The URL can be used to link to this page

Home My WebLink About930 DOGWOOD ST - Building Permitsr /J 1 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.��ILDING PERMIT n FAIR DFIVE, COSTA MESA, GA 92626 JobAddress: 930 DOGWOODST Suite: Viciniry: MASTER BATHROOM Parcel Number: 42252125 Applicant: FARTHING, SCOTT Address: Owner: KALATSCHAN, ZOYA Address 930 DOGWOOD ST Zoning: Phone: 949-500-2870 Zip: Phane: COSTA MESA, CA Zip: 92627-4161 Contracror. FARTHING DEVELOPMENT INC Address: 904 DOGWOOD COSTA MESA, CA Zip: 92627 Nch : Address: Phone: (949)500-2870 License: 560875 Eng: Address: Phone: Status: ISSUED Applied: 05/20/2003 Issued: 12/08/2003 ISSUED BY: t�� ,� y 5 3 9�`� Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT NEW 272 SF MASTER BATHROOM IN AN EXISTING SINGLE-STORY SFD. _. Plan Check: $287.46 Permit: $442.25 SMIP Res: $3.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $732.71 SETBACKS MAIN STRUCTURE FrOnt 2S 0 ACCESSORY Front 0-0 PARKING Exi_stinq; a NOTES: Rear t- 5 Rear 0- 0 Required: 4 FEE SUMMARY PLANNING & ZONING Left 12• 6 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 1-11 Right 0- 0 $30,000.00 $30,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspeetlons and tinal approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2aas+e Ie�I WORKERS' COMPENSATION DECLAAATION: I hereby aHirtn untler penalty of perjury ona of the tollowing declarations: ❑ I heve end will maintain a certifica�a ot consent to self-Insure lor workere' compensatlon, as provlded for hy section 3700 of the Labor Cotle, tor ihe pertortnance of the work tor wNch ihis permit is issued. ❑ I heve end wlll maintain workers' compensation insurance, as required Gy section 3700 0� �he Lebor Code, for Ihe partortnance of �he work fo� whlch this permit Is Issued. My workere' compensetlon Insurance wrder end policy number ere: Cerner. Policy Number: (This section neetl nof be cromp/etetl il the permit is veluetl af one hundretl tlollars ($700) or /ess.) (� 'I certiy Ihat in �he pedormance ol tha work tor which Ihis permit is issuetl, I shall not employ eny person in eny manner so es to becoma subjact to ihe workers' compensation lews of Celifomia, and ree t�et If I��yyy��IIIddd become sublect to the workers' compensatlon provisions of Section 3700 of the Lebor Catle, I shall torthwlih compty with Ihese pravision��/ ''Z//�( I /� /�/D �-- ApDIIcaM Signature: � �� Date: � ; WARNINO:FAILURETOSECUR ORKEP9'WMPENSATI ERAGEISUNLAWFULANDSHALLSUBJECTANEMttOYERTOCRIMINALPE� AN�GVILFlNESUPTOONEHUNDRED THOUSAND DOLIARE (5100,OW),IN ADDITION TO h1E WST OF WMPENSATION, DAMAGES AS PF�YI�ED iOR IN SEGTION 5lOB OF T}IE L4BOR CODE, IMEREST, AND ATiORNEY'S FEES. LICENSED CONTRACTORS DECLAHATION: I hereby aflirm ihat I am licje �s untl/e�r -r�s�i s ot Chapter 9(commencing with Sec�ion 7000) of Divislon 3 of the Business�@nd Protesslons Cotle, and my license is in full fome antl aHecL Lic. M. h� `�/� Class q /„/ %7�1�% cr� Cantractors Slgneture: ,�� /LC� Date: �� / o� s� 0�i CONSTRUCTION LENDING AGENCY; ❑ I hareby aHirtn that there is e conB�Nction lentling egency tor the peAormance of Ihe work for whlch this permit is issued. (Sec. 3097, Civil Cotle). Lentler'S Neme: Lender's Adtlress: Signatura: Date: OWNER•BUILDEH DECLARATIONS: I hereby ettirtn ihat under penelry of perjury that 1 am El(EMPT FROM THE CONTRACTORS LICENSE LAW for �he following reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which requires e pertnit �o consiruct, elrer, improve, demolish, or repair any structure, prior to its issuance, also requires the eppliwnt for such permit to lile e signea statement that he or she �s 1lcensed pursuant to Ihe provisions ot the Camrectore License Lew (Chapter 9(commencing wlih Sectlon 7000) of DlWsion 3 of the Business end Protessions Code) or ihe� he or she Is exempt therefrom antl t�e basis for the allegetl e:emption. Any violation of Section 7037.5 by eny epplicant for e pertnit sublecis Ihe applicent to e civll penalty o� not more then five hundred dollars ($500).): ❑ I, as owner ol the pmperty, or my employees with wages es iheir sole compensatlon, WILL DO THE WORK, antl iha siruc�ure Is not Intentle0 or oflared tor sele (Sec. 7044, Business entl Professions Code: The Con(ractors License Law Ooes not apply lo en owner of property who 6uilds or improves thereon, end who does such work himseN or hersetl or ihrough his o! her own employees, providetl that such improvements are not Intended or oflered for sale. tl, however, Ne bullding or improvement Is sold within one year ol completion. the owner�builder will have the hurtlen of proving ihat he or she did not builtl or improve for purpose of SaleJ. ' ❑ I, as owner ol ihe property, am EXCWSIVELV CONTRACTNG WI7H LICENSED CONTRAC70RS to construct the project (Sec. 7044, Business end Pmfessions COAe: The contreaors Licensa Lew tloes not apply to an owner of pmperty who bullds or Improves thereon, entl who contrads for such project wtlh a comractor(s) license pursuant to ihe Coniractors Licanse Laws.). ❑ I am e:empt under sec. Business antl Professions Code lor this reason: SignaNre: Date: Owner ID veritied by tlriveYs license. ❑ Yes ❑ No Drivers License No. E:pires: Venlication of Ownership by (type of doCument, i.e. - property tex bill ar deetl): DIVISION OF INDUSTRIAL SAFETY PEAMIT CERTIFICATION: ❑ I hereby certity ihat no excavation five (5) or more feet in depth in�o which e person is required to descend, will be made in connection with work authorized by this permit, and that no building siructUre, scattolding, lelsework, or demolition or dismentling Ihereof, will be mora ihan ihiny-six (36) teet high. (Chep. 32, Gry 2, Atl 2, Sec. 341, Title 8, Celifornie Administrati�e Code). ❑ As owner-builder, I will not employ enyone to tlo work which would require a permit from ihe Division ol Industnal Sefery, as noted above, unless such person has e permit to tlo such wark trom the di�ision. Signeture: Date: Division of Industnal Safery Pertnit NumPer: CERTFlCATE OF COMPLIANCE AND A�MORVJITION OF ENiAY: I certify untler penalry of perjury that I have read this epplication and stata that the intortnation given is correct. I agree to comply wilh flll state lews and ciry ortllnances relating to building construciion, entl auihonze representalives of �he Clry of Costa Mesa to enter upon ihe ebovadescribed properry tor inspection purposes. I egree not to occupy or allow occupenry af any buildinq authorized by this Dermit until final inspection. ippy?� t Leg r(s) /�/ ^/ /,� te �/f `�j C/ AnNOrAulhanz Dlicant ate , CQOE �. INSPEC710NTYPE PA7E �NTRIALS 1618 Fized Syslem Final Fire Preven�lon 1268 200 201 202 203 Pool Spa Finel Final Re-Raot Final8locWRetaining Well Final Factory Fire Place Final Sign 204 Final Demolition CODEN INSPECTIONTYPE 206 Flnel Mechanical 208 Final Plumbing 210 Flnel Electrical 212 Finel Fire Prevention 220 Final Planning ApDroval 222 Final Site 250 Final Building/Oaupanq QAIE I[�L9 September 13, 2004 , - Ga!'Y OF COSTA MES�► P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-7200 DEVELOPI,'ENT SERVICES DE?ARTMENT Steve Kalatschan 217 E. Balboa Blvd. Newport Beach, CA 92661 PERMIT NUMBER (S): FOR: PROJECT ADDRESS BUILDING DIVISION EXTENSION NOTIFICATION B03-00839, E03-00909, E03-01139, M03-00647, P03-00810 Addition 930 Dogwood St., Costa Mesa Payment of the permit fee on each of the above permits will be required in order to grant the e�ctension you requested per Ed Petros, Chief of Inspections. You may come in to the Building Division Permit Counter at City Hail to pay the fees. Your extension will be valid for 180 days. The job must be completed, inspected and receive final approval by then or your permits wili expire. Additional fees will be required to finalize expired permits. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will be happy 4o assist you. We appreciate your working with us to resoive this matter. Sincerely, / V l ,J°`�.�'µ'�� Ma ane Weidenkeller Office Specialist II i Iqnblinp Division (714) ]5a �� i'� . �;,,,I,: pnlorcement p14J 754-SfiZ3 • Planning Division p1a) 754.5245 _'...— _ FA%Ot4i7Sa9h�.n. IUDP11)756-5244. v.wwCicnSid-m¢SaGd.us 093-0 am004 � C�STA M SA, CA CeTY �nF Page 1 Requested Inspect Date: Thursday, QOD ST CMO, 2004 Site Address: 930 DOGW MASTER BATHROOM A/PID Information Activity: 803-00839 Type: BLD_SU62 Sub Ty pe: ADD_SFR Status: ISSUED Const Type: V-N Occupancy: 7 Use: Insp Area: Owner: KALATSCHAN ZOYA Contractor: FARTHING DEVELOPMENT INC Phone: (949) 500-2870 Designer: FARTHING DEVELOPMENT INC Phone: 949-645-9325 Dev coor: JK Applicant: ARTHING SCOTT Phone: 949-500-2870 Description: CONSTRUCT NEW 272 SF MASTER BATHROOM IN AN EXISTING SINGLE-STORY SFD. Reauestedlnsoectionfsl Item: 150 MISCELLANEOUS INSPEC7lON Requestor, Assigned To: """""' Action; • Time Exp: _ Insoection Histop� Item: 4 FOO71P Item: 6 SLAH Item: 10 ROOF Item: 12 ROOF Item: 16 SH�AI Item: 18 FRAM Item: 20 LATHI Item: 22 INSIIC Item: 24 DRv�n, Item: 26 PL'ASl Item: 150�MISC Item: 250 FINA FER Requested 7ime: 08:00 AM Phone: Entered By: WEIDE_MJ K \� � REPT131 Run Id: 9622 uest Requested Inspect Date: Thursday, December 30, 2004 Site Address: 930 DOGWOOD ST CM Nage s A/P/D Information Activity: E03-00909 Type: ELEC2 Sub Ty pe: Status: ISSUED ConstType: V-N Occupancy: Use: Insp Area: Owner: MONACO KIM Contractor: PALUCK �LECTRIC Phone: -949-6 Applicant: PALUCK JOE Phone: 949-673-0561 Description: CHANG�-OUT OF AN ELECTRICAL SERVICE IN AN EXISTING SFD. 1 SERVICE TO 200A NO OTHER WORK AUTHORIZED W ITH THIS PERMIT. Reauested Insqection(sl Item: 150 MISCELLANEOUS INSPEC710N Requestor: Assigned Ta: Action: Insnection HistQry Item: Item: Item: Item: ltem: Item: Item: Item: Item: Item: �tem: Item: Item: item: Time Exp: Requested 7ime: 08:00 AM Phone: Entered By: WEIDE_MJ K REPT131 Run Id: 9622 Requested Inspect Date: Thursday, December 30, 2004 Site Address: 930 DOGWOOD ST CM MASTER BEDROOM AIP/D Information rage 5 Activity: E03-01139 Type: ELEC2 Sub Type: Status: ISSUED ConstType: V-N Occupancy: Use: Insp Area: Owner: KALATSCHAN ZOYA Contractor: FARTHING DE�ELOPMENT INC Phone: (949) 500-2870 Applicant: FARTHING SCOTT Phone: (9491500-2870 Description: CONSTRU�`T NEW 272 SF MASTER BATHROOM IN AN EXISTING SINGLE-STORY SFD. 8 LIGHT FIXTURES, 15 OUTLETS, 4 SW ITCHES, 1 MOTOR TO 1 HP REF: B03-00839 Reauested Insoectionlsl Item: 150 MISCELLANEOUS INSPECTION Requestor: Assigned To: """""" Action: Time Exp: _ Insoection Historv Item: Item: Item: Item: Item: Item: Item: Item: Item: Item: Item: Item: Item: Item: Requested Time: 08:00 AM Phone: Entered By: WEIDE_MJ K REPT131 Run Id: 9622 rage ti Requested Inspect Date: Thursday, December 30, 2004 Site Address: 930 DOGWOOD ST CM MASTER BATHROOM AIP/D Information Activity: M03-00647 Type: MECH2 Sub Type: Status: ISSUED ConstType: V-N Occupancy: Use: Insp Area: Owner. KALATSCHAN ZOYA Coniractor: FARTHING DEVELOPMENT INC Phone: (949) 500-2870 Applicant: FARTHING SCOTf Phone: (9491500-2870 Description: CONSTRU�T NEW 272 SF MASTER BATHROOM IN AN EXISTING SINGLE-STORY SFD. 1 VENT FAN/SINGLE DUCT REF: B03-00839 Reauestedlnsoection(sl Item: Requestor: Assigned To: Action: 150 MISCELLANEOUS INSPECTION Time Exp: Insoection Historv Item: 64 ROUGH MECHANICAL Item: 66 ROUGH-FACTORY FIREPLACE Item: 72 GAS PIPE - ROUGH 8 TEST Item: 90 GAS P1PE TEST - FINAL Item: 114 POOL HEATER 8 VENT Item: 150 MISCELLANEOUS INSPECTION Item: 206 FINAL MECHANICAL Requested Time: 08:00 AM Phone: Entered By: WEIDE_MJ K REPT131 Run Id: 9622 0 Requested Inspect Date: ThursdaY, OOD ST CMO, 2004 Site Address: 930 DOGW MASTER BATHROOM A/P/D information Activity: P03-00810 Type: PLUM2 Const Type: V-N Occupancy: Owner. KALATSCHAN ZOYA Contractor: FARTHING DEV�LOPMENT INC Applicant: FARTHING SCOTf Description: CONSTRU�T NEW 272 SF MASTER BATI 1 SHOWER, 1 WASH BASIN SET, 1 WATI Reauested Insoectionlsl Item: 150 MISCELLANEOUS INSPECTION Requestor: Assigned To: Acfion: Time Exp: _ Insoection Historv Item: 52 Item: 54 Item: 56 Item: 62 Item: 68 Item: 72 Item: 90 Item: 92 Item: 102 Item: 108 Item: 110 Item: 150 Item: 208 REPT131 Sub Type: Use: Status: ISSUED Insp Area: SFD. i BATHTlJB, Requested Time: 08:00 AM Phone: Entered By: WEIDE_MJ K Run Id: 9622 Page 1 o,f 1 PEtROS,EDWARD From: MORGAN, BURT Sent: Wednesday, September O8, 2004 4:47 PM To: PETROS, EDWARD Subject: RE: Extension for my plans Chief Petros: Please note that despite the fact Mr. Kalatschan uses the term, "extension for my plans," in fact, he is speaking about his building permit. He is asking for a permit extension. Therefore, this is being sent back to you for your review and consideration. Burt D. Morgan, Chief Plans Examiner -----0riginal Message----- From: PEfFt05, EDWARD Sent: Wednesday, September 08, 2004 4:19 PM To: MORGAN, BURT Subject: FW: Extension for my plans ----0riginal Message----- From: Steve Kalatschan [mailto:steviek40@yahoo.com] Sent: Wednesday, September 08, 2004 8:35 AM To: EPetros@ci.costa-mesa.ca.us Subject: Extension for my plans Mr Peters, I am writing you to ask for an extension for my plans that have expired. In all honesty, I was not awaze of the expiration date. I understand it is my responsibility, but I am new at this and quite a bit ignorant of the process. I thought 1 was able to start construction when my contractor/ architect filed the plans, but I had a prepayment penalty on my loan and was unable to re-fi for a few months. I am now able and have re-fied and have the money to continue you with my project. I was hoping you'd be able to extend the plans and I can move on with the addition. Thank you for your time and I hope you can help Steve Kalatschan 930 Dogwood St Costa Mesa, CA 92627 949-515-3468 Plans # B03-00839 Steve Kalatschan 217 East Balboa Blvd Newport Bch, CA 92661 Do you Yahoo!? New and Improved Yahoo! Mail - Send l OMB messages! 09/04/2004 (71a) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FniH oHivt, cosin nntsn, cn aeeze ELECTRICAL PERMIT Job Address: Suite No Viciniry: Parcel Nunmber: 930 DOGWOOD ST 42252125 Applicant: PALUCK, JOE Address: P O BOX 5183 NEWPORT BEACH, CA Owner: MONACO, KIM Address 930 DOGWOOD ST COSTA MESA, CA Contractor: PALUCK ELECTRIC Address: P O BOX 5163 ISSUE FEE Temp service test Res. a/c package New Res (7-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 7000a Motors ta 1hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a NEWPORT BEACH, CA Phone: 949-673-0567 Zip: 92662 Phone: Zip: 92627-4161 Phone: 949-673-0561 Zip: -92662 License: 768524 SCOPE OF PERMIT CHANGE-OUT OF AN ELECTRICAL SERVICE IN AN EXISTING SFD. 1 SERVICE TO 200A- NO OTHER WORK AUTHORIZED WITH THIS PERMIT. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $30.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 FEE SUMMARY Status: ISSUED Applied: 10/03/2003 Issued: 10/03/2003 ISSUED BY: �xplR�� 3 '° oRZE 5 Temp Dist System / Lighting Busway/100 k Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System ! Ckt Misa Conduit Misa Conductor Circus ( gen or ride) Cirws (mech ride or lights) Christmas Tree Stand Fireworks Stantl Other Electrical Fee Investigation Fee Plan Check Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-20, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorizetl under this permit to be considered legal, such work must comply with all applicable codes, and all required inspeetions and final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2d4646IN00) WORKERS' COMPENSATION DECLARATION: ' � I hereby affirm untler penelry ot perjury one of the lollowing tleclaretions: ❑ I have antl will malntain a certificate ol wnsent to sell-Insure tor warkers' compansation, as provitletl for by section 3700 oi ihe Labor Cotle, tor the pertortnance of the work far which lhis pertni� i5 issued. ❑ I hava antl will maintain workers campensation insurence, es requiretl Oy section 3700 ot Ne Lebor Code, tor the pertortnance of Ihe work for which ihis pertnit is issuetl. My workers' compensation Insurence carder end policy num�er are: Carder. nat one hundred dollars ($100) or Iess.J Policy Number: �' I certity Ihat in the paAormence ot the work for which Ihis pertnil Is issued, I shall not employ any person in any manner so as lo become subject to t�e workers' compensation laws ol Cellfomia, antl egree Ihet if I should hecome sub�ect to Ihe workers' compensation provisions of Section 3700 of the Labor CoOe, I s�ell lorthwith comply with Ihese pje sions / Ap0licentSiqnaNre: � Date: _�f}� O � v WARNING: FAILURE TO S WORKE 5' COMPENSATION COVEMGE IS UNLAWFUL AND SW1LL SUBJECi AN EMPLOYER TO CRIMINAL PENPLTIES AND GVIL FlNES UP TOONE MUN�PED TFIOUSAND DOLLARE ( , 0), IN AD�RION TO THE COST OF COMPENSATION, DMWGES AS PROVI�EO FOR IN SECiION 3%O60F iHE LABOR CODE, IMEREST, AND ATTORNE`f5 FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm that I am licensetl untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, end my licanse is in full farce end eflect. LIc. A• Cless tl= L' /O �ir Comracmr's Signeture: ��y_y�,I��.-�/�— Date: � L/> / 2 CONSTRUCTION LENDIkG AGENCY: ❑ I hereby aHirm ihet there is a consiruction lending agency Por the pertormance of �he work tor which this permit is issued. (Sec. 3097, Civil Cotle). Lenders Neme: Lander's Address: Signa�ura: OWNER-BUILDER DECLARATIONS: Date: I hereby ettlrtn ihat untler penel�y of perjury thet I em E7(EMPT FROM THE CONTRACTORS LICENSE LAW tor ihe lollowing reason (Sec. 7031.5, Business entl Professlons Cotle: Any ciry or county whic� requires a permit to construc�, alter, improve, tlemollsh, or repair any sWcture, prior to its issuance, also requires the applicant tor such permit to file a signetl stetement Ihat ha or sha is Ilcensetl pursuant to the provisions of the Contrectors License Law (Chapter 9(commencinq with Section 7000) at Divislon 3 0l the Business and Prolessions Code) or thet he or she is exempt therefrom and the basis for the elleged exemption. Any violation o� Section 7031.5 by any applicant for e permit su6jects Ihe applicant to e civil panalry of not more then five huntlretl tlollars ($500).): ❑ I, as owner of tha properry, or my employees with wagas as thair sole compensa�ion, WILL DO THE WORK, and the siructure Is not imeritlad or oHered tor sele (Sec. 7044, Business and Professions Code: The Coniractors License Law does not appty to an owner of properry who builds or improves ihereon, and who does such work himself or hersetl or through his or her own employees, provided thet such improvements are not intended or olferad tor sale. If, however, Ihe building or improvement is soltl within one year ol completion, the owner-builder will heve the burden of proving ihat he or she did not build or improve lor purposa ot sale.). � ❑ I, as owner ol Ihe properiy, flm E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo wnstrutt ihe project (Sec. 7044, Bu5in055 end Professions Code: The coniractors Licensa Lew tloes not epply to an owner ol property who builds or improves thereon, antl who comracts lor such project wlih a contractor(s) license pursuant to tha Contractors License Laws.). ❑ I am exempi under sec. Business and Pmfessions Code tor this reason: Signeture: Date: Owner ID verifietl by tlriveYs license. es ❑ No Drivets LicenSe No. Venfication of Ownership Dy (type of tlocument, i.e. � praperty tex bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMI7 CER7IFICA710N: Expires: ❑ I hereby certity that no excavatlon five (5) or more teet in depth into which a person is raquired to descend, will be made in connection with work euthorized by Ihis pertnit, end that no builtling structure, sceMolding, talsework, or demolition or dismantling thereof, will be more ihan ihirry-six (36) fee� high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Califamia Administrative Cotle). ❑ As owner-builtler, I will not employ enyone to do work which woultl require e permit irom the Division of Industnal Safery, as nated ebwe, unless such person hes a pertnit to do such work Irom ihe Civision. Signature: Date: Division of Industrial Sefey Permit Number. CERTIFlCATE OF COMPUANCE AND AUTHORVA710N OF ENTRY: I cenity under penalry of perjury that I have reatl this epDlication and state Ihat ihe Information given is correct. I egree to compty with ell state laws end ciry ardinances relating to builAing construction, and authorize representetives ol Ihe Clry ol Costa Mesa to enter upon �he above-descnbed property tor inspection purpases. I aqree not to occuDY �� allow wcupancy of any building authonzed by this permil until linal inspection. 1616 1266 200 201 INSPECTIONTVPE Fixetl System Flnal Fire Prevention Pool Spa Final Finel Re-Roof Finel Blak/Retaining Well 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition �ItiG141 Date ��,�,� / � Date COOE 1 INSVECTION TYPE 206 Final Mechanical 208 Final Plum6ing 210 Final Electrical 212 Final Flre Pravenlion 220 Final Planning Approval 222 FinalSite 250 Final Builtling/Occupency Pdg Itil�l5 (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.E�ECTRICAL PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinily: Parcel Nunmber: Applicant Address: Owner. Address ConVactor. Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+uniLs) Pool / Spa Lighting Fixts Recept Oullets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors l0 1hp Motors to 70hp Motors to SOhp Mo[ors to 100hp Motors over 100hp Communicalion drops 930 DOGWOOD ST MASTERBEDROOM 42252125 FqRTHING, SCOTT 904 DOGWOOD COSTA MESA, CA KALATSCHAN,ZOYA 930 DOGWOOD ST COSTA MESA, CA Phone: (949) 500-2870 Zip: 92627 Phone: Zip: 92627d161 FARTHING DEVELOPMENT INC 904 DOGWOOD COSTA MESA, CA Phone: (949)500-2870 Zip: 92627 License: 560875 Status: Applied: Issued: ISSUED BY: ISSUED 12/08/2003 12/09/2003 4.�g�� j� �.�3 � A�� SCOPE OF PERMIT CONSTRUCT NEW 272 SF MASTER BATHROOM IN AN EXISTING SINGLE-STORY SFD. 8 LIGHT FIXTURES, 15 OUTLETS, 4 SWITCHES, 1 MOTOR TO 1 HP R�F: 803-00839 $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $8.80 $16.50 $4.40 30.00 $0.00 $0.00 50.00 so.00 $4.75 50.00 $0.00 $0.00 $0.00 $0.00 Duantiry 0 0 0 8 15 4 0 0 0 0 0 1 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 tt Standing Section Misc Electrical Equipment Trensformers up to 1 kva/kw ................up to 10 kva/kw .................up to SO�kva/kw .................up to 100 kva/kw ..................over 100 kvalkw Low Voltage Equipment Low Volt Wiring System ! Ckt Misa Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or IighLs) Christmas Tree Stand Fireworks Stand Other Eleclrical Fee Investigatlon Fee Quantiry $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 � 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 NOTICE: The work authqrized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 1247-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned for a peiiod of 180 days. INSPECTIONS: In order for ihe work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapeetlona and Iinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration oi this permit. FOR INSPECTIONS CALL: (714) 7545626 241Bd8 (8�00) WORKEfiS' COMPENSATION DECLARATION: I here6y aNirm undar penalry ol perjury one of the following tleclarations: ❑ I heve entl will malntain e cartificate of consent to setl-Insure for workers' compensetion, as pmvided for by section 3700 of iha Lebor Code, for the peAortnence of the work lor which this permii Is issued. ❑ I heve antl will maintain workers' compensation insurance, as required by section 3700 of Ihe Labor Code, for Ne perfortnance of Ne work tor which ihis pertnit is Issuetl. My workers' WmpensaUon Insurance carner end policy number are: Cernac Policy Number: jTh(s secfion need not be cromp/eled ii tbe permit is �alued at one hundretl dollars ($100) or /eu.J ❑ I cenity that in ihe pedormence of the work far which this pertnit is issueq I shall not employ eny person in eny manner so as to becoma subject to Iha workers' compensatioq lews of CeiHornla, and agree ihat houtd becoma subject to the workers' compensation pmvisions ot Section 3700 of the Lebor Code, I shall foRhwith comply with tl�ese provision 2 Applicant Signature: Date: /�/�f� - ) WARNING FAILURE YO SECURE WORKERS' COMPENS �N DVERAGE IS UNLAWFOL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDFED TYqUSAND DOLLARE (5100,000), IN ADDRION TO THE F COMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECiION 3]OB OF THE LABOR CODE, INiEREST, AND ATTOPNEI^S FEES. LICENSED CONTqACTORS DECLARATION: I here6y aHirm that I am licensed under provisions ot Chapter B(commencing wilh Section 7000) of Division 3 of the Business end Professioos Coae, end my license Is in fuU force end eHect. Lic. � Cless a ComractoYs Signat�re: � Date: _ �/ r � CONSTRUCTON LENDING AGENCY: ❑ I hereby eflirtn that there is e construction lending agency tor Ihe pertortnance ol Ihe work for which this permit is issued. (Sec. 3097, Civil Code). Lentlers Neme: Lenders Atltlress: Signeture: OWNER-9UILDER DECLARATIONS: Date: I hereby attlrm that under penelty of perjury thet I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Buslness and Professlons Cotle: Any city or counry which requires a permit to constmc�, elter, improve, demolish, or repair any sirucNre, prior to its Issuance, also requires the epplicant for such pertnit ta tlle a signed statBment that he or sha is licensed pursuant to the provislons ol the Contrectors License Law (Chapter 9(commencing with Sectlon 7000) of Division 3 oi the Business entl Profassions Cade) or Ihet he or she is exempt Iharefrom antl Ihe basis for the alleged ezemption. Any violetion oi Section 7031.5 by any appliwnt lor e permit sub)ects the epplica�� o e civil penelty of not more then five hundred dollers ($500).): ❑ I, as owner of iha property, or my employees with wages es their sole compensation, WILL DO TF1E WORK, end ihe siructure Is not intentletl or offered tor sale (Sec. 7044, Business end Professions Cotle: The Contraciors Ucense Law dces not apply to an owner of property who builds or improves ihereon, anC who does such work himsetl or herself or through his or her own employees, providetl that such improvements ere not intendeC or oflerad lor sale. If, however, t�e Duilding or improvement Is sold within one year of completion, the owner-builtler will heve Ihe burtlen of Oroving that he or she did not buiitl or improve for purpose ot sale.). ' ❑ I, as owner ot the property, am E%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct lhe pwjact (Sec. 7044, Business end Professions Coda: The con�rec�ors Licensa Lew aoes not epply to en owner of propeny who bullds or improves thereon, entl who coniracts far such prolect wlth e comrector(s) license pursuant to the Cartracto�s License Laws.). ❑ I em exempt untler sec. Business end Prolessions Code for this raason: Siqneture: Date: Owner ID venfied by drivers license. ❑ Ves ❑ No Drivets License No. Expires: Veriflcation oi Ownership by (type ol documem, i.e. - property �e: bill or deetl): DIVISION OF INDUSTR�AL SAFETY PERMIT CEHTIFICATION: ❑ I hereby certiy fhet no excava�ion five (5) or more leet in depth into which a person Is requireG to descend, will be mede in connection with work euthonzetl by thls pertnit, antl IhBt no buitding slrucNre, scattolding, falsework, or demolition or tlismantling �hereof, wiil be more �han ihirty-six (36) feet high. (Chap. 32, Gry 2, Ar12, Sec. 341, Tltle 8, Calitomla Atlminlstrative Code). ❑ As owner-builder, I will not employ enyone ta do work which would require e permit from the Division of Industnel Setety, es noted above, unless such person hes e pertnit to do sUch work from Ihe diNsion. Signature: Date: Division of Industnal Safery Pertnit Number: CEfiTIFlCATE OP COMPLIANCE AND AUfHORVATON OF ENTFiY: I certiy untler penalty oi perjury ��at I have read lhis epplicaiion antl stale ihet Ihe infortnation given is wrrect. I egree to cOmply with all stete laws and ciry ordinances relating to building construction, an0 euthodze representetives ot the City ot Costa Mesa to enter upon ihe ebove-described propeny for inspection purposes. I egree not to occupy or allow occupancy of eny building authonzed by thls permit until finel inspection. CO�E /. INSPECTIONTYPE 1616 Fixed System Final Fire Prevention 1268 Pool Spa Final 200 Final Re-Roa� 201 Finel BIocWReteininq Well 202 Final Factory Fire Place 203 final Sign 204 Final Demolition �.l .11LL . �QQ� NISPECPUNTYPE 206 Final Mechaniwl 200 Final PlumDing 210 Finel Elactricel 272 Final Fire Pre�enllon 220 Final Planning Approval 222 Final Site 250 Final BuildinglOccupency a. : / 0� � (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, GA 92626 Job Address: 930 DOGWOOD ST Suite No Vicinity: MASTER BATHROOM Parcel Nunmber: 42252125 Applicant: FARTHING, SCOTT Address: 904 DOGWOOD COSTA MESA, CA PLUMBING PERMIT Phone: (949) 500-2870 Zip: 92627 Owner. KALATSCHAN, ZOYA Address 930 DOGWOOD ST Phone: COSTA MESA, CA Zip: 92627-4161 Contractor: FARTHING DEVELOPMENT INC Address: 904 DOGWOOD Arch / Eng : Address: ISSUE FEE Backflow irrigalion Backflow Preventer Bathtub Clanfier System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain COSTA MESA, CA Phone: (949)500-2870 Zip: 92627 License: 560875 Phone: Zip: License: Status: ISSUED Applied: 12/OS/2003 Issued: 12/09/2003 ISSUED BY: I '; � �� ' �•� �. `;•, , . �.. � � � � � `/ � • SCOPE OF PERMIT CONSTRUCT NEW 272 SF MASTER BATHROOM IN AN EXISTING SINGLE-STORY SFD. 1 BATHTUB, 1 SHOWER, 1 WASH BASIN SET, 1 WATER CIOSET REF: 803-00839 . . � AMT $23.50 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 1 0 0 0 0 0 0 0 0 FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 k) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Private Line � $0.00 Shower $9.80 Sink, bar $0.00 QTY 0 0 0 0 0 0 0 0 0 0 1 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(1-0) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater/ vent Water Piping (Insl or Rep.) AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $9.80 $0.00 $0.00 QTY 0 0 0 0 0 0 0 1 0 1 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and tinal approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (774) 7545626 zaa8r61N00) WORKERS'COMPENSAnON DECLARAnON: I hereby ettirm under penelty of perjury one of the tollowing declarations: ❑ I heve entl will malntein e certificate oi consent to setl-Insure tor workers' compensation, as provitletl for 6y section 3700 of tha Labor Code, for the pertortnence of the work for w�ich this permit is issuetl. ❑ I have antl will maintain workers' compensation insurance, as requiretl by section 3700 of Ihe Labor Cotle, tor ihe pedormance of ihe work tor which Ihis permit is issuetl. My workers' compensation Insurance carner antl policy number ere: Carner: Policy Number: (This section neetl not be completed i1 the permit is valued et one hundred tlollers ($100) ar less.) �I certify thet in ihe pertortnance of ihe work for which this pertnit is issued, I shell not employ any person in any manner so as to 6 come sVbject to the workers' compensatlon laws oi Calitomia, and agree that it I should o me subject to Ihe workers' compensation provisions ot Seclion 3 00 ot th Lebor de, I shall forthwith comply with these pmvisions. Applicant Signature: Data: WARNINO: FAILURE TO SECURE W KERS' fAMPENSATION C IS UNLAWFUL AN� SHALL SUBJECT AN EMPLOVER TO CRIMINAL PE .TIES NN CIVIL FMES UP TOONE HUNORED TMOUSANODOLLARE($100,00p),INADDITIONTOTHECASTOF MPENSATIIXJ,DAMFGESASPROVIDEDFORINSECTION3]O60FTHELABOR DE,IMEREST,ANDATTORNEY'$FEES. LICENSED CONTRACTORS DECLAHATION: I hereby ettirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Protessions Code, and my license is in full brce antl eNect. Lic. a Cless N Contractor's5igneWre: � Date: % / CONSTRUCTION LENDING AGENCY: ❑ I hereby attirtn that Ihere is a consiruction lending agency tor ihe pedormance of ihe work for which ihis pertnit is issued. (Sec. 3097, Civit Cotle). Lendefs Neme: Lenders Address: SignaWre: Date: OWNER•BUILDER DECLARATIONS: 1 hereby aMirtn thet untler penalry of perjury iha� I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the toilowing reason (SecJ031.5, Business and Professlons Code: Any ciry or counry which requires a permit to construct, alter, improve, tlemolis�, or repair any sirucNre, pnor to its issuance, also requires ihe applicaN for such pertnil to file a signed statement ihat he or she is Ilcensad pureuant to the provisions of Ihe Comracrors License Law (Ghapter 9(commencing with Sactlon 7000) of Divislon 3 of Ihe Business end Pmfeuions Code) or ihat he or she is azempt Ihereirom and the basis for Ihe alleged axemption. Any violation oi Section 7031.5 by any applicant for a pertnit subjects Ihe applicant to e civil penalty ot not more than five hundred dollars ($500).): ❑ I, as owner of ihe property, or my employeas with wages as iheir sole compensation, WILL DO THE WORK, and ihe sWCWre is not imentletl or offered tor sale (Sec. 7044, eusiness and Professions Code: The Coniractors License Lew does not apply m an owner ot properry who builds or improves thereon, and who dces such work himseli or herself or through his or her own employees, provided Ihat such improvements ere not intended or ottered tor sele. If, however, ihe building or improvement is sold within one year of completioq the owner-builder will heve the bwden of proving that he or she did not build or improve for purposa of sele.). � ❑ I, es owner ol the properry, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consimct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not epply to en owner of property who builtls or improves thereon, and who wnirects for such project with e contractor(s) license pursuant to the Contractors Licensa Lews.). ❑ 1 am e:empi under sec. Signature: Owner ID verified by tlrivefs license. ❑ Ves ❑ No Business antl Professions Cotle for this reason: Veritication of Ownership by (rype of dwumem, i.a. - property taa bill or tleetl): DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION: Driver's License No. Date: Expires: ❑ I hereby certify that no excavetion five (5) or more feet in depth into which a person is required to descend, will 6e made in connection with work authonzetl by ihis permit, and that no building structure, scaffolding, falsework, or demolitlon or dismantling ihereof, will be more ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, California Administrative Code). ❑ As owner-builder, I will not employ enyone to do work which would require e permit from the Division of Indusirial Safety, as noted above, unless such person hes e pertnit to do such work from the divisian. Signature: Date: Division of Industnal Safe�y Permit Number: CER7IFlCATE OF COMPLIANCE AND AUTMORIZATON OF ENTAV: I certify under penelty ot perjury that I have read this application and state that the informatlon given is correct. I egree to comply with all stet�� n�nances rela�ing to building constmction, and au�horize representatives of the City of Costa Mese to enter upon the ebove-described D�operty for insp U urpos ee not to occupy or allow xcupancy ot any buiiding authori e y this permil until finel inspection. ignature Of Le al ner(s) e And/Or Authorized Applicant e COOE I. INSPECrIONTVPE �iE INTITIALS 1616 Fisetl Syslem Finel Fire Prevention 1266 200 201 202 203 Pool Spa Final Final Re-Root Final BIocWRetaining Wall Final Factory Fire Place Final Sign 204 Final Demolition CO�E I INSPECTION iVFE 206 Final Mechanical 20B Final Plumbing 210 Finel Elecirical 212 Finel Fire Prevention 220 Final Pianning Approval 222 Final Site 250 Final Building/Occupency PGg. I[�LS z (�ia) �sa-5z�3 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIFi �RIVE, GOSTA MtSA, GA 9'1626 JobAddress: 930 DOGWOOD ST Suite No Vicinity: MASTER BATHROOM Parcel Number: Applicant: Address: 42252125 FARTHING, SCOTT 904 DOGWOOD COSTA MESA, Cq MECHANICAL PERMIT Phone: (949)500-2870 Zip: 92627 Owner: KALATSCHAN, ZOYA Address: 930 DOGWOOD ST Phone: COSTA MESA, Cq Zip: 92627-4161 Contractor: FARTHING D�VEIOPMENT INC Address: 904 DOGWOOD COSTA MESA, Cq Phone: (949)500-2870 Zip: 92627 License: 560875 9p'� Status: ISSUED Applied: 12/OB/2003 Issued: 72/09/2003 ISSUED BY: �-/ SCOPE OF PERMIT CONSTRUCT NEW 272 SF MASTER BATHROOM IN AN EXISTING SINGLE-STORY SFD. 1 VENT FAN/SINGLE DUCT REF: B03-00839 ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall HV Refng Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < t0000cfm Air Handlers > 10000cfm Floof Furnace Floor or Suspend Heater $23.50 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 57.25 $o.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantiry 0 0 0 0 0 0 0 0 0 0 i 0 0 0 0 0 0 0 0 FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler Commercia l I ncinerator Domestic Incinerator Compressors / Absorption Svstems Upto3hp/100kBTU 3 To 15 hp / 500 k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp I 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Uplo3hp 3Tot5hp 15to30hp .... 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee . 4uantiry $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 50.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inspeetlona and finel approval must be obtained. Failure to obtain inspections and final approval will result in �he expiration of this permit. FOR INSPECTIONS CALL: (7/4) 7545626 244fi-46Ifi�00) WORKERS' COMPENSATION DECLARATION: I hereby aHirm under penalry of per�ury one of the following tleclarations: . ❑ I heve and will maintain e cert��lcate of consent to sell-Insure for workers' compensation, es pmvided tor by section 3700 of the Lebor Cotle, for Ihe pertortnance ot the work tor which this permit Is Itsued. ❑ I have and will maintain woAcers' compensa[ion insurance, es requiretl Dy section 3700 of Ihe Lebor Cotle, for ihe pertormanca ot Ne work for which Ihis pertnit is issued. My workers' compensationksur ca carrier and ' y number ere: Cerrier. � (% (n, Policy NumDer. �(This sec/tion need nof be com efed� i�f ie permit is v lu et one hundred dollers ($700) or less.) �ertify Ihet in Ihe pertormanGe of the work for whic this permit is issued, I shall not employ any person in any manner so as to become subject to ihe workere' compensetion laws ot CalifoMie, and egree tha ' s uld become subjecl to Ihe workers' compensation provisions of i ec� �700 oi t�e Labor code, I shall forthwith Comply with thesa provl5i0ns. /� i I� J l Applicant SigneWre: Date: �� WARNINp: FAILUPE TO SEC WORK RS' Cdr1FENS COVERAGE IS UNUWRIL AND SHALL SUBIECi AN EMPLOVER TO CflIMINAL PEMLLTIES D GVIL INES UP TOONE HUNDRED THOUSAND DOLIARE (5100,000). IN ADtlITION TO THE GQST OF COMPENSAiION, DMV�GES AS PfiOVIDED FOR IN SECiiON 3]OB OF THE UBOR CODE. INiEREST, AND FTTORNEI"S FEES. LICENSED CONTRACTORS DEC4ARATION: I here6y aflirm Ihat I em licensetl under provisions oi force end ettect Lic. N Comrectar's SigneWre: (commencing with Section 7000) ol Divisian 3 of the Business end Professions Code, and my license is in full cless a ` Date: � l�i�) CONSTRUC710N LENDING AGENCY: - ❑ I hereby aftirm Ihat there is e Constmction lentling agency for the pedormance of ihe work for which this permit is issued. (Sec. 3097, Civil Cotle). Lendefs Name: Lentler's Atltlress: Signewre: OWNER-BUILDER DECLAHATIONS: Date: I herehy aftirm ihet under penalry of perJury ihet I em E%EMPT FROM THE CON7RACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business entl Protesslons Cotle: Any Ciry or County which req��re5 e permit to constmct, elter, improve, tlemolish, or repeir eny stmcWre, prior to its issuance, elso repuires Ihe epplicant tor such permit to flle e signetl stetement ihat he or she is licensetl pursuent to the pravislons oi �he Contractors IJcense Law (C�epter 9(commencing with Sectlon 7000) at Divislon 3 of ihe Business and Professions Code) or thet he or she is azempt therelrom entl the basis lor Ihe ellegetl exemption. Any vlolatian ot Section 7037.5 by eny epplicant for e pertnit subjects the appliwnt to a civil penelry ot not more ihan liva hundretl tlollars ($500).): ❑ I, es owner ot the properry, or my employees with wages as their sole wmpensation, WILL DO THE WOqK, antl the structure is not intended or oMereA for sale (Sec. 7044, Business end Professions Code: The Conirectors License Law does not apply lo an owner of property who builds or improves Ihereon, and who does such work himself or herself or through his or har own employees, provided that such improvemenis ere not intended or oHered for sale. If, however, ihe 6uiltling or improvement Is sold within ana year ot comple�ion, the owner-builder will have ihe burden oi proving thet he or she did not build or improve for purpose of sele.). � ❑ I, as owner of the p�operty, am EICCLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to constmct Ihe project (Sea 7044, Business and Professions Code: The contrectors LicensB Lew does not epply to en owner of pmpeny who builtls or Improves ihereon, and who contracis for such prolect wlih e contracbr(s) license pursuant to ihe Contractors License LawsJ. ❑ I am exempt under sec. Business and Professions Cotle tor this reason: SlgnaNre: Date: Owner ID ventietl by Anver'S IitenSe. ❑ Ves ❑ No Drivefs LicenSe No. Vedfication ot Ownership by (rype ol document, i.e. - propehy �aa bill or deetl): Expires: DIVISION OF INDUSTRIAL SAFET� PERMR CERTIFICATON: ❑ I hereby certify thet no exceve�ion five (5) or more feat In depth into which a person is required to descend, will be made in cannection wlth work euthodzetl Dy this permit, antl Ihel no building stNCture, scaHolding, felsework, or demolition or dismantling ihereof, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Califomia Adminls�re�ive Code). ❑ As owner-builder, I will not amplay enyana to tlo work which would require e permlt Irom ihe Division of Intlustrial Sefery, as noretl ebove, unless such pereon �es e permit to do such work fmm �he Givision. Signature: Date: Division of Industrial Safery Pertnit Number: CERi1FlCATE OF COMPLIANCE AND AUTHORVJITION OF EMRV: I certiy under Denalry of perjury Ihat I have read this epplication and stete ihat the infortnation given is correct. I egree to comply with ell stele laws and ciry ordinances relating to building conswction, end aui�onze representatives of t�e Ciry ot Costa Mesa to enter upon Iha above-described properry for inspecdon Durposes. I agree not to occupy or allow accupency of eny building authorizetl by t�is permit until final inspection. COUE �, INSPECTONTYPE - QdIE ��LS 1616 Fiaed System Final Fire Pre�ention 1266 200 201 202 203 Pool Spa Final Final Re-Roof Final BIocWReteining Well Final Factory Fire Place Final Sign 204 Final Demolition f�, � � oa�e �— ` Date COpE! INSPECTONTYPE � -Q�d�j�$/1c� (,�' 208 Final Mechanical �_v/, 208 Final Plumbing , 210 Final Electncal . 212 Final Fire Preventlon . 220 Final Planning Approval , 222 Final Site . 250 FinalBuilding/Occupancy . OS-14-2009 Insp ection Request Re orting Page 18 3:20�m Costa_Mesa,_C9=Ci�jr_Of A/PID Information Activiry: M( Const Type: V-I Owner: KP Applicant FP Contractoc FP Description: Fp Notice: PE Notice: PE 7 Requested Inspect Date Site Address Occupanoy� MECH2 Wednesday September 30, 2009 930 DOGWdOD ST CM MASTER BATHROOM Sub Type: Use: Status: EXPIRED Insp Area: Phone: 949 500-2870 Phone: 949 500-2870 BATHROOM IN AN EXISTIN S NGLE-STORY SFD. 1 VENT I - WEIDE MJ OF FULL PERMIT FEES, PERMIT WILL BE EXTENDED 180 DAYS. - Requestedlnspection(sl Item: 150 MISCELLANEOUS INSPECTION Requestoc Assigned To: """""" Action: Time Exp: _ Inspection Historv Item: 64 ROUGH MECHANICAL Item: 66 ROUGH-FACTORY FIREPLACE Item: 72 GAS PIPE - ROUGH Item: 90 GAS PIPE TEST - FINAL Item: 114 POOL H�ATER & VENT Item: 150 MISCELLqNEOUS INSPECTION Item: 206 FINAL MECHANICAL 05/13/05 Inspector: MJW CommenC Requested Time: 08:00 AM Phone: Entered By: ZWART_B K �� Action: EXP Expired �- � I- Q� REPT131 Run Id: 12879 �i PflOJECT ROOPESS: � OWNEF1'^ NAME: S; . FC�iESS: q ..' COSTA MESA,CA 531-2972 ANCHIENGINEEN: AOOFE55: UNIT: 92627 HEG.NO.: UNIT: PEflMITTEE: EARTHING DEVELOPMENT INC ( 714 ) 673-1212 ADONESS: JOA DOGWOOD COSTA MESA CA 92627 LICENSEU CONTNPCTOfl DECIAPATION: I hereby a��irm Inat I am IicenseA untler pmvivons ol Chap�er 9(commencing wilh Sec�ion 7000� ol Division 9 0l I�e Busin¢s5 antl Pmfessions COUe. ana my Ilcense is in Iull lorce antl elfec�. cirr uc.: p�!,l l srnTe uc.:560875 c�s B Da�e: � 7 Signature:. _ — _ WOPNEFS'COM7ENSATIONOECIAflATION: I�eteOyalli�mNall�aveacetlilit olconsenttosell-inmreoracenifkateofwarkers' Compensalion Insurance or a certilietl copy Inereol (SecUon 3800. Lao. CI. ooucrNo.: 1182297-91 E%P.UATE: O3IOSI9Z �menxr: STATE FUND cen�ree coov �s ne�eoy mmanea. �£ cemrea �om �s riea w�� m��ry eu�o� ��o� / Uate: _��%�.�_ AOP�icam: ./.N [ E%EMPTIONFNOMWOflKEflS'COMPENSATIONOECUMTION: (i�i55xtionnee0nolbecomDlet i epermilislaronehunUre0g100)orless�. I ceNly ihal in ihe peAormance ol t�e work lor w�ic� Ihis permil is i55ceC. I shall not employ any Oerson in any manner so as to become 5u0�eti lo I�e Workers' Compensaiion Laws of Cahlomia. Daie: Signamre: NO710E: II. afler making Ihis Oecla�ation, you shoulJ �ecame suble�� o ihe Worker5' Compensation pmvisions al ihe LaEor CoC¢. you muSi ta�hvnth tromO�Y �^�h Sut� Dmviti0n5 Or ��i5 permil Stull �e ae¢med revOkeO. CONSTBOCTION LENOING PGENLV: I hereCy atlirm t�at t�ere is a consimction IenOinq agency for ihe Oedormance ai i�e work lor which ��is permi� is issuetl (Setlion 3097. Civ. C). LENOEN: aooncss: OWNEfl BUILDEP OECIABRTION: I hereby a��irm Ilui l am exempi Iram I�e Comracmrs' State Lkense Law �or the lollovrinp reason (Setlion 7031.5 Bu5ine15 an0 Prole55ional CoOe: Any tily ol couniy whiCh r¢puir¢5 a permii lo mn5imtl, al�¢r, impmve. Eertwlish, or �eDair any slmclure. o�ior lo ils issuance. also requires ihe apvhcant for such oermil Io lile a signetl statement Ihal he/she is litensee pu�swnt m t�¢ pmvisians at Ihe Coniracto�i State License Law (C�apter 9(mmmencing with Seclion 7000) of Oivision 3 oi t�e Busineu ana Pmleuions Coee) or IhallWsne is eeemo� �herelrom ana ine hasis lar Ine alleqee eMemD��n. My vialation oi Settion 7037.5 oy any aoolitani lor a permit suoiecls ihe apP�icant to a civil penalty ot nol rtrore ihan live hunAreA dollars (SNp). 1. as awner ol tne Ompeny or rtry employees with wages as ineir sole comDe��ion, vnll do Ihe wark, antl the ❑ suucwre is not intenaea ar onereu lor sale �Section 70aa. Business anU Pmlessional CaGe: The Contractors' State License Law tloes not aD�ly lo an owner ol a Ompeny wtw 6uibs or improves iAerean, anU w�o does suc� work Mmsell/Aerselt or tAmuAh his or ner own emDloyees, pwvitled Ihat such �mD��vemenis are not intenUeA or offeretl lor Sale. If, nowever the Luilaing or ' imprOvemenl i5 SoIA vnlhin one year 01 COm0lelion, Ihe awner will �av¢ I�¢ Eurden al proving he/s�e Citl not Gui10 or impmve lor tne ourvose ol satel. I, as owner ol Ihe O�operry, am excWsively comratling wit� Iicense0 conlrac�ors lo constmt� �he pmleci (Section 7044, Business ❑ ana Pmlessions Cotle: T�e Comraciors' S�ate Lkense Law Aoes noi apDly Ia an ovmer ot properry wha �m1As or imprmes ��ereon anC w�a com�acls �or 5uc� pmjects wilA a contracmqs) iitense Dursuani Io Ihe Conirac�ors Staie L¢ense Law�. I am aware t�a� pmof ol I�eir Worker'S CnmDen5ali0n insuranCe ShoulC De pmvitlea lo me. � I am ehemp� untler Seciion: B, 8 P. C. �� br thi5 reason: Date: Ownec I0o here0y cerliiy Ihai I am aware OI antl un0erslan4lh2 repuiremenis of Cabiomia Heaith ana Safery CoOe S¢tiions 25505. 25533. an0 2553A and Ihat lor anylulure �uilUing occupaniwill/will no� (circle one) neeU lo comply vn�h said Slaie cotle5 an4�he�equiremeni5 tora pennit lor con5lmciion or motli�icalion imm ihe Air uality ManaAemen� Dislrict. Fesitl¢nlial constmction applications are exempt imm Nese pmvisions. Oa�e. Applicam�, I her¢�y terlily I�al I �avereatllAiS aOPlit2lion and Sialel�at�he a0oveinlorma�ioni5 correCi. I aAre¢ (o tomply wiih allti�y antl tounry ortlinanres and slale law5 rHaling lo �uilUing consVuclion anA �ete0y author¢e �epresentalives al this ciry to enler upon ine aCove�mentioneU properry for inspection purposes. Date: _Jb�y Signamre: � �/' orivor's Lmense or Sonal Securiiy a: 164ba6 Wlvle—Bmltling; Gieon—CoOe Enlorcemenl: Canary—Ap{�litunl: Pink—Revenue: Goltlenrpd—ASSessor ` CITY OF COSTA MESA — BUILDING PERMIT PERM NO; H 054281 PERMIT NO: B 054281 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE; V—N PERMIT TYPE: STR PURPOSE: ALT JOH DESCRIPTION ; MISC PLMBING &T/OFF REROOF W/ COMP SQ FT: 3,495 CLAIM VALUE: 10,000.00 CALC—VALUE; 3,495.00 GROUP OCC: R-3 / COMMENTS: REMODEL KIT—BATHS REROOF ******x�*�*�e**********�x��r*�***�**�*+�***�******�**�rx**�***�r�x�+�*******�r��*�e*****�* Z-O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR; FT IN FRNT; FT IN REAR; FT IN LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARKING REQ• PFiOV; PARCEL: 92252125 ZNE: REF NO; PLANNING NiSTES> > iE it �f iF IE If �t iEif �E iF iF 3E if IE af 1E IF IE iE k iE if 3f k i! k 1E k IF if iF k iF k iF if iliF iE if IE k k IE �f iE if it k k If k iEiE if k iF ff iE IE if �E if i! iE iF 3f k.�f iE iF iE �lE k �F 3E 3E M D E V E L O P N E N T S E R V I C E S R E Q U I R E M E.N =,-x _,S ZONING APPROVED BY DATE: '�'%= BUILDING APPROVED BY ; APPLICATION ISSUEI7�BY: LEGALIZATION;N BLDG PMT PLUMBING PERMIT 63,00 PLAN ISSUE FEE BUZLDING—DZV—> PERMIT ISS TOTALS----> 63,50 0, REVENUE DIVISION TOTALS--> BLDG PMT PLUMBING ELEGT 63.00 DATE • � � : iFiEiFkiFMif3fifif�t ltkkkkiEifiEitiFlf�fklEikkk�kiFiFkfEifiE�k jE�ffFitkjFiFiEkiEiEiF F E E S M M A R Y STRUCTU�AL,SEGMENT;Y � .: ELEC IC MECHANIC FZRE SMIP/RES GRADING SMIP/1JON—RES PLAN=CHECK TOTAL PAID DUE 0 O 0.00 63.50 63.50 ,00 COLliECTED: 63,50 OVER/SHORT: ,00 RIC MECHANIC FIRE SMIP/TOO GRADING PLAN—CHECK iF iF k iF iE 3F if �F ik ikiF if if iE �f if IF iF if if k fE jf if k if if it �f �f iFiF if k it iF 3F k M if k if if if k if M 1f if if k if if M if iF 3f M iflf if �f af 1! iF iF 3f iF 1E iF iF if iE iE �! iE iE jf k I N D I V I D U A li; =.F E E B R E A K D O W N TYPE QTY D E S C R I P T I.O N UNIT COST TOTAL COST SFR 500 ALTER BY VALUE RESIDENTIAL NOZONE 1,00 500.00 SFR 2995 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 2,995.00 " END= OF FEES . i ��; ,17't ^,c'1';S�)br i� ii�._ _ . �'F.T�' y:' _ . , 7I :_ :: �. COG'STRUCTION AND PIANNING PO . SPA APeROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector i" 1�Temporary Electrical Servi�eor Pole N •� 52. Pool & Equipment Location .�n� J 2, Soil Pipe-Undrgmd. �,,y aott '' �/-• 53. Steel Reinforcement y � • -, � y,3::'E�ectric`al Condulty4Tjlity�Undrgrndy`�'' � - 54. Forms .rc 4r�El2ctrical CondUSt=Ucidrgrnd. ' 55. Electrical Bonding �=57f35ie21 Reinforcemerit'' �?��-�''.,. 56. Rough Plumbing & Pressure Test > a �. '�6i Electrical UFER-Grnc1. ru 57. APPROVAL TO COVER�GUNITE " � � � 7.:.Footings �� w 58. Electrical Conduit-Undrgmd. ��.J.J<l 'r,'_ L .. ,Z;�;�Foundation ,j �`.!� ,� � 59. Gas Pipe, O Undrgrnd., Test �� °' 9. Water Pipe-Und�gmd. ��? y 60. Backwash Lines, P�Trap, � Undrgmd. j��/� 10. Structural FIooFSystem % � %% 67. APPROVAL TO DECK �` 11 . Pr6perty Sewer-SLin€& Hoo �e COnnection • � 62. Backwash & Receptor-Final i� 72. Sewer Cap �• � -�hl y ;,� , 63. Heater & Vent-Final C �/ 13. Roof Drains � �i-, � 64. Plumbing SYstem - Final i,✓i . u 14. Rough Plumbi�g � �� 65. Electrical�Final /r � v 75. Rough Electrical-Condui[ � 66. Solar System-Final � 16. Rough Electri 4VJiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �; 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - ' - ' -- �7 C J',v[U'� u x- :�Ji' 20:;Rou�h Fctd� Fiteplace � �K:� �t : � �^. _^. "'� + �,ppROVAL=S+'�%CPer'ttiit # * �' "'" �� Z.. i'str ;X�i F 5•-� �r:+:x ��xcu:1[� � x irl. ' � �. � � r :. .r. : F � > �. a, � .n �, 21.,_Ducts, ip_Str;uctuce�g � .. .. ��5 ;r p ,y:r � �- 0. UFldergro�d:Hystro x. 22. Du�s, VBntieting- r C� S �_ ,r 5 �� '- 7, produc�j�i�g C�l�s ff�il 23 ;Gaf_Pipej'Rou h& Yest � � ' � T F:' Ti i -- r rJs :, .9 t :.S � r .. �t ..r :r 72. Unde�gioupci Flush= � �t. -• �va.. 24�sRoatFraming� '�r i[-F� �'r Y� O�.�y*S73�Undergrna?StoragA� aGnk�Gas ❑Oil^-� 25. Ro SHeathing �= � S v �: �n t�: `' �» �` 574.� Overhead XI drop� �� x °� S v��x t7 � v+ Y 26.��-Bar Ceiling (Stractural) &:Monocoat �1 � W � !�� x 75.�ry Chemical � �-{ G `2�. rn w ..r 27.';Frame a d Fl2shin y� 'v ; '-� �` �` "r� = � � S 'T' E"'� ,�. ! � _g�� ;�tK�F �. J' } �n- 4 76: D�Y Stand�!e� t-m [n -.,.. L28^Lathing�;& Siding�^+c' �. - r' . `,' �` � • fx �R 77 jFIXED SYSTEM�R�NAL� � r� � �• '29. Insulation � •=x ' � �' � � :�." � � k m 7gjFIRE PREV. FINA-L , 7 u; �,��• '.�30. DrywaII:INailtng �� I t s :-+ HEALTH�EPTxR-EQUIREMENT � -, ;-�.31. Plaster rown Ca'at � ' � J ! � * a9�'FINAL IN�P�CT16N �' `� � '� 7 � � 5 I b'l�' R Y;� :r iOC� c-32.=Electrical Power Me[e��Final� � OJ � � Y� �:*BO.��FOOD CERTI�FIC^/XTE ISSUED� ` tf ~ •- i C '� tit k% * ^ '" :?: x r'� 233.SFin�l El�trit, '� � � •S �. 4% � No s �� „ i, . �1 J . �L .Y � � �- � ' ' vy � '� ;�34,-Fina, Heating & AinConditionigg> �.. %t .r' � e < „�� : �� ^ v ,. `35.,.�,Fina1 Ga^jPipe�TesC' _ - �' ^ � �` � \ ='� t i i5V ll ✓.'� i: I �.'�.`� �`ri Viy � �-:.T in •� ' .' f T F 4i .• rz36: HoQd oi�fanopY � r� � :x - I 4 s . o x: `- �'SC^ I �r � r;� rt1 -37 �FinAi Fayto�y Fireplace , ' :�:^ '^ ' :'' ' z •': ' i -� + i ��' � � n I d� �s a � .r _ - -�38. FinylPlurnbing "1' - ' � � ty'% :S a:C �:39. Water Service=Finaly s_ � �� = z t n �, `�" r� `"� � I � -r .» _��40. Gas Servjce��inal ; T .;,ir•r S � cn � � Y�r G4 n�i� x� �� s'R7. Solar pomesFicFinal 5 .� �' �� i I �+ 'S"� _ a i ♦ r . �,a� � �-42.�Backflow Preventer�'� i� �K � i ri * '� > � . . '-�+ 43. Backflow Irr�ation� � °�S� ' -' * 'x ��• '�� % "'�� k r .i 'M ry � � ' " i'44. Landscape Iri�ipation SYstemb��i-,��^ .� a r ' c,-+ +:: N;+' r7i` z� v o0 ?135.:Sound Attenuatior4� ,3' .T •, s l " �' ` � �. :'� "i-' �= S `� r. F '„ �.7 �n - i- ,e� . � V , - ^ - � T l�� • ••+ � i .i 46.;Nandicap,RAgulations - � � - ,� ,,,� •S �_p :� � 47.hINaL STRUCTURE & BURDING Z� � �� vJ S' � • �n � F I - �• ^ i lH-��• •� � •� ' �. ✓ 48.'FIN�ALPLAI�NING , _ �. -q � . � .� �h � ;, � - � :49._ Eleatric Release to Edison i % � F* * a: �t t * � � ' � x 1 i'I' i11 .fi �' U , ,50.,Gas Release to Sout'hern California Gas Co Y I i �` � ' `'� �'"' ' , � � �r r 3. :_ �..� a: a�. r. �:51. CEFiTIFICATE OF�OCCUPA�JCY ;: , �, „ ^� i:,j ;r t .- c7C No. Date CITY OF COSTA MESA BUILDING DIVISION ROOF COVERING CERTIFICATION Property Address l3� l/OGt WOU G� Owner Contractor I� Permit No. � s y Zg � State Contractor License Number '�7� l% ��rJ Classification l� I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the above address in conformance with Chapter 32, and Section 1704 of the latest adopted edition of the Uniform Building Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the instailation instructions of the manufacturer. ❑ I further certiry that I am the owner of the property. (Owner-Builder permittee only). � I further certify that I am: ❑ Owner of sole proprietorship company ❑ Full partner of the company ❑ Limited partner of the company � Officer of the corporation I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this certification, which shall be binding on all successors or assigns of the company or corporation. I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building Division for acceptance. Received by Building Division BY: / � � %:/�� eF .: 0'J90-a8 WM1itaBuiltling Div.; Cenery�Conuaaa; Pink-0wner Fa ✓'t-�t i h H �IP �oo�Y.�t .tti �. Company or rporate Name 90y /Z�,u,v�� '� ACOfB55 �vsfi� �� s�i� � ��-�� 9/iz�/ � Signaiure Date S�o Tj`' �'�i-r-� t; , Prin�ed or lype ame r- � �_ PFOJECTpO�IHESS: 93O DOGWOOD ST OWNEH'S�{1ME: SHAW HUEY ROBERT � • aooness: g 30 �OGWOOD ST COSTA MESA,CA 531-2972 FNCHIENGINEEfl: aoosEss: 92627 flEG.NO.: u"iT: CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: P 054283 PLAN CHECK NO; N CONSTRUCTION TYPE; V—N PERMIT TYPE: PLU uxiT: JOB DESCRIPTZON : MISC PLMBING 6T/OFF REROOF W/ COMP PEfl""nEE: FARTHING DEVELOPMENT INC (714)673-1212 nooxess: g04 DOGWOOD COSTA MESA CA 92627 LICENSEU CONTPACTON DECLANRTION: I �ereby allirm iqat I am licensed under pmvisions ol C�apter 9(commencing wil� Se[Iion 7000) oi Oivison 3 o�l�e dusmess an0 Gm�ession5 Cotle. dn0 my license is in full brce and eilect. ciTruc.: 048 ]f� STATELIC.:S6OH%5 ��U`ss: Oa�e'. � Signature: �1�� WOflNEBS' OMPE SFTION DECIABATION: I hereby a�lirn� �pat I have a cenilica�e ot co� n� lo se �insure or a cenifica�e of Workers' Compensalion Insurance, ar a certifietl copy Ihereoi (Seclion 3800, Lab. C�. roucvNo.: 1182297-91 E%P.DA7E: O3IOSI9Z `romraxv: STATE FUND � Certihetl copy is hereby �urnished. � Cehilietl copy is file0 wilh e ciry Bui 'n �ivisio pa�e: D Applicanl:�„� � E%EMPTION FBOM WOHNEPS' COMPENSATION OECIAflRTION: (i�is seclion need not Ee comple�e0 il ihe permi� is larone hun�tl ($100) or 1¢55�. I ceNty Na� in Ihe peAormance ol ihe work �ar whic� this permil is issued. I shall not employ any person in any manner so as to become sublecl �o �he Warkers' ComOensation Laws ol Calilomia. Oale: Signamre: NOTICE: I�. afier making IAis tleclaraiion, you should bpcome suble�� to Ihe Workers' Compensaiion pmvisions ol ��e Labor Coae. you mus� lorihwith comDty wil� such pmvisions or �his permii shail be tleemed revokeA. CONSiXUCTION LENOING aGENCY: I hereby aiiirm ihat inere is a consimction lending agency br ihe peAormance oi Ne work for which this permil is issuetl (Section 3097. Civ. C�. LENOEfl: AUOflE55: OWNEN BUIL�EX UECIANFTION: I here�y ailirm �ha� I am exempt tmm the Conlractors' State License Law for ihe lollowing reason �Section 7031.5 Business an0 Pro�essional Code: Nny ciry 41 counry which requires a permit �o constmc�, aller, imD�ove, tlemolis�, Or repair any S�mcWre. prior �o ils issuance. also repuires I�e applicant �or sucA Oe�mit to tile a signed statemenl that he/she i5 Iicense0 pursuam m �he pmvisions o� I�e Coniracmrs' S�a�e License Law (C�apter 9(commencing wiU Section 7000) o� Division 3 of Ihe Business ana Pmlessons Cotle) or Ihat he/s�e is evempl Ihereiwm and the basis for Ihe allegetl eMemD�ion. Any viola�ion ot Seclion 7031.5 by any applican�for a Dermit su�lects Ihe applicant to a civil Genalry of not more �han five hundretl tlollars (5500). I. as owner of tfie pmDe�y or my employees wt�fi wages as their sole compensa�ion, will tlo Ihe work, antl Ihe ❑ s�mciure is nat imenaetl or ollere0 �or sale (Sec�ion )p44, Business antl Pmfessional Cotle'. The Conirac�ors' Sia�e License Law tlaes nol apply to an owner of a DmDerty who�builtl; or impmvw thereon, and who Aoes suc� woB �imselNherself or thmugh his or her own employees, pmvide� �hal such improvemenls are no� imentletl or oflered lor sale. If, however �he lluilding o� i I wi �in n ear o� com lelion wi v h b rtlen o� mvin he/she tli0 no� builtl or im mve im mvemen� 5 so 0 � o e , ihe owner II ha e � e u P P Y D P 9 for ihe purpose ol sale�. I, as owner ol lhe pwpeny, am exclusively con�racting with Iicense0 tontractors to constmc� �he pmlec� (Sec�ian 704d, Business ❑ antl Pm�essions Cotle: ihe Comramors' Siate Licen¢¢ Law tlaes nol appry to an owner o( pmDerty who builtls or impmves IAereon an0 wha conVaclS lor such pmlec�s wii� a contraqor�s�license pursuant�o the ConVaciors' S�a�e License Law�. I am awdre Ihat pmo� ot �heir Worker'S Compensation insuranc¢ ShoWU be pmviae0 �o me. � I am exemp� untler Sec�ion: 9, g p, C. PERM NO: P 059283 GOVT; N SUPP; N PURPOSE; ALT SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS: REMODEL KIT—BATH REF B54281 �t*�t*x��t�t**�t******�t�**�t�r�***********�t***�*�r��t*�t*�t**�t�e**�r�t�tx*********�r�e*+t**+�*�t*+r* Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING --------- FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARKING REQ• PROV: PARCEL: 42252125 ZNE; REF NO: PLANNING N<STES> i iF iE if if iF �t 1F iF 3F iF iE iF iFik if iF 1k iF if �F 1F iF ik 1k ik if if iF if !F iF �1f iE iF if iF iFlF iF 1F iE �)f iF 1f �F �t iF�1F if iE if if if if if �! iF iF ik iFlf #�lF 3F if �f iE �E iFiE if if ik if if iF iF iF ik - D E V E L O P M E N T S E R V I C E S;:", R E Q U 2 R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : APPLICATION ISSUED� 3F�EiFifiEiFifiFkkiFiFiFiflfiFiFik lFil iF �F �F if iE iF if iF�F if M iF if 3f iF iE 1E k k if LEGALIZATION:N F E E S BLDG PMT PLUMBING PERMIT 9,25i PLAN ISSUE FEE 3.00 HUZLDING—DIV—> PERMIT ISSUE TOTALS----> 4.00 3,00 REVENUE DIVISION TOTALS--> BLDG PMT PLUMHING ELECTR � iF iFlF 3f iE aE �1F iE if iE iE - �or mis reason: � T�IPE oate: Ownec PLU 1 do hereby cetlify iha� I am aware ol ana underslantl �he re�uiremen�s o� Califomia Health antl Satery CoOe Sec�ions 25505, 25533, antl pLU 25534 antl that I or any lulure buil0ing occupanl willlwill nol (�irtle one) need lo compty wiih 5ai0 state coCeS an� Ihe �equiremenis for a permn fo� con9mclion ar moailication irom I�e Nir Oualiry Managemeni OiSMci. Resitlential cons�mction applicalions are exempi IrOm i�ese pmvisions. �ate: Ppplicanl: I hereby cerlily I�a� I �ave reatl t�is apDlica�ion antl sta�e Iha� Ihe a�ove informatian is correcL I agree to camply with all ciry anU counry ordinances antl statelawsrelatinglo builtling con5imc�ion antl here0y aN�orizerepresen 5 o��hi i�yio en�erupon��e a0ove�men�ionetl proper�y forinspeclian purposes. / �a�e: �O � Signalure- � �� onver's License ar social Searity p.' � �6at�46 While—ButlOinq�, Green—Cotle EnlorcemenL Canary—AOPlicanP, Pink—Revenue', Goltlenmtl—Hssessor QTY i 1 DATE; —� y ATE: �U�� iE ififMiFiFiFif fE�f FiE iFififiFiEiF�f�k�F�FiflEiEilfFkiElEiEifiEifiF3fifiFiFiFififiEiFIfN�1tiElf�E M M A•R Y STRUCTURAL SEGMENT:N y`MECHANIC FIRE SMZP/RES GRADING - .�� "y;�; SMIP/NON—RES �` !—CHECK TOTAL PAID DUE 0,00 7,00 7,00 ,00 'TED,: 7,00 OVER/SHORT: ,00 IANIC FIRE SMIP/TOT GRADING PLAN—CHECK %, 0� � �� if �E k If k iFlF if iF iE iE 3F if ik iF iF iF 3FlE �E if iE iE iE if 1k if �E �F �EjE 1k k if iF k 1Elf �k 3F if iE if iF if iF iF iF if fF iE iF iF �! if iE k iE iF iF iE 1k �k I N D I V I D �U A li: ; F;�E E B R E A K D O W N D E S C R I P T I O N•�i' UNIT COST TOTAL COST BATHTUB ' 2,00 2,00 SINK, KITCHEN ,; ��" 2.00 2,00 .$ND;OF FEES �' t �`. Rl1QSt��JJ—��UUYJ� � i_. _ v�T�: t0:fr:/]t �t rr .i. . ... � G. ' _� J_ CONSTRUCTION AND PLANNING � P�`� ' SPA ' Date Inspector Date Inspector RPPROVALS Permit # � APPROVALS Permit # 1. Temporary Electrical Service9lPole �' 52. Pool & Equipment Location /-� n �. 2. Soil Pipe�Undrgmd. •/'� s�i I� 53. Steel fleinforcement � 'r- „� ,,., ;,3 `,€lectrical Condurt;�)t,ility-Undrgrnd�'� f 54. Forms . �.i,. c�4;�Elettrical Conduit�tlndrgrnd. . ' 55. Electrical Bonding �5.; �t�el B'einforcemerit'� � �-�' 56. Rough Plumbing & Pressure Test " •J'1 ;3Fi: �'Electrical UFER;Citnd. 57. APPROVALTO COVER�GUNITE �� n :�' ��LFootings �� G% � 58. Electrical Conduit-Undrgrnd. �v��Foundation ;� , -� � � 59. Gas Pipe, O Undrgrnd.. Test �� ' r, � 9. Water Pipe-Undigmd, i��l :<<, 60. Backwash Lines.P-Trap, O Undrgrnd. �;��» r � 10. Structural FIoo�SYstem � �_ 'i 67. APPROVAL TO DECK ;� 11. Pr.apertySewenLine'&Houie�Connection,�"�o �� s , ,rj 62. Backwash & Recepmr-Final , �'`% 12. Seiver Cap r� ' 7 y �,1 63. Heater & Vent-Final � �� 13. Roof Drains �n ��.. �';� 64. Plumbing System - Final �' 14. Rough Plumbir}g; - i�, �`,i '� 65. Electrical-Final � 75. Rough Electrical•Conduit � 66. Solar SYstem-Final 16. Rough Electric�liring � 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electric3YT Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' _ " _ - 4: J HCV,-� k. (-. 20.i-Etoug'h Factor Fiik� lace i �C!U ��:;"j �� U ; c'��K � tqppROVP;L'3%�-��.:Per'riiit # =r �-' '"�� + S �D �� 's..Q � s; [*' X<Z � 1- T Y. :Y i'� C[' 4'. N`-+' ., �.. �' 2 1i� •-� 'vc i r � :c �-i �7 ^:F -/. . F;i'7v, rt: :x rq 21.;.DuCts, in�-6tr�etu�g.g i �^ i-:S S C •�x �? J0. ndergqoupd;HydJo . 22. DucTS. �l�entil�tin'� � i �1 '�. `r Y !2i i�1. Produc[fli€iing Q�G"�s ffOil r ,-� i, � �.; �-- +� � 23.`,Gas�Pi e°Rou h &�Y st � 'i' �` r "" } `� �`� •, � � � t. �-� ,,P ,9 ,@ ;r�;� ,.,� T ,, p=.:r J2. UndergroundFlusFa✓ , �- .� ;,.: 24.cfloof.� Framing� !;�r .. •�;� �> L o' u.Y ry 573.?Undergrnd'Stora�e;57ank O Gas ❑ O�t 25. Roof SHeathing L"'' � �� ; y'-'� ".:+ NP n - �^:- :y ,� S a �,;Y: q �14.��Qverhead Hydro: * 26.:i.T-Bav Ceiling SSinictural) &�fvlonocoat � m l� mw. a 75 �ry Cfiemical �t- , Ct Vs:4 ^c �r �• �. v a n• �t •v 27 �FraR;e and Flashi�� ':� t `�-� �`'` � ' �=:� * 5 t� FS z -9r� � �x:t� �, ;?- ?+ �.r. � 76.�bry StandRiP_e :_:.u�- v ^«�' � 28. �LaThing;& Siding�i i i ��y',:. � +� 7. ••V. x' 77,-"FIXED Sl`STEf'v�RaN'AL�� v ^ r.� � ' ••I b � � [_ r- nl•�•r.. +.� n i - '�29. Insulation �'' `�' � � � �� .. �r ��l � (j � 78.'FIRE PREV. FIf�AL � _ � Y. x S s� s; � 30. DrywallYVailing � � � � I I Cr v r+ •v. •HEALTHrtDEPT��FFEQUIREMENT a a n� rr+ � � , � ��` 79 r'F1�fV�iL'l�V�PECTI� �'. G V � �31. Plaster Qrown,CoaI,.; .S ,�r�r z '•. n . � 4 � x. � - .- .;- i . . �� .-. � r- r32.:-Electrica� Po�er Mete2Final i� x ta � x t�80.vFO0D CERTIFICATE ISSUED ... ._ ` . n:i. � i ,Y s r. : :� r r .-+•, .. l� z33..'�in�El�tri� ^. ' ' � � '�lotes:/ !` -�� ' � , ..> � „� :n i �t :x .r. t��"�" v.-- . ,-� ., , _ ,. _. ,t-.- ` 1 ( ' f � �! +. � n34.;-Fin$F Heating:& /ik;:CorrcLitionjgq� Ct x I .. * �� _/,'� .�'1,^ :,( � ... . . -. .. , � y «. r �� m .� �or ��y�� 35 �inal Ga�Pip��Test" �"�^' � '`' � � � ��r �� * r� � «: ti. x �-, � 4 . `�� -� � ❑36.' Hoqd o�-fanopy i �r--+ - M c^ � I [: x 5. S_ c�o ;�� .-. ,- �. .- __ ""-. � �:s� v :a LT! i � `F F T �" ti rr �37:-Fine7 FAetory Firepraces i :-, :, - .� y� w _� . ,?� i 38. Fin@I PluInbing �,Rr u'n� � •.� --i '�` � �y �/ :F tt F� 'k �39. Water Service�Final�* � �- �' ; � F� R �� i� '�s n a s� i a. c: i x'r ,,, � ,. �;40. Gas Ser3j$e-Final ';; �;y ,Zi,.�r t; 7 I � �t� .f � on; .r, `�' :'�'G7. Solar pomesticFinal J ^ " �'� �=` I ( C. ` '7 � ~'J .k r �r� �+ i �x � rr r^ x� � 5.., '-J �t ! �s 1 1- .r y � - 42.'Backflow Preventer.r: c.. .T. T� � � f'. F ��G 7i-� r�"' �-+ J 43. Backflow Irri�ation" "�=�a " �E-'' � 'z;" -:J� ` .'�. � �, ,' , �.. :� n, � .� � _ . � �-- �� . , - ' _ �. , s " ._ �,44. Landscage li7�igatioii System�y�r„'d �:, +,=�t n � = 7 r, ir. v?� .,:;� a. N o:1 � T45.CSound Attenuation` �r-�F �`� "' " �"'�� .t � .' �-'� `�"L .r ` - � n� � 't :�7 ir.:t. V' .� . }.,�_ - + �� a, .n . . ..r � �^ .= i � �.� .-i x ,`3i6',HandicaD.Regulatio�s ry � ' , i„ �,i; � 7.� ;S �. 47:�IN.4L STRIYCTURE & BUIL'DING "- � I ls ""] :+! �S ^ x 'i � 'x I' ( ;7 :r. I r x �485'-,FINAL PLANNING; � "�`� T' V :R " " � . �: I F[-a � iU � � �. w l�i L�7 � w : c49.tEleciric Release to Edison i z ! i l: .r s" ci' - � .. ^j �x � tt i ta qc �n •r; r. r• •• K i t e Y LS l.i :J d :] '...... . 50.<,Gas Release to Southem Cali(ornia Gas Co , � � €, x F. �., .,^in � � •. ;;51. CEflTIFICATEOF;OCCUPpNCY' -; a: � ;� .,. �„� �; „ , .,,., No. Oate ntK �W, R. H.- UAIt Street tROUGN PLUMBING �PROP. $WR. LINE Q NOUSE CON. .y, SPRINKLINO 9YSTEM � MISCELLANEOUS ROUGN HEATING ANO AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND � POWER � ROIIGM WIRING TRENCHES FORMS STEEL RE FLOOfl SVSTEM BOND 9EAM ❑ STEEL REINFORCE � SMEATHING FRAME AND FLASHING LATHING - IN n OUT n PLASTER, BROWN COAT STRUCTURAL, FINAI HE' ''G, VENT., REFPIG. AND R.C., FI PL .NG, fINAL AND GAS TEST n SUBCONTRACTOR �[HJ� ` 362�.8 , COSTA MESA BUILDING-SAFETY DEPARTMENT �.0. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING C/ 5� A�DRESS I 30 DD�WOO"� OWNER R' N' S ' / " � ADDRESS 3O DoGwoop S�� TEL. CITV NO. CONSTRUCTION BRANCH ADDRESS — ARCHITECT �— TEL. � CONTRACTOR pW,�jER - 1��JlLOEI2 ADDRESS TEL. CITV NO. STATE CITV LIC. NO. LIC. NO. SI2E NO.OF BLDGS. � OF LOT I NOW ON LOT VSE OF ExI5TING BLDG. SIZE OF NO.OF NEWBLDG. ROOMS STORIES EMERIOF WALL ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED 1 her¢by ecknowletlga that I hava read this appllcation entl state that the abovo informetion is correct antl apree to comply with aIl lews reB�latinB buildin8 �onsttucNon, antl I shall not amploy any Oerson in violation of Ma workmen's compansatlan laws of Me Steta of Celifornie. 1 hernby carti(y [het I am prop¢rly licensetl as a contractor under the S[a�e of Californla Businau antl Profauions Cotla, Divisicn 3, Chapter 9, antl thei s�ch licenses ere In tull torca entl afiact, or I am exempt trom t�e O�a��sions of tha State of Celitornie Businass entl Protezsions Cotle, Division 3, Chepcer 9. SIB�etura of � � �i /1 . Permittoe .�st._q��lr Authorizetl Apant �µ,� �.�� Q�a� Ilqµ�� .,� _ v;,i' '1 ,?;-7, ,.0, 9t3'!�r ,::�.:�;.;:5,5Q f!" APPLICATION FOR BUILDING PERMIT A.P. NO. BVILDING ADDRESS TRACT FIflE ..s ZONE APPROVE� �'"LJ�� f -a PERS 0 �DC.wov a LOT .C7 I � u� VALUE /�O 5 - , GROVP � �.__3=�3- ZONE NO.OF USE OF NEW �f('j(`7 � FLAf�S � BUILDING VARDSAPPROVEO VAFDSAPPROVED MAIN BUILDING ACCESSOflV BUI DII (FROM GLSTREET) A DISfANCE BET MAIN BLOGS. VAR. �W C.V.G.qW APPROVED � i BEf. MAIN & ACCESS.BID 0.4TE 3- THE AMOUNT SHOWN UNDER V THE PUFPOSE OF ESTABLISHING A VALVATION 5 / Q� TOTAL FEE m e C � ¢ m n � E LL OWNER DATE 3-3-55 JOBADDRESS g�� Dornaood Street � BUILDINGPERMITNO. %%9 GENERALCONTRACTOR Owner-Buil3er VALUE $ 1�Z80,�� i 172 e�ocK TRACT 1712 Private Garage GROUP TVPE ZONE FIRE DISTRICT JSS PERMITS ISSUED I—NSPECTIONS DATE SUBCONTRACTOR DATE I NUMBI . _� �� Sr�L Foundation Forms and Grade to Rough Framing Plumbing, Rough to Slab Plumbing. Rough Complete Temporary Pole Final Sewer. St. . Septic Tank or Cesspool L�"•ing,ln � I ering Plumbing, Final, Fixtures Plumbing, Final Gas Test Wiring, Final Occupancy F'orm'L10 G-H 15001-5 Costa DZesa Building Department %—APPLICA�ION FOR PERiVIIT ' 111 EAST 20th STREET ✓ �S _ _ _ g__� _0, L_D ,I, N_G __ _ ._'_�. _ - .- rncre ucee re��rnonl�e PLOT PLAN Show location and distances from property line and hetween buildings. . } = � .. . . . . . ' � . .r�'s... .... ._ .. . . ... ... . . . ' Z ' ... � A � ' A Do you carry t9ork�an's Co�upensation - Insurance? I'�:, f � I:o � I am a�arare o i?; cv�-: � •• � a'' �he State I,abor Goce rr.:icii i �r,;� r• .,.�t-c^nloyer to be irsn:'�d a�ainst liaoility for �vorkman'e coWp 3a'= n• : � _— � Signed s 1 ORANGE COUNTY BUILDING DEPARTMENT � • 636 North Broadway � . .� SANTA ANA, CALIFORNIA ' , FOR APPLICANT TO FILL IN BUILDING n ADDRESS Q�O DORWOOU scnoo� oisT. C08L8 M@98 RE OR TOWN NEAREST � CROSS ST. M�(1r0o1Q BUI OWNER [HINOOK H�MES� IN[- AD[ MAIL 9363 w��SH�RE a��. 5« ADORE55 OR EVERLY IIIS rE�. R. 5 3� CITV NO. NE/ CR( ARCHITECT_OR _. .. TfL. . i. n ZO! TEL. LEGAL 7 e�ocq'� DESCRIPTION LOT NO. 'J 'J fATTACH METES 8 BOUND51 TRACT 512E OF LOT 7% % �OO I NOW ON LOT USE OF NO. OP N EXISTING BLDG. F�kiL�eg I Ri DESCRIPTION OF WORK L:C•�1CCh WALL ROOF COMPO COVERING STUCCO COVERING USE OF NEW BUILDING RESIDENCE _Atr_Q��02`i I HEREBV ACKNOWLE'.JGE THAT I HAVE REAO THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE�TO COMPLV WITM ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILOING CONSTRIICTION. SIGNATURHOF NEMPORT VISTA CO. LL�� L'iti�.: r�U� ..�-.�� $ 4830.0o P. �. : y_ I FfE / f' VALUATION / F@E � b APPLICATION FOR PERMIT BI�ILDING FOR OFFICE USE ONLY RECEIPT NO. PER! �,C�Ocr �/E :D BV DATE OF APPL. �DATE � �G � � � � �`�//i APPROVEO CORRECTIONS APPROVALS : LOCATION I IyJO6%EC MATERIALS, / � e i, � ��.. �❑ 0 A � Z D r � J � u "c1¢ n ��, ,. :s STP[ET . ..;�, • . : . ... � r � ��, . � � �r ' . `t ` r . . ...'t � ....�.... : )': I lf � • ,vJ �'li:"7:1 � ' . ( .... .. - ..: I: Y. '!: . � . ... •'L'-_ . . 7' �',1'= . _.� . I.' � \'i-. '�� .T :�'::', .: ff. i . ,� .�; ,� .i" , ��.'. � ':!.'l;�.V_ .C•'J. "I'.^: I�. � . .. � �. . ' ..-.. : � .. � �� x ._ . . I . .. . . . tf. ". _: :� . r-i _ . ;' ' . .. ' T.,p', � _ . ' :i'' .. . ' . ,_ ,_� .. _'_ _. _. -. -11F': - _ ' ' y ,. . _ .. . �'�r � _,.'.771'' . . D� '��'�� T.:r�.1=: