiFaFltif�FlfiFjfif LEGALIZATION:N F E E S U M M A R Y �� STRUCTURAL SEGMENT:N� BLDG PMT PLUMBING ELECTRIC �MECHANIC FIRE SMIP/RES GRADING PERMIT • 2 00 ' '15Y 'SMIP/NON—RES PLAN . ISSUE FEE 3.00 HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK ' TOTAL, ��PAID ' DUE TOTALS----> 2,00 3.00 0.00 5.00 5.00 ,00 REVENUE DIVISION TOTALS--> COLLECTED; ' S.00 OVER/SHORT; ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 5:00 , iE jF if if if IE �t �f �E iE 1f if if iE iflE iF iE k ik �If iE iF 1F if iE iF iF 1k iE iF M 1f if If �E iE if iF iF k iF iE if k iE 3f iF iF If K k ik IE if %iE if iE iE iE iE if k iE ik iE iE if iE 3f if iE iE iE k kik 3f I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 WATER HEATER AND/OR VENT END OF FEES i � 2,�0 2,�� 0 C�1 GilG3?4'1:'.—OQC�B?4l2 i �l"i(' .`.�,t14 RhT'E: 73/2.2iS1 iittE: 1�:34 CONSTRUCTION AND PLAN+__..G ?OOL & SPA � APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector 1. Temporary Electrical Servfc'�p or Polg�„_ � 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd_. �• � •�'� 53. Steel Reinforcement - > r•^, a, c.... n .Y t_ ,.,3�Ele'ctrieal Condui,i�Uiility-Undrgrnd,�'.rt� � 54. Forms ' J "�-+ 4CEIEctrfcal Conduit:Undrgrnd. '�� 55. Electrical Bonding ��n (�. 4 ' :l ,;. 5: Sjgel Reinforcem'g'n� ,; 56. Rough Plumbing & Pressure Test L �6.�.-iE1@ctrical UFE�R�f,rnd. `- 57. APPROVAL TO COVER�GUNITE i,; - ... � 7.aFontings ��: �' � 58. Electrical Conduit•Undrgrnd. cr B.i�Foundation " ~ ' 59. Gas Pipe, O Undrgrnd., Test ,�y ^ 9. Water Pipe-Undrgsd. , . 60. Backwash Lines, P-Trap, � Undrgmd. . 10. Structural Fioor System � 67. APPROVAL TO�DECK . 11. 2operty Sewer Lin $ HoGse Conrt2ction 62. Backwash & Receptor-Final _ 12. Sewer Cap �, � � • 63. Heater & Vent-Final ,- 13. Roof Drains �- 64. Plumbing System - Final � ,r. 14. flough Plumbin'g " 65. Electrical-Final 15. Rough Electrical-Condu�t � 66. So�ar SYstem-Final 16. Rough Electric�Jiring 67. Fencing & Access Approval 17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING 18. Rough Electricaj�T Bar Ceiling � 69. POOL{SPA SYSTEMS FINAL " 79. Rough Heating & Air Conditioning FIRE DEPT. FiEQUIREMENT - - �^s-:�z;[- :F F ' 20��Roiigh f.3ctor.y F�eplace . i+:tn �L" > _• .: �'x'< � ppROVA'LS?�CPer'Tnit# ' �' ' �: S rD c 2� I�[r �XC :> CY ti C: ' ] v' - 2L_Du�ts,irr�Str�uctur,e� j .... rS S ' �x � �70. hJndeignoUnd•Hyifro - �i, 22 �Ducts, V^ntil2ting.'� . (�:S _ � S •t�f -+. �-77. Produc�' ,iping D��s Q'lOil :r ..• �• CS. �' - ,-oc ..� _ rr �. � r. J •? 23.,�C'ias�Pipe�Ro�gh &��est � i,;� r� - ` �;,:.� .�72. Undergiopnd Flush:� :.: " - 24�Roof Framing �=-E^ ^.rt '? � 4�y Y s�3lrUndergma'Stora�g�.iank��Gas OOiI � S,r s n: .. �n r� : r�- . � :� ` �. � 25. Roof SYteathing :vy; � •� .* �. i3:4 y 74; Overhead �lydro,� � . 26^ T-Bar Ceiling (St�ueturel) &.tvlonocoat �- tr " !ne- -a 75� Dry Chem'ical - ' �- '� s �..� � � : -� . ,, . .s 27 =Fra�ne aod Flashii�_ �� , �.`, � �� , ' � 76'-Dr Standp'qe `_'�Dr � i � "� i,� v :, '1: ?- n:::: Y ! ,,. � .w r-w�^ .. ... r . ..,�.', .� ,.. �-28 iLat}7ing:& SidingJ � � ' _•�;_ K `• s' .. ••� 77r FIXED SY�ENF �I�AL�� J '�29. Insulatiqn ~?. ".;,.. .. � • c� � x . . � . . :- " rn � � � � 3a S I «�.,. 78s;FIRE PREV. FINAt ?� �s; :q ��'30. Drywall�.Nailinq F-x � �� w L �au•�'• �HEALTN�DEPT[ FEQUIREMENT �31. Plaster 87owuxCo'3t'�, � ' ,r•„• . � -fh :� r79 �F'INAL'INSP_ECTIgN '� " � e; t-32.�ElectricatPower Meie,�Final� Y�� = t� I '.�Ot�F00D CERTIFCC/ITE ISSUED^ � /� ! K .. . :� � ^ �. 1 � i < ^ �f � i. �33:�.Fin�.l E(�ctric, r�; t� i � ;` [ , I '�i; "Notes: .rj �-.M = �-, O �:�, LL' ' V. . - r-� v, .r �+. : .. � t^ �.. � n_34rfinal Heating & Air.Conditio�n�g� �^ � ,�;•� [. :. GC S ei x S:= _ 1: {r� �{^ '. . � , ti.c: `: a 1 ` ��h\* . , �� .�js * v- �� '35._Final Gas Pip€-Test'- w � , �i :2 -5 � {:•2� i �.CO _ `�'� �i�' : : a _ • • -+ , ` "� ` ;36' Hoqd or CanoPv , b•'-7 � :^. 1 � ��: � Cic r- � 4 s �r�. rr� m ^37�Fin�l Factory Firep�ace^ ' s�r °,' ' �'' � U � ' `, ; 1O R 1 rE- �.''c � w i.7 =38. Firnl Plumbing ,i .hp_ .• .. �S �j� ( [,�j�< �` ,�,"-� i-� �y . :39. Water Service�Finalx V � �• M � � � � • � �r " « . S T x � 1 iF v ,,� .. ,,,40. Gas Service-Final .; :� ,;,;;r•p. � x_ �, � � . �j�, � �� ' :5'47. Solar pomesticFinal5 r " `�='' � I y, r b' 40 ^� � X = 42.�8ackflow Preventer� �f �: �, �'' � ! �; _ � �F •.:� 43. Backflow Irr%yation' ^�•S � x` '^�"' * � �^ �. � � r . , u:u: � �- �� s v �: �44. Landscape liripation SYstemy�,�� t: �r tr� t7 �. .{ 's, 0; pJ ;r,G :t {u U �45'Sound Atterwation< =a:. *' z= F-' i� C'�� " - '-' r. ^'-_ �:-Z . �i r.� .� rn tr [r.. C K FC �46.`Handi� Regulatio�jis �' '� , '�� ` '� � � ;y p � � �_{ �. 'T ir; ,ti.�' �47.<_PINAL STRUCTURE & BUItDING y� j ��r r. `. (�i 5 : �.: � 48:�FIN�L PLANNING�. i�.F.. t�; ( I `r. �- i r x � � i c49 =Electric Release to Edison � � �r r< r.�C � � � �'7 ..�i Fr :a r:� d .;`l r . .. .. .. � ' . -�� r. :5 c c:L . c , +., �50. Gas-Release to Sout}�em California Gas Co ; i_� .� i,y , p . :51. CERTIFICATEOF,OCCUPANCY ;; ;:;; 5 ;� ;�;� - r ,- ,. No. Pate �I yl �� ADDPESSOFBVILqNG: �'� rj �:L ��R yZ„� OWNEX'SNRIAEIFplOWN: VUSSELIN, GREGG L ADDHE55: : 1 j DEL P4AP. AC'E cosTA r1FsA,ca �aa�. xauxc nooecss: AXCNRECT OH FJNiNFFP: CONiH1CTON'SNAME: CdiiHACTOX'SNYLNG /i00PE55: 9`1627 uc no.: 11C. N0: uHr: CITy pc CUSTA t9ESA — �JILnIP]G PEP.PI7T PERP3IT NO: 9 072363 FLAP: CHECK NU: `] COAISTP,zJ�_TIOr7 TYPE; PERP9IT TYFE; STR uxr: urir: LICENSEU CONTNpCTONS DEG�AAAT�ON: I hareby allim under paneMy M perjury ihet 1 em Icansad undm povoions d Chm�er 9 (wmmana�p wi�h Senion ]000) 0� �sbn 3 d t�e Businea aM Proleeaons Code, eiM my licenae ia in full torce end eHecl. CfTY LIC. NO.: ll0. CLASS: LIQ NO.: �S(ri ; oate: � cam,aen: OWNEH BUILDEfl DECLAXATION: I hereby eifirtn under peneYy�d perjvry ihet I em exemq Irom the Contree«a Licenae Lew (or ihe wing ramon (Seeion ]031.5 &i%iness anC Prdessiom COEe: Any cey n counry whid� requires e pe�mit lo mnatruM, elier, improve. of h, or repe'v any simclura. � to As oauerwe, abo reQuires Ihe epplirent br euch parmil to file e aipned stelement thet he a aM liceneed pursuent lo ihe provisions ot Ne Conireclws License Lew �Cheqer 9(canmerviip wil� Sedpn ]000) d D'v'sion 3 M ihe Business enC PrNeaons Cade� ��het ha or aha ia uemq ihxehum antl ihe besie br Ihe allaged exempton. My volelon o/ Sedion ]031.5 by eny epplirant fa e perm� subjxYs ihe epplicent to e avil penelry d nM more Ihen live hundretl dollers �55W�). �i I. es oxner d iha PropenY w mY emPbYeas wFh wepes es their eda mmpenee�ion. will do iM vrork. end tM avuciure's �wt ime�Med w aGerediw eale(SectwnT0a6. Busiireae eM Prdeeniona Cotle: T�e Contrer.voia Licanse Lew doea mt epply�o e�ow�x W propeM who bu1Es a inDroves Ihereo�. a�E wM10 Joea such vrork MmseM a harseM a through he a her oxn em0loyees, pmvided thel suc� improvamenls ere not inteMeE a oifueE lor aele. Ii, howevar, the buiMing «inqovemenl ie eold wilM1in one yeer d complelion, IM owrer�buiNer will have iha W�da� d V��9 � a ahe did na buiM or improve la iM W�e d aele�. � 1. az owner M Ihe Oroperly. Pm axdusivety mmreavp wilh licensed convec�on b conaVua ihe qojan (Sedion ]o6a. Buain a eM Profasaans COCa: The CoMreclon licensa lew tloes iwt eppy to en ovma� oF propeity who Wika w impovas ihereon who conVacts for such prqepa W�Ih e mMrenor(e) licansad pureuan� �o ihe Cont�aeora Limnae la . � I em eRemq mdar Senion: B. 8 P.C., i« ' reeson: � oa�e: . 1 c. � ownec � i do na,�M �nM m� i� a.e,. d�d ��m�e ma rea��.«�=ma d c�aoma N�nn �e e coda sm�. uws, zssaa, d,d zs5ae. e�w mm i m em nnure nunamy ow�c�� ..;n i wti �a ldmx me) neea �o �aH w�n �i ��, �a„ ,�a �na revwrem.ms m� epe�mnlaconavuctionormodifiudionhomiMRk u-OTl.renegementDia�nq.Resitlenlielconstrudionepplre�bnsareeumqfmnthme Drovisions. Dete: - Appikenl: W ORKEq'S COMPENSATION DECLRNATION: I Iwreby effirtn wMar penelry d perjury aro M ihe lollovnng Eetlare!una: ❑ I hava end wil meimein e ce��e d mnsenl to seX-insure fa w�kan' canpansalbn, av povided for by Swim 3]OU d the lebor Coda, tw Iha peNormeMe c� wa worM br which Ihis pa�mit is issued. � I hew enE vnl mantem xv�ke�s' aomPense�bn imu�arKe, ea required by Seclim 31f10 d ihe Lebor Cade, fa �M pe�lormence ol �M wwk br whirh �hia pertnn ia isaued. My wnken' mmpanealion insurer�ce fariier vM paliry number ere: c�e�: Policy Nnmber. i rhis sedion neeE nIX be canpleted / the permrt is M one hvndred dollars j8100) a bss.J � I cenM �ha� in iM parlame��e d iM wmk 1« whch ihia pe�mu is ieaoetl, I shell iwt employ erry pexn in eiy menner w u m bacome wbjed !a tha woMara' campensmion lewa N Celilomie. enE egrea Nm il I Mouk bacoma wbjeq �o iM v.�Mers' compenaelion povisons oi SeUion 9100 of �M Lebor COEe. I shell fanhwnh mmpfy vrilh ihme pmveions. Dete: Apdr��' W�rn/nD: Fllvro ro aec�n wort�+"comp�ruaHon rovereps /s unl�wNl, entl ahNl au6/ecf an employer to crlMiulOMaMpa and elH/ flrie� up ro one hunJretl tMumM dolbn (SI00,0001. In eJCltlon ro Ms eost ol romponutbn, tlamepu u provMW Mr In Sxf/on 9106 of Ms Labor CotlJ, ��a+a4 antl attomsys /su. CONSTFUCTION LENDING AGENCY: I hereby eifirm undar penalry d paryury thel Iham ia e mnal�udion biMinB epancy b� Hro performance M Ihe xoM (or wM1icl� th's permX ia ieaueC (SecYon 309]. Civ. C). LENDEN'S NAME: � LENpEN'S A�DqE55: I cerliy �hel I lieve reeE ihis eppliceiion enE pme thet iha ebove inlormetion ia cortecl. I epree to canpty wnh ell ory arM wunty ordinencee end ime levn rele�ing m buikirp conxrueion anE hereby einhorrza repreaenimivea M ihia city ta an�ar upon IM ebove-mentbned O�M forina�ypn ourpoean. � n ` . /�/ � _ �"l n r .- A om,: S t � S �5151<B.WP) WhAe �&iildiq 8 Se/my; Grean-file; Canery-Applicenl; Pink-Revenue; OaldenratiAsaessar JUB UESCRIFTION CLAIM VALUE: V ,.-�;I1'CHEN REP4JD�L, UPGRPSIE � REiO P4ET�R 3,000.00 CALC—�'�LDE: 3,040.U0 PEP.M I•dU: B 0?236_ GOVT: 2� SUnP: 1� ??U�n'uSE: ALT °i��% `1.: 3�O�p GRGUP OCC: R-3 i COMMENTS: X if if )f'IF iF %�K'N' iE �k �1f iF �Y if Y i; 1E-Y iF �lk i< if iF iG iF-K�-1E iE A4 ii #�ti� �K x-iF i4 if fG iF iF iF #�LY 1F #- i"t #` 1* rf iE+f �7f ri+' #` -�c iF �1L. iF i'r K x-k� i= iE #- i= aE i: iF i4 Y##�k'+�= i�� Z O N I N C� P. E Q U 2 P. E M E N T S S E T B A C'r: S ----------- P9AIP1 BLTILDING ---------- ------- r�CCES�UP.Y �UILDING -------- FRNT; FT IN REAP,; F_ ID7 fiANT: FT IN REAR; F? IN LEFT; FT It7 RGHT; FT ZD] LEFT: r^T IA7 P.GHT; FT IN PLAN�INGpNOTES> ,�'�UV; PAP.CEL; 93918132 �r1E: REF NJ: i iE �V-if 3E iE iE iF iF?4 j4 �c+F jE �iE �1E i iE # iE #-1i'+f iR Y iF if -IG-1f iG i4''4 �-1F i( 3f- iM1 if iF ac �F �: i' �14 iF �lc if aE i�� R iR iF if # if �IF if� 4 iF a[ �M if i' aE �14 iF i6' iF x##�iF ai� if a:#� if �1f -K jf� i;� D E V E L U F M E N T S E P. L' I C E S R E Q U I k E D1 E N T S ZObiING i�r�FROC'ED 3Y ��;, ; UATE: BUILDING APPkOC'EU Bi'� ; DATE: APPLICATION ISSUED EY; � DIiTE; '� � iF�-ri�*iE�:i+�v-ia?tm�u-r�cs�:�x-;cif�-irsrs�+tft�+rs+F*+rs-w�*,co-�it+�-.c.+rz�w+�u . �r�++r>,.w.+E�#ic-ux-xm�..r-+,F�r-»F«w+c�-w.-�cic, LEGI;LIZATIc�N;*] F E E S U D1 A1 A P. Y STRUCTURAL rEG,SENT:� bLDG PMT FLUM9ING Ei,ECTkIC MECHANIC FIRE SMIP;RES GRe�ING PERMIT 59,00 .SQ � SP92P 1NON—RES PLAN ISSBE FE� BUILDING—DSL'—>' PEAP4IT ISSUE PLAN—CAECK TOTAL PA?D UTJE T�TALS----> ,4,50 0.00 U,00 54,50 54.�0 .pp REL�ENU£ UT_t�I�IO2d TUTALS--i Cr�LLECTED; �4.50 OVEF„SHORT; .UO BLDG PA1T PLUMbIT1G ELECTP.IC MECHAT:IC FIRE SMIPiTUT GRADING PLRT7—CHECY, 5a.oa .J� i'r##i� #b'�#?r�r�#>a.#riiF �4«+F###'s, �M-ir-Y.'rE#iFsiFi�'ac#iFiEit##i:�a:r#a�#iE�k+fiE+E#if#i++EiF#+'1F#�+E-u#�i'iFa`-a-M--k#-sif�s}+Euic-Y i'.�7 U S V I D U A L F E E H R E A f; D 6 N: N TYFE SFR c;�TY 300Q L E S i P, Z P T S U N ALTER BY i�F.LUE RESIDENTIP.?. NdZONE END C�F FEES r r r �' l� �� o� ,� UNiT COST e: �aa Z.oa TOTAL �Uv'T 3,pOQ,UO ,Y f CONSTRUCTION ANOPLANNING HO ,.SPA APPROVALS Permit �F Date Inspector qppROVALS Pennit # Date Inspector t. Temporary.Elect��cal Service or Pole 52. Pool & Equipment Location _ 2; Soil Pipe•Undrgrnd. 53. Steel Reinforcement � 3� Electrical Conduit Utility-Undrgmd. �, 54. Forms '` � 4. Electrical Conduit-Undrgrnd. �� 55. Electriwl Bonding � 5. Steei Reinforcement 56. Rough Plumbing & Pressure Test . 6. Electricai UFER Grnd. 57. APPROVAL TO COVER-GUNITE I 7. Footings 58. Electrical Conduit�Undrgrnd. � 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. � . 60. Backwash Lines, P�Trap, � Undrgrnd. . 10. Structural F�oor System 61. APPROVAL TO DECK 1 t. Property Sewer 4ine & House Connection � 62. Backwash & Receptor�Final 12. Sewer Cap ; 63. Heater & Vent�Final 13. Roof Drains •fi4. Plumbing System - Final 14. Rough Plumbing • 65. Electrical-Final 75. Rough Electriwl-Conduit � 66. Solar SYstem�Final 76. Rough Electric4Virin9 •1 67. Fencing & Access Approval 17. Rough Wiring Sign - 66. APPROVED FOR PLASTERING �� -� 78. Rough Electrica�-T Bar Ceiling •� 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating &%a�r Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace - APPROVALS Permft # 21. Ducts, in Structure � 70. Underground Hydro 22. Ducts, Ventilating 71. Produc[ Pipin� � Gas ❑ Oil 23. Gas Pipe•Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro S 26. T�Bar Ceiling (Structuraq & Monocoat 75. Dry Chemical :f°" r 27. Frame and Flashing � u�gs"'�`� 76. Dry Standpipe � i 28. Lathing & Siding 77. FIXED SYSTEM PINAL '_. -: 29. Insulation � 78, FIRE PREV. FINAL �- 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ', . 37. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CEFTIFICATE ISSUED 33. Final Eleciric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe�Test 36. Hood or Canopy 37. Final Factory Firepiace 38. Final Plumbing 39. Water Service�Final � 40. Gas Service-Final 41. Solar pomestic-Finai 42. Backflow Preventer 43. Backflow Irrigat�on 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations � 47. FINAL STRUC7URE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison - 50. Gas Release to 5outhern California Gas Co � 51. CERTIFICATE OF OCCUPANCY No. Oate � noonessaew�axa: 215 DEL MAR AV OYMEflSNAMEIFqlO'M1: GOSSELTPI, GREGG L �� 15 DEL MAR AVE COSTA A9ESA, CA �rr�. xuuxc �ooxess: ANLXRECT ON �MiNFEP: /iPCll OR FNQ.'S AUDRE55: coxm�cTars ru� CdNfPACTOR5YN1➢q �noxess 9'1b27 uc.ea: us xo: u"' CITY OF COSTA MESA — HULLDIPIG PEP,PIIS PERM P:O: E 072364 PERMIT P7U: E 072369 PLAN CHECK PJO; id GOS�T: PI SUPP: N CONSTRUCTION TYPE; PERMIT TYPE: ELE PURPUSE; ALT JOB UESCRIPTZON , KITCHEN REMODEL, UPGRALE 5 RELO PIETEP. S(,i cT; UNT: i uxr: LICENSED CONTNACTOAS DEC�AP►TON: I Mreby aMim uMa paratly d pe�jury fin 1 am licenaed uMe pwieions W theqv 9 (eommercinp wilh SeeUon ]000) d Oivoian 9 a�� enE Pmlesaiom Code. erd mY �'eew w in full Mee eM Wed. CITY LIC. NO.: LIC. GV1SS: LIG NO.: FXP ; om.: comrea«: OWNEF BUILDEfl OECIARATION: I hereby Nfi�m under parelY d perjury ihe� I em e�emq Irom iM Camreeae Lironee Lew ta tha tdbwip reeson (�� J�1.5 Buaiwan eM Prdeabru Coda: AnY cry w wunty wfiich reQuirae e permG to mmtrud. elter. imOrova. demd'sh, n repair eny el�uclure; prbr �o ila ieaiiaKe, abo rtQuims �he apd�� a �h parmit to Rb e eqmd etalemeM ihel M or aM o licenaed pu�auenl to Ihe Orovieione d iM ��edwe Limnse lew �Chepter 9(cpnmmaiq wnh Sed'on ]000) d Orv'vion 9 d Ne Business enE Prdeaebna Code� ar ihv he ar ehe ia aremp thaeliwn end ihe beao la IM ellepeE exemqion. My violmion d Seqion ]031.5 W eny epWiranl i« e parmil eubjeas �M1a uGW�� to e dvil peneXy d m� mwe �hen live hundretl Edlen �SSOop. �� Q I,eaownerdlhe0ropeMyormyempbyeee'xilhwepeaavlhaeademmpenamion,xilldothework.eM�Mel�uctureondinlentleE " oroflerad(aeele(Seciion]OGC,BueinaaeendProlessiwreCda:TheConiredorsLicenaeLewEoee�wtepplytoenownerdproperry who Wilds or vnprovee Ihereon, end Wq tloee euch wok Mmsetl or Mnell ar thmuBh hu w har own emplayeee, qovided ihet euc� improvamanla era ral inteMed w dlerea �o� %ele. M, hawever, �he Wikiiq a unpiorement u edd wnhin wia yeer ol romplatbn. Ure o�.-w�u., �;n ne.� in. w,e� w w��oa na o� sn< am oa b��m o, �mw� io. ma wm�a d�l. . ❑ 1. m ox�wr d Ihe prtpeM. � eaduervM' �tredip wnh lieeeuad eonVaelas ro wnslrud iM prol� (Swion )OLI. Bini�e eM Prdeaebne Code: The Comreaon Licenae Lew doec m� epply w en o�mer d qopenY ��+ike a imqovn theroon arM xAw mnvecn M arh prol�s xiih e mmrPdala) IcemeE Ounuent to ihe Comreqore �imnae lew). , ❑ I em eRemq uMar Sec1 : B. 8 P.C..1« ' eewn: � l Dem: .�1 r _ �C� �� I do ha�eby carNy tlw 1 em ewve G ud urdds�end Me requiramenm d Galianie Heellh ey Gode SaGiom 25505. ?5533. ud �55N. eM NN I«erry Muie Wikinp owW��. �+11 / wil �wl (arcb one) neeA lo canply wih ' mte mds� vd iM rpuimnenp lor eP�nlnoorovunionamodifiraunhomiMAr u3�e�aBa��Diaria.RamdeMielcanqrW eCVF'etiomenexemNlmmlMu a�s��. Dete: Applram: W ORKEH'S COMVEN4ITION UKUIN�TION: I Mraby dfirm uMx penelry d pajwy wr d Ma IWbwiip Cdvazuna: � I here eM Mil meimein e ceMcme d c�sent lo eM-inwre br warkas' canpe�w�ion. n pro+ided la by Setlian �>00 al �M Lebar code, l« �ne pan«meooe a u. woik �« w+:cn mia pamiA u bs�ee. ❑ � n.va.�d m� meiman woAan• canoe�on in�waMe. m naub.d M seaim amo d �n. �.na wa. ro. �ne vmro.meMe a �ne work /a whiN Ihia peimX ia iasued. My wakaA' compens+�ion inwrarwe re�ner enE pdicy number ere: c.m . PolicyrNumber: (This senion med na 6s comple�ed / tM p�O�R is lor one huMreC ddlas �SfOJ) w bav.) ❑ I cenAy �het in Ihe perlormence d iM w� /a whbh ihis perm0 is ieeued, I ahell rat employ eny pe�von in eny menner a n �o become aubjed to tha vrorkere' compenae�ion lewe M Celibmie, end epree ihN il I ehouk become wbpU lo ihe xwkere' companution Oroviaione ol5edim �)W ol iha Lebar Cade, I ehell /orlhwilh mmON �h Ihove proviebne. oe�e: nadr�n: Waminy: Fallun ro ixun woMx�'rompMutlon cavere{ry b un/ewlul, and alull aub/ect en Imployx b eAMm/ poneltln entl clHl nnu up ro wro ni.narM tlwuwnd eW�an (sta0.00nA �� n ro tli. cwt ol rompxw0on e.m�p� .. povlWE ror In Sxtlon 3]O6 0l Ihs LaborCotls, Intxes4 and etlomsy's /eu. CONSTNUCTON LENDINO �OENCY: I hareby etF�m uMar penelry d peryury thet tMee u e aonrrud'wn bMiip eparcy tor Ne �no�� a�n� w�x �« wn� mo w�+ �• awad lseea, soe�, cw. c�. � LENDEN'S NMIE: LENDEX'S AOOFE55: I eMiy Ihet I hew eead Nia epplieazion uk de�e iMl �M eEove iniwmetion b mrim. I eprea to eompy wnh ell ay eM munry wdi�rcee arM aiete bMs mlmM m WiMM eanstruain� eeM Mr.M eWar¢e represeniatiree d Ina dlYto omx uo� IM abv.e�memioneE piapeny la inspeqp� Wrpwee. �^ _ . ^ • . /l, :� Y (5151-�b.WP) , Dme: W hXe-Buildiq 8 Sd�ery; GreeMFle; Ce�ary-App&an�; Rnk-Revenue; OakenroJ-Pseeaeor CLAIM VALUE; CALC—V.?LUE: i;ROliF OCC; R-3 , COAIPIENTS: RE;#H72363 -IE'I(-+F iF 3F if� if if if iF iF �lf #�' �IF')f fi 4 iF tf 1E'M')F if iE if if if iE iF'Y iF if iE'Y jR if iE if } M i a,` iF iF 1f 1f'M iE iF �lf iE k� Y w w iF af #' it- } iF i4 -x- M-�K Y Y i� w x+h iF i4 yF iF 1F 1f }' Z O N I N G P, E Q U I P, E M E N T S S E T B A C I{ S ------------ MAIN HUILDIP3G ---------- -------- ACCE�=a��iRY BUILDING --------- FRNT; FT IN AEAR: FT IN FP.NT; FT PD7 F.EAR; FT IN LEFT; FT IN RGHT; FT IT] LEFT: FT YN RGHT: FT IP7 FARKING REQ; PRUV; PARCEL: 43916132 ZNE; REF NU: PLANNZNG A]OTES> � Y"- if jE if 1E 1F iE �If �F iF iR �E if iE aF if i(� i41f iR iF <�F if �f ii iF 3f !F if ie,Y� # i� i4 if if �4 iF F if if ii iF Y- i4 �i af i: if i� �k � iF+f Y+f *{f jE �Y jf ii iE+4. Y it iF at i� #* Y iF iE a[ ac -Y a aG a U. E V E L O P M E N T 5' . E R C� I C E S R E C� U I R E M E P] T 5' � r,• ZGNING AP,PRUVED BY IlATE; P . BUILDIPIG APPROVED BY ; PATg; i APPLICATZON ISSUED BY; �'� DP.TE; Iy1—,� /] r*�E�f*�u�ux��t-***�-*aar+c�*�t*ar�+'�'iz+f��iF-rtx-+��ia*��i+i:u��ZiT�c3FiF�,F *,c.�-�+'acir*x�Era�-*�� -��c.�:a.��i LEGALIZATION;N F�E�E S U M M A R Y STRUCTURAi SEGMENT;D] BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GP.ADINC PEP.MIT 21 , 50 50& SMIP/NON-3E� pLAr� ISSUE FEE 15.00 BUILDING—DZV—> FERMZT ISSUE PLAP1—CHECK TOTAL PAID DUE TOTALS----> 21.50 ��.00 O.UO 36.50 36.50 ,UO REVENUE DIVISIGN TOTALS--> COLLECTED; 36.50 OVEP./SHORT: ,00 HLDG PMT PLUMBI*]G ELECTRIC MECHANIC FZRE SMIF/TvT GP.ALIPdG PLAN—CHECP: 36.50 +c iF'M"IE'M' '+' V' #'X"Y fM1'IF'V'1F 1f IM1'N"A 'N"If'If'1f ih i�- iE'M"iF iE'k"X"M"K-YF'k �E'M'iE' Y' M i(' i:' if ?�'1F If M' A#' M' iF 4-If N-'N"if Af'IE')E iE IE'M' i�- �4'T iI"1+ti il' V�+:' Y Y"K' iF")E'M' Y"V-'K' I Dl D I l7 I U U A L F E E B R E A K D O U] N TYPE QTY U E S C R I P T T U N UNIT CUST TC>TAL COST ELE 9 FIXTURES, LIGHTZNG 1 ST 20 EA. .75 3.00 ELE 1 SERVICES BELOW 6Q0 V G HELO?d 201 i119F� i8.5Q 18.50 EDIL OF FEES EXPIREI� DATE �� Z'I Y6: � � � . . _ > - - . - _-� •- ,� �.- .::.-.-t.:- - - �, � � CONSTRUCTION AN� PLANNING, "•. ` APPF20VALS Permit # Date Temporary�Electrical Serviceor Pole ��2� Soil Pipe•Undrgrnd. 3' Electrical Conduit Utility�Undrgmd. 4. Electricai Conduit-Undr9md. :5. Steel Reinforceme�t • 6:;:�Ir.ctrical UFER Gmd. . 7.�Footings � 8:- Foundation ._9. Water Pipe-Undrgrnd. 10. Structural Floor Sy.scem 11. Property Sewer line & House Connection 72. Sewer Cap 73. Roof Drains, 14. Rough Plumbing �., 15. Rough Elec[rica6Conduit T 16. Rough Electric 4Viring 6 17. Rough Wiriog Sign / 78. Rough Electrica6T Bar Ceiling , 79. Rough Heating & Air Conditioning �. . -, �. 20:. Rough Factory Fi�ep�ace '�;' � ;" 21. Ducts, in Structure+� � � 22. Dutts, Ventilating ,,, . - 23. Gas Pipe-Rough & Test � 24. Roof�Framing• ` '" 25. Roof.Sheathing - e� 26. T•BafCeSiing �Svuctural) & Monocoat 27. Frame and Flashing f �x+,X 28. Lathing & Siding •- 29. Insulation � - � 30. Drywall Nailing � 31. Plaster Brown Coat -- � a^�� 32. Electrical�Power Meter-Final � 33. Final Electric 34. Final Heatin9 & Air Conditioning 35. Final Gas Pipe�Test 36. Hood or Canopy 37. Final Pactory Pireplace 38. Final Plumbing 39. Water Service�Finai 40. Gas Service-Final 41. Solar pomestic-Fina� 42. 8ackflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenua[ion 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. fINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co Date � PO� _ d� SPA Inspector APPROVALS " � Permit # ' 52. Pooi & Equipment �ocation � 53. Steel Reinforcement /a 54. Forrrls �� 55. Electrical Bonding � 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER�GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test �� 60. Backwash Lines, P-Trap, O Undrgrnd. ` ' 61. APPROVAL TO DECK 62. Backwash & Receptor-Final �• _�63. Heater & Vent•Final �� 64'. Plumbing SYstem - Final `� 65. Electriral-Final � 66: Solar System-Final Q_ _ � 67.'Fencing & Access Approval . � 68. APPROVEp FOR P�ASTERING 69. POOVSPASYSTEMSFINAL �, , FIRE DEPT. REQUIREMENT _ P y C b"t-�C1F � _ �,� .:APPRyDV�LS�� Permit # .. ,� .a..... � . l7 �+Sc � � 70. �ilnderitrour�i_d Hydro � +: V -O� �+ ~ � - :-i ic .u:e ' Nri Mrd - _pu rv .• -�j � iCi i ~f `�t 1 Ft 1 f�i �n Gas ❑Oil Undergrr�. Sto�age Tank O Gas ❑ Oit 7 Date Inspector 1 �..r : � i i { , . � 77.:. FIXED S,Y',STEM FINAL J I 78' FIRE PFEV. FINAL � 11� ;HEALTH DEPT. REQUIREMENT 79.� FINAL INSPECTION � 80. FOOD CERTIFICATE ISSUED Notes: � � �uonEssoFemim�c: z15 DcL Mkk AV OWNERSN.WEIFRIOM�I: �OSSELIN, GREGG L ' wox�u: 215 DEL MAR AVE COSTA f7ESA,CA wci. wuuNo wowess: AIMHRECT OR EHtlNEEH: 1PCX. Ofl EN4'S AOOME55: canx�cTars wu�: CONfH1CTOR3YNILiG ADDRESS VIR: 92627 uc. ra.: uar: 11G N0: ��: LICENSED COMHACTONS DECLAflATION: I hereby �rm unEar peneEy d perjury Nel I em IicenseA uMer pmnione of Chaplm 9 (mmmmriip �mh Section )000) d Division � d ihe &m�eas end Fmfaceiana CoEe, eM my license m in lull brce anE eXetl. cm uc. No.: uc. cuss: uc. No.: Evp . ome: oom,aan: OWNER BUILDEfl DECLAHATION: I henby elfirm u�r pe�tly d perN�Y �� un a�emq Imm iM Conireeon lioenm lew la ihe �bw'vq �uson (�an ]W 1.5 9usiwsa eM Rafe�na Code: A�ry cty a muntY �� reVuiree e pa�mn lo mnebuct. ellx, impove. md'sh, a repei any siriwlure, p'v b n� awarKe, a�so raV�iree tha epplirant lor euch pa'mil to fib e agned awemem Ihet he a aha licenaed pureuent �o tM pwisiona d Ne Comreean lirama Lew IChepm 9(�mentlrp wuh Seaun 1000) d Oivoion 3 d iM Bumrbx eM Prdexiva Cadel «thm M« ehe o avemp �haelean vd tM b�a 1« tln e1k0� uamqion. MY violmion d Swion �mi.s M�rv md:�u t« e vermn wqea. ina wdiem io e avii ro�n d �a ma. mm, r. nu�dred dd4n �ssoop. Q I. m amier W tha popeM a mY �DMeac v.�h xapes m ihei ede mmpenution. wJl do tM xwk. enE Ne nVucluia e �wl inleMeE a oflareEfor aeb (Seciion ]Oad. Buairoa eM PrdessbmCade: The Coniredas lironsa lewdms rat ePGN �o en owner d propery wM WiM a'vnOb�as �ha�eon. eM v.tw daec eudi �k hlmsNl a hanell u thraqh hi «her own amplo�eea. pmviEeE �MI ewh improvameMs ere nd inianEeE a dlered lor ule. M. howevar, ihe buiMinB a inprwemam ie eoN wilhin one yeer d campb�un. �M wner-buiNer will heve tha burden d proviip M a%he Ek mt buiM « imqove br �M puryose d sela�! _ � I. sv mwwr o/ Ihe propeM. � eadueivety mnired�q mlh IicemeE conlreclon to wnsvua the qqea (Seqion IOH, Bueiiieea vM Prolessions Coda: TM Conlredon Licansa law ddam nd apqy lo en owner d propeny wla buiNa w improvm ihereon e�M who convecm Iw such prolatla wnh e mnlredor(s) IicO�sed Wnueni io the Conlredrne Licen e law). /� , � I em eaempt uMer Seaion: B, d P.G..1 eaon: . ��r 1 Dete: � J 1 l� �t' Owner I do Mreby ce�ily thet 1 em eware of eM uMermwd tM reVuiramenb d Cellomu IbW! d Sdety Coda Sepbm P55p5. 2551t. anE 255J0. eed Me� 1 a ury Mure buikiiq mvpenl vrill / will rwt (arcb arc) nsod lo campy wYh miE state mEa anA tM requ'vamann br e Dem!� IammUuctiona moEdxxtionhwn �MA'r�e�epamen� Oistiia. MeiEm�iel mmewun ePPke�iwreanvemq tmm iheae ��. Dete: Apd�� WORKER'S COMPENSRTION DECL�F�TION: I hmabY elfirm undar penelly d perjury ma d tM Idbwieq daderatcna: ❑ I heve end wil meinian e cMXiceb d mment io feM-ineu�e for xpken' compsnaetbn, ee qwked �a by Sepion 3]00 d Ihe Lebor coda �o. m, reno"�� m me �� io, w�n m+s ae�a �a ��,a. � I heva enE wil meinlen vrohere' oompenm�bn inPurence. es reQuired by Sauim 3)00 al iM lebor CoEe, for Ihe perlo�menm d iM wwk /w whrh thu permn ia ivued. My worken' �Penaetion insurenoe certier eM pdiq number era: ce„�a,: Pdky Number: (TM's sea'an neeE � Ea romWefe.i / fM Pe^�] w br are huMred Edlen /31001 wlm.) . ❑ 1 oenh ihm in iM V�mnence d tM wk 1« whch tnia o�d'o isweE. I tlWl m� ampm' em' ro� in em maninr � o to become wbpa to tM woikero' mnpenealion �ewe d CeNoma. ud prts IMt X I ahouM beroma wbjetl to IM xaken' �ve�� awuo�o d sw� a�ao a m. iab« cod.. i.ndi �onnwnn oom W wm, mo» pm�so�... De�e: Aod�� Wem/np: Fallun ro sxun woMer�'rompwuetlon Mwreps I� unbwlW, �ndslull �WW/ect en smp/oysr ro crlM�ul p�rrettlu eM clvll flnu � N om huntlrnl thouuM JO/Nn (5f00.�1. M�dtlltlon ro Ih� ro�t ol rompmuWn, Minp� n qovWW br In S�ctlon 9]06 0l tl�� Lebor COM, Intusst, entl ettorhsy i/esi. CONSTFUCTON LENDINO AOENCY: 1 Mreby elfirm uMx penaMy d perjury thm ihse u e const�udion biMinp eperwy la iM � peAormenro N ihe xoA /or which Iho prmY ia eweE (�� ]. CM. C). LENUEH'S NMIE: - LQlOEP'S A�UFE55: i cenM �nm � neve nee mu roW�wim ene am. inm ine amve int«me�ion u ca..a. � eyea m comqy »nn en dir aik coumr admww eM.tet, bws MeIM �o buJdM cons�Won entl MreGY aWwr¢, �drvee d �hd �Y io mma �W� �M ebow.meMior�etl V�G�A, la inspedion W�Wses. l P� Nema ^ � � I , - o�,: �� S re d OvmetlApenVAVP��onlrapw ,(S151de.WP1 Whilo-Buildin08SeletY:Gree�-Fle:CanW-AOVlieen�:Pink-Reronue:(iddeneo0.N»aaa CITY Oc COSTA MESA — 3UILDING PERP4IT �ER^9 t�:0• F� 0,'��G PERMIT NO; P 072365 FLADI CAECK PiO: N GOVT: N �UPF: N COPISTRUCT2GN TYPE; FERPIIT TYF�E; PLU PJRPUSE; ALT Jub UESCP.IPTION ; KITCHEN REMULEL, UPGRALE � RELO P1ETE3 SQ FT: CLAIM VALUE; CALC—:'ALUE: GR��UF OCC: R-3 ; COMMENTS: RE;tkB72363, REPIPE GAS G WATER LIDIES �lf i'r �1F iF-li� Y{F �lf iE 1F iF #-14 #'� 4 jf �le if +F is iF 1E �f if i4 if i%if if ic ic i4 i:+E ii ii �Y 1� �R aF i"r ic ts iF i'r �Y iF Yf if� ia i: iF i: aF �a: y: y: K� Y- i�- iia �1F i4 �1F r aG+f af a: i: i: i%a:.i� fE �i: x-{R zor� zrac P Egui� �raEn�Ts S E T B P. C k S _ ----------- MAIN bUILDID7G ---------- --------- ACCESSOP.Y bUILLING --------- FRNT; FT IN REAR; ; T IDl FRP]T; FT iD7 P.EAR: ?T IN LEFT; FT IN RGHT; FT IN iEFT; FT IA7 RCHT: FT IN PARF:ING REQ• PROV; PARCEL: 43918132 ZNc; REF P10; PLAPINING NOTES> 1 �jfx�lcif�tciF-Ki�-�R�Y3cs�bitiFaFif>i:+f�ii�?4itiEif4�lE#�-v�icic�7cissxiflRificxata:a;c+4aci�rtiE�Yar�icac+car.+:xuiEx iF-lu�N ifai.{c3Fic+xxac�xy:�k�lca D E C� E L O P M E N T S E P, C' I C E 5 R E Q U I D E M E N T S 20DIIP�G AFPP.QL�ED HY DATE; bUILDING AI�FROL�EL� BY . APPLICIiTIOhI ISSUED bY; jE�iFiEifiFjfif�f4iE�7ssjFi�Yif�FiEtF41F LEGALIZATION;N F E E S U M P9 A P, Y DATE; DATE: `� � �� KYi4i4iFtiiFYY4+... +M1�Y'Y'iri'iFii� STRUCTUF,AL SEGMEA7T;N BLilG PMT PLUMHING ELECTP.IC P9ECHANIC r^I^r,� SMIP: RES GRr1UTA7G F��arszT in , co z`� • sr�zFiNor�-ats PLAN � ISSUE FEE 20,Q0 ' BDILUING—DIV—> PERMIT ISSUE FLAN—CHECK TOTAL PAID DUE TOTF.LS----> 29,OU 20,00 U.OQ 74,00 34,OC. ,Qp RECrENUE L�I�'IS�C)N TpTP.LS--> Ct�LLECTEU; 34,00 O��E�;S?-?Or^,T• ,OU HLDG PMT PLUM�ING ELECTP.IC MECHAA]IC FIP,E �MIP; TQT GP,AL�ING Pi.A.*7—CHECP: 34,00 � r if'y'X'+f :f �' iF'k� if iF'IF'lf 4 Y-Y L t Y'M� 4'�(' af M tk Y �F 9E'IE ±F i� K'Y Yf �')f'1f M�'M' 1' F�f K Y�F 4 �f'lE �f 1'' �f'+F Y ii� �f f+F if Y' } M. 'M' if')(-4 if �! i' i i'- i s if ,Y- it iF jj' if'1t' i!. I N U T_ C' I D U A L F E E B R E P. 'r: D O�r? N TYPE �iTY U E S C R I P T I U N, ilNIT COST TCTAL COST PLU 1 GP.S RE—FIPE PLU 1 WATER P.E—PIPE EAID OF FEES .��PII� �n ART"_.��. `��(�'U� �- ! ?,OQ ?,OU �,�Q 7,�0 isi ��:82G�4—�039:OSL GP.Tt: CSi1+5/95 TL�F: .aa CONSTRUCTION AND PLANNING APPROVALS Permit # 7. TemDorary Electrical Service or Pole 2. Soil Pipe-Undrgrnd. 3. Electrical Conduii UtilitV-Undrgrnd. 4. Electricai Conduit-Undrgrnd. 5. Steel Reinforcement 6. Electrical UFER Grnd. 7. Footings _ _ 8. Foundation 9. Water Pipe�Ur,drgrnd. 10. Structural Floor SYstem 11. Property Sewer 4�ne & House Connection 12. Sewer Cap 13. floof Drains 14. Rough Plumbing ' � 15. Rough ElectricaPConduit 16. Rough ElectricN'�ring 17. Rough Wiring Sign - 78. Rough Electrical-T Bar Ceiling 79. Rough Heating & Air Conditioning 20. flough Factory �ireplace 21. Ducts, in Structure � 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test 24. Roof Framing 25. Roof Sheathing 26. T�Bar Ceiling �St�ucturap & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailing 31. Ptas2er Brown Coac 32. Electrical Power Meter-Final 33. Final Electric 34. Finai Heating & Air Conditioning 35. Final Gas Pipe-Tezt 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Fina� 41. Solar Oomestic-Finaf 42. Backf{ow Preventer 43. Backflow Irrigation 44. Landscape Irrigetion System 45. Sound Atienuation , 46. Handicap Regul�tions 47. FINAL STRUC7URE & BUILDING 48. FINAL PLANNING 49. Electric fielease to Edison 5D. Gas Release to 5outhern California Gas 0 No. Date Date � I nspecto .�. PO� � SPA r P V .# • Date Inspector AP RO ALS Permit � 52. Pool & Equipme�t Location -� 53. Steel Reinforcement 54. Forms 55. Electricai Bonding 56. Rough Plumbing & Pretsure Test 57. APPROVAI. TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. � 59. Gas Pipe, O Undrgmd., Test � 60. Backwash Lines, P�Trap, � Undrgmd. 67. APPROVAL TO DECK � 62. Backwash & Receptor�Final '63. Heater & Vent-Final 64. Plumbing System - Final �5. Electrical�Final 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPA SYSTEMS FINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hyd�o � 71. Product Pipin� rJGas ❑Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical � 76. Dry Standpipe 77. FIXEDSYSTEMFINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CEFTIFICATE ISSUED Notes: � ` G�S Qi G V P � - O Q � n � i� PFOJECT RDOflFSS: z 1 S DEL %i�iR �.V owNen•s NamE: ENDRES KATHLEEN E nooness: z15 DE�, MAR AVE COSTA MESA,CA 92627 ancnieNcixeex: � �14 ) 646-5933 FUOflESS: flEG.NO.: UNIT: UNIT: PEHMITTEE: COLLINS ROOFING COMPANY ( 714 ) 891-7475 aooness:15672 WILSON ST MIDWAY CITY CA 92655 LICENSED CONTNACTOP UECLABATION: I hereby a��irm that I am IicenSeU untler provisions ol Chapter 9(commencing with Sec�ion �0�0� of Divsion 3 ol�he Business antl Prolessions Cotle. ana my license is in lullforce ane effect. cirv uc.:0 066�� STATn E LIC, 3576 c�^ �5 �� Dale'. _ � 4 Signature: — _ WOflNEBS' OMPENSATION DECIAHATION: I hereby a rm at I have a certilicale ol consen� �o sell-insure or a certi�icate o� Workers' Compensation Insurance. or a certifiea copy Ihereof (5 c�i 3800, lab. C). voucvxo.:1016568-92 EXP.URiE:O%IOSI93 comraxv:STATE FUND � Cetlifie0 copy is here�y �umished. �( Ce�i�ied is filetl ith �he, iry B,�i i� u n. �aie'. �pYJ ^'9� Applica . E%EMPTION FpOM WONNEflS' COMPENSATION UECIA TION: his seciion ne 0 nol be comple�etl if Ihe permit is lar one huntlretl (5700) or less). I certily Inal in �he peAormance o� Ihe work lor whi � this mi� is issued. I shall no� employ any person in any manner so as to become subject lo I�e Workers' Compensation Laws of C ia. Oate: SignaWre: NOiICE: II, afler making IhiS declara�ion, you shoultl become suble�� o Ihe WorkerY Compensa�ion pwvisions o� �he Labor Coae. yau mus� larthwnh camply wil� such pmvisions or �his permit shall 6e deeme0 revoke0. CONSTNUCTION LENOING AGENCY: I hereby affirm �hai there is a wn5�mtiion lentling agency tor �he pedormanCe ol �he work for which Ihis perma is issuetl (Sec�ian 3097. Civ. C�. LENDEH: FODHESS: OWNEP BUILOEB OECLABRTI�N: I �eBby alfirm �ha� I am exempt Imm Ihe ConVactors' S�a�e License Law for Ih¢ tollowing reason �Section 7031.5 Business antl Pmfe55ional Code: Any city o� county w�ich reQuires a Oermit �o constmci, alier, impmve, Oemolish, or reoair any slmclwe. prior lo ils issuance, also requires ��e applicant �or such permil to lile a signed slalemeni �ha� �e/she is licensetl pursuanl m Ne pmvisions ai �he ConVacmrs Slaie License Law (Chapter 9(commencing wi�h Section 7000) o� OiviSion 3 0� the Business antl Pmlessions Cotle� or that he/she is e�empl lhere�mm and the basis lor I�e allegetl ecemption. Bny viola�ion ol $ection 7031.5 by any apDlicantlor a permi� subjects �he applican� to a civil penalry ot no� mo�e Ihan �ive hundretl tlollars ($500). I, as owner o� �he property or my employees with wages as Ihei� sole compen5aiion, will tlo the work, antl the ❑ simc�ureis no�intenUed orofleretl Iorsale�Sec�ion 7044, Business and Pmfe55ionalCoOe: The Coniractors' S�a�e License Law aoes nol apply �a an owner of a pmpe�y who �uiltls or impwves �hereon, and who does such work himsel�lherself or throug� his or �er awn emplayees, pmvitled Ihai suc� improvemen�s are nol inlentletl or ofleretl �or sale. I�, however �he buil0ing or improv¢meni is soltl within one year a� COmpleiion, �he owner will have �he bur0¢n 0� pmving he/she tlitl no� build of imD�Ove lor �he purpose of sale). I. as owner oi the pmperiy, am eeclu5iveiy commcting with Iicense0 contracmrs m constmct the pmlecl (Sec�ion 7044, Business ❑ and Pm�essions Coae: TAe Comraclors' S�a�e License Law Ooes nol apDly to an owner o� pmperry who �uilOs or improves �hereon ana w�o canVacls �ar such pmlecl5 wii� a coNrac�or�s)license pursuantto the Contractors' S�ate License Law�.l am aware that pmol o� I�eir Worker's Compensalion insuranw 5hoW4 be Omvidetl �o me. � I ain exempl untler Seciion� B. 8 P. C. lor I�is reason: �ate: Owner. I tlo here�y cerlily Ihat I am aware ol antl untlersland ihe requiremenis o1 Califomia Heal�h and Safery Cotle Seclions 25505, 25533, antl 25534 ana i�at I or any imure building occuDant will/will not (circle ane) need lo comply with saia s�a�e codes and the requiremenis for a permil lor con9mclian or motlilicaiion Imm Ihe Fu Ouality Manaqement Dislrict. Fe5i0ential cons�mction applica�ians are exempt �mm Ihese pmvisions. Date: Applicanl:. I hereby cetlily IAat 1 have reaa Ihis applicalion anA slale ortlinances and s�ate laws rela�ing to building consimclion: pmperly lor i spection purposes. Daie: �(�1� Signalure/: Driver's License or Social Security a: . is correci. I agreeto comply wi�h all ciiy and county p�ative o��hi 'rytoenieruponlheabave�mentianed .��% < � 166t�a6 WM1ne—Builtlmg; Green—Cotle Enlorcemenl: Canary—Appliwnl; Pink—Revenue: Goltlenrotl—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 060667 PERMIT NO; B 0667 PLAN CHECK NO; N GOVT; N SUPP; N CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE; ALT JOB DESCRIPTION : T/O, RESHEATH AND REROOF WITH 2OYR COMP SQ FT; 2,600 CLAIM VALUE; 2,600.00 CALC—VALUE; 2,600,00 GROUP OCC: R-3 /M-1 COMMENTS• SMORE DETECTORS RE�UIRED PER THE 1991 EDITION OFTHE UBC, �e**�e�r�r***�e�**�r�rx�r�r�r�r�r�*�r�r�r*�r +��r�r**�*��e��r******�r*�e�r�r�**�r**�r�e**�r�e*�r**�r*�r*�r�r*��r��r Z O N I N G R E Q U I R E M E N T S S E T H A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDZNG --------- FRNT: FT IN REAR; FT ZN FRNT; FT IN REAR; FT IN LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV; PARCEL: 43918132 2NE; REF NO; PLANNING Ni5'I'ES> % . 3f �f 1k iP ik 3F iE iF �E if if if ik ik if iF if 1E if iE 1E iE if �t ik if if �f if iF if 1F1E iE fE jf if ik if i4 iF if iE if'IF1F'If if if ilif iF iF iE ik'k aF �F'1E i! 1f iF if ik if'lE 3f 1F if� if 1k 1k iF iF If iE iF if i4 D E V E�L O P M E N T S E R V I C E S R E Q U I R E M E N T S 20NING APPROVED BY DATE: BUILDING APPROVED BY ; if �f �k �f ik IF �E �E if iE k if iFikdk �k �f iF dE jf iF iflf if ik 3F ik 3F 3F iF 1f �f iE iF 3k 3F iF jt if ik iF if iF if iPiF iF if �F if LEGALIZATION;N F E E S U M M A R Y BLDG PMT PLUMBING ELECTRIC MECHANIC DATE: DATE: �� iFiF'�F"�iF�fiEiFifiFifikiFik3E it�E iEiE iE #E iE * if if 3F �F�! �F IF iE �3F iE iF�E iE iF ii 3k 3E if ik iF iF iF. STRUCTURAL SEGMENT;Y PERMIT 54,00 FIRE SMIP/RHS� GRADING 5MI-P/NON—RES . PLAN ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID " DUE TOTALS----> 59,50 0.00 0.00 54.50 59,50 . ,00 / REVENUE DIVISION TOTALS--> COLLECTED: 54.50 OVER/SHORT; '' ,00 BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PI,AN—CHECK 54.�� .5� . , 1 �F �1! iE if iFif if if 3F ik if iF k iF ik iF if ik if iF iF iF �! if 1F if iF aE if iF k jf iF ik if if if iF iE iE if ik �E �E �f jE iE if 3f if M if iF iE �f 3F 3FjE �E �! if IE if iF �lt� aF iE �E �)F iF IE �E i! ik ik iE �F iE iE I N D I V I D U A L F E E B R E A K D O W N - TYPE QTY D E S C R I P T I O N SFR 2600 ALTER HY VALUE RESIDENTIAL NOZONE { END OF FEES � EXFIRED �ncomplete Inspections Dete _, _ � Sig 7 � UNIT COST , ' TOTAL COST 1.00 ' ��2,600,00 � !. ), =,�i--;- _ � — _ -- _ uhiE- ^1. : '• , �-1 ' CONSTRUCTION AND PLANNING PO(. . SPA � APPROVALS Permit# Date Inspector qppROVALS Permit# Oate inspector t, Temporory Electrical Servic,e'or Pole.,•; " 52. Pool & Equipment Location - �'� 2. $oil PiRe-Undrgrnd., -� " � . � 53. Steel Reinforcement . 3. Elhctrical Conduit-Ufility•Uncjcgmd-- 54. Porms - 4. ;��ectrical Conduit-Undrgrnd'U - ^ ..•, � 55. Elactrical Bonding - � .. 5. Steel Reinforcemeni� � + � 56. Rough Plumbirig & Preswre Test 6. Electctcai UFER 6rnd. 57. APPROVAL TO COVER-GUNITE " - ' 7, Footings �' i,- - � �� 56. Electrical Conduit�Undrgrnd. � 8. foundation •� '� ;r' � i�" 59. Gas Pipe, O Undrgrnd., Test ': i � 9. Water Pipe-Undrgmd. ', � 60. Backwash Lines, P�Trap, � Undrgrnd. �` 10. Structurai floor System .,;: '� _ 61. APPROVAL TO DECK �� ,� � 1 i, Prpperty Sevaer�Line & House Cl�nnectioa ��, 62. Backwash & ReceptorFinat 72. Sewer Cap . •�+ �, � � 63. Neater & Ven[-Final •�1 ; - .�'. 13. Roof Drains � � � 64. Piumbing System - Finat '� 74. Rough Plumbing 65. Electrical-Final • 75. Rough Electricat�Conduit �"�'- 66. Sofar System-Final � 76. Rough Electrio�Jirin9 � 67. Fencing & Access APP�oval •� y 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 78. Rough Electricel-T Bar Ceiling 69. POOl1SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning � FIR� D�,�T. REQUIREMENT 1 .J i ': ' < 1 :t a : r .-� - l; 20.�Roilgh �ctorLy �irEplace �� ` ` r R r'� "� '- � ,APPRQVA_L"S "�.Pern7it #»� 21. Ducts, iriStr'uctuTe� • " - ' ` - " % �0. Underground:Hydro � r " t' 22. _Ou�s. �;ntildting: ; ' . _ - ,: ;. �� . r71. Product �iping � Gas ❑�il 23.-Gas Pipe�Roagh & Tesi � • '�" ^ 72. Undergro6nd,FIu�K� � + 24, Root P,amin9 : ;: ' `�F C_ � � � y" �, ;73.rUndergrnd.Storag'e.T:ank DGas ❑Q�I � 4 25. (io� Sheathing r = i � t �2/l9Q �• �74; 'Overhead Hydro'= `� . , . V f t_! , x 26 �i•B�r Ceilin lSttp,�,turaq & M �ocoat - _ ' � ' � " ' - , 9 � , .. � , ; 75.;�y Chemical , _ 27. rame and F.lashir.g, - .. 76. Dry Stand�.+ipe ��= . ` ,.28. Lathing & SiBin� . � `;�, `E ;; ?' '� ' i ' Ix � 77•�FIXED SYS7EM_F1NAl'. � �� 29. �nsula[io� �. :�j.,.V ., .. � • � ;'T 78,'FIREPREV.FI�A`L "�' ` � 30. Drywall NailiM1g �:x � _ � '� HEALTH�DEPT; �iEQUIREMENT " •'.31. Plaster8�owrtCoat-.; � � � � � •79.�FINALINSPECTI0.*V � � . . 32. ElectricaYPowar Me,j�r-Finai w�- ! � ir '-80.�FOOD CERTiFIGATE IS$UED ^ 33. �final Electric � � i � • � � � �� r "Notes: _ -:r i = _ _, � J� �-34. Final Heating;& RilConditionit�g• � - � . �y� ` ` �' r ` _ - - � � - I � , - 35, Final Gas Pipe-Te:t� • . ,' r � v �86. Hood or�Canopy - * " ' � ! ' i � � . '�' I x ' . . � • 37.'Finsl Far,ory FrePlacex. ; . - - :� � .' i� . -_ ��; _ ' . ; � � � 38. Final P�umbing '� �. - ; � ;r � "39. Water Service,Final., � � r ! ' �, c � � ' � - I � .�40. Gas Serv"rce-Final - � 1 � � ( I � � '� ' � =S_ � 47. Solar Oomeetic-�inat �� _ � ' ' � � �� '- _ � . . � 42. BackflovZ Preventer•� � = - �- - _ .. . 43. Backflow Irrgatio�, : ' � �� . . � � . �44. Landsca�ie IrYigation System; {� - ` ' _ �t; _ •'- � � 45. Sound Qtte�wactbri, ' , r ' � !- - � .1. - .. . " ! _46. HandicapRegulations -� ^ - . ; - - `X P°I-R-E D - _ � �. _ ., .� .� Incomplete Inspections 47. FINAL STRYJCTURE & BUI�IDiNG ' � '�+' i ' � ' �� 48. PINAL PLANNING • ' � I ' ',. , c l�t! ��SIg= - -�(�.�- � Ir L c49. , Electric Release to ;Edison , ; j= i , " � 50..Gas Release to Southem Califomia Gas Co • � •^�� . - i ' 51. CERTIFICATE OP'OCCUPANCY + -- � - No. Date CITY OF COSTA MESA BUILDING DIVISION ROOF COVERING CERTIFICATION Property Address �- 1 S ,�P_� ��./` Owner Contractor n �' �' ' " y Permit No. ��`�-�� State Contractor License Number 3 S%!� a� Classification C�3 � 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 32, and Section 1704 of the latest adopted edition of the Uniform Building Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the manufacturer. ❑ I further certify that I am the owner of the property. (Owner-Builder permittee only). 0�1 further certify that i am: LYOwner of sole proprietorship company ❑ Full partner of the company ❑ Limited partner of the company ❑ Officer of the corporation I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this certification, which shall be binding on all successors or assigns of the company or corporation. I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building Division for acceptance. Received by Building Division By: /� � Initi Date 0990.A6 W�ite-84ilding Div.; Canary-Conha[tor; Pink-0wner