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Home My WebLink About919 DOGWOOD ST - Building Permits, , � CITY OF COSTA MESA � F��'�p~FSq BUILDING D/VISION � 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wvaw.ci.costa-mesa.ca.us �`� g FOR INSPECTIONS CALL: (714) 754-5626 fi PERMIT TYPE APN: 42252204 Zoning: , B_MISC JOB ADDRESS: 979 DOGWOOD ST CM Vicinity: SQ. FT: 350 SCOPE OF WORK: HOUSING REHAB PROJECT PERMIT NUMBER: BX09-00124 STATUS: ISSUED DATE ISSUED: 06/03/2009 ISSUED BY: BJK SuitelUnit: Primary Occ: 32 Const Type :?? Valuation: 55,642.00 350 SF LATTICE PATIO COVER AT THE REAR OF AN EXISTING SFD. OWNER: WALLIS,WILLIAM J AND CHRISTINA M City/State: COSTA MESA, CA Phone: 949-689-2130 APPLICANT: LEYVA, ROBERT City/State: COSTA MESA, CA Phone: 714323-5820 CONTRACTOR: ROBERT L�YVA CONSTRUCTION CO Address: 953 UNION AV City/State: COSTA MESA, CA Zip Code: 92627 ARCHITECT: Phone ENGINEER: Phone FEE SUMMARY Building Plan Check: Building Petmit: Electrical PQrmit SMIP Residential SMIP Commercial Bldg Std Admin Fund TOTALFEES Address:: 919 DOGWOOD ST Zip Code: 92627-4116 Address: 953 UNION AV Zip Code: 92627 License No. 825124 Phane 714-323-5820 Cell: License No. License No. $81.41 $125.25 $0.00 $0.00 $0.00 $1.00 $207.66 Unit Unit Unit: NOTICE: The work authorized by this permit shall comply vnth all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 9248, § 7, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DA7E OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this pertnit 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 fnal approval will result in the expiration of this permit. LODEt. INSPECTIONTYPE DAiE IN1111AL5 CODEt INSPELlIONTYPE DRiE INTITIALS 7616 Fized System Final Fire Prevenlion 206 Final Mechanical 7266 Pooi Spa Final 208 Final P�umbing 200 Final Re-Roof 210 Final Electriwl 201 Final Block/Retaining Wall 212 Final Fire PreveNion 202 Final FaGory Fire Place 220 Final Planning Approval 203 FinalSign � 222 Final Site /7 . I 204 Final Demolition ` 250 Final Building�Occupancy x�o—�—�'i ��'v WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consenl lo selbinsure for vrorkers' compensation, as provided for by sectibn 3700 of t�e Labor Code, !or ihe peAormance of the vmrk for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by seclion 3700 0( the Labor Cotle, for the performance of Ne v.ork (or which this permit is issued. My workers' compensation Insurance carrier and policy number are: Cartier: (This sedan neetl �af 6e mmpeted d I�e peimry � vylunl at one huntlretl dwlars (5100J aless.) Policy Number: Q I certify that in the peAormance Of the work tor which this permit is issued, I shall not employ any person in yny manner so as to become sUbject to the workers' compensation laws of Califomia, and agree that if I should become subject to the vrorkers' compensation provisions ot Section 3700 of the Labor I all f vrith comply Wi[h Ihese provisions. �-3�o y Ap iwm's Signa ure Date � WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RS ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF 7HE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARAYION: I hereby a�rm that I am licensed untler provisions of Chapter 9(commencing wi[h Section 7000) o( Division 3 of the Business and Professions Code, antl my license is in tull force antl e(fect. Lic. # 7t � � �/ Class # � � 6=3-0 5 amrador's Sgnatore Date CONSTRUCTION LENDING AGENCY: ❑ I hereby affrm that ihere is a consiructbn lending agency for the perfortnance ot the v.urk fa which this pertnil is issued (Sec. 3097, Gvil Code�. Lender's Name: Lender's Atltlress: Signawre Da�e OWNER•BUILDER DECLARATIONS: I hereby aKrm that untler penalry of pe�ury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5, Business and Professions Code: Any cily or county which requires a permit to consWct, alter, improve, demolish, or repair any strucWre, prior to its issuance, also requires the applicant for guch permit to file a signed statement that he or she is licensetl pursuant tq the provisions of the Contracrors License Law (Chapter 9(commencing vJ�th Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt lherefrom and the basis for the alleged ezemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ot not more than five hundred dollars ($500).): ❑ I, as ovmer of the property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, and Ihe struclure is not intended or oftered for sale (Sec. 7044, Business antl Pro/essions Code: The Contractors License Law does not apply to an ovmer of pmperty who builds or improves thereon, and who does such vrork himself or hersel( or [hrough his or her own employees, provided that such impmvernents are not intended or oRered for sale. If, however, the buiiding or improvement is sold within one year of completion, the owner-builder will have the burden of pmving that he or she did not build or improve for purpose of sale.). ❑ I, as owner o( the property, am EXCLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to constmct the project (Sec. 7044, Business and Professions Code: 7he contractors LicenSe Law dces not appty to an ovmer oi property who buiWs a improves thereon, and who contracts ta such project witb a cont2cta(s) license pursuanl to the Coqlractors License Laws.). ❑ I am exempt under sec. Business and Protessions Code (or this reason: SignaWre Date 305J-46(3/09) Owner ID verified by driver s license. ❑ Yes ❑ No Driver's License No. Expires: Verifcalion of Ownership by (type o! tlocument, i.e. - property tax bill or Oeetl): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I hereby certify �hat no excavation frve (5) or more feet in depih into which a person is required to descend, will be made in connectqn vnth work authorizetl by this pertnit, and thal no building siructure, scaf(Wding, falsev.ork, or demolition or disman�ling Ihereof, will be more than thirty-sin (36) feet high. (Chap. 3.2, Grp 2, M 2, Sec. 341, TiUe 8, Califomia AdministraMe Code). ❑ As ovmer-builder, I will not employ anyone to do work which would require a permit from Ihe Division of Induslrial Safety, as noled above, unless such person lias a permit to do suc� work trom the division. Appiram's Signawre Dale Division o( Industrial Safety Permit Number HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to fle antl certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of Ihe Califomia Health and Safety Cotle requires, with some exceptions, that a Business Plan be Gled with the Costa Mesa Fire Department by every business which has al any one time dunng a reported year a quantity o( hazardous materials equal to or greater than a weight of 500 pounds, or a volume ot 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or fWure building ocCupant need to file a regislration form for acutely hazartlous materials? ❑ Yes ❑ No (Section 25533 0( the Califomia Health antl Safery Code, wilh some exceptions, requires registration with the Costa Mesa Fire Depariment by each business which at any one lime has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feel of compressed gas at standard temperature and pressure). 3. Does or will the applican� or present or fuNre building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazartlous materials)? ❑ Yes ❑ No (Section 25534 of the Cali(ornia Health and Salery Code provitles that the Costa Mesa Fire Department may require the preparetion, certifcation and filing with the Fire Depariment of an RMPP by businesses which are requiretl to register acutely hazardous materials with the Fire Deparimen[. 4. If an RMPP is presentty required, has Section 25534 0( the Cali(omia Health and Safery Code been tully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or luWre building occupant require for lhe work which is the subject of Ihis application a permit for such conshuction or motlifcation from lhe South Coasl Air Quality Management Dislrict or from any other air polWtion control tlistnct or agency? ❑ Yes ❑ No (Seclan 658502 of the Califomia Govemment Code requires [hat the requestetl informalion be fumished on applications fa nomresidential building permits). 6. Will any part of Ihe faciliry to be constructed under Ihis permil be vnthin 7000 feet from the outer boundaries of a school? ❑ Yes ❑ No Qf "yes", the facility must meet the requirement of Sections 25534 and 42303 of Ihe Califomia Heallh and Sa(ely Code). 7. It a permit from Ihe South Coast Air Quality Management District or other air pollution coNrol districl or agency is required �or the vrork which is the subject of this application, have all of the disclosures prescribed by Calitornia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf "yes", attach certilcate o( compliance trom the appropriate air pollution contml offcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correcL I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. S�gnaWre Oale CERTIFICATE OF COMPLIANCE ANO AU7HORIZATION OF ENTRY: I certify under penalty ot perjury that I have read this application and state that the inlormation given is correct. I agree to comply vnth all state laws and city ordinances relating to building constmction, and authorize representatives of the City of Costa Mesa to enter upon the above-tlescribed property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si r e al qs) Oate 6-�-09 Antlbr ulM1onzetl Appli ant Dale Lattice Cover . Lattice � Lattice Rafter Joist Hanger Ledger � � 2�/, Slab � Slope to Drain Lattice r.OV2f Rafter Header Solid Floor Cover I� Roof Covering 26 Ga. L Roof Sheathing FRAMING PLAN Roofing 12" Sheathir 0 � — Header = — Posc r c � m — . � — Footing — SECTIONS SPECIFY LUMBER: [� DF ❑ Redwood ❑ Hemfir SPECIFY GRADE: ❑ No. 1 � No. 2 CONCRETE: 2500 psi min. @ 28 days CONNECTIONS: ICBO approved or equal Rafter— Joist Hanger Slab� Solid Roof �'iOVBf � 2% Slope to Drain 1. Roof covering: IJ L BTI ZC L Slope: O:12 2. Roof sheathing: Maximum spans: lattice: 2 x L@�" o.c.: 2x2 - 6'; 2x3 - 8'; 2x4 - 10' solid: " CCX plywood or _" lumber: 1" - 2' - 8"; 2" - 8' - 0" �3. Raflers: x_ @_" o.c. � Single ❑ Double ' �4. Header: �x� ❑ Single ❑ Double 5. Ledger: 2 x�_ (2x min) � 6. Fascia: �_x H (2x6 min) 7. Post: �x� (4x4 min) Raise 1" min above slab surface 8. Footing: �x_ 12"x12" min for up to 66 sf tributary area; 18"x18" min for 67-150 sf tributary area " depth (Expansive Soil Zone � 9. Slab 5 " thick (Expansive Soil Zone � 10. Connedions a. Joist lo Ledger - Metal joist hanger Joist lo Header - Solid blocking with framing anchor c. Doubled joist or header to post -(2) 1/2" dia. thru bolts w/ washers d. Joist lo Fascia - Metal framing anchors each side (min. capaciry = 0.5" joist span 'joist spacing' 15) , �Header to Post - Column Cap Post to Slab or Footing - Metal AnchodPost Base g. Rooi Sheathing - 8 d@ 6" o.c. Edges and 12" o.c. Field DETAIL OPTIONS Check the ones that appty: Lattice Cover: �A ❑B �C'I�ID �E ❑F Solid Cover: ❑A ❑D ❑E ❑F Post Anchor Post 6' min Footing Depih PAD FOOTING A 750# max perpost Pas� 6' min '� s�ne SLAB FOOTING B 2x8 Min Zx Joist Fascia J ExiSting Anchors wa118 Z•_p� g•_p• I mof Ma. Ma: SOan EAVE CONNECTION C 7/2' x 5' JoiSt Lag Screws Q 7s• o.c. Ezisting Joist wall Hanger Letlger WALL CONNECTION D Latlice eolts Rafter Dummy Post =Support Post � eeyonU RAFTER/HEADER E Rool Sheathing or Latlice Rafter Framing Anchor Each 81ock HeaOer Z X Blaking Post Column Cap JOIST/HEADER F z��-ac eau� �ss� uac � . • ' J a i 2❑ � c m v m w u n L'� °� L�ov�a ��eda �'uiE� �ic�¢iac� BUILDING PLAN REQUIREMENTS FOR ATTACHED PATIO COVERS (Note: Detached patio covers require an engineered design.) ❑2 P.L. Feet � — ——� —� ❑5 6 ❑6 � Post (�vP.) �' � � " � . � Edgeof _� PROPOSED STRUCTURE Q patio cover � � 3� i House � Garage ❑3 � 0 Owner �-l�kZSiXA%f W8C(qC� Address�/9 n��Y�/�nO1J ❑2 P.L. Street 1❑ ❑2 � � T N N INSTRUCTIONS - 3 COPIES MUST BE SUBMITTED Using this as an example draw your own plot plan on a separate drawing. 1❑ Show owner's name, projed address, north arrow and scale. ❑2 Show and dimension all property lines, easements and driveways. ❑3 Show locations of existing and proposed strudures, including all setback dimensions 4❑ Show dimensions of proposed structure. 05 Show setbacks from property lines to proposed structure. (3'-0" min.; verify if Planning Dept. requires greater setbacks) ❑6 Dimension overhangs 2]33i6 1"� SPAN TABLES LATTICE PATIO COVER SOLID PATIO COVER 1997 UBC 27]3-46 Tables . - :. ;.. . _,� ' o, n c' . . .. .,� -- — -- - , . r�� : : � c . �.� �' , a � ~ �ti � �� . _ �-: . r ..;. �_ � - .�, _ ._i_rL o-.i _x ' -�, . �r—, ��'__—^-_—T_rz"____.�'vp'�-- ` � . . . �. 3 r� p, Q..r . . S ' � ., �v .i.,t �m..- �'`v.i_��. � _ . _� _+ .gy �'� rLL� �� . `t ..? � ' ,. ",.UkST�„i_ . ' � . . - . . . � .l""'v'i� �i r�i' '3 .Jr '1.�� p k�,�„ ::3�,-- �.I ... 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I �," ti.�rd�+r tP�`' �) ��, y � {' + �"t,J'��'� 1 {'�.fi � u �- � y'r. ,','v Lf'a� '�` �a � -. �'�� i�s. y! / �`�4e�' -e' _� �tf �+'i?1�c� � �, ,�� ; �( tlfa,;� � -�v �*y* �L..7�i �.. ,�, �' � ��'rw�fl� r �3 �l', 5"t� ,'Y�^'"' �i�+ ��`- • 1;�' � q;_^`yF :T.,�y,k'I ` � 1 .�a , 7 �,�.� n� �i� � �.� sr� o,� }�" MIW � D 1 � h•- � �� .�,,. �`ry t� �� I �� _ �'I � °i4 � � �. � ��! :f: "'�...� � � ° U r- . . i.../� :.�I �� 1 ��ar�t��. � /� � .; I CITY OF COSTA MESA Neighborhood Improvement Program Final Work Write Up 03/31/09 ve��D �� pA-cE�. �--r' Name: Wil(iam & Christina Wattis Cell Phone: 949-689-2130 Christina Propertv Address: 919 Dogwood Cell Phone: 949-307-3833 Jason Alt work is to be done per City of Costa Mesa Building, Planning and Public Works Codes. In order to establish standards of quality, the detailed specifications may refer to a certain product by name and/or from a major manufacturer. This procedure is not to be construed as eliminating from competition other products of equal or better qualiry by other manufacmrers. The Contractor shall fumish the list of proposed desired substitutions prior to signing the contract. All items listed on the work descripdon, unless otherwise specified, shall include a!! patching and finish work, including trim, hardware, patching and finish painting and/or staining. The Contrac[or is responsible for all pertnits, fees, City business licenses, plans, etc. City of Costa Mesa Standard Rehabilitation Speci�cations applies to all items listed on work description. Work Descri tion: Estimate: I. Lead AbatemenUReplacement: Assume full responsibility and liability for compliance with Lead abatement all Federal, State and local regulations pertaining to lead in order to provide material and and replacement labor. Coordinate removal of lead base paint on the following: cost only: Kitchen: Using lead safe work practices remove and replace kitchen door and frame (per owner's preference). Install new hardware and dead bolt. 2nd Bedroom: Using lead safe work practices remove and replace window sill. Prime, prep and paint to match existing color. Roof Trim: Box soffits and eaves. Prime, prep and paint roof trim. Owner to choose color. Carage: Using lead safe work prac[ices use approved lead safe work practices to remove lead based paint on beams and columns. Properly encapsulate with approved primer and paint. $7,300 Remove and replace side garage doors (2), frames and dead bolts (per owner's preference). Frame, drywall, seal, prime, prep and paint (to match existing color) existing access to attic. Obtain all re uired ermits from the Buildin De artment. 2. Front Patio Cover; Legalize existing (ront patio cover (26.5 ft. X 19 ft). See anached. Obtain all ins ections, includin final ins ection for BXOS-00348. $700 3. Kitchen: Prep, prime and paint walls/ceiling in kitchen. Owner to choose color of pain[. Remove ezisting cabinets. Replace with all modular, 42" high ki[chen cabine[s, new hardware, install solid counter tops and back splash. New kitchen sink not to exceed $400. Faucet to be American Standard or equal ma[erial not to exceed $125. See attached desien per owners' nreference. Install task lighting undemeath the cabinets. Remove existing kitchen floor. Legalize the electrical work in the attic and ground the exhaust hood to S16,200 comply with wrrent code requirements. Obtain all required permits from the Building De artment. J. Flooring: Remove and dispose of existing tiled Floor in kitchen, dining/living room, hallway and bedroom 3 only. Install hardwood floor and baseboards (prime, prep and paint). State the approximate square footage needed to complete work (544 sq. ft.). Flooring material cost $5500 e ual to Lumber Li uidators' rices or less. 5. Bedroom 3: Remove existing glass door located in 3` bedroom. Close access to garage. Frame, insulate, comply with occupancy separation of a I hour modified wall, prep, prime and paint wall to match esisting color. Remove existing window and replace with existing lass dooc Header will remain the same. �_ — �= � � � i, ._,i ��';� � , J/, ,'%,/�%; \%�% . //1; p-� (,� � � �o r/ �j/i�� J� ,j/ i ,, h� )l/ ��/ �:: Do not dispose of 2 glass doors. Sand, prime, paint and install new deadbolt on glass $850 doors. Obtain re uired ermit b the Buildin De t. 6. Electrical Service panel: Remove and replace flush electrical service panel with 200 amp service panel located at rear of property. Obtain required permit from the Building $2,800 De t. 7. Exterior Eleclrical Work (Front Porch): Legalize electrical work (2 exterior lights, 2 receptacles, I switch, and conduit) done without the benefit of permits. Add ceiling fan and switch (per owner's preference). Fan not to exceed $I50. Enclose existing rafters $1,800 with 1' x 6'. Obtuin re uired ermit from the Buildin De t. 8. Ezterior Sensor Lights: Replace 4 exterior sensor lights throughout property and install I exterior sensor li ht in rear ard. Obtain re uired ermit from the Buildin De L 5450 9. Block Wall: Remove and repiace approximately 90 lineal feet of 6' high block wall per Ciry's Standards of 14" width, 10" thickness, 24" depth of eanh tooth and 12' spacing of earth tooth with cap located on side of property only. Replace 2 ga[es and hardware. $7.800 Dis ose of all debris. 10. Locks and Hardware: Replace 5 dead bolts/locks, hardware and rekey all locks to match (5 doors and eaterior ara e door handle . �625 I i. Wooden Rails: Install wooden rails in front porch (owner to indicate location), prep, rime and aint to match existin trim. $I,I50 12. Slab and Patio Cove _r.. Provide and install approximately 390 s.f. of concrete slab with slate tiles and drainage in rear yard. Provide and install wooden, lattice patio cover in reay yard per Ciry's handout. Add 2 electrical receptacles at rear of house. Obtain required $8,500 lan check a roval Plannin and Buildin and ermil trom the Buildin De t. LEAD TOTAL (Item #1) $7,300 TOTAL (Items #2 thru #12) $46,375 ESCROW FEES $364 RECORDER'S FEE $9 CONTIGENCY MONEY $3,252 LOAN TOTAL 550,000 GRAND TOTAL $57,300 I have reviewed the above work descrip[ion and understand Iha[ any changes, addi[ions or deletions shall have prior approva� oy [ne c.iry or c.osca mesa rveignoornooa �mprovemen[ rersonnei. Signamre of Property Owner Date Signature of Properry Owner Date Signature of Contractor Date p MFS ot � �' > ,,,. . : J � '�'+row�nn d,� � CITY OF COSTA MESA BIIILDING D/VISION � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT TYPE: B COMBO Sub Type: RES_ALT �os aDDR�ss: 919 DOGWOOD ST CM APN: 42252204 � � Zoning: , , Vicinity: ConstType: V-B SQ. FT: 0 PERMIT NUMBER: BC09-00192 STATUS: ISSU ED DATE ISSUED: 06/'12/2009 ISSUED BY: Suite/Unit: Primary Occ: R-3 Valuation: $3,000.00 SCOPE OF WORK: HOUSING REHAB PROJECT KITCHEN: REPLACE/FRAME EXTERIOR DOOR. 3RD BEDROOM: REMOVE GLASS DOOR LEADING TO GARAGE, FRAME INSULATE, DRYWALL TO COMPLY W ITH OCCUPANCY SEPARATION; REMOVE EXISTING WINDOW AND REPLACE WITH GLASS DOOR (HEADER TO REMAIN). ROOF: BOX SOFFITS AND EAVES. GARAGE: REMOVE/REPLACE SIDE GARAGE DOORS; FRAME, DRYN/ALL, SEAL, PRIME, PAINT EXISTING ACCESS TO ATTIC. ELEC: LEGALIZE ELEC WORK IN ATfIC, GROUND EXHAUST HOOD, 8 LIGHT FIXTURES (INCLUDES UNDERCABINET TASK LIGHT, 5 EXTERIOR SENSOR LIGHTS), 1 CEIL FAN, 4 OUTLETS, 2 SW ITCHES, 1 CONDUIT, 1 SVS TO 200A PLUMBING: 1 KITCHEN SINK OWNER: WALLIS,WILLIAM J AND CHRISTINA M Address: 919 DOGWOOD ST Phone: 949-689•2130 City/State2ip: COSTA MESA, CA APPLICANT: LEYVA, ROBERT Address: 953 UNION AV Phone: 714323-5820 City/Stale/zZip: COSTA MESA, CA CON7aaCioa: ROBERT LEYVA CONSTRUCTION CO License No. 825124 Phone: 714323-5820 Address: 953 UNION AVUnit: Cell: . City/State: COSTA MESA, CA . ARCHITECT: ENGINEER: COMBINA710N PERMIT FEE SUMMARY Building Plan Check: Building Fees: Electrical Fees: Mechanical Fees: Plumbing Fees: SMIP Residential: SMIP Commercial: Bldg Std Admin Fund TOTAL FEES: "Re(er lo fee receipts tor all fees paid for projecl License No. License No. $0.00 $8325 $10325 $0.00 $33.30 $0.50 $0.00 $1.00 $221.30 Unit: Unit : ZipCode 92627 PHONE: PHONE: 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, 72-21-92) EXPIRATION; PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CO�Et. INSPECTIONTYPE ORTE IN7ITIALS CODEt INSPECTIONTYPE � ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical / 1266 Pool Spa Final 208 final Plumbing 200 Final R¢-{ioof 210 Final Eleclrical ( lr�� 201 202 203 2�4 FinaI8l�WRetaining Wall Final F�ctory Fire Place Final Sign Final D¢molition 212 Final Fire Prevention 220 FinalPlanningApproval 222 Final Site 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATION: I hereby aRrm under penal�y of perjury one oF the following declarations: ❑ I have and will maintain a certifcate of conseM Io self-Insure (or worker5' compensation, as provitletl for by section 3700 of the Labor Code, for the performance of the vrork tor which Ihis pertnit is issued. ❑ I have and will maintain workers' compensation insurance, as requiretl by seclion 3700 of [he Labor Cotle, (or the peAormance of the work fw which this permii is issued. My workers' compensation Insurance carrier and policy number are: Cartier. (Tna secfion need rrol be cnmpetetl Alhe permrt k valvetl a1 one nondmtl tldlars f5100i or less.) Policy Number: I ceAify that in the performance o( the work for which this permit is '�� is ued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of CalifOmia, and agree that if I should become su 'ect to Ihe vrorkers' compensa[ion provisions o! Section 3700 of the Lab d I 5h orthwith comply with UeSe provisions. � 6 y,2 -o � Applicam's ignalure Oate WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE NUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LqBOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, antl my license is in full force and eftect. �j Cic: # � 5 2 Class#- /� � Co�c� Signalure � � D e� � CONSTRUCTION LENDING AGENCY: ❑ I hereby af(irm that there is a consiruction lending agency for the peAortnance of ihe wvrk fa wfiich ihis pertnit ig issued. (Sea 3097, Civil Code). lender's Name: Lender's Address: OWNER-BUILDER DECLARATIONS: I hereby affirm that untler penal�y of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Profe55ions Code: Any city or county which requires a permil to construct, aller, improve, demolish, or repair any slrucNre, prior to ils issuance, also requires the applicant for such permit to (le a signed statement Ihat he or 5he is licensed pursuanf to Ihe provisions of �he COMractors License Law (Chapler 9(commencing with Section 7000) of Division 3 of Ihe Business and Professions Code) or that he or she is exempt therefrom and the basis tor the alleged exemption. Any violation of Section 7037.5 by any applicant (or a pertnil subjects the applicant to a civil penalry of not more Ihan fve hundred dollars (5500).): ❑ I, as owner of the property, or my employees with v`ages as their sole compensation, WILL DO THE WORK, and the struclure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves �hereon, and who does such vrork himself or herself or lhrough his or her own employees, providetl that such improvements are not intended or oftered for sale. If, however, the building or improvement is sold within one year of completion, the ovmer-builder will have the burden of proving that he or she did not build or impmve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTR4CTING WITH LICENSED CONTRACTORS lo construct the project (Sec. 7044, Business and Professions Code: The cont2ctors License Law dces not apply to an owner of property who builtls or impmves thereon, and who contracts tor such project vrith a contracta(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sea _ Business and Professions Code for this reason: Ovuner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Venfication of Ovmership by (rype of document, i.e. - property tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify Ihat no excavation frve (5) or more feet in depth into wfiich a person is requiretl to descend, will be made in connection vrith work authorized hy this pertnit, and that no building stnicture, scaffdding, falseewrk, or tlemolition or dismanlling thereof, will be more than Ihitly-six (36) (eet high. (Chap. 32, Grp 2. AA 2, Sec. 341, Ttle 8, Califomia Atlminist2tive Code�. ❑ As ovmer-builtler, I will not employ anyone to do work which would require a permit from the Division of Intlustrial Safety, as noted above, unless such person has a pertnit to do such aork from lhe division. Apdiwm's Signature Dale Division of Industrial Safely Permit Number HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant neetl to file and certify a Business Plan for emergency response to release or threatened release of a hazartlous material? ❑ Ves ❑ No (Section 25505 0( the Califomia Health and Safe[y Cotle requires, vrith some exceptions, that a Business Plan be filed with Ihe Costa Mesa Fire Department by every business which has at any one time durinq a reported year a quaNiry of hazartlous matenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will Ihe applicant or present or future building occupant need to (le a registration form for awtely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health antl Safery Cotle, with some exceplions, requires regislration with the Cosla Mesa Fire Department by each business whic� at any one lime has on hantl a quantity o( acutely hazardous materials equal to or greater [han a weight of 500 pounds, or a volume o! 55 gallons, or 200 cubic feel of compressed gas at standard temperature ana pressure). 3. Does o� will the applicant or present or Wture building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Ves ❑ No (Section 25534 of the California Heallh and Safety Code provides that Ihe Costa Mesa Fire Department may require the preparation, certi(cation and filing with Ihe Fire Department of an RMPP by businesses which are required to register acuiely hazar0ous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the Califomia Health and Safety Code been fully complietl wilh? ❑ Yes ❑ No 5. �oes or will �he applicant or present or tuture building occupant require for Ihe work which is Ihe Subject of this application a permit for such construction or modification from the South Coast Air Quality Management Distnci or from any other air polWtion control dislricl or agency? ❑ Yes ❑ No (Sectbn 65850.2 of the Califomia Govemment Code requires that Ihe requestetl infOrmation De (umishetl on applications la non-residential building pertnits). 6. Will any pah of �he faciliry to be constructetl untler this permit be within 1000 feet from the outer boundanes of a school? ❑ Yes ❑ No pt'yes", the faciliry must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7. I( a permit from Ihe South Coasl Air Quality Managemenl District or other air polWtion contml district or agency is required for the wnrk which is the subject o! this application, have all of the disclosures prescribed 6y Califomia Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf yes", attach certifcate of compliance from the appropriate air polWtion control offcer�. CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correcL I agree to comply vnth all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature Date CERTIFICA7E OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state lhat the infortnation given is cortecl. I agree 10 comply with all state laws antl ciry ordinances relating to building construction, and authorize representatives oi lhe City of Costa Mesa to enter upon the above-descrihed property tor inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signa� Le al Own (s) Date n o/ SignaWre Dale .:�� `�� —�/ / 305]-46(3/0'/) �onxBd Appl qnl - Oale � CITY OF COSTA MESA Ncighborhood Improvement Program Final Work Write Up 03/31/09 Name: William R, Chris[ina Wallis Propertv Address: 919 Dogwood oo� � �� pPSE:�� Cell Phone: 949-689-2130 Christina Cell Phone: 949-307-3833 lason All work is to be tlone per City of Costa Mesa Building, Planning and Public Works Codes. In order to establish standards of quality, the detailed specifications may refer to a certain product by name and/or from a major manufacmrer. This procedure is not to be construed as eliminating from competition other products of equal or better qualiry by other manufacturers. The Contractor shall furnish the list of proposed desired substimtions prior to signing the contract. All items lisred on the work description, unless othenvise specified, shall include all pa[ching and finish work, including Vim, hardware, pa[ching and finish pain[ing and/or staining. The Contractor is responsible for all permits, fees, City business licenses, plans, etc. City of Costa Mesa Standard Re6abilita[ion Specifications applies lo all items listed on work description. Work Descri tion: Estimate: I. Lead Aba[ement/Replacement: Assume full responsibility and liability for compliance with Lead abatement all Federal, S�ate and loc�l regulations pertaining to lead in order to provide material and and replacement labor. Coordinate removal of Iead base paint on the following: cost only: Kitchen: Using lead safe work practices remove and replace kitchen door and frame (per owner's preference). Install new hardware and dead bolt. 2nd Bedroom; Using lead safe work practices remove and replace window sill. Prime, prep and paint ro match existing color. Roof Trim: Box soffits and eaves. Prime, prep and paint roof trim. Owner [o choose color. Garage: Using lead safe work practices use approved lead safe work practices to remove lead based paint on beams and columns. Properly encapsulate with approved primer and paint. $7,300 Remove and replace side garage doors (2), frames and dead bolts (per owner's preference). Frame, drywall, seal, prime, prep and paint (to match existing color) exis[ing access ro a[tic. Ob[ain all re uired crmits trom the Buildin De artment. Z. Front Patio Cover: Legalize existing front pa[io cover (26.5 ft. X 19 ft). See attached. Obtain all ins ections, includin final ins ection (or BXO8-00348. $700 �3. Kitchen: Prep, prime and p�int wnlls/ceiling in kitchen. Owner to choose color of paint. Remove exis[ing cabinets. Replace with all modular, 42" high kitchen cnbinets, new hardware, install solid counter tops and back splash. New kitchen sink not to exceed $400. Faucet ro be American Standard or equal material not to exceed $125. See attaehed desien ner owners' nreference. Install task lighting underneath the cabinets. Remove existing kitchen floor. Legalize the electrical work in the attic and ground the eshaust hood to S16,200 comply with current code requirements. Ob[ain all required permits from the Building De artment. 4. Flooring: Remove and dispose of existing tiled floor in ki[chen, dining/living room, hallway and bedroom 3 only. Install hardwood Ooor and baseboards (prime, prep and painQ. Sta[e the appro�imate square footage needed ro complete work (544 sq. ft.). Flooring material cost $5500 e ual ro Lum6er Li uida[ors' rices or less. 5. Bedroom 3: Remove existing glass door Iocated in 3`d bedroom. Close access to garage. Prame, insulate, comply with oceupancy separation of a I hour modified wall, prep, prime and paint wall to match existing color. Remove existing window and replace widi exis[ing lass door. Header will remain the same. ;� Do not dispose of 2 glass doors. Sand, prime, paint and install new deadbolt on glass $850 doors. Obtain re uired ermit b� the Buildin De t. 6. Electrical Service panel: Remove and replace Flush electrical service panel wi[h 200 amp servfce panel located at rear of property. Obtain required permit from [he Building $Z,800 De t. 7. Exterior Eleclrical Work (Fron[ Porch): Legalize electrical work (2 exterior lights, 2 receptacles, 1 switch, and conduit) done without the benefit of permits. Add ceiling fan and switch (per owner's preference). Fan not to exceed $150. Enclose existing rafters $1,800 with I' s 6'. Obtain re uired ermit from the Buildin De t. 8. E�[erior Sensor Lights: Replace 4 exterior sensor lights throughout proper[y and install 1 ex[eriot sensor li h[ in rear ard. Obtain re uired crmi[ from the Buildin De L $450 9. Block Wall: Remove and replace approximately 90 lineal feet of 6' high block wall per Ciry's Standards of 14" width, 10" thickness, 24" depth of earth tooth and 12' spacing of earth tooth with cap located on side of property only. Replace 2 ga[es and hardware. $7,800 Dis ose of all debris. 10. Locks and Hardware: Replace 5 dead bolts/locks, hardware and rekey all locks to match (5 doors and exterior araoe door handle . $625 I I. Wooden Rails: Install wooden rails in front porch (owner to indicate location), preq rime and aint to match existin vim. 51,150 12. Slab and Pa[io Cover: Provide and ins[all approsimately 390 s.f. of concrete slab wi[h slate tiles and drainage in rear yard. Provide and install wooden, lattice pa[io cover in rear yard per Ciry's handout. Add 2 electrical receptacles at rear of house. Obtain required 58,500 lan check a roval Plannin and Quildin and ermit from �the Buildin De t. LCAD TOTAL (Item #1) S7,3U0 TOTAL (ICems #2 thru #12) �46,375 ESCROVV FEES $364 RECORD�R'S FEE S9 CONT[GENCY D10NEY �3,252 LOAN TOTAL $SO,OUO GRAND TOTAL 557,3U0 1 have reviewed the above work descrip[ion and understand that any changes, additions or dele[ions shall have prior approvai by [he City ot Costa Mesa Ne�ghborhood Improvement Personnel. Signature of Property Owner Si�nature of Properry Owner Date Date Si�nature of Contractor Date 1 � CITY OF COSTA MESA . BYILDING DIVIS/ON ` ' F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • w.vw ci.costa-mesa.ca.us ° FOR INSPECTIONS CALI: (714) 754•5626 �pF PEI2MIT TYPE APN: 42252204 Zoning: , PERMIT NUMBER: B_MISC STATUS: DATE ISSUED: ISSUED BY: BX08-00348 ISSUED 12111/2008 KJB J09 ADDRESS: 919 DOGWOOD ST CM Suite/Unit: Vicinity: � primary Occ: ', 32 . � - Const Type :?? S�. FT: 513 � Valuation: $6,269.56 � ' . . -.. .. , . . , . . SCOPE OF WORK: ' • LEGALIZE 26.5 FT. X 19 FT. PATIO�COVER IN �FRONT OF THE SFR. 10 FT. FROM LEFT SIDE AND 27 FROM FRONT PL. OWNER: WALLIS,WILLIAM J AND CFIRISTINA M Address:: 919 DOGWOOD ST Unit City/State: COSTA MESA; CA ' � ' Zip Code: 92627-4116 Phone: 949-689-2130� APpLICANT: WALLIS,WILLIAM J AND CHRISTINA M City/State: COSTA MESA, CA ' Phone: 949-689-2130 �JTRACTOR: Adqress: City/State: Zip Cade: ARCHITECT: : Phqne ENGINEER: � Phqne Building Plan Check: Building Permit; Electrical Permit � � SMIP Residential � SMIP Commercial TOTAL FEES Address: 919 DOGWOOD ST � Zip Code: 92627-4116 � License No, Phone Cell: License No. License No. � FEE SUMMARY $108.71 $167.25 $0.00 $0.83 � $0.00 $276.79 Unit: Unit _-�i: ;;�.si° w:. ._ : � �' ; NOTICE: The work authorized by this Dermit shall comply with all applicable handicap access requirements under Califomia statutes antl related regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRATION: PERMIT EXPIRES 160 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under lhis pertnil to be considered legal, such work must comply with all applicable codes, and all required inspeetions and final approval must be obtained. Failure lo obtain inspections and final approval will result in the expiration of this permit. oe iwsvecnoxTrve o� ixn a� cooe� ixsvecnoxttre psg iNnnn�s 1818 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final � 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BlocklRetaining W all 212 Final Fire Prevention 2pz. .' Finat Factory Fire Place z20 Final Planning Approval z03-' FinalSign' � , �_ :,222 � FinalSite ' 264 Final Demolition ' �� _'T 250 Final BuiltlinglOccupancy �� WORKERS' COMPENSATION DECLARATIO� ' I hereby affirm under penalty of Derjury one of l�e following declarations: ❑ � have antl will maintain a �ertifiw[e of consent lo self-Insure for workers' compensation, as provided.fo� by section 3700 0( Ihe La6or Cotle, (or the peAormance of lhe vrork for which this permit is issued. � � I have and will maintain uorkers' compensatbn insurance, as required by section 3700 01 the Labor Code. fw the perfwmance of Ihe v.vrk for which this pertnit is issuetl. My vrorkers' compensation Insurance wrrier and policy number are: Carne[ (TM1ic secAon neetl rpt pe mmpelEd a(he pemM is valuetl a1 ane nurMred tlollars (St00) a less) Policy Number: C'�❑ I certify that in the pertOrmance of the work tor which this permit is issued, I shall not employ any person in any manner so as to become subjec� to the workers' compensation laws of California, and agree lha[ if I should become subject to Ihe worker5' compensation provisions of Section 3700 ot the Labor Code. I shall foAhwitq �mply with [hese provisions. �i� Gy7i�6�_� i� - i z „ p - �remsaig�urE � Dal _ —r WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 9706 OF THE LABOR CODE, INTEREST, AND ATfORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm Ihat I am licens0d under provisions of Chapter 9(commencing with Seclion 7000) of Division 3 of the Business and Professions Code, and my license is in full torce and eHect. Lic. # Class # ConVador's SignaWr¢ Dale CONSTRUCTION LENDING AGENCY: ❑ I hereby a(fmn that thefe is a cons[ruction lending agency !a lhe peRormance W lhe v.ork for wfiich this permit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lender's Address: OWNER-BUILDER DECLARA710NS: I hereby affirm Ihal under penalty of perjury that I am EXEMPT FROM THE CON7RAC70RS LICENSE LA�N for the following reason (Sec. 7031.5, Business and Professions Code: Any city or counry which requires a permit to conswct, alter, improve, demolish, or repair any strucwre, pnor ro its issuance, also requires the applicanl (or such permit to file a signetl statement that he or she is licensetl pursuant to the provisions of the Comractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt there(rom and the basis (or the alleged exemp�ion. Any violation of Section 7031.5 by any applicant for a permit subjects �he appliraN [o a civil penalty of not more than five hundretl tlollars ($500�.�: ❑ I, as owner of Ihe property or my employees vrith wages as their sole compensalion, WILL DO THE �NORK, and the slruclure is not intended or of(eretl for sale (Sec. 7044, Business and Professions Code: The Conlractors License Law does not apply to an owner of property who builds or improves thereon, and who dces such wnrk himself or herself or through his or her own employees, provided Ihat such improvements are not intentled or oHered for sale. If, however, Ihe building or improvement is soltl wilhin one year ot completion, the owner-builder Will have the burden of proving that he or she did not build or improve for.purpose of sale.). . ❑ I, as ovmer of lhe �property. am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consWct the project (Sec. 7044, Business and Pmtessions Code: The contractas License Law dces no[ apply to an owner o( propeny vfio builtls or improves Ihereon, and who contracts for such project v.iih a contracta(s) license pursuant to Ihe Con[ractars License Lavrs.). ❑ I am ezempt under sec. Business and Professions Code for this reason: � . I L �I � D� c� ature l.: Dale � 305L48 (9I0]) �� t Owne�'ID verified by A cense. ❑ Yes ❑ No �Driver's Litense No. Expire5: Venfication of Ovmership by (type o( tlocument, i.e. - property tax bill or deed):' DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � ❑ I hereby certrfy Ihat no excavation frve (5) or mwe fee� in depth into wfiich a person is required to descend, will be made in conneclion wilh wark aulMrized by this permit, and that no building strucfure, scaffdding, falsework, a demolilion or dismantling thereof, will be more Ihan thirty-s& (36) feet high. (Chap. 32, Gry 2, M 2, Sec. 341, Title 8, Califomia Adminislrative CodeJ. ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as notetl above, unless such person has a permit to tlo such work fmm [he division. Appliwnl'S SignaWre Division of Industrial Satery Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicanl or presenl or tu[ure building occupant need to file and certify a Business Plan for emergency response to release or threateneA release of a hazardous matenal? ❑ Yes ❑ No (Section 25505 of the Cali(ornia Health and Safery Cotle requires, with some excep[ions, Iha[ a Business Plan De filed wiN the Costa Mesa Fire Department by every business which has at any one lime dunng a reportetl year a quantity of hazardous malenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic (eet of compressed gas at slandartl temperature and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration (orm for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of Ihe California Health and Safety Code, with some exceptions. requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of awtely hazardous materials equal to or greater than a weight oF 500 pounds, or a volume of 55 gallons, or 200 cubic teet o! compressed gas at slandard temperalure and pressure). 3. Does or will the applicant or presen[ or (uWre builtling occupant need lo prepare an RMPP (Risk Management and Prevenlion Program for acutely hazardous matenals)? ❑ Yes ❑ No (Section 25534 of the Califomia Health an0 Safery Code pmvides thal the Costa Mesa Fire Department may require the preparation, certifcation and filing wi�h Ihe Fire Department o( an RMPP by businesses which are required ro register aculely hazardous malerials with lhe Fire Department. 4. If an RMPP is presently required, has Section 25534 of the Califomia Health and Safely Cotle been fully complied with? � Yes ❑ No 5. Does or will the applicant or presenl or fulure builtling occupant require for the work which is Ihe subject of this application a permil for such conslruction or modification from the South Coast Air �ualiry Management Dislrict or from any other air pollution control distncl or agency? ❑ Yes ❑ No (Section 658502 of Ihe Califomia Govemment Cotle requires that �he requested in(ormation be fumished on applications for non-residential building pertni�s). 6. Will any patl of Ihe faciliry to be consWc[etl under Ihis permit be within 1000 feet from Ihe outer boundanes of a school? ❑ Yes ❑ No (I('yes", Ihe facili�y must meet Ihe requirement o( Sections 25534 and 42303 of Ihe California Heatlh and Safery Cotle). 7. If a permit fmm ihe South Coast Air Qualiry Management DisMct or other air polNtion control district or agency is required for the work which is the subject of this application, have all of the disclosures prescnbed by Calilornia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Q('yes", attach cedifwte ot compliance fmm the appropriate air pollulion contml offcer). ' CERTIFICATE OF COMPLIANCE: I certify that under�penalty of perjury lhe information given above is,correct. I agree to comply with all stale laws and ciry ordinances regarding �Hazardous Matenals and�Emissions. ,�� SignaWre Date . CERTIFICATE OF COMPUANCE AN� AUTHQRIZATION �F ENTR`l; 1 certify under penalty of perjury that I have reatl this application and sta�e Ihal the in/ortnalion given is corred. I agree [o comply with all state laws and city ordinances relating to building construction, and authorize representatives of the Ciry of Costa Mesa lo enter upon the above-0escribed property for inspection purposes. I agree not lo occupy or allow occupancy of any building authonzed by lhis permit un[il (nal inspec�ion. __ 2 ignaWre e � � 0 �e � ' � --��+ AnOlor orizetl Applicant Dale Y / / / ♦ / �� / I / / ' � / � OWNER-BUILDER VERIFICATION Address: � �� D OG ini o t71� S t COd'fA� M�A�re`1262 � A city or coimty, which is required ro give notice pursuant to Section 1983Q shall attach to such notice, and, as a condition preceden[ to issuing a building permit, require the completion and require the retum of, an owner- builder verification. Attention Property Owner: An 'owner-builder' building pennit has been applied for in your name and bearing your signature. Please complete and retum this informa[ion in the envelope provided at your eadiest opportunity to avoid unnecessary delay in processing and issuing your building permit. No buildin£ permit will be issued until this verifica[ion is received. l. 1 personally plan to provide the major labor and matenals for construction of the proposed property improvement. ❑ Yes [� No 2. I(have/F�a�caet) signed an application for a building permit for the proposed work. 3. I have contracted with Ihe following person (firm) to provide [he proposed construction: Name N��- Address City Phone ( ) Contractor's Lic. No. 4. 1 plan to provide portions of the work, but 1 have hired the following person to coordina[e, supervise and provide the major work: Name . Address Phone ( City ) Contractor's Lic. No. 5. 1 will provide some of the work but [ have contracted (hired) [he following persons to provide the work indicated: Name Address Phone Type of Work t0a2<6 (Rev.if/Oa) I hereby affirm that I have received a copy of the informafion set forth in Section 19830 of the State of Califomia Health and Safery Code and have completed the above information ro the best of my personal knowledge, in compliance with tMs State law. Signed: G.�� Date: I � /� / �� Name: W i l. i, I�r�- � � j'R-l. l� t S' (Rintui or Ty�sl) � C.D.L. # For more information call City of Costa Mesa Building Division at (714) 754-5273. t0a2-a8 (Rw. 11Na) 01�1° Z1U9 UH:J9 F:IS 15USdJ5 a0t .`!J Cic11 i%]i�0° . ' �. � --- I . . . . 1 � I� ��----�� APPRO� T CITY OF COSTq N[ESA PLANNlNG DIVISION- SUBJECT TO BLDG. DEPT. I NOTE: ADDITIONS, ELF.TION OR GORRECTION fiHALL BE PPROYED BY THE ANNING I �� r.% l -.i' i ---- � .t?`� Z '�' I � � � I r' � yrJ / ` �Z�J _ : .___� / �� ... � ,,t t�1Y IILt��' � 0 nF E;� STA Mk �A � 10�� r 1'!X-YW'a�Jo�L�'t�Tv o` R�� v e�� 'i,-�=� �"7}� S �� -�,�� r.,,P ._— ��to C7�'"`� ...,mcs ana �', Is M t n�h��t�:��rr,. ..p'�y�5iond�� —. . ..... . .... /�PN '��;�t—��z—c�:t......_._�.----_ �( '%.�v.� 1 I i i hP, NFO �' � c<-0P �fOf:'!,r !L/VI P�Itifa�l00C•i..� Kfr°�I�r �_�. �ti�5 sel ot ans ard sP - � on same w:ihoN ��,y�,qes oi alteia6on. ti, ��d!o co�^�t or tn be � t��. Gry of Costa""z $NALL NO` � . � lery• iar. ane spec�icatiions . oi Gosta Mesa O�anTnce anNo� 6�� a ----- ------ot ��aroF anv.Pi�v�s�ons at any�i� ro and 1�^`� nat��vo�d �t � i�• � a�� d�� shail exprtetY � CEC g¢c.i0S5 1� TheseP y�dmy�mau�edacicie� l.J ✓ �� o� ,�� oi:iz zoos o9:aa ea� isu�aasaaot y9 c1�-ii Lattic� Cover < lattice � LaHice 1_ RaRa� ~ � Joist Hange� LCKiger i F 29'0 -- Slab Slope io Orain Laflice Covar Rafter 5alid Ficwr Cover 26 Ga. FFiAMING PLAN ;2" sneatnmg- � � �� Heeder--- Rafter— 4 Jo�st Hanger � Pasl—' � Laclgdr— `1. � g =o �O m �S� b � �o Slab—� fa0ting 56CTIGN9 - Roof'Cove.ring Root Sheathing � Sofid Root Cover @�ooa DETA!L tlPTiON9 C�etic the unus thal apply: Lattko Caver. ❑A OB OG �G OE OF sawco�r. ❑A ❑D CE C1F pest ti�pr Pp9t a m�,. Fa�4rg Depm PAO F6QFING ': A 750d RA% ^.2'i,09� P�, �0� I'il i �-Sl.4B . SLAB FOOTING ._„ Zu� 2a6 Nin —� � � Slepe ��-y�� asca 40 L1fd(f7 EYiaivg LL Ar.c; .w_r�' Z, o, �, ��' ruct tac tnxz S ERVE CONNECTlON • • SPEClFY. LUMBER: �'(GF ❑RedWood ❑ Hemfir SPEGIFY GRADE: � No. 1 � No. 2 CQNCRETE: 250U psi min. Q 28 days GONNEGTIGNS: IGBO appraved or equal t. Rooi covzrng: ,�l - I�c,y�F=iw, Slope:___ :12 2. Roof sneafhing�. MaXimum spans: +:r: s t.a�7 Scrows � t e• o.c. . �� I I \� :'�au WAII CONNECTION ^ tnr.ice lattice: x �_' o.e.[ 2x2 - 6'� 2x3 - 8': 2x4 - 10' ��eoi� solitl: _�" CCX plywootl or _ '.)umber: 1" � Z' . 8'; 2" • 8': 0' � Rfirya,� � o�mr!y Fost .3. Rafters: �x�_ Q��" o.c. � Single [j Deuble �p� �i 4: HeuAer. �x� �6irx,�le ClOoubie I �aeicr:a � 5.'Ledger. �2 x_jC (Dc min) 1�iqF � E WHEADER E 6. Fasd'a: '�- x�, (2� rr�n) 7. Post: �x,�(4x4 rctin) Raise t' min abova slab surlaca � eoorsneazn�ne ,u �ae�ra A. Footing: ,�x]�." 12"x�2" min for up to 56 sf hibu�ary area: 18"z1 d' mirt for 67-? 5p sf LnDutary area � "depth(FxpanslveSoilZone,_� . ��; �; �y+`++ o 9. Stab k� 'thick (Fxpensive Sail Zone ) p(VISION OF BUfLDIN ��sci�x, STA ME� �0. Conneclions: a. JoistroLedger ✓,. � -Metatjoisfhanger CITY OF CO HeBce�_ 1%B`oca'ng t O V �%�� ppy�.•�"`- `Column ap � b. JOLat to Headrn� - Solid blacking with framoig ar�cl�p� c. poubled joist or header to post -�(2) V2' Gia. thru bolts wi washers ✓. � _Da e�p�� F d. Joiet to Faecia - Met I traming anchors eachsitl�t �— �� min. ca xi� 0.5"'oiat 3 an "'bis. - �. �ica�io��s MUST'�°� �'�! �" �h�s I°h �1 a;"' , � G y� 1 D I�� 1 s aM sF- �en certres<on'�ar, �.he Drdswn ot &n'�9 e. Header to Poat - GoluiAR � p � y�1e1� �,or sa^:� ,"'�'�. `'� , . f. P�tto5labwFootlng� -iviB___ � �. � ,�:•a��ocea�a� g. Root SheatlVn9 ✓ - 8 d(�§�'��PcryE�d es ��C y��dlE�� Ali NOT N'^e�d to C ��_�� g�ymping o- �'� - P" � �oviSions ot an Git of Gosta �re5� �'�i°�"�E �ndlo� State law• �c Y y ol lheviolation o' anY �� 105.5withinl8(1da ��' These P�ns and perm�i shailmeaxPa�ned acti et'per GBC Secme nuu and vo�d �1 the buii q�y workisnotcommenceda�d ^_`�� jX�� - i�U 0 0 { �. �t ...�.. :: I... :I�' •'��t"I " - ~.� . �.�h.. �G: . JI � ��' . . .. . . � . ✓1'"' ,.,, '' � . .. �f ... ��4� Y -i . a 0 ��' tS�t� , .. � i \ � �IJC��Y�� i2 �)j/'.'O'" !� lfi.l�i�l.'' f f./ . �.�.:puaw . :E .5ti . .,�vCi„M1'dl {.l!i�l� e . 1tl�eb'� :1 IG O1./12 2(�ON U9:J9 F:iX Y805di54401 � .::�;�i,� zy �D � _ . „---- w_ -"'--.. t��--^f`:— -f...—'—� . T � .�.-z'. s'� ; ,;— � „ _s�`..�,,�1y.,— � - . 1 '. :rYv.j � �f 1'I ; �V � jl �—=— ��—'----,._. _--- I �=_-.:..- --- 7T - - i. � !o-i��'_I_I_ �� ...�'-' 7 �— �--" � . - ., ---'— _ - � . ._� �� .. i; ; f � � '' � ��I.,�� a9 f�' �i �� ili I �i . �—.__ ................. . ---- ;�,.r—� ��' .-. ' �— +I � 2.�' �c.C^!e.) ,� � ��'. � II ��.. .. il__'_�J__ _..."_ ,� '- ---`.-.:. , .�..._-- i�----- ------- __,�' I 1 I �KR��p�s� i � ;�.�_�-- � _F� -- �� .�-T- . -,, �_ �� - ` � �J� -�- _:-_�- ._:.- _ _ -- N _I��-- �---- � --�«T I � lK _2„��;,n:�. � ;— ir 4�fp' �r'%T M� CLvll � ;'.�:• �ax �c�, iY„ �:1�Y C��.15 SCL^�+1� - � ^cr a.c.['•.Pi ��-:niU�ca-�wrttcu 'iit�naT�.E u%s.^.,y � N=�zl .'i'- o.)... � E�1i",�y�- C� w�..i,o:i 2[l^f WAtL� �� n ,,;;� _. �� .:�I w�R�M�, VJn.LI� `a19 'D�'n'�.Y.�'%P �'. �.! �1'A MGEA, CA 9'Co27 C�b?} a,i-i2�3:� ad C9diJ(pQ14'Z13t� . � , / Il � � �oor y� �" � S 3 � DIVISION OF BUILD N<: �,., Y CITV OF�p ST�,�',A O�� _ . P�()�'ED � �1'�� iC).�-- — --�ate_ �2=�-1 v � Tp�ia se of p�ans and ;p�� .fon� "! i' '��_ eec� on this �ob a� a'I tim�•�, and it is unl2wlul lo make�y charge< x a" �ra;:, ",� .: -e �v�a�o,:! :. .�, pe•m,ss�on hom Ne fhvrsim of BuilQng and Safery. Ciiv o' �0.,�a ":� , TI1B$(2fI1PIfIJo'ih6�4L1,�fM150Pq�iGUnr,eiFAI.iNCTb?flf'f]:ppQrtnr itinb22f12�I0V2� of the violation of any piovisions ol any ury of Gosa A�esa Ordinanre anNor State law. These plans and perma shall eryire 6y hmitation and become nuil and void il the building oy�/� work is not commenced and maintained actrve per CBC Sec.105 5 w�thin 180 days of issuanp�. �x�i- � �J� � CITY OF COSTA MESA BYILDING DIVISION i � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Faz (714) 754-4856 • www ci costa-mesa.ca.us : �.�� FOR INSP ONS CALL: (714) 754-5626 . 0� PERMIT NUMBER: BX09-00124 PERMITTYPE B_MISC O� STATUS: FINALED APN: 42252204 O DATE ISSUED: 06/03/2009 Zoning: , � ISSUED BY: BJK JOB ADDRESS: 919 DOGWOOD ST CM Viciniry: � - - SQ. FT: 350 � Suite/Unit: Primary Occ: 32 � Const Type :?? Valuation: E5,6a2.00 � SCOPE OF WORK: HOUSING REHAB PROJECT � � ' 350 SF LATTICE PATIO COVER AT THE REAR OF AN EXISTING SFD. OWNER: WALLIS,WILLIAM J AND CHRISTINA M Address:: City/State: COSTA MESA, CA � . � _ Phone: 949-689•2130 � � � APPLICANT: LEYVA, ROBERT ' � City/State: COSTA MESA, CA � � . � Phone: 714323-5820 - CONTRACTOR: ROBERT LEYVA CONSTRUCTION CO Address: 953'UNION AV � City/State: COSTA MESA, CA Zip Code; 92627.. - '. ARCHITECT: Phone . '. ... - , . ENGINEER: - Phone " FEE SUMMARY. Building Plan CFieck:- Building Permit � Electrical Permit: SMfP Residential SMIP Commercial Bldg Sld Admin Fund TOTALFEES 919 DOGWOOD ST Zip Code: 92627-4116 Address: 953 UNION AV , Zip Code: 92627 License No. 825124 Phone 714323•5820 .. . � . � . �$81.41 $12525. $0.00 $0.00 $0.00 ' $1.00 $207.66 License No. License No. Cell: Unit Unit: Uni�: NOTtCE: The work authonzed by Nis permit shall comply with all appiicable handicap access requi2ments under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21•92) � EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTiONS: In order for the work authonzetl under this pertnit to be wnsidered legal, such work must compty with all applicable cades, and ali required inspectfons and final approval must 6e obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. COOEt. INSVEC710NlYPE Q/yl� IJILIUI�$ 4QQ�( INSPEC710NTYiE �TJF IN11M15 1618 Fixed System Final Fire Preventian 206 Final Mechanical 1268 Ppol Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electncal 201 Final BlocklRetaining W all 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 FinalSi9n 222 finalSite � � � 204 Final Damolition 250 Final Builtling/Occupancy WORKERS' COMPENSATION DECLARATION: . • - I hereby aKrm under penalty of perjury one o( the following declarations: ., � I have and will maintain a ceAifwte of conseN to self-Insure for vrorkers' compensation, as provided for Gy section 3700 of the Labor Code, for the peAormance of the work for which this permit is issued. ❑ I have antl will maintain workers' compensation insu2nce, as required by section 3700 of the Labor Code, for ihe performance of the wnrk for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Cartier: (This serlion neeC �pf De cnmpleted qthe pemM a vdluetl al one hu�re00aNars (f 100) w Mss ) Policy Number: ❑ I certify that in the per(ormance of the work for which this permit is issuetl, I shall not employ any person in any manner so as to become subject to the vrorkers' compensation lavrs of Califomia, and agree thal if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply wilh tpese provisions. AOW��'s SignaWre WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm tha� I am licensed under pmvi5ions o( Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and eHect. Lic. # Cless # Gonvaclor's Signamre Daie CONSTRUCTION LENDING AGENCY: ❑ I hereby affvm thal Ihere is a constNction lending agency for the pertortnance W the work tv which this permit is asuetl. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: OWNER-BUILDER DECLARATIONS: I hereby af(irm that under penalty of perjury that I am EXEMPT FROM THE CON7RACTORS LICENSE LAW for the (ollowing reason (Sec. 7031.5, Business and Professions Code: Any cily or county which requires a permit to construct, alter, improve, demolish, or repair any strucwre, pnor to ils issuance, also requires the applicant for such permit lo (le a signed statement that he or she is licensed pursuant to the Provisions of the Contracbrs License Law (Chapter 9(commencing wilh SBction 7000) of Division 3 of Ihe Business and Professions Code) or that he o� she is exempt �herefrom and the basis (or the alleged exemption. Any violation of Section 7031.5 by any appliwnt for a pertnit subjects the applicaN to a civil penalry of nol more than five huntlred tlollars ($500).): ❑ I, as ovmer of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and ihe slructure is not intended or oRered for sale (Sec. 7044, 8usiness and Pro(essions Code: The Contractors License Law does not apply to an ovmer of property who builds or improves thereon, and who d0e5 suth vrork�himsel( or herself or through his or her own employees, provi0ed that such improvements are not intended or offeretl for sale. If, hovrever, the huiltlinq or improvemenl is sold wilhin one year of completioq the ovmervbuilder will have the burden of proving that he or she ditl not build or improve for purpose of sale.). ❑ I, as owner of the property, am E7(CLUSIVELY CONTRACTING WITH UCENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professbns Code: The coniraclors License LaW dces no� apply to an owner of propetly who builds or,improves thereon, and vfio coM2cls fw such project with a cont2ctor(s) license pursuant to the Contracto�s License Laws.). ❑ I am exempt under sec. Business and Professions Code for ihis reason: Date ]OS)-a6(3/0]� Owner ID verified by Ariver e��cense. ❑ Yes ❑ No Driver's License No. Ezpires: Verification of Ownership by (rype of documenl, i.e. - property taz bill or deed): DIVI�INDUSTRIALSAFETYPERMITCERTIFICATION: , ' � ❑ I hat no excavation frve (5) w more feet in depth into v.hich a perso re d d, vnll be made in connection with work authodzed by Ihi ertnit, �tliy9� mcWre, scalfdtling. falsework, or tlemolition or dismanthng t II mb n Ihirty-six (36) fee� high. (Chap. 32, Grp 2, M 2, Sec. 34 Tit Rornia ministrative Code). ❑ As owner-builder, I wil employ anyone to do vrork which would require a permit from the Division of Industrial Safety, as noled above, unless such person has a permil ro do such vrork from the division. AVW��'s Siqnawre Da�e Division of Indusirial Sa(ety Permit Number HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicanl or presenl or tuture building occupant need to file and certily a Business Plan for emergency response to release or threatenetl release of a hazardous material? O Yes ❑ No (Section 25505 of Ihe California Health and Safely Cotle requires, wilh some ezceplions, lhat a Business Plan be filetl with the Costa Mesa Fire Depanment by every business which has at any one time during a reported year a quantiry of hazardous matenals equal to or greater Ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperaWre and pressure). 2. Does or will Ihe applicam or present or (uture builtling occupant neetl to fle a registration form for awtely hazardous materials? ❑ Yes ❑ No (Seclion 25533 0/ the Califomia Health and Safety Cale, with some exceptions, requires registration wi[h the Costa Mesa Fire Depanment by each business which at any one time has on hand a quantity of acutely hazardous malerials equal to or greater lhan a weight o( 500 pounds, Or a volume of 55 gallons, or 200 cubic feet o( compressed gas at slandard temperature antl pressure). 3. Does or will the applicant or presenl or future building occupant need to prepare an RMPP (Risk Management and Prevention Program !or awtely hazardous materials�l ❑ Yes ❑ No (Section 25534 ot the Califomia Heallh antl Safery Code pmvides that lhe Cosla Mesa Fire Depanment may require the preparation, certification antl filing with the Fire Department of an RMPP by businesses v+hich are requiretl b regisler acutely hazardous materials with the Fire Oepartment. 4. If an RMPP is presently reQuireO, �as Section 25534 of lhe Califomia Health and Satety Cotle been fully complied with? ❑ Ves � No 5. Does or will the applicanl or present or tuture builtling occupant require for ihe work which is the subjecl of this applicalion a permit for such consWction or modification from lhe South Coast Air Qualiry Management District or from any other air pollution wntml tlistricl or agencyT ❑ Yes ❑ No (Section 65850.2 of the Califomia GovemmeN Cotle requires Ihat the requesled infortnation 6e fumished on applications for rron-residential building permits). 6. Will any paA of Ihe facility to be constructed under lhis permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No Qf yes", Ihe facility musl meet the requirement o( Sections 25534 antl 42303 of the Califomia Health and Safety Cotle). 7. I( a permit from the South Coast Air Quality Management District or other air pollulion control tlisMct or agency is required tor the vrork which is the subject of this application, have all of the disclosures prescribed by Califomia Heallh and Safety Code Seclion 42303 heen made? ❑ Yes ❑ No 8. (If'yes", attach certificate of compliance from the appropriate air pollution control officeQ. � CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the intortnation given above is cortect. I aqree to comply with all state laws and city ordinances regarding Hazardous Materials antl Emissions. �" ' S�gnaWre Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury thal I have read this appliwtion and state lhat Ihe in(ortnalion given is correcL I agree to comply with all state laws and cily ordinances relaling to building constmclion, and authorize representatives of the City o! CosW Mesa to enler upon [he above-tlescribetl pmperty for inspection purposes. I agree not to occupy or allow occupancy of any building auihorized by Ihis permit until final inspection. Si8^awre o� Legal Ovmeqs) oa�e Anplar AUlhonxe0 Appl¢anl CITY OF COSTA MESA . B(/ILD/NG D/VIS/ON F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • w�^,v ci.costa-mesa.ca.us �.�p� FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: M08-00155 PERMIT TYPE MECH STATUS: ISSUED APN: 42252204 � DATE ISSUED: 12/12I2008 ISSUED BY: RMD JOB ADDRpySS: 919 DOGWOOD ST CM . Suite/Unit: Vicinity: F•(`:'(�/l„(,� _ . , _ � , � SQ. FT: 0 � . SCOPE OF WORK: M CHANICAL PERMIT.FOR THE INSTALLAION OF A NEW MECHANICAL KITCHEN RANGE FOR A SFD. �e.�� ba�- dD�31 O NER: WALLIS,WILLIAM J"AND CHRISTINA M Address: 919 DOGWOOD ST Unit: PHONE: 949-689-2130 - , ._ City/State/Zip: COSTA MESA, CA - APpLICANT: PRADO, SOFlA -� ' - � Address: 915 LAKE STREET Unik � PHONE: 714-960-7052 � . . � City/State/zZip: HUNTINGTON BEACH, CA -. CONTRACTOR: J K CONSTRUCTION Adtlress: 915 LAKE STUnit: � PHONE: City/State: HUNTINGTON BEACN, CA CELL: 714-960-7052 714-004-9846 CELL � MECHANICAL PERMIT FEE=SUMMARY MECH ITEM FEE: � - $34.15 PLAN CHECK FEE: __ � $0.00 INVESTIGATION FEE: - $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $34.15 License No. 450297 ZipCode: 92648 n y NOTICE: The work authorized by this pertnit shall comply with all applicable handicap access requirements under Califomia statutes and related regulatlons. (Ortl. No. 92-28. § 7, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. . INSPECTIONS: In order for the work authorized under this permit to be considered legal, such vrork must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspeclions and final approval will result in the ezpiration of this permit. �Q$�/ INSPECLION7YP DAT N L OOE/ INSPECTIONTYPE QRjF p pIN7171AL5 1616 Fized System Final Fire PrevenGon 206 Final Mechanical � -� l L"] nl 1268 200 201 202 203 2119 9 Pool SDa Final Final Re-Roof Final8locWRetaining Wall Final Factory Fire Place Final Sign Final Dertqlition 208 210 212 220 222 250 Final Plumbing Final Electncal Final Fire Prevention Final Planning Approval FinalSite Final 9uiltling/Occupancy WORKERS' COMPENSATION DECLARATION: I hereby aKrtn under penalry of perjury one of [he following declara6ons: ❑ I have and will mainWin a certificate of consent ro self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the peAo�mance of the work for which this permit is Issued. ❑ I have antl will maintain workers' compensation insurance, as requiretl by section 3700 of the Labor Code, for the peAortnance of the �+ork for which this permil is issued. My workers' Compensaliorl Insurance carrier antl policy number are:C=�n//� � Carrier: C��(�.r �n% {Ul (ihaseemnee�(a��p� efeC mece��we0afare�uMreCcblars(SfOp)wless) 1 (r l� Policy Number: b0 0 ❑ I certify thal in the Per(ortnance of the work for which this permit is issued, I shall not employ any person in any manner so as lo become subject to the worke�s' compensa[ion laws o� California, and agree [hal if I should beco subject b the w rkers' compensalion provisions of Sec[ion 3700 of the La , . d, s I f wit�h�g mply with ihese provisions. �y-/ Wl, �2-� Z-d Q pli s ig��ure Da�e WARNING: FAIL RE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SNALL SUBJECT AN EMPIOYER TO CRIMINAI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOUARS ($100,000), IN AODITION YO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECYION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aRrm Ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of lhe Business and Pro(essions Code. antl my license is irnn full force and effect. (0 —�7 Lic.#' .�v�� Class# �'v� I (2-(Z-d� acto s S Oate_ CONSTRUCTION LE DING AGENCY: ❑ I hereDy affmn that there is a consWction lentling agency (or the peAortnance M the work fW which this permit is issuetl. (Sec. 3097, Civil Code�. Lender's Name: Lender's Atldress: OWNER-BUILDER DECLARATIONS: I hereby aHirm that under penalty of perjury ihat I am EXEMPT FROM THE CONTRAC70RS LICEN5E LAW lor t�e following reason (Sec. 7031.5, eusiness and Prolessions Code: Any ciry or county which requires a permit lo conslruct, alter, improve, demolish, or repair any sWcture, prior lo its issuance, also requires ths applicant /w such permit to file a signetl statement [hat he or she is IicensBd pursuant lo Ihe provisions of the Contracrors License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of the Business antl Professions Code) or that he or she is exempt therefrom and the basis for [he alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty o( not more Ihan five hundred dollars ($500).): ❑ I, as owner of lhe property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, and Ihe structure is not inlended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law dces not apply to an owner ot property who builds or improves thereon, and who tices suCh work himselt or herselt or through his or her own employees, provided that such improvemenis are not intended or o(tered for sale. If, however, the building or improvement is sold within one year o( completion, lhe owneo-builder will have lhe burtlen of pmving that he or she did not build or improve tor purpose of sale.)., . ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professbns Code: The contractors License Law dces'not apply to an owner o( property who builds or improves thereon, and who contrac[s for such project with a contracta(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Pro(essions Code for Ihis reason: 9gnawre � ' Oate 305J�48 pro1) Owner ID veri(ed by drive� ,..�cense. ❑ Yes ❑ t�b Driver s License No. F�cpires: Veri(calion of Ownership by (lype of document, i.e. - property taz bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � ❑ I hereby certAy Ihat no excava�ion frve (5) or more feet in depth into which a person is required to descend, will be made in connection with v,nrk authorized by this permit, and that no building stmcNre, scaf(dtl�ng, falsework, a tlemolition or dismantling IhereoF, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2. M 2, Sea 341, Title 8, Califomia Administrative Code). ❑ As owner-builtler, I will not employ anyone to do work which would require a permit from the Division of Industnal Safery, as noted above, unless such person has a pertnil lo do such vrork from the division. Appl¢anl's Signalure Division ot Industrial Safety Permil Number. _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICA710N: 1. Will the applicant or present or fWure building occupant need to (le and certify a Business Plan for emergency response to release or threate�ed release o( a hazardous matenal7 � Yes ❑ No (Section 25505 ot the Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one lime during a reported year a quantity of hazartlous materials equal to or greater Ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o( compressetl gas at standard temperaWre and pressure). 2. Does or will Ihe applicanl or present or future building occupant need lo (le a registralion form (or acu[ely hazardous matenals? ❑ Yes ❑ No (Section 25533 0! the California Health and Safery Code, wii� 5ome exceptions, requires registration wilh the Costa Mesa Fire Department by each business which at any one time has on hand a quantity ot acutely hazardous matenals equal to or greater than a weight of 500 pounds, or a volume o( 55 9allons, or 200 cubic feel of compressed gas at slantlard temperature antl pressure�. 3. Does or will ihe appliwnt or present or (uture building occupant neetl to prepare an RMPP (Risk Management and Prevention Prog2m for acutely hazardous mate�als)? ❑ Yes ❑ No (Section 25534 of the Calilomia Health and Safery Code provitles that the Cosla Mesa Fire Depariment may require the preparation, certifcalion and fling with Ihe Fire DepartmeN o( an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. I( an RMPP is presently reQuired, has Section 25534 0! the California Health and Sa(ery Code been fully wmplied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subjecl of this appliwtion a pe�it for such construction or modification fmm lhe SoWh Coasl Air Quality Management District or from any other air polution control dislrict or agency? ❑ Yes ❑ No (Sec[ion 658502 of Ihe Califomia Govemment Cotle requires Ihat ihe requested informatan be lumished on applications !or ron-resitlential building pertnits). 6. Will any paR of the facility lo be conslructed under this permit be wilhin 1000 feet from the outer bountlaries of a school? ❑ Yes 0 No Q!'yes", the facility must meet the requirement of Sections 25534 and 42303 of the Cali(omia Health and Safely Cotle�. 7. If a permit (rom Ihe South Coasl Air �ualiry Management Districl or other air polWtion control disMcl or agency is requiretl for the vrork which is ihe subject of Ihis application, have all of the disclosures prescribed by Califomia Health and Satery Cotle Section 42303 been matle? ❑ Ves ❑ No 8. (If'yes", attach certificate of compliance from Ihe appropriate air pollution wntrol oKcer). ' CERTIFICATE OF COMPLIANCE: I certify Ihat•under penalty of perjury lhe information given above is correcl. I agree to comply with all stale laws and ciry ortlinances regarding Hazartlous Matenals and Emissions. . Si9naWre - - �a�e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have reatl this application antl state that the information given is correct I agree to comply wilh all state laws and city ortlinances relaling to building conslruction, and authonze repiesenWlives ot Ihe Ciry of Costa Mesa to enter upon ihe above-descnbetl property tor i�spectio� puryoses. I agree nut to occupy or allow uccupancy ot a�y huilding authonzetl by Ihis pertni� until (nal inspection. u i e e 7 Da�e tZ-(Z-0 /OrAul� i dApp�icanl '��'Da�e CITY OF COSTA MESA . BYILpING DIYISION i 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us F ��m�. FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: M08-00154 PERMIT TYpE MECH STATUS: ISSUED. APN: 42252204 DATE ISSUED: 1 211 2/2 0 0 8 ISSUED BY: RMD JOB ADDRESS: 919 DOGWOOD ST CM Vicinity: ATTIC � � - � ' Suite/Unit: SQ. FT: 0 SCOPE OF WORK: MECHANICAL�PERMIT FOR THE INSTALLAION OF A FAU < 100 K BTU IN AT71C WITH NEW DUCTING FOR A SFD. REF#: E08-00430 '� ' � OWNER: WALLIS,WILLIAM'J AND.CHRISTINA M PHONE: 949-689-2130� ,' ' APPLICANT: pRADO, SOFIA � , . PHONE: 714-960-7052 - . - ' Address: 919 DOGWOOD 5T . Unit: City/State/Zip: COSTA MESA, CA Address: 915�LAKESTREET Unit: CitylState/zZip: HUNTINGTON BEACH, CA CONTRACTOR: J K CONSTRUCTION Address: 975 LAKE S7Unit: PHONE: 7l4-404-9846 CELL City/State: HUNTINGTON BEACH, CA CELL: 714-960-7052 � MECHANICAL PERMIT-FEE SUMMARY MECk ITEM FEE: $52.00 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: � - $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $52.00 ' � License No. 450297 ZipCode: 92648 � , � NOTICE: Thg work authorized by this pertnit shall comply with all applicable handicap access requiremenls under Califomia statutes and related regulations. (Qrd. No. 92-28, § 1, 12-27-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work aulhorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and finat approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. COOE/, INSVECTIOMIYVE 1678 Fized System Final Fire Prevention 1288 Pool Spa Final 200 Final Re-Roof 207 Final BI�klRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition r � � N �L GODEt INSPECTIONTYPE 20fi Final Mechanical 208 Final Plumbing 270 Final Electdcal 212 Final Fire Prevention � 220 222 250 Final Planning Approval FinalSite Final Building/Octupancy jld,� IN717UL5 �I9_09 (�n, WORKERS' COMPENSATION DECLARATION: � I hereby affirm under penalty of perjury one o( the following declarations: ❑ I have and will mainwin a certificate of consent to self-Insure for workers' compensation, as provitlad for by section 3700 0l the Labor Cotle, for tha pedormance of Ihe work for which ihis permit is issuad. ❑ I have antl will main[ain v.orkers' compensation insurance, as required by section 3700 of the LaDor Code, fa Ihe peAortnance of the work lor which this permit is issued. My vrorkers' compensation Insurance wrrier and policy number are: �Carrier'.. � (TNssectimneetl t m'�pefetlJllrepertMardNCHatme�uMreON¢ars(5100)cvleuJ Policy,Number g�� ❑ I certi(y Ihat in the peAortnance of the work for which lhis permit is issued, I shall not employ any person in any manner so as to become subjecl b the wnrkers' compensation laws ot California, and agree that i( I should becom� to the w0�kers' com ensa[ion provisions ot Section 3700 of the Labor Co e I II � t om ly with these provisions. �pplio 1's i9n re � � � WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPIOYER TO CRIMINA� PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAF2S ($700,000), IN ADDITION YO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEC710N 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby a(frm that I am licensetl under pmvisions o! Chapter 9(commencing with Section 7000) of Division 3 0( the Business antl Professions Code, and my license is in (ull (orce and eHect. Licr# � �_. Class # �Z-IZ-0 �� alure Date CONSTRU TIO LENDING AGENCY: ❑ I hereby a irtn ihaC there is a construction lending agency fa the peAwmance of the work for wfiich this permit is issued. (Sec. 3097, Civil Code). Lender 5 Name: Lender's Atldress: Signalure Oale OWNER-BUILDER DECLARATIONS: I hereby aKrm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7o31.5, Business and Pmfassions Code: Any ciry or county which requires a permit to consiruct, alter, improve, demolish, or repair any sirucWre, prior to its issuance, also requires th8 applicant for such permil lo file a signed statement that he or she is IicensBd pursuant to the provisions of the Conlractors License Law (Chapter 9(commencinq with Section 7000) of Division 3 of the Busines5 and Professions Code) or Ihat he or she is exempt there(rom antl the Dasis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a pertnit subjects ihe applicant to a civil penalry of not more than five hundred dollars ($500).): ❑ I, as owner o( the property. or my employees wilh vrages as their sole wmpensation, WILL DO THE WORK, and the struclure is not intended or oHered for sale (Sec. 7044. Business and Professions Cotle: The Contractors License law does not apply lo an owner of property who builds or improves thereon, and who dces suCh work himselt or herself or through his or her own employees, provided that such improvements are not imended or oftered for sale. If, however, the building or improvement is sold wilhin one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for Purpose of sale.). ❑ I, as owner of the properry, am EXCLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business and Professbns Code: The con��c[ws License Law dces not apply to an ovmer of propeny vfio builds or improves thereon, and who contracts for such project with a contracta(s) license pursuant [o the Contractps License Lav+s.). ❑ I am exempt under sec. Business and Professions Cotle for lhis reason: � Signawre Date JOS]�48(3/0]) Owner ID verified by Arivei „ ncense. ❑ Ves ❑ No •Dnver's License No. Expires: Verifcation of Ownership by (rype of document, i.e. - propeny tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cetlify Ihat no excavation frve (5) or more (eet in deplh inlo which a person is required to descend, will be made in connectbn with v.ork authorized by [his permit, and IMt no building struclure, scaffdding, (alse�wrk, p demolilion or dismantling Ihereof, will be more than thirty-siz (36) feet high. (Chap. 32, Grp 2, M 2, Sec. 341, Ttle 8, Cali(omia Administ2tive Code�. ❑ As owner-builder. I will no[ employ anyone to do vrork which would require a permit lrom the Division of Industnal Sa�ery, as noted above, unless such person has a permil lo do such work from Ihe division. ApPliwnl's SignaWre Date Division of Intluslrial Sa(ety Permi[ Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file antl certify a Business Plan for emergency response [o release or lhrealenetl release of a �azardous malerial? ❑ Yes ❑ No (Section 25505 of I�e California Healt� antl Safety Cotle requires, with some eaceptions, lhat a Business Plan be filed wilh the Costa Mesa Fire Department by every business which has at any one lime tlunng a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic teet of compressed gas at standard IemperaNre and pressure�. 2. Does or will the applicant or presen[ or future building occupanl need to fle a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Health and Safety Code, with some exceptions, reQuires registration with the Costa Mesa Fire Department 6y each business which al any one time has on hantl a quantity of acutely hazardous materials equal to or greater than a weight ot 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standartl temperature and pressure�. 3. Does or will Ihe applicant or present or (uture building occupant neetl ro prepare an RMPP (Risk Management and Preven[ion Program lor acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 0( the Califomia Health antl Safery Code provides tha� the Cosla Mesa Fire Department may require the preparation, certifcalion and filing with the Pire DepaRment of an RMPP by businesses which are required lo regisler acutety hazardous materials with the Fire Department. 4. If an RMPP is presently reQuire0. has Section 25534 of the Cali(omia Health antl Safery Code been fully wmplied vrith? ❑ Yes ❑ No 5. Does or will Ihe applicant or presenl or fuWre builtling occupant require tor the work which is the subject of this application a pertnit for such construction or modification from Ihe South Coast Air Quality Management District or from any other air pollution control distric� or agency? ❑ Ves ❑ No (Section 658502 of the Cali(omia Govemment Code requires that the requested infortnation be fumished on applicatbns (a non-residential building permi[s�. 6. Will any paR of the (acility to be construc[ed under this permil be within 7000 feel (rom Ihe outer boundanes o( a school? ❑ Yes ❑ No Qf'yes", the faGility must meet Ihe requiremen[ of Sections 25534 and 42303 of the Califomia HeaIN and Safery Code). 7. If a permit from Ihe South Coast Air Qualily Management District or other air polWtion control district or agency is required (or the work which is the subject of this application, have all of lhe aisclosures prescnbetl by California Health and Safety Code Section 42303 been matle? ❑ Yes ❑ No 8, pf'yes", attach certificate of compliance from ihe appropnale air pollution control oKcer). CERTIFICATE�OF COMPLIANCE: I certify that under penalry of perjury'�the information given above is cortect I agree to comply with all stata laws and city ordinances regarding Hazartlous Matenals and Emissions. , Signamre ' �ale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury lhat I have read I�is application and state that the information given is wrrecL I agree to comply with all state laws and ciry ordinances relating to builtling consiruction, and authorize representatives ot the City of Costa Mesa to enter upon the above-descnbed property for inspeclion purposes. I agree not to occupy or allow occupancy ot any Duiltling aulhorized by Ihis permil until (nal inspection. Sig 1� eBa r Da�e �7_- (2-�� 10/Aut Onz ApPI¢ant —D'J12�'- CITY OF COSTA MESA . BI/ILDING DIVISION � � 77 FAIR ORIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us ��' ° FOR INSPECTIONS CALL: (714) 754-5626 .�.�+'R PERMIT NUMBER: E08-00430 PERMIT TYPE ELEC STATUS: ISSUED ApN: 42252204 DATE ISSUED: 1 2/1 212 0 0 8 ISSUED BY: RMD ' JOB ADDRESS: 919 DOGWOOD'ST CM ViCinity: ATTIC � ��- SuitelUnit: �.,� SCOPE OF WORK: ELECTRICAL PERMIT FOR i LIGHT FIXT AND 1 OUTLET FOR A NEW FAU LOCATED IN THE ATTIC OF A SFD. REF#: M48-0� �Sy � . .. � - .� � . OWNER: WALLIS,WILLIAM J AND CHRISTINA M Address: 979 DOGWOOD ST Unit: PHONE: 949-689-2130 `�, - CitylState2ip: COSTA MESA, CA APPLICANT: PRADO, SOFIA ' - � Address: 915 LAKE STREE7 Unit: PHONE: 714-960•7052 ' � - City/State/zZip: HUNTINGTON BEACH, CA CONTRACTOR: J K CONSTRUC710N � �� License No. 450297 ' Address: 915 LAKE STUnit: PHONE: 714-004-9846 CELL . � ". � City/State: HUNTINGTON BEACH, CA � ZipCode: 92646 � ' C�LL: 714-960-7052 • ' � - � � � . - i�.� , ,�. . � -.. ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $25.70 Reinspection Fee $0:00 TOTAL FEES $25.70 , •' �� NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related rsgulations. (Ord. No. 92•28. § t. 12-21-92) - � EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the vrork authorized under this permit to be considered legal, such work must comply with all applicable codes,- and all rBquired inspections and Rnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiretion of this permit. DE INSPECTONTYVE Q�,j�F INTRIRLS 4QD�Fa INSPECTIONTYPE � Qsjg IN717IAL3 1816 Fixed System Final Fite Prevention 208 Final MeU�anipl 1266 Pool Spa Final 20b Final Plumbing 20p Final RaRoof 210 Final ElecUiwl a-,9 - 0�1 � 2Qi Final Block/Retaining Wall 2/2 Final Fire Prevention 2Q2 Final Factory Fire Place 220 Final Planning Approval 2Q3 FinalSign 222 FinalSite z04 Final Demolition 250 Final BuildingiOccupancy WORKERS' COMPENSATION DECLARATION: I hereby affirtn under penalty of perjury one of the following declarations: ❑ I have and will maintain a cartificate of consent lo selt-Insure for vrorkers' compansation, as provided tor by section 3700 of the labor Code, !or t�e peAormanca ot the work for which t�ls permit is issuetl. ❑ I have antl will maintain workers' compensation insu2nce, as required by section 3700 0� lhe LaDor Code. fa the peAortnance of Ihe work for which Ihis permit is issued. My vrorkers' compensation I surance carrier and policy number are: �� } p :Camer. ��/�/�� (Tnisseain atlrro��p—eF rr�eredb�hepermakvaWetlararehunMedtlo¢ars(Ef00)wless) Policy.Number � D 0 K/�� ❑ I certify that in the perfo�ance o( the vrork for which Ihis permil is issued, I shall not employ any person in any manner so as to become subject to the vrorkers' compensation laws of Califomia, and agree that if I should become subje to the workers' compensation provisions of Section 3700 of the Labor Co s I(o hwit com vrit� these provisions. L-1z-0 p� 1's re Dale WARNING: FAILUR TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensstl untler provisions ot Chapter 9(commencing wit� Section 7000) o! Division 3 of the Business and Professions Code, and my license is in (ull force nd eHect. Q� �Lic..#�- �� Class# V n ` Z �� Z'�/ , - amr tlor' Signalure Date. .- CONSTRUCTION LENDING AGENCY: ❑ I hereDy aKrm tha[ there is a construction lending agency for the peAortnance of tha �nork fv v.hich this permit is issuetl. (Sec. 3097, Civil Cotle). Lender's Name: Lender's Address: OWNER-BUILDER DECLARAYIONS: I hereby aKrm that under penally of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LA�N for the /ollovring reason (Sec. 7031.5, Business and Professions Code: F�ny ciry or county which requires a permil to construct, alter, impmve, demolish, or repair any sWCWre, prior to its i55uanCe, also requires Ihe appliwnt for such permit ro file a signe0 slatement that he or she is licensetl pu�suant ro the provisions ot the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe Bu5ine55 and Professions Codz) or thal he or she is exempt lherefrom an0 tha basis (or the alleged ezemption. Any violation of Section 7031.5 by any appliwnt for a permit subjects the applicant to a civil penally of nol more I�an five hundred dollars ($500)J: � ❑ I, as owner of Ihe property, or my employees vnth wages as their sole compensation, WILL DO THE WORK, and the slructure is not intended or offered for sale (Sec. 7044, Business and Protessions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such vrork himselLor herself or through his or her own employees, provided that such improvemenls are nol intended or offered for sale. If, however, the building or improvement is sold within one year of completion, Ihe ovmer-builtler will have the burden of pmving thal he or she ditl nol build or improve for purpose of sale.). ❑ I, as owner of �he property, am EXCIUSIVELY. CON7RAC71NG WITH LICENSED CONTRACTORS to �onswct the project (Sec. 7044, Business and Professbns Code: The contractds License Law dces not apply to an ovmer of property who builds or improves thereon, and who contracts fa such prqect with a contracta(s) license pursuant to the Contractars license laws.). ❑ I am exempt under sec. Business and Pro(essions Code for this reason: Sigwwre ' ' ' Wie JOS].481�I01) Owner� ID verifed by tlrivei � ncense. ❑ Yes ❑ No Dnver's License No. Expires: � Veri(cation o/ Ovmership by (lype o( document, i.e. - propeny tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICATION: � ❑ I hereby certify Ihat no excavation frve (5) or more feet in deplh into wfiich a person is required to descend, vnll be made in connection with Hork authorized by this pertnit, antl that no building strucWre, scaffdding, falsewvrk, or demolilan or tlismantling thereof, will be more than ihiAysix (36) lee� high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Cali(omia Administrative Cotle). ❑ As owner-builder, I will not employ anyone lo do work which would require a permit from the Division of Intlustnal Safety, as noted above, unless such person has a permit to do such work (rom the division. AOdiwm's SignaWre pa�p Division of Industrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuNre builtling occupant need to file and certify a Business Plan for emergency response to release or Ihreatenetl release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Cali(omia Health antl Satey Cotle requires, with some exceplions, lhat a Business Plan be filed with the Costa Mesa Fire Department hy every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume ot 55 gallons, or 200 cubic feet of compressed gas at standartl lemperature antl pressure). 2. Does or will [he applicant or presenl or (uture building occupant need to file a registration form for acutely hazardous matenals? ❑ Yes ❑ No (Section 25533 0/ the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal ro or greater t�an a v.eight of 500 pounds, or a volume o! 55 gallons, or 200 cubic feet of compressed gas at stantlard temperature antl pressure). 3. Does or will the applicanl or present or fuNre builtling occupant need to prepare an RMPP (Risk Managemenl an0 Prevention Program for awtely hazardous malenals)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require lhe preparation, certification and filing wilh Ihe Fire Deparlmenl o( an RMPP by businesses which are required ro regis[er acutely hazardous materials with the Fire Department. 4. If an RMPP is presently reQuired, has Section 25534 of the Califomia Heallh and Sa(ery Code been fully complied wilh? � Yes ❑ No 5. Does or will the appliwM or presenl or fuNre building occupant require for the work which is the subjecl of this application a permit for such consimction or modification from the Soulh Coast Air Quality Management Distnct or tmm any olher air pollution control tlistrict or agency? ❑ Ves ❑ No (Seclion 658502 of the Califomia Govemment Code requires that Ihe requested in(ortnation be fumishetl on applications !a rwn-residential builtling pertnit5). 6. Will any part of the facility to be constructed under this pertnit be within 1000 teet from the ourer boundaries of a school? ❑ ves ❑ No (I� "yes", the facility musl meet Ihe requirement of Sections 25534 and 42303 of Ihe Califomia Healih and Safety Cotle). 7. If a permit (rom the South Coast Air �uality Management District or other air pollution control disMct or agency is required for the work which is the subject of this application, have all of Ihe tlisclosures prescribed by Califomia Health and Safery Code Section 42303 been made? ❑ Yes ❑ No 8. Q�'yes", attach certificate of compliance trom the appropriate air polWtion conlrol oKcer). � ' CERTIFICATE-0F COMPLIANCE: I certi(y that onder penalty of perjury the information given above is correcl. I agree to comply with all state laws and city ordinances regarding Hazartlous Materials and Emissions� SignaWre � Oate CERTIFICATE OF COMPUANCE AND AUTHORIZA710N QF ENTRY: 1 certify under penalry o( perjury that I have reatl this application and state Ihat Ihe infortnation given is correcl I agree to comply with all state laws and ciry ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-0escribetl properry tor inspection purposes. I agree noi to occupy or allow occupancy of any building authorized by lhis permit until final inspection. Sig r of g I O n ) Da�e _lZ-�Z- N � tlfOn W A P 1 Dal¢ CITY OF COSTA MESA B(IILDlNG DIVIS/ON . � F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 75a-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.ca.us �. FOR INSPECTIONS CALL: (714) 754-5626 �� PERMIT NUMBER: E08-00431 PERARIT TYPE ELEC STATUS: ISSUED APN: 42252204 DATE ISSUED: 12112/2008 ISSUED BY: RMD JOB ADDRESS: 919 DOGWOOD ST CM Vicinity: KITCHEN Suite/Unit: SCOPE OF WORK: ELECTRICAL PERMIT FOR i SWITCH AND 1 OUTLET FOR THE INSTALLATION OF A NEW MECHANICAL KITCHEN RANGE FOR A SFD. REF#: M08-00155 OWNER: ; WALLIS,WILLIAM J AND CHRISTINA M Address: 979 DOGWOOD ST Unit: PHONE: 949-689-2130 City/State2ip: COSTA MESA, CA � APPLICAN7: PRADO, SOFIA Address: 915 LAKE STREET Unit: PHONE: 714-960-7052 ' City/Stale/zZip: HUNTINGTON BEACH, CA CONTRACTOR: J K CONSTRUCTION - License No. 450297 Address: 915 LAKE STUniC PHONE: 714d04-9846 CELL � ' � CiryiState: HUNTINGTON BEACH, CA � ZipCode: 92648 CELL: 714-960-7052 � ELECTRICAI. PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: �25.70 Reinspection Fee $0.00 TOTAL FEES $25.70 � �, �s >c,,, 1 NOiICE: The work authorized by this pertnit shall comply with all applicable handicap access requirements under Calitomia statutes and related regUlations. (Ord. No. 92-28. § 1. 12-21•92) EXpIRAT10N: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. IN9pECTIONS: In order for the vrork authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and Flnal approval must be obtained. Failure lo obfain inspections and final approval will result in ihe expiration of this permit. cooe �. INSVECiIOMTYPE 1816 Fi:etl System Final Fire Prevention 7266 Pool Spa Final 200 Final Re-Rao( 2111 FinalBfack/Refaining Walf 202 Final Factory Fire Place 203 Final Sign 204 Final Dertrolition p�g xim�� Q.Q% INSVEL710NTYPE 208 Final Mechanical 208 Final Plumbing 210 Final EleCtrical 212 Finai Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building�Occupancy � H �� WORKERS' COMPENSATION DECLARATION: I hereby affirtn under penalty of peryury one of the tollovring declarations: ❑ I have and vrill maintain a cetlifcate of wnsent to self-Insure (or vrorkers' compensation, as providetl (or by.section 3700 of the Labor Cotle, for tha peAormance of I�e vrork tor which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code. tor [he peKortnance of t�e vqrk for which this permil is issued. My wnrkers' compensation Iqsurance carner and policy number are: �` / i A .I%1' .-Carrier. L.� _ ,��v�� Thb'SedmneaErplqIe yp� / �e�>nm9is(�rdAretlafare�urMreCckfars E100 akss PolicyNumber. `�V �J�J ( / .1 ❑ I certify that in the pertormance ol the work (or which this permit is issued, I shall nol employ any person in any manner so as to bewme subject to the �+rorkers' wmpensation lavrs ol Califomia, and agree that if I should bewme subjec� to the wnrkers' mpensation provisions ol Section 3700 of Ihe Labor Co h II f h', h omp vrith t�ese pmvisions. 1 (Z-�z-v� io tb prw re Daie�. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,OW�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND A7TORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrtn Ihat I am licensed under provisions o! Chapler 9(commencing with Section 7000) of Division 3 of Ihe Business anC Professions Code, and my license is in lull lo�rcfe (aw'ntl eflect. Lic. # _ v l Class # �_ _ - �2-Iz-O� or re Date CONSTRUCTION LENDING AGENCY: ❑ I hereby affmn that there is a construction lending agency fa the peRormance o( the woAc fa wfiich tttis pertnit is issued. (Sec. 3097, Civil Code). Lender'S Name: Lender's Address: Sipnawre Date OWNER-BUILDER DECLARATIONS: I hereby aKrm that under penalry of perjury that � am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7037.5, Business an0 Professions Code: Any city or county which requires a permil to construct, alter, improve, tlemolis�. or repair any strucNre. prior to its isSuanCe. also requires Ihe applicant for such permit to file a signed stalement Ihal he or she is Iicense0 pursuant to the provisions of the Contraclors License Law (Chaptar 9(commencing vrith SectiOn 7000) of Division 3 of ine Business antl Pmfessions CoOe) or that ne or she is exempt therefmm and the basis for the alleged exemption. Any violation o( Section 7031.5 by any appliGant lor a permit 5ubjetl5 the applicant to a Givil penalty ot not more lhan five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as Iheir sole wmpensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Prolessions Code: The Contractors License Law tloes not apply to an owner ot property who builds or improves thereon, antl who does such v.ork himsel( or herself or [hrough his or her ovm employees, provided lhal such improvements are not intentled or oReretl lor sale. II, �owever, Ihe builtling or improvement is soltl within one year of completion, the ownervbuilder will have Ihe burden of proving that he or she did not build or improve for purpose ol sale.). ❑ I, as owner of the property, am EXCLUSIVELY CON7RACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law dces not apply to an owner o( properry who builds w improves thereon, and wfio contracts tor such project with a cantractor(s) licensa pursuaN to tM Contractors license laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: SignaWre Date ]051dfi (3/0]) Owner ID verified by Arive� ., ncense. ❑ Yes ❑ No Drivei s License No. Expires: Verifcation of Ownership by (type of document, i.e. - property tax bill or Ceetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: . ❑ I hereby ceAily ihat no exwvation frve (5) or more feet in tlepth into wfiich a person is required to descend, will be matle in connectbn with work authorizeC by fhis permil, and thal no builtling slructure, scaNdtling, falsework, a demoli�ion or tlismantling �hereof, will be more Ihan thiAy-su (36) feet high. (Chap. 32, Grp 2. Atl 2, Sec. 341, Ttlle 8, Califomia Administrative Code). � As ownerbuilder, I will not employ anyone lo do work which wnuld require a permit from Ihe Oivision of Induslrial Safey, as noted above. unless such person has a permit to do such wnrk from Ihe division. nppiranfs SignaWre Date Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or presenl or future building occupant neetl to file antl certify a Bu5ine55 Plan for emergency re5ponse lo relea5e or threatena0 release ol a hazartlous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Cotle requires, with some eaceptions, Ihat a Business Plan be filed with the Costa Mesa Fire Department by every Dusiness which has at any one time during a reported year a quantity o( hazardous matenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cu6ic feet of compresse0 gas at standard tempereture and pressure). 2. Does or will the applicant or present or future builtling occupant need to file a registration form for acutely hazardous materials7 ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, wit� some ezceptions, requires registration with the Costa Mesa Fire Oepartment by each business which at any one time has on hand a quanlity o( acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard IempereNre and pressure). 3. Does or will the applicant or present or �uture building occupant neetl to prepare an RMPP (Risk Management and Prevenlion Program for aculely hazardous material5�7 ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safery Code provitles thal the Cosla Mesa Fire Depanment may require the preparation, certification and filing with the Fire Departmenl ot an RMPP by businesses which are required lo regisler aculely hazardous malerials wilh the Fire Department. 4. If an RMPP is presently required, has Section 25534 of lhe Calitomia Health antl Safety Cotle been fully wmplied vrith? ❑ Yes ❑ No 5. Dces or will the applicant or present or (uture building occupanl require for the work which is the subject of this application a permit for such conSWction or modifcalion from the South Coasl Air Quali�y Management Disirict or (rom any other air pollution control Oislnct or agency? ❑ Yes ❑ No (Sectbn 65850.2 of Ihe Calilomia Govemment Cotle reduires Ihat the rcpuested information be lumished on applications !a non-residential builtlirg pertnits). 6. Will any paA of lhe facilily lo be constructetl untler this pertnil be within 1000 leel from the outer boundaries o! a school? ❑ Ves ❑ No Qf'yes", ihe facility musl meet the requirement of Section5 25534 an0 42303 of the Califomia Heallh antl Safery Cotle). 7. If a permit from Ihe South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is lhe subjecl ot this application, have all of Ihe disclosures prescribed by Calilomia Health and Safely Code Section 42303 been made? ❑ Yes ❑ No 8. (If yes", attach ceAificate of compliance from Ihe appropriate air pollution control o�cer�. CERTIFICA7E OF COMPLIANCE: �I certify that under penalry of perjury the inlormalion given above is correcL I agree to comply with all state laws and ciry ortlinances regarding Hazardous Materials and Emissions.' CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read lhis application and sWte that the information given is correcL I agree to compty vrith all state laws and city ordinances relating lo building construction, and authorize representatives of the Cily of Costa Mesa to enter upon the above-described property for inspeclion purposes. I agree not to occupy or allow occupancy of any builtling authorized by Ihis permit until fnal inspec[ion. Wr o1 ai mer � � DaJe��' or ul� rize OIiW� I �le CITY OF COSTA MESA Bf/ILDING DlV►SION F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • �wiw ci.costa-mesa.ca.us � POR INSPECTIONS CALL: (714) 754•5626 � �� PERMIT NUMBER: BCOS-00301 PEF2MIT TYPE: B COMBO STATUS: ISSUED Sub Type: RES_ALT DATE ISSUED: 06/25/2008 ' ISSUED BY: RMD JOB ao�RESS: 919 DOGWOOD ST CM APN: 42252204 Vicinity: BATHROOM Const Type: V-B Zoning: , , SQ. FT: 0 Suile/Uriit: Primary Occ: R3 Valuation: $3,000.00 SCOPE OF WORK: MINOR BATHROOM REMODEL TO INCLUDE CHANGE FROM SHOWER ONLY TO SHOWER/TUB COMBO, WITH NEW LATHING, WASH BASIN AND WATER CLOSET CHANGE OU7 AND ASSOCIATED DRYWALL WORK. OWNER: WALLIS,WILLIAM J AND CHRISTINA M Address: 919 DOGWOOD ST Phone: 949-689-2730 CitylStatelZip: COSTA MESA, CA APPLICANT: GHODSI, DANI Address: 19562 VENTURA BLVD Phone: 910344-4213 . CitylStatelzZip: TARZANA, CA CON7RACTOR: E M C CONSTRUCTION INC Phone: 370344-4213 Cell: ARCHITECT: ENGINEER: License No. 658148 Address: 19562 VENTURA BIVDUnit: CitylState: TARZANA, CA License No. License No. CQMBINTATION PERMIT FEE SUMMARY Building Plan Check: $0.00 Building Fees: $83.25 Electrical Fees: $0.00 MeChanical Fees: $0.00 Plumbing Fees; $62.70 SMlp Residential: $0.50 SMIp Commercial: y0.00 TOTAL FEES: $146.45 "Rater to feo recoipts tor all fees paid for project Unit: Unit: :UNI7 270 UNIT 210 ZipCotle 97356 PHONE: PHONE: NOTICE: The vrork authonzed by this permit shall wmply with all aOPlicable handicap access requirements under Cali(omia statutes and related regulations. (Ord. No. 92-28. § 1. 12-21-92) EXpIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INBPECTIONS: In order for Ne work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. coos, INSVEL110NTYPE }1/yj� N �l LOOE/ INSPEGTIONTYVE f1�F �� N � 1878 Fized System Final Fire Prevention ZOB Final Mechanical 1288 Pool Spa Final 208 Final Plumbing Q/� ��r�� 200 Final Re-Roof 210 Final Electrical / �� 207 Final8locklRetaining Wait 272 Final Fire Prevenfion 202 Final Factory Fire Place 220 Pinal Planning Approval 203 FinalSign 222 FinalSite �/ �� 20A Final Demolition 250 Final BuiltlinyOccupancy WORKERS' COMPENSATION OECLARATION: I hereby aRrm under penalry of perjury one of the following declarations: ❑ I have and vnll maintain a cetlifcate of wnsent to selFlnsure for vrorkers' compensation, as proviCetl for by sec6on 3700 of the Labor Code, for the peAormance of lhe v.ork lor which this permit is issued. ❑ I have antl will maintain workers' compensation insu2nce. as requiretl by' sectbn 3700 of the Labor Code, for Itie pedortnarKe of the v.vB fw wfiich this permit is issued. My vrorkers' compensation Insurance carner antl policy number aie: �arri@r.=:_,_ !�\hrss�ecti/onnye* Oemnpef¢tlathepe�mlisvaWetlalonenurMretlGdlars(5100)aMss) �P.olicy.Nv ertt6 r: � I certi(y that in the pertormance of the work for which this permit is issued, I shall not employ any persOn in any manner so as to become subjecl to the workers' wmpensation lavrs of Califomia, and agree Nat if I should become subject e workers' compensation provisions of Seclion 3700 of �he Labor Co , I ha lorthwit co pty with these provisions. 6�s/-� � fs Sienaivre LDate, WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CAVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLAF2S ($100,000), IN ADDITION TO THE CAST OF CAMPENSATION, DMMGES AS PROVIDED FOR IN SECTION 3706 OF THE U1BOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm Ihat I am licensed untler provisions oi Chapter 9(commencing with Section 7000) of Division 3 0l the Business antl Professions Code, and my license is in full force and eHecl. p Licr#� Class�#' [�_ .. +—� ��?_� r�1{ aaor's S namre -' "b5te' l�— � CONSTRUCTION LENDING AGENCY: ❑ I hereby affum that there is a construction lending agency fa Ihe peAortnance of [he work for wfiich Iltis pertnit is issuetl. (Sec. 3097, Civil Code). Lender's Name: lender s Address: SignaWre Oate OWNER-BUILDER DECLARATIONS: I hereby aHirm that under penalry of peryury that I am EJ(EMPT FROM THE CONTRACTORS LICENSE LAW lor the tollowing reason (Sec. 7031.5. Business and Professians Code: Any city or wunty which requires a pertni� lo conslruct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant lor such pertnit to file a signed slatement that �e or she is licensed pureuaN to the pmvisions of the Contractors License Law (Chapter 9(commencing wilh Seclion 7000) of Division 3 of Ihe Busine55 an0 PfOfes5ion5 Cotle) or lhat he or 5he i5 exemp� lherefrom antl Ihe basis tor the alleged exemption. Any violation ot Section 7031.5 by any applicant (or a permit subjecls the applicant lo a civil penalty ol not more man five huntlred tlollars ($500).): ❑ I, as ovmer of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and Ihe structure is nol intended or oflered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law tloes not apply to an owner ot propeny who builds or improves there0n, and who.does 5uch wark him5ell or herself or through hi5 or her ovm employees, proviCed Ihat such improvements are not intended or offered lor sale. If, however, the building or improvement is sold within one year of completioq the owner-builder will have the burden of proving that he or she did not build or impmve for purpose ol saleJ. . ❑ I, as ovmer of the property. am EXCLUSIVELY CONTRACTING WITH UCENSED CONTRACTORS lo construct the project (Sec. 7044, Business and Professions Cotle: The cantractors License Law dces rat apply to an ovmer of propeAy who Duiltls or improves thereon, and who cmtracts fw such project with a cantractor(s) license pursuanl to the Cont2ctors License Laws.�. ❑ I am exempl under sec. Business and Professions Code for this reason: �Owner ID verified by drh. ,,;ense. ❑ Yes ❑ No Driver s License No. Expires: Verification of Ovmership by (type of document, i.e. - property tax bill or Eeed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby ceAify that no excavation frve (5) or mo2 feet in depth into which a person is required to descend, will he made in connection vrith work authorizetl 6y this pertnit, and Iha� no building struclure, scaffdding, lalsework, p Cemoliibn or dismanfling thereof, vnll be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, M 2, Sec. 341, TiHe B, Cali(omia Administ2tive Cotle). ❑ As owner-builder, I will not employ anyone to do work which woultl require a permil fmm the Division ot Inaustrial Safety, as noted above, unless such person has a permit to do such work from the tlivision. AOWiwnfs Sgnalure Da1e Division of Intlustnal Safety Permit Number. __ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant neeC lo file antl certily a Business Plan for emergency response to release or threatened release ol a �azardous material? ❑ Yes ❑ No (Section 25505 0l Ihe Calilornia Health antl Safety Code requires, vrith some ezceplions, that a Business Plan be fled with the Costa Mesa Fire Depanment by every Dusiness which has at any one time tluring a reportetl year a quanlity of hazardous matenals equal to or greater than a weight ol 500 pounds, or a volume of 55 gallons, or 200 cubic feel o( compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or fuwre builtling occupant need to file a regislration fortn for acutely hazartlous materials? ❑ Yes ❑ No (Section 25533 of Ihe Calitomia Health antl Safery Code, vrith some exceptions, requires registration with the Costa Mesa Fire Depanment by each business which at any one time has on hand a quantity ol acutely hazardous matenals equal to or greater ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or vrill Ihe applicant or presen[ or fuWre building occupant neetl to prepare an RMPP (Risk Management and Prevention Program !or acutely hazardous materials�? ❑ Yes � No (Section 25534 of ihe Califomia Heallh and Safety Code provitles that the Costa Mesa Fire Department may require Ihe preparation, certification antl filing vrith the Fire Department of an RMPP by businesses which are requiretl to register acutely hazardous materials vri[h the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the Califomia Health and Sale�y Cotle been fully wmplied vrith? ❑ Yes ❑ No 5. Does or will the applicant or present or future builtling otcupant require for the work which is Ihe subject of Ihis applicalion a permit for such conSWction or malifitation frOm Ihe Soulh Coas� Air Quality Management DisMct or from any other air pollution conlrol Distnct or agency7 ❑ Ves ❑ No (Seclion 658502 of the Califomia GovemmeN Code requires that the requested information be (umished on applications far rron-residenlal builtling permits). 6. Will any part of Ihe faciliry to be consiructe0 untler this pertnit De vrithin 1000 feet from Ihe outer bountlaries of a school? ❑ Ves ❑ No (II yes", the lacility musl meet the requirement of Seclions 25534 and 4230J ol lhe California Health and Safely Cotle). 7. If a permit !rom the South Coast Air Quality Management DisMct Or other air pollution conlrol tlislrict or agency is required for the work which is the subject ol this application, have all o� the disclosures prescribetl by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No -8. Qf 'yes", allach certifcate o( compliance from ihe appropnate air polWtion control offcer�. CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the intormation qiven above is correct. I agree to comply with all sWte laws and cily ordinances regartling Hazardous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty ol perjury that I have read this application antl state ihat the infortnation given is conect. I agree to comply with all slate laws antl ciry ordinances relating to building wnstruction, and authorize representatives ol the Ciry of Cosla Mesa lo enter upon the above-describetl pmperty for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this pertnit until final inspection. Si n e o e al O�wne�r DJa e o SiB�amre Daie 8� �//� �j�/,, ]OSI161�0]) �� C �lor AW�onze0 Apphwm �Date—� —�.__ _ `� � , on �M Requested Inspect Date: Friday July 25 Z008 Site Address: 919 DbGWOOb ST CM BATHROOM AIPID Information Activity: BC08-00301 Type: 8_COMBO Sub Type: RES_ALT Status: lSSUED ConstType: V-B OccupancY: Use: Insp Area: Owner: WALLIS,WILLIAM J AND GHRISTINA M Phone: 949-689-2130 Contractor: E M C CONSTRUCTION INC Phone: 310-344-4213 Applicanl: GHODSI DANI Phone: 310344-4213 Description: MINOR �ATHROOM REMODEL TO INCLUDE CHANGE FROM SHOWER ONLY TO SHOWER/TUB DRYW�ALLVWORK W�THING, WASH BASIN AND WATER CLOSET CHANGE OU7 AND ASSOCIATED Reguested Inspectionlsl Item: 208 FINAL PLUMBING Requestor: Comments: AM Assigned To: """""" Action: Time Exp: Inspection Historv Item: 56 SEWE Item: 70 DUCT ifem: 3 JOB SI' Item: 4 FOOTIP Item: 6 SLAB Item: 8 STRUC Item: 11 PRE-II Item: 12 ROOF Item: 16 SHEAI Item: 18 FRAM Item: 20 LATHI Oi Cor Item: 22 INSUL Item: 24 DRYN Item: 26 PLASI Item: 30 PRE-C Item: 31 NPDE Item: 36 UFER Item: 38 ELEC Item: 44 ROUC Item: 45 SUBP, Item: 50 ELEC. Item: 51 TEMP Item: 52 SOIL F Item: 53 Item: 54 Item: 55 Item: 62 Item: 63 F Item: 64 F Item: 66 F Item: 68 � Item: 72 C Item: 90 C REPT131 SYSTEM iLDG HEIGHT .. �__,_.._,, « �WN COAT JD iIT-UNDERGROUND ;TRICAL - WIRING R FINALIMETER RELEAS 2 FINAL NDEpRGROUND "Approved" NOTeREP,D BN Inspector: BN J -UNDERGROUND ND GAS 1BING ' Approved " Inspector: PT Requested Time: 08:00 AM Phone: Entered By: TEMPEMP K Aclion: AP APPROVED Action: CONT Continued Action: AP APPROVED Action: NA No Access Inspecfor: BN Action: CO Correction(s) Required PROVIDE PROOF OF PRESSURE BALANCE VALVE Inspeclor: BN Action: CO Correction(s) Required PROOF OF P/B PROVIDED IS FOR A DIFFERENT MODEL OF VALVE THEN THE VALVE INSTALLED Inspector: BN Action: CONT Continued OWNER WILL RESCHEDULE Inspector: BN Action: AP APPROVED Run Id: 9976 REPT131 Run Id: 9976 ORANGE COUNTY BUILDING DEPARTMENT 636 North Broadway . . . , „ SANTA ANA, CpLIFORNiA . i FOR APPLICANT TO FILL IN ADD EI55 919 Dogwood 9t• SCHOOL DIST. COB VA MBQS OR TOWN NEAREST caoss sr. Monrovia St. OWNER CHOCTAy HONES� (NC. MAIL 6 1�J11SHIRE BLyD. ADDRE55 ci'rr BEVERLY HIILS No�� CR. j 3 � ENGINEERTCAIN & MCKERRA�HER No� SY.6489i enoRe552j�O E. WALNUT ST.. PASADENA ADDRE55 6 WIISHIRE �LVO.� BEV.HII;LS � LEGAL I c;9O BLOCK ��2 OESGRIPiION l0T NO. (ATTACH METES & 60UND5l SIZE OF LOT 66 X� � O I NOW ON LOT O USE OF I NO. OF I NO. � E%ISTING BLOG. FnvLLi¢s ROO! DESCRIPTION OF WORK NEW I X I ALTERATION I I ADDITION ES USE OF NEW 'ILDING RESIDENCE I HEREBY ACKNOWLE'JGE 7HAT I HAVE REAO THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AN� STATE LAWS REGULATING BUILDING CONSTRUCTION. SIGNATURE OF ��.. PERMITTEE�sLi AUTHORIZED AG . � s 4830.0o P. �. $ y, FEE � VALUATION s FEE L � UILDING APPLICATION FOR PERMIT � -�l��'�� - FOR OFFICE USE ONLY ftECE1PT NO. PERMIT NO. 3S2C S'l$S� BY DATE OF APPL. 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