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Home My WebLink About909 EVERGREEN PL - Building Permits, CITY OF COSTA MESA \ BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT (714) 754-5273 • Fax (714) 754-4856 • wvnv.ci.costa-mesa.ca.us JobAddress: 909 EVERGREEN PL Suite: Vicinity: Parcel Number: 42252117 Applicant: SMITH, DOUG Address: 5201 CAPITOL BL #159 TUMWATER, WA - owner: HADASH, KIMBERLY ANN Address 909 EVERGREEN PL ,� '� , - ' COSTA MESA, CA � Contractor: O W N ER-B U I LD ER Address: � Zip: Arch : Address: Zip: Phone: License: ADD 182 S.F. FOR A NEW BATHROOM AIJD ADD 511 S.F. � ALSO ADD 68 SF COVERED PATIO AT REAR OF ADDTION. CONVERT EXISTING 3 BEDROOM, 1 BATH S.F.D. TO A 3 BI NEW GARAGE 20 FT BY 22 FT INSIDE�CLEAR DIMENSION � Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspeotion: Total: $294.03 $452.35, $3.03 $0.00 $0.00 $0.00 $749.41 SETBACKS MAINSTRUCTURE Front 20-0 ACCESSORY Front 0- 0 0 949-631-2336 98502 (949)642-2572 92627-4136 � Eng: Address: i' � , PE�IT NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 07125/2003 Issued: 03/31/2004 ISSUED BY: Phone: License: JYt Ut YtKMI l ATTACHED�GARAGE TO EXISTING S.F.D. ADDITION IS ONE STORY. OOM, 2 BATH S.F.D. SET6ACK�20 FEET FROM FRONT PROPERTY LINE. . � rte aumrvuarcr- Calc Valuation:, ". Claim Valuation: � � PLANNING & ZO� Rear 38-10 Left 5- 0 Rear 0- 0 Left 0- 0 Right 12-11 " .. Right 0- 0 ' $30,330.26 $o.00 NOTICE: The work authorized by this permit shall comply with ell applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 9$-28, § 1, 1241-92) EXPIRATION: This permit shall automatically ezpire and become v i id 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. FaiWre�to obtain inspections and final approval will resWt in the expira�ion of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 244G46 (fi/00) � WORKERS' COMPENSATION OECLARATION: I hereby aNirtn under penalry ol perjury one of the tollowing tleclarations: ❑ I have end will mainlain a certificate of consent to self-Insure tor workers' compensetion, as provided for by section 3700 ai the Lebor Code, for the pertormance of the work for whiCh this pertnil is issued. ❑ I have end vrill maintain workers' compensation insurance, as required hy section 3700 of t�e Labor Code, for Ne pertortnance of the work for which ihis pertnit is issued. My workers' wmpensation Insurance carrier end policy numbar ere: Cartiar. need no( be comp/eled il the permit is valued at one bundred dollers ($100J or less.) Policy NumDer: 1� I certity ihat in the pertortnance of the wo r which this pertnit is issued, I shall not employ any person in eny manner so as ro become subjecl to the workers' .7� 'compansetlon laws of Californla, and ag that it I should become subject to the workers' compensation provisions of Seclion 3700 ot t�e Labor Code, I shall lorthwith comply with these pro ' ions. �7 Appliwnt SigneWre: ��_� Date: n?i^ ?J—�� WAFMN6: FWLURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNL4WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALilES AND CIVIL FINES L/P TOONE MUNDRED THIXISAND DOLLAFE (5100,OW). IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDED WR IN SECTION 3]W OF THE LABOR CADE, IIJrEREST, M1D ATTORNEY'S FEES. LICENSED CONTRAC70RS DECLARATION: I hereby aNirtn that I am licensed under provisions ot Chapter 9(commencing with Seciion 7000) of Division 3 oi the Business and Professions Cotle, anA my license Is in full torce and eXecl Uc. N Cless # Contrectors SigneNre: Date: CONS7RUCTION LENDING AGENCV: ❑ I hereby eNirtn ihat there is a construction lending agency tor the peAormance of the work for which this permit is issuetl. (Sec. 3097, Civil Code). LBntleYs Nama: Lender5 Addre55: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby attirtn that under penalry ot perjury Ihat I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for Ihe Following reason (Sec. 7031.5, Busineu and Protessions Cotle: Any city or counry which requires a pertnit to conswct, alter, improve, tlemWish, or repair any sWcture, prior to iis issuance, also requires the epplicant for such permit to lile a signed statement that he or she is licensed pursuaN ro the provisions of the Camraciors License Lew (Chapter 9(commencing with Section 7000) of Divislon 3 of the Business end Protessions Code) or thet he or she is ezempt therefrom and the basis for the ellegetl exemption. Any violation oi Section 7031.5 by any applicant tor e permit subjects the ap0licant to a civil penalty of not more than fiva hundred dollars ($500).): .ftl I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and Ihe siructure is noi intended or oHered for sale (Sec. �� 7044, Business and Pmfessions Code: The Contractors License Law dces not apply to en owner of propetly who builds or improves thereon, entl who does such work himself or hereelf or ihrough his or her own employees, provided that such improvements are noi inientletl or oflered for sale. It, however, the Duilding or improvement is ,,,11{..,,, sold wit�in one year ot completion, the owner-builder will have ihe burden of proving that he or she did noi build or improve for purpose of sele.). .y,.I I, as ov+ner of the pmperty, am EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRAC70R5 to construct the project (Sec. 7044, eusiness entl Professions ^ Code: The wntrectors License Law s not epply to an ownar 01 pmperty who builds or improves t�ereon, and who coniracts for such project wlih a coniractor(s) license pursuant to the Coniracto cense Laws.). ❑ I am ezempt /und�er sec. Business and Professions Code tor ihis reason: Signature: [Li� q n _ _ Date: Owner ID verifieC by dnver's license, Ventication of Ownership by (type oi ❑ No Drivers License No. i.e. - property taz bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify ihat no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connaction with work euthonzetl by ihis pertnit, end that no builtling strucWre, scaflolding, talsework, or demolition or dismaniling �hereoi, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, Calitomia Atlministrative Cotle). ❑ As owner-builder, I will not employ anyone to tlo work which woultl require a permit from the Division of Industrial Safety, as noted above, unless such person has e permit to tlo such work imm ihe division. Signature: Date: Division ot Indusirial Safery Permit Number. CERIIFICATE OF COMPLIANCE AND AUTHORVATION OF EMAY: I certity under penalry of perjury that I have reatl this epplication and state �hat the inFormetion given is wrrect. I egree to wmply with all state laws and ciiy ordinances relating to building consiruction, and authorize representatives of the Ciry ol Costa Mesa to enter upon the above-describetl property for inspection purposes. I agree not to occupy or allow occupancy ot any building authorized by Ihis permit until final inspection. / SignaNre Of gal Ow% (s) D a ..� ) ��^v An uthonzetl licant D�el GQOE I. INSPEGTIONTYPE 1616 Fizetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 FInaI BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demoli�ion P1y¢ IMRIALS LOpE I INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Eleclrical 212 Final Fire Preven�ion 220 Final Planning Approval 222 Final Sile 250 Final BuildincyOccupancy �g �/� .iut. � ° DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS f Street,4ddress: �%�� G�4�� 1. I (we), �, � reterenced real property, and that I(we) hereby Name: � l d�1i5 S Street Atldress: �� I Cr} pyiDL �11�L J� ��s� Bldg. Permit# �(7� ��.�7� This Permit f1 AP Number: declare that I am the Owner of Title of the above I ��/.'�i_ ,i% �� •. . .• - City: %JM�1�1'lttlt.- I State: k!' ) Zip: �S�' r� to obtain permits in my behalf, as ownedbuilder, for �� v1'�'L/I-�� ry4i�%}S� at the above referenced property. � 2. Should any person become an employee engaged in tlie improvement of the property, I(we) shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. I 3. As own�r/builder in facl, I undersland and accept that my responsibilities do not transfer to any other person, company or corporation. � 4. I agree to indemnity and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correct. Executetl this _� day o( O]]9J6 (rev.� �/00) Prinl Name: Date: 20l�]L , at l��S%'7 M��i�-t' , California. ! Note: This autlror¢ation does not grant authorization to perform the work as owner, il solely provides for limited power of attomey to secure ihis permit in any behalf. CITY OF COSTA MESA BUILDING DIVISION /ELOPMENT SERVICES DEPAFTMENT PERMIT (714) 754-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.ca.us Job Address: Suite No Viciniry: Parcel Nunmber: 909 EVERGREEN PL 42252117 Applicant: DOUGLAS PATRIC SMITH Address: - . , , c NUMBER E05-00551 77 FAIR DRIVE, WSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: O6/08/2005 Issued: 06/08/2005 , � � - Phone: � I '/ � /. � " Z'P� � . '_ . . Owner� "HADASH, KIMBERLYANN Add'ress��" I909 EVERGREEN PL`--`�-�' � � % �, Phone: (949)642-2572 � ', �� COSTA MESA, CA Zip � 92627-4136 // { /.; f. � � Contracto'r. `� OVVNER-BUILDER � , � � > " Address: " � �, � . .� -- - „ �: ,. � �� . , . .. , .. , . . � '-Phone: � . _ .- � ' ... Zipl , j 0 � ` �- . `;` j( ,. � .�� 'SC ' ELECTRICAL PERMIT FOR ADDITION"� ' ATTACHED GARAGE TO EXISTING S.F . ALSO ADD 68 SF COVERED PATIO AT � CONVERT EXISTING 3 BEDROOM;�t B � NEW GARAGE 20 FT BY 22 FT INSIDE �, ,PROPERTY LINE. , �`� -, REF #B03-01275' " WORK TO INCLUDE: 32 LIGIHTING F,IX _ UPGRADE TO 200A(TO BE RELOCATE .. , ,Q1` � ._ .._ . �� 'E OF-PERMITt%; � �% "�':�' � ' 182 S.F: FOR A NEW BATHROOM AND ADD 511 S.F. NEW, ADDITION IS ONE STORY. - , 4R OF ADDTION. � ' � � i S:F.D.�TO A 3 BEDROOM, 2 BATH S.F.D. �� iAR DIMENSION AND SETBACK 20 FEET FROM FRONT � � -- . � :.��, � . -. _- _ . : �� , , � �' - �i; . '26 RECEPT OUTLETS, 18 SWITHCES, 1 SERVICE PANEL 1 SUB PANEL TQ.100A, 1 LOW VOLT WIRING.SYSTEM/CI(T: . � �h � ` . ,.___ _. . . . ..i/! � _ : ' ��V � -� �'�� x �;,"� 'oFEE�SUMMARY, ,�.,� � . ._� ,; , �., � ._ �: , \ - � j/ � ,Quantity � � n " � , !%� Quentity ! � ii ISSUE FEE �� ,_' � ,' $23; 50� - ,A� -= - � Temp Dlst System / Ligtiting� ' $0.00 ; i�0� . ' Tempservicetest�:`, „$0;00-��., � � �'-.- _ �''Busway/t00ft- -�;-. ,� � $0.00,' �0 � �" � .. . � . � _ _ . ,��. - . : :� � _ i . � ' Res. a/c package �� , $0.00 � � ; � _ � Standing Section -' • � $0.00-� �tr , New Res (1-2 uniLs) � ��$0.00 � �� ,�' � 0_ �� - �Misc Electrical Equipment � \ j$0.00 �; ^0 New Res (3+units) �� $0.001��- �' � 0 � � •. i- , Transformers upto,t kva/kw $0.00�� 0 Pool / Spa ��$0.00' � _ � ' 0 , -- = ' - ,� . :..........:...up.to 10 kva/kw _. $0.00 �' 0 LightingFixts 530.76�� ,�..:,:.32�� '- �-....:upto50�kva)kw� -�.j�$0.00 0 Recept Outlets $26.38 ' '-,26 �-- "'' � � �....�...�.:......'.:up to 100 kva/kw-�!,,.� $0.00 0 Switches 519.80 -18'; � -�� - �__ _ ...............:,over,100 Kva/kw' $0.00 0 Non Res Appl $0.00 0 .� .- � Low Volta�ge Equipment $0.00 0 Res Appl $0.00 0 - Low Volt Wiring System / Ckt $25.00 1 Service to 200a 530.50 1 Misc. Conduit $0.00 0 NOTICE: The work authorized by this permit shall comply with [ regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become vi for a period ot 180 days. INSPECTIONS: In order for the work authorized under this permil requlred inspectlons and final epproval musl be obtained. Failure FOR INSPECTIONS CALL: (714) 7545626 2dbfiAfi (fi/00� applicable handicap access requirements under Calitornia statutes and if work is not commenced within 180 days, or if work is suspended or � be considered legal, such work must comply with all applicabl yodes, antl all obtain inspections and final approval will result in the expiration ithis permit. WORKERS' COMPENSATION DECLARATION: ' — I hereby affirm under penalry of perjury one of ihe following decleratlans: ❑ I heve en0 wlll meintein a certlNcate of consent to selt-Insure for workers' compensation, es provided tor by sectian 3700 ot t�a Lebor Code, for Ihe peAortnence of the work lor which Ihis permit is issued. ❑ I heve end will maintain workers' compensation insurance, as requiretl by section 3700 of Ihe Lalwr Code, br the perfortnance oi Ne work for whlch this pertnit is issuetl. My workera' compensatlon Insurance carrier entl policy numDer ere: Carrier: Policy Number: (Th/s sectlon need naf be completed lllhe permit is velued et one hundred dW/ars ($f 00) or less.) . I! _ rtity that In the peAormance oi the wo c�for which ihis pertnit is issued, 1 shall no� employ any person in eny manner so as to become subject to the workere' compensetlon lews oi Califomie, end e 4 that if I should become subject ta the warkere' compensatlon provisions of Sectlon 3700 of the Labor Cotle, I ahall forthwith � �compl wilh th�ese provisions. App canC��—� `&sIgnetuie - Date:6i:.%-.� �. £i �O � � —O � AN�RNINO: FNLUR�O SE RE WORKE0.S' COMPENSATION COVERAOE IS UNLAW FUL M!D SFIFLL SUBIECT AN EM OYER TO CRIMINAL PENALTIES AND CML FlNES UP TO IXJE HUNDiiED TNOUSPIJD DOLLARE (5100,OW), IN MDITION TO THE COST OF COMPENSATION, DMMGES AS PROVIDED WR IN SELTION �OB OF TiE UBOR CODE, INTEREST, AND ATTORNEV'S FEES. LICENSED COHTAACTORS DECLARATION: I hereby eXirtn thet 1 em licensed untler provisions of Chapter 9(commencing with Section 7000) oi Divislon 3 of Ihe Business end Professions Code, end my Ilcense Is In full force entl etted. IJc. q Class M Comrectofs Signeture: Date: CONSTRUC710N LENDING AGENCV: ❑ I hereby ettirtn Ihat there is a conslructlon lentling agency for Ne peAormance of iha work tor which this pertnit is issued. (Sec. 3097, Civil Code). Lendefs Neme: Lendefs Atltlress: Signature: Date: OWNER-BUILDER DECLARAT10N5: I hereby attirm Ihet untler penalry of perjury ihet I am EXEMPT FROM THE CONTflACTORS LICENSE LAW for �he following reason (Sec. 7031.5, Buslness erM Professions Code: Any city or wunry which requires a pertnit to consiruct, elter, improve, demolish, or repair eny strudure, prior to its issuence, also requires �he epplicant for such pertnit to file a slpnetl atetement ihat he or she is Ilcensed pureuant to the proNsions af ihe Contrectors License Lew (Chapter 9(commencing with Section 7000) of Dlvlsion 3 of ihe Business en0 Professions Cade) ar ihet ha or she Is exempt Iherefrom end ihe basis tor the alleged exemptian. Any violation of Sectlon 7031.5 by eny applicent for e pertnit subjects ihe epplicent to a civil penelry of not more than fve huntlreO dollers ($500).): ❑ I, es owner o� �he properry, or my employees with wages es their sole compensation, WILL DO THE WORK, antl Ihe struclure Is not Intended or oHered for sale (Sec. 7044, Business and Protessions Code: The Coniractors License Lew does not appy lo an owner of property who builtls or imD�oves thereon, and who does such work himseN or hersetl or through his ar her own emplayees, pmvided that such impmvements ere not intended or oHeretl tor sale. If, however, the building or impmvement is sold within one year ot completion, the owner-builder will heve ihe burden of proving that he or she did not build or improve for purpose of sale.). • - 1? s owner of the properry, am EXCLUSIVELV CONTAACTING WITM LICENSED CONTRACTORS to construct ihe projact (Sec. 7044, Business anC Professlons Cotle: TTe wntrecrors License Lew does no� apply to an owner oi properry who builds or Improves thereon, and who coNrects tor such project wlth e contrector(s) license pursuant to the Contra tor5 'cense Laws.). ❑ I am exe ntler sec. Business and Professions Code for Ihis reason: � ig�S`"'�na10"�f 'i v / . — 17 ✓ Owri rlDvedfletlbytlriver'slicense. es ❑No nvers�Cicens" EWiires: rJ� Vetltication o1 Ownership by (rype ot document, i.e. - property tau 6111 or tleatl). DIVISION OF INDUSTRIAL SAFETV PERMR CERTFICATION: � ❑ I hereby certity that no eacavetion tive (5) or more feet in Cepth into which e person is requiretl to descend, will be made in connection with work authorized by Ihis permiL and that no building siructura, scattolding, talsework, or tlemolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia Administrative Cotle). ❑ As owner-builder, I will nat employ enyone to do work which would require e permit from Ihe Division ol Industnel Sefery, es notetl ebove, unless such person hes e pertnit to do such wodc from t�e tlivision. Signature: Date: Division of Industnal Sefery Permit Number. ICERTIFlCATE OF COMPLIANCE AND AUTHOHVJ1T10N OF EMiiY: I cenity under penalry oi perjury ihat I have read t�is epplication end state that the infortnetlon given is I wrtect. I egree to wmply with all stete laws end dry ordinances relating to building construction, and euthodze representatives of �he Ciry of Coste Mesa lo enter upon �he above-descriDed properry for inspection puryoses. I agree not to occupy or allow occupancy of any building euthonzed by this permi� until final inspection. COOE I. INSPECTIONTYiE PAIE UiI�ALS 1616 Fixetl System Final Fire Preventlon 1266 Pool Spe Final 200 Final Re-Raof 201 Finel BIocWRetalning Well 202 Final Fectory Fire Place 203 Flnel Sign 204 Flnel Demolition COOEI MSPECTIONTIPE 206 Finel Mechanital 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Finel Site 250 Flnel Buildlnp/Occupen< QAg I[�ELS �� CITY OF COSTA MESA 'LDIN6 DIYISION 'MENT�SERVICES DEPARTMENT I PERMIT (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us JobAddress: 909 EVERGREEN PL Suite No Vicinity: Parcel Number: 42252117 - ., _ �.-. � _ � ' .,i�-'-. -., i, ,. Applicant SMITH DOUG PATRICK , f Address: 3438 68TH AV SW ,�.; -�- ' /�:j��'�. �,� -'^� � `, :—Fh� � ' OLYMPIA, WA \ � i . .�'''-;��=�-Zip � ' � ' ` �� -:!' - �- �, j % i � �i' � - ownec' �' HADASH;�KIMBERLY ANN , � , . � �,, ,, Address: 909 EVERGREEN�PL - , ,, ,,i��;.� � i�� :-� Phi �// ' ,'„� f��` C Sj�f ESA, CA ' Zip ,1-�Contractor: OW�NER-BUILDER °R°• . i � /iii/�� i' ili �� .Fs � ' .�Address: '�.` ' , � _ � �"' ��/ - . - � � � ; - - . ' P-h� � � . , � � '. Zip �� `� � _ � . . . �� Lici ,i� , - - •' ADD 182 S.F. FOR A' NEW BATHRO� � if� ' � EXISTING S.F.D. ADDITION IS�ONE � ;��', ADDTION. REF.:'B03-01275 � MECHANICAL TO INCLUDE: 1� VENI ,�i �� ,.��' ISSUE FEE � � � `, Inst FAU'<100 k BTU � �V�� InstFAU'�>100k�B'fU� �:��`�� Repair % AII��Cooling/Heat \A Inst / Rep; �Recess Wall Htr �� Refrig Sys.<100 k BTU ( �' Refri S s>100 k BTU' $23.50 $0.00 $0.00 ! NUMBER 05-00397 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 07/13/2005 Issued: 07/13/2005 . . , - ,- . � � � ISSUED BY: , � ` � �,�i�� i -' � v : �� . ie:.714=407-456T-� , r ' :� `� � _ -�_ -� _ ._ _ �-��: ; . � � - �� 98512__`'�,\ �._.-_ - - _ -` � � � ie: (949) 642-2572 �� .;� -'. , . . \ .�92627-0736 ��A� ' �. � � r , ��Lt �, t � � J� ,� �v ,� �� -- �� '. �, ��' ... �� . ,. , . . . - ie:� -.. , .. . ' � . , j' �. \ \ �PE OF FERMIT � ,,,, �,� 4ND ADD 511 S;F. NEW ATTACHED GARAGE TO � )RY. ALSO ADD 68 SF-COVERED�PA710 AT REAR OF `i �+ � -- — . _._: _ 1 �', ,, � N/SINGLE DUCT AND 1 REPAIR/ALT COOLINGMEAT. �� ` ' %: _ _ . ' �� 3 - ' — � �� FEESUMMARY,� � � ,=;��; ,� Quantity .�,.,;�� _ ��'� �� Quantity� �C,_ Repair:!_'AICAbsorbtion Unit � 'I,j � ,$0.00 0 � 0 Repair/AltRefrigerationUniC G�i� �$0;00` 0� , i 0 +..r`��t�VentlllationSystem � � �� $0.00! .0� � � '�s'�� Evapo`ative Cooler j% � $0.00 ! 0' � d ;'+�r��c <,� ,. , '� G,'� 0 - »/„�,, - „ Comrderciallncinerator „f�j , $O.00j, 0 c�..;'a 0 , . .� , ' `;: Domestic Imm�erator�.,; u, y, � ,j��' � ' _, $0.00,: � 0 g y . .. '0 �`�' ' s �: Compressors / Absorption Svstems ' � � � Gas Piping � �;A � - � �$0 00� -0 -t' � � -. Up to 3 hp / 100 k BTU ,,�///' � � �, $0,00� 0 Factory Fireplace �V ( � /� $0 00 ��0�_ - , , 3 To 15 hp / 500 k BTU�% �� /� �- � $0.00 0 Hood w/Mech Exhaust\ ✓�' $0 00- �� 0��1� � , 15 To�30 hp / 1 OOO,kBTU �-,/- -; �' �$0:00 0 �`� � .$0.00 0 VAV Boz �� ,' ��$0'00 0 , �- .,��, ��30To�50�hp�/.1;750 k BTU" � .�; - � � Vent Fan / Single Duch �1 � `�� $7 25 � t.... =:Ovec50 hp / Over 1,7568TU �� %" ' $0.00 0 Appliance �� `$0:00� � ,0,. �,� ,- �' ..-- Boilers �. -� ',� l / ' j' j FireDampers ��.$0.00��0�-/ � ?/_ �.� ��--Up�to3:hp-��•�� j $0.00 0 Smoke Dampers �,, =,$OAO "0��„ , � r J � . ; � , � -3�To 15!hp .�� , ��1 /j'!.% $0.00 0 Inst or Relocate Appl Vent -�` $0.00 �--0_ , i� � 15 to 30�hp �" '� �l ��- $0.00 0 Air Handlers < 10000cfm $0.00 , 0;��-�. - `�' ' 30 to 50 hp . � $0.00 0 Air Handlers > 10000cfm $0.00 �0� -, _ -'� � � OveG50�hp ��-� .-- � $0.00 0 Floor Fumace $0.00 0 -- �_ � -� �"Othe�,Mechanical Fee Floor or Suspend Heater $0.00 0 � Investigation Fee $0.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) I I�.,,w� EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or• clonetl for a period of 1 BO days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with al plicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspeclions and final approval will result in the ezpiration of lhis permit. FOR INSPECTIONS CALL: (714) 7545626 I 2446-46(8/00) WORKERS' COMPENSA710N DECLAFiAT10N: ' — I hereby ettirm untler Denelry oi perjury one of the following tleclarations: ❑ I heve and wlll malntain e cenificete ot consent to sell-Insure for warkers' wmpensatlon, as D�a�tled tor by section 3700 of ihe Lebor Code, for the pertortnenca ot ihe work �or w�iCh Ihis permil is 155ued. ❑ I have aM will melntain workers' compensa�on insu2nce, as requireO Dy sectbn 3700 of Ihe Lebor Cade, for the peAortnance of the work for which this pertnit is issued. My workere' compensetion Insurence cerrier antl policy number are: Cerder. Policy Number: need not be completed il Ne permit is velued ef e hundred dollers ($f00) or less.) ihat in Ihe periormance of the wo r whi is permil is issueC, I s�all not employ any person in any manner so es to become subject to �he workers' isetion laws of Celitomia, enC Nat If ould become suD�ecl �o Ihe workers' compensation provislons of SecUon 3700 of tha Lebor Cotle, I shell torihwlth wiN �hese p ' ions. � —,,;.._. �_ �7—/ � S ��e:: � : _URE TO RE ORKERS' COMPENSATION COVERAGE IS UNIAW FUL AND SHALL SUBJECT AN VER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDREO iLARE (Sl ,000�, IN ADDfTION TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 3]OB OF THE LABOR CO�E. INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eXlrtn that I am licensetl untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, end my license is In full torce antl eNed. Llc. a Class x Conlractors Signeture: Date: CONSTAUCTION LENDING AGENCY: �� ❑ i hereby affirtn that there is e construction lentling agency for Ihe performance ot Ihe woAc for which Ihis pertnit is iuued. (Sac. 3097, Civil Cotle). '� Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DEGLARATIONS: 1 here6y ettirtn thet under penelry of perjury Ihat I am EXEMPT FHOM THE CONTFiACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business entl Professlons Code: My dry or counry which requires e pertnit to construct, alter, imprwe, demolish, or repair eny strudure, prior to its issuance, also requires t�e applicant for such permlt to file e signed slatement that �e or she Is IlcenseA pursuent to the provisions oi the Contraclors Llcense Law (C�epter 9(commencing with Sectlon 7000) of Dlvision 3 of t�e Business end Professions Code) a� ihet he or she is eaempt therefrom end the basis for ihe elleged exemption. Any violation of Sectlon 7031.5 by eny applicent for a pertnit sub�ects t�e applicant to e cMl penalry of not more ihen tive hundred ddlars (5500).): ❑ I, es owner oi Ihe property, or my employees with wages es t�eir sde compensation, WILL DO THE WORK, end the structure Is not Intended ar aHeretl for sale (Sec. 7044, Business and Protessions Code: The Coniractors Llcense Law does not appty to an owner of property who builds or improves thereon, and who does such work himselt or herself or thwugh his or her own employees, provided that such improvemenis ere not intentletl or oHered for sale. II, however, ihe builtling or Improvement is sold within one year oi wmpletion, iha owner-builder will heve tha burden oi proving that �e or she did no� build or improve for purpose ol sale.). ' ❑ I, es owner of the pro0erry. am E%CLUSIVELY CONTRACTING WI7H LICENSED CON7RAC70RS to construct the project (Sec. 7044, Business end Professions Code: The conirectors License Law does not epply to en owner of propeny who builds or Impraves thereon, antl who contrects for such projact wl�h a coMrector(s) license pursuant to the Contrectors License Laws.). ❑ I em e:empt under sec. Business antl Professions Code for this reason: Signature: Date: Owner ID verified by Oriver's license. ❑ Ves ❑ No Drivefs License No. Ezpires: Vedficatlon o1 Ownership by (type of tlocument, i.e. - property tex hill or deetl): DIVISION OF INDUS7RIAL SAFETV PERMR CERTiFICATION: ❑ I hereby cerGfy t�ai no excavation tive (5) or more feet in depth into which e person is required to descend, will be matle in wnnection with work aut�orizetl Dy Ihis permit, and that no building siruclure, scattWding, falsawork, or demolition or dismantling �hereof, will be more ihan thirry-six (36) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Ttle e, Celitomla Administrative Code). ❑ As ownar-builder, I will nat employ enyone to do work which would require e pertnit irom the Division oi Intlustriel Sefery, es noted ebove, unless such person hes e permit to do such work fmm Ihe divlslon. Signature: Date: Division of Industrial Safery Permit Number: CERTIFlCATE OF COMPLJANCE AND AUTMORQATON OF EMiiY: I certity under penalry of perjury that I have read this epplication end state that ihe Infortnetion given is wrrect I agree to compy with ell stete laws and city ordinences relating to building consWction, end euthorize representatives ot Ihe Ciry ot Coste Mesa to enter upon ihe ebove-described properry tor inspection purposes. I a�ree not to occupy or ellow occupancy of eny building authonzed by this permit until final inspection. COOE �. INSVECTION TYPE 1678 Fixed System Final Fire Prevention 1288 Pool Spa Final 200 Final Re-Root 201 Finel BIocWRetaining Wflll 202 Final Factory Fire Place 203 Final Sign 204 Finel Demolltlon � I�� CO�E� INSYECTONTYPE 206 Final Mechanicel 20B Final Plumbing 210 Final Electfiwl 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Flnel Building/Occupency •73I riiii�IS� 1 1 �' CITY OF COSTA MESA � � BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us Job Address: 909 EVERGREEN PL Suite No Vicinity: Parcel Nunmber: 42252117 App�icant: SMITH, DOUG Address: Owner: HADASH, KIMBERLY ANN Address 909 EVERGREEN PL Contractor: Address: Arch / Eng : Address: ISSUEFEE ,' BackFlow irrigation BackFlow Prevenler Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drein, Floor COSTA MESA, CA 949-642-2572 ine: (949) 642-2572 Zip: 92627-4136 l Ph Ine: Zip: _ _ - _ License: � NUMBER PO4-00440 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 06/22/2004 Issued: 06/22/2004 ADD 182 S.F. FOR A NEW BATHROOM AiD ADD 511 S.F. NEW ATTACHED GARAGE TO EXISTING S.F.D. ADDITION IS ONE STORY. � - � ALSO ADD 68 SF COVERED PATIO AT REAR OF ADDTION. REF: 603-01275. � PLUMBING TO INCLUDE: 1 BATH TUB, 1 I UNDRY TUB/WASHER, 2 WASH BASINS, 1 TOILET, 1 SEWERCONNECT. I � � � AMT $23.50 $0.00 $0.00 $9.80 $0.00 so.oa $0.00 $0.00 $0.00 QTY 0 0 1 0 0 0 0 0 Laundry Tub / � Landscape Irn� P-Trap Pressure Regi Process Pipinc Receptors Septic Tank Sewer Cap (or SewerConnec AMT QTY Vasher $9.80 . 1 . ation $0.00 0 $0.00 0 ator $0.00 0 (per 10 ft) $0.00 0 ' $0.00 0 $0.00 0 lemo $0.00 0 � . � �- $0.00 0 SumpPump Swimming Pool Trap Primer � � , " Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System AMT QTY $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $19.60 2 $0.00 0 $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. § 7, 12-21-92) I EXPIRA710N: 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 inspectlons and tinal approval must be obtained. Failure i o obtain inspections and final approval will result in ihe expiration of this permi�. FOR INSPECTIONS CALL: (714) 754-5626 zaaUa6 (8�00) � � WORKERS' COMPENSA710N DECLARA710N: ' I �erehy attirtn under penalry of parjury one of the lollowing daclarations: ❑ I heve antl will maintein a certiticate of consent to selt-Insure for workers' compensetion, es provided for by section 3700 ot Iha Lebor Code, for the peAormance ot the work for which Ihis permit is issued. ❑ 1 have flnd will maintain workers' compensation insurance, es requiretl by section 3700 of Ne Lebor Code, for Ne performance of Ihe work for whic� Ihis pertnit is issued. My workers' wmpensation Insurence carner end policy number are: Cerner. Policy Number. (This secflon need not be complefed i! fhe permit is velued ef one hundred dollars ($100) or less J ❑ I certity that in Ihe pedormance ot the work for which this pertnit is issued, I shall not employ any person in any manner so as to become subject to Iha workars' compensetlon laws ot Califomia, and egree that if I shoultl become sub�ect to Ihe workers' compensation provislons ol Section 3700 of Ihe Lebor Cotle, I shell fort�with comDly with these provisions. � Applicant SigneWre: Dete: WARNING: FAILURE TO SEIXIRE WORKERS' COMPENSATIqJ COVEMGE IS UNLAWFUL AND SHNLL SUBIECT AN EMPLOVER TO CRIMINAL PENALilES AND CIVIL FlNES lIP TOONE HIINDRED TqUSAND DOLLARE (5100.000�. IN AD�fTION TO THE COST OF COMGENSATIqJ, DAA41CaES AS PROVIDED FOR IN SECTION 3]fb OF THE LABOR W�E, IMEFEST, AND ATTORNEYS FEES. LICENSED CONTRACTORS OECLARATON: I hereby aNirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Oivision 3 of the Business and Professions Code, enA my license is in full force end effect. Lic. a Class # Contractors Slgnature: Date: CONS7RUC710N LENDING AGENCY: ❑ I hereby aRirm that there is a construction lentling agency for the peAormance of the work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lendefs Nema: Lender's Adtlress: Signature: Date: OWNEFi-BUILDER DECLARATIONS: I hereby ettirm that under penalry of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7037.5, Business antl Professions Code: Any ciry or counry which requires e permit to consiruc�, alter, improve, demolish, or repair eny structure, pnor to its issuance, also requires ihe epplicant for such permit to file a signed stetemem thet he or she Is Iicensad pursuant b Ihe provislons of ihe Contrectore License Lew (Chepter 9(commencing with Sectlon 7000) of Divislon 3 oi the Business end Pmfessions Code) or that he or she is eaempt thereFrom and the basis tor the alleged exemption. Any violation of Section 7031.5 by any epplicant for a pertnit sub�ects the epplicant to e civil penalry of not more than tive hundretl dollare ($500).): ❑ I, as owner of the properry, or my employees with wages as their sole wmpensation, WILL DO THE WORK, and the structure is not intentletl or oltered tor sale (Sec. 7044, Business and Professions Cotle: The Contrac�ors License Law tices not epply to an owner ot property who builds or improves thereon, antl who does such work himself or herselt or Ihrough his or her own employees, provided Ihat such improvements are not intended or oHeretl for sale. If, howaver, ihe building or Improvement is sold within one year ol completion, the owner-builder will have ihe burden of proving that he or she did not build or improve tor purpose of sale.). � ❑ I, as owner oi the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business and Professions Code: 7Tie conirectors Llcense Lew does not eppty to an owner of properry who builds or impmves thereon, end who contrects tor such pmlea with a conirector(s) license pursuam to the Contractors License Laws.). ❑ I am exempt untler sec. Signature: Owner ID ventied by drivers license. ❑ Yes ❑ No Business end Pmfessions Coda tor this reason: Verification ot Ownership by (rype ot document, i.e. � properry tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMR CER7IFICA710N: Dnvers License No. oate: Expires: ❑ I hereby certity ihat no excavation tive (5) or more feet in tlep�h into which a person is required to descend, will be made in connection with work euthorizad by this permit, and that no building siructure, scaHolding, falsework, or demolition or dismantling thereof, will be more ihan thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Calilomla Adminisire�ive Code). ❑ As ownar-builtler, I will not employ anyone to do work whic� would require e permit from the Division of Industrial Sefery, as noted ebove, unless such person has e permit ta do such work from t�e division. Signature: Date: Division ot Indusirial Safery Pertnit Number: CERf1FlCATE OF COMPLIANCE AND AUTHORVJITON OF ENTRY: I certiy untler penalry oi perjury Ihat I have reatl this application end state ihat the intortnetion given is correc�. I egree to comply wilh all steta laws and ciry ortlinances relating to building construction, and authonze representatives of Ihe Clry of Costa Mesa to enter upon the ebove-described property for inspection puryoses. I agree noi to occupy or allow occupancy of any 6uilding authorized by this permit until finel inspection. COpE1. INSPECTIONTYPE � INfI71RL5 1816 Fi:etl System Final Fire Prevention 1266 Pool Spa Final 200 Final Ra-Rooi 207 Final BIaWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition Cn -da -��5`� oate CODE I INSPECTION TYPE 206 Final Mechanical 20B Final Plumbing 270 Final Electncal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Finel Builtling/Occupancy reiE 1� Y �� VlClfll[Y: AIIHI:FitUIiHKHlit65UNKVVM Parcel Number: 42252117 npp�icant SMITH, ZACK Address: 1048 IRVINE AVE #489 - NEWPORT BEACH, CA Owner: HADASH, KIMBERLY Address 383 MONTE VISTA AVE #C COSTA MESA, CA Contrector: OWNER-BUI LDER Address: Arch : Address: Zip: Phone: License: �� DEMOLITION OF EXISTING 1-CAR ATTACHED GAF Plan Check: Permit: , SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $38.75 $0.50 $0.00 $0.00 $0.00 $39.25 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING ezistinq: o NOTES: Rear 0- 0 Rear 0- 0 Required: 0 (949) 631-2336 92660 (949) 642-2572 92627 ■ Eng: Address: 155uetl: 1 Z%16/ZUUU ISSUED BY: S�- -Fr �� Phone: License: JYt Vh F'tKMll- , . -� � & 200 SQ FT SUNROOM AT.TACHED TO REAR OF HOUSE. FEESUMMARY LeR 0- 0 Lek 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: - r. . . � /; Right -.�0-0�'� . � Right . �0-0 - - � EXPI I� � D �a� o; � _ -�� . ° �� $i,000'oo $1,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for ihe work authorized under Ihis permit �o be considered legal, such work must comply wi[h all applicable codes, and all required inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 I 244fi-4fi (N00) WORKERS' COMPENSATION DECLARATION: � I hereby afrirm unaer penalry oi Oerjury one oi ihe following tleclarations: . ❑ I have and will maintain a cenificete at cansent to setl-Insure for workere' compensation, as provitled tor by sedion 3700 oi the Lebor Code, tor the perfortnenca of the work for which this pertnit is i55ueC. ❑ I have enG vrill maintain workers' cwnpensatlon insurance, es required by section 3700 oi the Labor Code, for ihe peAortnance of the work for which this pertnit is issued. My workers' compensation Insurenca carner and policy number are: Carrier: ' Policy Number (Tbis section need not be completed i! the permif is velued et one huntlretl dollars ($f 00J or less.) ❑ I certify that in the peAormance of the work for which this permit is issuetl, I shall not employ any person in eny manner so es to become subject lo ihe workere' compensation laws ot Califomia, end egree [hat it I should become sub�ect to the workers' compensatlon provisions ot Section 3700 oi ihe Labor Cotle, I shall fort�with comply wiih �he59 D�Ovi5ion5. - Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVEfUGE IS UNLAWFUL AND SHALL SU&IEGT AN EMPLOYER TO CRIMINAL PENA�TIES AND GVIL FINES UP TOONE MUN�RED hKKISAND DOLLARE �E100,000), IN ADORION TO THE COST OF COMPENSATION, DAAKGES AS PFiOVIDED WR IN SECTION 310fi OF THE LABOR CODE, IPREREST, ANO ATTORNE`fS FEES. LICENSED CONTRACTORS DECIARATION: I hereby attirm Ihat I am licensed untler provisions ot Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in tull force antl eNect. Lic. M Class q CoNracbfs Signawre: Date: CONS7RUC710N LENDING AGENCY: ❑ I hereby attirm that there is a constmction lending agency tor ihe peAortnance of ihe work for which this Dermit is issued. (Sec. 3097, Civil Code). l»ndels Name: LendeYs Atltlress: Signature: Data: OWNER-BUILDER DECLARATIONS: I hereby attirm Ihat under penalry of perjury �hat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7�31.5, Business and Professlons Code: Any city or counry which requires e permit to construct alter, improve, demolish, or repair any siructure, prior to its issuance, elso requires the epplicant lor such permit to lile a signed stetement Ihat he or she Is licensetl pursuant to Ihe provisions of the Contracmrs License Lew (Chapter 9(wmmencing with Section 7000) of Division 3 of the Business and Professions Code) or that ha or she is e:empi t�erefrom and the basis lor the allegetl exemption. Any violation oi Section 7037.5 by any epplicaN for a pertnit subjects ihe applicant to a civil penalry of nm more than five huntlretl dollars (5500).): ❑ I, as owner of Ihe Droperty, or my employees with wages as their sole compensation, WILL DO 7HE WORK, and the swcWre is not intended or otteretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Law dces not apply to an owner of properry who builds or improves theraon, antl who tloes such work himsetl or hersell or �hrough his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the builtling or improvement is sold wit�in one year ol completion, the ownerbuilder will have the burtlen of Drodn91hat he or she did not build or improve tor purpose of sale.). ❑ I, as owner oi ihe property, am EXCLUSIVELV CON7RAC71NG WI7H LICENSED CONTAACTORS to construct the project (Sec. 7044, Business ana Professions Code: The wntrectars License Law tloes not epply to an owner oi pmperty who builds or Improves Ihereon, antl who coniracis for such projed with a comractor(s) license pursuant to the Contractors Licensa Laws.). ❑ I am e:empt untler sea eusiness and Professions Code tor this reason: y Signature: �/�p q� � .� Date: �.Z �a�- �g ' Owner ID verifi96 by dnvers license. ❑ Ves ❑ No Driver's License No. } Expires: Q�/' 0� Veritication of Ownership by (rype ol tlocumem, i.e. - property tex bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � I hereby cenify ihat no eacavation five (5) or more teet in depth into which a person is requiretl to descend, will ba matle in wnnecllon with work euthodzed by this pertnit, and that no building strudure, scaflolding, talsework, or demdition or dismaniling ihereof, will be mora Ihan thirty-siz (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Calilamia Administrativa Cade). ❑ As owner-builder, I will not employ anyone m tlo work which would require e pertnit fmm the Division of Indusinal Sefery, es noted ebove, unless such person hes e pertnit to tlo such work irom the division. Signeture: Date: Division ot Industnal Safery Permit Number: CERTIFlCATE OF COMPIJANCE AND AUTHORVA710N OF ENTTiY:�l.certify untler penalry ot perjury �hat 1 have read Ihis application and state that the iniormation given is correct. I agree to comply with all stata laws entl ciry ortlinances rela'ting Ib builtling construction, and authorize representatives oi ihe Ciry of Casta Mesa to enler upon Ihe eDove-described property for inspection purposes. I agree not to occupy or allow occupancy ot eny building authonzed by this permit until final inspection. � I And�Or A Ihonzed Applicant CpDE �. INSPECTIONTYPE �¢, �$ 1616 Fiaed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Root 201 Final BIocWReiaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition LOpE I INSPECTION TYPE 206 Final Mechaniwl 208 Final Plumbing 210 Final Electrical 212 Final Flre Prevention 220 Final Planning Approval 222 Final Site 250 Final BuilUing/Occupancy �g �� DECLARATION OF AUTHORITV FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS I � Street Address: � �% � 1. I(we), �� rn l�j f� �'. I,�'� f 6/CE.f� referenced real property, and that I(we) hereby authorize: Name: z i�L K S M L%/� Street Address: _�� `�� Z��'�� Fi�'c- � y� c�r,: v4.-�aal�r (�ik/�cr� to obtain permits in my behalf, as owner/builder, for I� at the above referenced property. Bldg. Permit # This Permit # C OS�� Mk-si} �a� � d p Number: declare that I am the Owner of Title of the above TelephoneNumber. y�y-6j/_�3} 5e State: C''T Zip: 9:� �c' �o C� Mo J� G 2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as requiretl by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. I 4. I agree to indemnify and hold the City of Costa Mesa and it§ employees or officers harmless from any claim resulting in damage or personal injury to myself or any other paRies as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is Executed this � S' day of `l% E C'E"� �i�i 2 0779-46 (rev.11/00) Print Name: ��`L and correct. 20� , at ��579� ^'�45�T , California. G. _ Date: I I C�� O I Note: This author'¢ation does not grant authorv_ation to perfortn ihe work as owner, it solely provides for limited power of attomey to secure ttiis permit in any behalf. Tuesday, December 26, 2000 City of Costa Mesa 77 Fair Drive Costa Mesa, CA 92626 Kimberly Hadash 909 Evergreen PL Costa Mesa, CA 92627 To Whom It May Concern: I am requesting a demolition permit for the and sunroom that flood. No person is curre that I will pursure construction for a new g� days or sooner per the date of this letter. Kimberly Hadash kYi ,� �� e,�- �OGun �d ,�'1 � �c.ta h,o �c� c�.n�--� ��'fl G,l-,G� l Gi � ��''�' ,l �ose of removing a non-permitted one caz gazage residing at the above listed address. I promise and that completion of said project will be in 80 ��(iil"L��' �I <�GL,L�f l�J� u� ' / ; f�-t/Y)'LL �J T �-�C��Ce' �'�' i��.� D� /� S0. . COAST AIR QUALITY MANAGENI� .'��'DISTRICT NOTIFICATION OF DEMOLITION OR ASBESTOS REMOVAL 21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000 MAIL FORM AND FEE TO SCA�MD, ASBESTOS NOTIFICATIONS, FILE # 55641, LOS ANGELES CA 900745641 AQ'. . _ MD USE ONCY ;, �, a� �$CREEN BY ,; , . ;RECENED ' POSTMARK "'4 ?i',' "ENTERED BY :- �" -.NOTIFICATION , .�.,..,., :_ _........_ _.. ._. ., � �,�o� --..� �,... _:. ..._„ . ._•. � .. � CO..,.. . __, ..�_. 4 _.. �,= >__ MPLEfED BY �-SM ('�.f� k�� %t�j� COMPANY � ' PHONE �)l��_ (� y�-a � a � DATE /�—(({-c';C' CHECK� FEE$ I PROJECT'� NOTIFICATION TYPE WGINAL Rension Dares f Rension Ort{eR (highlight) CnNceuanoN PROJECT TYPB � E.MOlR10Nj ORCERED DEMOLITION I RENOVATION (fErtlOVal) ENERGENCY REMOVAL PLANNED RENO (dMUBI) SRE INFORMATION I. SITE NAME siTe Aoo�ss � c 5 k i; ��<6r.�C �� i' L c�T�' C � 5 i r} n� k 5/� STATE C� DESGRIBE WORK LOCATION � AR ��}�j�1 D SJ �% �0 � BUILDINGSIZE(SQF'f) j{�fl Syt h i NUMBEROFFLOORS BLDG PR10R / PRESENT USE Co�+eacv� HQSPRAL iNous SITEOWNER V\SMriKYil j Nvi��ASJ-i CITY �� j j�} �'1ti S f} STATE �/�- ZIP �1.�(,3� REQUIRED BUILDING ASBES70S YES NO ASHE: INFORMATION PRESENT? SURVI PROJECT DATES START / � _T(o ASBESTOSAMOUNTTOBE FRIABLE REMtl�/ED (in square feet) ASBESTOS REMOVEDFROM SURFACES DESCRIBE TYPE 8 AMOUNT OF ACOUSTIC CEfLING LINOLEUM ASBESTOS (in square feet) FLOOR TILES (VA� DRY WALL PLASTER TR4NSITE R001 CONTRACTOR INFORMATION I CSLB UCENSE r ��, y�� NAME j�rti,p7;�'�� —if4nF�5� - cirr ��57� �nk5l.�- srarc �� ziP y�� WASTE TRANSPORTER #1 ADDRESS ��n STATE ZIP CROSSSTREET ihuN.�.�e�y'/� va %G��% couN�v C�cl�6/c.. �{ BUILDINGAGE(YEARS)c��k� NUMBEROFDWELLINGUNITS OfhOf OFFlCE PUBUCBLDG. HOUSE j SCHOOI SHIP UNNICOLLEGE ADDRESS G��Cj f�J �.l�i�f�� L CONTACT '�i �✓1'.'-}l,�L /�; Z�}LG� PHONE �J � j�'-<r l/�. � j / ES NO ASBESTOS YES � BUILDING TO BE �5 NO REMOVED? DEMOLISHED? END ��_3;� WORK SHIFT (aMpm) %:GC' ' S v' ASS I CLASS II TOTAL REMOVED(add row) PIPES COMPONENTS FlRE PROOFING DUCTING STUCCO MASTIC OTHER (describe) OSHA REG � ApMDIDn zess y��, r'� r G: r;�,�-� i'L SUPVR PHONE )FILL w f�Si¢ !Y1�„��{M/.I tESS �`f�( a� �.� a�� f.�}L i��,� CSrY.LI.T Cr'S% (�J��- M.�i��r STATe ��r� ZIP Asbe5ros Demolition/Renovation Notifcation Form REV 950607 I Page 7 of 2 Fomu, instrurons, ard Ne Rule 1403 mn be ohtai�ed from AQMD web site http://www.aqmd.gov : . � . .sca,aMo r� MA1L ORIGINALTO SC. yypSiE TRANSPORTER #Z ADDRES3 ��Ty STATE 'CATION OF ASBESTOS N( � CON�ROLS: �ESCRIBE WORK PR4CTICES AND CONTROLS 70 BE Fa asbestos removals drde the combination of Rule 1403 procedures used. ASBESTOS DETECTION PROCEDURE: CIRCLE THE PROCEDURES AND Bulk Sampling, Inspection, Survey, PLM, PCM, TEM, Assumed as As6estas, C FOR DEMOLITIONS GIVE THE COMPANY NAME AND DATES OF FOR ORDERED DEMOLlTION SEND A COPY OF THE ORDER AND GIVE AUTHORIZING PERSON: DATE OF ORDER' FOR EMERGENCY ASBESTOS REMOVAL GivE THE NaME AND atiONE EMERGENCY AND DESCRIBE THE SUDDEN, UNEYPECTED EVENT: EXPUIIN HOW THE eVEM WOULD CAUSE UNSAFE CONDfTiONS, �ICONTINGENCY PLAN: �ESCRIBE ACTIONS AND PROCE�URES TO BE FC ASBESTOS MATERIAL BECOME CRUMBLE^D, PULVERIZER OR REDUCED TO LUST�� N1✓cSA � �^�� /'i�1Mp 1Mv1�Jiui TRAINING CERTIFICATION: I Certify that art individual trained in the provisions evidence that the required training has been aaomplished by this person will be Company Name Print name of owner/operator Signature � I INFORMATION CERTIFICATION: I certify that the above infortnation is correct i-��M/z. cwNf'1� �rn�S�E,Zc�y HA Company Name Print name of owner/operator Signature o No6fra6ons are not accepted without the required asbesros fee (AQMD Rule Piease make checks payable to'SCAQMD'. Fees are per notification, not rel COMMERCIAL DEMOLITIONIRENOVATION FROM 100 T01,000 SQUARE FEET FROM 1,001 TO 5,000 SaUARE FE�'f FROM 5,001 TO 10,�00 SQUARE FEET MORE TN�AN 10,000 SQUARE FEET DEMOLITION OF LESS THAN 100 SO FT 5 2620 5 80.10 5187.10 4294.00 52620 )N OR ASBESTC , FILE # 55641, LOS . WASTESTORAGESRE ADDRESS MOVAL .LES CA 900745641 CITY STATE ZIP AT TY,E RENOVATION AND DEMOIJTION SITE. Procedure # t, 2, 3, 4, 5 or ONer. 4 and 5 submit plans for AQMD prior approval. YTICAL METHODS USED TO DEfERMINE ASBESTOS IN THE BUILDING: e Other. REMOVAL:. �ENCY NAME & PHONE # TRLE DATE ORDERED TO BEGIN: OF THE PERSON DECLARINGlAUTHORIZING iHE EMERGENCY, OATE AN� HOUR OF OR UNREASONABLE FINANCIAL BUROEN: IF UND(PECTED ASBE�TOS IS FOUND DURING DEMOLRION OR NONFRIABLE �✓ c:.� yu.. .v:. n; 1 �� c-v� ,, �7%�c G.�'T7 c,� �k.. C/'k.•!z /iaJ �a: �2�NLCYT6.� _ regulation AQMO Rule 1403 and NESHAP will be on site dunng the removal and 3ilable for inspection during nortnal business hours. Tittle o(�6vinedope2tor Date la-/c�-cb Date Removals of less than t square feet are ecempt from no6ficaVon and fees. e, and vary accordi o the asbestos amount to be removed. Fees are as follows: �� RESIDENTIAL REMOVALS ' 26.20 REVISION OF NOTIFICATION � 10.60 CANCEUATION OF NOTIFICATION $ 0.0 PRQCEDURE40RSPLANS 5294.�� RETURNED CHECK CHARGE 5 26.00 SPECIALHANDIINGFe� g 25.40 ATTENTION: Keep a copy of your notification. State law requires that you provide a copy of the demolition no6fication to Buiiding and Safety before issuance of a demoliton pertnit. For questions call 909-396-2336. For your convenience pfease mail the form and fe= and do nat hand carty to A�MD. MAIL FORM AND FEE T0: SCAQMD, ASBESTOS NOTlFfCATIONS, FILE # 7ELEPHONE :(909) 39G2336 FAX: (909) 3963342 Asbestos D� foms. instrucJons, and the Rule 7403 nn be obtained from ApMD weh site. http:��l LOS ANGELES CA 900T45641 /Renova6on Notification rorm REV 990fi01 .aqmd.gov Page 2 of 2 Monday, March 19, 2001 Kimberly Hadash 909 Evergreen PL., Costa Mesa, CA 92627 (949)642-2572 City of Costa Mesa 77 Fair Drive Costa Mesa, CA 92626 RE: 909 Evergreen Place renovation To Whom It May Concern: I am currently behind schedule in builc 909 Evergreen Place. I still have not n renovate the home with new molding repairs. Please allow 90 days from the for city approval and construction of a Sincerely, ,. AGG erl Hadash KH a new garage at the property located at d into the residence as I continue to ; fence repair, and other miscellaneous ; of this letter to provide enough time garage. Tuesday, December 26, 2000 City of Costa Mesa 77 Fair Drive Costa Mesa, CA 92626 Kimberly Hadash 909 Evergreen PL Costa Mesa, CA 92627 To Whom It May Concern: I am requesting a demolition permit for the and sunroom that flood. No person is curre: that I will pursure construction for a new ga days or sooner per the date of this letter. Kimberly Hadash kh ,jZ �,, �e�, �OGcur'd � ,y, ��y,,o �t�vw� � ./�t G�I.G�'� �� :�.2. G � G�t,[lc. � Vt,��l� '�'i `+ �! . Le 3 l,�.3 3� iose of removing a non-permitted one car garage residing at the above listed address. I promise and that completion of said project will be in 80 d >ii(/(�'�' I l�IGC.��U �, `�Cin.%��,c.2, �t,vrn,c.6� •� � ��-(,C,�' �e., �,2e,t. Q,� , �� __� __• - �-- � --= �.--..-- I 1 � .� .� � � ' MASTER BDR�d � za, ire i ; f ; � � � � --- —;- ` -- -- j- ; ii i�' � 1 j ��I i"'.. .. � I i GAFtAGE I I Ij ; ZO' � 208 i � a � ii � !j � � I i �' i ! i; -. •: � s_ �i' i I':j i� �I ;'I I '�.I ,,; :I �: �eoee F-z�'1.___,_'c— __:�z�= �:-_�'_—___.____.____ �°"_______—"_. r -�--� . a Kims Plan Draft 9 ,. i i _ �,--- --�._.�.,_. �ao CLCF.,[! >r.e• � � I_. ' ..... _� cxrar� BEDROOM � e ire.�n I _1. � _ � --- � � �.tr;a�� r� � j — ,., — � ; .::. BATH�� ,p 5� v B'11 n— � �.._." � ".g'__'y —� ^�s � I � ,� I ��o�a��'j" n- � , —i----�--__ � i�..l ; Ji ' DINING � "- ''—� irn,n•a f! I . . , M ° _�'�..:i}:' K9 .��a7N S I'ii•.') ` $�OP1i1B —� e. ° dinning �,� _ � ' . _ room --� ---- �=—..-=—��` --- t-- — "cwo �ao _. . . LIVING AREA ' tcaz��.w .-._s— .. r— .-ae . __e'_' -- ��-------- --T---�-� en --�— a'-- _'____ ____ _._____ ___....�_.___'__._.______'._____..__.'_ � � i�� ia� � 64 � � GARAGE � —�'/ �I'� - - - - - - =42-sq tt - •- - - - -�^-�—�� 33a2 �? r eose I I 5'4=� I��'�I�-- ias— �� i BED 5'� h 3lGZ �, � Fred Stonestreet and Kathy Orourice Residence 909 Evergreen P�ace Costa Mesa � E � FREDS ROOM 140 sq tt 13•y � 610 dM MASTER BDRM iso�tt I � 13iq h � LOSET ��j iawn �� ,,,�� z� � ,,, „ � � �`= � � BATH � �92sqrt �- � ,� -,.� �- I Z3 ' I `�`-' h 4 _ �� ,�, II !� � il I I DINING 293 sq fl �o. � ------=+ wonEssaewiuxc: �'1VNb.5TRr.r.i, FREL A OWNEA5IUYEIfIOqWN: V'ItVURXt.� KAitiL�r.hi S A0°"��' 9U9 EVERGREEN YL �► CuSTA MESA,CA 52027 APYL.IIAIIINfi ADDIIE53: � yl ARCXRECT Ofl �NFEX: 41CIL OP ENG'S AOOflE55: sUNDANCE ROGFING CO ca+m�crarswue: 1751 MIKAMAR LR � ca�rn�croRswuw�c �ALHVA l.A I�ODHE53 J L b b 1 uNr: � uc. r�o.: uxr i719)o73-ouo3 �ia�by uc xo.: uxr: LICENSEO COMFACTOPS �ECLAN1ilON: I heregb�yyefl'rm undm panely d pp�arj�ury Mel I em liceneed uMer prwivme d Cheqx 9 (canmemiM ��` �1)0001 d Division 3 d the l. �awq� Vmleavona / i�d�vd�m m �n /`) & CRY 11C. NO.: 1 1 LIF C1A55: � NO.: �� ^ oma: / �' .��% ` � % c��mor �////('�/iN.�'S' ao �-✓� OWNEN BUILDEN OECIARATION: I hneby effirtn uMer penely d per'ryry tlw I am ezemq hom iM CW�eea+ lioeme lew lor Iha Idbwvq renvon (�� ]031.5 &niims eM Prdasvom Code: A�ry ciy a oouny whiN epu'vea e pemiil lo cmaWcl. Mw. impove. 'emoloh, or repei eiry struclure, prior io as aeuence, e6o requirea tha epplicent for wch peimil lo file a mgirod sbtemeM Ihet he «eM licenaetl punuenl lo IM O��w�a d ihe Canvmon Lixnu Lew �Chepter e(commeiwi�p vrilh Seaion 1000) d Diveion 3 d iM aimm ard Rdav'iom Godal « ihm he or eM o avemp IMrelrom eM tM Eea la tln elb9� awemqion. Iury violetion d Swion ]W 1.5 by eny eppliceni la e permn euEjeds �ha epd�� lo e avil penelry d �wl mors Ihen INe huMred Edlen �5500��. ❑"�. av ownar d iha wooenr o. nn amdweee wvn waem ec �nai ede comv�smion. wi�� do u�e wwx. ena ine ewnure c na uHendee a artmed I« eeb (Seetbn 1a4. Busimea eM PeWesaona Cade: The CwNretlon Lieeme lewtlom M xpplyto en oxmr d qopeity .no waes or mv� inereo�. �d.no eoas sum wonc nimsarc or nen.n «m,o�an n: w n�. o..,� emWwae+, w%+aea mm.uan impmvemanM era nd iMeMed «oHered la sele. tl, however, ihe buiNirq a inprovameeu ia add wnhin oro yeer d mmpblun, IAe owror-0uiNm xill heve �M buNen d proviiq M« she dk ewi buiM a impo.e la IM qnpme d vebl. � I. ea oxiwr d tM O�OaM. em axdwiveN �Iredinp wilh IicenseE wntrectas to mnstrutl Ne pmjed (Sedion ]014. Bueimea uM Pm/eaions coCa: TM Con�recwe Isenm lew tlo» �wl eDdY lo en owiw a qopem xM Euiltls « unWa'm Ine�ean ud Mn wnleeels 1« m�di pqws wnh e wMrmw(s) lieensed Wrsuent to tM Cont�mae Lieerme lewl. � I em eaempt uiMer Section: B. 8 P.C., for thie reeaon: Dete: �wner: i eo narenr �anM �nm i em ewme a e�e um�n�,d m. rea��e�e d cw�b He.nn e�a sme�r coaa see�. zzws, zssx�, .�d 25510. eM iMt 1 a ury Mure buitli�q omipenl will / WI M(dreb one) �aed to canply wY� eek 5ela oodm eM IM rtqui�mne� br eperm�IwoonavuctianamoE�imtionhamtheA'v e�iy arepemamDimnd.ReeidaMialmnevuaonappfratiomarexemptlromlheee pfWll10119. Deie: ApplicenC WONKEN'SCOMPENSATION.UKLAP�TION:.IherWyalf �uderpa�eAydpe�jurywwWthabtlow'vq0stlere�bro: ❑ I heve end wil meintem e ceMicele d coneenl b eeM-imure Iw workers compeneetian, m paitled Iw by Sedion 3]00 d ihe Lebor code, �« ine penormence m ine wak �« w:cn mi, y,rmn u u,u,a. � I heva vM xil maiman warkeie' oompeneelion imurerce, m raquiroE by Smim 3)OD d tM leEa COEa. br IM pa�ormenw W IM work Iw wTich Ihie peimn ie iaeued. My w«ken' campeneetion ineurarica wner eM poliry number ere: Cemer: Pd'cyNumber: ' (Thi ivn rreed nd ba canpleteE % tM parm] is hr wre huMred dd/ers /5100/ a bm.1 i cenN �nei in me veAor��ce a ma wax tor wnen mm ro� A.�ad. i. a�Wnf y{nen�r ao ro �o w�' bacame aubl� �a �� re' campenae�ion lewe bmie, entl e N tl I o�ild b m jaMo �M warken' compa��n9vtion pm+i—su]m d^G,� 3)OU d tM C ffoTh ' mp�y ii we pro 0 Data: /v `�� / ` / � Av ' anc Wamliq: F�llun ro ueun woilrwi rorr�owwtlon eovorp� l� unl�wNl, mtlWll a�b/�et � w�olorir ro eNnYnl pwWtlq uM e/vll Ilnu up ro on� hu�tlrod eMus�nd tlo1Hn fStOq000A In eJtlltlon ro fM ewt ol rompxu�trory Minp�a u povltlM br In Sxtlon 3106 0l fhs Lebor COW, InNre�f, and ettomsy's /w. GONSTHUCTOH LENDINO AGENCY: I Mmb/ elfiim urder perely d parNN Ihet �hca n a mnatrudion bMiip epaMy for tM paAormence ol iha vrork lor whi h tha parme ie esuaE (Sedan 309], Civ. C�. LENDEF'S NAME: LENOEH'S RDDflE34: I ceniN �hm I eM 9�eIB IBM above iMwme�ion o canetl. I e9rta lo oomdY �il� all tl1Y enE oou�T/ adi� � eutMrrze reqeeenteirvea d �hie ary ro emer upon �he abwa-mentioneE o�M om,: /O ;27�i7 (5151-48.WP) Whno-BuilAvp 8 Seleiy; Orae�le: Cenery-AppSrant: Pink-Hevenue; OdEenro�Aeveveor CTTY OF CGSTA MESA - BU3LuZNv PEkMIi Yt.iCM NU: a uu� u YERMIZ NU: B C7N541N YLAN CHECK N��: N �uv'f; ri SUl'Y: IV lVNSIt(U1.71VN TYk't: 1'Et(MIT lYY�: J1Ft Y�t(YlJSE: Vltl JUB LESCnIPIZUN : I'i� 6 RERGGF 15"vGSF W/ASPHAL'I SHIN�LtS Su Y'L; L,5"v0 CiAIM 'vAL'UE: 2,506.00 CALC-VALUE: 2,5"v0."v0 GROUP GCi:: i't-3 /U-1 CuMMENTS: kERuGF 1��"v5F kESIUENCE iS/CGMP ` if ie i'r ie �w iF i'r ii �lE �e iF if ie iE iE ih ii ih iE ip �le ie±e'se ii iF �k iF iE iF ie iF iF if ve y'r ie iF iE ie iF iF iF iF �7't �lE iE iE ie ii ie ie iF �e ie i'r i' iF ie i2 �e ie iE iE iF iE iF iF ie i'r ie i4 ir ie iiie ii'rf ic ' Z G N I N G k E� u I it E M E N i S 5� 7 b A i: K 5 ------------ MAiN buILLING ---------- --------- ACCESSORY tlUlLUlIVI+ --------- FANT: FT IN REAH• FT IN FRNT: FT IN kc;t�t; Fi Iiv LEFT: FT IN RGHT: FT IN LEFT: FT IN AGHT; FT IN Pt�.AKING REi�: PkOV: Ft1riC't:L: 422521i'i ZNfi: kEF iv0: PLANNIN� NuTES�:? _- J ie i6 it iF iE ie'sF iE iF iE ib ie iE iF i'r.i'r ii je iF x iE iE iE i'v i2 iE ic if iE iE ie iE ie i'r ie i'r ii �lt iE iE i2 ii ii ic iF ii ie ii� ie iiii ii ie ie ie ii if iE'r'r ii iF ii ii� ii i'r ie ie i'a ie �it ie "vE �if iF ii� ie ie i's i'a L n V E�L G P M E N T S E R ti Z i E 5 R E u U l tt E M �. N`,-i 5 i ZuNING APPRG4�.Iir', BY LAZE: - �- &UILuING AFPRUti'nL FtY" : uATE: 7 ' APPLICATIi�N ZSSiIEL BY: uF�TE: IO�� __� ifiiiFiiiii�if3eiiiiiiiiiiiiwiewifieiiifi4xsr�rirsr�e7e7rxsi'xx%xww'ie�t�tx�t��w +'wxx w "TieiFwi'rir'seirwiei'e xx�ifi' LEGALIZA7IUN:N F E E S U M M A R Y 57kUCTiifiAI; StiGMEN7:Y bLUG PMi PiiJMBING ELY.C�11tIC ME�fiAiVIC PEkMIT 74.75 FLAN riRE SMTPii2t5 �R.�ING .5"v SMIP i NGN-iir.5 buILLING�-uIV-> PcRMIT ZSSUE PLAN-CiiECK IuIAi, rAIu LliE TorALs----> �s.zs o.00 o.00 �s.zs ��.�s ,00 kEVENUE LIVISZGN TUTALS--� CULi,EC'IEL: 7�.25 GVER/SIiOk'f: ."v� bLLG PMT PLUMbING ELfiCTRIC MECHANIC FIRE SMIF/70'I �kAuINi� YLAN-CHECK %4.%5 .�� ii� ic'se ii ii ii iE i'r i? ie ii i2 id ii ie ie ie it ie ii� ii ii ie iP ie i'r ii ii� ii� ii ie ie ii iP ic ii iF ic-k ie ii ie ii ic ie ie ie ie iF ie ie ie ii iE iE ie ii iE if iE i'r iF i"r iE ii� ie �iE iF i'r i'r •k iE iE iF ieif ii iF ie I N L I ti i L U A L r r, r. t't k E A K u G W N �IYYY. �lY L t S C R 1 Y 1 I V N � uNiT I.VS�I �1V1AL I.VSl SFR 25uu RERt7UF �tY vAL"uE nESILENTIAL NUZ�1vE 1,Ov 2,Suv.-u'v �,NL uF Y tY.S IB-27-1997lB9:18 A19/f75.Z5 RCPTN:81-8d14460 PERMIT=085418 . '� - . � CONSTHUCTION ANDPLANNING' POO. SPA , APPROVALS Permit # � •Date Inspeitor AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or_Pole , ,' S2.� Pool & Equipment Location - � 2. Soil Pipe�Undrgrnd. ' - � - . 53. Steei Reinforcement � i =.3=;Electrical Conduit Utility-Undrgmd. " 54. Forms � ,ti � - _ -4. Efectrical Condui(=Undrgrnd. - � �55. Electricai Bonding �" _. , . ; .5:r,Steel Feinforcement � � � 56. Rough Plumbing & Pressure Test ''r ' ': 6" Electrical UFER�`Grnd. � - - 57. APPROVAL TO COVER�GUNITE . � � ': �. ,7 �Footings ' � - " � 58. Eleciriral Condui[-Undrgr,nd. � � :8. Foundation �� a� . �. - . 59. Gas Pipe, � Undrgmd., Test � � � , �!'.`9.'Water Pipe-Undrgrnd� � ' ' ' 60. Backwash��Lines,�P�Trap; �7�UndYgrnd: �� :70. Struciura� Floor Svstem � �61. APPROVAL TO.DECK �� • 11. Property Sewer Line & !iouse Connection . 62: Backwash & �Receptor:Firial � � '. � 12. S,ewer Cap � _ < 63. Heater & Vent-Final � � " 13. Roof Dra�ns ' �64. Plumbing System � Final �, 14. Rough Plum6ing --,, • : 65. Electrica6Finai � " ' � 15. Rough Electricai-G�nduit 1' ��. 'r 66: Solar�SYstem-Fina� �• � � . 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�FINR� • �19. Rougti Heating & Air Conditionin9 � ' --- � FIRE DEPT.�REQUIREMENT - - -� � �� _ � � _ � � +, ,-� 1� -;�xi s; _ t . 20.rRough Factoiy F�ireplace ' T � ,� ? '� � ."`'� qp�OVhtLS � eermit #`�� " ° t.. �- r 21. Duas, in Scruauis �•• •• ; _ � -++ � 7Q:+ Underg7o,ynd7�ydro k i 22. /Ducts. Yentilatin . ' '- • J � - � �" ` ` 9. � ,.-. � j ;;� 71. Prodi�ct,'Fiping'QGas a�0i1 23.: Gas,Pip�Rough &.7est r- ., � t:� 72. Underglound�FlLs++ � '� 24.^RoofFraming ?' '-"' "" �:� .� _Y 73. Undergmd.Siqi2geTankOGas OOiI 25. iioof Slieathing ;� � %� /�_TO_Q'j ^�(� zq- Overhead HydFo J t (y G,Z vr 26.=�T-Bar Ceiling (Structuraq & Mo2ocoat ' �� `t" '.751 Dr ChemicalJ�' " � � � -1 k K .� '�1 �I f Y ..N.J ' `fi 27..;Frame and F,lashing zi . >� �y j: 76� Dry Sxandpipe � R '� - � . . '.� � 28. Lathing�& Siding- � = _ �, ti � "� "� "tti, '7.7. FIXED',$�(ST�a9 FINAL, � " 29. Insuiation �� - �• �� I I �: 28. FIRE PREV. F77UAL �'' -. �Y '' 30. Drywalf Nailing �'' ` � � �� r '� kiEAL?H DEYT' REQUSREMENT 31. Plaster Browp Cqat �- '-. : e,^ ! � �ti n 79. FINAL ifs{SPEC�ION i: �- � _ -� 32yElectri�l Power iJ�eter�Final '' " � 1 '; '� S0. FOOD CERTIF'I�ATE"IS�SUE� _ y .. , . . � .�1 I '� i: Ty I I �}� Zi T� �l 7 L. .} T 33.`'Final �ectcic -. � S F; i � �e ,Notes: . ;•�q . _ _ ��,n 34.-,Final Heacing & Ai+ Conditioninq `� � ' 1 + •z i ; = i: . � ' , �- . 'r •v _� _:.r x �r 35. Finai Gbs Pipe�TesE y' � { _ j ! fy � ' `�� , j = r �` . - 36. Hood or Canopy i� � V ' � - �. � ' ' 'i .� �: '� � ti - r �� 1 . n .� _ � n - 37.;;Pinal Factory Firepla'ce= ;'� _' � � 4: ' E� ,;: - 38. FirtAI Plumbing > � -- 4 � � �t _ = ,r � � � 39. Water Service-Fina� _ ' ` � � � 'h � . -.. � r _ � ' k� ( I ' 1 . t. 40. Gas Servjce Final .+, F,; { 1i _��;� .�w = �. i e •u :: ^ 47. Solar pomeS'ticFinal r . ` - � � iF „ :y.;' .� K , � 42'Backtlow Prevente�. � � � Ct �� • � x� .r+ � • k • - 43. Backfiow Irngation, � ' � ' �'� : ' � -, V �. � .,44. Landscape Irrigation System� ,t�; r ,. _ + ^ i +z v r = ;, . i, : � � i'r r =45:�Sound Attenuatio� - ... �� `- ', ,� ,K � .� .-''; '� ' R J '. " 'ti * -46...Handicap��Regulations ` - - •r _�v 5 . - i � -, -, 97�.-FINAL STRUCTURE & BUlLDING 1 k�-3-� 7 �yL,,/ �'' ' ,- � ' ' y C 48.=FINAL PLANNING . . � ' ` � � - • . I �� - �� ` .� A =49."Elearic Release to'Edison � ' �^ ` � '� . �� -, - � � � + - • ' - , . . ,. �=50. Gas Releaie �to: Southern Caliiornia Gas Co •� �� `. - b' � �� - � � • �.- n 51'. CERTIFICATE O�:OCCUPANCY < - .., � - No. Date �op��^+� 9U9 EVERGREEN PL owwexsr+u/eic�wr+: STONESTREET, FRED A dUDPESS Q� ROURKE, KATHLEEN S 909 EC�ERGREEN PL COSTA MESA,CA 92627 - �. �,u�2'woxess: ,�NRECT OX FNfd�ffP: UC. NO.: �xcx. on �e.•s �oonea: mxrw�aars wwe: CONfH�CTORS MYIWO �ooxess llt. NO.: uNr: CITY OF COSTA MESA — HUILDZNG PERMIT �� PERMIT Nu: P 082420 PLAN CHECK NO: N CONSTRUCTION TYPE; l'—N PERMIT TYPE: PLU UM: uxr: LICENSED CONTflACTOPS DECURATION: I hereby eflvm uMm panely d parjury �hel I em Icanaed uMs yo.iuore d Cheqw 9 (commeianp xil� SxYion )000) d pivision J d Ne Budrev enA Pmlwsima Coda. vd mY limrue u in tull taca vM ellea. cm uc. No.: uc. cuss: uc. No.: ' E X P: ome: com.m«: OWNEH BUILDEN DECLANATON: I hareby etfum uMm penelly d pmjury �hm I em exemq Irom iM Comreaaa Licenee Lew la Ne idiow��o �e� (Setlion ]031.5 Buamss eM Pmlesaiona Cade: Riry ciry a caunly MfiiM �epuim e pe'mG �o canahucl. eller, impan. demde�, a repei eny sleuelure, pia b ns'veueMe, aho reyuiree IM eppli'znt lor sueh psimu to fib a aqmd e�emam Mal ho a ehe ie licensed W9uenl lo Iha provisiom d Ihe Lomreaae Licensa Lew �Cheqs B(canme��q xiih Sepion ]000) d D'veion 3 d �he Bueinms eM Prdmeiona Cade� a �hm he n aha ia memp Iherelmm eM IM b�is la �he e11peE exemqion. My vulnion M SeUion 1031.5 by eny eppliunt lor e parmil eubpde IM eppl'rant b e ovil panalry d iwl mas Ihen frva huMred EdWe j5500j). � I, m owner d iM praperry a my empbyeea xih wpee ea thei eole compemelbn, will do ihe work. eM ths a4udure e ial mteMeE a Wared M aeb (Sacibn 1WG. Biniren end Prdeaabm COEe: TM Convedae Licaue Law does not WpIYloan ownerd qopaily wM W ilEa w improvee �heeean, end w1w doee euc� wuA hvneeM a MneR ar iMraqh he a her own empbyeee, povided thal eueh impovemenb ere nd inteided u d1ereE la seb. M. however.IM Wik'uq a'vnp�ovamem ie edd �mhin ma Yev W odnple�ion. Ma owiwrWiNer will heve tM burEen d peoving he or eha dN nd build w improve la Ihe WNoee d ede�. � I, es owner d iM propary, em uduervNy conlreaip xith licemed conlrenae �o conercua the prol� (`�� • Bueir�me eM PMesaions Coda: Tha Ca�tretlwa lieenx lew Eros rwt xOdY b en owew d pW�Y who WJda a'unPwm ihmeon eM who contrectn Iw eutli prqaea with e wmreaor(n) licemed punuent m the Comrea«a Lim law). � i,,,.,m��m«s«��3p7044 e.ar.c..ro�m�„��a E- UIL ER i oda: �- �— o«„a: . i ,anr �nM mm i� aw� a�a �.i.�a ma �.a��..m«�n a c,v«oe H„nn s.�r coe, s,a�. ssws, zssv, �a 255x, ena �net � or.nv Mure buildine «cuo�t win � wm na (dreb one) naee io candY wm aeie swe codm ene ihe �ew'uemena I« � epemiNtameWctianamodifimtionkpn�MAi�enepamemDiaria.RendemelmnnruaunappFatoenerawmqtromthesa oe�e� nvpicem� WOPKEN'S COMPENSFTION �ECLAN�TION: I hereby etfirm_�iMer peneby tl prjuy ar d the blloniiq dWerubu� � I hera eM wil me'u�ten e ceMJicele d mneant io aeM+neure Ior xorken' canpenution, m prmided lor by Sedim 3100 d the Labor com, i« m. o.rt«�. a m. won� �« �n w�a o��ed. ❑ � n.ve end m� meimv� xv�keA• oomo�on iroureMe. m ma��roe M smbn a�ao d me �.m« coe.. �ar me ro�o�� a me work la M�idi Nie permil u wsued. My warkert oompeme�ion imurenca umer ud poliry number ua: c.�,: . Pday NumCec . �inis sxriw, neee rior ne canWeroe � m. ro�. � ro, w. n�,n,ad dwaR rsrool w rm,.l ❑ I cMN �� PM�e d �M wak br which iho peimit ie uaueE. I Mell � employ eiry pmn in em� menner eo m to bewme subjad lo Ihe wwken' companeetion lewa d Celilwnu, vM aprae �hY J I ahouN become aibjea �o tM MvrYero' �w�+� r�ore d seaia, a�ao a ine �mor coae. �.w� �onnwnn comW wnn moea qm;9ims. Dete: Appl'ran: W�mlip: F�INn ro wevn woAsri NI1pOIWt1011 COYNt�p IlW1I]N?III� IIW IIN/I HC�ICf 1l1 M1PIOyN b CIIIMNIOM�lMM IIW croa nr�ss w ro ons nunerse rnow.�w eaw. fsiao,00al, M wn�uon ro ns co,� or mmps�w�ron eem.o.... poMwd ror �n sectlon J106 0l tlro Lebor cotls. Inrxwt, md atlomey', I�u. CONSTNIICTON LENdNO AOENCY: I I�xeW ellum uMx penaly d perjury �hm thare n e mm��uaion kiMiiq apercy br iM �do�� d m..wa m� wn��n mo o�a �s aa�ae csea� xs�. ca. c�. LENOEN'S NAME: LENUEF'S AODNESS: ' I cenily ihet 1 hwa read Nia epplration mE qate IhM Na ebove iMametion o conetl. l qpea lo cpnply wnh dl cey eM munry wdire�ee enE slate lawa mle�ing lo Wildep conslruqion ard hereby eu�hor¢e repmaemetivea d thie by lo enter upon Ihe ebove�maMianed qoparry r«msc�wm�..KA'CITLEF.I�I iJ'ROURF�E : rl _ . ome: `� ��- %t7 White-Buik'vq 8 Setery: Greer�Fle; Ceneiy-A00��: R�k-Revenue: (3oldm�aFAsamsn PERM NO: Y 06242U GOC�T: N SUPP: N PURPOSE: OTH SUB DESCRIPTION : REPAIR SEWER LINE SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC:•R-3 / COMMENTS; X ' 7E 1E 1E iE 1E if iF 3E iE �E jE iE iE �IE iE jE iE �E IE 3E iE �f �E 1E iE �lE �f 1E 9E iE �E iF !F 9E 3ElE iE fE iE iE iF ik iF iE �E if' �E if !E iE 1E iE �f if ff �E iF iE iE fF jF 3f �143E iE iE iE iE �' iE iE iE �t jE IE iE iE �k if Z O N I N G R E Q U I R E M E N T S S E T B A C K S ----------- MAIN BUILDING --------- --- — -- ACCESSORY BUILUING -------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT . IN . LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV; PARCEL; �12252117 ZNE: REF NG: PLANNING Nt�TES> ,, i iE 1f l41ElE �IE iElElE iE iF 1E iE'1ElE iE iE iE k 9E 1E 1E �E 9f iE iF 3E iElE �IE iE iE # iF �)E 1F iE �)E!E iF iE i(- jE �IE iFlf �%�3E iE if' ik iE 1E� iE ff �E iElf if 1f �4 iE iFlE fF � iE iE iElf iF �E �lE iE 1E jE iE 3f �£ D E V E L O P M E N T S E R V 7 C E S'"— R E Q U I R E M E N T S ZONING APPROVEU BY . �L DATE: BUILDING AFPROVEG BY : APPLICATION ISSUED BY: ��+��**�***�****+�*��** LEGALIZATION:N F E E S U M M A R Y BLDG PMT PLUMBING ELECTRIC htECBANIC PERMIT 22.00 25E � .- , •r.,�, ISSUE FEE 22,00 HUILDING—DIL'—> PERMIT ISSUE PL'AN—CHECK TOTALS----> 22.00 22.00 '; 0,00 REVENUE DIC�ISION TOTALS--> COL�ECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC ia,00 DATE: % DATE: ****x*�* � STRUCTURAL EG ENT:N FIRE SMIP/RES GRADING TGTAL PAID UUE 44.00 44,00 .00 A4.00 OC�ER/SHORT: .00 FIRE SMIP/TOT GRADING PLI�N—CHECK iE iE 3E # 3E iE �E iE tf iE � iE iE iE 3E iE jE iF iE iP i(- iF iE iE iE iE iE if iF 1E iE 1E ik iF iE�i(-iE �)E iE 3E 3E iE il� i! iE iE 3E iE iE IF iE iF iE iF iE iF iE 3(-iE �1(-iE if-iE iE it iF iE iE iE �1E iE it �IE iE iE iE 1E iE iE I N D I V I D U A L� F E E B R E A K D O W N .1+ TYPE QTY D E S C R I P T I C��N UNIT COST TOTAL COST PLU 7 SEWER, CONNECI'ION T'O�HDILUING EACH 22.00 27.00 EtdL� OF FEES /I : �lX 84-11-1997/82:56 GM/f44.00 FCPTq:dl-8B04761 PERMIT:082420 ' CONS�C.TION AND PLANNING - -, -. � . . . ,. POOL & . .� Date (nspector � ' Date Inspector APPROVALS Permit # - _ , • APPROVALS , Permit # : 1. Ten��orary Electrical Service or Pole � , . 52. Pool & Equipment Location - " 2. Soil Pipe•Undrgrnd. . � �' .53: Steet Reinfarcement - � � 3. Elettrical Conduit Utility�Undrgrnd. � � �- ' , 54. Forms� - " - 4. Electrical Conduit-Undrgrnd. �� 55. Electrical Bonding �. . � 5. Steel Reinforcement .� - 56. Rough Plumbing & Pressure Test . '"� 6. Electrical UFEfl Grnd. ' , 57. APPflOVAI:-TO COVER�GUNITE • 7. Footings . . �58. Elect�ical Conduit�Undrgrnd. 8. Foundation ' 59. Gas Pipe, t7 Undrgrnd., Tert . 9. Water Pipe�Undrgrnd. ' � � �60.� Backwath Lines, P-Trap, O Undrgrnd. 10. Structural f�oor System � � 61. APPROVAL TO DECK . � . 7 7. Property Sewer Line & Hoase Connection _ . 62: Backwash &�Receptor-Final , - � 12. Sewer Cap � ' _ -63. Heater & Vent-Final ' 7 3. Roof Drains _ . � , . 64: Plumbing System - Final 74. Rough Plumbing � . r 65. Electrical-Final ' - : ' 15. Rough ElectricabCqnduit � � 66. Solar System-Finai ' � � � 76. ftough Elettric Wiring ' � . 67. Fencing & Access Approval ' 17. RoughWiringSign � '68. APPROVED�FORPLASTERING � 18. Rough Elettrical-T Bar Celling . � . � -69. POOL/SPA SYSTEMS FINAL � � 19. Rough Heating & Ai'r Cpnditioning- " " FIRE DEPT. REQUIREMENT - 20. Rough Factory Fireplace APPROVAIS Permit # 21. Ducts, in S2ructure 7Q. Unde�ground Hydro 22. Ducts, Ventilating , 71. Product Piping �Gas ❑O�I 23. Gas Pipe-Rough & Test ' 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank L�Gas ❑Oil 25. Roof Sheathin9 � 74. Overhead Hyclro 26. T-Bar Ceiling IStructurall & Monocoat . 75. Dry Chemical 27. Frame and Fiashing 76. Dry Scandpipe 28. Lathing & Siding � 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drvwall Nailing . HEAITH DEPT. REQUIREM1IENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Gower Mecer�Final 80. F00� CERTIFICATE ISSUED -- 33. Final Eleciric - Notes� ' `,�� _� �� t-- � `�i 34. Final Heating & Air Conditioning �-""'� 35. Final Gas Pipe-Test � � 36. Hood or Csnopy ' . ' 37. Final Factory Fireplace 38. Final Plumbing -z��1 � % 39. Water Service�Final 40. Gas Service-Final ' ' 41. Solar pomestic�Final � - 42. Backflow Preventer 43. Backflow Irrigation � 44. Landscape �rrigation System . 45. Sound Attenua[ion � 46. Handicap Regulations 47. FINAI STiiUCTURE & BUILDING 48. F�NAL PLANNING 49. Electric Release to Edison � 50. Gas Release to Southern Caiifomia Gas Co 51. CERTIFIC/+TE OF OCCUPANCY No Date ORANGE COUNTY BUILDING DEPARI ' 636 North Broodway � SANTA ANA, CALIFORNIA FOR APPLICANT TO FILL IN BUILDING I ADDRE55 909 EvergrPPn Plar.w SCHOOL DIST. I ORTOWN COHY.A Mesa NEAREST I CRO55 ST. MA7'1POp1 A crrv j� ARCHITEC ENGINEEf AODRE55 LIG. I CONTRAGTOR NPjd�}orT. V1 at3 No. '1 9,fiRR2 oREss 9363 Wilshire—A�vPrl�v H LEGAL LOT BLOCK TRACT y7 )ESGRIPTION NO. 26 I (ATTACH METES & BOUNDSI I n NO. OF BLOGS. SIZE OF LOT /Z X � On I NOW ON LOT O USE OF I NO. OF I NO. OF E%ISTING BL�G... Fnvi�i[s ROOMS SETBACK LINE FROM; REAR VARD � CENTER OF STREET Fjn i�1 SIDE YAROl� DESCRIPTION OF WORK I OF USE OF NEW �UILOING I HEREBY ACKNOWLEflGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY OROINANCES AND STATE LAWS REGULATING BUILDING CONSTRUGTION. SIGNATURE OF NeUr O t V C I PERMITTE J AUTHORIZEO e�T� PENMIT FEEI $ �, VALUATION S 4830�00 PtnN CNECK 5 TOTAL I / L FEE S SM 9-30�59 � APPLICATION FOR PERMIT �� FOR OF.FICE USE-ONLY � ftECEIPT NO. PERMIT ,: �3•3i sa li D BV DATE REC'O. �ATE I55 �-� S3 q-3._ , i G, , )IST. i /i�i'�. � . . LATN.INT IPLANS _ I �• f CORRECTIONS APPROVALS J�_ 0 a � z a � . . ,, r