HomeMy WebLinkAbout2812 EUROPA DR - Building Permits. CITY OF COSTA MESA
o�""'Fs9 B{IILDING DIVISION
Ft� . � 77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 •�.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: E09-00110
PERMIT TYPE ELEC
APN: 13940115
JOB ADDRESS: 2812 EUROPA DR CM
Vicinity:
SCOPE OF WORK: 1 ELEC. CONDUIT FOR FUTUTE SPA.
1 GAS LINE FOR FUTURE SPA
OWNER: RANSOM,ROGERTR
PHONE: 949632-0943
APPLICANT: RANSOM, ROGER TR
PHONE: 949632-0943
CO NTRACTOR: OW NER-BUI LDER
Address: Unit: PHONE:
Ciry/State: ZipCode:
��
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $41.70
Reinspection Fee $0.00
TOTAL FEES $41.70
STATUS: ISSUED
DATE ISSUED: 05/2112009
ISSUED BY: CAC
Suite/Unit:
Address: 2812 EUROPA DR Unit:
CitylState/Zip: COSTA MESA, CA
Address: 2812 EUROPA DR Unit:
City/State/zZip: COSTA MESA, CA
License No. 000000
CELL:
L {l-Qii'i � i!
r;'.t „,;";��.3 ,� �}
NO710E: 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable wdes, and all
.required inspections and final approval musl be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODEt. INSPECTIONTYPE DATE INTITIpLS LOOEt INSPEGTIONTYPE OqTE INTRIALS
1616 Fiaed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing ��
Z00 Final Re-Roo( 210 Final Electriwl
201 Final BIak/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site �•� f•��' �� "' �
20a Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the follovnng declarations:
❑ I have antl will maintain a certifcate of consent ro self-Insure (or vrorkers'
compensation, as pmvided for by section 3700 of the Labor Code, tor the
peAormance of the vrork for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by
secfqn 3700 of lhe Labor Cotle, for the peAortnance of Ihe work for which this
pertnit is issued. My vrorkers' compensation Insurance carrier and policy
number are:
Carriec
(This section need irol6e mmplete0 d(he perm� is valuetl al one huntlred dollais (Sf 00) w less )
Policy Number:
❑ I certify that in the peAormance of the work for which this permit is
issued, I shall nof employ any person in any manner so as to 6ecome subject
to the workers' compensalion laws of Califomia, and agree that i( I should
become subject ro the vrorkers' compensation provisions of Section 3700 of
the Labor Code, I shall (orihwith comply with these provisions.
AOPliwnl'S $ign9Wre
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(3100,000�. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) o( Division 3 of the Business and Professions Cotle, antl
my license is in full force and eRect.
lic # Class #
Convacmr's SiBwwre
CONSTRUCTION L.ENDING AGENCY:
❑ I hereby affrtn that there is a consWctbn lending agency for the
peAormance ol Ihe wurk fa witich this permi� is issuetl. (Sec. 3097. Civil Code).
Lender's Name:
Lender's Address:
Date
OW NER-BUILDER DECLARATIONS:
I hereby affrm ihat under penalty of perjury ihat I am EXEMP7 FROM THE
CONTRACTORS LICENSE LAW for lhe following reason (Sec. 7031.5,
Business and Pro(essions Code: Any ciry or county which requires a permit to
constmct, alter, improve, demolish, or repair any stmcture, prior to ils
issuance, also requires the applicant for such permit to fle a signed statement
that he or she is licensed pursuan[ to the provisions of the Contractors
License Law (Chapter 9(commencing vrith Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom antl
Ihe basis for the alleged exemption. Any violation o/ Section 7031.5 by any
applicant tor a permit subjects the applicaN to a civil penalty of not more than
five hundre0 dollars ($500).):
❑ I, as owner o! lhe property, or my employees with wages as their sole
wmpensation, WILL DO THE WORK, and lhe structure is not intended or
offered for sale (Sec. 7044, Business antl Professions Code: The Contracrors
License Law does not apply to an owner o( property who builds or improves
thereon, and who does such work himself or herselt or through his or her ovm
employees, provided that such improvements are not intendetl or offered for
sale. If, hovrever, Ihe builtling or improvement is sold within one year of
completion, the owner-builder will have the burden of proving ihat he or she
did not build or improve for purpose of sale.). �
❑ I, as owner of the property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl
Professbns Cotle: The contractors License Law dces not apply to an ovmer of
property who builds or improves thereon, and who contracts for such projecl with
a contracla(s) license pursuant to the CoNractors License Laws.).
� I am exempt under sec.
Business and Professions Code tor lhis reason:
�-2�-oy'
SignaWre Date
JOS]�a6�J101)
Owner ID verifetl hy tlriver s license. �Yes ❑ No
D�nver'sLi �� No. Eapires: Oy'04-13
erificaV tion of Ownership by (rype of documenl, i.e. - property tax bill or deetl�:
DIVISION OF INDUSTRIAI SAFETY PERMIT CERTIFICATION:
❑ I hereby certi/y that no excavation (rve (5) or more leet in depth inro which a
person is required to tlescen4 will be made in connection with work authorizetl
by this permit, and �hat no building structure, scaHdtling, falsework, or tlemolition
or dismantling thereo/, will be more than lhirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Tlle 8, Califomia Administralive Code�.
❑ As owner-builder, I will not employ anyone to d0 work which would
require a permi[ from the Division o( Industrial Salety, as noted above, unless
such person has a permit to do such work (rom the division.
Appliranfs SignaWre
Division of Industdal Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSiONS CERTIFICATION:
1. Will the applicant or present or (u[ure building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Calilomia Health and Safely Code requires, with some
exceptions, that a Business Plan be filed with Ihe Costa Mesa Fire
Department by every business vmich �as at any one time dunng a reported
year a quantiry of hazardous materials equal to or greater lhan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperaWre antl pressure).
2. Does or will the applicant or present oi fWure building occupaN need to fle
a registration fortn for awtely hazardous malenals? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safery Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business v+hich at any one time has on nand a quamiry of awtely
haurtlous materials equal to or greater than a vreiqht of 500 pountls, or a
volume of 55 gallons. or 200 cu6ic feet o( compressed gas at standard
temperaWre antl pressure).
3. Does or will the applicant or preseN or (uWre builtling occupaN need to
prepare an RMPP (Risk Management and Prevenlion Program (or acutely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire DepartmeN may require the preparation, certifiwtion and
filing with the Fire Department of an RMPP by businesses which are requiretl
to register acutely hazardous materials with Ihe Fire Department.
4. If an RMPP i5 presently required, has Section 25534 of the Califomia
Health and Safety Code been fully complied withl ❑ Yes ❑ No
5- Does or will the applicant or present or future builtling occupant require for
the vrork which is the subject of this application a permit for such constmction
or motlifcation trom the South Coast Air Qualiry Management District or from
any other air polWtion control tlistrict or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires Ihat the requesletl
infortnalion be (umished on applications (or nornresidenlial building pertnits).
6. Will any part of lhe faciliry to be constructed under this permit be within
1000 feet fmm the outer boundanes of a school? ❑ Yes ❑ No
Qf'yes", the facilily must meel lhe requirement of Sections 25534 and 42303
of lhe Califomia Health and Safety Code�.
7. If a permit from the South Coast Air Duality Management District or other
air pollution control district or agency is required for the work which is ihe
subject ot [his application, have all o( the tlisclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qt'yes", attach certifcate of compliance from the appropnate air pollution
control oKcer�.
CERTIFICATE OF COMPLIANCE: I certify Ihat under penalty of perjury the
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials antl Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certi(y under penalty of perjury that I have read this application and state that
the information qiven is correcl. I agree to comply with all sWte laws antl city
ordinances relating to b�Iding construction, antl aulhonze repreSeMatives of
the City of Costa s to enter upon the above-descnbetl pmperty for
inspecti rf3urposes I� ree not to occupy or allow occupancy of any building
author rfby this Kfirt until final inspection.
5-2J-ay
Sig wre al Legal Ovmeqs) Daie
Antllor Autbonze0 Applicanl
�
� CITY OF COSTA MESA -�
0�'�pMFs'q BUILDING DIVIS/ON
it�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax Q14) 754-4856 • �wiw.ci.costa-mesa.ca.us
:
� ` FOR INSPECTIONS CALL: (714) 754-5626
4°*.e.mw'"`
PERMIT NUMBER: P09-00064
PERMIT TYPE PLUM
APN: 13940115
JOB ADDRESS: 2812 EUROPA DR CM
Vicinily:
SCOPE OF WORK:
1 GAS LINE FOR FUTURE SPA
OWNER: RANSOM, ROGER TR
PHONE: 949632-0943
APPLICANT: RANSOM, ROGER TR
PHONE: 949632-0943
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/lJnit:
ISSUED
05121 /2009
CAC
Add�ess: 2812 EUROPA DR
City/State/Zip: COSTA MESA, CA
Address: 2812 EUROPA DR
City/State/zZip: COSTA MESA, CA
CONTRACTOR: OWNER-BUILDER License No. 000000
Address: PHONE:
City/State: ZipCode: CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
�
$0.00
$33.30
$33.30
�M..C'�fQ64
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ly �4
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and relatetl
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. --
INSPECTIONS: In order (or the work authorized under this permit to be considered legal, such work musl comply with all applicable codes, and all
required inspeclions and final approval must be obWined. Failure to obtain inspections and Mal approval will result in the expiration of this permit.
CO�E/ INSPEC710NTYPE � INTIiULS � INSPEC710NTYPE D�iF NI IIIlALS
1876 Fixed System Final Fire Prevention 206 Final Mechanital �-'-+`--`�-�+—� =W= `
1266 Pool Spa Final 20B Final Plumbing
200 Final Re-Rool 210 Final Electncal
201 Final Block/Retaininq Wall 2t2 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning ApprOval
203 Final Sign 222 Final Site �' ,
204 Final Demolition 250 Final Buiiding�Occupanty
WORKERS' COMPENSATION DECLARA710�
I hereby affirm under penalty of perjury one ot the following declarations:
❑ I have and will maintain a certificate of consent to 5el!-Insure for workers'
compensation, as pmvitled (or by section 3700 of the Labor Cotle, br the
pertormanCe o( lhe work (or whiGh lhis pertnil i5 i55uetl.
❑ I have and will maintain v.orkers' compensation insurance, as required �y
section 3700 of the Labor Code. fa the pedormance of the work tw vfiich this
pertnit is issued. My vrorkers' compensation Insurance carrier and policy
number are:
Carrier.
(This SMion need nof Oe mmpetM dNe peinK u rdluetl al ana huMretl tlodars (5100) a less )
Policy Numher:
❑ I certify that in the peAormance of lhe work lor which this permit is
issued, I shall not employ any person in any manner so as to become subjecl
to Ihe vrorkers' compensation laws of Califomia. and agree that if I should
become subject to the workers' wmpensation provisions ot Section 3700 0(
the Labor Code. I shall fort�with comply vrith these provisions.
Ap01i�nCs SignaWre Wie
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNIAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($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 aKrm thal I am licensed under provisions ol Chapter 9(commencing
with Section 7000) of Division 3 of the Business antl Professions Cotle, and
my license is in full force and eKect.
Lic. # _ . . CIaSs #
Conlraclor's
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn that there is a construction lending agency for Ihe
peAortnance of the kork ta which Ihis pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SignaWre Date
OWNER-BUILDER DECLARATIONS:
I hereby a(firm lhat under penalry of perjury thal I am E%EMPT FROM THE
CON7RAC70R5 LICENSE LAW for the following rea5on (Set. 7031.5,
Business and Pmfessions Code: Any ciry or wunry which requires a permit to
constmct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires Ihe applicant lor such pertnit to fle a signetl statement
thal he or sha is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing v.ith Section 7000) ot Division 3 of tha
Business and Professions Code) or Ihat he or she is exempt �herefrom and
the basis for the allegetl exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty ol not more Ihan
five hun�retl dollars (3500).):
❑ I, as ovmer o( the property, or my employees with vldges as Iheir sole
compensation, WILL DO THE WORK, and the strucWre is nol intendetl or
offered for sale (Sec. 7044, Business and Professions Coda: 7he Contrectors
License Law dces not apply to an owner ol property who builtls or improves
lhereon, and who tloes suc� work himsell or herself or lhrough his or her ovm
employees, provided that such improvements are not intendetl or offeretl for
sale. If, however, the building or improvement is sold vrilhin one year ol
completion, Ihe ovmer-builder will have the burtlen of proving that he or she
did nol build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to wnsWct the projecl (Sec. 7044, Business and
Professbns Cotle: The cont2ctas License Law dces not apply to an owner of
pmperty wfio builds or improves Ihereon, antl who cont2cts for such projecl wilh
�a c t2ctm(s) license pursuant to the Contractors License Laws.).
I am exempt under sec.
Business and Pr t ssions Code for lhis reason:
5-- � i-� 9
SigruWre Dale
305]<6 (]I09) �_
r
�
Owner ID verified by driver s license.� Yes ❑ No
Ddver's License No. �%� . Expires: DY 9Y-/
�— -
Verification of Ownership by pype o( tlocument, i.e. - pmperty tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify Ihat no excavation frve (5) or mae teet ui depth into wfiich a
person is required to descend. vrill be made in connection vnih v.ork author¢ed
by this pertnit, and thal no building sinicture, sc�fdding, (alseuwrk, a demolition
or dismaniling ihereof, will be more ihan Ihirty-six (36) (eet high. (Chap. 3.2, Grp
2, Afl 2, $QC. �i1, TII�f 8, C.2�I/ORlld Adff11f115lfdWC l'.Od2).
❑ As ovmer-builtler, I will not employ anyone to do work which wouitl
require a permit from the Division o( Induslrial Safety, as noted above, unless
such person has a permit to do such work from lhe tlivision.
ApPliranfs Sgnalure
Division ol Industrial Safety Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future builtling occupaN need to fle and
certity a Business Plan for emergency response lo release or threatened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the Califomia Healt� antl Safery Code requires, vnth some
exceplions, that a Business Plan be (led vrith the Costa Mesa Fire
Department by every business which has at any one time during a reportetl
year a quantiry of hazardous matenals equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet o! compressed gas
at stantlard temperature and pressure).
2. Does or will the applicant or presenl or future building occupant need to file
a registration form for aculely hazartlous ma[erials? ❑ Yes 0 No
(Section 25533 of the California Health and Salety Cotle, with some
exception5. requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazartlous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet oi compressed gas at standartl
temperature and pressure�.
3. Does or will �he applicant or present or (uture building occupant neetl to
prepare an RMPP (Risk Managemenf and Prevention Program for acutely
hazardous materials)7 ❑ Yes ❑ No
(Section 25534 0! the California Heallh and Safety Code provides that tne
Costa Mesa Fire Department may require the preparation, certifcalion antl
61ing with the Fire Department o� an RMPP by businesses which are required
to register acutely hazardous materials with the Fire �epartment.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Heallh antl Safery Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicanl or present or future 6uilding occupant require !or
the work v+hich is the subject ot this application a permit (or such wnslruction
or motlification from lhe Soulh Coasl Air Quality Management District or !mm
any other air pollution conlrol districl or agency? ❑ Yes ❑ No
(Seclan 658502 of the Califomia Govemment Code requires thal t�e requested
infortnation be fumis�etl on applications for rmrnresitlential buiitling permits�.
6. Will any part of the laciliry to be consuucted un0er this permit De within
1000 feet (rom Ihe outer bountlaries of a school? ❑ Yes ❑ No
(II'yes", lhe (acility must meet Ihe requirement of SettiOns 25534 antl 42303
of lhe Cali(omia Heallh and Sa(ety Code).
7. If a permit (rom the Soulh Coast Air Q�alily Management District or other
air polNtion control distdct or agency is required for the v.ork whic� is the
subject of this application, have all of the tlisclosures prescribed by Califomia
Health antl Safely Code Section 42303 been made? ❑ Yes ❑ No
8. p('yes", a« ach certificate of compliance from the appropriate air pollutlon
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify tha[ under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
cily ordinances regarding Hazardous Matenals and Emissions.
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this appliwtion and state that
the information given is conecL I agree to comply with all sWte lav+s and ciry
ordinances relatin o building wnstruction, antl authorize representatives of
the City of C Mesa to�e er upon the above-0escnbed property for
inspection pu � ses. I agree ot to occupy or allow occupancy of any building
authorized, this permi ilfnalinspeciion.
`�"� .�' Z � - U /�
5' alure o� Lega1 Ovmeqs) .� le
MOlor Aut�onz¢0 Apdi�'anl
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�oSta M�sa
City of Casta �esa ��� ilc�ing 1�ivisio�z
77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
�oti -oo � �o
Permit# Poi-0006`/
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the
property improvements specified at „2 $ I 2 �u �vP�+ 9R .
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
D/ TIONS: Read and inrtra! each statemenl below to srgnify you �nderstand or verify this information.
understand a frequent practice of unlicensed persons is to h�ve the property owner obtain an "Owner-
ui der" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
an aware of the limits of my insurance coverage for injuries to workers on my property.
I understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
�I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I may protect myseli from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
/ p4�understand Contractors are required by law to be licensed and bonded in California and to list their
license numbers on permits and contracts.
�5 I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
and the total value of my construction is at least fve hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
�6 I understand if I am considered an "employer" under state and federal law, I must register with the state
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
�J I+inderstand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
�I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
CALBO Jan t, 2009 OB Packel template 1 Of 2
f�� '�I understand I may obta'.,. _.�ore information regarding my obligations ,+n "employer" from the Internal
Revenue Service, ihe United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
_C=�?0-Y"am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
that I am the party legally and financially responsible for proposed construction activity at the following address:
��1 i'T agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern Owner-Builders as well as employers.
�E-1 i�agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. It you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property ow�er
and returned to the agency responsible�for issuing the permit. Note: A copy of the property owner's
driver's license, form notarization or other v r�(�cat�on acceptable to the agency is required to 6e
presented when the permit is iss to veri(yt property owner's signatuie.
Signature of property owner Date: S Z�- v�
Note: The (ollowing Authorization Form is required to be completed by the property owneronly when
designating an agent of the property owner to apply for a construction permit (or the Owner-Builder.
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location o� Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy o(the owner's driver's license, lorm
notarization, or other veri(ication acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's 5ignature:
Date:
CALBO Jan 1, 2009 OB Packet template 2 Of 2
� r � � .. ..`�,�: :.
' � . CITY OfYCOSTA MESA � � " ' � °`, K ';
0 Mf q � � BlIILDING DIVISION '� '
>� . � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • w�vw.ci.costa-mesa.ca.us
f
�.���. FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: BC07-00381
PERMIT TYPE: B_COM� � TUS: ISSUED
Sub Type. RES_RRIP ,� DA UED: 12113/2007
�D BY:
JOB ADDRESS:
APN: 73940115
Vicinity:
2812 EUROPA DR CM
Zoning:R1, ,
Suite/U�it:
Primary Occ: 7
� . . „ ;
_ r-
,. F:'",
ConstType: V-N ' SQ. FT: 726 Valuation: $92,304.72 .
SCOPE OF WqRK: CONSTRUCT 726 SF SINGLE-STORY ADDITION TO (E) 2-STORY SFD. WORK INCLUDES: 230 SF:FRONT�
ADD; 468 SF REAR ADD; AND 28 SF CONVERSION OF GARAGE SPACE INTO HABITABLE SPACE. ALSO INCLUDES INTERIOR
REMODEL ( N�W KITCHEN, NEW M.BATH, MODIFY STAIRS) AND ADD 56 SF COVERED ENTRY
1 FAU 1 HOOD 2 VEN7 FANS. 1 SHOWER 2 WASHBASINS 2 701LETS 1GAR8AGE DISPOSAL 1 KITCHEN SINK. 1 TANKLESS
WATER HEATER. - � �
2 BATRHOOM FANS 1 TANKLESS WATER HEATER 43 LIGHTS 45 OUTLETS 2Z SWITCHES 1 SUBPANEL 1 SERVICE YPGRADE
T0200AMPSICONDUIT �_ � � � ,1,�!.j-U��II�
OWNER: RANSOM, ROGER TR Address: 2812 EUROPA DR Unit:
Phone: � City/State/Zip: COSTA MESA, CA -
APPLICANT: ROGER RANSOM
Phone: 949-632-0943 �
CONTRACTOR: . �.
Phone:
Cell:
ARCHITECT: �
ENGINEER: '
Address:
�� Ciry/State/zZip: -�
� Address: Unit:
- City/State:
-, � � License No.
� license No.
COMBINTATION PERMIT FEE SUMMARY
Building Plan Check: $614.09
Building Fees: . $944.75
Electrical Fees: $230.65
Mechanical Fe�s: $48.65
Plumbing Fees; $98.25
SMIP Residential: $9.23
SMIP Commercial: $0.00
TOTAL FEES: $1,945.62
"Re(er to fee receip[s (or all fees paid for project
� Unit: .
License No. �
_ . :P.:or . ;f�r
ZipCode � ' � ' ' �
PHONE:
PHONE:
�.,r, ,r-t:;ioN;r
' �'•.r-S IPi7FRlt.-�'R
`:Ki_E>5
-'" C:c vc.�RA.pt:.
.,.� �'_�: :f;,�„!'I
�iC
NOTICE: 7he work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and relaled
regulations. (Ord, No. 92-28, § 1, 12-21-92) � � � ' �
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. �
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 appmval will result in Me expiration of this permit. �
GppE t, INSPEC710NM� OAiE INTITIRLS C UE� INSPEL7IONTYPE D�T N11RUL5
1816 Fixetl S}5t�m Final Fire Prevention 206 Final M�hanical '��� �-"� �� T:
..: i `.h:IVit
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Rppf 210 Final El�triwl I � �,��,
T01 Final Block/ReWining Wall 212 Final Fir¢ Prevention
202 Final Factory Fire Place 220 Final Planning Approval
:i� ..i: � :, )�_
203 Final Sgn „ 222 Fina15ite � � � '� '= �t
204 Final Dem0lition - 250 Final Building/Occupancy ► n..9 ���
f
WORKERS' COf�JiPENSA�ION DECLARATION: �
I hereby affirm under penalty o1 p�rjury one of the following declaralions:
❑ I have and will maintain a certificate of consent to self-Insure for workers'
compensation, as providetl (or by section 3700 of Ihe Labor Code, for Ihe
peAormance of Ihe work (or which this pertnit is issued.
❑ I have antl will maintain norkers' compensation insu2nce, as requiretl by
sectbn 3700 of Ihe Labor Code. fa the peAortnance o( lhe v✓ork for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Cartier.
(Tlus serton neM not Ge mndete0sll�e ce�1 k vdlucd al me huiMiM tlodars (5100) abssJ
PolicyNumber. �i"� �
.,,�� �
❑ I certity that in the pertormance of lhe work tor which:this,permit is
issued, I shall not employ any person in any manner so as [o tiecome subject
to the vrorkers' compensation laws of Califomia, and agree that�if I shoultl
become subjecl to Ihe vrorkers' compensa�ion provisions of Section 3700 of
the Labor Code, I shall foAhwith compy with ihese provisions.
Applicanfs Slgnalure
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, 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 ihe Business and Professions Code, and
my license is in full torce and eFlect.
Lia # Class #
COnVatlOr s SignaWR
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn that there is a constructqn lentling agency for the
peAormance of Ihe work (a which Ihis pertnit is issued. (Sea 3097, Civil Code).
Lender's Name:
Lender's Address:
Signalure
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty of perjury that I am EXEMP7 FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5.
Business and PrOfe55ions Code: Any city or coun[y which requires a permit to
constrvct, alter, impmve, demolish, or repair any strucWre, pnor to its
issuance, also requires Ihe applicant for such permit to (le a signed statement
that he or she is licensed pursuant to the provisions of lhe Contractore
License Law (Chapter 9(commencing vnth Section 7000) of Division 3 of the
Business and Professions Cotle) or that he or she is exempt Nerefrom antl
the basis (or 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 ot the property, or my employees vnth wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
oKered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does nol apply to an owner of propeAy who builds or improves
thereon, and who does such work himself or herself or lhrough his or her own
employees, provided ihat such improvements are not intended or offered for
sale. If, however. the building or improvement is sold within one year of
completion, Ihe ovmer-builder will have the burden of proving [hat he or she
Oitl not build or improve for purpose of sale.).
/
C� �, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
{ICENSED CONTRACTORS to construct the project (Sec. 7644, Business and
Pro(essbns Coae: The cont2ctors License Law dces nol apply lo an owner of
pmperty who builds or improves thereon, and who coniracts for such project with
a contracta(s) license pursuant to lhe Contractors License Laws.).
❑ 1 am exempt under sec.
Busi antl Prof sions Code for this reason:
z o
Csignanne—= _� - Daie�
309.d (]/0]) ��"
� �
C��ner ID veri(ed by driver .� ❑.Yes �] No '� L1
Driver's�LicenseNo:��' �Expires:-'7��—Vi
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certrfy that no excavation (rve (5) or more feet in tlepth in[o which a
person is required ro descend, will he made in connectbn with work auttwrized
by this pertnit, and that no building,sWcture, sc�ldding, talsework, a demolition
or dismantlinq thereo4'.will be moie. than thiny-six (36) feet high. (Chap. 32, Grp
,-` 2,'lvC2. Seci 341. Fitle�B.iCaliforrjia'Atlministrative Code).
1. � .}�;� ' c,,j , ;�. �ro. ��:. � �'
�[]•=�As owner-builde�, L,will not employ anyone to do work which would
require�a pertriit frorti the Division of Induslrial Satety, as noted above, unless
such person has a pertnit to tlo such vrork (rom the tlivision.
Appliwm's SignaWre Date
Division ot Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or tuture building occupant need to file and
certify a Business Plan for emergency response [o release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safery Code requires, with some
exceptions, that a Business Plan be filetl wilh the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantiry of hazardous matenals equal to or greater than a v+eight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at slantlard temperature and pressure).
2. Does or will the applicant or present or (uture building occupanl neetl to file
a registration fortn for acutely hazardous materials7 ❑ Yes ❑ No
(Sec�ion 25533 0( the Califomia Health and Safery 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 [o or greater than a weigh[ of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at s[andard
Iemperature and pressure).
3. Does or will the appliwnt or present or fulure building occupant need ro
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)7 ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Sa(ety Code provides that the
Costa Mesa Fire Department may require the preparalion, certification and
(iling with �he Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials vnth the Fiie Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Heallh and Safety Code been fully complied wi[h? ❑ Ves ❑ No
5. Does or will the applicant or presenl or future building occupant require for
the work which is Ihe subject ot this appliwtion a permit !or such construction
or modifcalion from the South Coast Air Qualiry Management Disirict or trom
any other air pollution control tlistrict or agencyl ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires ttiat the requested
infortnation be Wmished on applications !or nomresidential builtling permits).
6. Will any part of the facility lo be consWcted under lhis permit be within
1000 feet (rom the outer boundaries of a school7 ❑ Yes ❑ No
Qf "yes", lhe facility must meet the requirement of Sections 25534 antl 42303
of the Califomia Health and Safety Cotle).
7. If a pertnit from the Soulh Coast Air Quality Management District or other
air polNtion control district or agency is required for the work which is the
subject of Ihis application, have all of the tlisclosures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. (If'yes", attach cetlifcate of compliance trom Ihe appropriate air polWtion
control officer).
CERTIFICATE OF COMPLIANCE: I certify Ihat under penalty of perjury the
information given above is correct I agree to comply with all state laws and
city ordinances regarding Hazardous Matenals and Emissions.
Signawre Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certi(y under penalty of perjury that I have read ihis appliwtion and sla[e that
the information given is cortect. I agree lo comply vdth all state laws and ciry
ordinances relating to building construclion, and authorize representatives o(
the Ciry of Costa Mesa to enter upon the above�escribed property for
inspecti urposes. gree not to occupy or allow occupancy of any building
aulhovlPd by Ihis rmit un[il fnal inspec�ion.
�%i � 6
SignaWred.Lega�O�mer(s� Dale—. *
Anald Aut�onze0 AOOIit'ant
.
> .� :�.� - .
;:
� R.P.I. .� ` .. `�
Deput�� lnspectiori
. ,
. �. . �, � .� �
n• i n .. r .
'Gell(949) 291-3912
Office(949) 366-9452
Fax(949)481-5866
1903 Via Pimpollo
I HEREBV CERTIFV THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS O7HERWISE NOTED, AND TO THE BEST OF MY
ABILITY, I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS.
MATERIAL INFORMATION: CONCRETE p GROUT p MORTAR O OTHER p
SUPPIIER: MIX NO.: ADMIX: SAMPLES CAST:
SPEC. PS.I.: TVPE: lSLUMP; YDS. PLACED:
AIR-TEMP: CONCTEMP: � MIXINGTIME:
DATE START STOP REG.HOURS O.T.HOURS
(//\'`� �
inspections basee on a minimum af 4 hours antl over a hours - B hour minimum, in 1
fition, any insDec�ion eztending past noan haur will �e an 8 hour minimum. All la�e SIGNATURE OF REGISTERED INSPECTOR
:ounts will be charged the �ighest legal ate ot inmresC including all collection costs
iattorneyfees Allretumed'checkswillbesuhjecttoa520.00fee.
� 4/-3D-AA, io� n�_
�proved By�6 DATE OF REPORT REGISTER NUMBER
t
. . ,
.�� � r�
,p' � � ECIAL INSPECTOR REGISTRATIOI ''
., 1
Job Address ^_�i� �� \ lAC u D ia �1Z ^ C OS � � C'� �-`_�9 Li' ��
InspectoPs Name � � � � � �` � � '� � � �c
Reside�ceAddress ���� ��� �' � ���LL�
Number
Laboratory 2 � �
Address �/a�"
3
All licenses listed-below-must_be_cur[ently valid and legible copy(s) and must be attached to this registration.
/ — �� � /
CDISCIPLINE L.A. COUNTY i A.—CITV�----ORANGE COUNTY OTHER 1��
CONCRET@ I"�� /l
ll l/-
DVCTILE MOMENT
RESISTING FRAME
REINFORCING $TEEL
PRESTRESSING STEEL
WELOING 1 O(j� I\ O�./� /O _ VS
MIGM STRENGTH BOITING
STRUCTURqI
MASONHV
0.EINFORCED GVPSUM
CONCRETE
INSULATING CONCRETE
FILL
SPRHVED ON FIRE
VNOOFINQ
___ VIlINGS, ORILLED PIERS, _ _ , . _ _ _ _ _ _ _
CAISSONS ' - -
SVECIAL GRADING,
E%CAVATION Oq FILLING �
SPECIAL CASES
UNUSUALMAZAqOS
I hereby certify that I am qualified by training and experience to perform the inspections for which I hold
the above listed Special Inspectors licenses, and will provide all certifications required by the City of Costa Mesa.
I will inspect and certity the following procedures: 4- �OX v� �-�r�\"�C ��.1q ,
e
I will certify not only to the job conditions but that they are in conformance with the approved plans. If at
any time, progress occurs on the above mentioned job relating to my area�s) of responsibility, without my knowl-
edge or approval, I will stop the jobs progress immediately with notification in writing to the job superintendent
and notify the Building Division of the situation. A record of my tests and/or inspections as agreed to above will
be available upon request by the Building Division. Upon request I�wiyYsubmit a complete package of testing and
inspection results. A letter certifying satisfactory complet46n will betiprovlded by rr upon completion.
This registratioh is`accegted and approyed by:
ding Official)
iose-ie wn�ee � e�ae��y ow�s�oo: eana.r � saeciai insoecm.: vink � oe.eiooer
__J •
f
{ � CITY OF COSTA MESA �
BUIIDING DIVIS/ON
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • v+ww.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PEF2MIT TYPE PLUM
APN: 13940115
JOB ADDRESS: 2812 EUROPA DR CM
Vicinity: BACK YARD
PERMIT NUMBER: P08-00190
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
08/2712008
YH
SCOPE OF WORK: GAS LINE STUB OUT UNDER CONCRETE !N REAR PROPERTY FOR FUTURE USE.
OWNER:
PHQNE:
APPLICANT:
PHQNE:
RANSOM, ROGER TR
HOLLAfJO, MIKE
949-235-9477
Address: 2812 EUROPA DR
City/State2ip: COS7A MESA, CA
Address: 28081 MORRO CT ;
City/Stale/zZip: LAGUNA NIGUEL, CA
CONTRACTOR: MIKE HOLLAND CONSTRUCTION INC License No. 8987'14
Address: 28081 MORRO CT PHONE: 949-235-9477
Ciry/State: LAGUNA NIGUEL, CA ZipCode: 92677 CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PLqN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$29.65
$29.65
^ :,r
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia sUtutes and related
regulations. (Ord. No. 92-28. § 1, 12-21-92) .
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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 musl be oblained. Failure to obWin inspections and final approval will result in the expiratlon of this permit.
fODFt INSYECTONTYPE Q�ijE NTI RL �D [ INSPECTIONTVPE �¢, IN7IML5
7616 Fixed System Final Fire Prevention 208 Final Mechanical
12fi6 Pool Spa Final 208 Final Plumbing �'� Hm �l�z�
200 Final Re-Roof 210 Final Electrical
207 Final Blpck/Retainirtg Wall 272 Final Fire Prevention �
202 Final Faclory Fire Place 220 Final Planning ADProval
203 FinalSign 222 Final Site
204 Final Demolition 250 Final BuildinglOccupancy
WpRKERS' COMPENSATION DECLARATION:�
1 hereby anrm unCer penaly oi perjury one ot tha follrnving declarations:
❑ I have antl will mainlain a certificate ot wnsent to self-Insure for vrorkers'
coA�pensation, as provided �or hy section 3700 of �he Labor Gotle, for Ihe
p Aortnance o� the work (or which Ihis permit is issued.
� 1 have a`W wtiil maintain vA`keos' compensation insu2nce. as required by
ec ion 3700 0l the Labor Cotle, (w the per(wmance o( tlie v.ork fa which this
pertnit is issued. My wnrkers' compensation Insurance carner antl policy
�nVlnberare: � �//.q �7- ���
Carrier. ��/r / T
(Thasedionn naGa�/�� eC-�l7fMpe�MrtNSvahretlatw�envM/iMqXars(51001aku)
�policyNumDer, �YY'�G�✓'7 � ���b
❑ I certify that in Ihe per(ortnance ol the work for which this pertnit is
issued, t shaU aut emplay any person in any manaer so as to bewme subject
to �he vrorkers' compensation laws of California. and agree that if I should
beCome subjed to th vrorkers' compensation provisions of Section 3700 of
the Lah d, I sh rt ' compl �Ih Ihese prov
Ap icanl'sS9�lure �Da��
WARNING: FAILURE TO SECURE WORKERS' CAMPENSP.TION COVER4GE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAIJD DOLLAF2S
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE 1A80R CODE, INTEREST, AND
ATYORNEI^SFEES.
LICENSED CONTRACTORS DECIARATION:
I h6reby aKrtn thal I am licensed under provisions of Chapter 9(commencing
witn Section 7000) ot Division 3 of Ihe Business and Professions Code, and
my license' i fuJ� force a d effect.
CL'7 �
L . tt �� ( Class N /�
iS _7i?
Convacbr's Signawre a�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum that there is a construction lentling agency for Ihe
peAortnance of the v.ork !or wfiich tlds pertnit's'ssued. (Sec. 3097, Civil Code).
Lentler's Name: _
Lender's Adtlress:
Sipruture Date
OWNER•BUIIOER DECLARATIONS:
I he�eby aKrm ihat under penalry of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for [he following reason (Sec. 7031.5,
Bus��ess and Prolessions Cotle: Any city or wunry which require5 a pertnil to
construct, alter, impiove, demolish, or repair any structure, prior �o i�s
iss�ance. afso requires ine applicant for sucti pe�mit to file a signed statement
lhat he or she is licensed pursuam to the provisions of tha Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 0l the
Business ana Prolessions Cotle) or Ihat he or she is exempt therefrom antl
the basis for the allegeA exemption. Any violation of Section 7031.5 by any
applicant for a permit suDjects the applicani to a civil penatty oF not more than
five huntlretl tlollars ($500�.):
❑ I, as owne� of the property, or my employees vnth wages as their sole
compensalion, WILL DO THE WORK, and the structure i5 not intended or
of(eted lor sale (Sea 7044, Business and Protessioas Cale: Tha Contractors
License Law Ooes not apply to an ovmer of property who builds or improves
thereon, and who Oces such work himsel( or herself or through his or her own
employees, provitled that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completioq the owner-builder vrill have tRe burde� ot proving Nat he or she
did not build or improve for purpose of sale; ).
❑ �, as ovmer of the property, am EXCLUSIVELY CON7RACTING WI7H
LICENSED CONTRACTORS to construct the project (Sec; 7044. Business an0
Professio�s Coda: Thfl cont2ctas Ucense Law dces not appy to an ovmer of
property who builds or improves thereon, and who cont2cts fa such pmject wilh
a conlractp(s) litense pursuant to the Contractors License Laws.�.
❑ I am exempt under sec.
Business and Professions Code lor Ihis reason:
3057A6 (]ttl])
c ,
Owner ID venfied by tlriver � .❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (type of tlocument, i.e. - property Ux bill or Ceed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICA710N:. '
❑ I hereby certify Ihat no exca�ation (rve (5) or more feet in tlepth inro wfiich a
person is required to descend, will 6e made in connection with work authorized
by this pertnit, and Ihat no building structure, scaHdOing, falsev.ork, p demolition
or dismantling ttiereof, vrill be more than thirty-sia (36� (eel high. (Chap. 32, Grp
2, An 2, Sec. 341, Tipe B, Califomia Atlministrative Code).
❑ As owneo-builder. I will not employ anyone to do work which would
require a permi� (rom lhe Division o! Industnal Safety, as noted above, unless
such person has a permit to do such vrork (rom the division.
Applvanl's SigndNre W te
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFIC�ITION:
1. Will the applicant or present or future huilding occupant need to file and
certity a Business Plan for emergency response to release or t�reatened
release ol a �azardous material? ❑ Yes ❑ No
(Section 25505 0l the Califomia Heallh antl Salety Cotle requires, vnth some
exceptions. lhat a Business Plan be filed with the CosW Meu Fire
Department by every business which has at any one time dunng a reportetl
year a quamiry of hazartlous materials equal to or greater than a weight of
WO pountls. w a volume ot 55 gallons, or 200 cu�ic feel ot compressetl gas
al standard temperamre antl pressure�.
2. Does or will the appliwnt or present or (uNre building occupant need to file
a registration form tor awtely hazardous materials? ❑ Yes ❑ No
(SecGon 25533 0( the Califomia Health and Satery Code, vritN some
exceplions, requires registration vrith the Costa Mesa Fire Department by
each business which at any one time has on hantl a quantiry of acutely
hazardous matenals equal to or greater than a weighl of 500 pounds, or a
volume ot 55 gallons, or 200 cubic feet of compressed gas a1 standard
lemperature and pressure).
3. Does or will Ihe applicanl or present or (uNre builtling occupant need [o
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 ot the California Health and Safety Code provitles Ihat the
Costa Mesa Fire Department may require the preparation, certifwation and
filing with the Fire Department of an RMPP by businesses which are requireC
to register aculely hazartlous matenals with the Fire Department.
4. I( an RMPP is presently required, has Section 25534 of the Califomia
Health antl Satery Code been fully complied vnth? ❑ Yes ❑ No
5. Does or will the applicant or present or tutwe builtling occupant require lor
the work which is the subject ol lhis applicati0� a permit (Or such tons«uction
or modification (rom the South Coast Air Qualiry Management Dislnct or fmm
any olher air pollution control distnct or agency? ❑ ves ❑ No
(Secl'pn 65850.2 of lhe Califomia Govemment Cotle requires that the requescetl
inlortnatbn be lumished m applications for norxesidential buildirg pertnits�.
6. Will any part of Ihe faciliry to be wnstruLled untler thi5 pertnit be wilhin
1000 feet from Ihe oNer boundaries of a school? ❑ Yes ❑ No
(If yes'. the IaciGry must meet the requiiement ot Sections 25534 antl 42303
ol the Califomia Heallh antl Safely Coda�.
7. II a permit from the South Coast Air Qualiry Management Districl or other
air polWtion contml dislrict or agency is required for the vrork which is lhe
suhject o( lhis applicatio�, have all uf the disdosures pre5cribed by California
Health and Safely Code Sedion 42303 been matle? ❑ Yes ❑ No
8. Qf'yes", attach certificate of compliance frorti tfie appropriate air polWtion
control offcer). � � ' � � •
CERTIFICATE OF COMPLIANCE: •I�certify Ihat under:penalry of perjury'the
information given above is wrrect. I agree to.comply with all sWte Wws and
city ordinances regardiny Hazardous Materials antl Emissions: �
Date '
CERTIFICATE OF COMPIIANCE AND AUTHORIZATION OF ENTRY: I
certity under penalry of perjury lhat I have reaa this applicaGon and state Nat
the information given is cortecL I agree to wmply vrith all slate laws and ciry
ordinances relating to building construction, antl authorize representatives of
the G[y of Costa Mesa to enter upon the abwe-tlescribed property for
inspection purposes. I agree not to occupy or allow occupancy of any buiiding
authorized by this pertnit until final inspection. .. .
i natu e �I mer(s � 031C �
, AnOlar Aut�onzea Appliwnt ��
�
CITY OF COSTA MESA '
.
BIIILDING DIVISION
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754•5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
�.�p FOR INSPECTIONS CALL: (714) 750-5626
A'
PERMIT NUMBER: P08-00190
PERMIT TVPE PLUM STATUS: ISSUED
APN: 13940115 DATE ISSUED: 0812712008
ISSUED BY: YH
JOB ADDRESS: 2812 EUROPA DR CM
Vicinily: BACK YARD
Suite/Unit:
SCOPE OF WORK: GAS LINE STUB OUT UNDER CONCRETE IN REAR PROPERTY FOR FUTURE USE.
10/29/08
PERMIT SUPPLEMENT TO EXTEND GAS ADDITIONAL 50' FROM EXIST. STUB OUT FOR FUTURE USE.
OWNER:
PHONE:
APPIICANT:
PHONE:
RANSOM, ROGER TR
HOLLAND, MIKE
949•235•9477
Address: 2812 EUROPA DR
City/State/Zip: COSTA MESA, CA
Address: 28081 MORRO CT :
Cily/Slate/zZip: LAGUNA NIGUEL, CA
CONTRACTOR: MIKE HOLLAND CONSTRUCTION INC License No. 898774
Address: 28081 MORRO CT PHONE: 949•235-9477
City/Slate: LAGUNA NIGUEL, CA ZipCode: 9267� CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$35.80
$43.30
1�
NO710E: The vrork authorized by this permit shall comply with all applicable handicap access requiremenLs under Cali(omia statutes and related
regulations. (Ord. No. 92•28. § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work aulhorized under this permit to be considered legal, such work must comply with all applicabla codes, and all
required inspections and flnal approval must be obfained. Failure to obtain inspections and final approval will result in the expiration of this permit.
COUE t. �NSPEC110N 7YPE
1878 Fized System Final Fire Prevention
1288 Pool $pa Final
200 Final q¢.Roof
201 Fina101ock/Retaining Wall
202 Final Cactory Fire Place
203 Final Sign
204 Final bemolition
� I pl
s�
CODE�
206
208
210
272
220
222
250
�NSPEGTION TYPE
Final Mechanical
Final Plumbinq
Final Electncal
Final Fire Prevention
Final Planning Approval
Final Site
Final Building/Occupancy
QLijE N A
�
WORKERS' COMPENSATION tlECLARATION: . •
I hereby aflirtn under penalry oi perjury one of ihe lailowinq Aedarations: .
❑ I have antl will maintain a c@rtificate of consenl lo self-Insure for workers'
compensation, as provided tor by section 3700 ot the Labor Code. for the
�peA ance o1 the work for which this pertnil is issued.
�ave and will maintain workers' canpensation insurance, as required by
seclion 3700 0l the Labor Cotle, for Ihe peAortnance of Ihe v.ork !w which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Camer: G% � �N D
(Thisseaonn-��.,,���p��� -0b mlarsfEt001nkssJ
Polity Number:
� I certity Ihat in Ihe peAortnance o( tha work tor which this permit is
issue0. 1 shall not employ any pe�son in any manner so as ro become subject
to the workers' compensation laws of Califomia, antl agree thal if I shoultl
bewme subjecl to t e workers' compensation provisions ot Section 3700 of
the Lab ode. I o 'th compl wilh Ihese provision .
� �' %0 ?� O�
ApPliwnfs Signa W re Dale
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERP.GE
IS UNIAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED 7HOUSAND DOLLARS
($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 DEG�RI�TION:
I hereby aKrm Ihat I am licensed under provisions of Chapter 9(wmmencing
with Section 7000) of Division 3 of the Business and Protessions Cotle. and
my liGense is in jCul�l (ofCe a(n�Q efleG�.
Lic. # C� v � I Class #
l�
Gwvactw's S9reWre Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum that there is a construction lending agency tw the
perfortnance of the v.ork fa v.fiich this permit is issued. (Sec. 3097, Civil Code).
Lentler's Name:
Lender's Atltlress:
SignaWre
OWNER-BUILDER DECLARATIONS:
I hereby affirm lhat under penalty o( perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW �or ihe lollowing reason (Sec. 7031.5.
eusiness and Professions Coae: My city or counry which requires a permil to
construct, alter, improve, Aemolish, or repair any structure, prior to ii5
issuanCe, al5o requires the applic8nl (or such permit to file a signed statement
that he or she is licensed pursuant to the provisions o( the Contraclors
License Law (Chapter 9(commen���9 with Section 7000) of Division 3 0l Ihe
BuSinesS and Professions Code) or thal he or she is ezempt Iherefrom antl
the basis for the alleged exemption. Any violalion of Section 7037.5 by any
applicant for a permil subjecls the applicant lo a civil penally ol noI more Ihan
fve hundred dollars ($500).):
❑ I, as owner ot the propeRy, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intentled 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 dces such work himself or herself or through his or her own
employees, provided that such improvements are not intended or otfered for
sale. II, however, the building o� �mprovemenl is sold vnihin one year ol
complelion, the owner-builder will have the burden of proving Ihal he or she
tlitl not build or improve for Durpose of uleJ.
❑ I, as owner of the' property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to co�sWcl lhe pmject (Sec. 7044, Business antl
Professbns Cotle: The contractas License Law dces not appty to an owner of
property who builds or improves th6reon, and v.fio contracts fa such projecl with
a contractor(s) license pursuant to the Cont2ctps License Laws.).
❑ I am exempt under sec.
Business and Professions Code for Ihis reason:
Sigiuture
305]-a6(J/O])
. �
Owner ID veri(ed by Arive� . nce�. 0 Yes � No
Driver's License No. Expires:
Verifcalion o( Ownership by (rype of document, i.e. - property tax bill ar deeC):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �•.
❑ I hereby certily Ihat no excavation frve (5) w more feet in depth inro wfiich a
person is requiretl to descend, will be made in wnnection with work author¢ed
by this permit, and that no building structure, scaHdding, false�wrk, v demdition
or dismantling Ihereof, will be more than thirty-s& (36) feet high. (Chap. 32, Gry
2. M 2, Sec. 341, Ttle 8, Cali(omia Adminisl2tive Code).
❑ As ovmer-builder, I will not employ anyone to Oo work which wou10
require a pertnit tmm the Division o! Industrial Satery, as noted above. unless
such person has a permit to do such work from the tlivision.
Appliwnl's Signalure
Division o( Industnal Safety Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. will the applicanl or presenl or future builtlinq occupant need to fle and
certity a Business Plan for emergency response to release or threatenetl
release of a �azardous material4 ❑ Yes ❑ No
(Section 25505 of the Cali(omia Health antl Safety Code requires, with some
exceptions, that a Business Plan Ge filed with Ne Costa Mesa Fire
Department by every business which has at any one time during a reportetl
year a quantiry o! hazartlous materials equal to or greater than a weight of
500 pountls, or a volume oi 55 gallons, or 200 cubic feet oF compressed gas
al standard temperature antl pressure).
2. Does or will Ihe applicant or present or fuNre building occupanl need to file
a registration form for awtely hazardous materials? ❑ Yes � No
(Section 25533 of the Califomia Health and Safely Code, vrith some
ezceptions, requires registration with Ihe Cosla Mesa Fire Department by
each business which at any one time �as on hantl a quantity of acutety
hazardous materials equal to or greater than a vreight of 500 pounds. or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperaWre and pressure).
3. Does or will ihe applicant or present or fuNre building occupant need �o
prepare an RMPP (Risk Management and Prevention Prog2m (or acutety
hazardous materials)? ❑ Yes ❑ No
(Section 25534 0( the Califomia Health and Safery Code provitles that Ne
Costa Mesa Fire Department may require the preparation, certification and
fling vrith the Fire Department o� an RMPP by businesses which are requiretl
Io register awtely M1azardous materials wil� lhe Fire Department.
4. If an RMPP is presently required. has Seclion 25534 of the Califomia
Health and Safery Code been fully complied with7 ❑ Yes ❑ No
5. Does or will Ihe apPlicanl or present or future huilding occupaM require for
the work which is the subjecl ol this application a pefmit for such COnstNction
or mOdifiGalion from Ille SoWh CoaS� Air �uali[y Managem8nl DiSIfIG[ Or from
any other air pollution wntrol OisMct or agency? ❑ Yes ❑ No
(SeCI'qn 65850.2 of lhe Calilomia Govemment Code requires that ihe requested
in(ormatbn be lumishetl on applications fv rq�residential twildiry pertnits�.
6. Will any part of the lacilily to be Constructed untler lhis pertnit be wiUlin
1000 feet from the outer houndaries o( a school7 � Yes ❑ No
Qf yes", the faciliry must meet the requirement o! Sections 25534 and 42303
ol the Califomia Heallh antl Safely Code).
7. II a permit from the Swth Coasl Air Dualiry Management Dislrict or other
air pollution control district or agency is requiretl lor the wurk which is the
subjecl ot this application, have all ot the disclosures prescribetl by Califomia
Health and Safety Code Section 42303 been matle? ❑ Yes ❑ No
8. pf'yes", attach certificate ol compliance from the appropriate air pollution
control oKcer). � ' . -
CERTIFICATE OF COMPLIANCE: I ceeify that under penaly ol perjury the
information given above is wrrecl I agree ro compty with aIL state laws antl
city ordinances regartling Hazardous Materials antl Emissions.
Signalure Da1e'
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certily under penalty of perjury that I have read this appliwtion antl sWte that
the informalion given is wrrecl. I agree to comply with'all state laws antl ciry
ordinances relaling to building construclion, and authorize representatives of
the Ciry of Costa Mesa to enter upon the above-tlescnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authnrized hy this permit unlil final inspection.
n ure of ) Date
MOItt Aul�onie0 AOW��nI pole
.+ �
- ' CITY OP COSTA MESA
BYILDING DIVISION
i � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Faz (714) 754-0856 • �wwv.ci.costa-mesa.ca.us
�, FOR INSPECTIONS CALI.: (714) 754-5626
�im �`
PERMIT NUMBER: BX08-00241
PERMIT TYPE B MISC STATUS: ISSUED
APN: 13940115 � DATE ISSUED: OS/1112Q08
Zoning: R1, ISSUED BY: KJB
JOB ADDRESS: 2812 EUROPA DR CM Suite/Unit:
Vicinity: REAR OF PROPERTY ` � -Primary Occ: � ".. Const Type :??
SQ FT: 359 � Valuation: '- $10,000.00 � �
SCOPE OF WORK:
CONSTRUCT (1) 14 X 10 LATTICE PATIO COVER AND ONE 14.6' X 15' SOLID PATIO COVER BOTH ATTACHED TO
RESIDENCE. - .- ' � - � � . - - - �
10/29/08 - PERMIT SUPPLEMENT TO INCLUDE UNDERGROUND ELECT. - 50' ELECT. LINE @ REAR YARD.
OWNER: RANSOM, ROGER TR : - Address:: 2812 EUROPA DR - Unit
City/State: COSTA MESA; CA' � � � -. - � - � Zip Code: �926263526- . � , .
Phone: �
APPLICANT: MIKE HOLLAND CONSTRUCTION INC Address: 28081 MORRO CT
City/State: LAGUNA NIGUEL, CA Zip Code: 92677
Phone: 949-235-9477 �.. � � - � - . � .
CONTRACTOR: MIKE�HOLLAND CONSTRUCTION INC � License No. 898714
Address: 28081 MORRO CT
CitylState: LAGUNA NIGUEL, CA
Zip Code: 92677 Phone 949-235-9477
ARCHITECT: �
Phone
ENGINEER:
Phone
Building Plan Check: _
Building permit:
Electrical Permit:
SMIP Residential
SMIP Commercial
TOTALFEES
_ License No.
. � License No.
F.EE SUMMARY
$117.81
$18125
$4170
$1.00
$0.00
$341.76
Unit
Unit:
Gell:
;,. .
.r
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under.Califomia statutes and related
regulations. (Ord. No. 92-28, § t, 12-21-92) � �
EXPIRATION: PERMIT EXpIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. . ,
INSPECTIONS: In order for the work authorized under this permit to be wnsidered 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.
CODE/, ixsveenoNrrve on� ixnnn�s eooet rosvecnoxrne � o�' ' iNTITIqLS
1616 Fired System Final Fire prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root 210 Final Elecirical
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/OccuOancy
WORKERS' COMPENSATION DECLARATION: .
I hereby affirm under penalty of peryury one of the following tleUarations:
❑ I have and will maintain a certificate of consent to self-lnsure for workers'-
compensation, as providetl for. by section 3700 of the Labor Code, for the
perf ance of the work for which tliis permit is issued.
G.� I have and will maintain wvrkere' compensation insurence, as required by
section 3700 of Ihe Labor Code, fa the perfortnance of the work for which this
permit is issued. My workers' compensation Insurance carrier antl policy
number are: .�/'
Carrier. �� r V �'� �
(This sed.nn neetl irot be mmplefetl �I fhe permrt is va7lue�tl a( one hunEied dollars (5100) or less )
Policy Number � ���� `7 '��
❑ I certiry that in Ihe peAormance ot the vrork for which this permit is
issued, I 5hall not employ any person in any manner so as to become subject
to the workers' compensa[ion laws o( Califomia, and agree iha[ if I should
become sUbject lo t e vrorkers' compensation provisions o( Section 3700 of
the Labor e, I s II f rthvrith mply vrith these provisi ns. �
�t.j /0�08
Appliwnfs SignaNre �Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL fINES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000), 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 DECIARATION:
I hereby aKrtn that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 0( the Business and Professions Code, and
my licenseC � ip II (orce d eHecl �
Licr#_ � . 1 � � �Class #
✓
Q
Gontrador's SignaWre �a�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn lha[ Ihere is a constmction lending agency for Ihe
perfortnance of the work for v,fiich this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lenders Address:
Dale
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty of perjury lhat I am EXEMPT FROM THE
CONTRACTORS UCENSE LAW for the following reason (Sea 7031.5,
Business and Professions Code: Any city or counry which requires a permit to
constmct, alter, impmve, tlemolish, or repair any structu�e, prior to its
issuance, also requires the applicaN for such permit to fle a signetl s[atement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Sec[ion 7000) o( Division 3 0( the
Business and Professions Code) or that he or she is exempt therefrom and
�he basis for the alleged exemption. Any violation o( Section 7031.5 by any
applicant for a permit subjects [he applicant [o a civil penalty of no[ more ihan
five hundred dollars ($500).):
❑ I, as ovmer of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
oHered 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 thmugh his or her own
employees, provided that such improvements are not intended or ofteretl for
sale. If, however, [he builtling or improvement is sold within one year of
completioq the ovmer-builder vnll have the burden of proving lhat 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 wnstruct the project (Sec. 7044, Business and
Pro(essbns Code: The contractas License Law dces not apply to an owner of
property who builds or improves thereon, and who cont2cts for such project with
a cmtracta(s) license pursuant to Ihe Contractars License lav5.).
❑ I am exempt under sec.
Business and Professions Cotle for [his reason:
' SignaWre oate
905]�46(10])
,.
Owner ID verified by dme� ., na. .. ❑ Ves ❑ No
, Driver's License No. Expires:
Venfication of Ovmership by (type o( document, i.e. - property taz bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: '��
❑ I hereby certRy that no excavation frve (5) or more feet in depth into which a
person is requiretl to descend, will be made in connection with work autFronzed
by this pertnit, and Ihal no building slrucWre, scaHdtling, falsev.ork, or demolition
or dismantling Ihereof, will be more �han thitly-six (36) fee� high (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone [o do work which vrould
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from Ihe division.
Applicanl's SignaWre
Division o( Industrial Safe�y Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or (uture building occupant need to fle and
certify a Business Plan for emergency response to release or lhreatened
release of a hazartlous matenal? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, with some
exceptions, lhat a Business Plan be fled wilh the Costa Mesa Fire
Department by every business which has at any one time during a reportetl
year a quantity o� 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 antl pressure).
2. Does or will ihe applicant or present or future building occupant neetl to file
a registration form tor acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 ot the Califomia Health antl Safety Code, with some
excep�ions, requires registra[ion with the Costa Mesa Fire Department by
each business which at any one time has on hand a quan[ity of awtely
hazartlous materials equal to or greater Ihan a weight of 500 pounds, or a
volume of 55 gallons, or 200 wbic feet of compressed gas at s[andard
[emperaNre and pressure).
3. Does or will �he applicant or present or fu[ure building occupant need to
prepare an RMPP (Risk Management and Prevention Program tor awtely
hazardous materials�? ❑ Yes ❑ No
(Section 25534 of [he Califomia Health antl Safery Code provides that [he
Cosla Mesa Fire Department may require the preparation, certifcation and
filing with the Fire Department of an RMPP by businesses which are required
to regis[er acutely hazardous materials with the Fire Departmen[.
4. If an RMPP is presenlly requiretl, has Sec[ion 25534 of ihe California
Health antl Safety Cotle been /ulty complied vn[h? ❑ Yes ❑ No
5. Does or will the applicant or presen[ or future building occupaN require for
the vrork which is the subjecl of this applicalion a permit tor such construction
or modifcation (rom lhe South Coast Air �uality Managemenl District or from
any other air polWtion control dishict or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
information be fumished on applications ta nornresidential building pertnils).
6. Will any part of Ihe faciliry to be construc[ed under this pertnit be within
1000 feet from the outer boundanes of a school? ❑ Yes ❑ No
Qf'yes", the facility must meel the requirement of Sections 25534 antl 42303
of Ihe Califomia Health and Safety Code).
7. I( a permit trom the South Coast Air Quality Management Districl or other
air pollution control districl or agency is required for ihe work vfiich is the
subject ot this application, have all of the disclosures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. (I('yes", attach certificate of compliance from the appropriate air pollution
control oKcer�. � . � .
CERTIFICATE OP�COMPLIANCE: I'certi(y Iha[ under.penalty of�perjury Ihe
information given above is covect I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and�Emissions. _ �
SignaWre
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION� OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the informalion given is correcl I agree to comply with all state lavrs and ciry
ordinances relating to building constmction, and authorize representatives of
ihe Ciry of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy ot any building
au[horized by �his permi� until fnal inspection. . .�
(,�SipnaWre 1 er(s Date
//V�. f� _ v
�ME/or .lianzetl ApPliont . 'Da�e
em�oixa: Zp12 EUROPA DR
���" RANSOM ROGER G
�op�+ 2012 EVROPA DR
COSTA MESA,CA
�vv�. �uuxo �ooxFss:
, urcxrtecraa�w�n:
��, AXCH ON FNQ'S 100NE53:
92626
UNT:
FLOOD: AE-46
uc. no.:
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uNr:
LJCOlSED COMNAROFS DECIAfl�TION: I M1nepy �Ifim uMs pruly d pm'ryry OW 1 un ficanasd �vds pwirim� d Cheqa B
lmm�«eno .an s.uon �aaol a oirua� a a ms a�an ana c�d...vm cods. m,d mv 4aw o b i�m ba rd ema.
cm uc. No.: uc. cuss: uc. No.: EXP :
Dms: ���>
'UMNEP BUILUEP DECtAN�TION: I Mnby dlum under paWy d pwWY ����q M1� tM Corurom liowa lew la tM
lowip iaecn (Satlion ]W IS Biniets md NMw'vu Code: MV JY a mWY Mid� npmo e DwmC lo mmbutl. NW.'vnpaw.
emWeh. a�Wu enY WucPvs. pv b ia euwre. ebo nC�m {h0 ePP� te vrl� D�� ta Ne fl vpad UatameN CW M a W
e ficanaed W�� lo IM Vv+ubne tl IM CaNmWs linroe laM I�tiPa 9(mmmenmq wvh SWion ]000) d Oxwian � d Ihe
6uairiem ena Prdms'an codel « �w ne «ahe o aumq �naenvm ena tne bem �n �ne eOepeE memwin,. Ivrv vowun d senun
]0��.5 b/ vry epptireiu la e perm9 abjea� iM eppG�an �o e tlN pNW d np mpe ihmi fns hundea0 Eadeis jf500p.
� I.moMnerdlhopW�YamY^mVbr�+xih�p»mtheidemmV��.vAEotlawk.andiM�NMivaenal'vtleMeE
a Meed br eeb (Sarton )ou.6�aw aM Profadwn Catle: The Catlretlore liowa law Aam na eGGN �o enoxnard propwry
who Euide a inqwae thaeon. md Mu do» auN wak FbnaeO a henN u Waqh hi o her own w^WvNa�, pw'idsE thel ach
" povameMe vs nol iiusded o Wend ta Ws.:tl. hows.er. iM bu�dinp a inpo.mmpa u wN xitM ms yaer d wnWlMun. IM
" ow�wr-0uikm wiil lave iM WNen d pavi�q M a�eha did rid beld n impwe la �M Wmoea d We�.
Q�. v owrwr a �ne ww�r. ���N ���.a�ro •^m rmnre mnvenoro m mmiw Ne wd� (swun 1ou. a,.'va...nd
Prolevbn� Code: The Cap�m Lr.ems law doss np �pph� b en ovmer W popaty rAa bu� a L�par tAweon eM rAa
convecia br wM prqeda nn� a mnireeMe) lcenrd punuem io ihe Convapon Lioenas lew).
�i,m,.,mq�m«s«��,: e�arc..i«mro : .C/./���
oa,J� /2 �3 �4(� o�,
i�eo n.r.nv �.�r uw i.m ...,s a.�a �d.,w�e ine �+a��.m o„�. �en�.m smar coae seam. zssos. zssa�. �e
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ewmulacaM�uctimamoA'dmionhantMAi3w�iiy wpenW��.�dv���eppk'etbmenasmqlromthra
Dma: Appfraia:
WORKEN'9 COYVENS�TION DECWI�TION: I M1ershy dfim uWN D�etly d pvpvy ons d tM IoOOWp AWvmbm:
� I Mn end vN me'vit�n a ceNiuts M mroaM lo �aAimun b waMen' mromsnim. o pwidad la by Beqion �ro0 d tM lebar
coe.. �a in. o.n�. w m..on r« w:� um w�a 4 er�e.
I] I hm eM wil mentrii wvMw�' cvmD�ion'vuu�uios. n n�°°d M Sadin �100 d Ihs Lebar Cod�. b �M D� W tM
wak la wM1idi Ne V+�M u ieueE. My waken' wmpsnWion cmanu ulrier W W�+�Y m�mEr ma:
c�«:
v�y r�n«
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� I calh Ntl m Ns GNmmuic� M IM Vak for xfiU ilw D>� e minE. I tlW m� +nWM �Y Dr� b M' memw n n to
becairo wbjea to iM wta�' minpa'uNian Nw d CeNome. �d aWw CW ! I Ywq Decme abjW to IM w�Mn'
�� o�on. a s.ac� aroo w m. ien« coa.. i a� io�m.en m„oh wn mo.e pwuore.
Deu: MW�+�v:
w.m�na: %.uvn ro..cvn roik.r: carc«u�mn eavnw �. ut�..M ua.rw�.,eNN.n uro�w�'ro crtnm�nNrou uM
c/MI Ilnu ,p h m� h�ntliwl WuuM GelYn (SIPqOWA h MU� b M rosl 01 wmpwu�tbM1 Qumpu u prorMN br In
9�ctlan l]06 0/ IM LNor Cod�. IMrv4 ����Y i l�u.
CONSTtiUGT10N LENMNO A�ENCI: I hweb/ al�rm imder pMeIM d perjvy �het �Mn e e mutwion bnNnp epe�x,y /a tlw
pxbnneme d iM Mvrk lar xA'rA iAe M�� e ewsJ (Sadion �04I. CH. CI.
LENDEP'9 NAME
LENDEP'4 �DDXE49:
1 urWY �MI I luw med Nu eDWiuiian W tleta Ilut Ne ebws'udamNion u canea. I nW� to oom W�nh eY tlty ad couM' admerces
eM vims lewe rek�vq Io buikvq canatrupion erd Mraby euihor'¢a re�e�elrvse d Ihu dly ro omm upon �M ebme-memianed paperry
���'°"'�0��°� ROG RANSOM
Pml Nama
ome: 2 �o
� �_
1 (5151JE.WP)
Whils9uitlip 8 Selery: G�aemFb: Canery-ApWanl: PinkJle�aws: Oddenm�Anamwr
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 080742
PLAN CHECK NO: OSU43-96 L
PERM NO: B 000742
GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: CON
SOB DESCRIPTION : CONSTRUCT 90LF 6' HIGH BLOCK WALL SQ FT; 90
CLAIM VALUE: 6,000.00 CALC—VALUE: 1,800.00 GROUP OCC; U-2 /
COMMENTS: X
**itititit*�**�*�*�*�*�r*�**it�itft��r**�t���it*itit*��r**�tit�r**�itit**it*�*****��**x*�*�tifitit*«�*+t�
Z O N I N G R E(j U I R E M E N T S
S E T H A C K S
------------ MAIN HOILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 13940115 ZNE: R1 REF NO: PA-96-60
PLANNING NO'TES> CONSTRUCT 6` HIGH HLOCR WALL ALONG SOUTH CAPELLA COURT. 90
> LINEAR FEET,
iE 1E 1E 1f k 1f 1f !f 1E 1E If 1f 1E iE if iF iE iE 1F fF 1E 1E fE 1E 1E 1E 1E if 1E if 1E 1F iE 1E 1E 7! 1E 1! iE k 1f 1f ik �k IE fk f! iE iE iE IE 1F 1f 1E iElE fE fE iE 1E 1k ik iE 1E IE i! ff if �f fE iE f! �E if iF fElE 1E iE
D E V E L O P M E N T S E R V I 7C E S R E Q U I R E M E N•T S
ZONING APPROVED BY t�-�= DATE: /
BUILDING APPROVED BY : DATE: •�� �
APPLICATION ISSUED BY: DATE:
,�,�,���«,�,� �,�,�,� � �,�,�+� *,� * *�,� * �,�,� * �+�*+�,���*
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 56.75 .50
SMIP/NON—RES
PLAN 36.89
ISSUE FEE .
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 57,25 0.00 36.89 94,14 94.14 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 94.14 OVER/SHORT; 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
56.75 ,SO • 36.89
M 1k 4 k 1f 1E k 1E k 1E 1f if 1E 1k if 1! 1E 1E iE 1E iE iE iE 1E 1f 1E k 1E 1F k 1E if 1f 1f IE 1E 1E IE IE 7E 1E 1E 1f 1k iE if IE ff fE iflE if 1F 1E k fE 1E 1E ik �k �E IF 1E 1E 1F 1E if 1k iF if 1! ik i! iE 1k if fklf 1E
I N D I V I D U A L F E E B R E A K D O W N
TYPE
SFR
��
D E S C R I P T I O N UNIT CO$T TOTAL COST
RES—CONCRETE BLOCK WALL / FT, 20.00 1,800.00
END OF FEES
�D -�� i �i �
DEC 0 31996 - .-
CIiY OF COSTA MESA �
� CONSTRUCTION AND PLANNING � � P� & SPA I
APPROVALS Permit # Date InspA\to� qppROVAIS Permit # Date Inspector
� t. Temporary Electrical Service or Poie � 52. Pool & Equipment Locauon
2, Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility•Undrqrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical 0onding `
5. Sxeel Reinforcement 2-iY� �1,�[_ 56. Rough Plumbing & Pressure Test •
6. Electrical UFER Grnd. 57. APPqOVAL TO COVEfl•GUNITE �
7. Footings Z--�t.�_�7 � 58. Electrical Conduit�Undrgrnd.
B. Foundation 59. Gas Pipe, C] Undrgrnd., Tezt
9. Water Pipe�Undrgmd. � 60. Backwash lines, P-Trap, � Undrgrnd.
10. Structural Floor Svstem 61. APPROVAL TO DECK
17. Properry Sewer Line & House Connection 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent•Final
7 3. Roof Drains 64. Plumbing System • Final
14. Rough Piumbing 65. Electrical•Final
15. Rough Eleetrical•Conduit 66. Solar System-Finai
i 6. Rough Elettric Wfring 67. Fencing & Access App�oval
77. Rough Wirin9 Sfgn 68. APPROVED FOR PLASTERING '-
18. Rough Electriwl-T Bar Ceiiing 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. �Rough Factory Fireplace . - APPROVALS Permit #
21. �Ducts, in Struccure �. , . ' 70. Underground Hydro
22. Duas,Ventilating . . 77. Product�Piping�Gas QOii
23. Gas Pipe•Rou9h & Test " 72. Underground Flush .
24. Roof Framing � 73. Under9rnd.StorageTank OGas ❑Oii
25. Roof Sheathing _ 74. Overhead Hydro
26. T-Bar Ce4ling IStructurall & Monocoac � 75. Dry Chemicai .
27. Frame and Flashing . . 76. Dry Standpipe _
28. Lathing & Siding � - . 77. FIXED SYSTEM� FINAL
29. Insulation " 78. FIRE PREV. FtNAL �
30. D�Y`�`�all Nailing � ' HEALTH DEPT..RE�UIREMENT
31. Plaster Brown Coat; ' 79. FINAI INSQECTiON
32. Electricai 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. Finai Factory Fireplace . " _
. � _
38. Final Plumbing .
39. Water Service-Final -
� 40. Gas Service-Pi�al - � _ '
� 41. SO�ar pomesticPinal
42. Backflow Preventer : � . -
43. 88ckflow Irrigation � - � " � - .
44. Landscape Irrigacion System � Z-Z � 7� e� � �_���
45. Sound Attenuation � - �T-��
46. Handicap Regulations . �
47. FINAL STRUCTUFiE & BUILDING -Z�� �pG�j
48. FINAL PLANNING
49. Etectric Release to Edison
50. Ges Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY •
Np. Date
� �367 � �
1-� �� ���
CITY OF COSTA MESA
PLANNING DIV.
SUBJECT TO BLDG. DEPT. RI
BY � DATE�?-L
%� �`�I, b[o�1� wal��
R[f10[NCC
IIEtID[MCE
s
oi�\
� S OryoF�UlLof ��� �I 1
A �sT NC
a��s Se\..�\�Pr��q� v� ly�sq AFETY
oir�s °ans D
G�?,.ys., �:'ig.,; dn� � �...
ThO:t-J nr``�"'uy°mak<e::ilicahons /
+�Q ln �d u,�,,;y ei rh� �ivis%o�B �9� oUs � �e �1 T /
`� G,�, � 37���� Snlaq �oying al,r��a�. Pi pn �h' b
i�'�S,%a,������cw,nwc�SaeBNo��° oaG'o� H�eryCyo �w�lhnu(W��es
k�i�r,i,7��o;Frc�� s ir��`.. w a�yp� .�CN�T �M��n
'�L a �QC^v�\ �\��abYl�i�tr ��a�YCe�rOPe
"c� �vanuma°j;a!roer,,u tyoi�s�
11[61D[NC[
ver�e���
2,o�t t
C'Q6sr��s ,
RElIDENt[
TREET A �.(1'�pP/� O R ,
�
�
�
U
TYPICAL 6�� CONCRETE BLOCK FENCE
Cement Coping Oot�onal --
Channel Block With 1-3/8�
Horizontal Top of all
Fences°
For�Fences 5' or Less
Vert:�Bars 3/8"�i at 4' -0" O.Cr�
For F� ces Higher Than 5' �
Vert. Bars 3/6"� at 32" O.C. �
�,
Fill Cells`Solid With Grout �
Where Steel�0icuri ' - �
Reinforcing Steel Shall �
Conform to"Sec.A-15-39
A.S.T.M. �`1 _.
All Steel to be Lapped
24" or to Code � ,
�� � , ,
NATURA'L�GRADE—i
TWO 3/e"¢ BARS
CONTINUOUS TOP
& BOTTOM
HORI2.STEEL MUST BE TIED IN
PLACE AT TIME OP TRENCH
INSPEC710N.
a
�
>
¢
w in
LL
' .
�'� - -
A -p N
u n - '
D '
. I-�-W'IDiH
� SEE CH[
� BELOW
�Ie
FOOTING REQUIREMENTS CHART
GENERAL- NOTES
MORTAR; pne Part Plastic Cemenf, and
Three Parfs Sand
GROUT; One Port Cement Three and
One Half Parts S�and
COPING: One Part Cement, Three
Parts Sand
CONCRETE: Well Mized 1:2-I/2:3-I/2
• Mux. of 7- I/2 Gallons of
•• Water Per Sack of Cement
GROUT MAV BE POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE S7EEL
OCCURS.
CELLS AND AREASOF HOR120N7AL REtN�
FORCEMEN7 SHALL BE CIEAR, CLEAN &
FREE OF ALL MORTAR DEeRIS, ETC.
H GF E4RTNTCOTH
i/� ThIE NEIGTM OF fENCE
B��LOW BOTTOM OF FOGTiNG
SCALE: I/2��= I'
A
WIDTH 14" . . . . . . . . 14�� . . . 12��_ 12��
THICKNESS . . 10��. . . . . . . . .
10" .. .... ..... 8". 8„
DEPTH OF EARTHTOOTH ... 24"... 20"
16'� . . . . 12„
SPACING OF EARTHTOOTH. . 12' 14� ..... 16'. . 16'
City of Costa Mesa, California
, , Building Department
!GF':!'�EP hlov.e2 . •
.
PARTY WALL AGREEMENT
THIS AGREEMENT, made and entered into this 5cn day of
May 1995
by and between ���Z ���So'"1
hereinafter referred to as "IANDOWNER;' and ���—L ����
hereinafter referred to as "ADJACENT PROPERTY OWNER:'
It is hereby agreed that a party wall will be constructed on the property line
between n2 c� (oZ � 2o(�A (� R— • � i
(Address of Adjoining Properties)
ao4 � s. cA-P�� �,-.
in the City of Costa Mesa, County of Orange, State of California, as per map recorded
in Book ��y' , Page 32 �3'� of Miscellaneous Maps, in the office of the County Recorder
of said County. The party wall shali be permitted to encroach bN ��tE'�T �'�P�zN
.J}C� l�-N �tj-��loN OF 6Z�ST�.ILY tn/KLL TD Ti�C�"�`( F.CuntDltw'f
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
LANDO ER ADJACENT PROPERTY OWNER
_ j��� T_ �,l (�.Q.t--=— �'�. l. �ll-C-�
(Signa��k) (Signature)
L/
�oC-�LZ ��t-.v..fo✓"t w ��� �-�-Z�
Name (Typed or Printed) Name (Typed or Printed)
�cS' / a �c..2o�rs ��2 , C /'v%. �7i � �L`i-L � G�"i ,
(Address) (Address)
• NOTARIZATION REQUIRED
t906 a6
�
�
��� _ ����
�j \ LC� 'f1Fi('��
CITY OF COSTA MESA
BUILDING DIVISION
OWNER-BUILDER VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shail attach to such
notice, and, as a condition precedent to issuing a building permit, require the completion and require the
return of, an owner-builder verification.
Attention Property Owner:
An 'owner-builder' bu'rlding permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit wilf be issued
until this verifiCation is received.
1. I personally plan to provide the major labor and materials for construction of the pro-
posed property improvement. ❑ Yes J$� No
2. I(have/have not) hc�J2- �o� signed an application for a building permit for the
proposed work.
3. I have contrac
Name ntn
with the following person (firm) to provide the proposed construction:
Address !`ffia}'1 !"!/iK(;-HlE Ln! City NUn�! A�Yf
Phone (7�y ) 9�i•S Oi���{_ Contracror's Lic. No. SF�yS��
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name _
Address
Phone (
City
Contractor's Lic. No..
5. I will provide some of the work but I have contracted (hired) the following persons to pro-
vidQ the work indicated:
Name
I heret
of California
sonal knowl�
Signed:
Name:
Address
Phone
Type of Work
aftirm that I have received a copy of the information set forth in Section 19830 of the State
��ea and Safet-� ode and have completed the above information to the best of my per-
in compli cfe.ivith this State law.
�� ��1��— Date: J /�/�.�
- �rnntea or iypea)
C.D.L. # or S.S. # � � ��
754-5273
Applicant to fill in all soaces exceo� those witnin neavY OmEer lines ana siqn all aoorooriate tleclarations.
P MIT NO. TRACT NO. LOT NO. UNIT NO.
CiTV oF COSTA MESA CONSTRUCTION•PERMIT �f 3� A.P.Sf� Zone
Pr�ect Address � ��1"O, 0. �
r; S Main Building: Accessory Building:
Applicani'S Mailin Addre55 F^ � TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OT ER T Front p
=Qwner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. �r hnQ �C� /�ro B N
A Rea� �
/�ddress Zx%% ���/ nl- �(�Q?'�Y�Yn�<r=f'jOR i �,tfr1�S
Arch/Eng. License No. TVPE�ERMIT / LJ GRADIN�UrTDA7iON STRUCTURAL K Right G
Address ❑ TENANT ❑ ELECTRIGAL ❑ PLUMBING ❑ MECHANICAL i S' Left
Contractor's Nam Phonep��72_ 4 ��oTHER -� Ping. Ref. # Parking Peq./Provided E
PROJECT DESCRIPTION S4.FT. ocCuaaNCv n
Address (m '�� „I �{t� T d•I/L' �'�3 � �//�(' ,l Planning Notes: �
/t CONSTRUCTIONTVPE 1J� VALUATION$ Y�BQ M
�Z/ J � T
City LicenSe No. ZONE GRA�ING CU. VDS. ACRES '
LICENSEO CONTRACTOR DECLARA7I�N S'
1 hereby affirm that I am licensetl untler provislons of Charter 9(cammenGn9 Remarks: '
with section ]000) of Divislon 3 Of the Business antl Prote55ion5 Cotle, antl
my license is in !tull f rce antl effect. 1 ` ELECTRICAL FEES
License Class �+��% --� Lice se No ���/�<
Date � ��'� � S:g�� ����� ��- PLUMBING FEES
Au[omatic Washer Transformer ❑ 15-50 KW
WORKEHS'COMPENSATIONOECLARATION ConStructionPoleSub. � 50+KW
/I h¢�eby aftirm that 1 have a certificate O/ Consent to self-insure or a Certiflcate Bd� Siflk ShOw¢f5 -
� ot Workers' Compensation Insurance, oY a certifietl copy tnereoi (Sectlon . Cooking Unit Meter ❑up to 100 amps
3800, Lab. C.) ,�f- D BackflowPreventer ServiceSink ..
Poiicy r�o. /�'i f S%J Company ' I�P �k� �1 gackflow Irrigation Sewer Cap Dishwasher Meter ❑over 100 amps
�Certifietl copy is hereby furnishetl. Dryers ❑Gas ❑Electric Sub Panel ��" -
Certj Ietl copy,is tiletl w�th the city Builtlifjg Divisio� v. B2thtubS S¢w2f COf10¢CtiOn
oace.�" / �- T� - Applicant,SlYIYTh /�c�Of-r �1( Fan
EXEMPTION FROM WORKERS' COMPENSATION DECLARATI N Cld�ifi¢�5 SOId/ COII¢Ct0�5 MOtOfS OQ7 HP O1 h- B
(This section neetl not be completetl if the Permit is for one huntlretl ($300) or F.A.U.
Iess). Dishwasher Solar Piping Inc. Solar Q 9-15 HP: � 16-75+
1 certify that in tne pe�fo�mance of the wo�k fOr whith thi5 pe�m�t is i55uetl, I
shall not employ any person in any mar+ner so as to become subject co the Drinking Fountains Sol2r�Tank Fixtures Microwave .•
Wo�kers' Compensation Laws ot caiifornia. Device Boxes
Date Si9nature Floor Drains Swimming Pool w/Spa Pole Light
NOTIGE: If, afte� making thi5 tletlaration. You shOultl become subject to [he
(�(� Workers' Compensation provisionz of thi �bor Cotle, you must forthwitn Floor Sinks Urinal Outlets Range
:+�,J comply with such provisions or tnis Permit shall be Ceemetl revoketl.
1 CONSTRVCTION LENOING AGENCV SWitChes
Gas Servic.e Outlets Water Closet Sign
1 hereby a(firm that there is a mnstruction lentlin9 agency tor the oerformance
� Of th¢ work for which this pe�mit is� issuetl (Section 309] Civ. CJ � �nterceptors We[ef H¢2t¢� Garbage Disposal StdOding $ECtiOOS
� Lentle�'S Name
Lender's aaaress Kitchen Slnk Water Service Generator 00.5 KW �5-t5 KW Trash Compacmr
^, OWNER BUILDER DECLARATION
lV I he�eby af(i�m l�at I am exemp[ from the Cont�actor's License Law fo� the Lavatories AutO-WeSh
followin9 reason (Section 7031.5 Business antl Protessional Cotle: Any city or
county which requires a permit to constrNct, alfer, improve, aemolish or repair p-Trap � Laundry Trays
any strutture, p�io� to its i55Uance, also requi�es the applicant fo/ such permit
to tile a si9netl slatement that he/she is Iicensetl pursuant to the provisions of Roof Dralns
'^e Contractor's License l.aw (Chapter 9(�ommencing with Section ]000) of
ision 3 of the Business antl Professi0ns CoOe) or that he/she is exempt Reins ection Fee
,efrom antl the basis for the allegetl axemption. Any violation of Sectlon P $15 I55U8 FBB $ 3
,j1.5 by any applicant for a permit subjects tne aOP�icant to a civil
enalty of not more than tive hundred tlollarz (ESoO). DEVELOPMENT SERVICES REQUIREMENTS:
� 1, as owner of the property or my employees with wages as their sole ReinSpBttion Fe9 $15 ISSue Fee $ 3
compensation, will tlo the work, antl the structure is not intentletl or ofteretl 2oning Appfoved By nate
tor sale (Section 1044, Business antl Professional Cotle: The Contracmr's - MECHANICAL FEES Building Approved By Data
License law tloe5 not apply [O an owner Jf a p�operty who builtls or imprOves e� —�8
thereon, antl who tloes such wo�k him58��/herself o� tn�ough his or he� own AppliCdtlOn ISSued By Det
empioyecs, provided roat such improvements are not intentled or ofteretl tor Bo��er Hood or Type I ❑
zale. If, howeveq the builtling o� imp�ovement Is soltl wlthin one year ot com- C3nOpy Type 11 ❑
pletion, tne owner will nave the burtlen tl� Proving he/she tlitl not buila or im- puct � Under Ground SUMMARV OF FEES
proveforthepurposeotsaie). BUILDINGPERMIT $ �%N SMIP $ �i�
❑ I, ♦�s owner of the property, am exclUsivery contracting with Iicensetl con- Duct -Structural Refrigeration System pLAN CHECK $ PERMIT
tractq � to construct the project (Section �044, Busin¢55 antl Profession5 Cotle:
The yntracmr's Li<ense Law does not apply to an owner ot property who Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU PLUMBING $ ISSUANCE $
builtl/ �� impwves thereon. antl who cont�act5 for such oroiects with a r.on-
tracVll;s1 license pursuan� ro cne Cantractors License Law). I am aware thai Exhaust System � Multiple ❑ System Repair/Alteration PLAN CHECK 25% $ ENEfiGV P.C. $
proo�of their WorkeYs Compensatlon insurance shoultl be provitletl to me. �JI O00�O9�S-l�(GAADI.NG TL$T �� ��
❑ I am exempt untler Section—� B. & P. C. for this reason Firepl/Fact. Blt. ICBO # Fire Dampers ELECTRICAL $ � �
PLANCHECK 50°h $ UHIt� 1L/UlIEiMICROFILM�-�$=
_ .. 0 � ^'�� Heating System & Ducting Registers $ —��7�$-
c MECHANICAL TOTAL FEE $ ___L_�
I hereby certify that I have reatl mis aPo�ication antl state that the above ❑0.100,OOOBTU �t00,000BT
Information is correct. 1 agree to comply with all city and county ortlinances PLAN CHECK 25% $
and state laws relating to builtling constluction, antl hereby authorize repre-
sentatives of Ihis city to enter upon tM1e above-mentionetl property for
in5pection purpo .
Signatvre oate � Reinspection Fee $15 luue Fee $ 3 ACC.nUMi �$� $tt]Q(��OjQ
Dr�vers' �icense or 55 �. �J1 O�4q CIO°'i t7�i1209fIS-finfi7G+Pft<
0865-46, rev. 5/88 Wni[e - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor ��/�1�8�5 01 (.N. TEt,D !%.'��
i CONSTRi1CTION AND PLANNING P�� SPA'
Date Inspector � Date Inspector
A�PROVALS Permit #� i APPROVALS Permit #
1. Temporary Electrical Service or Pole ,� 52. Pool & Equipment Location '
2. Soil Pipe�Undrgmd. ,•+ ,; � 53. Steel Reinforcement � '
3.� Electrica, Conduit,Utility-Undrgrrid. �� 54. Forms j
4. Electrlcal Condui{-Undrgrnd. ' 55. Electrical Bonding � �
5. Steel Reinforcement �� 56. Rough Plumbing & Pressure Test
6. ElQctr,icaiUFERGrnd. ; 57. APPROVALTOCOVER-GUNITE �,i
7. Footings �' �i _ 58. Electrical ConduirUndrgmd. � � I
8. Founiiation • �: : 59. Gas Pipe, � Undrgrnd., Test '.i �
9. Water Pipe-Undrgmd'. _-� . 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System , 61. APPROVAL TO DECK , �
11. Property Sewer Line�'& HouseConnection . � 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
96� 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 H2ating & Air Conditioning FIRE DEPT, REQUIREMENT
20.�Rough Fa'ctory Fireplace APPROVALS Permit #
21. Oucts, in Structure 70. Underground Hydro
22. Ducts, Ve'ntilating 71, Product Piping O Gas ❑ Oil
i :
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing ' j_! 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Shedthing ' 74, Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �
27. Frame end Flashing � 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulatjon 78. FIRE PREV. FINAL
30. Drywa4,l Nailing HEALTH DEPT. REQUIREMENT
31. Plaster�BrownCoai, ; 79. FINALINSPECTION �
32. Electri�al Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final E�lectric Notes: � � Q
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 pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation '� �:
44. _Landscape Irrigation System �:i
45. Sound Attenuation "
46. Handicap Regulations _
47. FINAL STRUCTURE & BUILDING � 8
48. Special Requirements Completed ., ,
49. Electric Release to Edison "', �
50. Gas Release to Southern California GasCo � � i
51. GERTIFICATE OF OCCUPANCY ; � .';
No. � Date ' i
OWNER NOF'SI�R. M.
DATE
FIRE ZONE DLSCRIPT[ON OF WORK
J GROUP,T TYPE III ^-mZONE
� SUl3COtv'rltnczo:t PER.MI7
�
ennin
f 1944�
:f
' COSTA MESA BUILDINGSAFEfY DEPARTMENT
P.O. BOX 917 GOSTA ME6A, CALIFORNIA
��
For Applicant fo Fil1 In Comple►ely
TYPE OR PRINT
BUILDIN6��-�g\Z, �NyLoQ�
ADORESS
COSTA MESA, CALIFORNIA .
OWNER� . `�1oES'�(,E�„l,�
MAIL -%Q\9� �'•�,CLOP �
A�DRESB
crrr c�sC-o. \�\6 S •s+ re�.
NO.
ARCHITECT ' TEL. �
•ORC'��'�' GS:�\� �
�4�'��.C�a�J
■ SETBACK LINE FROM
�E REC�Il���
,�eY .l 0 1963
APPL ATIOtN1�0 �F�PRT�,r
CI Ys�i�dii����i�3�
For Office Use Only
ZONING ee�+ldu,��T
NO.OR I U6COFNeW � / !�1 G�
PLANH %/{ BWLDINO ' n��
LHOAL
NOTE: NO EAVE OVERHANG SHALL BE LESB THAN
Q NEL. , �-S Zf� 90" TO 61DE 8 REAR P. L.
Y
EAVE9
. I no.opB�oae.i ALLOWED (U.B.C.REQUIREMENT
NOW ON LOT
YAR�SAPPROYED YARDSAPPROVEO
SZ MAIN BUILDING AGCESSORY BUILDING
DESCRIPTION OF WORK
BUILOIN6 ��
SIZE
EXTERIOR WALL
GOVERING -�
lJ$FQF BUILDING AND Y
8 _- STI
iF
ERIN6 �'
BEP6RFORMI
1 VAR. iL
��
1
I HENEBY ACKNOWLEDOi THAT I HAVB READ TNIB APPL�CATION
ANO ST/�TE THAT H6 ABOVQ I6 CORFECT ANO AOREfi TO COM.
PLY WITH ALL CI Y OP ANO BT�TB L�WB p80UlATINO
BUILDIN6 CON6T UCTI N.
61GNATURE OF
PERMITTE
AUTHORIZED A6ENT
I.h\Ya
C
�
� // r 8�. F'��X � / �%��. m
THE AMOUNT 6HOWN UNDEP VALUATION I6 FOF THE F'
PUFPOSH OF fi8TABL19HINO w PERM�T FEE ONLY. �
VALUATION m
N
PERMITFEE� $ j
0
$/// ✓ PLAN CHEGK $ � 0
LL
TOTALFEE S �
l6524
COSTA MESA BUILDINGSAFETY DEPARTMENT
P. O. BOX 9f7 COBTA MEBA. CALIFORNIA
For Applieanf to Fill In Completely
TYPE OR PRINT
1 ARCHITECT
� �!Z E �RoF.4� _ DiZ, vE
COSTA MESA. CALIFORNIA
G�X
I 86TBAGR LIN! FROM
TEL.
N�: �j,� ��
I NO. OP
DESCRIPTION OF WORK
BUILDING J CI�jO
81ZE C/ /
EXT6RIOR WALL . W�'d
COVBRING ar�no
USE OF BUILDING AND W
OF
F�E ��C�1�l�i�
MFlR 2 tg��
F;N�t�CE �EPT.
ci,r oF ccsiN ���sa
APPLICAT�ON FOR PERMIT
BUILDING
For Office Use Only
RECEIVEO
/
BUILDING
GOSTA MESA. CALIFORNIA
FIRE
�
ZONING
ZONE NO.OF USE OF NEW%/�5 �
R—� IPLANB � BU�LDING (y gyf y
��o�e,e.,,... Lot 3 y r�e v3v9
/� IGENiER LINE 8T.)
FRONT SO
R. SIDE � 8
L. SIDE / 8
IREAR /3
I APPROVED
BY u%r,(i
6z
� d
i�
� S�
IN.
IN.
�re ZIfG/6z
1 HEREBY ACKNOWLEOGE THAY � HAVE REAO TX19 APPLJGTION }HE AMOUNT BHOWN UNOER VALURTION 19 FOR THE
ANO eTATE THAT THE A60VE IS COitR¢CT AND AGREE TO COM- pppp08E OF EBTABLISH�NG A PERMIT FEE ONIY.
PLY WIiH ALl CITY OFiDiNANGEB ANO 9TATE LAWB REpULATING
aWLDINo coNBTRUCi�oN. VALUATION ��j�
SI TURE OF PERMIT FEE $ Yi/
P M �/t/�� // �,6�
- � 't`'_ —_— —'' �O'r�J t l � PLAN CHECK $r-.F/—
THORIZED AGENT 2
TOTAL FEE