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HomeMy WebLinkAbout117 FLOWER ST - Building Permits '1-. -t pl�' CITY OF COSTA MESA a BUILDING DIVISION . • .,,.�, ',! DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. 1Pria PERMIT M07-00086 tvbes6-r (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 117 FLOWER ST Status: ISSUED Suite No co.......... Applied: 02/15/2007 Issued: 02/15/2007 Vicinity:Parcel Number: 42545216 S // /�V y -. ��+ ISSUED BY: Applicant: FONZ RODRIGUEZ . 0 Address: 7050 LAMPSON AV _ Phone: 714-530-7320 GARDEN GROVE,CA • Zip: 92841 Owner: /ATKINSON, DENNIS PATRICK Address:, •117,FLOWER ST - " Phone: COSTA MESA;CA " Zip: 92627 • Contractor: EMPIRE PLUMBING Address: 7050 LAMPSON AV Phone: 714-530-7320 . GARDEN GROVE,CA Zip: 92841 License:794154 "' SCOPE OF PERMIT- FAU CAHMGE OUT SAME PLACE . - ' FEE SUMMARY _ Quantity ,. • Quantity ISSUE-FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 - Repair/Alt Refrigeration Unit $0.00 0 , Inst FAU>100 k BTU $0.00 0 , __ . _ • . _ _, Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 - 0 Evaporative Cooler $0.00 0" ,Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU • $0.00 0 - 'Compressors/Absorption Systems ' Gas Piping $0.00: 0 . -- -- ,- ' _ Up to 3 hp/100k BTU ; $0.00 0 Factory Fireplace $0.00 0 - - 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 ' • VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 • Vent Fan/Single Duct , $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers • , , $0.00 0 Up to 3 hp . ' $0.00 0 Smoke Dampers $0.00 0 3-To 15 hp $0.00 0 Inst or Relocate Appl Vent ' , $0.00 0 1510 30 hp . $0.00 10 Air Handles< 10000cfm • $0.00 0 30 to 50 hp'` $0.00 0 Air Handlers> 10000cfm . $0.00' : 0' • Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater ' .j $0.00:-.0 . ' Investigation Fee $0.00 Plan Check Fee • $0.00 Reinspection Fee 40.00 _. . - TOTAL CALCULATED FEES ' $38.30 COMMENTS (SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) . EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS U U WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the ork for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this pemlit is issued. y worsks'c/pmpensation Insurance carrier and policy number are: er: finati r/Ahf a -'--Pop)4�mbar: Wfioati34 -0/ (This section need not be completed lithe permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith co .• ase provis' t p..,.: i B /5-07 W W -I/r 1 LIIRE TO SECURE W�- ERS'COMPENSATION COVE a UNLAWFUL AND SHALL SUBJECT RR TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COM SATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereb rm that I am licensed n er provisions of Chapter 9(commencing with Section 7000)of Division 3 Susines end Professions Code,and my license is In full fo and eft ' # 7 Class# (% C na urs - - olc0 • 0.-- - te: c - /C--O7 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: _ _ Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feel in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 6,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need t0 file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature• : e.. .er(s) [dip And/Or Au ort^•.Ica ' D ic' CODE f INSPECTWN TYPE . PAIE )NTRIALS CODES INSPECTIONTYPE DEE DIMIALD 1516 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 .Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall - 212 Final Fire Prevention 202 Final Factory Fire Place - • 220 Final Planning Approval 203 Final Sign 222 Final Site . 204 Final Demolition - 250 Final Building/Occupancy • 4r"F44 CITY OF COSTA MESA 4$ •. P.O, BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 FIU � ma;Turmu, _ rs 1.4 *y:, �ra; DEVELOPMENT SERVICES DEPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION • August 14, 2009 • Dennis Patrick Atkinson 117 Flower Street Costa Mesa, CA 92627 PERMIT NUMBERS: M07-00086 PROJECT 117 Flower St., Costa Mesa, CA FOR: Forced Air Unit Our records indicate the above listed permit(s) were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of the last inspection for the project. Our records do not show an inspection for these permits within the last 180 days nor have they had an approved final inspection. If you have a signed inspection card showing that an inspection was made within 180 days, or that the final inspection was approved, please contact this office so we may correct our records. If you do not have an approved final inspection, your permits will expire on August 25, 2009. Additional fees will be required to finalize expired permits. Requesting an inspection - If you need to request an inspection, please call our Inspection Request Line at 714-754-5626. • • Requesting an extension -If you wish to request an extension, requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of completion. If you have any questions, please contact the Building Division at 714-754-4871, between 8:00 a.m. and 4:30 p.m., and a staff member will assist you. The accuracy of records affecting your pro.erty is our goal and we appreciate your working with us to resolve this matter. Sincerely, 5 • Barbara J. L rt Office Specialist II cc: Empire Plumbing Building Division(714)754-5273 • Code Enlorcemenl(714)754-5623 • Planning Division(714)754-5245 FAX(714)754-4856 - TDD(714)754-5244 • www.ci.costa-mesaca.us ,fat CITY OF COSTA MESA 4 i • BUILDING DIVISION }:'a,z I DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER 4t 4 .! PERMIT "9 E05-00628 4%"munrs (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 117 FLOWER ST Status: ISSUED Suite No Applied: 06/22/2005 Vicinity: Issued: 06/22/2005 Parcel Nunmber: 42545216 I Applicant: NICK MANCUSO -- _ .,-- ISSUED BY: Address: - - , - _ '"- .'7 - - Phone: 909-664-3105 , • i 7,7 '- � Zip / '� 't Owner:-' ,,,ATKINSON, DENNISPATRICK= - - - - .. _ ' Address;/2117 FLOWER ST j-L , Phone: - ' COSTA:MESA;,CA Zip: 92627 ' ' ii2/ 7' . Contractor: ' HOMETOWN ELECTRIC - • ' • Address: 12055 E SUN,CANYON ST *:' - • - , ;�. • / Phone.. 909-664-3105• _ _ - _ it RIVERSIDE,CA!° - -� • Zip: 92503 • - - - ` - i - ` ' • C License:831471 - "`ftp <' � ,. V �7 - ' it-i;:",-. .y SCOPE OF PERMIT /- :.,-n: ` ' SERVICE UPGRADE TO 100AMP. /i• .tee --- • - - - - - - - _ ' - - . - .. 5: - . „ . FEE SUMMARY ` Quantity- �'� i u> - Quantity -,� ISSUE.FEE ; ' $23.50 - ` -. -- - -- - - Temp Dist,Systerri/lighting $0.00 0 Temp service test', $0.00 '-- Busway/100 ft _L $0.00 0 1. Res.a/c package $0.00 Standing.Section ' $0.00 0 ' 1. , New Res(1-2 units) " ', $000 0 Misc Electrical Equipment ' $0.00 02/ New Res,(3+units -.,� v'%" $0.00 0 Transformers up to-1 kva/kw $0.00 Pool/Spa,, A s ) �< .�cy $0.00 0 - up to 10 kva/kw $0.00 /0 i -•L� !, Lighting Fixts }P,.rt-r ' gg \" , $0.00 0 .r., i; - up to 50 kva/kw $0.00 72.0/ Recept Outlets `'� \\-$0.00 ' 0 a yt5",t "' up to 100 kva/kw $0.00//7,0 - '- / / 1 Switches���\ 1 \$000 0 i'c `= - " over-100 kva/kw $0.00/x/ 0 / / Non Res Appl z 5 $0:00--\ ; 0 w, -. . Low Voltage Equipment..f ,-i $0.00 j 0 ' // 7 Res Appl \O $0.00: _o,.t H > 'Low Volt Winng System/Ckt" .-$0200 , 0 - ,S-/ Service to 200a A� /j-$30.50'. 1 -Mist:Conduit --;$0.00/// 0 Service to 1000a N.� $0.00 0 .Misc.IConductor - - i/ $0 00 0 1' Service over 1000a ' , $0.00: b:'-„--&...c.. Circus(gen or ride) -� -$6.00;;',// 0 / , Motors to 1hp N '10.00 /,-,..--., 0.'--:---- *- '�� ._Circus(meth ride-or lights) ,,27,--„$6.00,r',/ 0,//./V Motors to 10hp '7/��$0.00/4 /0�, __:- _ ChristmasTree'Stand -<',v $0007//0 Motors to 50hp $0.00\ j 0-:? ) Fireworks Stand,r , , -$0.00 o' Motors to 100hp $0.00., /4 0 / Other Eleetncal,Fee l'-, < $0.00" I , L Motors over 100hp $0.05-4--;-� 0`'- �` •' " , 1 G,1 ,1 /i/%• Communication drops $0.00`x,-1 0.. `-=J; NInvestigation Fee"- - -:,,t,21.;$0:00 Sub panel to 200a $0.00 0= _ Plan Check Fee- ,./=r $0.00 Pole Light Pkg $0.00 0 '- c2;-7.-Reinspection"Fee - $0.00 Sign Circuits $0.00 0 - - -- -- - " NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS n WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($1 )or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith campy with these prows) / Applicant Signature: .y Date: R Z 7443 WARNING:FAILURE TO SECU WORKERS'COMPEN COVERAGE IS UNLAWFUL MD-SHALL SUBJECT AN EMPLOYER TO CRI NAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOILARE($100, ),IN ADDRION TO THE ST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Sectio )of Division 3 of the Business and Professions Code,and my license is in full force and effect.Le.N f3 / ,{ Class A C U Contractors Signature: .K i . /- Date: E,L 3/0 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: • I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. _ _ Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (if yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the woriT which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signaturlial Owner(s) / Date An r oozed Applicant Date CODE 1 QISPECTIONTYPF PATE REALS LODE! INSPECTION TYPE P>!TE Imo$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ��++,, 200 Final Re-Roof 210 Final Electrical T5 ji oto`S 11'"8//h'Lr 201 Final Block/Retaining Wall 212 Final Fire Prevention / 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ( 1 _, _T - - - _Applicant to fill_in all spaces,except those within heavy border lines andslgn all appropriate declarations. . _ _ ., .. CLTY OF COSTA MESA ,CONSTRUC.�I N PERMIT PERMIT",' ['/ TRACT NO. LOT NO., i UNIT NO.„. , 0090 7/24/86 . i 5450', TL I Project Address I � � /, / '> '1� T 7 In i I rr I , r,I_ • , t I _I. '._ • t t • _ TYPE OF CONSTRUCTION ‘❑ NEW• u ADD L I ALTERATION L4 REPAIR. 1 ' j pplicanCs Mailin dor s ' , g , - ❑ CONVERSION ❑ DEMOLISH ❑ OTHER_ ' . Owner's Name. /tf'- I eki Va• h'C e'• I Phone ! - _ _ — _ rA.P.#_ _ } - ._ - . _ _ .__ _ ; .Zone _ ___ I DESCRIPTION OF.WOR K/USE OF BLDG. _ • Address • .j CLIMB ' - I I S Main Building: ' ;Accessory Buildings, I , • Arch/Eng,' ' License No. TYPE OF PERMIT ❑ GRADING FOUNDATION El STRUCTURAL I T Front' I I 1• •I . I • Os" ' Address I I. ••/ , '❑ TENANT .111 ELECTRICAL PLUMBING 171 MECHANICAL B Rear '• _ • J N 1 Contractor's Name*/ -f't• RIA SSPlf T �✓I•r Phones � '�MN.� :❑ OTHER_ - I t •-. I _ I p'. --I_ I 1 I - C Right j , N• I y- PROJECT DESCRIPTION. Sq. Fr. + •_ OCCUPArvcv - Addr¢sS(mdiling) Z�'yL �• Lglvrp r S' ;CONSTRUCTION TYPE • I K Left 1 - i { • G VALUATIONS $ , R City License No. I CTS / Z0 IZONE I GRADING CU.YDS. ACRES � E LICENSED CONTRACTOR DECLARATION, - Ping. R¢f.# , , , , , .ParkingReq./Provided 1 I hereby affirm,that I am licensed under provisions of Charter 9 (commencing Remarks: , • s , - , Pld nning Notes: 1 I I ! D with section 7000) sof Division 3 of the Business and Professions Code, and - - I I I I . - M My license,is in WI t c and effect: `C ' -- - f , _ , 1 $^ License CI ss • ILiven a No. �'3 L ' _ I , ' Date ' Signature q/ •/a2-71,11-2-4-4a _ PLUMBING ' ,- -• .FEES I ' I ` = '4 - j I • �- WORKK R�SATION DECLARATION I ,Bar Sink1 s ' 1 s r 'J I hereby affirm that I have a certificate of consent to self-insure or a certificate - _ - .Showers _ ELECTRICAL, FEES • of Workers' Compensation Insurance, or a certified c py th of (S tion - - -- ' ---- , - - • 3800• Lab. ) Backflow Preventer • -• l ,Service Sink -- . - '❑'15.50KW , F ' q /JR e /��'9Automatic Washer Transformer C6 Policy No. WCs '"37 ?t'5-? Company''t+t' -' / 0,"i""u' Backflow'Irrigation Sewer Cap • ' • , 1 - ' 0'50+KW O e Certified copy - • a _ Conitrucilon PoleSub. is hereby turn iehetl. �' Certified cop is filed with the city Buildds�q ivision., •,C, Bathtubs _ -Sewer Connection Cooking Unit Meter Dud to 100 amps Date 7 -1.d- 4' t Applicant - Ir "�`4"�''et ''J y�• ' - • - - - EXEM•PTION FROM WORKERS'CO ENSATION DECLARATION t Clarifiers: , ' Solar Collectors • t Dishwasher Meter'Dover 100 amps ' ; (This section need not be completed if the permit is for one hundred ($100) or - - - ' ' - - ' - ' I less). I Dishwasher.] Solar Piping' • ' - Dryers ❑Gas ❑Electric, - • Sub Panel' ' ' , I certify that in the performance of the work for which this permit is issued,I _ '" } shall not employ any person in any manner so as to become subject'to the Drinking Fountainst • • Solar Tank - Fan .Motors 00-1-HP ❑1'h-.B ' 1 Workers' Compensation Laws of California. - -' __ •- - • Date' Signature I - Floor Drains ' - - (Swimming Pool W/Spa,. • F,.A.U. Inc.Solar ❑9-15 HP ❑16-15+ -NOTICE: If,.after making'this-declaration,you.should-become subject to the — - - _ - - - - - - - - - ._ .. Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • - - 'Urinal I ' 1 comply with such provisions or •this permit Shall be deemed revoked. , Fixt Fixtures Microwave , I - 1 CONSTRUCTION LENDING AGENCY / Gas Service ,Outlets Water Closet �•,� Device BoxesI I hereby affirm that there Is a construction lending agency for the performance f' Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors - Water Heater • Outlets Lender's Name •• I , �- Range i • Lender's Address - - -- -- - - -- 2--- Kitchen Sink--r -- Water Service 1 - • ' Switches - ----I- Sign 1 I _} - --' -"" OWNER BUILDER DECLARATION - - I hereby affirm that I am exempt from the Contractor's License•Law for the Lavatories Auto-Wash 4 Garbage Disposal ' I ' , following reason (Section 7031,5 Business and Professional Coded Any city or _ . 9 P Standing Sections I ., county which requires a permit to construct,alter,improve,demolish or repair P-Trap • , LaundryTrays ' I • any structure, prior to its issuance, also requires the applicant h;permit y • Generator ❑0-5 KW ❑5-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of 1 • • , the contractor's License Law (Chapter 9 (commencing with Section 7000)of Roof Drains 1 • Division:3-of the'Basiness and Professions Code) or that he/she is exempt ' -• - - '" - -" - -"' "- _- -- " ' - •i erefrom'and the basis for the alleged exemption. Any violation of Section ! ' I ,� ' I penalty �.by any applicant for a permit subjects the applicant to a civil 1 - 1 i _ - penalty of not more than five hundred dollars $500)- I 1 • I ' 0 I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 , `1 • 'Issue Fees $ 3 • compensation, will do the work,and the structure is not intended or offered 1 _• Reinspection Fee , -.I;$15 Issue Fee , for, sale (Section_7044, Business and Professional Code: The Contractor's , MECHANICAL - - I FEES - - - - -• • License Law does•not apply to an owner of a property who builds or improves _ __ __ ' thereon;-and who does such wimpromself/herself or through his or her own I 4 DEVELOPMENT SERVICES REQUIREMENTS: r employees, provided thatl such improvements are not intended or,offered for Boiler _ Hood or •Type I 0 . . , 4 , •sale. If, however,•the building or improvement is sold within one year of corn- Canopy Type II 0 I 1 t Zoning Approved By - I I Date I I ,pletion,'tte owner will-have the burden of proving he/she did not build or fin- Duct-Under Ground - , � - : • rove for the'purpose of sale)„ Building-Approved 6y - Date pf • I, as owner of tile property, am exclusively contracting with licensed con- Duet-Structural • Refrig • eration System - . Application Issued By I I Date 7-ag:gG, tractors to construct.the project (Section 7044,Business and Professions Code: • The Contractor's License Law does not apply to'an-owner of property who Duct-Ventilating - ❑O-100,000 BTU ❑100,000 BTU ' ' ;; SUMMARY OF FEES - '- •I builds or improves thereon,and who contracts for such projects with a con- - - - - I _ { • tractor(s) license pursuant to the Contractor's License Law), I am aware that • Exhaust S stem ❑; Multi le❑ S BUILDING PERMIT,. ERMIT $ -SMIP I.- " $ • - ' ' proof o their Worker's Compensation insurance should be provided to me:. Y P - ys[em Repair/Alteretion - - I - - , •, . _ _ PLAN�CHECK $ .'PERMIT '. t:'I am ekempt under Section ' r 6..g, P.C.for this reason' Firepl/Fact,BIt.-ICBG# Fire Dampers I •• _ I _ - • , PLUMBING $; . ' -S*Su ISSUANCE $ ' IDate " Owner" - t. I Heating System&Ducting Registers.' • - _ - -•' P1AN CHECK I.25%.. $ � • ENERGY P,C:, $ ' - I hereby certify 'that Ii have read this application and state that the above ❑0.100,000 BTU ii 100,000 BTL - '• ELECTRICAL GRADING $ ' -" '- 'information is correct. I agree'to comply with all city and county ordinances • ' - . $- , - and s to laws relating to building construction, and hereby authorize repre- - - ' > ' - PLAN CHECK -50%! $ - -MICROFILM $ - - ' _ sent ryes of this c ty to enter upon the 'above-mention d-property for i ., - I •- - • - _ �_ _ _ - y l ms ection p s/f�, ,7 - _ • _ MECHANICAL $ _ TOTAL FEE $ St-S O gnature (.LWLGGgl 44- • Reinspection Fee $15 Issue Fee • - . •$ 3 . • PLAN•CHECK 25%•$= j • i CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink Accounting; Goldenrod - Assessor L •CONSTRUCTION AND PLANNING POOL &SPA . . - APPROVALS Permit# Date-- Inspector - APPROVALS Permit# - Date Inspector gi 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement , 3. Electrical Conduit Utility-Undrgrnd. 54. Forms . . , r• , "I 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ( x • U 5. Steel Reinforcement 56. Rough Plumbing & Pressure,Test i 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE . 7. Footings , 58. Electrical Conduit-Undrgrnd. ' ! 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test ; 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd. • 10. Structural Floor System ' " 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final • ' 12. Sewer Cap • . 63. Heater & Vent-Final 13. Roof Drains : - • . 64. Plumbing System - Final ' 14.-Rough Plumbing - 65. Electrical-Final ' 15. Rough-Electrical-Conduit I 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing& Access Approval 17. Rough Wiring Sign • - 68. APPROVED FOR PLASTERING . 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning • FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace . - - • APPROVALS Permit# _ 21. Ducts,in Structure 70. Underground Hydro . 22. Ducts; Ventilating 71. Product Piping 0 Gas 0 Oil - - 23. Gas Pipe-Rough& Test 72. Underground Flush ' 24. Roof Framing . 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing . 74. Overhead Hydro . 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe - ' ' • 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL ' 30. Drywall Nailing HEALTH DEPT. REQUIREMENT . 31. Plaster Brown Coat 79. FINAL INSPECTION - . 32. Electrical Power Meter-Final 80.'FOOD CERTIFICATE ISSUED 33. Final Electric Notes: . , , 34. Final Heating& Air Conditioning ' • 35. Final Gas Pipe-Test 7-Z&-bt (•,r?,-- • 36. Hood or Canopy . 37. Final Factory Fireplace 38:Final Plumbing 7-Z6-h' Cato . 39. Water Service-Final - ._ I^ 40. Gas Service-Final 1.41. Solar Domestic-Final- r 42. Backflow Preventer - - 43. Backflow Irrigation ' . 44. Landscape Irrigation System .45. Sound Attenuation. - - 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING �' 48. Special Requirements Completed • ' • ' ,• 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co • ` 51. CERTIFICATE OF OCCUPANCY - No. Date - - • . . . PROJECT ADDRESS: 117 FLOWER ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 061573 OWNER'S NAME: TAPP JENNIFER G • ADORESS: 117 FLOWER ST PERMIT NO; B 061573 PLAN CHECK NO: N GOVT: N SUPP; N COSTA MESA, CA 92627 CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: OTH ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/O EXIST„ RESHEATH & REROOF W/COMPO SQ FT: 4 , 000 ADDRESS: UNIT: PERMITTEE: CLAIM VALUE: 4 , 000 . 00 CALC-VALUE: 4, 000 . 00 GROUP OCC: R-3 /M-1 ADDRESS:VAN DIJK & ASSOCIATES ( 714 ) 586-3828 28 HAMMOND G COMMENTS; PROVIDE SMOKE DETECTORS PER THE 1991 EDITION OF THE UBC " ' " IRVINE CA 92718 **'x*>Exx-**f6xfE*x*x**XXx*****>E*OE**%*±F -%dt**%TCx*%x**xX*************x%%xxx udc%r-*craft LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS Pe it- /'rte Q$s 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS .*.c,//, �/w/� CITY LIC.: STATE LIC.: �Q/4�K eK %Q✓n Q 366ure �' • L. -39 ✓ J r' Date: .313/43 Signature- Ae , MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affir • .11 ay a c- i icate of consent to self-insure or a certificate of Workers' FRN'(': FT IN REAR; FT IN FRNT: FT IN REAR: FT IN �i �j Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN .� POLICY NO.:0682775-93 EXP.DATE: 03/01 /94 COMPANY:S'TATE FUND PARKING REQ.._ PROV: PARCEL : 42545216 ZNE; REF NO: 0 Certified copy is hereby furnished. � Certified copy is filed th• -' Building Division, PLANNING N ES> Date: 3'3// 3 Applicant: > A- ******-x******* ************************************1E*********1(•****-1kjf ******* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: This section eed not be completed if the permit is for one hundred(St W)or less). DEVELOPMENT SERVICES REQUIR EN EN- 'T, s ( 1 certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become 1 subject to the Workers'Compensation Laws of California. ZONING APPROVED BY _ DATE; Date', Signature: NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : • DATE: , Code,you must forthwith comply with such provisions or this permit shall be deemed revoked, '%//ter�/q� CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED $Y; ` 0 {y `—y DATE: ) /1.9.,,c/79 r which this permit is issued(Section 3097, Civ.C), ***********************k,rie* -Ft. It It/tic.**n- xx ?r**,FX-Ft*Itxxxe X-***fE****iE..w -x-xH.Ft It Ae*% 1 LENDER: ********************************************x***!E*3E******x3f*****.*..11.*.M.S(.,K'****iF**** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTUR LIL1SEGMENT: Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for following reason BLDG PMT PLUMBING ELECTRIC MECHANIC ' FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 63 . 00 ,50 f repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NONjrR ES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by P LAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 1 I, I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID :; DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 63 . 50 0 . 0 0 0 . 00 6 3 , 5 0 6 3 , 5 0 • i . 00 does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through ' his or her own employees, provided that such improvements are not intended or offered for sale.lf,however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED' 63 , 50 OVER/SHORT: ,00 for the purpose of sale), BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63 . 00 . 50 - ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon J I and who contracts for such projects with acontractors)license pursuant to the Contractors'State License Law). l am aware ,******xa(.,N.x*-xX*x**.x.%.%.-%.x.*.*.X*X***.*****.'x..x.x.*%.x.*.*x.X*.',f.*,.x.%..1f.x.**x-.x.%.**.x.*.*******.tFix1e******** that proof of their Worker's Compensation insurance should be provided to INDN D IVIDUAL F E E BR EAKDOWN ❑ 1 am exempt under Section: B.8 P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: owner: SFR 4000 REROOF BY VALUE RESIDENTIAL NOZONE • 1 . 00 '' 4 , 000 , 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and 'END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air(Malay Management District.Residential construction applications are exempt from these provisions. Dale: Applicant'. I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ' / (J- 2:23,• ' r _ i, - ,.. a. ordinances and state laws relating to building construction and hereby authorize r•' 'sentatives of this city to enter upon the above-mentioned 'e - -- - . '" property for inspection purposes. 410) a SMOKE DETEC°I`O r'�' Oale'. 313I�<{3 Signature: � • • ' • Driver's License or Social Security x: , F 1 P �� i 164i-46 White—Building;Green—Code Enforcement',Canary—Applicant:Pink— �^ - � R Revenue:Goldenrod—Assessor �-e° - CONSTRUCTION AND PLANNING POOL & SPA • APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service-qr Pole _52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. .. 54. Forms .. 4. Electrical Conduit.Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test , 9. Water Pipe-Undrgrnd. `-- 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System f' i 1 61. APPROVAL TO DECK .; 11. Property Sewer Line & House'Connection • 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final • 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final - 16. Rough Electric Wiring 67, Fencing&Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING • 18. Rough Electrical-I Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts,in Structure 70, Underground Hydro 22. Ducts, Ventilating • 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding I I 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL I . 30. Drywall Nailing i 1 2 , HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat I 1 • 79. FINAL INSPECTION • 32. Electrical Power Meter-Final �:- 80. FOOD CERTIFICATE ISSUED }_ 33. Final Electric I -- 'j Notes: S.5;d17-e.: .[.Ica' /� Y 7�3 _ 34. Final Heating& Air Conditioning L I r----)� 35. Final Gas Pipe-Test l j'' 1 36. Hood or Canopy ! ' 1 37. Final Factory Fireplace 38. Final Plumbing I , 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 1. i 42. Backflow Preventer - 43. Backflow Irrigation -_ 44. Landscape Irrigation System ;1/4. ` 45. Sound Attenuation - 46. Handicap Regulations_ I //'' y�1' / . - 47. FINAL STRUCTURE &BUILDING t� �y/Ot I .$flga �(y O GL )r' I- 48. FINAL PLANNING ( 1 49. Electric Release to Edison ' i 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date-- = - 1 _ r,