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Home My WebLink About291 FLOWER ST - Building Permits(714) 754-5273 • Fa�c (774) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address Contractor: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Ligh[ing Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Motors to 1 hp Motors to 10hp Mofors to 50hp . Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole 291 FLOWER ST 11721315 MILLS,SCOTT 291 FLOWER ST COSTA MESA, CA BURTON,THOMAS W 291 FIOWER ST COSTA MESA, CA ELECTRICAL PERMIT Phone: 949-642-7185 Zip: 92627 Phone: Zip: 92627 Phone: Zip: License: ISSUED BY: Status: APPLIED Applied: O6/22/2000 Issued: SCOPE OF PERMIT PART OF WORK WAS DONE WITHOUT A PERMIT.REMOVE EXIST. 6 WINDOWS AND REPLACE WITH SAME NO AND SI2E. REMOVE INTERIOR PANNELS IN TYHE DINNING AREA AND DRY WALL, INSTALL REDWOOD ON REAR OF RESIDENCE. REF B00-00926: 10 LIGHTS, 7 OUTLETS, 5 SWITCHES. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $71.00 $7.70 $5.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 10 7 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /700 ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES $47.70 COMMENTS / SPECIAL CONDITIONS Quantity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: Tha work authorized by this permit shall comply with all applicable handicap access requiraments under California statutes regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is for a period of 180 days. related abandoned INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all plicable codes, and required Inspectlons and final epprovel must be obtained. Failure to obtain inspections and final approval will result in the piration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 � WORKERS'COMPENSAnON DECLARAnON: I hereby aHirm untler penalty of perjury one of the following declarations: ❑ I have antl wlll maintain a certificate of consent to seN-Insure tor workers' compensation, as provitled for by section 3700 of tha Labor Code, for Ihe pertormance of ihe work tor which this permit is issued. � ❑ I have and wlll maintain workers' compensation insurance, as required by seclion 3700 of the Labor Code, for tha pertortnence oi the work for which ihis pertnit is issuetl. My workers' compensation Insurance carrier and policy number era: Carrier: Policy Number: (This section need not be compleretl il the pe�mif is velued et one hundred dollars ($700) oNess.) ❑ I certity that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so es to become subject to Ihe workars' compensation laws ot Calitomia, entl agree Ihat il I should become subject to ihe workers' compensation provisions of Section 3700 of ihe Labor Code, I shall forthwith comply with Ihese D�ovisions. Applicant Signawre: Date: WARNING: FAILURE TO SEWRE WORKERS' fAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJEGT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (3100,000�, IN ADOITION TO THE COST OF CAMPENSATION, OAMAGES AS PiiOVIOED iOR IN SECTION 3/060F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions ot Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Cotle, and my license is in tuil torce and eftect. Lic. N CIa55 # Contractors SignaNre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirtn that there is a consiruclion lentling agency for �he peAormance of the work tor which this pertnit is issued. (Sec. 3097, Civil Code). Lenders Nama: Lendefs Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that untler penalty ot perjury ihat I am E%EMPT PROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a pertnit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such pertnit to ille a signetl statament thet he or she is licensed pursuant to the provisions of the Contrectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Pmtessions Code) or thet he or s�e is exempt iherefmm and the basis for the allegetl exemption. Any violation oi Section 7031.5 by eny epplicant tor a permit sub�ecis the applicant to e civll penalry oi not more than tive hundred dollars ($500).): ❑ I, as owner of ihe property, or my employees with wages as their sole compensation, WILL DO TF1E WORK, and tha structure is not intentled or otteretl for sale (Sec. 7044, Business and Protessions Code: The Contrectors License Law does not apply to an owner of properry who builtls or improves ihereon, antl who tloes such work himsetl or herself or Ihrough his or her own employaes, provitletl that such improvements are not intentled or oNered for sale. If, however, ihe building or improvement is soltl within one year of completion, ihe owner-builtler will have the burden of proving that he or she tlid not build or improva tor purpose of sale.). �I, as owne�the p�.�CLU5IVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct tha project (Sec. 7044, Business and Professions Code: The �ract s aoes not apply to an owner of property who builds or improves thereon, and who contrecis for such projecl with a contractor(s) license Our ant t orira License Lews.). Bu5ine5s and ProfeSsions Code for Ihis reason: verifiad by driver'S IicenSB. ��Yes ❑ No Verification of Ownership by (type of document, i.e. - propetly taa bill or deed): � E�1lII (I�� . ��!t"d DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION: ' ❑ I hereby cetlify that no excavation five (5) or more teet in tlepih iNo which a Oerson is required to descend, will be made in connection with work authonzetl by �his permit, and that no building strudure, scaHoltling, falsework, or tlemolition or dismaniling thereoi, will be more ihan Ihirry-six (36) feet high. (Chap. 32, Grp 2, Atl 2, Sec. 341, Title 8, Califomia Atlminisirative Code). ❑ As owner-builder, I will not employ anyone to do work which woultl require a permii from ihe Division of Industrial Safery, as noted ebove, unless such person has a pertnit to da such work irom ihe tlivision. . . Signa�ure: Da�e: Division of Industrial Safery Pertnit Number: CERTIFICATE F COMPLIANCE AND AUTHORVATON OF ENTFiY: I certi(y under penalty of perjury that I have read this applica�ion and s�ate ihat ihe information given is correct. I agr to comply with all sta a law and city ordinances relating to builtling cons�mction, and amhorize representatives ol the City of Costa Mesa to enter upon ihe above-desc etl property for' ction pu�oses. I agree not to occupy or allow xcupancy of any 6uiltling euthorized 6y this pertnit until linal inspection. CODE Y, INSPECTIONTYPE Q9?S MTITIRLS 1616 Fixetl System Final Fire Prevention 1266 200 201 202 203 Pool Spa Final Final Re-Roof Final BIocWRetaining Wall Final Factory Fire Place Final Sign 204 Final Demolition 26a6 46 r.: , 1 , r�� _ �� CODE♦ INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Prevenlion 220 Final Planning Approval 222 Final Sita 250 Finai Building/Occupancy U� INTITIALS ' 'G '� (714) 754-5273 • Fax (774) 754-4856 . 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 291 FLOWER ST . Suite No Vicinity: Parcel Nunmber: 11721375 Applicant: MILLS,SCOTT Address: 291 FLOWER ST COSTA MESA, CA Owner: BURTON, THOMAS W Address 291 FLOWER ST COSTA MESA, CA Contractor�. Address: Arch / Eng : Address: PLUMBING PERMIT Status: APPLIED Applied: O6/22/2000 Issued: ISSUEDBY: �/� Phone: 949-642-7185 Zip: 92627 Phone: Zip: 92627 Phone: Zip: License: Phone: Zip: License: SCOPE OF PERMIT PART OF WORK WAS DONE WITHOUT A PERMIT.REMOVE EXIST. 6 WINDOWS AND REPLACE WITH SAME NO AND SIZE. REMOVE INTERIOR PANNELS IN TYHE DINNING AREA AND DRY WALL, INSTALL REDWOOD ON REAR OF RESIDENCE. , REF B00-00926. . WATER HEATER, AND KITCHEN SINK. ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Ciarifer Syslem Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (i-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, OII) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 SewerCapforDemo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $9.80 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 t 0 0 0 COMMENTS I SPECIAL CONDITIONS SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or RepJ Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 TOTAL CALCULATED FEES: $45.60 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSVECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of ihis permit. FOR INSPECTIONS CALL: (714) 754-5626 / WORKERS'COMPENSAnON OECLARATON: I hereby aHirm untler penalry of perjury one ot ihe tollowing declarations: ' ❑ I have antl will maintain a certificate of consent to self-Insure for workers' compensation, as providetl for by section 3700 of the Labor Code, tor the peAormance of ihe work for which ihis pertnit is issued. � ❑ I have antl will maintain workers' compensation insurance, as requiretl by section 3700 ot Iha Labor Code, for the pertormance of the work fo� which this pertnit is issued. My workers' compensa�ion Insurance cerner and policy number ere: Carrier. Policy Number. (This section need not be comp/efed il (he permif /s valued at one huntlred dollers ($100) or less.) ❑ I cehify that in Ihe performance of ihe work for which ihis permit is issued, I shall not employ any person in eny manner so as to become subjact to ihe workers' compensation laws oi Calitomia, and agree ihat if I should become subject to ihe workers' compensation provisions ol Sec�ion 3700 of Ihe Labor Code, I shall forihwith comply with these provisions. Applicant Signature: Date: WARNINO: FAILURE TO SECUFE WORKERS' COMPENSATION COVERAGE IS IINLAWFUL AND SHALL SU0.IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINE$ UP TOONE HUNDRED TFIOUSAND OOLLARE �5100.000). IN ADORION TO THE COST OF CQNPENSATION, DPMAGES AS PFOVIDED FOR IN SECTION 3]O6 OF THE LABOR CODE, IMERESi, ANO ATTORNEV'S FEES. LICENSED CONTRACTORS OECLARA710N: � I hereby aMirm Ihat I am licensed under provisions oi Chapter 9(commencinq with Section 7000) of Division 3 of ihe Businass and Professions Code, antl my license is in full force and ettect. Lia p ' Class tt Coniractors Signamre: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn that there is a construction lending agency for the pedormance of the work for which ihis pertnit is issuetl. (Sec. 3097, Clvil Code). Lentlers Name: Lendels Address: SignaWre: Date: OWNER-BUILDER DECLARATIONS: I hereby eflirtn that under penalty of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7037.5, Business antl Professions Code: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any structure, pnor to ils issuance, also requires ihe epplicant tor such permit to file a signetl statement that he or she is licensed pursuant to the provisions of the Contractors License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 of the Business antl Professions Code) or thet he or she is ezempt thereirom antl the basis for iha aileged ezemption. Any violation of Section 7031.5 by any applicant for a permit sub�ects the applicant to e civil penalry of not more than five hundred dollars ($500).): ❑ I, as ownar of the property, or my employees wilh wages as their sole compensation, WILL DO THE WORK, and the structure is not intentletl or offered for sale (Sec. 7044, Business antl Pr ssions Cotle: The Contractors License Law tloes not apply to en owner of property who builtls or improves thereon, antl who does such work himself or herself or o gh his or her own employees, provitletl thai such improvements are not intentletl or oftered for sale. If, however, ihe building or improvement is soltl within one ye of� n, the o�er will have ihe burden of proving that he or she did not builtl or improve for purpose of sale.). ❑ I, as owner of t perty ELV ONTRACTING WITH LICENSED CONTRACTORS to consiruct ihe project (Sec. 7044, eusiness and Professions Cotle: The w ors L' aw does ot ly to an owner of properry who builtls or improves ihereon, and who contrecis for such projed with a contrector(s) license ours o t ractarstisen 1. ❑ I am exem�Gnd .____�_ 8usiness and Professions Cotle for this reason�. Signature: � {� � ��V Owner ID verifietl by arivefs license. ❑ Yes ❑ No Driver'S License No. _�- Venfication of Ownership by (type ot document, i.e. - pmperty tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � ❑ I hereby certity th no excavation five (5) or more feet in tlepih into which a person is required to descend, will be made in connection with work authorizetl by this parmit, and tha�uilding structure, swffolding, falsework, or demolition or tlismantling Ihereof, will be more t�an ihlrty-siz (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Ttle B, C mia Atlminisirative Code). ❑ As owner-b e permi� to Division ot Industrial Safery Number: which would require a permit from ihe Division of Intlustrial Safery, as noted above, unless such person has a Date: (/ ✓ � CERTIFICATE OF MPLJANCE AND AIJT}iORIZATION OF� NTHY: I certify under penelty ot periury that I have reatl ihis application and s�ate ihat ihe information given is correct 1 agree t mply with all state 1 ciry or�in{�Ces wlating to building constmctioa, antl auttwriza representatives ot tha Ciry oi Costa Mesa to encer upon lhe above-describ roDerty fo� i n purposes. I ag�,�fot �o occupy or allow occupancy of any building authorized by ihis pertnit until final inspection. Antl/Or Authorized Applicant COOE 11. INSPECTIONTYPE �[F� INTRIALS 1616 Fized System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Si9n 204 Final Demolition 2446-46 COOE• INSPECTIONTYGE 206 Final Mechanical 20B Final Plumbing 210 Final Elecincal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy G Date DATE NTI ITIALS \ • 11r � � (7/4) 754-5273 • Fax (774) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 Job nddress: 291 FLOWER ST Suite: Vicinity: Parcel Number: 11721315 npp�icant: MILLS,SCOTT Address: 291 FLOWER ST COSTA MESA, CA Owner: BURTON, THOMAS W Address 291 FLOWER ST Contractor. Address: Arch : Address: Zip: COSTA MESA, CA Phone: BUILDING PERMIT Zoning: Phone: 949-642-7185 Zip: 92627 Phone: Zip: 92627 Phone: License: Eng: Address: Status: APPLIED Applied: O6/22/2000 Issued: ISSUED BY: ! Phone: Zip: License: License: . SCOPE OF PERMIT PART OF WORK WAS DONE WITHOUT A PERMIT.REMOVE EXIST. 6 WINDOWS AND REPLACE WITH SAME NO AND SIZE. REMOVE INTERIOR PANNELS IN TYHE DINNING AREA AND DRY WALL, INSTALL REDWOOD ON REAR OF RESIDENCE. Plan Check: $0.00 Permit: $69.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $69.75 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existinq: o NOTES: Rear 0-0 Rear 0- 0 Re uired: 0 FEE SUMMARY PLANNING & ZONING LeR 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0-0 Right 0- 0 52,000.00 sz,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) � EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period of 180 days. INSNECTIONS: In order �or the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspectione and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permi� FOR INSPECTIONS CALL: (714) 7545626 � WORKERS' COMPENSATION DECLARATION: I hereby ettirm under penelry ot perjury One ot ihe tollowing declaretions: ❑ I have an0 wlll maintain a cetllticate of consent to self-Insure for workere' compensation, as provided for by section 3700 of the Lebor Code, for the peAormance of ihe work for which this permit is issued. � ❑ I have antl will maintain workers' compansation insurance, as required by section 3700 ot Ihe Labor Code, tor ihe pertormance of the work for which this pertnit is issued. My workers' compensation Insurance carrier anC policy numbar ere: Cerrier: Policy Numbec (This sec(ion need no( be completed il fhe permit is valueC af one hundretl tlollers ($100) or less.) ❑ I certity ihat in the peAortnanca of the work for which this permit is issued, I shall not employ any pereon in any manner so as to become subjact to ihe workers' compensation laws of Calitomia, and agree Ihat it I should become subject to the workers' compensetion provisions of Section 3700 of Ihe Labor Cotle, I shall fotlhwith comply with these provisions. Applicant Signature: Date: WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNL4WFUL AN� SHALL SUBJECT AN EMPLOYER TO CPIMINAL PENALTIES AND CINL FWES UP TO ONE HUNDRED THWSANO DOLLARE ($100,000�, IN ADDfT10N TO iHE WST OF COMPENSATION, OAh1AGE5 AS PROVIDED FOR IN SECTIQV 3]O60F THE LABOR WDE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirtn that I am licensed under provisions ot Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Code, and my license is in full force antl etteci. Lic. 8 Class # Coniracbrs Signature: Date: CONSTRUC710N LENDING AGENCY: ❑ I hereby attirm ihat there is a constmction lending agency for ihe pertormance oi ihe work for which Ihis permit is issuetl. (Sec. 3097, Civil Cotle). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DEClARA710N5: I hereby affirm that under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for tha following reason (Sec. 7037.5, Business antl Professions Code: Any city or wunry which requires a permit to construct, alter, improve, demolish, or repair any slrucNre, pnor ro its issuance, also requires the applicant for such permit to file a signed statement ihat he or she is licensetl pursuaN to Ihe provisions of ihe Coniractors Licanse Law (Chapter 9(commencing with Section 7000) ot Division 3 of ihe Business antl Professions Code) or that he or she is exempt Ihereirom and ihe basis tor Ihe allagetl ezemption. Any violation oF Section 7031.5 by eny epplicant for a permit subJects t�e applicant to a civil penalty of not more ihan five hundrad dollars ($500).): ❑ I, as owner of tha propetly, or my employees with wages as Iheir sole compensation, WILL DO THE WORK, and ihe stmcture is not intentlatl or oNered tor sale (Sec. 7044, eusiness and Professions Cotle: The Contractors License Law tloes not apply to an owner of property who builds or improves thereon, and who does such work himself or hersalt o ihwugh his or her own employees, provided that such improvements are not intended or ottered for sale. If, however, the building or improvement is �sold within one y ot completion, ihe owner-Duiltler will �ave ihe burtlan of proving ihat he or she did not build or improve for purpose of sale.). I, as owner oi properry, am E IVELY CONTFACTING WITH LICENSED CONTRACTORS to consiruct iha project (Sec. 7044, Business antl Professions � Code: The co ctors Lic aw oes npt apply to en owner of properry who buiitls or improves ihereon, and who contracis For such project with e coniracPor(s) license ours t to t ¢ntractor icenSAAlaws.l. lam by drivefs licensa. �f�s ❑ No Business and Professions Code for this reason: Venfication ot Ownership by (type ot tloamen�, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION: No. ❑ I hereby certify ihat no excavation five (5) or more teet in tlepth imo which a person is required to descenq will be made in connection with work authorizetl �y this permit, and that no builtling structure, scaffoltlinq, talsework, or demolition or dismanHing thereol, will be more than thirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, TiOe 8, Calitomia Adminislrative Code). ❑ As owner-builtler, I will not employ anyone to do work which would require a permit trom the Oivision of Indusirial Safery, as noted above, unless such person has a permit to do such work from the tlivision. Signature: Date: Division of IndusMal Safety Permit Number. CERTFICATE OF COy1pLIANCE AND AUiHORIZATON OF EN7RV: I cenih/ under penalry ot perjury thai I have read ihis application and state that the information given is correct. I agree to c((ply with all state laws i�di nces relating to building constmqion, and authorize representatives of Ihe Ciry oF Costa Mesa ro enter upon ihe above-tlescnbed p berty for ins oses. a re ot to occupY or allow occupancy of any builtling authorizetl b�/this permit until final inspection. � 1 nature t Lega (s) ' �j Date �� (i � CODE L INSPECTIONTYPE 1616 Fiaetl System Final Fire Prevention 7266 Pool Spa Final 200 Final Re-Foof 201 Final 81ocWRetaininq Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 2M646 2n*� NI TRIALS COOEt INSPECTIONTYVE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 250 Final Site Final Building/Occupancy Q9I� INTIi1RL5 JIRJ-22-2000 10�48 THOMGS W. BURTON 949 955 3772 P.01i01 W. FACSIMILE TRANSMITTAL * FOR IMMEDIATE DELIVERY * * TO: Charles FIRM: City of Costa Mesa Buuding Department PA.X: 714/754-4856 PHONfi= FROM: Thomas W. Burton DATE: June 22, 2000 RE: Scott M►1ls ( Permits OI2IGINAL DOCUMENT(S) [] WILL [ X] WILL NOT BE SENT. This facsimile consists of 1 page(s), including t}vs cover sheet. If you do not receivc all pages, please telephone (949) 250-0700 and ask for Jeaaae Wagner. SENDER'S COMMBNTS: Please be advised that Scott Mills 6as the authority to use my credit card in connection with the construcH�n business he is conductiag on my behalf. /� ••" CONFIDENTIALITY NOTICE •" This message is intended only for t6e use of thc individuel or entity ta which it is addressed aad may contain iutormstion t6st Is privileged, eoefldentlal and ezempt iYom d'uclosare undcr appliceDle law. i[ the rceder ot thie message is not the intended recipienf, or t6e employce or agent responsibls for defirering t6e mess�ge to the intended recipient, you are hereby notlfted tLat any disseminatlon, d'utribu4on or eopying of this communlcadou ia svietly pro6ibited. It you have receiv�d t4ic eommuuicafion in error, please notify ae immediately by talephone, and return the originel message to us at the sbov� addrcss via the U.S.1'ostal Service. Thank you. 2424 S. E. Bristot Street, Suite 300. Newport Beach, CA 926B0-0757 (949) 2S0.07p0; Fau (949) 9553772 E-mail eddress: tambQlantronix.wm TOTAL P.01 :, DECLARATION OF JTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS Bldg. Permit # This Permit # �Z�l f='� �v� �r, l/ 7- Z-1 3-l� Street Address AP Number 1. I(we), )/�G�� • �� U�7�N , declare that I am the Owner of Title of the above referenced real property, and that I(we) hereby authorize: �077- �'t�! 1 L LS � y � � �% 2 -' % $ �' Name � Telephone No. �`'� l ��v w r7l_ .S J� � s�'A- � �- G4- ��,Y State to obtain permits in my behalf, as owner/builder, for M��2- �� T�hi�� k.fh'��?-�Z. at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I(we) shall im- mediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As ownerlbuilder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correct. Executed this Z� �/ day of d U�� t�ao, at N��2'T d�, ali i. -��/L✓-�-5 w. ,1su27�,1� �,Z/_a� Printed Name � Date NOTE: This authorization does not grant authorization to pertorm the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. aLL==_ � OWNER � 108 AC � GENER �A° �O_ C � S � GAS W ATER BURTON, T.W. SPRINKLING SYSTEM MISCELLANEOUS ROUGH NERTING ANO / TEMPORnRV SERVICE UNDERGROUNO � ROUGH WIRING �L� TRENCHES � F RM FLOOR SYSTEM BOND BEAM � ST SHEATNING FRAME ANO fLASHING LATHING — IN PLASTER,BROWN COA 5" 'iUftAL, FINAL G, VENT., REFI P� .dING. FINAL AN[ STEEL REINF. DATE 12-8-75 BUILDING PERMIT N0. r. UtJIKIY I WN ot WUHK hac TRACT FIRE ZONE VALUE Si �or�.e Dare TVPE GROUF SUBCONTRACTOR COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 120� COSTA MESA, CALIFORNIA 92626 For App(icant [o Fill in Completely - Use Ink Only ADDRESS Z� I � �� (,� 'Z S OWN� �C�� ADDRESS L� I I L'OW L/!.� �"' CITV W S�� t`L �"1 L--�� N�L � 1�� I CON5iRUCTION BRANCH ADDRESS '—�- ARCHITECT TEL�� no cnirinmvo �'� nin A�DFESS �� CONTRACTOR !' � ADDRESS � C! rjJ r.' � _ CITV L_.� F STATE �" LIC. NO. "�" LIQ NO.'�—'" � {axj SIZE �+'� � ` ' NO.OF BLDCaS. �. OF LOT J I� J NOW ON LOT � a USEOF .2� h_ // � EXISfING BLDG. � �GL S y FSeparate permits are required for 0 electric, plumbing and heating work. o� USE�/dP L IfyT-AND W RK TO BE PERFORM /'�� l�L-/fiG� — � a p/C '%�� O�/� �, S% � .7 ' C4 w o. , Q I hereby acknowletl9a that I have reatl this application antl state y! ffiat the above information Is coFrect and agree to comply with a all laws regulating building consiruction, antl I shall not employ Weny person in violation of the workman's compensation laws of � the State of California. . 3 I hereby cartify that I am properly licensed as a contractor untler �the Stete of Caltfor��a Business antl Profassions Cotle, Dlvision 3, Chapter 9, and thet such licenses are in full force antl ettect, or I am exempt from tha Provisions of t�e Stete of Califor ' usiness and Professions Cy�� Division 3 hapter 9 Signamreof�// /n / jSvT// /�. � Pe�mktee G� l� // '��(/`� Authorized Agent PAID � �**�* pFC -5-75�MS�00 309 7.50 APPLICA'IION FOR STRUCTURAL PERMIT EC�I�D BY D�+TE R�CEIVED neTr wmicr �i3--iS `1 A.P. NO. �� ' AD'DRE S 2 I I T LOWCR TRACT S / i LOT �2 OWNE FIRE ZONE APPROVED ZONE � � NO.OF � PLAN$ S YARDSAPPROVED . MAIN BUILDING VAR. # nraaoveo USE OF NEW A�Ti BU�LDING r�� VARDS APPROVED ACCESSOFV BUILDI � 1 � FT. FT. �� FT. FT. IEf. BET. MAIN Si i. ACCESS. BLDGS. OATE APPROVED �i� y+' I\ L nnTc j< ." g— 7� THE AMOUNT SHOWN UNDER VALUAT THE PURPOSE OF ESTABLISHING A PERMIT VALUATION PERMIT FEE $ O O PLAN CHECK $ . $ �00 '" TAX $ � TOTALPAID $ � n m i ` m N 7N IS FOF m E ONLV: � a I 0 � ._-__. m 0 LL / � U