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HomeMy WebLinkAbout1620 ELM AVE - Building Permits ' 'Z CITY OF COSTA MES • A � BUILDING DIVISION F 1-r,,,!� .,11 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 74• it PERMIT * PO4-00663 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT • • Job Address: 1620 ELM AV Status: ISSUED Suite No Applied: 10/01/2004 Issued: 10/01/2004 Vicinity: i ISSUED BY: Parcel Nunmber: 13931223 Applicant: FARTHING DEVELOPMENT INC _ Address: 904 DOGWOOD _ ' • Phone: (949)500-2870, • COSTA MESA,CA . ' Zip: 92627 V - - Owner CORRIGAN, JOHN"T "- . Address ' 1620 ELM AVE ."- • Phone: , . COSTA MESA,CA Zip: 92626-4953 ,�'k , 'Contractor: FARTHING DEVELOPMENT INC - ' Address: , 904 DOGWOOD _- - 1 , - . - _ Phone:- (949)500-2870 • COSTA MESA,CA Zip: 92627 , .- V _ , . - License: 560875 Arch /Eng... " '�' -I - Address: - .- . - .�-� . ... _ + .. - _ . , Phone: — Zip: - ,. _ __ _ License: ' --' - J, +I SCOPE OF PERMIT , CONSTRUCT 326-SF LIVING ROOM ADDITION TO AN EXISTING SINGLE-STORY SFD.A FIREPLACE- ` ': °i WILL BE RELOCATED.WORK TO ALSO INCLUDE PARTIAL:REMOVAL OF AN EXISTING WALC/BETWEEN/ ' t ,--> 7 THE EXISTING LIVING ROOM AND KITCHEN; REMOVAL OF ROOF AND CEILING FRAMING'IN. ,' ^/ ,/ EXISTING LIVING ROOM AND CONSTRUCT-,VAULTED ROOF;AND,REMODEL OF KITCHEN.-NO` :.1 / \ - i /l'/ „,,..:7 N / //) / t 'ti ADDITIONAL PLUMBING FIXTURESxREF.: 604-01500 _ - , � ' r, / / PLUMBING TO INCLUDE:S'GAS(1-4 OUTLETS), 1 GAS(OVER 4) 7AND`1;GAS.REPIPE.t ' `- ' FEE SUMMARY;' , 'V N v` AMP./ QTY ' `'” ` AMT -•QTY i' c �� \ ,'// AMT QTY N. l-t ISSUE FEE "$23.50 . • - Laundry Tub/Washer $0:00-=0 `. Sump Pump / $0.00 0 Backflow irrigation '. $0.00 .- 0 " '1. Landscape Irrigation $0.00 — 0 Swimming Pool„,' $0.00 0 Backflow Preventer '-$0.00-- 0 ' . - -P-Trap, _ . $0.00 - 0 --•� ` Trap Primer', $0.00 0 Bathtub $0.00--- '0 '.Pressure Regulator'`,1, ;$0.00.-10' Urinal.%`. $0.00 0 Clarifier System $0.00" -o,,- - '- Process Piping(per 10 ft): • $0.00 .`-0..' ' Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 .0..;_'.= Receptors.— . \\,, "" t:$0.00- 0 -7./1' Vacuum Brkr Bktow(5+) $0.00 0 Dental Units $0.00 0 � ,Septic Tank $0.00 0 - ';moi'Wash Basin $0.00 0 Dishwasher $0.00 0 -• - Sewer Cap-for Demo(- _.,$ 0.00' ' 0- - Wash Basin Set $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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)754-5626 ./gr �--`' 244646(6/00) DECLARATIONS r l WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) - 'I{mrtify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' fdoompensation laws of California,and,•ree tha if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provision i P 7/ / A c rAoelitgnt'S n lura: ' It�y / WARNING:FAILURE TO SECURE WORKERS'COMP SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I a Ift'rm Ihahf•arn.licensed under provisi s of C pter 9(commencing with Section 7000)of Divisio ajusiness and Professions Code,and my license is in full for �"ot£LkrN� �"�j r!/ 7�5 _ Contrecto�-Signature:- .i��-f :. .a e ✓/J//70 V • CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falseworic,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gry 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one 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 feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Cale,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a.aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes P No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of 'gal Owner( , Date /D�// LDV VVVAnd/,OrA uthorized Appli Jet - Date:•_ . ODE I INSPECTION TYPE PATE )NTITIALS CODE INSPECTION TYPE MTh UITIMLH 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing : LJ^22'03 (J� 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall - 212 ,Final Fire Prevention 202 Final Factory Fire Place - 220 ' Final Planning Approval ' ' 203 Final Sign 222 Final Site • 204 Final Demolition' _ 250 'Final.Building/Occupancy �`� CITY OF COSTA MESA BUILDING DIVISION L :1 ,,,- 11 DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER �, r/i PERMIT -"�*o'nm�m"'p E04-01056 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1620 ELM AV . Status: ISSUED Suite No Applied: 10/01/2004 Vicinity: Issued: 10/01/2004 Parcel Nunmber: 13931223 • Applicant: FARTHING DEVELOPMENT INC ISSUED BY: Address: 904 DOGWOOD - Phone: (949)500-2870" COSTA MESA,CA ,c Zip: 92627 Owner: ,CORRIGAN, JOHN-T - / Address 1620 ELM AVE - - ,_ / - Phone: ',COSTA MESA;CA• Zip: 92626-4953 \., ' Contractor: ' FARTHING DEVELOPMENT INC Address: , 904,DOGWOOD "Phone: (949)500-2870 . • s COSTA MESA,CA -,-Zip: 92627 • License: 560875 - SCOPE OF PERMIT .\ . . ._. ' ' — ' CONSTRUCT 326 SF LIVING ROOM ADDITION TO AN EXISTING,SINGLE;STORY SFD.A FIREPLACE WILL BE RELOCATED:WORK TO ALSO INCLUDE PARTIAL REMOVAL OF AN EXISTING WALL BETWEEN THE EXISTING LIVING ROOM'AND'KITCHEN;;REMOVAL-OF ROOF ANDCEILINGFRAMING IN ' ! I ' ,I EXISTING LIVING ROOM AND CONSTRUCT VAULTED ROOF;AND,REMODEL OF KITCHEN. NO'': ' - ' ADDITIONAL PLUMBING FIXTURES.REF.: 1304-01500 n¢ - v' , , ELECTRICAL TO INCLUDE: 1.RES..A/C.PACKAGE- ,`l0 LIGI.HT'FIXT,URES,20.OUTLETS, 10 SWITCHES,AND 1 SERVICE TO 200 AMPS. - ' " - - - _ // - . '�.% / '-� , FEE SUMMARY - = --- r `:<I/ r ` - - Quantity - r:: Quantity / / ,.r, / �` •„ Jo ISSUE.FEE ---': >>•.`$23.50 r y-c,�... . . Temp-Dist System/Lighting $0.00 / .0 `� / . ,Ii Temp service test $0.00 - Busway7100,ft,- $0.00:/'/0 /� Res.a/cpackage:- �i -$54;50 : ` Standing Section •- -„.-;.- $0.004/ 0 , ' . /1/ New Res(1-2 units) $0.00. ''0` .Misc Electrical Equipment•- $0.00- 0 , New Res(3+units), //,.$0.00, ' ` 0- . - / , ' -Transformers up to 1 kva/kw - •�s$0.00/ :- 0 '” / Pool/Spa , -'N - • $0.00 " '-�0 , •, - up to 10 kvalkw ;.--c-10.00\//,' 0' ;in'' Lighting Fixts ' N„ <., $11.00 10 - up to 50 kva/kw` $0.00 ' 0 //: Recept Outlets "$22.00 - 20� ,, - • °_ ,up to 100 kva/kw . /-$0.002 ` 0/7' , Switches �' `- $11.00 10 - . - - over 100 kva/kw,‘,',' $OA0- ,'0;' ' Non Res Appl e: -$0.00 - 0- Low Voltage Equipment $0.00 ,-, ,0- Res Appl $0 00 ,0 Low Volt Wiring System/Ckt ' $0.00 ,•'0 Service to 200a $30.50• "' 1, • Misc:Conduit'_- -',. - $0.00," 0 Service to 1000a $0.00 = �0 ,�Misc:Conductor. (:,$0.00 0 Service over 1000a $0.00 - 0`; _ - • Circus(gen or ride)-, :' -'- $0.00 0 Motors to lhp $0.00 '-0- -) _ .Circus(mech.ride or lights( $0.00 0 Motors to 10hp $0.00 0 ' 'Christnias,Tree Stand $0.00 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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)754-5826 2446-46(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: _ • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as piovided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. - ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at pne hundred dollars($100)or less.) • • certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and a r is that'f I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Jam✓R� /0///O A titan pJe: 09I . )� Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSW.COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,0110),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I here.,_'_uirmjba l am licensed under.rovisioys of C apter 9(commencing with Section 7000)of Division 3 of the Busines and Professions Code,and my license is in full QyTi edeot?tUc-M-=' -/4S 'lass' 1 c o s Signeile', —c% � 9 (Ards CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,Le.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one 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 feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aaermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signatu Of Legal Own _ /D// gate a'AlTd/ [140_Apo - //Date„_:' CODE I INSPECTION TYPE PAN INTRIAL5 C00EI INSPECTION TYPE PAM INTRy1Lq • 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208, Final Plumbing U ��.• 200 Final Re-Roof 210 Final Electrical l -Z7-Qf 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place • 220 Final Planning Approval 203 Final Sign • 222 Final Site • 204 Final Demolition - " - 250' Final Building/Occupancy /6: CITY OF COSTA MESA • t BUILDING DIVISION > ••,,,,, ' ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. * / PERMIT Eno Mntnn514 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT • Job Address: 1620 ELM AV Status: ISSUED Suite No Applied: 10/01/2004 Issued: 10/01/2004 Vicinity: Parcel Number: 13931223 ISSUED BY: Applicant: FARTHING DEVELOPMENT INC - Address: 904 DOGWOOD- y'"-- " Phone: (949)500-2870 ; COSTA MESA,CA - Zip: 92627 - _ Owner:' CORRIGAN, JOHN T - - Address:' ,1620 ELM AVE N\, Phone: COSTA MESA,,CA Zip: 92626-4953 , 'Contractor: ' FART.RING DEVELOPMENT INC Address: 904",DOGWOOD - - - - ' Phone: (949)500-2870 1 - , COSTA MESA,CA -,:Zip:" 92627 - •- . - License:560875 - - . SCOPE OF PERMIT CONSTRUCT 326 SF.LIVING ROOM ADDITION TO AN EXISTING SINGLE=STORY SFD.A . . FIREPLACE WILL BE RELOCATED.WORK TO ALSO INCLUDE PARTIAL REMOVAL OF AN ' EXISTING WALL BETWEEN THE-EXISTING LIVING ROOM AND KITCHEN;•REMOVAL OF ROOF AND CEILING FRAMING.IN,EXISTING LIVING ROOM AND CONSTRUCT VAULTED ROOF;AND, REMODEL OF KITCHEN.-NO ADDITIONAL PLUMBING-FIXTURES.-REF.: B04-01500 MECHANICAL TO INCLUDE: 1 INST FAU< 100K BTU AND 1 FACTORY FIREPLACE. - - - ' FEE SUMMARY .1 ; --- ; , . - Quantity j� . i,, - -,Quantity, ISSUE FEE $23.50 Repair,/'Alt Absorbtion Unit ii/ $0.00 `-0 '' i Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit `,/ / -$0.00-- 0, ^- ,, Inst FAU?100 k BTU\ V\ . $0.00 0 Ventillation System X;I $0.00 t o.)i� Repair/Alt,Cooling/Heat I\ v $0.00 0 -,w.^ '- •Evaporative Cooler /%' c,$0.00 01 \' \\.� E'2 X. Inst/Rep:Recess Wall Htr ; , $0.00 0 ,.-Y Commercial Incinerator K/,'%,/ $0.00 1f0/ Refrig Sys`<100 k BTU' $0.00 0 y;:,,; ,. Domestic Incinerator , 'ifs j ,. - $0.00/9/ 0' Refrig Sys>100 k BTU I -x±C$0.60,$0.00_ 0 - - - Compressors/AbsorptiomSystems: 7 Gas Piping \: $0.00 ..0 Up to 3 hp/100 k-BTU $0.002 .0 Factory FireplaceN . %% ` -$10.65' .1 _ , '" 3-To 15 hp 1-500 k BTU- %.' . (,/,,,,, ,$0.00' 0 Hood w/Mech Exhaust ` X $0.00"'`0 :. 15 To-30 hp/1,000 k BTU- /,$0.00 0 VAV Box \ $0.00 —0 _-.� • - ',30 To 50 hp,/-1-750!k.BTU K �,j $0.00 . 0 Vent Fan/Single Duct - $0.00 - 0�- rOver-50:hp./Over 1,750.BTU / /,',,I- /$0.00 0 Appliance - $0.00 0- - - - Boilers- - - Fire Dampers $0.00 0.- , Up to 3 hp. - - - $0.00 0 Smoke Dampers - ' $0.00 0- ' ' /. , -,% ,3 To 15 hp $0. 00 0 Inst or Relocate Appl Vent � $0.00, 0 ` .. ' ' -15 to 30,hp _ ' - $0.00 0 Air Handlers< 10000cfm '$0.00: .•0- \„ c-30 to.50 hp" ---H-->- $0.00 0 Air Handlers> 10000cfm $0.00' -.0'- -- _ Over 50"hp ' $0.00 0 Floor Furnace $0.00 0 - _ - ' -- . Other Mechanical Fee NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) , EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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 �- V 2446-46(6/00) DECLARATIONS n WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and wit maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit Is valued at one hundred dollars($100)or less.) QMr-ay that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' mpensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions /0//2�yAp lgoeture: YE wuwlNct:'F URE TO SECURERE WORXERS'COMNSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100000).IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affir , m.lice0sed u d9{�` Chapter 9(commencing with Section 7000)of Division 3 of the Business a Professions Code,and my license Is in full .4044Cetic.'t(—'---a- (/ // •lass C. `Contr ID �+— Date: 42 g CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,I.e.-properly lax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file end certify a Business Plan for emergency response t0 release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one 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 feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time hes on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? Ul Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If ryes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal er(s) ialDg(e ' _ // �lDe�temie4_L SOU 6 IfJ$PEC110NTYPE PATE MALI ;ODE, E121.021= . . DATE f9f 1616 Fixed System Final Fire Prevention 206 Final Mechanical tj'2-7'05 1268 Pool Spa Final 208 Final Plumbing . 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall • 212 ..Final Fire Prevention 202 Final Factory Fire Place - - - 220 Final Planning Approval • - • 203 Final Sign. 222 Final Site 204 Final Demolition - 250' Final Building/Occupancy CITY OF COSTA MESA . 44 -,017-JIL BUILDING DIVISION lircirF „_ �i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 Pligh PERMIT ". B04-01500 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1620 ELM AV . Status: ISSUED Suite: Applied: 08/24/2004 Vicinity: LIVING ROOM AND KITCHEN Issued: 10/01/2004 Parcel Number: 13931223 Zoning: R1 R1 • tile, � Applicant: FARTHING, SCOTT ISSUED BY: / Address: ._ . -'- -- Phone: 949-645-9325' __— Zip: / Owner: CORRIGAN,JOHN T , ' . Address 1620 ELM AVE - - ' - • - Phone: ,-/ COSTA MESA,CA, - - . - Zip: 92626-4953- ,,, , Contractor FARTHING DEVELOPMENT INC ' - ' �' v `\ Address: 904 DOGWOODi - ' - Phone: (949)500-2870 C' 27 ' COSTA MESA,CA - ' ` ` .-N ‘ ,Zip: 92627- - License:,; 560875 Arch : Eng: L.P. LEAVITT ' • Address: _ Address: 9724 BLANDWOOD ST .• ' -. ' , Phone: -- '' " " phone: 714-670-0941' - _ , Zip: ; / - License: 90240 - �- -.License: 11792 ' SCOPE OF PERMIT CONSTRUCT,326 SF LIVING ROOM ADDITION TO AN-EXISTING SINGLE-STORY SF.D.AFIREPLACE WILL BE RELOCATED.WORK TO'ALSO INCLUDE PARTIAL REMOVAL OF AN EXISTING WALL'BETWEEN-THE EXISTING LIVING ROOM AND KITCHEN;REMOVAL OF ROOF AND CEILING FRAMING IN EXISTING • - - `= -_ y_u : ._' ' , - - ' LIVING ROOM AND CONSTRUCT VAULTED ROOF;AND,REMODEL OF KITCHEN.NO,ADDITIONAL PLUMBING FIXTURES. �.FEE`SUMMARYj , , t_ I,' � <-Plan Check: ' ' $392.50 _.-- - - — , — -Calc Valuation: 'i -' $45;122.40 ' Permit: $603.85 i�� Claim Valuation: /hi/ ; SO:oO -SMIP Res: �t $4.51 . SMIP Com' $0.00 - -' s:1,57 Other $0.00 / ', t -,/ i''il/1 Inspection '$0;00 ,v„ • ' /'% c -� ,1// / %'/ / ,i � Notal: $1,000.86' ' //' //2 ".',.' -,'. ', 'C, r .:/ftz /7- ' PLANNING'&ZONING /,_ •, •, SETBACKS " r - ii / -/ MAIN STRUCTURE Front- 0-0- - ' 'Rear 12-0 ' Left - -7-9 1 Right , 35-6 ' , i ACCESSORY Front N,0-0-- , - 'Rear,. `0-,0 Left , 0-'0' - `, : Right -0,0 ,.' PARKING Existing: 4 ` :Required: 0 ' ' 1'-Proposed: " 0 -"-' - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. it INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, andel required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this It. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) DECLARATIONS fl .1 WORKERS'COMPENSATION DECLARATION: - • I hereby affirm under penalty of perjury one of the following declarations: • O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which thls permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued et one hundred dollars($100)or less.) • K.. ,pbrtiy that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia,and a ree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith tomljy WeRNese,prOvisions. 0 plicanUSlgnatu[e:_�" • - . Date: -tri /4 O:FAILURE TO SECURE 0 RS'COMP TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am Scans.• U..er pr. 'sions• hapter 9(commencing with Section 7000)of Division 3 of 'n ss -.d Profgssic ode,and my license is in full otawyuJ A xt �/ _ r'7` actor's-Signature:. .. / 0 a.— CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one 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 feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes B No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signatur I Legal Ow er Date Whdr //,761//i // T I//, D//DY . 900E A INSPECTION TYPE • PATE INTRIAL£ 9OOE( INSPECTION TYPE , PATE Make 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place - 220 Final Planning Approval' • 203 Final Sign 222 Final Site II 204 Final Demolition . • 250' ' Final Building/Occupancy ' 4/.27/os- FP ?ac=_2 or 2 2004-10-22 20'41:34(GMT) 949.645.7927 From:Scott Farthing ..-..t 12:16 949555 QUALITYASSURAN. NC PAGE 02 • RECEIVE® • A L NOV 1 0 2004 • j`�INSPECtIONS: 17942 Sky Park Circle,Suite D,Irvine,California 92614 CITY OF COSTA MESA JOB SET UP AND REPORT DISTRIBUTION g1,,111 DING DIVISION rN1 R.Slane DSA/OSHPD/PERMIT NO. • PROJECT NAME: Residence iO3S7.E ADDRESS: 1620 Elm Avenue,Costa Mesa,California 92626 NTACT: Scott Farthing PHONE: 949-645-9325 i?:Ea; : $200 4hr Epoxy Bolt Inspection OR❑ SEE ATTACHED PROPOSAL . . REPORT DISTRIE ITIION, 511-LING&20 DAY PRELIMINARY NOTICE INFORMATION :;-carr nralinuraxy notice Intel x'nation must be provided as of January I, 1995, per Civil Code Section 3097. In -' ctess invoice and d:intribute reports timely and accurately,we require the following information: RE:T. PREVAILIN';.; WAGE ❑ YES IX NO CERTIFIED PAYROLL ❑ YES X NO CLI£NT/Attention to: Farthing Development,Inc / Attn:Scott Farthing ' Invoice Mailixur Address 904 Dogwood Street City,State,Zip Code Costa Mesa,CA 92627 aI Phone/Fax Number 949-645-9325 I fax 949-645-7927 OWNER/Atteatlon to: Mailing Addxgz' City,State,Zip Code Phone/Fax Number GENERAIJAtri_ntion to: _ Mailing Address City,State,Zip Code _ Phone/Fax Number STRUCT. ENC ./Attention tot • Mailing Addre:hs • City,State,ZIT: Code Phone/Fax Number • • • A, CHJTECT/ Attention to: Mailing Addr€tt s City,State,Zip Code Phone/Fax Nunber • TOR/Attention to: A. j).42.5.14 Addl.t!:;s City,State,Zip Code Phone/Fax Number BLDG. DEPT;!Attention to: _ . a c (w'i'ly of Coda Mese* Mailing A ddz :55 e MI!-"" rp-o. -apt. r -o. City,State,Zil i Code S r.iri L9 P r n• (d �1Z C kits ti CA fix,2,7 Phone/Fax Number P A if v1 4 QUALITY.ASSURANCE :. 17942 Sky Park Circle ,.,.$;.„..0 Suite D •' , 4, t Irvine, CA 92614 Phone: (949)553-0370 _ • e:.rr- INSPECTI-� {I ON S"+ - Fax:(949)553-0371 .r • .. • Inspection Report 16708 INSPECTORSillOWI J08 NUMBED o.r , DATE -2 O ( JOB NOT BUILDLI� T W T F I S S - C PERMIT NUMBER/DSA/OSHPD APP. FILE# JURISDICTION Lb4lei linN 12elLAnte a toeis oo 63�#.o aye A ADDRESS I EIYL /�; 4 A-de. WS Ike ke GEN f ai�&..K4Ly..4 v a-0 'AL CONTRACTOR Ip. t.JC . . ARCHITECT ENGINEER SUB CONTRACTO t: 4. p, Lea-a,tii-' REQUIREMENTS:Limit of one job number,one permit number per sheet. Identify alt work by type and SPECIFIC location.Non-compliant work must be specifically identified.Communication(RFI,Sketch,etc.)voiding previous non-compliant items must be listed,record conversations and communications with project designers,building and permit granting authority officials. HOURS REGULAR I 1.5X 2X . TIME IN TIME OUT 41 9:00A-in. ro61 oo,4.Ise. n Re-Inspection n Show-Up Only ❑ Expenses ❑Reinforcement Concrete ❑Concrete Placement ❑ Masonry ❑Reinforcement Masonry ❑ Fireproofing n Quality Control ❑Administration n Prestress/Post Tension ix Other ip.vi �7.rto.5- �4e g, R7�jK_ .iggfix•ONrOFWOR ;NSECw t 31 { " :.11114 _ x o6.544.h.R. rfo xi po,,,t1 kW r�4., 2.4.1f 13d c4 IA' 5 2 ?`I - __3 i. D;A M es G" .b N A LD " /8 St,;,1.5b,., Au -44A-4.44 A s Si tr' sof 2) Feb? 0Lr S (-Cotes 4..1 .. 4 ►,:a (idus"5s _ -�e�o_sh(�_ 5sy..4,/c ,nl s-., 0.4 50-t4.4-1..,; MI 5ot1/4.142,( SA a 42,( a -l4 D wLo rs ii f'o4(0-;444-4.-74,4) / _ t5r 12424 4-0vcAnS 7" 1...,. 6eJ•w.-t...1. 41e.4- wa.Ci 345-e 244 i ? e. s Q 404( '7 " Eat Le-24,4-4. MIX USED DESIGN SLUMP ADMIXTURE DESIGN PSI CUBIC YARDS SPECIMENS ❑ Contains ❑ Additional Page(Page N)CM_ REPORT Non-Compliant Items ijkfitt Not Contain Certification of Compliance All inspections based on minimum of 4 hours and over 4 hours-B hours minimum. I declare under penalty of perjury that all of the above statements are true, If inspector is called to a project and no work is performed, a 2 hour minimum and that of my own personal knowledge the work during the period covered charge will be applied. by this report has been performed and installed in compliance with the approved plans,specifications and all applicable codes p Approved/Authorized by Inspector's Name wA 4-°'( (Project Superintendent) Inspector's Signature 414 - Submitted by Inspector's ID/Lic. # /Cr 4 /o&JG r!9- 49 Quality Assurance Inspections arcnl iiatiksc DErCIVRn Ntl4' 01 ?R96 4`el 9 CITY OF COSTA MESA BUILDING DIVISION F i_,1I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER • PERMIT B03-00106 %Aviators°'1 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.c7•VSILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1620 ELM AV Status: ISSUED Suite: Applied: 01/22/2003 Vicinity: Issued: 01/24/2003 Parcel Number: 13931223 Zoning: R1 R1 Applicant: FARTHING, SCOTT ISSUED BY: Address: 904 DOGWOOD Phone: (949)500-2870 COSTA MESA, CA ' ' Zip: 92627 Owner: CORRIGAN, JOHN T ' Address 1620 ELM AVE Phone: 714-444-3910 COSTA MESA,CA - Zip: 92626-4953 : \ Contractor: FARTHING DEVELOPMENT INC ' Address: 904 DOGWOOD Phone: (949)500-2870 COSTA MESA,CA Zip: 92627 License:, 560875 Arch : . Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 528 SQ.FT SINGLE STORY MASTER BEDROOM AND BATH. , ' • ' BLDG. COVERAGE-2,508 S.F. - LOT-8,887 S.F. PAVING-440 S.F. . OPEN SPACE-73% - - FEE SUMMARY Plan Check: $412.20 Calc Valuation: $48,787.20 Permit: $634.15 Claim Valuation: $0.00 SMIP Res: $4.88 - SMIP Corn: $0.00 • Other: $0.00 , Inspection: $0.00 ' •—• • - Total: ' $1,051.23 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 22-3 Rear 26-0 Left 10-0 Right 5-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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)754-5626 2446-46(6/00) ' DECLARATIONS ( I) (T j WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation suran ,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compe atl n I surance carder d number are: Carrier: Policy Number: (This eon need no complet i1 th pe is valued at one hundred dollars($100)or less.) - , I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and a that If I should become subject to the workers'compensation provisions of Seq1 ion � �3700( I1( WARNING:FAILURE TOSE RE WORKERS' ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENthe Labor Code,I shall forthwith comply with these provision P� ll Applicant Signature: � Date: ��+ iTALTIES D CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Prole ions Code,and my license Is In full force and effect.Lic.M Class N Contractor's Signature: Date: Inn lor CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business end Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health end Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one 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 feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this implication a_aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes u No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes*,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature egal Ow r D. e A Or Authorized Opti Date CODE r INSPECTIONTYPE PATE )11TrTIALS CODE. INSPECTIONTYPE DATE JNTRIAL$ • 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BlocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site �q 204 Final Demolition - • -250 Final Building/Occupancy- ‘C-19-AS l� NEWPORT-MESA UNIFIED SCHOOL DISTRICT N2 4218 CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 L To: (✓ ) City of Costa Mesa District Receipt No.12c-l200 ( ) City of Newport Beach /y�_�/r/ ( ) County of Orange /J �/ �/� Hyl /� \ - Plan Check/heN/o 03 l� Applicant: l vAi1/lT tli(`&tA1 l�}�iT_/�L1 i(�)/%At , Address: ' i� 4. & is `11 ' �(--)6'� Telephone Number: 9 - (p 4S - 93zrs- Tract/Parcel and Lot Number(s):n ,� ate . /) y�/j / Location of Project: /(P2-0 PIM Ct / �/r ' ` l.//7 Number of Square Feet of: Residential Space 528 x $1.84 Total L /-7 /- S2 Commercial and , Industrial Space x 3 .30 Total CommerciaUlndustrial Project is: (Check One) _ Warehouse _ Motel _ Preschool _ R & D _ Bank _ Auto Repair _ Movie Theater _ Neighborhood Shops _ Hospital _ Mini-storage Racquet/Health _ Large Office Heavy Industrial _ Hotel _ Office Bldg. Regional Shops _____ Medical Office _ Restaurant Light Industrial _ Office Park _ Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Pemits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport-Mesa Unified School District. B : a. Art , // •uthorized Repr ntative The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not true, then this certificate shall automatically terminate and the appropriate City/County shall befi d2683118:37 PHA 971.52 Date: '/1,'t I Da ,0$41,4r RCP :01-0107756 124286 Applicant • • ' CITY OF COSTA MESA 44 BUILDING DIVISION > : DECLARATIONS (j' n WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the . work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the Work for which this permit is issued. My workers'compensatioq IncaOpe carne poli number are: r 1 RA "1 , ` , - Cemer: omple fl1/ Policy Number: W /1lJI\'lJ---�. /�\(\T/ris section need not be completed rrhe permi is va ued at one hundred dollars($100)or less.) l b}.il'certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' i compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Sectlo 3700 of t e Labor Code,I shall forthwith comply with these provisions. Applicant Signature: �r Date: ` 2' 6 WARNING:FAILURE TO SECURE WORKERS'COMPEN ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AN IL FIN25 UP TO ONE HUNDRED THOUSAND DOLLARE(S1W,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR DE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Profes 'ons Code,and my license is in full force end effect.Lic.# Class 4 Contractor's Signature: �/e i Date: ‘: /) (4 (Y5 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. _ - Expires: Verification of Ownership by(type of document.i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). . ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 W III the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one 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 feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to tile a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aaermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (Pre,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /J�a'{,ature ner(s) I q�V\te AnNOr Aum Licari �� 1 V4 l Date CODE P INSPECTION TYPE PAA IEDIIESS CODE r INSPECTION TYPE . DAB RIE➢ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical - _r (] IO 1266 Pool Spa Final 208 Final Plumbing 6- I3-o3 Al 200 Final Re-Roof 210 Final Electrical • 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place ' 220 • Final Planning Approval 203 Final Sign 222 Final Site , 204 • Final Demolition • - • 250 Final Building/Occupancy • CITY OF COSTA MESA :‘,#;11-We BUILDING DIVISION Y I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �1iNtpoRms� PERMIT M03-00035 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1620 ELM AV Status: ISSUED Suite No Applied: 01/22/2003 Issued: 01/24/2003 Vicinity: Parcel Number: 13931223 ISSUED BY: 'Si _ Applicant: FARTHING, SCOTT ' • i Address: 904 DOGWOOD' Phone: (949)500-2870 COSTA MESA,CA Zip: 92627 Owner: .CORRIGAN, JOHN.T Address: - 1620 ELM AVE Phone: 714-444-3910 COSTA MESA',CA Zip: 92626-4953 Contractor: FARTHING DEVELOPMENT INC Address: 904 DOGWOOD Phone: (949)500-2870 COSTA MESA,CA _ Zip: 92627 License:560875 SCOPE OF PERMIT REF: B03-00106. CONSTRUCT 528 SQ. FT SINGLE STORY MASTER BEDROOM AND BATH. MECHANICAL TO INCLUDE: 1 REPAIR/ALT OF EXISTING HVAC SYSTEM, 1 VENT FAN FOR NEW / BATHROOM. ' / FEE SUMMARY Quantity - Quantity ISSUE FEE $23.50 - - - - -- - - Repair/Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $0.00 '0 - Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System - $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 ' ' Compressors/Absorption Systems Gas Piping $0:00 0 - Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0:00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust • $0.00 _ 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box • $0.60 0' 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $7.25 1 - Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm • $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace - $0.00 0. Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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)754-5626 2466-46(6/00) DECLARATIONS n f 1 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. • - ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.. My workers'compensate�n In�s)Pran carrier and po er are: (,Aj \IVxVxV��o ma Carrier: \l• ` Policy Number: (This section need not be completed if the permit Is ve ed at one hundred dollars($100)or less.) certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agr Ta if I should become subject to the workers'compensation provisions of SectiDn 3700 of he Labor Code,I shall forthwith comply with these provisi Applicant Signature: Date: •L u WARNING:FAILURE TO SECURE WORKERS'COMPEN ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES D CIVIL FINES UP TO ONE HUNDRED THOUSAND DO.LAKE(5100,000),IN ADDMON TOME COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR DE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Profess'ons Code,and my license is In full force and effect.Lic.tt Class tt Contractor's Signature: i Date: ( 2� On LI CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one 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 feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0N (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,hes Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a2ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ul Yes LI No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SignLegal O mer fie And/Or Authorized AppjeAit - Dat? 900E f INSPECTION TYPE OATS IN�/LS CODE( INSPECTION TYPE Ap�T 1t(�2�AL5 • 1616 Fixed System Final Fire Prevention 206 Final Mechanical 6-13 13 -Q 3 1268 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof _ 210 Final Electrical 201 Final Block/Retaining Wall. 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site • 204 Final Demolition - 250 Final Building/Occupancy . CITY OF COSTA MESA 44 -a9 BUILDING DIVISION > • ,,,,' ,r DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER t.I4 PERMIT E03-00046 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1620 ELM AV Status: ISSUED Suite No Applied: 01/22/2003 Vicinity: Issued: 01/24/2003 Parcel Nunmber: 13931223 Applicant: FARTHING, SCOTT ISSUED BY: _491._ __H Address: 904 DOGWOOD - ,Phone: (949)500-2870 COSTA MESA;CA Zip: 92627 . Owner; CORRIGAN, JOHN T 1; Address , 1620 ELM AVE . - - Phone: 714-444-3910 COSTA MESA,CA Zip: 92626-4953 Contractor: FARTHING DEVELOPMENT INC - Address: 904 DOGWOOD - .Phone: (949)500-2870 ' 'COSTA MESA. CA - Zip: -92627 - License: 560875 ' SCOPE OF PERMIT REF: B03-00106.CONSTRUCT528 SQ. FTSINGLE STORY MASTER BEDROOM AND BATH. ELECTRICAL TO INCLUDE: 10:LIGHTFIXTURES, 11 OUTLETS,5 SWITCHES, 1 SMOKE DETECTOR. ' FEE SUMMARY - • 'Quantity • • Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 - -Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 " . up to 10 kva/kw $0.00 0 - Lighting Fixts $11.00 10 ' up to 50 kva/kw $0.00 , - 0 Recept Outlets . $12.10 11 _ up to 100 kva/kw $0.00 0 Switches - $5.50 5 '- over-100.kva/kw" ` $0.00 0 Non Res Appl $0.00.. , 0 - Low Voltage Equipment $0.00 0 Res Appl $4.75 - 1 Low Volt Wiring System/Ckt ' $0.00 0 Service to 200a\ - $0.00 - 0, Misc.Conduit $0.00 0 - Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a - $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 ., 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 - Fireworks Stand $0.00 ' 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 . 0 • Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 1, 12-21-92) / EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiratlonrof this permit. FOR INSPECTIONS CALL: (714)754.5626 2:' 2446-48(8/00) DECLARATIONS 1-I1 (Th WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: - ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. - ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work or which this permit is issued. My workers'compensa; n IIT( urapccee earner relic number are: Carrier: Policy Number: is section need not be completed if the permi is va ued at one hundred dollars($100)or less.) . I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,an gree that I ould become subject to the workers'compensation provisions of Section 300 of the bor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: (�2 V WARNING:FAILURE TO SECURE WORKERS COMPENS ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE ES AND IVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.# - Class# Contractor's Signature: ,/ Date: 2-cf-i On} CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one 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 feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? j01 Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Le. Owner(s) 1 12r ' fDaQ ^ And/0 u o e.Applicant - Dat CODE I INSPECTION TYPE PATE IIfffAL$ COPE# INSPECTION TYPE QATS IKIITUL$ • 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing .tet 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place • • 220 Final Planning Approval • 203 Final Sign 222 Final Site 204 Final Demolition '250 Final Building/Occupancy PROJECT ADDRESS: 1620 ELM AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 067684 OWNER'S NAME: SWEET, TIMOTHY R ADDRESS: SWEET, KAREN D PERMIT NO: B 067684 PLAN CHECK NO: 02252-94 S GOVT: N SUPP : N 1620 ELM AVE COSTA MESA CA 92626 CONSTRUCTION TYPE: V—N PERMIT TYPE: STA PURPOSE: CON 714 ) 545-6549 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : CONSTRUCT 91 ' X 6 ' BLOCK WALL SQ FT: 90 ADDRESS: UNIT: CLAIM VALUE: 2, 000 . 00 CALC—VALUE: 1, 800 . 00 GROUP OCC: R-3 / PERMITTEE: TIMOTHY SWEET (714 ) 545-6949 ADDRESS: 1620 ELM AV COMMENTS : CONST. 91LFBLOCK WALL BETWEEN "2" PROPERTY LINES C.M. CA 92626 ** FTE********,E*yE*********ac*aF+E***+6TEir*y6tFTF*********XEa6**T6T ********46**+c*I:*x****+L***bF* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING REQUIREMENT S 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. S E TB ACK S CITY LIC.: STATE LIC.: CLASS: EXP Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent o self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN Compensation Insurance,or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO,: EXP.DATE: COMPANY: PARKING REO: PROV: PARCEL : 13931223 ZNE; R1 REF NO- r7 Certified copy is hereby furnished, 0 Certified copy is filed with the city Budding Division. PLANNING NOTES> 90 LF OF 6 ' HIGH BLOCK WALL ALONG LEFT SIDE PROPERTY LINE , > WALL TO BE SETBACK 10 ' FROM FRONT P/L . PARTY WALL AGMT READ Date: Applicant: ************************************************************************** **** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be temple id if the permit is for one hundred WOO)or less), DEVELOPMENT S E R Vg1/4.-- NOTI IC E S R E Q U I R E M E N 'T S I cenif that in the performance of the work for which this permit issued. shall not emp/ any person in a y manner so as to become — eL MeW ers Co ensation Laws of California. / f ZONING APPROVED BY DATE:DaD' / "d�// Signature' BUILDING APPROVED BY (/"� q�:If,after making((his declaration,you s•sold become subject to the Workers'Compensation provisions of the LaborDATE: A GJ ll::: Code,you must forthwith comply with such ,visions or this permit shall be deemed revoked. q , CONSTRUCTION LENDING AGENCY: I hereby . irm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: DATE- 1r : W Ci which this permit is issued(Section 3097.Civ. ). ***********************************.>l.gc*.rt* *..*.y,*.*.*{F.>4**.***-*****,*.**.>E***-?7 ;c*.*-*48"v****- LENDER: ***************************** *******************************************i ***** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: Y OWNER BUILDER DECLARATION: thereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PERMIT 41 . 00 5 0 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 26 . 65 SMIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($5001. ISSUE FEE • I. as owner of the progeny or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL '-I PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 41 . 50 0 . 00 26 , 65 68 . 15 68 . 15 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale. If, however the building or REVENUE DIVISION TOTALS--> COLLECTED : 1 68 . 15 OVER/SHORT: 0 0 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP:TOT,' GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the protect(Section 7044,Business 41 . 00 50, 26 . 65 [� and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with acontractor(s)licensepursuantto theContractors'State License Law).l am aware **********************************************+F************T'******************** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOMW N ❑ I am exempt under Section: B.8 P.C. mr this reqs � /9 .- — Q� TYPE QTY DESCRIPTION UNIT COST TOTAL COST 4 / '— Own �/1I SFR 90 RES—CONCRETE BLOCK WALL / FT. 20-, 00 1 , 800 , 00 do hereby cern that I am aware of and understand the requiremen of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle o e)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from • 1 these provisions. LI Date:_ Applicant: ' 'l I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and her.y authorize representatives of is city to enter upon the abo e-mentioned \ . property for inspection arpeses /)dcj 1 ,. i DATEa1pb60� 0016TIptE: 12aD1 68.15 ' - / Signaler. �wen's License or Social Security h: 164146 Whne—Building:Green—Code Enforcement:Canary—Applicant,Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING / POOL ,PA / APPROVALS Permit# D4ie .Inspector PPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 11 /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 6-36..9'4 &(,dei 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. i57. APPROVAL TO COVER-GUNITE 7. Footings 6-50 (pCJq 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test - 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 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 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 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 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 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. 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: 34. Final 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-Final 41. Solar Domestic-Final 42. Backflow Preventer • 43. Backflow Irrigation 7/3-4Y- t*- t4,j ,e - 4--- 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 7 48. FINAL PLANNING . 49. Electric Release to Edison cel • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY n . No. Date _T ^.- t it 'I Y PARTY WALL AGREEMENT THIS AGREEMENT, made and entered into this _13th day of • June,, 1994 , by and between T. R. Sweet . hereinafter referred to as "LANDOWNER," and A. C. Kling hereinafter referred to as "ADJACENT PROPERTY OWNER." • It is hereby agreed that a party wall will be constructed on the property line between 1620 Elm Avenue and 2832 Andros Street (Address of Adjoining Properties) in the City of Costa Mesa, County of Orange, State of California, as per map recorded in Book , Page of Miscellaneous Maps, in the office of the County Recorder of said County. The party wall shall be permitted to encroach 3 inches onto the . _property line of 2832 Andros Street (not to exceed 6 inches ) . IN WITNESS WHEREOF, the parties have entered into this Agreement the day and year first above written. LANDO NER ADJACENT PROPERTY OWNER (Sig a ae) (Signatures T. R. Sweet A. C. Kling Name (Typed or Printed) Name (Typed or Printed) —15.20—Elm_A.v_enue.Costa_Mesa_ 2832 Andros Street, Costa Mesa (Address) (Address) NOTARIZATION REQUIRED 1906-46 • ! CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT No.5907 I State of California County of Orange On June 13, 1994 before me, Linda Lee Dahncke,, Notary Public DATE NAME,TITLE OF OFFICER-E.G.,'JANE DOE,NOTARY PUBLIC' personally appeared A. C. Kling and T.R. Sweet NAME(S)OF SIGNER(S) x❑ personally known to me - OR - I51 proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)-is/are subscribed to the within instrument and ac- knowledged to me that he/she/they executed the same in 44s-he-r/their authorized capacity(ies), and that by #iskh-e-r/their signature(s) on the instrument the person(s), Public—Californiaor the entity upon behalf of which the OTARVSEAL acted, executed the instrument. ri LINDAOFFICIALNLEE DANOV 2 person(s) tNotary �4, ORANGE COUNTY °°•� MyComm.Exp. NOv2e19aa WITNESS my hand and official seal. AO F.,e „A.44QQ IGNATU E OF NOTARY OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER • DESCRIPTION OF ATTACHED DOCUMENT ® INDIVIDUAL n CORPORATE OFFICER Party Wall Agreement TITLE OR TYPE OF DOCUMENT TITLE(S) ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL 1 ❑ ATTORNEY-IN-FACT NUMBER OF PAGES ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER: 6/13/94 • DATE OF DOCUMENT SIGNER IS REPRESENTING: NAME OF PERSON(S)OR ENTITY(IES) Non e T.hamaelves SIGNER(S)OTHER THAN NAMED ABOVE ©1993 NATIONAL NOTARY ASSOCIATION•8236 Remmet Ave.,P.O.Box 7184•Canoga Park,CA 91309-7184 DIVISION OP ISINISIDIO WSW I oto n - '� ii.L t Vt miles CITY of os ,a c: +� �` id PLANNING 0_91, c „sea. \ y auuxr TO BLDG. DEPT. neo- isY...tit_ r P bisectors tat isidtillitallf i optsmane asd 9 L2- switituai:Ctoz plan the Onto d meeeieefriaitt p OP PtAHA➢!a tl 8i1il4LQydCesdAMa 'r �'P Sears dlldsdanend epe SNAf1NOT beMHO - * erste at lord of dg Mola0l O dsay mottos of anY CRY Ta Con \\ 0 Gs� I� � Qneeanewstation ` g +diva tcadit s,�e>4*ebyoe 1,andbecaaernmant onV 9 /6 I�blifgasok is nol and maintained active per WIC WO \ (SWIM tao days a issuance ; cp ADDITIONS, DELETIONS, OR CORRECTIONS SHALL \ 9Z tl BE APPROVED BY THE PLANNING DEPARTMENT. I ,77 i) Rumen G NUMMI IIEEIOENCE NEEIOENCE k. W rJ W 415 Cr 01 M rd / 1 - ---V44,- _ alikQ STREET a _ _ _ CITY OF COSTA MESA BUILDING SAFETY DEPARTMENT Registered Deputy Building Inspector — Certificate-of Compliance Date of this Certificate ) ' 1 g Building Address ) 6 2..0 F L Owner 0 A1.£ S Hl A kA.5 Contractor £n,`TEt & S E GV N� Address -1'S t: 'Oa- N.) i) . R-k,,in.1101b^11Ch Permit No. ` Bc ' — Date Issued 9" I • - 8 • To the Director of Building.Safety: . . I hereby certify that the following portions of work on .the.buildings at, the above address which required continuous inspection and which I was employed to inspect, were inspected by-me and comply with the provi- sions of the Building Code applicable thereto. [ ] Concrete [ 1 Masonry [ I Welding [ 1 Reinforced Gypsum [ ]Special Cases Swimming Pool Size 378 Q [vGunite [ ]Hand Pack • Sacks of Cement /3/ Tons of Sand ae Approximate percent of water in aggregate L O This report covers work completed during week ending 9" /Z,-7 8 - REMARKS: • Sit- 1_ ON071t 6 3. ' - > Registered Deputy Building Inspector W ° ti�:rhnNS\>, SN��s�o'-`" Rq, q� ,�� 1';.h1Q11�(�.•Cy1N0i3O. Nam4,.4nCt_ i t�Stla'lit -- - ------- pp \\ 111.1.10+.9 � SSS` +,.EsvVSS Address'?92� 111.110+.9S\onpc-S\v6 ul ass 1..ipa Cs Q'as6 Laboratory 1 hl) 411`.1C. Telephone)i f,S.L4 -8 I rj CMF 0406-46 (BU 6) • - • • 20 -�s ` p ��41dh► F� Twznf CIinct Laboratories OJUE/ZE Z/Z @C. t P.O BOX 47 • 3310 AIRPORT WAT . LONG BEACI CALIF. 00601 • (213) 4203355 . 11'31 336.2366 . pu) 121.6432 BRANC,, OIRCES TESTING '. • •.. ,z.,.• v -D ....., .< ^. 9.41 .$Sll tcl' , d B • 1 _- .o . : + _ %CeCI lA i', oic ase September 20, 1978 Examination: . SC78-4532 COMPRESSION TESTS ON GUNITE CYLINDERS Richard Hubbard 17422 Yellowstone Avenue Yorba Linda, California 92686- ---- - - • PROJECT SWIMMING POOL ADDRESS 1620 Elm, Costa Mesa SAMPLE FROM Shallow end, main drain, deep end bond beam ARCnI1F�1 CONIRAC1OR California Pools - Orange E NGIN.E+ SUSCONIRAC IOk H. M. Hansen Enterprise Gunite Co. SPECIFIED MIX 4.2 - 1 STRENGTH 2,000 psi DATE CAST 9-11-78 CYLINDER SIZE DATE TESTED 9-18-78 9-18-78 9-18-78 CYLINDER NO. 1 2 3 COMPRESSION 7-Day 7-Day 7-Day TOTAL LOAD, LBS. 52,000 51,000 , 53,000 • POUNDS PER SO. IN. 2,092 2,,052 2,444 Size: 5-5/8" x 12" 5-5/8" x 12" 54" x 12" COMPLIANCE 7-day test complies with specifications. MADE BY DELIVERED BY RECEIVED ON CYLINDERS Wesel R Hubbard 9-14-78 DISTRIBUTION Richard Hubbard - 3 a,: a Mesa Bldg. Dept. / l� ., peri'. ... .e 'lo .c ., f.l V ,u ,. .,NS ...u,- •..OY O+ .B'.4. n\ e, C u(UOn.S CO`CLUSION♦ O E. I • 46482 COSTA MESA BUILDING-SAFETY DEPARTMENT 1421 , IVO lin 42.50 TL I P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ud" -4 •( - ' . '^' AP LI ATION FOR STRUCTUR• L PERMIT For Applicant to Fill in Completely— Use Ink Onlyjl� R . ' .. 5OCKTO EI Iire,la d BUILDING , J ' ADDRESS . ,w _ i '`1.�//J tI PERMIT NO. OWNER #(}1 ./ IXliI _ A.P. NO • 1HHl/// BUILDING MAIL ADDRESS 4,W✓L/ ADDRESS /�h' (J �f z:s.� 4 . CITY TEL. - TRAC Ley BLOCK M at-1-..-a CONSTRUCTION NEW ADJ. ALTER REPAIR MOVING OFMClI ISH • LENDER BRANCH //� CC OWNER //'L.��./ ADDRESS VALUE ARCHITECT TEL. VSE/( ( '$ B '- ORENGINEER /.�'si� TO. y p/ FIRE S ADDRESS �Q/ n ` J ^��,/�f�j • ZONE VPE� GROUP ���[.L C ti ier. �- APPROVED (4110 CONTRACTOR YY BV DATE g r �� ADDRESS/33 ✓z J egasta TEL. ZONE NO.OF USE OF NE CITY N°77/12 710 / PLANS BUILDING V 5," STATE _ CITY YARDS APPROVED YARD APPROVED gLIC.NO. / Ys/�f, LIC.NO. MAIN BUILDING ACCESSORY BUILDING W '£4-Zr 4 � - NO.OF BLDGS. (FROM C/L STR EFT) •L - , NOW ON LOT RONT— AP FT. Slant FT. AGe Q USE OF - • /'} 4 .... EXISTING BLDG. g,SIDE s FT.L../ FT, 0 / 61 FSeparate permits are required for ` L.SIDE , ' FT. FT. electric,plumbing and heating work. W ' REAR FT. FT. [ti USE OF BUILDINGLANDORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 0 / ) ` 1:)01/4- MAIN BLDGS. ACCESS.BLDGS. 1� I (\ VAR.# DATE a d0 _ C.U.P.# APPROVED _ELY lal�" ,- DATE ->a2r- 7K = /// a. I hereby acknowledge that I have read this application and state N O that the above Information is correct and agree to comply with n L all laws regulating building construction, and I shall not employ m HOLD FOR SPECIAL [tE0U1REMF1 T. z any person in violation of the workman's compensation laws of m the State of California. ...: 61.1 %V 1 I hereby certify that I am properly licensed as a contractor under �J irSO, FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such censes are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the pr. Islons of th to of California Business ^ {� a VALUATION ,�J PERMIT FEE $�[/ ei and Professions Code, '• Kit, 3,Chapter /ION v G/'(((fff a iO /J��� �]r /t PLAN CHECK $ /� n Signature of /OL /�✓� $ /V\ !/ // Z Permittee TAX $ 9-t Authorized • :en/ 1 TOTAL PAID $1•.( �Jr U 1075 • FEE Ilk -IIVED COSTA MESA BUILDING-SAFETY DEPARTMENT (-64/ ii_ '7' 0 1' P.O.BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT. FOR APPLICANT TO FILL IN COMPLETELY APPLRTUYTIMIaMIT TYPE OR PRINT BUILDING BUILDING 1620 Elm Street ADDRESS COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY OWNER Knightwell Land Company RECEIPT NO. PERMIT� NO. 4 li'ff—{1 MAIL 419 E. 17th Street REC IVSD BY DATE]j REL�C//ggIVSD -"DATE IBSULD� ADDRESS iI /—,-s-9 I L,I11/ v ingta CITY Costa Mesa, California No:Ll 81159 BUILDING ADDRESS ARCHITECT Carlson & LIC. OR ENGINEER Middlebrook NO. EiI ",Y.0COSTA MESA, CALIFORNIA le- /� ADDRESS 419 E. 17th St. , Costa Mesa FIRE ZONE TYPE �/ GROUP _ l/ CONTRACTOR Colegrove, Inc. L C No 167293 AAPPROVED BY DATE �/ ADDRESS 419 E. 17th St., Costa Mesa ZONING LEGAL LOT 81 A 3457 /�!, NO.OF USE OF NEW fe0 / ' DESCRIPTION I NO. BLOCK TRACT l / ( PLANS ,l'I BUILDING APPROVED / A.P.NO. BY L7/4) DD /AASSE II 34 " SIZE OF LOT 911 X 1001 I NO.OF SLOGS.None YARDS EVES NOW ON LOT REQUIRED ALLOWED USE OFNone (CENTER LINE ST.) �--�1 EXISTING BLDG. FRONT S ` FT. IN. SETBACK LINE FROM 501 1 29 CENTER OF STREET REAR YARD R.SIDE FT. IN. SIDE YARD I LEFT 121 I RIGHT 51 L.SIDE / >- FT. IN. DESCRIPTION OF WORK (��{{ REAR �J FT. IN. NEW I X I ALTERATION II ADDITION I ' REPAIR I I MOVING I DEMOLISH O BUILDING 1480 NO.OF ROOMS 6 STORIES 1 • • �d S SIZE .......----r EXTERIOR WALL. ROOF COVERING `5t11CC0 COVERING Shake USE OF BUILDING AND WORK TO BE PERFORMED Single family residence with attached garage Plan X 730 E I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTION.IO� VALUATION SIGNATURE OF 1/442g.. �_ PERMIT FEE $ 35.00 PERMITTEE j'� n't� $ 15 PLAN CHECK $ 17.50 AUTHORIZED AGENT•Dike & COprov ee c. �Inf TOTAL FEE $ 52.50