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Home My WebLink About2914 ELLESMERE AVE - Building Permits(714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mese.ca.us BUILDING PERMIT JobAddress: 2914 ELLESMEREAV Suite: Vicinity: Parcel Number: 13927216 � i. Applicant: JOHN FLORES Address: 324 S DIAMND BAR BL SUITE 136 DIAMOND BAR, CA Owner: MURTAUGH, LESLIE ANNE Address 2914 ELLESMERE AVE - COSTA�MESA, CA Contracror C A CONSTRUCTION Address: 324 S DIAMND BAR BL SUITE 136 DIAMOND BAR, CA Zip: 91765 Arch : Address: Zoning: R1 R1 Phone: 909-396-5835 2ip: 91765 Phone: Zip: 9262&3608 Phone: 909-39G5835 License: 610218 Eng: Address: 77 FAIF DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applietl: 70/14/2004 Issued: t011412004 0 ISSUED BY: Phone: . Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 250 S.F. GUNITE SWIMMING POOL WITH AN ATTACHED 8 S.F. GUNITE SPA. Plan Check: Permik SMIP Res: SMIP Com: Other: Inspection: . Total $254.31 $391.25 $2.50 $0.00 $0.00 $0.00 $648.06 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0. 0 PARKING Existlnq: o 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 $25,000.00 s25,aoo.00 NOTICE: The work authorized by this permlt shall comply with all applicable handicap access requlrements under Califomla statutes and retated regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permlt shall automatically expire and become voitl II work Is not commenced wlthin 180 days, or if work is suspendad or abandoned for a period of 1 BO days. INSPECTIONS: In order for Ihe work euthorized under this permit to be considered legal, such work must comply with ell epplicable eodes, end all required Inapectiona and Iinel approvel must be abtainetl. Faliure to obtain inspections and final approval will result in the exptration of this pertnit. FOR INSPECTIONS CALL: (714) 754-5648 !44&08(8/00) WORKERS'COMPENSAnON DEGLANATON: ' I hereby effirm undar panalry of perjVry one oi the followi , decl.Ltions: � ❑ I have end will meintain e certi�iwte of consent to sell-Insurc�tor workers' compensetion, es pmvitled for by section 3700 of iha Lebor Cotle, br the pedortnence ol the rk for wNch this pertnit is 155ued. . 1 have end will maintain workeri' pensaLan insurence, as requiretl by sectlon 3700 0l Ne Labor Cotle, lor ihe pertortnance ot ihe work lor which NI5 pertnit is issued. My workers' compensation In e carri r and olicy n mber ar : O Cartier. ��N � Policy Number. `S S� ] I O (This sec(ion neetl not be canol i! �e permi( ve/ued ef e hundred dollers /S f00) or IessJ ' ❑ I cenity Ihat in the peAortn ' t work lor which this pertnit is issued, I shell not employ eny person in eny menner so es �o become sub�ecf to the workers' compensetion laws ot Cali a, agree that if I should become sub�act to lhe workers' compensetion provislons at Sectlon 37 of the Labor Cotle, I shell torthwith comply with Ihese pmvisio Applicant Signeiure: ` Da�o: ( D• �� W A0.NING�. FAIIURE TO SECURE W CERS' O]MPENSATtON � IS UNUwFUT AND SHnIL SUBIECr AN EMPLOVEA TO CFIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED THWSANDDq.L4RE(5100,000),INA OITIONTOTHECOSTOF TION,DAMAGESASPROVIDEDFORINSEGTION3l080FTHELABOHLODE,IMEREST,ANDATTORNEY'SFEES. LICENSED CONTRAC70R5 DECLAAATON: I hereby eNirm that I em force entl eflect. LJc. # _ Contractors Signature: with Sectlon 7000) of DiNslan 3 ot the Business and �essions Cotle, end my Iicense Is In full CIB99 M Oele: ( � • � _(Z CONS7RUC710N LENDING AGENCY: ❑ I hereby eNirtn that t�ere is e construction lendinp agenty tor the peAormance of the work br which ihis permit is luuod. (Sac. 3097, Civll Code). Lendefs Neme: Londers Atltlress: Signeture: De�e: OWNER-BUILDER DECLARATIONS: I hereby affirtn thet under�penalry ot perjury that I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reeson (Sec. 7031.5, Business and Prolesslons Code: Any ciry or counry which requires e parmit to consiruct, elter, improve, demolish, or repair eny siructura, pnor to its issuance, elso requires the epP��ent lor suc� pertnit to file a signed statement that he or She Is licensee pursuem to the proWsions ot the Contractors Llcense Lew (C�apter 9(wmmendng wlih Section 7000) ot DMsion 3 oi the Business antl Professions Code) or Ihat he or she is e:empt iherefrom entl t�e besis lor the elleged e:emption. Any violatlon oi Section 7031.5 6y any applicant for a pertnit subjects the applicant co a cMl penalry ol not more than five huntlred dollers (5500).j: ❑ I, as owner ot the pmperty, or my employees with wages es thelr sole compensatlon, WILL DO THE WORK, and the structure Is not Intentletl or oMered for sale (Sec. 7044, Business and Pmfeuions Cotlei She Contractors Ucense Lew does not appty to an owner of pmperty who builtls or impmves thereon, and who does such work himself or herselt or Ihrough hiS or her own employees, pmvided Na� such impmvements ere not intended or oNered for sele. If, however, the building or impmvement is sold within one year of comDledon, Ihe owneo-builder will heve the burden of proving i�at he or she did not build or improve for purpose of sale.). � ❑ I, as owner ot the properry, am EXGLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (SecJ044, Business enC Pmfessions Code: The coniractors License Lzw does not eppry to en owner of propeny who builtls or improves thereon, and who contracts for such project wIN e comreaor(s) license pursuani Io ihe Contraclor5 License Laws.). ❑ I am exempt untler sec. Business antl Pmlessions Code br this reason: Signature: Date: Owner ID verified by dnvefs license. ❑ Yes ❑ No Drivers License No. Expires: Vedfication of Ownerehip by (rype ol document, i.e. - properry tax bill or tleeC): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby cartify thet no eacavation Iive (5) or more teef In depih inm which a person is requireC Io tlescentl, wlll be made in wnnectlon with work euthodzed by this permit, end Ihat no builtling siN�iure, scaHdtling, talsework, or demoli�ion or tlismantling thereof, will be more then thirty-six (38) teel high. (C�ap. 32, Grp 2, An 2, Sec. 3C1, Ttle B, Calilomia AdminisUetiva CatleJ. ❑ As owner-bullder, I wlll not employ enyone to do wark which woultl requlre e permit from the Division ol Industriel Sefety, es noted ebove, unless such person hes e permit to do such work trom t�0 division. Signature: Dele: Division ol Industnal Sefery Permlt Number: CQpE 1, INSPEGTIONTrPE 1616 Fizetl System Final Fire Pre+enllon 1266 200 201 202 203 Paol Spe Finel � Final Re-Rool Final BIocWRelaining Wall Final Factory Fire Place Flnel Sign 204 Final Demolitlon G�IE It�l$ � FOpE� INSPECTIONTYPE 208 Finel Mechenical 20B Final Plumbing 210 Final Eleciricel 212 Finel Fire Prevantlon 220 Finnl Planning Approvel 222 FinelSite � 250 Final Bulltling/Occupency �7.\i �iii� I1i� ✓ �11 � _ �� (714) 754-5273 � Fax (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT JobAddrBss: 2J74 ELLESMEREAV Suite No Vicinity: �. Parcel Number: 13927216 Applicant: JOHN FLORES Address: 324 S DIAMND BAR BL SUITE 136 DIAMOND BAR, CA pwner: MURTAUGH, LESLIE ANNE Add�055: 2914 ELLESMERE AVE COSTA MESA, CA Contracmr. C A CONSTRUCTiON Address: 324 S DIAMND BAR BL SUITE 136 DIAMOND BAR, CA Phone: 909-3965835 Zip: , 91765 Phone: 2ip: 92626-3609 Phone: 909-396-5835 Zip: 97765 License: 610218 Status: ISSUED Applied: t0114/2004 Issued: 10/14/2004 ISSUED BY: ♦ ' ' . � ��/ .' i • SCOPE OF PERMIT CONSTRUCT 250 S.F. GUNITE SWIMMING POOL WITH AN ATTACHED 8 S.F. GUNITE SPA. REF.: 804-01763 , � MECHANICAL TO INCLUDE: 1 INST FAU > 100K BTU � ISSUE FEE Inst FAU <100 k BTU Inst FAU >700 k BTU RepairlAlt Cooling/Heat Inst I Rep. Recess Wall Htr Refrig 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 < 10000cfm �. Air Handlers > 10000cfm � , Floor Furnace Floor or Suspend Heater 0 $23.50 $0.00 518.20 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $D.00 $0.00 $0.00 $0.00 $0.00 30.00 $0.00 FEE SUMMARY Quantity � - , Repair / Alt Absorbtion Unit Repair / Alt Refrigefation Unit Ventillation System Evaporative Cooler Commercial I nci nerator . Domestic Incinerator ' Compressors / Absorption Svstems - Upto3hp/t00kBTU , 3 To t5 hp / SOO k BTU � . 15 To 30 hp I 1,OOO�k BTU - 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp-. � , 3To15hp 1510 30 hp 30 l0 50 hp - . • � Over 50 hp , Other Mechanical Fee � Invesligatlon Fee - - Plan Check Fee - , .. Reinspection Fee Quantity $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 So.00 0 50.00 0 So.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 NOTICE: The work authorized by this permit shatl comply with all applicable handlcap access requiremeMs under California statutes and related I regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become vold if work is not commenced wlthin 180 days, or if work Is suspended or abandoned tor a period of 180 days. INSPECTIONS: In ordar tor the work authorized under ihis permit to be considered legal, such vrork must comply with all app�icable cotles, and all requlred Inapectlona end finel approval must be obtained. Failure lo obtain inspections and final epproval will result in the expiration of this permit. \FOR INSPECTIONS CALL: (714) 7545626 2at�ae �erno� WORKERS'COMPENSAnO LARAnON: � ' ' - • - I heraby ettirm under penalty e ury one of the tollowing declarations: � ' � ❑ I heve and will meinta' ce ific te of consent to self-Insure tor workers' compensetion, as provided tor by section 3700 of the La6or Code, for ihe pertormance oi ihe work for whith ihis p i is tl. � I have antl will mainta rk compensation insurance, es required by section 3700 oi the Labor Code, tor the pertortnance of the work tor which ihis pertnit is issued. My workers' compen t ra cartle end licy number ere: Carrier: PolicyNumJber. �,�j,�7�� (This section need nof be pleted il the per e uetl at e undre dolleis ($ f 00) or less.) ❑ I certify ihat in Ihe performance ot the w f ch this pertnit is issued, I shall not employ eny person in eny manner so as to become subject to tha workers' compensation laws oi Califomia, and eg e I shoultl become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with Ihese provisions. , Applicent5ignature: Dete: �(�%•%6�_,7� WARNING FAILIIRE TO SECURE WORKERS' COM NSATIIXJ COVERAGE IS UNLAWFUL ANO SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO qJE HUNDPED THOUSAND DOLLARE (Et00,OW), IN AODITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31060F THE LABOR WDE, IMEFEST, AND AiTORNE`fS FEES. LICENSEO CONTRACTORS DECLARATION: I hereby aNirm ihat I am licensetl untler provi1sions oi force and eHect Lic. N ��%J� Coniractar's SignaWre: 9(commencing with Section 7000) of Division 3 of Ihe Business antl Professions Cotle, antl my license is in full Cless q �! / Date �o � IQ. • CONSTRUCTION LENDING AGENCY: ❑ I hereby attirm that there is a construction lentling agency for ihe performance of ihe work for which this permit is issued. (Sec. 3097, Civil Cotle). Lentler's Name: Lender's Address: SignaWre: Date: O W NE R-B UILD E R, DECLARATIONS: I hereby affirm that under penalry ot perjury that I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Buslness and Professions Cotle: Any ciry or county which requires a permit to construct, alter, improve, demolish, or repair any stmcWre, prior Io its issuance, also requires Ihe aOPlicaM for such pertnit b tile a signed statamentYhat he or she is licensed pursuant to the provisions of the Contrectors Licensa Law (Chapter 9(commencing with Section 7000) oi Division 3 of t�e Business and Professions Code) or that he w she is exempt theretrom antl the basis tor the aileged exemption. Any violation of Section 7031.5 by eny epplicant For e permit subjects �he applicant to a civil penalry of not more than tive hundred dollers ($500).): ❑ I, as owner of Ihe propeny,.or my emplo'yees with wages as iheir sole compensation, WILL DO THE WORK, antl the sWc�ure is not intended or ofleretl tor sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of properry who huilds or improves thereon, and who does such work himself or herseN or throu9h his or her own employees, provitletl ihat such impmvemenis ere not intentletl or oHered for sale. If, however, the building or improvement is soltl within one year of completion, Ihe owner-builder will have the burtlen of proving Ihat he or she did not 6uild or improve for purpose of sale.). � ❑ I, as owner of ihe property, am EXCLUSIVELV CONTRAC7ING WI7H LICENSED CONTRACTORS to consimct Ihe project (SecJ044, Business and Protessions Cotle: The contrectors License Law does not epply to en owner oi property who builds or improves ihareon, entl who coNrac�s for such project with e contractor(s) license pursuant to ihe Contrectors License Lews.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verifietl Dy tlriver's license. ❑ Yes ❑ No DriveYs License No. Expires: Veritication of Ownership hy (type oi document, i.e. - property taz bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMI7 CER7IFICATION: ❑ I hereby certify that no excavation five (5) or more feet in tlepth into which e person is required to descend, will Oe matle In connection with work au�honzed by this permit, and that no building structure, scaHolding, falsework, or tlemolition or dismantling thereof, will be more than thirry-six (36) teet high. (Chap. 3.2, Grp 2, An 2, Sec. 341, 7tle B, Calitomia Atlminis�retive Code). ❑ As owner-builder, I will not employ anyone to do work which woultl require a permit from ihe Division of Indusiriel Sefety, as noted a6ove, unless such person has a permit to do such work irom Ihe division. Signature: Division of Industrial Setety Permit Number: Date: 1 Will ihe applicant or present or tuture building occupant need to file and certify a Business Plan for emergency response to release or threatened release of e hezertlous meterlal? ❑ Yes ❑ No (Section 25505 of the Celifomia Health and Satety Code requires, with some exceptions, ihat e Business Plan be filetl with ihe Costa Mesa Fire Depertment by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic teet of compressed gas at standard temperature and pressure). ........................................................................................................................................................................................................................................................................................................................................................................................ 2 Does or will the applicant or present or tuture building wcupant need to file a registration fortn tor ecutely hazardous matenals? ❑ Ves ❑ No (Seaion 25533 of the Calitomia Heelih and Sefety Cotle, with some exceptions, requires registretion with the Costa Mesa Fire Department by each business which at any one time has on hend a quentity of acutely hezardous materials equel to or greeter ihan a weight of 500 pounds, or e volume of 55 gallons, or 200 cubic feet of COmpfessetl p83 0� s�entlafd �ampefetula 8nd pfessufe). Of prepare an (Section 25534 of the Calitomia Healih antl Satery Cotle provitles that the Costa Mesa Fire Depanment may require �he preparation, certifica�ion and filing with ihe Fire Depatlment ot an RMPP by businesses which ere required to register ecutely hezerdous materiels with the Flre Depahment. ....................................................................................................................................... ............................................................... ............................................................................................... 4 tl en RMPP is presently required, has Section 25534 oi �he California Heelth antl Satery Code been fully complied with7 ❑ Yes ❑ No ........................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the epplicant or present or future builtling occupant require for the work which is tha subject ot t�is a plication a permit for such consiruction or modllicetion from the South Coast Air Ouality Managemant District or fmm any other air pollutlon control tlistrict or agency7 � Ves u No (Section 658502 of the Calitornie Govemment Code requires that the requested information be fumishetl on epplications for non-residential huilding permits). ........................................................................................................................................................................................................................................................................................................................................................................................ 6 Will any pah of the facility �0 6e constmcted under ihis parmit be within 1000 teet fmm the outer boundaries ot a school? ❑ Ves ❑ No (If yes", the facility mus� meet ihe requirement of Sec�ions 25534 antl 42303 of Ihe Califomia Healih and Safery Cotle). ........................................................................................................................................................................................................................................................................................................................................................................................ 7 If e permit irom the South Coas� Ait Quelity Menagement Disiric� or other air pollution control tlisirict or agency is required for �he work which is �he SUDjeC� of Ihis applicetion, have all of lhe disclosures prescri6etl by Califomia Health and Safery Cotle Section 42303 baen made7 ❑ Ves ❑ No ........................................................................................................................................................................................................................................................................................................................................................................................ 8 Qf'yes", anach certificate of compliance from the appropriate air polWtion control oHicer). CERTIFICATE OF COMPLIANCE: I certiy that under penalry oi perjury the information given above is wrred. I agree to comply with all state laws end ciry ordinances regarding Hazardous Materia and Emissions. Signature: Date: CERTIFlCATE OP COM E AND AUTHORVA710N OF ENTRV: I cehify under penalry ot perjury that 1 have read this application and state that ihe infortnation given is correct I egree ro com t all ete laws antl ciry ordinances relating ro building construction, antl authorize representatives of the City of Costa Mesa to enter upon ihe above-described prope o i p,e tion purposes. I egree not to ocapy or allow occupancy of any building authorized by this permit until tinal inspection. COOE I, INSPECTIONTYYE . . UATE 1616 Fi:ed System Final Fire Prevention 12fi6 Pool Spa Final 200 Finfll fie-Root 207 Final Block/Reteining Wall 202 Final Factory Fire Place 203 20 Final Sign Final Demolition � �� iNsreenoxnve 206 Final Mechanical 208 , Pinal Plumbing. 210 Final Elecirical 212 220 222 Date � n •Id.o Date Final Fire Prevention Final Planning Approval Final Site 250� FinalBuilding/Occupency PdIE It�4$ I (714) 754•5273 • Fex (714) 754•4856 • www.ci.costa-mesa.ce.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2914 ELLESMERE AV Suite No Vicinity: REAR OF,PROPERTY Parcel Nunmber: 13927216 Applicant: JOHN FLORES Address: 324 S DIAMND BAR BL SUITE 136 DIAMOND BAR, CA Owner: MURTAUGH, LESLIE ANNE Address 2914 ELLESMERE AVE COSTA MESA, CA Contractor. C A CONSTRUCTION Address: 324 S DIAMND BAR BL SUITE 136 DIAMOND BAR, CA Arch / Eng : Address: PLUMBING PERMIT Phone: 909-396-5835 Zip: 91765 Phone: Zip: 926263609 Phone: 909396-5835 Zip: 91765 License: 610218 Phone: Zip: License: Status: ISSUED Applied: 10/14/2004 Issued: 10/14/2004 ISSUED BY: � � . �. .. ��. � � _/�� SCOPE OF PERMIT CONSTRUCT 250 S.F. GUNITE SWIMMING POOL WITH AN ATTACHED 8 S.F. GUNITE SPA. REF.: B04-01763 PLUMBING TO INCLUDE: 1 POOL AND 1:SPA. ` ISSUE FEE Backflow irrigation Backflow Preventer. � � BathWb Clarifier System � Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof AMT . . QTY 323.50 $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 $0.00 0 FEESUMMARY AMT Laundry Tub I Washer 50.00 Landscape Irrigation 50.00 P-Trap $0.00 Pressure Regulator 50.00 Process Piping (per 10 ft) 50.00 Receptors 30.00 Seplic Tank � 50.00 Sewer Cap for Demo, $0.00 Sewer Connect � � $0.00 Sewer Private Line $0.00 Shower � � $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 SumpPump Svnmming Pool Trap Primer . Urinal Vacuum Brkr BkBow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin .Wash Basin Set Wasle and Vent System Water Closet (Toilet) Waler Healer! vent A 0 AMT 50.00 $60.75 50.00 50.00 50.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 QTY 0 1 0 0 0 0 0 0 0 0 0 NOTICE: Tha 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 pertnit shall automatically expire and become vold if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inapectlons antl flnal epprovel must be obtalned. Failure to obtain inspactions and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zaess le�oo) \, WORKERS' COMPENSATION DECLARATION: I hereby attirm under penelry o� Oerjury one of ihe following declaratlons: �' � ❑ I heve end will meln�eln P cenificate ol consent to self-Insure br workers' compensation, es provitled for by section 3700 ot the Labar Cotle, for the pe�ormence oi ihe rk for whlch ihis permil Is Issuetl. , I have antl wlll maintain woMers' compensation insurence, es require� 6y SecUon 3700 ot the Lebor Cotle, for the pedortnance of the work for which lhis pertnit Is issued. My workers' compensetion In uren c r�e�.@nd policy number are: Certier. �� ' PoliryNumber: I�S� % �] I� (1/ris sectlon need not p�efed il ( e permit is et one huntlred dollers ($100) or less.) ❑ I certify that in the peAormanca of t�e work f c is pertnit is issued, 1 shall not employ any person in any manner so es to bewme subject to the workers' compansetion laws of Celifomia, entl egree i I ultl be e sub�act to Ihe workers' compensation provlsions of Secilon 3700 0l the Lebor Catle, I shell torthwith comply with ihese provisions. / `' /1 Appliwnt Signature: Date: ,� � � 4! CJ�' WARNWG FAILURE TO SECUPE WORKERS' COMPENS ON COVERAGE IS UNIAWFUL PND SHALL SUBJECi qN EMPLOYEF TO CR�MINAL PENALTIES ANO CML FlNES UP TOONE HUNDRED THOUSAND DOLLARE (5100,OW), IN ADDITION TO THE CAST OF COMPENSATIIXJ, DAMAGES AS PROVIDED iOR IN SECTION 37060F THE LABOF CAOE, IMEREST, AND A170RNEY'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby eflirm ihat I am Ilcensbtl untler mvisic force and eflect Llc. N (¢PD Z Contrectofs Signeture: with Section 7000) of Division 3 of the Business and Pmfessions Code, antl my license is in full qass p G • � 3 �e�e: t�T�.o CONSTRUCTION LENDING AGENCV: ❑ I hereby aflirm �hat ihere is e consiruction lending agency for the pertormance of ihe work for which this permd is issued. (Sec. 3097, Civil Cotle). Lentler's Nflme: Lendar's Atltlress�. SignaWre: _ .._ Date: OWNER-BUILDER DECLARATIONS: �� I hereby aNirm ihat under penalty of perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for �he tollowing reason (Sec. 7031.5, Business and Protessions Code: Any ciry or counry which requires e permit to consirucL eiter, improve, demolish, or repair any structure, prior to its issuance, also requires ihe appliceN for such parmit to lila a s�gnetl statement that qe or she Is Ilcensetl pursuant to tha provisions of the Contradors License Law (Chepter 9(commencing wlih Sactlon 7000) ot Divislon 3 of Ihe Business end Pmfe4sions,Cotle) or thet he or she is exempt therefrom and ihe basis for the alleqed ezemption. Any viotation ot Section 7031.5 by any apDlicent br e permlt subjects the applicent to e c�vil penalty of not more than five hundred dollars ($500).): C. , ❑ I, as owne� of ihe property. or my employees wllh weges es �helr sole compensa�ion, WILL DO THE WORK, and the stmcture Is not Intendetl or oflered for sele (Sac. 7044, Business antl Professions Code: The Coniractors License Lew does not apply to an owner of propeRy who builds or improves theraon, entl who does such work himsell or harseN or ihroUgh his or her own employees, provided Ihat such improvements are not intended or offered lor sala. If, however, the building or improvement is soltl within one year of complelioq �he owner-builder will have the burden of proving ihat he or she did nol builtl or improve lor purposa oi sele.). ' ❑ I, as owner ot the property, em EXCLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to consiruct t�e pmject (SecJ044, Business antl Profeuions Cotle: The contractors LiCense Law tloes not apply to an owner ol pmpeny who builds or Improves thereon, and who contrac�s br such project with e contrector(s) license pursuen� to the Contractors License Lews.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signawra: Date: Owner ID verifietl by dnver's license. ❑ Ves ❑ No Driver's License No. Ezpires: Venfication ot Ownership by (rype oi tlocumem, i.e. - property ta< bill or deetl): DIVISION OF INDUS7RIAL SPFETV PERMI7 CERTIFICATION: ❑ I hereby ceriily thai no ex�avetion five (5) or more feet in deplh into which e person is required to descend, wiil be made in connection with work authodzetl by this permit, and that no builtling siructure, scaflolding, falsework, or demolition or tlismantling Ihereof, will 6e more ihan thirty-siz (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Celitomie Administrative Code). ❑ As ownerbuildar, I wiil noI employ enyone to do work which would require a permit from ihe Division of Intlustrial Sefety, as notetl above, unlass such person has a permit ro do such work trOm Ihe division. Signature: �ate: Division ot Industrial Safery Permit Number: 1 Will ihe epplicent or present or future building occupant need to tile and certity a Business Plan for emergency response to releasa or Ihreatenetl releese of e hezerdous materlall ❑ Yes ❑ No (Section 25505 of the Cali�omia Healih end Sefety Cotle requires, with some exceptions, that a Business Plan be filetl with the Coste Mesa Fire Depenment by every business which hes et any one time tlunng a reponed year a quantity of hazardous materiais equal to or greater ihan e weight o1500 pountls, or e volume of 55 gallons, or 200 cubic teet of comprOssed gas at s�andartl temperature and pressure). ....................................................................................................................................................................................................................................................................................................................................................................................... 2 Does or will the applicam a� presen� or tuWre building occupant neetl to file a registration form for acutely hazardous materials7 ❑ Ves ❑ No (Section 25533 0l the Celifornla Heallh end Salary Cotle, with some exceptions, requires regis[ration with Ihe Cwte Mesa Fire Depenment hy eech Dus��ess which a1 any one time has on hand a quantity of ecutely hazerdous meterials equal to or greater than e weight of 500 pountls, or e volume oi 55 gallons, or 200 cubic feet ai compressetl gas el stentleld temperature end pressure). ....................................................................................................................................................................................................................................................................................................................................................................................... 3 Does or wiil ihe epplicant o� p�esent or IUNre building occupam need to prepare an RMPP (Risk Management and Prevention Program for acmely hazertlous materials)4 ❑ Ves ❑ No (Section 25534 of t�e Calilornie Haalih end Safary Code provides Ihat the Costa Mesa Pire Depanment may require ihe preperation, ceriHlcatlon end filing with Ihe Flre Deoenment ol en RMPP 6Y businesses which ere required to re9ister acmelv hazardous materials with Ihe Fire Depahment. 4 It en HMPP I9 presan�ly reQWrBO, nB9 JBCtIOn LSSJ9 oi Ifle l:a0tomla MBBIIII 9ntl 53fety GOtle been tUlly Compll8a WIi11'! U Y85 U NO .....................................................................................................................................................................................................................................................,................................................................................,..................... 5 Does or wiil ihe epplicenl or present or fuWre building occupant require for the work which is ihe subject of this a Olication e ermit lor such constmction or fmm Ihe Sauth Coast Alr Oualily Manegement Dlstdct or imm eny other air polWtion control disMct or agency7 ��es � No (Section 65850.2 of t�e Calibmla Govemment Code requires i�at Ihe requested information be fumished on applications for nomresitlentiel bulltling pormits). ..................................................................................................................................................................................................................................................................................... ....................... ...................................... 6 Will eny pan ol the feciliry to be constmctetl under this permit be within 1000 feet Irom the outer bountlaries of a school? ❑ Ves ❑ No (If yes', lhe tacitlty must meet the requiremem of Seciions 25534 antl 42303 of Ihe Califomia Health and Safery Code). .......................................................................................................................................................................................................................................................................................................................................................... 7 II e permit from the Souib Coast Air Qualily Menegemen� District or olher air polWtion conirol disirict or egency Is required br �he wOrk which I9 Ihe s� aoolication. have all ot Ihe disclosures prescribed by Celifornia Health and Safetv Code Section 42303 heen meda7 ❑ Ves O No COMP4IANCE: I certity Ihat under penalry of perjury Ihe information given above is correct. I egree to comply with ell stete laws and city ordinances is Mate�als end Emissions/ Signeture: CERTiFlCATE OF COMPLIANCE AND correct I agree to comply with all steU ebove-descnbed propertyforin5pectiar COOE �. INSPECTONTYPE 1616 Fixed Systam Finel Fire Prevention 1266 Pool Spa Finel 200 Finel Re-Roof 201 FInaI BIaWRetalning Wall 202 Finel FaCtory Fire PlaCe 203 Finel Sign 204 Final Demolition Date: OF ENfAY: I cenify under penalry of perjury that I have �ead this appliwtion and state that the Infortne0on given is inances relating to builtling conslNc�ion, antl au�horize representaiives ot the Ciiy ol CWta Mese to enter upon Ihe not to occupy or allow occupancy of eny building authorized by this permit until finel inspection. Q� INTRIALS cooe� 206 208 210 212 220 222 250 Date 1D•I .� Dare INSPECTONTVPE Final Mechanical Final Plumbing Final Elecirical Final Fire Prevention Final Planning Approval Final Site Finel Building/Occupency PdIF I[�E4II (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ce.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Viciniry: Parcel Nunmber: 2914 ELLESMERE AV REAR OF PROPERTY 13927216 npplicant: JOHN FLORES Address: 324 S DIAMND BAR BL SUITE 136 DIAMOND BAR, CA ; Owner: �MURTAUGH, LESLIE ANNE Address : 2914 ELLESMERE AVE COSTA MESA;�CA Contractor. C A CONSTRUCTION Address: 324 S DIAMND BAR BL SUITE 136 DIAMOND BAR, CA ELECTRICAL PERMIT Phone: 909396-5835 Zip: 91765 Phone: Zip: 92626-3609 Phone: 909-396-5835 '� Zip: 97765 License: 610218 Status: ISSUED Applied: 10/14/2004 Issued: 10/14/2004 ISSUED BY: 1. � `� :�• �' ��y i/ •��C; � , ' V'',' SCOPE OF PERMIT , CONSTRUCT 250 S.F.,GUNITE SWIMMING POOL WITH AN ATTACHED 8 S.F. GUNITE SPA. REF.: B04-01763 . � �� . - - � �� , . � . , - . _ .. /- _ � ISSUE FEE Temp service test Res. a/c package � New Res (1-2 units) New Res (3+units) Pool / Spa - , Lighting Fixts �. Recept Outlefs Switches Non Res Appl ., Res Appl - \ � Service to 200a Service to t000a , \ Service over 1000a�. �� _ Motors to 1hp � Motors to 10hp Motors to SOhp Motors to t00hp Motors over 700hp Communication drops Sub panel to 200a Pole Light Pkg ; FEE SUMMARY . Quantity _ _: . . . . � . . - " � � Quantity $23.50 $0.00 $0.00 $0.00 50.00 $49.50 $0.00 $0.00 � $0.00 $0.00 � .!. $0.00 � ��. $0.00 � - $0.00 $0.00 $0.00 $0.00 . $0.00 $0.00 , $0.00 , - $0.00 � $0.00 $0.00 0 0 1 0 0 0 0 0 0 0. 0 0 0 0 0 0 0 0 0 Temp Dist System PLighting $0.00 0 Busway /100 ft - $0.00 0 �� Standing Section 50.00 0 Misc Electrical Equipment $0.00 0 Transformers up to 1 kva/kw $0.00 0 � -:- - ..-':.'.:........up to 10 kva/kw $0.00 � 0� ��7'"'" .........::..r.upto50kva/kw $0.00 � �-'.0 ..,.... . . . .' ,. , ., . . . .............::..up to�100 kva/kw $0.00 � . . 0 .'�-`;'. � ....:.............over�100kva/kw.. _. $0.00' - 0 � Low Voltage Equipment $0.00 � 0 � Low Volt Winng System / Ckl ,$0.00 0 Misc. Conduit �. $0.00 0 � . Misa Conductor - $0.00 � 0 � � Circus ( gen or ride) " , $0.00" 0 Circus (mech ride or lights) " $0.00 0 Christmas Tree Stand $0.00 0 � Fireworks Stand $0.00 � 0 Other Electrical Fee . $0.00 � � InvestigationFee , � �$0.00 � . Plan Check Fee - � " $0.00 . � ' �Reinspectian Fee $0.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related egulations. (Ord. No. 9248, § 1, 1241-92) 'XPIRATION: This pertnit shall automatically expire and become vold if work is not commenced withln 1 BO days, or if work is suspended or abandoned r a period of 1 BO days. �' SPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all ��uired inepectlona and fi�al approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. 1R INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSATION DECLARAnON: � � . ' - I hereby aHirtn under penalty ot perjury one of th� following declarations: , ❑ I have antl will meintein a cenitiwte of consent to sel4lnsure for workers' compensation, as Drovided for by se'aion 3700 of ihe Labor Code, lor the pedortnance of �he br which this permit is issuetl. I have and will mainiain workers' compensaiion insurance, as requiretl by section 3700 of Ihe Labor Code, br �he pedormance of Iha work for which this pertnit is issuetl. My workers_compensatjpn Insurance carri�r antl policy number ere: Carrier. ��/�� _Y, (Thls section need nof be cbmplerea il ❑- 1 certiy that in the peAormance < compensation laws oi Califomia, comply with ihese provisions. Applicant Signeture: WARNING: FAILURE TO SECURE WORKER THOUSAND DOLL4RE (5100,000�, IN AODITIi Policy Number: I s5�� 3 � isvaluedetonehuntlretl.dollers($1oo)orless.) , x r f r which this permit is issued, I shall not employ any person iri any manner so es to 6ecome subject to the workers' e� at if I shoultl become subject to the workers' compensation provisions oi Section 3700 of the Labor Cotle, I shell forthwith Date: '�.�'�1� �'i� P%U� �PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED THE �ST OF COMPENSATION, �AMAGES AS PROVIDED FOR IN SECTION 3]060F THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTOflS DECLARATION: I hereby aNirm that I am licensad under provisions (orce and ettecL Lic. N (,�409.1 ConiracbYs Signawre: with Section 7000) of Division 3 of Ihe Business and Professions Code, entl my license is in full � Class x Date: CONSTRUC710N LENDING AGENCY: ❑ I hereby aHirtn that there is a consiruction lontling agency for the pertormance of ihe work tor which this permit is issuetl. (Sec. 3097, Civil Cotle). � Lentlefs Name: Lender's Adtlress: Signawre: Date: OWNER-BUILDER DECLARATIONS: . I hereby affirm ihat under panalry of peryury ihat I em EXEMP7 FROM THE CONTRAC70RS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business antl Professions Cotle: Any ciry or counry which requires a permit lo consfruct, alter, improve, demolish, or repair any stmcture, pnor to its issuanca, also requires Ihe epplicant tor such permil to tile e signetl statemaN that he or she is licensed pursuant ro the pmvisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Cotle)'or ihat he or sbe is exempt theretrom antl Ihe basis for the allegetl exemption. Any violation of Section 7031.5 by any appliwnt for e permlt subjecis the applicant to e civil penalry of not more than five hundred doilars ($500).): G ❑ I, as owner of ihe,property, or my employees with wages as iheir sole compensetion, WILL DO THE WORK, antl the simcture is not intentletl or offered for sale (Sec. 7044, 8usiness and Professions Code: The C'ontractors License Law does not apply to an owner of property who builtls or improves thereon, antl who tloas such work himself or harseN or through his or her own,employees, pmvided Ihat such improvemems are not intended or oflered for sele. If, however, ihe building or improvement is sold within one year ot completion, the ownerbuiltler will have ihe burden of proving Ihat he or she did not build or impmve for purpose of sale.�. ' � I, as owner ot Iha property, am E%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct ihe prolect (Sec. 7044, BuSiness antl Professions Cotle: The contractors License Law tloes not epply to en owner oi property who builds or improves ihereon, and who coNrects for such pmjeci with a coniractor(s) license pursuant to the Coniractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for ihis reason: Signature: Date: Ownar ID venfied by driver's license. ❑ Ves ❑ No Driver's License No. Ezpires: Verifiwtion of Ownership by (type ot document, i e. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CEFITIFICATION: ❑ I hereby cetlih/ thet no excavation five (5) ol more faet in tlepih into which e person is requiretl to tlescend, will be mede in connection with work euthorizetl by this permit, and that no building stmcture, scaHolding, talsework, or demolition or dismaniling �hereot, will be more than ihiny-siz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttie 8, Celifornia Atlminis�rative Coda). ❑ As owner-builder, I will not employ anyone lo do work which would require a permit irom iha Division oi Industnal Safery, es noted abova, unless such person hes a permii to tlo such work irom the divisian. Signature: Date: Division ot Indusirial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CEATIFICATION: 1 W ill the applicant or present or tuture builtling �upant need to tile and ceM1iry a Business Plan for emergency response to release or threatened release of a ha¢artlous material? ❑ Ves ❑ No (Section 25505 of ihe Califomia Health and Satery Cotle requires, with some e:ceptions, ihat a Business Plan be tiletl with the Costa Mesa Fire DeDariment by every business which has at any one time tlunng a reported year a quantity of hazardous matenals equal to or greater ihan e weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet oi compressed qas at standard temperaWre end pressure). � ........................................................................................................................................................................................................................................................................................................................................................................................ 2 Does or will the applicant or present or tuture building occupant naetl to file a regisiretion torm for acutely hazardous meterials9 ❑ Ves ❑ No (Section 25533 of the Califomia Heelth antl 5afery Code, with some e:ceptions, requires registretion with tha Costa Mese Fire Department by eech business which at eny one time has on hand e quantity of acmely hazardous matenals aqual to or greeter �han a welght of 500 pounds, or e volume ot 55 gellons, or 200 cubic feet of compreued gas at stantlartl temparewre end pressure). ................................................................................................._..................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Managemem and Prevention Program for acutety hazardous materials)7 ❑ Yes ❑ No (Section 25534 of the California Health and Safety Coda provides ihat ihe Costa Mesa Fire Deparimen� may require ihe preparation, certificalion and filing with ihe Fire Depanment oi en RMPP 6y businasses which are required to register acutely hazardous materiels with ihe Fire Depanment. ........................................................................................................................................................................................................................................................................................................................................................................................ 4 If an RMPP is presamW requiretl, has Section Z5534 of the Celifornia Health entl Safety Code been tulry complied with7 ❑ Ves ❑ No Does or will ihe epplicant or present or future builtling occupant require tor the work which is the subject of �his a plication a ermit tor such conSWdion or trom Ihe South Coast Air �uality Manegeme�t Distnct or trom eny other air pollution conirol disirict or egenc�? � Ves � No (Section 658502 of the Califomia Govemment Code requires ihat ihe reQuested information be lurnished on applications for non-resitlentiel building permits). ................................................................................................ ..... .............................................................................................. . Will any part of the facility ro be constructed Under this permit be wi�hin 10001ee� imm ihe oNer boundanes of a school7 ❑ Yes ❑ No Qf "yes", ihe facility must meet the requirement of Sections 25534 entl 42303 of ihe Calitornia Healih antl Safety Code). ................................................................................................................................................................................................................................................................................................................................................ If e permit from the South Coast Air �uality Manegement District or other elr pollution control district or agency is repuiretl tor ihe work which is the s� aoolication. have all of the tlisclosures �rescnbetl hY California Health antl Sately Cotla Section 42303 bean made? ❑ Yes ❑ No CERTIFICATE OF COMPLIANCE: I certity ihat under penalty of perjury ihe information given above is correct. I agree �o comply with all state laws and ciry ordinancas regarding Hazartlous Materials and Emissions. Signature: Date: CERTFlCATE OF COMPLIANCE AND AUTX correct. I agree to comply with all state laws above-descnbed property for inspection purp< CQOE I. INSPECTONTYFE 1616 Fized System Final Fire Prevention 1266 Pool Spa Final , 200 Finel Re-Roof 201 Final BlocklRetaini� W all 202 Final Factory Fire Place 203 Final Sign 204 Final Demolltion � - DF ENTRY: I certity untler penalry of perjury that I have read ihis epplication and state that the information given is nances relating to builtling construction, and authonze representetives of ihe Ciry of Costa Mesa to en�er upon lhe not to occupy or allow occupancy of any building authonzed by this permit uNil final inspection. p� irmn � � � . / /� � �.: COOE 1 INSPECTION TYPE 206 Finel Mechanical � 208 Final Plumbing 210 Finel Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency QAg 1NImElfl I AOP�icant to fill in a1l soaces ezcevt those within neavy Eorder lines ana si9n ail appro0riate aeclarations. ciTv oFCOSTa MESA COp�S�TjRUCs�TION PERMIT - PER NO. �� TRACT NO. LOT NO. UNIT NO. .� ik'oject Address � ��, ��.f ��/��`�/ ' �� App��ant's Mailing Addresst TYPE OF CONSTRUCTION � raEW �P.oD ALTERATION REPAIR � �%�,�„�/� ��/��3'� Phane �— V � ��NVERSION ❑DEMOLISH ❑OTHER A.p.# Owner's Name � DESCRdPTION OF WORKNSE OF BLDG. � l/_T - : . • S Main Buildi Address ' - - E Arch/Eng; License No. TVPE OF PERMIT ' GRADING .FOUNDATION ❑ STRUCTURAL T Front Addre55 - . ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL . - B Reaf '� ,O OTHER �� ' A Contracior's Name '� � P� }one � � � . � C Right Addresslmailingl—�n��%�� fj ,�/" PROJECTDESCRIPTION Sq.FT. � occuaaivcV _ K �• � /� CONSTRUCTION,TVPE ' VALVATION$ S Lef[ City License No. T� .�� s ZONE - GRADING CV. VDS. ACRES LICENSED CONTRACTOR DECLARATION ' Plny. RCf. # I hereby aftirm that I am.licensetl untler provisions of Charter 9(commencing Remarks: � , i . � ' , PIBnOing NOteS: with section 7000) of Division 3 ot the Business and Professions Cotle, antl ' ' - my iicense is in lf rce and eifeci. � '---.�..7 � License I s_ '� � I�yce se o Date�� Signature � U �-� WORKERS' COMPENSATION DECLARATION ' ' � , �hereDy affirm that I have a certiticate of consent to selt-insure or a certificate i Workers' Compensation Insurance, or� a certifietl copy thereof (Section 3800, Lab. Q) � �/y.�/� �� -- �}-- ' // � -� / ��.i�/�CT( L� iJ ��(f��.X Policy No. ,� Company ��y'l �,.er[ifietl copy is hereby furnishetl. IQ Cert�fl'etl pq% y is flletl �'ith the city 'Idi i' i�. / /'�)�� 1' Da[e�..`/—/' APPlicant �^� !/�� EXEMDTION FROM WOHKERS' COMP NSATION DECLARATION (ThiS section neetl not be mmpletetl it the permit is for one huntlred ($100) or less�. ' t the work to� which this erm�t is'issuetl I I certify�thal in the pertormance o P shall not employ any person in any manner so •as ta become subject to the Worke�s' Compensation Laws of Calitomia.' ' � � Date ' Siqnature �- ' 'NOTICE: If, atter making this tleclaration, you shoultl become subject to tne , Workers' Compensation provisions of tthe labor Cotle, you must forthwith cOmply :with'such p�OviSions o� this permit Shall be tleemed rewk¢tl. CONSTRUCTION LENDING�AGENCV - ' ' ' ' 1 hereby afHrm [hat there is a,mnstructionlentling a9ency for the performance af the wo�k for which this permit is Jssuetl (Section 309] Civ. CJ Lentler's. Name. Lentler's Htlaresi . OWNER'BUILDEH DECLARATION - � ^ I hereby affi(m that 1 am exempt from the ConVacio�'S ILicepse Law fo� the following reason (Section 7031.5 Business antl Professional Cotle: Any city or county which �equires a permii to consGuct, alte�, improve, tlemolish or reDai� any ztructure, prior to its issuance, also requires the applicanCior such'permit to file a signetl statement'tnat he/she is licensetl pursuant to the provisions of [he Con[ractor•z License Law (GM1apter 9(commencinq with Section ]000) oP Divisiom 3 of the Business antl Professions Cotle) or that he/she is ezempl the�efrom antl the ba5i5 (or the alle9etl exemption. Any violation_of 5¢c[iOn 7031.5 by any applican[ for a permit subjects the applicant to a civil eenalty of not more tM1an five hUntlretl dollars ($500). LJ I, as owner of ihe property or my employees with wages as meir sole � compensation, will Go the work, antl the structure is not intentletl or o�feretl . for sale' (Section 7044, Busin¢Ss Sntl Professional Cotle: The Contractor's , License Law tloes nol appty to an oWner ot a prope�ty who builtls o� imp�ovEs ' thereon, antl wno tloes sucn work himselt/herself or through his or her own . ' employees, pwvitletl that such improvements are not intentletl or offeretl tor ' sale. If, however, the buildinq or improvement is soltl within one year of com- pletion, the owner will have the burtlen of proving he/she tlitl not builtl o� im- prove for tne purpose of sale). . ❑ I, as owner of tM1e proOcrty, am ezclusively mntracting with licensetl con- tractars to construct the project (Section Jo44, Business antl Professionz Gotle: The Contractor's License Law tloes not apply to an owner oi properiy who builtls or improves thereon, antl who conVacts for such projects with a mn- traclor(sl license pursuant�to tM1e ContractoYs License Law). I am aware tM1at prouf o( their Worker's Compensation insurance sM1oultl be provitled to�me. ❑ I am exempt untler Seciion B. & P. C. tor this reason � Date Owner . I nereby certify that I have read'tM1is application antl state that the above � informatlon is correct. I agree to comply with a1l city antl county ortlinances antl �state laws relating to builtling conSVuction, and he�eby authoriie �ep�e- sentatives of°[hi5 city to epppter,upon the above-mentionetl property for , inspectlon p sp �/ �- ; /�� / / Signa[ure � � �ate r / I � I Drivers' License or 55 � _ �� Bar Sink � Backflow�Preventer �� Backflow Irrigation � Bathtubs � � Clarifiers . . Dishwasher Drinking Fountains � Floor Dreins � Floor Sinks .� Gas Service � Outlets Interceptors Kitchen Sink ' " Lavarories � P—TraP .. ftoof Drains .Reinspection.Fee . $15 Boiler Duct-UnderGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepUFact. Blt. ICBO # Heating'System & Ducting . ❑0.100,000 BTU 0100,OOOBT.i i � Reinspection Fee � $15 CMF 0865�46, rev. 10/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor Showers Serv'�ce Sink � Sewer Cap � ' Sewer Connection Solar Collectors SoJar Piping Solar Tank Swimming Pool w% Urinal � � - - .Water Closet � Water Hearer - � Water Service ' Laundry Trays � '1 � Issue Fee - � $ 3 IANICAL � FEE Hood or� Typel ❑ .� Canopy Type I I ❑ � Refrigeration System � CJO-t00,0008TU 0100,OOOBTU System Repair/Alteration ' - � Fire Dampers. Registers � ' laue Fee .'� $ 3 COOStIUCi1011 Cooking Unit Dryers LJGas LJE Fan � F.A.U. F ixtures Device Boxes Outlets Switches Garbage Disposal Generator �0.5 KN Fee 3270 10/31/85 Zone Parking Req./Provided - Transformer- �- 15-50 KW � 0 50+KW �� Meter ❑up to 100:amps � _ �Meter ❑over]OOamps' lectric 5-15 K W $15 � 'Su6 Panel. Motors �0-1 Ina Solar OS ' 'Microwave �Pole Light Range �,G: Tt, Z O N I N G R' � E Q M T S FEES � I •� � ' ■ . �� 1 ; Standing Sections � Trash Compactor Fee ` DEVELOPMENTSERVICESREQUIREMENTS:. Zonin9 APProved BY Date . _ Building Approvad By / � Date� Appliption Issued By Data ' �SUMMARV OF FEES • , BUILDING PERMIT � $ _� SMIP , $ ' PLAN CHECK $ PERMIT � — PLUMBING $ _�'"`.`G I 'ISSUANCE $ � PLAN CHECK 25% $ ENERGV P.C. $ � ELECTRICAL $ ' GRADING $ PLANCHECK 50% $ MICROFILM $ — � MECHANICAI. $ ' � TOTAL FEE $ i �� PLAN CHECK 25% $ ' � - ��ONSTRUCTION AND PLANNING ' POOL & SPA �APPROVALS Permit# Date Inspector qppROVALS Permit# Date InspPcrnr .,1. Temporary Electrical Service or Pole . 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit�llndrgrnd. 55. Electrical Bonding - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6� Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings � 58. Electrical Conduit-Undrgrnd. 8. Foundation � 59. Gas Pipe, � Undrgmd., Test - 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 1 t. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap � 63. Heater & Vent-Final � 13. Roof Drains ' 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electriral-Conduit 66. Solar System-Final 16. Rough Electric Wiring 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 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 � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Freme and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. DrYWall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:3 -Z7_X6 �,ryFT �21� �2:0( �,�EO 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 3S. Final Plumbing 6-10-�(,(, L�fi 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap flegulations. 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison �� 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY . � Nn. Date �i ADUNFSSOFBNldNO: 2�Jl�i ELLESMERE�AV oxmercsx.y[iva+axn: MURTAUGH, RICHARD L wo�ss 2914 ELLESMERE AVE � COSTA MESA,CA 92626 549-0148 �vv�. �,mu�c woaesx UICNRECT OP FHfJNFFA: AXCN.OR ENfi.'4 ADOflE53: ca�m�cTarswu� COUNTRYMAN' S CONSTRUCTION CQAP�CTORSYNIRMiz4SS1 VIA SAN FERNANDO �op�;MISSION VIEJO9z69Z CA UNT: uc.ao: UNi: (714)768-2952 ��, 626343 VNT: IICEN4ED COIRP�CTOPS OECLAP�TION: I Mmb/ dlim uMw pmNy d Po�IwY � I am lieemad ueder ywuiore d Chepm 9 Immmeriorp .+iM1 Seciian 1000) d ONaun 3 d O�e Bwinem enC Prdmeima CoEe. enC mY �� n� lulxl Iwca enA eXerJ. cmuc.No.:054074 uc.cuss: BC39 uc.No.: 626343�E P: � 98 c.C�l ode: l- Z b-�/ � c«n�aa:�0 ov ttW/n.hw . r. 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Buvroas aM Prdessvu Cade: TheCantreewa lireme law Eoea ewl ePW loan ownx d G�WaM ��, wla Wdda ar inprovea ihereon. eM who doea suUi hak limwp a MnM a tl�rouph he «her oxn ampbyaee. pewiEeE �I� suen imp�oremmb ue rwt inmMed n oXered lar eab. tl, howv.er. �M bnNi�p a inpmanem is wk v.ilhin aa Y� d rompbion. the owrorbuiHer hill M1are �M1e buNen el pm'nq M a she d"d nal diiltl a impev+e la IM W�e d We). � I. n ovmr d iM pWe�Y, am e*rinh+�Y cw�Lq with NosueE cantrecb� b metruC Ihe pol� 15eqion NM. 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LENDER'S NAME: LENOEfl'9 �UORE53: I eeniN thet 1 Mre eaed Nia eppliration ud mma Ihet tM ebova iMammion e earea. l ap�ee to eompy wilh all aty eM eoumy ordiraneae end e�me le� rNe�iq io buM'vq consvunian vd Mreby eWia¢e iepreaentatiws d �h'v aryw amer upan iM eEwe�menlionad popeM �� 'De�� "�P�'"' ED�JNTRYMAN � o�,: /—Za- P�' (S15t-aB.WPI NT�e-9uildip d Selery; GreeMFlla: Ganay-AppfmM: Rnk-Ra.enue:OdCenm�/ueaesor CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 086792 PERMIT NO: B 086742 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V-5 PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTZON : T/O RESHEAT3i 6 REROOF W/LT TILE ICB02093 SQ FT: 13,000 CLAIM VALUE: 13,OOO.UO CALC-VALUE: 13,000.00 GROUP OCC: R-3 /U-1 COMMENTS: SMOKE DETCTRS REQ PER 99UHC, REROOF 3300SF W/TILE/5.95P�SEF MAjLiXF�1f �W��T �jE ifffi4�fifiEkiFikiF3Eif'lElF��k3EiEiEiliEiElfifiEiEiEi(�iEiEiEkfEifdflkikiE3E^iFiEikiFif�lE3EkiE3EiEiEjfiP��j(�]��dEM�1..�V ��! {� Z O N I N G R E;� U I R E M E N y��d S E T H A C K 5 ------- ---- MAIN BUILDING ---------- .FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT': FT IN --------- ACCESSORY `�I'L'�ProO�D ---,� FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 13927216 ZNE: REF NO; PLANNING NO'TES> !. _ 'i! . if-�E ik'lE iE iE iE 1E fE 1F iE iE if iE iE'1E,if iE iF iE if 9E if iE iE 3E')E iE fE �1f 3E iE iE �F'IE iE 3f 1f if 1E'JE'1F iE if iE iF'1E 1f jE iE if if iE'lh aE iE jf fE'IE 9f iE iE �lE iE �1(-aF iE 1(� � iE ik?F 3E iE �lE iE iE jf iE D E V E, L O P M E N T S E R V I C E S R E Q U I R E M E N'F• S � / ZONING APPROVED'�bY DATE: BUILDING APPROVED BY : r APPLICATION ISfSUED BY: �E 3E iE 3E i(� iE iE ik iE iF if 3t iE iF iE.k 1f jF if iE iE iE3FiF�F�iF iFiFiF7F3F�FiFiF3F�7FiF7FiFiFiFiF�F'if'iFiF 3Fif�FiFiF'iF7F9E LEGALIZATION:N F E E S U M M A R Y � BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE PERMIT 199,75 PLAN ISSUE FEE BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL TOTALS----> 201.05 0.00 0.00 201.05 DATE: . -, DATE: ��!2=� �`2g �E �E 3E iE �f af if 3f jF�+�iE jE STRUCTURAL SEGMENT:Y SMIP/RES GRADING 1�:30{ SMIP/NON-RES PAID DUE 201.05 ,UO REVENUE DIVISION TOTALS--> COLLECTED: 201.05 OVER/SHORT; .00 BLDG PMT PLUMBING ELECTRZC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK 199.75 1.30 dE * ip if 3E �! �E �E iE if 1f iE iE iE k ik �k 1f iE 1! ik if �f iE 1E iE iE iE if iFiE 1F iE iE iF fE iE iE �E 1F iE �E 1f if 1E if �E 1! ik i6 i! k�F dk iElF iE 1ElE 1E iF df iF �E iE iE jE �1F IE iE 3f iE �1E �E �f M if iE if I N D I V I D U A L F E E H 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 SFk 13000 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 13,000.00 END OF FEES 91-26-1996/RCPTq:BI-9818695 PERNIT:086742 � CONSTRUCTION AND PLANNING POOI & SPA "' �APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector 1. Temporary E�ectrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgmd. ' - 54. Forms " � 4. Electrical Conduit-Undrgrnd. 55. Electricaf Bonding .� 5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test �; 6. Electrical UFEfl Grnd. 57. APPROVA� TO COVER•GUNITE �.. 7. Footings 58. Electrical Conduit•Undrgmd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test � 9. Water Pipe�U�drgrnd. � 60. Backwash Lines, P•Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final' � 12. Sewer Cap 63. Heater & Vent�Final � � 73. Roof Drains 64. P�umbing System - Final � 14. Rough Plumbing � 65. Electrical-Final . 15. Rough Electrical-Conduit �� . 66. Solar System-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING � lfl. ftoughElectcica676arCeiling 69. POOL;SPASYSTEMSFtNAL 79. Rough I-leating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Pactory Fireplace APPROVALS Permit # 21. Duccs, in Siructure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil 23. Gas Pipe�Rou9h & Test � 72. Underground Flush 24. iioof Framing � /_ / 73. Undergmd.StorageTank OGas ❑Oil 25. Roof Sheathing //L�/I� 74. Overhead Hydro [G 26. T-Bar Ceiling (Structurall & Monocoat � 75. Dry Chemical 27. Frame and Flashing . 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Piaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter�Final 80. FOOD CERTIFICATE ISSUED 33. Finai Electrit . Notes: 34. Finat Heating & Air Conditioning 35. Final Gas Pipe•Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing � ' 39. Water Service-Final . , , 40. Gas Service-Finai 41. Solar pomeszic-Final 42. Backflow Prevente� 43. Backflow Irrigation � 44. Landscape Irr(gation System 45. Sound Attenuation �T 46. Handicap Re9ulations "-' 47. FINALSTRUCTURE&BUILDING �/f�� - � 48. FINAL PLANNING �' „ 49. Electric Release to Edison .�t �ij 50. Gas Release so Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY ", No. Date � 11_.`3�30 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 31] COSTA MESA. CALIFOftNIA fOR APPUCAN7 TO f/[l /N COMPLETELY TYPE OR PRINT BUILDING 2914 Ellesmere Avenue ADDRESS COSTA MESA, CALIFORNIA ow�ERKennrof Development Co ,Inc MAIL 1555 Placentia Tvn � _ �EE RECEiVE� G�ct1 �-,s -60 FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING FOR OfF/CE USE OM[Y I flECE1PT NO. I� .PE4Nl2 1 FIRE r"' - zone �E�.� �oT 60 � � 29 o[scniviiOH NO. BLOCK T ACf APPF A.P. NO. BY SIZE 75x1oo I NO.OF BLDGS. _ veor OF LOT r+ow oH to USE OF None E%ISTING BLDG. 6ETDACH LINE FROM [ CENTER OP 6TftEEf �� fO � REAR YAR� SIDE YARD I LEFT J� '� I RIGHT � DESCRIPTION OF WORK - .,�,., I X II ., r�oer,�v I II s��,r,�. 'BUILDING �poo b,f ROOMS SIZE V e 8 COSTA MESA, CALIFORNIA _..__ r� _......... 0 � ZONING NO. OF � 118E OF NEW :� � PL�NB BUILOI�N/6� �^ C� ST— .�r O ' OGTF � � I � �CENTEH LINE BT.) FRONT �� FT. R.SIDE S�, � ��..� ��. a�C " I HEHEBY ACI( LEOGE THAT 1 HAVE FFJ�O THIS APPLICATION THg AMOIINT BHOWN UNDER VALUATION 19 FOR THE /�ND 8TAT6 T AT HE ABOV IS CORHECT AND AGREE TO COM- PLY WITH M1 CI ONDINA 5 flEGOLATING . PURPOBE OP E6TIBLIBNIN6 A PERMIT FEE ONLY. euaoiHo C n8r ciiorv. Vp�UATION SIGNATURE F �` PERMIT FEE S 3� PERM17TEE - /// '/�4 — CJ g j� �� PLAN CHEGK S /J � AUTHORIZE� AGENT TOTAL FEE $ �S�%�