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Home My WebLink About2852 ELLESMERE AVE - Building Permits(714) 754-5273 • Fex (�14) 754-4856 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: � CITY OF COSTA MESA avao�N� �ms�oN �� DEVELOPMENT SERVICES DEPARTMENT PERMIT � \, 2852 ELLESMERE AV 13933412 FARTHING,SCOTT 00904 DOGWOOD COSTA MESA CA ELECTRICAL PERMIT Phone: 2ip: 92627 Owner: HILL, RAMONA SAWYER TR Address 2852 EILESMERE AVE Phone: COSTA MESA, CA Zip: 92626 Contractor: FARTHING DEVELOPMENT INC Address: 00904 DOGWOOD ISSUE FEE Temp service tesl Res. a/c package New Res (1-2 units) New Res (3+units) Pool I Spa Lighting Fizts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to 50hp Molore to 100hp Molars over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circui[s Temp Pwr Pole Intermed Pole COSTA MESA CA Phone: Zip: 92627 License: 560875 SCOPE OF PERMIT 1 LIGHT, 30UTLETS AND 1 SWITCH, REF 898-1806. $22.00 $0.00 $0.00 $0.00 $0.00 so.00 $1.00 53.00 51.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Temp Dist System / Lighting Busway I100 it - Standing Section Misc Electrical Equipment Trans(ormers up to 1 kva/kw ................up to 10 kvalkw .................up l0 50 kva/kw .................up to 100 kvalkw ..................over 100 kva/kw Low Voltage Equipment Low VOIt Wiring System / Ckt Misa Conduit Misc. Conductor Cirws ( gen or ride) Cirws (mech ride or lights) Christmas Tree Stand Fireworks Stand Olher Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee 73 77 FAIR DRIVE, COSTA MESA, CA 92626 status: ISSUED Applied: 03/04/1999 Issued: 03/04/1999 a f nL,�, � �. Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.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 $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES 527.00 COMMENTS / SPECIAL CONDITIONS EXPIRATION: This pertnit shall automatically expire end become vold if work is not commenced within 180 days, or if work is suspended or abandoned for e perlod of 180 days. INSPECTIONS: In order for ihe work authorized under Ihis permit to be conslderetl legal, such work must comply with all applicable codes, end all requlred Inepeetlona end final epprovel must be oblained. Failure to obtain inspections and final approval will result in the expiratlon of this permit. FOR INSPECTIONS CALL: (714) 7545828 WORKERS' COMPENSATION DECLARATION: � I hereby atfirtn under penalry ol pe�jury one ot Ihe following dedaretions: ❑ I heve entl will melntein a cerlHicete oi consent to setl-Insure for workers' compensetlon, es provitled lor by sectlon 3700 of the Lebor Code, for the pertortnence of t�e work lor which this permit Is issued. �I �ave end will meintain workers' tampensatian insurance, es required by section 3700 ot the Lebor Code, tor Ne peAortnance at the wark br which Nis pertnit is issued. My workers' compensatlon Insurence cerriar end poliq number ere: Cerrier: Policy Numbar. (Th/s sectlon need not be camp/eted ll the permit 15 ve/ued e( one hundretl tlollars ($100) oi /ess.J � I cerlify thet In the pertortnnnce of the work for w�ich Ihis permit is issueQ I shall not employ eny person in any menner so as to become sublect to ihe workers' compe ' ews of Celiforyle, end g ee thet it I should become sub�ect to the workers' compensetion provislons of Section 3700 of the Lebor Cotle, I shall forthwith Co with thes r0 S. . pllcenlSlgneWre: �L �Bele, �'/''��//9�q WAPNINO: FAILU SECURE WORKERS' W ATION COVERAGE IS UNLAWFUL AND SMALL SU&IECT AN MPLOYER TO IC �INAL PENALTIES AND CIVIL FlNES UP TO ONE MUNORED E(5100,000), IN ADDITION TO THE COST OF COMPENSATION, OAM1L1fiES AS PROVIDED FOR IN 5 THE LPBOR CODE, IMEREST, AND ATfOfiNEY'S FEES. LICENSED C6NTRAZFpRS DECLARA710N: at Chapter 9(commencing with Sactlon 7000) of ffiroe ena eNecL Lic.» Contrectofs Signature: Date: Protesslons Code, end my Ilcense Is in tull CON6iAtlCT10N LENDING AGENCY: ❑ I hereby attirtn Ihet there is a constructlon lending egency for the pertortnance of the work for whlch this permit is issuatl. (Sec. 3097, Civil Code). Lender's Neme: Lendels Atldress: Signature: Date: OWNER•BUILDER DECLARATIONS: I hereby etlirtn thet under penelry at perjury that I am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for the following reawn (Sec. 7031.5, Business entl Professlons Cotle: Any clry or county which requires a pertnit to consiruct, elter, Improve, demolish, or repair eny slruMura, pnor to its Issuance, also requires ihe epplicent tor such permit to ille e signetl stetement thet he or s�e Is licensed pursuant to the provisions ot tha Contrectors LJcense Lew (Chaptar 9(commencing with Sectlon 7000) of Dlvision 3 of Ihe Business and Pwleuions Code) or that he or she is exempt theretrom and t�e basls for Ihe alleged exemption. My violation of Section 703L5 by eny epplicant for e permit sub�ecls the epplicant to e civll penalry of not more than five hundred dollars ($500).): ❑ I, es owner of,the property; or.my emplayees with wages as iheir sole compensatlon, WILL DO THE WORK, entl Ihe structure Is noi Intended ar aHered tor sele (Sec. 7044, Business entl��Brotesslons Cotle: The Contractors llcense Lew does not apply lo en owner of property who builds or impmves thereon, entl who does such work hlmself or herseli or ihrough hls or her�o'wn�employees, provlded thet such Imp�ovemenls ere not intended or ottered tor sele. Ii, however, Ihe building ar Improvement is sold within ane yea� oi completlon; tlie�owner-builder will have the burden ot proving Ihat he or she tlitl not bulld or Improve br purpose of sele.). ❑ I, as owner of �he property, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct Ihe project (Sec. 7044, Business end Professians Cotle: The coniractors License LAwrtloes not epply to an owner of praperty who bullds or Improves Ihereon, end who contrecis tor such proJect wlth a cantractor(s) Ilcense pursuant to the Contractors License Laws.). ❑ 1 em ezempt under sec. Busineu entl Professions Code for this reason: Signeture: Date: Owner ID venfietl by dnvefs license. ❑ Yes ❑ No Drivefs License No. Veriflcation of Ownership by (type ot document, i.e. - property lex bill or tlaeC): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICA710N: Ezpires: ❑ I hereby cartly that no excavetlon five (5) or more feet in depth into which a person is repuired to descend, wlll be metle in connectlon wlth work authorizetl Dy this pertnil, entl thet no builtling structure, scattolding, felsawork, or demolition or dismantling t�ereof, will be more than thirty-sia (36) teet �ig�. (Chep. 32, Grp 2. Art 2, Sec. 341, Title 8, Califamle Atlminlstretive Cotle). ❑ As owner-builder, I will not employ enyone ta da work which woultl require a pe�mit trom the Dlvision at Industriel Safery, as notetl ebove, unless such person has e pertnit to do such work trom Ihe tlivision. Signature: Date: Divisian of Industnel Satety Permit Numher: CEHTIFlCATE OF COMPIJANCE AND AIJTHORVATION OF ENTRY: I ceRity under penalry of parjury that I heve reetl this application and stete that the Information given is correa. I egree to comply with ell state laws end city ardinances releting to building construction, end authorize represematives oi the Ciry ot Casta Mese lo enter upon the above-describetl prope�nspectionpygoses. I agrea not to occupy or allow occupancy of eny 6uilding authorized by this permit until finel inspection. COOE 1. INSPECTIONTYVE pAIE I�LS 1878 Fixetl System Finel Fire Preventlon 7288 200 Pool Spe Finel Flnel Re-Roof 201 Finel BIocWRetelning Well 202 Flnel Fectory Flre Plece 203 Flnal Sign 204 Flnel Demolltion 2H8-,8 �Qp(j INSVECTIONME 208 Final Mechanical 208 Finel Plumbing 210 Finel Electricel 212 Finfll Fire PrevenUon 220 . Flnal Planning Approvel 222 Flnal Site 250 FinalBuiltling/Ocuipency Ip.\i�I:l00�S1 n� ri� (714) 754-5273 • Fax (714) 754-4856 Job Address: Suite No Vicinity: ! CITY OF COSTA MESA BUILpIN6 DIVISION �I�,�� DEVELOPMENT SERVICES DEPARTMENT PERMIT 2852 ELLESMERE AV LIVING ROOM Parcel Nunmber: 13933412 App�icant: FARTHING, SCOTT Address: 00904 DOGWOOD CSText1 COSTA MESA CA ELECTRICAL PERMIT Phone: CSText1 2ip: 92627 Owner: HILL, RAMONA SAWYER TR Address 2852 ELLESMERE AVE Phone: � COSTA MESA, CA Zip: 92626 Contractor: FARTHING DEVELOPMENT INC Address: 00904 DOGWOOD 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 1000a Morors to 1 hp Motors to 10hp Morors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel [0 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole COSTA MESA CA Phone: Zip: 92627 License: 560875 PER NUMBER F99.0(16R� 77 FAIR DRIVE, COSTA MESA, CA 92626 status: ISSUED Applied: 0623/1999 Issued: 06/23/1999 ISSUED BY: h � �- � F9q.d _ . �, - �.. � <' ,�� ,• � R � �✓ ! , �,t�Y SCOPE OF PERMIT SUPPLEMENTAL ELECTRICAL PERMIT FOR 2-OUTLETS, 1-SWITCH 8 1-LIGHT IN LIVING ROOM. E99-00773. $22.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1.00 $2.00 $1.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 1 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System I Lighting Busway /100 ft Standing Section Misc Electriwl Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .....:...........up to 100 kva/kw ..................over 700 kva/kw Low Voltage Equipment Low VOII Wiring System / Ckl Misa Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Chnstmas Tree Stand Fireworks Stand Other Electrical Fee Invesligalion Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES E26.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorizad by this permit shall comply with all applicable hendicap access requirements under Calitomia stetutes and related regulations. (Ord. No. 92-20, § 1, 12-21-92) EXPIRATION: This permit shall eutomatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 deys. INSPECTIONS: In order for the work aulhorized under this permit to be considered legel, such woric must comply with all applicable codes, and all required Inepectlone and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � WORKERS'COMPENSAnONDECLARATON: I here6y atlirm under penelty of perjury one oi the following tleclaretions: � � - ❑ I heve entl wlll melntein a certificete af consent to self-Insure tor workers' compensation, as provitletl for by section 3700 of the Labor Code, for Ihe performence of the work tor which this Dermit is issued. ❑ I have entl will main�ain workers' compensa[ion insurence, as requiretl by sectlon 3700 ot the Lebor Code, br the performance of t�e work for which Nis pertnit Is issued. My workars' compensatian Insurence cerner and policy numbar ere: Cerrier Policy Number. (Thls sec(ion need nof be comp/e(ed i! the pertnit is velued a( one huntlred dollers (S 100) or /ess.) � I certify that In lhe pertormenCe of the work tor which thi5 permit is issuetl, I Shall not employ any person in any manner so es to becomB Sublecl Ia the workers' compensation laws of Californie, antl egree that if I shoultl become subject m the workers' cnmpensation pmvisions of Section 3700 0l Ihe Lebor Cotle, I shall forthwith comply wlth these provi ' Appliwnt Siqneture: �� ! oe,e: lo/a s/9� WARNING: FAILURE TO SECURE WORKERS' TIIXJ COVERAGE IS UNLAWFUL AND SHAl15U61ECT AN EMPLOVER TO CRIMINAL PENALPES AND dVIL FINES UP TO ONE HUNORED TMOUSAN� WILARE (5100.000). IN ADDfiION TO THE WST OF COAIPENSATION, DAMAGES AS PROVIDED FOR IN SECiiON 3]O60F THE LABOR CODE, IMEREST, AND ATiORNEI"S FEES. LICENSED CONTRACTORS DECLARA710N: I hareby attirm Ihat I em force end eHecL Lic. a_ Contractofs Signemre: Chapter 9(commencing wlih Section 7000) of Division 3 of tha Business and Professions Cotle, and my license is In full Class # � oate: /: Z �. -ri 9 CONS7RUC710N LENDING AGENCV: ❑ I �ereby ettirm thet �here Is a consimction lending agency for ihe pedormence of lhe work for which Ihis permit Is issuad. (Sec. 3097, Civil Code). Lenders Neme: Lentler's Atldress: , Signawra: Date: OWNER-BUILDER DECLARATIONS: I hereby attirm that untler penalty of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW For Ihe following reason (Sec. 7031.5, Business end Professions Cotle: Any ciry.or counry which requires e permit to construd, alter, improve, demolish, or repair eny siructure, prior to its issuance, elso requires Ihe applicant for such permit to file a signed�statement ihat he or she is licensed pursuant lo Ihe pmvislons ot the Con�rectors Llcensa Law (C�apter 9(wmmencing with Sectlon 7000) ol Division 3 ot ihe Business antl�Professions Code) or thet he ar she is exempt IhereFrom and tha besis for the alleged exemption. Any violation oi Sectlon 7031.5 by any epplicent for e permit subJects the applicanClo�a cMl penalry oi not more than five hundred tlollere (5500).): � n G u r,� ❑ I, as ownar ol ihe�,ptopetly, or:my employees with weges es Iheir sole compensation, WILL DO T11E WORK, antl the sWcture is nat Intentled or oHeretl for sale (Sec. 7044, Business end Professlons'Code: The Conirectors License Lew tloes not apply to en owner of property who builtls or improves therean, antl who tloes such work himself or hersalf ar through'�his oi her own employees, provided that suc� improvements are nat intended or ottered for sale. It, however, the builtling or improvemem is soltl within ona yeer at campletion!ihe owner-builder wiil heva Ihe burtlen oi proving that he or she tlitl not builtl or improve for puryose oi sala.). ❑ I, as owner ol the pmperty','�em,EXCLUSIVELY CON7RACTING WITM LICENSED CONTRACTORS to construd Ihe project (Sec. 7044, Business entl Professions Code: The contrectors License�Law.does not epply to en owner oi property who builtls or impmves Ihereon, and w�o contrects tor such proJect with e contrector(s) license pursuent to the Contractors'Cicense LawsJ. ❑ I am exempt untler sec. Business end Professions Cotle for �his reason: Signature�. Dale�. Owner ID venfied by driver's license. ❑ Yes ❑ No Driver's License No. Venfication of Ownership by (type of tlocument, i.e. - propetly tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Expires: ❑ I hereby certity that no ezcavation tive (5) or more feet in tlepi� Into whlch a person is required to descend, will be made in connectlon with work euthodzetl by ihis pertnit, entl ihat no building siructure, scaHoltling, talsework, or demolition or Aismantling thereol, will be more than thirry-six (36) teel high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, Tule B, Celifomla AtlminlslreGva Cade). ❑ As owner-builder, I will not employ enyone to do work which woultl requlre a permit from the Division of Indusirial Safery, as noted above, unleu such person has a permit to do such work tmm the division. Signature: Date: Division of Intlusirial Safery Pertnit Num6er: CERTFICA7E OF COMPLIANCE AND AU7HORIZATON OP ENTRV: I certily under penelty of perjury that I have read this application and stete thet Ihe informetion given is correct. I agree to comply with all state laws and ciry ortlinances relating to bullding construcNon, entl authorize represen�atives of Ihe Clty ol Costa Mesa to emer upon the above-describetl property for inspection purposes. I agree no� �o occupy or allow occupancy oi any building authonzetl 6y Ihls permit untll flnel Inspection. GOOE I, INSPECTONTYPE 1616 Fixetl System Final Fire Praventian 7266 Pool Spa Finel 200 Finel Re-Roof 201 Final BIocWReteining Well 202 Final Fectory Fire Place 203 Final Sign 204 Final Demalition 2M6�96 ¢eg u�e�a COOE 1 INSPECTION TYVE 208 Final Mechanical 20B Final Plumbing 210 Final Elec�rical 212 Final Fire Prevention 220 Final Planning Approval 222 250 Dete �/� 3/y'9 a�a Final Site Final Building/Occupancy � � / ► � ` I*J, r . � CITY OF COSTA MESA ; _ � BUILpIN6 DIVISION c�l�j� � DEVELOPMENT SERVICES DEPARTMENT a � �• PERMIT � E� �� 698-01806 (714) 754•5273 • Fax (774) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 2852 ELLESMERE AV Suite: Vicinity: ParcelNunmber: 13933412 npp�icant: FARTHING, SCOTT Address: 904 DOGWOOD ST COSTA MESA, CA Owner: HILL, RAMONA SAWYER TR Address 2852 ELLESMERE AVE Zoning: R1 Rl Phone: (949)645-9325 Zip: 92627 Phone: COSTA MESA,CA Zip: 92626 Contractor: FARTHING DEVELOPMENT INC Address: 00904 DOGWOOD Phone: COSTA MESA CA Zip: 92627 Arcn : C. K. ALLEN Address: 1967 ROSEMARY PL License: 560875 Eng: Address: Phone: COSTA MESA CA Zip 92627 License: C1823 Zip: SCOPE OF PERMIT EXTEND EXISTING MASTER BEDROOM BY 112 S�. FT. ALONG THE SIDE PROPERTY LINE. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $105.46 $16225 $0.91 $0.00 $0.00 $0.00 $268.62 SETBACKS MAINSTRUCTURE Front 64-0 ACCESSORY Front 0-0 PARKING Existin : 0 NOTES: Rear 48-6 Rear 0. 0 Required: 0 FEESUMMARY PLANNING 8 ZONING Left 9- 0 Left 0- 0 Proposed: 0 Status: ISSUED Applied: 10I06/1998 Issued: 03/04/1999 �a : + � `" , . Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 Phone: License: s9.iz8.00 so.00 EXPIRATION: This permit shall automatically expire and bacome vold if work is not commenced within 180 days, or If work is suspended or abandoned for e perlod of 180 days. � INSPECTIONS: In order fo� the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapectlona end final epproval must be oblained. Failure to obtain inspections and final approval will result in the expiretion ot this permit. FOR INSPECTIONS CALL: (7/4) 7545826 WORKERS' COMPENSATION DECLARA710N: � 1 hereby effirtn under penalry ot perfury one of the tollowing declaretions: ❑ I have end will meintaln e certllicate of cansent ta self-Insure for workers' compensatlon, es proviCed for by section 3700 of Ihe Lebor Code, far tha peAortnance ot the for which IhiS pertnll Is issue0. I heve an0 will maintain workers' compensation insurance, es required by section 3700 af the Labor Code, for the pertortnance of ihe work for which ihis pertnit Is issued. y workers' compensation Insurence carrler en0 pollcy number era: Cartler: Policy Number: (This section need not be canp/e(etl !l the permlt /s valuetl et one hundred dollers ($700) or less.) ' ❑ I certify ihet in ihe Dertortnence of the work tor which Ihis permit is Issuetl, I shall not employ any person in any menner so es to become sub�ect ta the workero' compensatio ws of Celltomia, end agrea that i1 I should become subject to the workers' compensatio visions oi Section 3700 of the Lebor Cotle, I shall forihwlth �P cam � rovislon ��/,�� I m Si nature: e: z W NING F TO SECURE WORKEiiS' COMPE IXJ COVERAGE IS UNLAWFUL AND SHAl1 SUBIECT PLOYER TO CRIMINAL PENALTIES AND dVIL FlNES UP TO IXJE HUNDRED DOILARE (5100.000). IN ADDfTION TO i ST OF COlAPENSATION, DMMGES AS PROVIDED FOH IN SECTIIXJ 31060F THE LABOR CODE, INTEREST, AND ATTORNEI^S FEES. LICENSE TRA S DECLARATION: I har irm ihet I a lice sedy nd r provJis'ons of Chepter 9(commencing with Sectlon 7000) of Di ' ion 3 ot iha Bu iness entl Professions Code, end my license is in full rce end eHect. Lic. N J�� i5 %Jr Class p � Conirec[org Siana� D q CONSTRUCTION LENUING AGENCY: ❑ I hereby aflirtn thet Ihere Is a construction lentling agency Por the pedormance of ihe work tor which this pertnit is issued. (Sec. 3097, qvil Cotle). Landers Nama: Lentler's Atldress: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby ettirtn thet under penelry al perjury thet I em EXEMPT FROM 7HE CONTRACTOfiS LICENSE LAW for the following reeson (Sec. 7031.5, Buslneu end Protessions Code: Any ciry o(�county which requires a pertnit to construct, elter, Impmve, demolish, or repair any structure, pnor to Its Issuance, also requires the epplicent for suc� permit to file e slgneC steteinen��that he or she Is Ilcensetl pursuent to the provlsions of the Contrectore License Lew (C�apter 9(commencing with SecOon 7000) at Divislon 3 oi Ihe Busineu end Professions Code)�or ihe� he or she is exempt iherefrom and Ihe basis tor the alleged exemption. Any violation oi SeIXion 7031.5 by any epplicant tor a permit sub�ects the epplicant to'a�clvll penalry of not more ihan Nve hunOretl Gollars ($500).): � I, es owner of Ihe properry, or,my em0�oyees with weges as Iheir sola compensation, WILL DO THE WORK, and the structure is not intended or ottere0 for sale (Sec. 706a, Business end Protesslans'Cade�jThe Contractars lJcense Lew does not apply lo en owner of properry who builtls ar improves thereon, end who does such work hlmself or herself or ihrough his or lier�own employees, provlded that such impmvemems are not Intentletl or oNered for sele. tl, however, the bulltling or improvement Is sald within one year of completlon, the owner-bullde� wlll have the bur0en oi proving ihet he or she did not build or improve for purpose of sele.). -alr_ ❑ I, es owner of the property, em E7(CWSIVELY CON7RACTING WITli LICENSED CONTRACTORS ro consWct the project (Sec. 7044, Business entl Professlons Cotle: lTe contractors License Lew tloes not epply to en owner of property who builds or improves thereon, antl who contrects for such prolect wlth e conirector(s) IlCensa Oursuant lo the Contractor5 License Lews.). ❑ I em e:empt under sec. Signeture: avner io venriea oy arivers ncense. ❑ ves ❑ No Business and Pmfesslons Code for this reason: Verlflcation oi Ownerehip by (rype of tlaument, I.e. - proDerry te< bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: omers u��sa No. oeie: Expires: � I here6y certlly Ihat no excnvetlon Ilve (5) or more feet In tlepth Into which e person is reQuired to descentl, wlll be metle in connactlon wlth work euthorizetl Dy thls pertnit, end that no bullding structure, scattalding, lalsework, or tlemolltion or tlismantling �hereat, will be more ihen thirry-six (36) feet �ig�. (ChaD� 3.2, Grp 2, Ar12, Sec. 347, Title B, Califomla AtlmInlSlreUve Cade). ❑ As owner-bulltler, I wlll not employ enyone to do work whic� woultl require a permli trom Ne Division ot Indusinal Satery, as notetl ebove, unless such person hes e pertnii to do such work trom the division. Signature: Date: Division of Industrial Satery Permit Number: CERTIFlCATE OF COMGLIANCE AND AIJiFiOROATION OF ENTRV: I certify under penelty of perjury ihat I have reed this epplica�ion end stete Ihet the intortnetion given is wtrecL I egree to comply wlih all stete lews end dry ordlnences releting to building canstruction, and authorize representatives oi lhe Ci�y of Coste Mesa to enter upon the ebove-0escribed pro for Inspe tio purposes. I agree not to occupy or allow occupancy of eny builtling authorized by Nis pertnit until finel inspection. ��;�f Signeture OI Legal o�ca � plicent --- -� ��4 CO�E I. qSVECTONttPE 1818 Fixetl System Finel Fire Prevention 1288 Pool Spa Final 200 Final Re-Root 201 Finel 81ocWReteining Well 202 Flnel Fectory Flre Plece 203 Finel Sign 204 Fnel Demolitlon 26aBJ8 �� CODE � MSVECTION TYPE 206 Finel Machanical 200 Finel Plumbing 210 Final Eleclricel 212 Final Fire Preventlon 220 Flnal Planning Approvel 222 FInalSite 250 Fnal Builtling/Occupenty � 11�� (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: MECHANICAL PERMIT 2852 ELLESMERE AV BEDROOM #2 AND MASTER BED/BATH Parcel Number: 13933412 Applicant: FARTHING, SCOTT' Address: 904 DOGWOOD COSTA MESA, CA Owner: HILL, RAMONA SAWYER TR Phone: (949) 500-2870 Zip: 92627 Address: 2852 ELLESMERE AVE Phone: COSTA MESA, CA 2ip: 92626 Contractor: FARTHING DEVELOPMENT INC Address: 904 DOGWOOD COSTA MESA, CA Phone: (949) 500-2870 Zip: 92627 License: 560875 ISSUED BY: Status: ISSUED Applied: OS/29/2002 Issued: 09/18/2002 SCOPE OF PERMIT CONSTRUCT 278 SF ADDITION TO BEDROOM #2 AND THE MASTER BED/BATH. 1 REPAIR/ALT COOLING/HEATING IN BEDROOM #2. . REF: B02-01384 ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >700 k 8TU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000chn Floor Fumace Floor or Suspend Heater $23.50 $0.00 $0.00 $13.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refdgeretion Unit Ventillation System Evaporative Cooler Commercial I nci nerator Domestic Incinerator Compressors / Absorotion Systems Upto3hp/t00kBTU 3To15hp/SOOkBTU 15 To 30 hp / 1,000 k 8TU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Uplo3hp 3To75hp 1510 30 hp 30 to 50 hp Over 50 hp Olher Mechanical Fee Investigafion Fee Plan Check Fee Reinspection 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 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 7241-92) EXPIRATION: This pertnit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and ffnal approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zas-ae (r✓oo) WORKERS' COMPENSATION DECLAfiAT10N: V � 1 hereb eftirtn undar penatly oi perjury one of the following declarations: ❑� av and will maintain a certiticate of consent to self-Insure for workers' compensation, es providetl for 6y section 3700 of the Labor Code, for the pedortnance ot the tar which Ihis pertnit is issued. I �ave antl will maintain workers' cwnpensacion insurance, as requirea by section 3700 of the Lebor Cotle, tor the pertortnance of ihe work for which this pertnit is issuetl. My workers' compensation Insurance cerrler and policy number are: Carrier: Policy Number: (This section need not be comp/eted il the permit !s velued af one hundred dollars ($f00) ar less.) �I certify ihat in the pertortnance oi Iha work for which ihis permit Is issued, I shell nol employ eny person in any menner so es to become suhjecl to ihe workers' compensation laws of Celifornie, entl egree t G f I should become sub�ect to the workers' compensation provisions of Sactlon 3700 of t� LaObor tle hell forihwith comply with these provisions. —� ��[y � Applicant SignaNre: o �l�f Dete: �/ u WARNINCi:FAILURETOSECUR W�COMPE OVERAGEISUNLAWFULANDSHALLSUBIELTANEMPLOVEHTOCRIMINAL ENALTIESANDGVILFlNESUPTOONEMUNDRED THOUSANO OOl1AFE ($10U,OW), IN NDDRION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]W OF THE LABOR CODE, INTEREST, AND ATfORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em licensed under provlsions ot Chapter 9(commencing with Section 7000) ot Division 3 of ihe Business a Proi yi �s-�f�� and my license is In full brce end ettect. Lic. M Cless #�_ ��25 /> �--�s�-�--� Contrector'sSignaWre:�,,,.�o Dete: ��Y�7� I �� CONSTRUCTION LENDING AGENCY: ❑ I hereby aNirtn �hat there is a wnslruction lentling agency for tha pertormance oi �he work tor which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signeture: OWNER-BUILDER DECLARATIONS: Date: I hereby aflirm that under penalty oi perlury thel I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for t�e tollowing reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or county w�ich requires e permit Io consiruct, alter, improve, tlemolish, or repair any structure, prior to its issuance, also requires the epplicant for such permit to file e signetl stetement that he ar she Is licensetl pursuant to the provisions of the Contrectors License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 of the Business end Professions Code) or thet ha or she is exempt iherefrom and the basis tor the alleged ezemption. Any vloletion af Section 7031.5 by any epplicant for a pertnit subJects the epplicant to e civil panelty of not more than five hundrad dollars ($500).): ❑ I, es owner ot Ihe properry, or my employees wl�h weges as �heir sole compensetion, WILL DO THE WOHK, entl the siructure Is not intended or oHeretl for sele (Sec. 7044, Business and Protessions Cotle: The Contractors License Law tloes not epply ro an owner of property who builtls or improves thereon, and who tloes such work himselt or herself or ihrough his or her own employees, provided that such improvements are not intendea or oMered for sale. It, however, ihe building or Improvemant is soltl within one year of comple�ion, the ownar-buildor will have ihe burden of proving that he or she did not builtl or improve for purpose of sale.). ❑ I, as owner oF the pmperry, am EXCLUSIVELY CONTBACTING WITH LICENSED CONTRACT08S to consiruct the prolect (Sec. 7044, Business antl Professions Code: The contrec[ors License Law does not apply to en owner of property who hulltls or Improves ihereon, and who contracts for such prolect wl�h a contrector(s) licen58 pursuant to lhe ConlractOrS LiCense Lews.). ❑ I em exempt under sec. SignaNre: Owner ID verifiad by tlnveYs license. ❑ Ves ❑ No Business and Professions Code for this reason: Verificetion ot Ownership by (type of tlocument, Le. - property tae hill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICA710N: Drivers License No. Date: Expires: ❑ I hereby cartify t�at no excavetion tive (5) or more fee� in tlepih into whlch e person is required to descend, will be metle in connection with work authodzed by this pertnit, and �hat no buildinq structure, scaHolding, falsework, or demolition or dismantling thereof, will be more then �hirry-sia (36) feet high. (Chap. 3.2, Gry 2, Atl 2, Sec. 341, Title B, Califomia Adminisiretive Code). ❑ As owner-builder, I will not employ enyone to tlo work which would require e permit from the Division of Industnal Satety, as notetl above, unleu such person hes e permi� to tlo such work from �he Oivision. SignaNra: Date: Division of Industrial Setaty Permit Number. CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I certiy under penalty oi perlury that I have read ihis epplication and state Ihet ihe information given is correct. I agree to comply wiih ell state laws end ciry ortlinances relating to builtling constmction, and euthorize representatives of Ihe Ciry of Costa Mese to enter upon the above-described property br inspection puryoses. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. COOE 1. INSPECTION TYPE 7616 Fized System Finel Fire Prevention 1266 Pool Spe Finel 200 Finel Re-Roof 201 Final Block/Retaining Well 202 203 Final Factory Fire Place Final Sign 204 Final Demolition DpTE 1tiIIDALfl -"- �- / �� Date CODEt INSPECTIONTYPE 206 Final Mechenical 208 Final Plumbing 270 Finel Electricel 212 Final Fire Prevantion 220 Final Plenning Approval 222 Final Site 250 Final Builtling/Occupency PAiE lt�4fl 3-n-o.3 �pL (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: ELECTRICAL PERMIT 2852 ELLESMERE AV BEDROOM #2 AND MASTER BED/BATH 13933412 FARTHING, SCOTT 904 DOGWOOD COSTA MESA, CA HILL, R,4MONA SAWYER TR Phone: (949) 500-2870 Zip: 92627 Address 2852 ELLESMERE AVE Phone: COSTA MESA, CA Zip: 92626 Contractor: FARTHING DEVELOPMENT INC Address: 904 DOGWOOD ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept OuOets Switches Non Res Appl Res Appl Service l0 200a Service to 1000a Service over t000a Motors to 1hp Motors to 10hp Motors to 50hp Molors to 100hp Motors over t00hp Communication drops Sub panel to 200a COSTA MESA, CA Phone: (949) 500-2870 Zip: 92627 License: 560875 ISSUED BY: Status: ISSUED Applied: 08/29/2002 Issued: 09/18/2002 SCOPE OF PERMIT CONSTRUCT 278 SF ADDITION TO BEDROOM #2 AND THE MASTER BED/BATH. 4 LIGHT FIXTURES, 10 OUTLETS, 6 SWITCHES. REF: B02-01384 $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $4.40 $11.00 $6.60 30.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 4 10 6 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist Syslem / Lighting Busway /100 ft Standing Section Misc Electncal 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 nde) Circus (mech ride or liqhts) Christmas Tree Stand Fireworks Stand Other ElecMcal Fee Investigation Fee Plan Check Fee Quantity 50.00 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 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 50.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all�applicable codes, and all requlred inepactiona end final epproval must be obtained. Failure to obtain inspections and final approval will result in Ihe expiration oi this permit. FOR INSPECTIONS CALL: (714) 7545626 `� / zaeae �eAo� WORKERS'COMPENSAnONDECLARAnON: �' � I hareby affirtn under penelry of perjury one oi the following tleclaratlons: ❑ I have end will melntain a certificeta ot consent to self-Insure lor workers' campensetlon, es Dmvided tor by section 3700 ot Ihe lebor Code, for Ihe peAormence ot the work for which this pertnit is issue0. ❑ I have entl will mainWin workers' compensetion Insurence, as reduired by sectlan 3700 of tha Lebor Code, tor the pertarmance of Ihe work for whlU Ihis permit is issued. My workers' compensetlon Insurence carrier and palicy number era: Carner: Policy Number: (This secNon need not be cromplefed i! the permif is valued et ane hundred dollers ($f 00) or less.) � I cenity that in the peAortnance of the work lor wNch this pertnil is Issue4 I shall not employ eny person In eny manner so es to become subject to the workers' compensation laws of Califomia, end egree th tJ ahould become suD�ect to Ihe workers' compensatlon pravisions oi Section 3700 oi Iha Labor Code, I shall forthwith compty with these pmNsions. ^ �� (y �/� Applicant Signeture: � Daie: ��1 /j ( % WARNING: FAILURE TO SECURE WORKERS' COtAPEN COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED THOUSAND OOLLARE (St00,000�, IN ADDITIpJ TO THE COST OF COMPENSATIIXJ, OAMAGES AS PFOVIDED WR IN SEGfIIXJ 31O80F THE LA80R ODDE, INiERE$T, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirm that I em licen� ynd§,ryqvJ�C force antl eNect. ua a �O CJ a/ Contractors Signature:� Chepter 9(commencing wilh Sectlon 7000) ol Divislon 3 ot the Bi C1859 M �� Date: _ CONSTRUCTION LENDING AGENCY: ❑ I hereby attirtn that ihere is a construction lending egency for the pertormance ol Ihe work for which �his Oermlt is issued. (Sec. 3097, Civil Code). Lentlefs Name: Signature: _ OWNER-BUILDER DECLARATIONS: Lenders AtlAress: Date: my license is in full I hereby ettirtn Ihat under penalry of per�ury Ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the lallowing reeson (Sec. 7031.5, Business flnG Professions Code: Any ciry or counry which requires e pertnit to construct, alter, improve, tlemWish, or repair any swcture, prior to Its iuuance, elso requires t�e applicant for such permit to file e signetl statement ��et he or she Ls Iicensed pursuant to the provisions ol the Comrecrors License Lew (C�apter 9(commencing with Section 7000) ot Divislon 3 of ihe Business entl Prolessions Code) ar t�et he or she is exempt iherefrom end the besis tor the alleged exemption. Any violatlon oi Section 7031.5 by eny epplicant tor e partnit subjecis Ihe epplicant to e civil penalty of not more then tive �undred dollars ($500).): ❑ I, es owner of the property, or my employees wl�h weges es �helr sola compensetion, WILL DO THE WORK, end Ihe structure Is not intended or otteretl tor sale (Sec. 7044, Business and Professions CoOe: The Contractors Licensa Lew does not eppty to an owner of property who builtls or improves ihereon, and who Coes such wark himselt or harsetl ar through his or her own employees, provided Ihat such improvements ere not Intended ar oMeretl tor sale. If, however, Ihe builtling or Improvement is sold within one year oi wmpletion, the owner-builtler will have ihe burden ol proving t�at he or she did not build or improve lor purpose of sele.). ❑ I, as owner of the proparty, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sac. 7044, Business antl Professions Cotle: The contractors License Lew does not apply to en owner oi properry who hullds or Improves Ihereon, end who contrects for such project with a contrector(s) license pursuant to the Contractoro License LewsJ. ❑ I am exempt untler sec. Signature: Owner ID veritietl by tlrivets Ilcense. ❑ Ves ❑ No Business end Professions Cotle lor this reeson: Venfiwtion oi Ownarship by (rype oi documenL i.e. � property tex blll or tleeA): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Drivefs LlcenSe No. Date: Expires: ❑ I hereby certity ihat no excavation tive (5) or more feet In depth Imo which e person Is required to descend, wlll be made in connection with work euthonzetl by Ihis permit and Iha� no builtling structure, scettolding, felsework, ar demolition or dismantling Ihereot, wlll be more than thirry-six (36) teet hig�. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltle e, Celilomla Administrative Cotle). ❑ As ownervbuiltler, I will not employ enyone to do work which would repuire a permit Irom Ihe Division af Intlusirial Safery, es nated ebave, unless such person has e permit to do such work irom the division. SignaWre: Date: Division ol Indusirial Selery Permit Number: CER7IFlCATE OF COMPLIANCE AND AIJTHORVA710N OF ENTAY: I certify untler penalry ol perjury thai I have reaG this aDDlication and state that the information given is correct. I egree to compty with all sta�e laws flnd ciry ordlnances relatinp to building consWction, entl euthonze represematives of Ihe Ciry oi Costa Mesa ro enter upan the above-tlescribed properry tor Inspection purposes. I egree not ta accupy or allow occupenq at any building authanzed by this pertnit until final inspection. ... R�i�1��Y� f.r : �� / • • � � _ � CODE t, INSPECTIONTYPE QejF IIi�IALS 1616 Fixea System Finel Flre Prevention 1268 Pool Spa Final 200 Final Re-Rool 201 Final BIocWRe�elning Well 202 Final Factory Fire Place 203 Finel Sign 204 Finel Demolition COOE� INSFECTIONTYPE 206 Final Mechanical 208 Finel Plumbing 210 Final Electrical 212 Finel Fira Prevention 220 Final Planninp Approval 222 Final Site 250 Final Bullding�Occupency �� 3- D3 1[� (714) 754-5273 • Fax (7/4) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: > �� 2852 ELLESMERE AV MAST�R BATH Parcel Nunmber: 13933412 Applicant FARTHING, SCOTT Address: 904 DQGWOOD COSTq MESA, CA PLUMBING PERMIT Phone: (949)500-2870 Zip: 92627 Owner: HILL, RAMONA SAWYER TR Address 2852 ELLESMERE AVE Phone: COSTq MESA, CA Zip: 92626 Contractoc FARTHING DEVELOPMENT INC Address: 904 DOGWOOD Arch / Eng : Address: ISSUE FEE Backfiow irtigation Backflow Preventer Bathtub Clanf er System Connect pce,Soda,etc) Dental Units Dishwasher Dra'rn, Floor Drain, Rainwater D2in, Roof Dnnking Fountain � COSTq MESA, CA Phone: (949) 500-2870 Zip: 92627 License: 560875 Phone: Zip: License: Status: ISSUED Applied: 08/29/2002 Issued: 09/18/2002 ISSUED BY: SCOPE OF PERMIT CONS7RUCT 278 SF ADDITION TO BEDROOM ii2 AND THE MASTER BED/BATH. 1 BATHTUB, 1 WASH BASIN IN THE MASTER BATH. REF: B02-01384 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 FEESUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landscape Irtigation $0.00 0 P-Trap $0.00 1 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 SepticTank $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 0 Shower $0.00 0 Sink, bar $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Pnmer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater! vent Water Piping Qnst or Rep.) AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 1 0 0 0 0 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetions end final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (77q) 7545626 2aaba6 (8/00) WORKERS'COMPENSAnON DECLARAnON: � w I hereby aRirm under penalty oi perjury one of ihe following tleclarations: ❑ ave entl will mainteln a certificete of wnsent to self-Insure tor workers' compensetion, as provided for by section 3700 ot the Le6or Code, tor the pertormenca ot the tor which Ihis permit is issuetl. I have antl will maintain workers' compensation insurence, as requiretl by section 3700 of the Labor Cotle, Por the pedortnance of t�a work for which ihis pertnit is issued. My workers' compensation Insurance wrrier and policy number are: Cerrier: policy Number: (This section need not be comp/eted il fhe permif is velued ef one hundred tlollars ($100) oNess.) � I certity Ihat in Ihe peAormance of tha work tor w�ich this pertnit is Issued, I shall not employ any person In flny manner so as ro become subject ro the workers' compensation laws of Califomia, anC agrae that II I should become subject to the workere' compensation provislons ot Sectlon 3700 ot the LaDor Code, I shell forthwith comply with Ihese provisions � � � � �j/ �� Applicant Signatura: � Dete: Q � WARNINO: FAILURE TO SE RE WOFKERS' COM ON COVERAGE IS UNLAWFUL AND SNALL SUBIECT AN EMPLOYER TO CFIMI� IES AN� CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 3]OB OF iHE 1A80R CODE, IPIrEREST, AND AiTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am torce and ettect Lic. A Contrecbrs Siqnature CONSTRUCTION LENDING AGENCY: Chapter 9(commencing with Section 7000) of Division 3 ot Ihe Bi Class q � Date: end my license is in full ❑ I hereby eHirm that there is a constmction lending agency for the pertormance of the work for w�ich this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lendefs Address: SlqnaNre: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn that under penalry of perjury that I am EXEMPT PROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7037.5, Business antl Professions Code: Any city or counry which requires e pertnit to construct, alter, improve, demolish, or repair any structure, pnor to its issuance, elso requires ihe applicant tor such pertnit to file a signed statement that he or she Is Ilcensed pursuent b the provislons of the Comractors License Law (Chepter 9(commendng with Sectlon 7000) of Division 3 of the Business end Professions Code) or ihat he or she is exempt theretrom end the basis tor the alleged exemption. Any vlolation o� Section 7031.5 Dy eny epplicant for a permit su6jecis the applicant to e civil penalry of not more than ilve huntlretl tlollars ($500).): ❑ I, as owner ot the property, or my employees with wegas es iheir sole compensation, WILL DO THE WORK, end the siructure Is not intended or otterea tor sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law dces not epply to an owner of property who builds or improves Ihereon, and who does such work himself or herself or through his or her own employees, pmvided Ihet such improvements are not Intended or ofleretl for sale. It, however, ihe builtling or improvemem is sold within one yeer of complation, the owner-builder will have ihe burden of proving ihat he or she did not build or improve for purpose of sele.). � I, as owner ot the property, am E%CLUSIVEIY CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (SecJ044, Business and Protessions Cotle: The contractors Llcense Lew does not apply to an owner of property who bullds or Improves ihereon, and who coNracis lor such project wi�h e contrector(s) license pursuant to the Contractors License taws.). ❑ I am exempt under sec. Business and Professions Cotle for Ihis reason: Signature: Date: Owner ID ventied by driver's license. ❑ Yes � No Drivefs License No. Verification ot Ownership by (type of daument, i.e. - propeny taa 6iil or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATION: Expires: ❑ I hereby certify thet no excavetion five (5) or more faet in tlepth into which a person is required to descend, will be made in connection with work euthorized by ihis permit, end Ihat no building structure, scaflolding, falsework, or demolition or tlismantling ihereot, will be more than thirty-six (36) feet high. (Chap. 32, Gry 2, Atl 2, Sec. 341, Title B, Califomla Atlminis�retive Cotle). ❑ As owner-builder, I will not employ enyone to do work which woultl require a permit from the Division of Indusirial Safery, es noted ebove, unless such person has e permit to do such work from �he division. SignaNre: Date: Division ollndusMal Safery Permit Number: CERT1flCATE OF COMPLIANCE AND AIfTHORIZA710N OF EMRV: I cenity under penalry of perjury that I have read this applicalion and state ihat the infortnalion given is conect. I agree to comply with all stefe laws entl city ordlnences rela�ing to buiiding construction, end authorize represantatives of Ihe Ciry of Costa Mesa lo enter upon Ihe above-described property for inspection purpases. I agree not to occupy o� allow occupency of any building authonzetl by this permii until final inspection. CODE 1. INSPECTIONTYYE Q� �MRIpLS 1676 Finetl Sysiem Final Fire Preven�lon 1266 Pool Spa Final 200 Final Re-Roof 201 Flnel Block/Retalning Wall 202 203 Final Factory Fire Place Final Sign 204 Finel Demolition � -� �U Date COUE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Finel Electdcal 212 Flnel Fire Prevention 220 Final Planning Approval 222 Final Site 250 Finel euilding/Occupency QAiE Itl�L@ • �1 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 2852 ELLESMERE AV Suile: Vicinity: BEDROOM #2 AND MASTER BATH Parcel Number: 13933412 Applicant: FARTHING, SCOTT Address: Owner: HILL, RAMONA SAWYER TR Address 2852 ELLESMERE AVE COSTA MESA, CA Zoning: R1 R1 Phone: 94&6459325 Zip: Phone: Zip: 92626 Contractor: FARTHING DEVELOPMENT INC Address: 904 DOGWOOD COSTA MESA, CA Zip: 92627 Arch : Address: Phone: (949)500-2870 License: 560875 Eng: Address: Phone: ISSUED BY: Status: ISSUED Applied: 08/27I2002 Issued: 09/18/2002 Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 278 SF ADDITION TO AN EXISTING SINGLE-STORY SFD. WORK TO INCLUDE 236 SF ADDITION TO EXISTING BEDROOM #2, 42 SF EXPANSION TO AN EXISTING MASTER BEDROOM AND BATHROOM, AND 37 SF OPEN PORCH. 2,699 SQ.FT. BLDG. COVER4GE (36%) APPROX. 532 SQ.FT. (7°/ ) Plan Check: $254.31 Permit: $391.25 SMIP Res: $2.44 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $648.00 SETBACKS MAINSTRUCTURE Front 10-6 ACCESSORY Front 0- 0 Rear 10- 8 Rear 0-0 FEE SUMMARY Calc Valuation: 82a,3es.aa Claim Valuation: So.00 PLANNING & ZONING Left 6 0 Right Lett 0- 0 Right 5- 0 NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1B0 days, or if work is suspended or abandoned for a period of 7 BO days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspections end final epproval must be obtained. Failure to obtain inspections and final approval will result in ihe ezplration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244&a8 (NW) WORKERS'COMPENSATONDECLARATON: � _ I he��/r```e�by aflirm under penalry of parjury one ot the tollowing tleclaretlons: �I�have end will meintaln e certlficele ot consent to selt-Insure for workers' wmpensetion, as provitled for by section 3700 of tha Lebor Cotle, for the pedormence of the work for which this Oermit is issued. I have entl will maintein workers' compensation insurance, as requiretl by sectian 3700 oi Ne laDor Code, for Ihe peAortnance oi the work for whlch Nis permit is issued. My workers' compensatlan Insurance carrier end pollcy number ere: Carner: Policy Number: (,,,111T...,,,h...is section need not be completed I! the permit Is valuetl et one huntlretl tlollers ($f00) or IessJ �7 I certify Iha� in the peAormence ot th work fo ich this pertnit is issued, 1 shall not employ any person in any manner so es to become sub�ect to the workers' /\ campensation laws at Califomia, egre t� I houlA become subject to the workers' compensation provislons of Sectlon 3700 f the Lebor Code, I shall forthwith camply with these provision /� _( /'� � Applicant Signature: Dete: " E E ��J WARNINp: FNLURE TO SEWRE WORI(ERS' COMPENSATION WVERACE IS UNUW FUL M1D SHALL SUBIECT PN EMPLOYER TO CRIMINFL PENALTIES AND CML FlNES UP TO ONE HUNDRED TiqUSPND DOLLARE (5100,000�, IN ADDITION TO THE WST OF COMPENSATION, OAMAGES AS PROVIDED FOfl IN SECTION 31060F TME LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSEU CONTRACTORS DECLARATION: I hereby aflirtn that I am Ilc e ury�er t torce anA ettecL LJc. tl U ' Gontrectofs Slonature: �%.1 � (commencing wIU Sectlon 7000) oi Division 3 of the Bi Class x Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirtn that Ihera is e consiruction lending egency for the partortnance ol �he work for w�ich Ihis permit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lender'S Adtlress: Signature: OWNER-BUILDER DECLARA710NS: Date: my Ilcense Is In tull I hereby eHirtn that under penelry of perjury thet I em EXEMPT FROM THE COMRAC70R5 LICENSE LAW tor the lallowing reeson (Sec. 7031.5, Buslness end Professlons Code: Any ciry or counry which requlres a pertnit to constmc6 alter, improve, tlemolis�, or repair any structure, pdor to its issuance, elso requires ihe epplicant for such permit to file e signed statemeN thet he or she Is Ilcensed pursuant to the provisions of the Comrecrors License Law (Chepter 9(commencing with Sectlon 7000) of Dlvlsion 3 ol the Business entl Protesslons Cotle) or thet �e or she is eaempt Ihereirom end ihe 6esis tor Ihe elleged exemption. Any vlolation oi Sectlon 7031.5 by eny epplicant for e permlt sublecis ihe eDD�icant to a civll penalty ot not more ihen five hundred dollers ($500).): ❑ I, es owner ot Ihe pmperty, or my employees wlth wages as thelr sole compensation, WILL DO 7ME WORK, entl the sirucNre Is not imendetl or otteretl tor sale (Sec. 7044, Business and Professions Code: Tha Conirectors License Lew does not apply to an owner of property who builds or Improvas theraon, and who Ooes such work himsell or herself or Ihrough hls o� her own employees, provided thet such improvements are noi Intended or ottered for sale. If, however, Ihe builtling or Improvemant is sold within one year ot completion, the owner-builder will hava tha burden of proving �hat he or sha tlitl not build or impmve for purpose ot sele.). ❑ I, es owner ot the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe prolect (Sec. 7044, Buslness entl Professlons Coae: The contractors Licensa Lew tloes not epply to en owner ol properry who bullds or improves thereon, entl who contrects lor such project wlth e contrector(5) licensa pursuant to tha Conirectors License Laws.). ❑ I am exempt under sec. Business entl Pmfessions Cotle for Ihis reason: Signature: Date: Owner ID ventietl by tlriver'911ten56. ❑ V05 ❑ No Drivefs License No. Vedfication ol Ownership by (rype of document, I.e. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Expires: ❑ I hereby certify that no excavatlon flve (5) or more teet in depth Into which a pereon is required to descend, wlll ba made in connectlon wllh work euthorized by Ihls pertnit, end that no building sirudure, scattolding, telsework, or tlemolition or tlismantling thereoi, will be more �hen Ihirty-six (38) feet high. (Chep. 3.2, Grp 2, Ah 2, Sec. 341, Title 8, Celifomia AdminlstratNe Code). ❑ As owner-builder, I will not employ enyone to do wark which would require e pertnit fram Ihe Divisian of Indusinel Sefery, as noted ebove, unless such person has e pertnit to tlo such woB fmm the divisian. Signature: Date: Division ot Indusinal Satery Permit Number: CEfiTIFlCATE OF COMPLIANCE AND AllT}10RIZATON OF ENTRV: I certify under penalry of perjury Ihat I have rea0 t�is aDPlica�ion end siate that Ihe informetion given is wnect. 1 agree to comDly with all tete laws antl ciry ordinences relating to building construction, entl authorize representatives of the Ciry oi Coste Mesa to enter upon the ebova-descriDeQO�PPerty tor I ction � s. I agree not ro occupy or ellow occupency of eny building euthonzed by Ihis permit un�il tinal inspecUon. S/, (�� g, alure O 9 (s /�/ O D`�' � An r Authodz plicant Date COOE I. INSYECTION 7YPE 1676 Fizetl System Finel Fire Preventlon 1266 Pool Spe Finel 200 Finel Re-Rool 201 FIneI BIocWReteinin8 Well 202 Final Fectory Fire Place 203 Finel Sign 204 Finel Demolition QAIE It�Li CQOEt INSFECTIONTYPE 206 Final Mechenical 208 Finel Plumbing 270 Final Electrical 212 Final Fire Prevention 220 Finel Planning Approval 222 Final Site 250 FinalBuilding/Occupflncy PAIF •-%7_ Cr Itil�Lfl (714) 754-5273 • Faz (774) 754-4856 • www.c�.costa-mesa.��LDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2852 ELLESMERE AV Suite: Vicinity: Parcel Number: 13933412 Applicant CHAMBERS,DARRELL Address: 474 N SHATfUCK PL ORANGE,CA Owner: HILL, RAMONA SAWYER TR Address 2852 ELLESMERE AVE COSTA MESA, CA Contractor: CORNERSTONE ROOFING Address: 414 N SHATTUCK Pl ORANGE,CA Zip: 92666 Arch : Address: Zoning: R1 R1 Phone: 714-7713658 Zip: 92666 Phone: Zip: 92626 Phone: 714-771-3658 License: 616586 Eng: Address: StaNs: ISSUED Applied: 11/04/2002 Issued: 11/04/2002 ISSUED BY: O-� Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF INSTALL 7/16" OSB- 1-30 LB FELT AND 40YERA COMP. SHINGLES. Plan Check: $0.00 Permit: $195.25 SMIP Res: $1.09 SMIP Com: $0.00 Other: $0.00 lnspection: $0.00 Total: $196.34 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existin : 0 NOTES: Rear 0- 0 Rear 0-0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 s�o,esa.00 $10,868.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) 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 penod of 180 days. INSPEC710NS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectlona end (Inal epproval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 taasae �aroo� WOPKERS' COMPENSATION DECLARATION: � , "� � �"' I heraby effirm under penelty of perjury One oi Ihe lollowing tleclaratlon5: � ❑ I have end will maintain e ceM1ificele of consent to self�lnsure tor workers' compensetion, es proviaed for by section 3700 oi ihe Lebor Code, for ihe performence of the work lor which ihis permit is i5sue0. �I �ave anG wlll meintain workers' comPensatlon Insurence, as reQUlreC by section 3700 of �he Lebor Catle, for t�e pedortnance of ��e work for whic� Nis pertnii Is Issued. My workers' compensaelion Insurance carner and pollcy number ere: Carrier. �1.��., J�C n/iiu� .. /� Pplity Number: �l %6 � � (Tiiis sechon need not be comp/eted ll tne permit is valued et one hundred dallers ($100) or /ess.J ❑ I cenily t�at in the peAormance of the work br which this pertnit is issueq 1 shall not employ any person in eny manner so as to become 5ubject to the workers' c�o ron-M�raeFCfl�omia, end agree that It I should Eecome subject to l�e workers' compensation p�ro '''ons of Sectlon 3700 of Ihe Labor Code, I shall forthwith /�y. mp�Y'�m- e��e p'%��✓�L�[ �� —� is� //— %^O Z 7 pD��t00� Si9ne�ufe: ete: : AILURE TO SECURE WORKERS' �MPENSATION COVERAGE IS UNUWFUL AND SMALL SU8IECT AN EMPLOYER TO CRIMINAL PENALTES AND GVIL FlNES UP TOONE HUNDRED TYIOUSAND DOIURE (5/00,OOYi, IN ADDITIOH TOiHE WST OF WAtPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 3]O60F iNE LABOR CODE.IMERES7, PND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARAnON: I am licensetl under provisions ot Chepter 9(commencing wl(h Section 7000) ol DlWsion k .Sg% �re: �.d..�.� � � � Code, antl my license is in full CONSTRUCTION LENDING AGENCY: ❑ I hereby aNirtn Ihat ihere is a consm+ciion lentling egency for ihe peAormance of Ihe woAc for which Ihis permil is issued. (Sec. 3097, Civil CoOe). Lentlef5 Nema: Lentlaf5 Address: Signature: Dete: OWNER-BUILOER DECLARATIONS: I hereby affirtn thei under penelry of perjury that I am E%EMPT fROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or counry which requires a pertnit to construct alter, improve, demolis�, or repair eny structure, pnor to its issuance, also requires Ihe applicant for such pertnit to tile a signatl statement that he or she ls Iicensetl pursuanl b the provisions ot the Contracmrs License Law (Chepter 9(commancing with Section 7000) oi Dlvislon 3 ot �ha Business end Protessions Cotle) or �het he or she is exempt theretrom and ihe basis for the alleged exemption. Any violetion ol Section 7031.5 by any applicent for e partnit subjects the epplicam m a civil penalty ot �ot more then tive hundretl Aollars (5500).): ❑ I, es owner of the properry, or my employees with wages as iheir sola compensetion, WILL DO THE WORK, anC �he strudure is not intendetl or oHered for sale (Sec. 7044, Business entl Professions Code: The Contractors License Law dces not epply to an owner of propeny w�o builds or improves �hereon, end who tloes such work himseN or herself or through his or her own employees, provitleU t�at such Improvements ere nol Intended or oHeretl tor sale. II, however, Ihe building or improvement is sold within one year of completion, the owner�huilder will have ihe burtlen ol proving thel he or she tlitl not build or improve for purpose ot sale.). ❑ I, a5 owner ol the property, am EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS lo construct ihe project (Sec. 7044, Busineu end Protessions Cotle: The wntrac�ors license Lew does not epply to en owner of propeny who builtls or improves Ihereon, antl who wnlrects lor such pro�ect with a crontraaor(s) license pursuant to Ihe Conirectors �cense Lews.). ❑ I am exempt under sec. Business end Prolessions Code for ihis reason: Signature: Data: Owner ID vedfiBd by dnver'S1iCense. ❑ Ves ❑ No Dnver's Litense No. Vedfiwtion ol Ownership by (type ol tlocument, i.e. - property tax bill or deetl): DIVISION OF INDUSTRIAL SAFETV P&AMIT CERTIFICATION: Expires: ❑ I hereby certify that no excevetlon fl�e (5) or more leel in depth Into which e porson is requiretl to descend, will be metle In connection with work euthodze0 by �his permit, and that no Euilding swcWre, scaitolding, talsework, or demolltion or disman0ing ihereof, will be more Ihen thiny-six (36) feet high. (Chap. 32, Grp 2, Ari 2, Sec. 341, Ttle B, California Adminisiretive Code). ❑ As owner-builder, I will not employ anyone to tlo work which would require n permit from the Divlsion ot Intlustdel Sefety, as noted abova, unless such peraon hes a parmit to do such work irom Ihe division. Signatura: Date: Division of Indusirial Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AU7MORIZA710N OF EMRY: I cenity under penalry ot perjury that I have read this application and state t�at ihe iniortnation given is cortect. I agree to comply with all state laws and ciry ordinances relating to builtling construction, entl authorize representatives oi the Ciry of Costa Mesa to enter upon the above-described pmperty br inspection purpases. I egree not to occupy or ellow occuDency of eny builtling euthonzetl by this permit unlil finel inspection. [�77��ISF93{91PPifli7. 1616 Fixed System Final Fire PrevenGon 1266 Pool Spa Final 200 Final Re-Foot 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolitian � � u�us / �— -o �_ //— '� O COOE I INSPECTION TYPE 206 Final Mechanical 208 Finel Plumbing 210 Finel Electricel 212 Finel Fire Preveniion 220 Final Planning Approval 222 Final Site 250 Finel Building/Occupancy �I5�uL\bi S, CP �—AOG�i�ant to fill in all soaces except those within heavy borCer lines antl sign aIl aoo�ooriate Aeclarations. UCTION PE�RM IT PERMIT O. TRACT NO./ LOT NO. UNIT N6. hi�h� �GU��.�cEsn � �-�331 0 �s . � TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR _ ��'% � � . -��-��p�- '❑ CONVERSION ❑ DEMOLISH ❑ OTHER G Owner'sName' A/�N�l fL� -' phone�� AC-iid/7� '��, p0l.� A.P.# � DESCRIPTION OF WOFK/USE OF BLDG. Address 2�,5'�. � �S�C�D'�� • �'�1.�5.'% Areh/Eng. ' License No. Address Contracror's Name Phone Address (mailingl� City License No. - LICENSED CONTRACTOR DECLA ATION 1 hereby aitirm that I am licensetl un r provisions ai Charter 9(commencing wltM1 section �000) 01 Divislon 3 of he Business antl Professions Cotle, antl my Iicense is in full force ana etiect. License Class � License No. Date Signature WORKERS' COMPENSATION DECLARATION • 1 hereby affirm that I have a certiticate oi consent to self-insure'or a certificate , ` Workers' Compensation' Insurance, or a certitletl mpY thereof (Sectlon 00, Lab. CJ ' olicy No. • Company 8 Certifietl copy is heieby furnishea. i. • Certlfietl mpy is (iletl with Ihe city Builtling Division. , Oate APplicant EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (-TM1lssection neetl not be completetl if the permit is for one huntlretl ($100) or� less). I cerlify that In the pe�fo�mance ot th¢ work for hich this pe�m�t i5 i55uetl, I shall not employ any person in any manne a�b� me Su �e�ct t the Worke Co pensat' ws of Cali � Date ' Signatur� t-Cf5 NO IC : If, after maklnq this tled �aLon, you shOultl become subject to the Wo kers' Compensation provisions of the Labor Cotle, you.must forthwlth comply witn such provisions o� tnis permit Shall b¢ tleemetl �evoketl. CONSTRUCTION LENDWG AGENCV ' ' I hereGy affirm that there is a construction lending a9ency tor the performance of the wark for which this permit is issuetl (Section 309� Civ. C.) Lentler's Name Lentler's Atltlress , OWNER BUILOEH UECLARATIOfV � - I hereby affirm that I am exempt from the Contractot'S License Law for the following reason (Section �031.5 Business antl Professlonal Cotle: Any city or munty whiGh requires a permit to-conStruct, alter, improve, tlemoli5h or re0ai� any sfructure, prior to its issuance; also requires the applicant for sucb permit to file a signetl sta[ement that he/she is licensetl pu�suant to th¢ P�ovisions of rna r��r.a�rnr•a i icense i aw tChaoter 9 lcommencin4 with'SecUon �000) of rom antl the basis for the alle< 5 by any applicant (or a pc y of.not more tnan five hundrei as �owner of the prop¢rty or ;nsatiOn, will Oo the work, antl ile (Section ]044, Business ar :e Law tloes nol apply [o an ow m, antl who tloes such work h ry¢es, provitletl that such imprc (, howeveq the builtling or imF n, the owner wili have the bu�� to� the purpose of sale). as owner oi the Oroper[y, ain < �mit subjects the applicant to a Crvll 1 tlollars ($500). my,employees�with wa9es as their sole the structure is not intentled or o�feretl a Professional Cotle: The Contractor's ne� ot a p�ope�ty who builtls o� improves Imselt/herselt or through hls or her. own vements are mt intentletl or offeretl tor rovement is soltl within one year of com- en of proving he/she tlid not builtl or im- xclusively contracting with licensetl wn- IOII J044. BU510255 dfld PIOi25510f15 GOd2: not apply to an owner-of oroperty who TYPE OF PERMIT LJ cRADiNG ❑ TENANT ❑ ELECTRIGAL ❑ -OTHER PROJECT DESCRIP.TION SQ.FT._ CONSTRUCTIONTVPE �- i ZONE GRF 'Remarks: � . "�%/�. "u' �L Bar Sink � Backflow Preventer - �� Backflow Irrigation Bathtubs Clarifiers Dishwasher Orinking Fountains � � Floor Drains Floor Sinks Gas Service �11L1EL5 Interceptors � Kitchen Sink - � Lavatories P-Trap : ' Roof Dreins � Reinspection• Fee • $15 i � BOiI¢f Duct - Under GrounH / ' Duct - Structural builtls or Improves [nereon, ana wno contracts fo� such Du,ctr�ntilating pro�ects wrth a con- tractor(s} license pursuant�to�the Contractor'{ License Law). 1 am aware that Exhaust System ❑ Multiple ❑ proof of their WorkeYs Compensation insurance shoultl be ptovitletl to me./i' __ ❑.I am exe'mpt untler Section B. & P. C.'tor this rea�N Firepl/Fact Blt. ICBO # Date Owner Heating System & Ducting I hereby ce�tity that I have reatl tM1is�application antl state that the above - ❑0.100,OOOBTU 0100,OOOBT information'is correct. I a9ree to comply with all city antl county ortlinances� antl state laws relafin9 to builtling construction, antl hereby authorize repre- sentatives ol this 'Ey to enter upon tbe above-mentionetl. property for . inspectian purpqs / � � ��% . ' 4YS' � � Signature �+� <�c� Daf Drivers' License or - APplicanp Plnk - Attounting; Goltlenrotl - Assessor 1 FOUNDATION p'J STRUCTURAL PLUMBING ❑ MECHANICAL ' V A�UATI ON $ CV.YDS. Ai Showers Service Sink Sewer Cap . Sewer Connection Solar Collectorr ' Solar'Piping �� SolarTank. � - Swimming Pool w/Spa Urinal � Water Closet - Water �Heater Water Service ', AUtO�Wd5I1 . j� Issue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System � ❑aiao,000eru ❑ioo,000 System Repair/Alteration FireDampers � Registers Issue Fee $ 3 FEES $ 3 S Main Building. E T F.ront ARear / � C Ri9ht � g Left � Ping. Ref. # Pianning Notes: � 86c8 8/15/85 c'Ls,G'u T�_ 3 — � -. � ,. �zone � Accessory Buildin9: 2 , Q - N � . N - G R ' Parking Req./Provided - E ' ' M T ' S Automatic Washer Construction PoleSub. Cooking Unit Dishwasher ' Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes ELECTRICAL , Transformer� � 15i50 KW ❑ 50�+ KW ' � Meter �Aiip to 1002mps Meter ❑over100amp`s ' Sub Panel . Motors D O-1 � HP 01'/: - 8 Inc.Solar �9-75 HP �16�75+ Switches . � Garbage Disposal' � Generator �0.5'KW �5-75 KW � P 9 ' I Reinspection Fee' I$15 I DEVELOPMENTSERVICESRE�UIR Zonin9 APProvetl By —• �, � Bui�ding Approved By ,_NC�.� Appliteti0� ISSuOd BV Pole Light � Range Si9n ', Standing Sections Te�sh Compacror Issue Fee FEES $ 3 �. � ' , SUMMARV OF FEES 1 , BUILDINGPERMIT $ I�%e`�JO SMIP $ _y�¢��_ PLAN CHECK g q 5. 2�i pERMIT � �. PLUMBING ` $ ISSUANCE $ PLAN CNECK 25% $ ENERGV P.C. $ ELECTRICAL. " $ .� /L%f GRADING $ � PLANCHECK�. 50% $ �� -D MICROFILM $� � �� MECHANICAL _• $ TOTAL FEE $ �L- ° � PLAN CHECK 25%� $, ' � _ _ , _ _ J .'CONSTRUCTION AND PLANNING j POOL 'A . ` ~•(�PPFJ��VALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector � 1; Te'Fnporary Electrical Service or Pole 52. Pool & Equipment Location . � 2' Soil Pipe-Undrgrnd. - 53. Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding 5.�Steel�Reinforcement 56. �Rough Plumbing & Pressure Test 8. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings � � 58. Electrical Conduit-Undrgrnd. � 8.� Foundation S��.L� � 59. Gas Pipe, � Undrgrnd., Test � 9.^Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, O Undrgrnd. 10. Structural Floor System � 61. APPROVAL TO DECK 11. �Property�Sewer Line & HouseConneCtion 62. BacRwash & Receptor-Final 12. Sewer•Cap 63. Heater & Vent-Final , 13. Roof Drains 64. Plumbing System - Final ' 14. Rough Plumbing 65. Electrical-Final . . 15. Rough Electrical-Conduit 66. Solar System-Final ._ 16. Rough Electric Wiring 7' � v 67. Fencing & Access Approval 17. Raugh 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 20. Rough Factory Fireplace APPROVALS Permit # � 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating � 71. Product Piping O Gas ❑ Oil 23.,Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25.�Roof Sheathing �d 74. Overhead Hydro � ' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � �� 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding �� 77. FIXED SYSTEM FINAL 29. Insulstion �r1�-�r �Ci 78, FIRE PREV. FINAL 30. Drywall Nailing �-/y � (/�i HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION - 32. Electrical Power MeterFinal �� a� /?tJ" � 80. FOOD CERTIFICATE ISSUED 33. Final Electric ; S�� Notes: 34. Final Heating & Air Conditioning ` s 35. Final Gas Pipe-Test �•� i�,:yv Gs+A�C£�� 36. Hood or Canopy ` /t%�s SC`i0�'t) G�ffCLtlO �lt 37. Final Fac[ory Fireplace ��f{ �2 N��q,�.. W�,�ti. 38. Final Plumbing � ,( ppy�,s^ y�, � 39. Water Service-Final ��pGKl+W 0� Q� � 40. Gas Service-Final � 41. Solar pomestic-Final 42. Backflow Preventer . � � - 43. Backflow Irrigation 44. ,Landscape Irrigation System 45. Sound Attenuation • 46. Handicap Regulations ��47. FINAL STRUCTURE & BUILDING 'l �f C . 0°' 48. Special qequirements Completed 49. Electrie Release to Edison ' , .� 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date�" � � / .-- c%i: t� � _ ' :�J�� ,�,�� ; OSTA MESA BUILDING-SAFETY DEPARTMENT � P. O. BOX 917 COBTA MB9A, CALIPORNIA For Applieanf fo Fill In Complefely TYPE OR PRINT ADD EiSB �Z. LLEl�i�/E�(� ��/J� �L�'�COSTA MESA. CALIFORNIA �or�a TEL. ^�/ � JUL 311�si �. fiNANCE DEPT. CITY Of COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only NHC8IPT NO. P[RMIT�lyLD t/ V BY OATe RECEIVCD DATB 198UE - �_�s—G/I -,_�./_ COSTA MESA. CALIFORNIA FIRE ZONE TYPE GROUP Mesa Perde BLL�ZdeTS IIiO. pppROVE� fOR BY DATE 165 Minorca ZONING CiOSt,fi M@Sfl zoNe I Ho. ov ^J I usa on x�wl��a..., R�� PUM= C�� BUILDING 161269 No: Ri 9-0345 �EOAL /�- � Z �. yoo�, oescxirrioH nenn n_ v�. � I�o: oR BLDae. n � BBTBACK LINB FROM' �} eeHiax oP BTx[eT �O , REAft YARD JO SIDE YARD ILEFT % IRIGHT 6� DESCRIPTION Oh WORK BUILDINGr��O S.Fti. ROOMS 7 STO41E5 1 SIZE 1 + EXTERIOR WA SyUCCOIROOF e COVERING �004 COVERING St11II 12 U8E OP BUILDING AND WORK TO BE PERFORMED Standard Plan � r 1 HlPBBY ACKN WLEDO THAT.I�XAV6 A�� 1 •ND 9TAT6 TH THE OV8 IB ECT AND PLV WITH ALL O INANCEB A ATH L BUILDINO CO N. f SIGNATURE PERMI7TE AUTHORIZED AGENT IQNT6R LIN6 BT.1 / ' FR�NT `7 O 7�z. </�C� D �ed gerage 450 Sq.Ft. SION � THE AMOUNT BNOWN UNDEA VAWATION �8 POR THE COM- pUtiPOBE OP EBTA9LIBHINa A PERMIT FEE ONLY. R O VALUATION �/`� , ''I,y0 PERMIT PEE 3 ` $ , / PLAN CHECK $ N e. � �� ' �" 2 .� , � COSTA MESA BUILDINCrSAPEfY DEPARTMEPfr P.O. BOX 12J0 COSTA MESA� CALIFORNIA 92ET! For App11mM ro F(11 In Comp►Ndy TYPE OR PRINT COSTA MESA, CALIFORNIA � LIN6 FROtl DESCRIP710N OP WORK ). OP )OMH ROOr 1 X6RCpY ACKNOWL[DO[ TNAT.� NAV6 RGD TMI� APPLIGTION wNo eTwT6 TXAT iM[ AlOYt.18 COrtRtCY ANC ACR[6 YO COY. PLY WITX ALL CITT OROINANCfa AryD �iATt L�WI R[OYMTINY GUILOINO CONBTpU�C�T10�N/,/J (/ HIONATURlOP —/('A __ _� _ , T/ � d— AUTNORIZ[D AOtN'C HQ4 73-68Cq5,a,00 �a96 �****f�3.OG A►RLICATION FOR PERMR BUILDIN6 for Offk� Us� Only ZONING NO.OI Yl[ ruru � euii YARDDAPPROVlD MAIN BUILDINO v�n. it ��1?-ii:IR1 YAR�BAPPROVHD ACC6880RY BUILDINO eer. Mw�N e nccess.eu DAT6 TX8 AXOYNT �HOWN YNO[R VALUATION IB ►OR TXQ IURPoB� OP itTApYGXIMO A PCpY1T PE[ ONLT. VAWATION 'J' � PERMIT F6E J l- _ �OD -- Q f Z . d U F- Z ZQ � N am J � J N Q W p] J m J Q U N Za W � aw WZ J Q m Z J � W W � ZF W � N � � Q . ' 71 2 PAID 1UG —3-73�riSr�O 24C� �-**�6.50 COSTA MESA BUILDING-SAFETY DEPARTMENT r P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 � /AP LI ATION FOR BUILDING PERMIT For Applicant to Fill in Completely REG � �BY T C D EISSU ADIDRESS pZ p S �I 1'✓� �� OWNER � A.P. NO. ' �� 3 — � PERPM1J O� � J MAIL / ADDR'ESS G�7{ S� E��ESKrF � ADDRESS b p / p CITV - NOLSYO' IO TRACT�"LJJ 6 LOT � BIOCK CANSTFUCTION EW DD ALTER P LENOER N 'Q BfiANCH OWNER ADDRESS VALUE . G Bq ARCHITECT TEL SE -$ O OR ENGINEER N . FIRE ADDRESS ZONE TVPE GROUP � �( / APPRO �j.�/ J CONTRACTOR (,y K e✓L ^' C.l a tl e N B� � � DAT ADDRESS ZONE NO.OF USE OF NEW TEL. 2I p�qryg Z BUILDING `�1{ CITV NO. STATE CITV �'�+RDSAPPROVED VAflDSAPPROVED �IQ NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING SIZE NO.OF BLDGS. (FROM GL� S�j T�)� OF LOT NOW ON LOT FRONT G""`�T.'� FT. USE OF EXI5TING BLDG. SI S FT. FT. SIZE OF - I %� I r. NO. OF TJ FT. FT. NEWBLDG. ROOMS STORIES L.SIDE EXTERIOR WALL ROOF COVERING COVERING REAR FT. FT. USE OF BUILOING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BlOGS. ACCESS. BLDGS. / VAR.# DATE P Y'CO O� C.U.P.# APPROVED APPROVED %S / I hereby acknowledge that I have reatl thiz application and state that the above intormaiion is correct and agree to comply with all laws regulating b�iltling construction, and I shall not employ any per�son in violation of th¢ workman'S compensation laws ot the State ot California. < i I hereby certity tM1at I am Oroperly licensetl as a contractor under SQ. FT. < the State of California Business and Professions Code, Divisicn 3, HE AMOUNT SHOWN UNDEF VALVATION IS FOR Chapter 9, antl that such I(censes are in full force antl effect, or I THE PVRP06E OF ESTABLISHING A PERMIT E ONLv: � am exempt from the provisions of ffie State of California Business VALUATION � antl Professions Co�e, DivisiOn 3, Chapter 9. � �5 ERMIT FEE $ ! Signatura ot S, R. (N f� S 0 K �/ ��+�� ` Permittee $ �D PLAN CHECK$ . Authorized ABent � � TOTAI FEE 5