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HomeMy WebLinkAbout165 ALBERT PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 165 ALBERTPL Suite: Vicinity: NEW 2ND STORY ADDITION Parcel Number: 42606305 Zoning: Applicant: MC GILL, MIKE Address: 165 ALBERT PL Phone: (949)645-5792 COSTA MESA, CA Zip: 92627 Owner: MC GILL, ANN LINDSAY Address 165 ALBERT PL Contractor: Address: Phone: (949) 645-5790 COSTA MESA, CA Zip: 92627 Phone: Zip: License: Arch : STERN, ROBERT Address: 3261 MICHIGAN AVE Phone: (714)434-1290 Eng: Address: ISSUED BY: Status: ISSUED Applied: 06/11/2001 Issued: 07/17/2001 Phone: COSTA MESA, CA Zip: License: License: SCOPE OF PERMIT CONSTRUCT NEW 1232 ADDITION TO EXISTING SINGLE FAMILY RESIDENCE (270 SO FT TO 1 ST FLOOR & NEW 962 2ND FLOOR ADDITION). ALSO CONSTRUCT NEW 190 SO FT 2ND STORY DECK. ADDITION TO INCLUDE 2 NEW BEDROOMS, BATHROOM, LAUNDRY ROOM, & MASTER BED/BATH ON 2ND STORY, AND NEW DINING ROOM ON 1 ST FLOOR. ALSO, REMODEL EXISTING 1ST FLOOR. PARKING OK PER PV Plan Check: $678.70 Permit: $1,044.15 SMIP Res: $10.86 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,733.71 SETBACKS MAIN STRUCTURE Front 20- 0 ACCESSORY Front 0-0 PARKING Existing: 1 NOTES: FEE SUMMARY Calc Valuation: $108,588.80 Claim Valuation: $0.00 PLANNING & ZONING Rear 80-0 Left 10-8 Right 5-0 Rear 0-0 Left 0-0 Right 0-0 Required. 2 Proposed: 2 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 / 24464616/001 N V DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as 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 Cade, for the performance of the work for which this permit is issued. My workers' compegsatlon Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certity that in the performance of the work for which this pernit is issued, I shall not employ any person In any manner so as to became 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 comply with these provisions. Applicant Signature: 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 DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license Is in full farce and effect. Uc. x Class a Contractor's Signature: Date: 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 Cade: 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 pertN' 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. 724 , 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 self 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 contractors) 'license pursuant to the Contractors License Laws.). ❑_ I am exempt and d Professions Code for this reason: — Signature: '� Date: Owner I led by driver' se. TDiiver's License Nc. '�- l Expires: 3 Verification of O e 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,.l 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 pernit 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? ❑ Yes ❑ 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). _ .............. _ .. .........I............................ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials. ❑Ves ❑ 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 ...4...........Department. enR.MP.................................................................................................................................................................................................................................................. ............................................................................................. is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................... ............................................... ............... ......-............................................................................ ... ....................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes 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 par of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes [INo (it 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................. .................................................................................. ............ ................................................................................................... ............................................................... -.............. .............................. ................................. I.............. 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? ❑Ves❑ No ........................s.................................................................................................pro......................po-I.............................................................................................................................................................................................................................. e (If'yes", amach 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 compl -wl ordinances relating to lou ding construction, and authorize representatives of the City of Costa Mesa to enter upon the above -describe Ctio or allow occupancy of any building authorized by this permit til f`31/sb ion. Signature Of Legal 'i Date/ AndlOr Authorized Applicant Date CODE t. INSPECTION TYPE PAIF INTITIALS CODES INSPECTION TYPE gPjE 1y�1 $ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final 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 Buildmg/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 165 ALBERT PL Status: ISSUED Suite No Applied: 10/08/2001 Issued: 10/08/2001 Vicinity: ADDITION & REMODEL liO,57 ISSUED BY: Parcel Nunmbec 42606305 Applicant: MC GILL, ANN LINDSAY Address: 165 ALBERT PL Phone: (949) 645-5740 COSTA MESA, CA Zip: 92627 Owner: MC GILL, ANN LINDSAY Address 165 ALBERT PL Phone: (949) 645-5740 COSTA MESA, CA Zip: 92627 Contractor: OWNER -BUILDER Address: Arch / Eng : Address: Phone: Zip: License: 0 Phone: Zip: License: SCOPE OF PERMIT PLUMBING PERMIT FOR ADDITION & REMODEL OF EXISTING SINGLE FAMILY RESIDENCE. INSTALL 1 BATHTUB, 1 WASHER, 2 SHOWERS, 2 WASH BASINS, 2 WATER CLOSETS, & 1 WATER SERVICE. REF: B01-00871 �tA& y'0L,7t, (1/-71b r- liO,57 FEESUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub / Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 1 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $19.60 2 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $19.60 2 Drain, Roof $0.00 0 Shower $19.60 2 Water Heater /vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $9.80 1 Gas (1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $111.70 NOTICE: The work authorized by this permit Oill requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 vr.r=Ji y �-� 1 I ECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby altinn under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 1 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 completedif the permit is valued at one hundred dollars ($100) or less.) ❑ 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 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 comply with these provisions. Applicant Signature: 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 DOIIARE (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Llc. N Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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 pem;' subj s the applicant to a civil penalty of not more than five hundred dollars ($500).): _ 1, 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. It, 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 Cade: 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 contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. -- - d Professions _Code for this reason: Signature: Owner I 'vers license. ❑ V No Drivers License No. r Expires. 03"ID f- Verification of Ownership by (type of document, i.e. - property tax bill or dead): -' 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 hazartlous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be tiled 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 builtling occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some excetions, 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 aqua 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? ❑ Yes [I No .........................................................ica-......................................................ildi...............................................................................1'c"h..is"t........................of........................................................'o.r....................................................difi................ 5 Does or will the applicant u present or future builtling occupant require for the work which is the sor agency? this a plication aL j No for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes (� No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ....................................................................................................................................................................................................................................................................................................................................................................................... 6 Will any pan of the facility to be censtmcted under this permit be within 1000 feel from the outer boundaries of a school? []Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ....................................................................................................................................................................-............................................................................................................................................................................ ......................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ..............................................................--........................-........................................................................................................................................................................................................................................-...................................................... 8 (if "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. 1 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 anddly, ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described prope r-i es to occupy or alintli ncwpiricy of any building authorized by this permit until final inspection. _Date AftEN cant Data CODE If INSPECTION TYPINTITIALS CODE INSPECTION TYPE ATE ItIDDELB 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BlocklRetaining 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 165 ALBERT PL Suite No Vicinity: ADDITION & REMODEL Parcel Nunmber: 42606305 Applicant: MC GILL, MIKE Address: 165 ALBERT PL Phone: (949)645-5740 COSTA MESA, CA Zip: 92627 Owner: MC GILL, ANN LINDSAY Address 165 ALBERT PL Phone: (949)645-5740 COSTA MESA, CA Zip: 92627 Contractor: OWNER -BUILDER Address: Phone: Zip: License: 0 ISSUED BY: Status: ISSUED Applied: 10/29/2001 Issued: 10/29/2001 SCOPE OF PERMIT ELECTRICAL PERMIT FOR ADDITION & REMODEL OF EXISTING SINGLE FAMILY RESIDENCE. INSTALL 30 LIGHTING FIXTURES, 37 RECEPTACLE OUTLETS, 25 SWITCHES, & 1 ELECTRICAL SERVICE. REF: B01-00871 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 246&66(6100) FEESUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 It $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool / Spa $0.00 - 0 ................up to 10 kva/kw $0.00 0 Lighting Fixts $29.30 30 .................up to 50 kva/kw $0.00 0 Recept Outlets $34.41 37 ..... ..... ...... up to 100 kva/kw $0.00 0 Switches $25.65 25 ..................over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Service to 200a $30.50 1 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus (mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $143.36 Intermed Pole $0.00 0 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 246&66(6100) DECLARATIONS WORKERM R R"99 DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 pennit is issued. ❑ 1 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 carder and policy number are: Carder: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ I cedity 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 Callfomia, and agree that If l should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: 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 DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect. Lic. N Class At Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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 pem:. su cls 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 appi o an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License La 0_Lam exemp Business and Professions Code for this reason: Signature:! jDate:= Owner ID verified by drivers license. [:1 Yes [:1 No [`'`Iver s License No. / (—Expires:, �2 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, talsework, 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 Cade). ❑ 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Cade 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). ill applicant or resent or future building occupant need to file a registration form for acute) hazardous materials? Yes No ............................ ..... ..... 2 Does or w the app ca p 9 P 8 Y ❑ ❑ (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 Dces 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? ❑ Yes ❑ No ...................................................................................................................................................................................................................................................................................................................................................I............ 5 Does or will the applicant or present or future building Occupant require for the work which is the subject of this a plication apPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? J Yes 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? ❑ Yes ❑ No (if "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ......................................................................................................................................................................................................................................................................................................................................................... 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ........................................................................................in................................................................11ut................trol...........er).................................................................................................................................................................................. 8 (If 'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certity 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 comp) it all 19te laws and city, Ina relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-describedd in coon pups o occupy or allow occupancy of any building authorized by this permit until final inspection. Slgnatur Legal s) ( Dale - And/Or Authorized Applicant Date CODE #. INSPECTION TYPE PATE INITTIAL CODE.0 INSPECTION TYPE 2AN INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical ' ©2 201 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us MECHANICAL PERMIT Job Address: 165 ALBERT PL Suite No Vicinity: 1ST FL CLOSET Parcel Number: 42606305 Applicant: PAQUIN, STEVE Address: 2221 E WINSTON RD #P Phone: (714) 774-9707 ANAHEIM, CA Zip: 92806 Owner: MC GILL, ANN LINDSAY Address: 165 ALBERT PL Phone: 949 645 5740 COSTA MESA, CA Zip: 92627 Contractor: A/C PLUS Address: 2221 E WINSTON RD #P Phone: (714)774-9707 ANAHEIM, CA Zip: 92806 License: 616420 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: SCOPE OF PERMIT MECH PERMIT FOR INSTALLATION OF A NEW FAU IN CONJUCTION WITH A SFD ADDITION/REMODEL. 1 INST FAU < 100K BTU. REF: 601-00871 Status: ISSUED Applied: 11/06/2001 Issued: 11/06/2001 COMMENTS I 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 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 hip/ 100k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp 1500 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 15 to 30 hp $0.00 0 Air Handlers < 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers > 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee - $0.00 TOTAL CALCULATED FEES $38.30 COMMENTS I 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 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 peer/mit is issued. My w�torkers' compensation Insuranc.J¢9,.,carrier end policy number are: O 14OOa.S6 7 i Carrier: � I A (�_,I j 1 ;7. l /o e. (,I ufl /1 C( Policy Number: (This section need not be completed it the permit is valued of one hundred dollars ($100) or less.) ❑ 1 certity 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 became subject to the workers' compensation laws of Calif a, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pro isi // / / Applicant Signature: W N I /Lq.LL` Date: /%— b —04 WARNING: FAILURE TO SECURE WORKERS' COMPENSATIONVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED LL00), THOUSAND DOARE($100,0IN ADDITION TO THE COST O COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed; un er provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my Ilcanse is in full force and effect. Lic. N Class x /C _1&9 Contractors Signature: _ Date: 41 Z — O 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: 1 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 Cade: 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 penrk 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 contractors) 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 ❑ 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? ❑ Yes ❑ 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). r building occupant need to file a registration form for acute) hazardous materials? Yes No ..........................................................................................I........ ...... ..... 2 Does or will the applicant or present or future bu d g p g y ❑ ❑ (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). .................................................................................................................................................................................I.............................. 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. ........................................................................................................................................................................................................................................................................................11 ............................................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? []Yes ❑ No .................................................................................................................................................................. ................................................................-...........................................................................................-................ ..................... I .............. ....... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this ..e��ppplication a ermil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agencyr LJ Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ......................................................................................................................................................................................................................................................................................... .......................................................................................... 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? Cl Yes ❑ No (if "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................ .............................................. .................................................. ........................................................ ............... .................................... ........................................................................................ .................. .................. I ................ ........ 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is requiretl 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? ❑Ves ❑ 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 Jt1he 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 u above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sign3l Of Legal Owner(s) Date And/or thonzed Applicant Date CODE.. INSPECTION TYPE 2AIE INTMIALS CODE r INSPECRONTYPE GATE IBM$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final 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 ADDRESS OFBUILNNO: 165 ALBERT PL:. WMER'SKMEIFKNONNN:MCGILL ANN LINDSAY AgDms:165 ALBERT PL COSTA MESA, CA 92626 MAIUM AOORESS: l ARCXTECT OR ENGINEER: MICIL OR ENG.'S ADDRESS: X. MO.: CONOIACTOR'S NAME CONTRACTOR'S MMUNG ADDRE59: UC. NO, UNIT: UNIT.- UMT: LICENSED CONTRACTORS DECLARATION: I hereby al under pmaly, of perjury the I am licensed under provisions d Cheger 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full faros and effect. CRY LIC. NO.: LIC. CLASS: LIC. NO.: EXP: IOWNER BUILDER DECLARATION: I hereby affirm under peva ly of perjury that I am exempt from the ContrW oa License Lew for the ',lowing reason (Section 7031.5 Business and professions Cala: Any city or county which rtteuiree a permit to omesgud, eller, improve, nollsh, or repay any mmdure, prior to its issuance, also rmuimm the applicant fm such permit to fib a signed statement that he or she canoed potatoes to the provisions of the Contractors License Lew )Ghaplm 9 (commencing rah Section 7000) of Droll 3 of the , meas and professions Cods) or that M m and Is exempt Ihmamm and the basis for the doped exemption. My vulmicn of Section 7031.5 by any applicant for a permit subjects the eppl'eant to a evil penalty of not more than five hundred dollars )55001). )3 I, es ower of the lxopenya any employees with wages as Chair ede commmo on, will do the work, and the aruduer is m1 intended or offered fm seta (Section 704,1, Business mrd Professions Cade: The Comrades License Law does but apply to an ownerd property who builds or m moas thereon, and me does such work himself or herself or through he ar her own employees, provided that such impo+wmeats ere non Weeded Or offered for seat, 9, however, the Witlinq or inprwamed is sold within one year of mmplation. Ne owner-builter will have the burden of proving he or she did not build or improve fa IM purpose of aide). I, «owner of the propend. ahr exclusively tmtmoung with licensed oontmotms to commons the pojed (Semon 7Wa, B«imas and Professions Code: The Contractota License Law does not appy to an ower of property who Wilda sir imprwx thereon and w110 contracts for such projems with a mmrectons) licensed possum, to the Contractors Use as Law). 1 em exempt uMqr Sysfion,. B. 8 P.C., for thio ^` Date: S C/Owner: I do hereby car ify that I are soma of and understand she reguirmnants of California Health end Splay Code Sections 25505, 25533, and 2553x, and the I «any inure Wilding masseur will / will not (ctroat ore) all to cmnply with said mesa mates and the reauirem«ts for apmmnformnslmdiononmadifirationhomtMAi ua�TW—n mint Dimrid.R«id«lidmWrudionappEWiauanexemptfmmth«a prawaions. Dale: Applicant: WORKER'S COMPENSATION DECLARATION: 1 hereby affirm under penahy of perjury one of the tdowiM dodmmiom: ( have and witl erf. a the d con eivch self -insure torssuodL 'rompmW ion, «proyidnd for by Section 3700 d the lobar cove.Im the mdomvice d the woA for wNch Nie permd Is intoe. I have and mU mdnli waken' a ern«ton insurance, m n uinad by Semim 3700 ofthe labor Code, fm tM performance d IM work fa which MIs permh Is Issued. MY wokari commnW ion i... comer and policy number me: Carter: policy Number: . his section need not be oompleNd ff the perm2 is lar one hundred dales /S1001 m lama.) I cenly this in the pinfomance d IM work for w ch this parent a Issuae, I shelf not employ any, person in any maoner se a to become subject to the workers' compensation doe of Caldanie, end pre that it 1 should become subject to tM workers' commnseion pro nsons of Semen 37W of the Labor Cade, I shall fouhwhh comply with those provisions. Dale: Applicant: Warming. Failuro M •«uro wodlera' rompertsatlon roarage Is unlawful, and shall anti an employer to dMm/.M. and eivll Mess up a one hundred IMuand dollars ($IOR 000), In sell m &a roof of comperbleUm, damages as provided lar /n S«tlon 3706 of Me Labor COW, lateral and amrnay's Ions. CONSTRUCTION LENDING AGENCY: I hereby affirm under pondty of perjury that them is a construction leading agency for the perform. of the work ire which this perm is issue! (Semon 3097, Civ. C). LENDER'S NAME: LENDER'S ADDRESS: I county this I here read this application and male that the above mformdion ie carted. I agree to comply with ell city and muny ordinances and area laws ratting to building construction and hereby toommrze repasentativ« of this city to enter upon she above-mentioned property for inspedimn purposes MIKE MCGILL Pam Nem / ` Date: ' ---If' S1 urs of Oyu n p nUConrremo (5151460P) Whhe-Buildim A Solely; Omer- ile: Canary-Appficant; Pink -Revenuer Goldenrod-Assenor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 077664 PERMIT NO: E 077664 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH JOB DESCRIPTION ELECTRIC SERVICE UPGRADE SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: / COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT *RF 1E iE iE 3E BE RE***BE*BE BE RE BE 9E 9E iE 9E 1E 1E iE 1E*dE*iE BE*sE iE*1E***iE iE**iE iE*RE iE iE 9E 3E iE 1E BFk BF BE iE iFiE***iE*1E 9E 9E BE BE*1E+E iF iE 9E RE BE** Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 42606305 ZNE: REF NO: PLANNING NOTES> > •t BF dE 1E RE 9E BE 1E 9E iE iE dE dE***SE RE SE IE 3E BE 1E 1E RE iE ii BE iE RE*iE dE*RE BE RE 9E dE*BE IE RE*dE*BE**if IE iE BE*iE BE iE BE BE*dE RE 9E iE*3E BE iE iE 1E iE BE BE 9E iE 1E*dE 1E 1E D E V E L O P M E N T S E•R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY 1,'' DATE: (BUILDING APPROVED BY DATE: APPLICATION ISSUED BY: �- DATE: �E4b RE dE*9t *dE BE BEBE iF iE iE*1E * * *dE iE iE*iE1F�F7F�F�7FTF3F3F3F7F7�7F7F3F3Fi�3F3FTF3F7FTF�F�F—�FTF7FT�iF�FIF d(-iE if iE lE iE iEfEiE E iE lE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/AES GRADING PERMIT 18.50 50% SMIP/NON-RES PLAN ISSUE FEE 15.00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 18.50 15.00 0.00 33.50 33.50 •00 REVENUE DIVISION TOTALS--> COLLECTED: 33.50 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 33.50 BE BE IE RE 9E********6E 1E iE BE N•3E IE BF BE*BF BF dE BF 1E dE df BE BE***if iE**6E 1E iF BE BF iE RE 1f BE if dE eE 9E lE if iFiE BE*dE iE)E*iE*BE 1E****dE9E RE BE***9E RE I N D I V I D U A L. F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 1 SERVICES BELOW 600 V & BELOW 201 AMP 18.50 18.50 END OF FEES CONSTRUCTION AND PLANNING POC SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location Soil Pipe-Undrgrnd. 53. Steel Reinforcement -2. - 5 '-3..Electrical Conduit Utility-Undrgrnd. 54. Forms 4t Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' S. Steel Reinforcement 56. Rough Plumbing & Pressure Test �6: Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE - 7:� Footings 58. Electrical Conduit-Undrgrnd. �8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60, Backwash Lines, P -Trap, ❑ Undrgrnd. '10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap r 63. Heater & Vent-F(nal 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing ,� 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19.Rough H,e_ating &,Air Conditioning w ;,- ^> •- -^ FIR-E'CJEPT:.REQUIREME4tT "' gppSOVhU.$.. P-mit # ' 20. Rough Factory Fireplace - �•h = Z' �- 21, Pucjs, in,5tru`cture 70.t-Undergroynd Hydro 22. Ducts, VentilaYing'i 71. ProductPiping as CJOil - 23. Gas )sipe•Rou7yh &cTest rr �-' Y -• tr =; r 72. Underground plush 24. Roof Framing y'' s -'" 73: Undergrnd.Star7�.ggTankOGas C3 Oil 25. Roof Sheathing �;, -. "V - - �, 74. Overhead Hydrae - 26. T -Bar Ceiling (Structural) & Mbnocoat 79. Dry Chdq�jcal , 27. Frame arid Flashinq 76. Dry Sta[ipipe. . 28. Lathing & Siding -- r _ '?%. C ! �° 771 FIXED -SYSTEM FINAL _ - 29. Insulatip6 a 4 _ ; 7�. FIRE PREV. FINAL -_ 30. Drywall Nailing HEAL74_i -D EP*T,-R ECLUIFMENT r 31. Plaster Browri;Coat., y t 79. FINAL_,r _ -- fI;dSPECT,ADN 32. 33. Electricar.Power Meter Final FinalrElectrict. �L� �q� �� 80F, FOOD CERTIFICATE ISSUED _ NDS¢s:C_q/l�D -A lr�l(jll� • 34. ,tmal:Hei;CmT_& Air Conditioning`r ..v o �.v.� - 35. pnal GasYilaeTest36. Hoog,or Canopy . 37. Final'Factory Fireplace ,• , - . �, - r:. 38. Final -Plumbing - o-+ - ----- 39. Water Service-Final"'n r 40. Gas Service -Final �'' �- ,rj t- a 41. Solar Domestic -Final ''- • - ` * '- - 42. Backflow Prepenter .t 43. Backflow Irrigation 44. Landscape Irrigation.SystemGC u< a 'e 2 45, Sound Attenuation, -. "' rr, '? �.; t' `r _�• t I 4.6 Handicap Regulations x 5 47. FINAL STRUCTURE &BUILDING " 48. FINAL PLANNING 49. Electric Release to Odison ' - - 50. Gas Release to Southern California Gas Cn 51. CERTIFICATE OF OCCUPANCY No. Date 19 ADDRESS OF SUILMNG: 165 ALBERT PL UNIT: OWNER'S NAME IF KNOWN: MC G I L L, ANN LINDSAY ODREM165 ALBERT PL COSTA MESA, CA 92626 APPL. MAILING ADDRESS ARCHITECT OR ENGINEER: UC. NO.: ARCN. OR ENG.'S ADDRESS: UNIT: CONi11ACTORS NAME: CONTRACTORSMAUNG ADDRESS: UC. ND.: UNIT: LICENSED CONTRACTORS DECLARATION: 1 hereby affirm under pemly of perjury IMI I em lironsed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 0 the Business and Prdnsiau Coda, and my license is in full face and eNaa. CITY LIC. NO, UC. CLASS UC. NO.: EXP: Date: Contractor: OWNER BUILDER DECLARATION: I hereby affirm under penalty of perjury that I am exempt from the Contractors liceme Law for the 'Abwhg reason ISepbn 7031.5 Business end pretensions Code: Any cdy or county which requires a peri to mmauct, after, improve. xnolth. or repak any stmclurs, prior to ha muaca, also .quires the applicant for such peril to fib a signed statement that he or and limned Wreuant to the provision of IM Connectors License Law (Chapter 9 (commenaaQ with Seapn 7000) of Division 3 of lM Business and Profeaions Cade( or that M or she is exempt therefrom and the basis for the af e e i exemption. My violatlon of Section 7WI S by any applicant for a p ned subjects the applicant 10 a aril penalty of net mea than Nva hundred clot. (5500(1. ] I, as or of the progeny or my employees win wages n their ado compensation, will do IM wort, and the structure a net intended or offered for sat (Section 7044, Business and Professions Code: The Conrado. License Law does net appy to an owner of property who Wada or hnproves tMreon, awl who dose vain wait Nmseff or herself or Mraph he or her own employees, provided that such improvement are not intended or offered for sets. H, however, tM Welding or h summed is sold within ora year of completion, the owner builder will have the burden of poring M or she did nil build or improve for the purpose of oda). ❑ I, as owner of the properly, am exclusively contracting with li ahead mnvactom to construct IM project (Section 7044; Business and Professions Cab: The Contractors L'cenee Law does not apply to an owner of progeny what Wilda or improves IMr who mavens for such !roprojects with a contraclale) licensed pursuant to the Contractors License laws ❑ I e{{m exempt under S�ect'y4 B. 8 P.C.. Date: �i1 / /��_ Cwnar! I do hereby candy Mat I am aware of end understand the requirement of Cadiomie Neaah end Safety Code Sections 25505, 25533, ad 25534, and that I or any Mu. W ildico occupant will 7 will not (circle me) need to campy with sale erste cedes and IM requirement for apemnlorwnstmpianamodificatdnhomlhe Ac u�2i'ty 'gamml District. Residents] construction applications ars, exempt from these provisions. Date: Applicant WORKER'S COMPENSATION DECLARATION: I Mreby elfin under penalty of perjury ora of the following de simmions: ❑ I Mve end will mailman a cend'cae d mment t seM4nwm b workers' axnpenaatlon, w povded for by Salim 3700 d the Leber Cade, for the petloranca oft" workfor which this perd is issued. ❑ nam end will maiden wOM.' mmoematbn iauraca, n on insurance by Seaton 37nd o1M Labor Code. rat fend palormenm d fend wok la which his perft b Mued. MY waken' mmoenatbn imurenca miner end policy number aa: Carver: Policy Number. (This section need net as womistad if me peri is la one hundred dollars (51001 or Ins.) ❑ I mniy that in the Worm rvat of the work for which this perp is cause. I shaft net employ My poem in any manner so as to become subject to the workers' aanpeqWipn twat of California, ane stirs Mat 1 1 slwuld baccme subject to the Soria.' compensation provisions of Section 37W d the Labor Cade. 1 "I forthwith campy with those provisions. Dote: Applicant: Wvll floe W Is fe en:uro wortai rompsnatlon roverage nudition , eneAMll epbl%t en employe t ees as pp videcI a ane c/vll fm 3 up M ossa Labor Ca tMuaaM dale. (Sf0G000A In adtlltlon t Ma root of eompemet/on, tlemeUss a prov/esd for In SscHon 3706 of Ms Laaor Coes, Interoa4 and ettomsy'a tNe. CONSTRUCTION LENDING AGENCY: I Mmby affirm under penalty of perjury Iha them is a construction lending agency for theperform. d the work for which this pari Is issued (Seabee 3097. Cl, C). LENDER'S NAME: LENDER'S ADDRESS: I candy that I Mve reed this application and state (het One above information is comp. I gree to comply with all city and county odirrenoee and state laws railing to building construction and hereby authorize ropraeentatives of this city to enter upon the above-mentioned prgnny for inslaaction pu,mae.MIKE MCGILL `° Dae: Sibnalure d CimdAgenH umn ontractor - (5151.46.wp) Whne-Buildng A Safety: G en-Fi1e; Canary-Appimnl; Pink-Reveque; GoIde.od-Aseesnr CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 077693 PERMIT NO: E 077693 PLAN CHECK NO: N GOVT: N SUPP: Y CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH JOB DESCRIPTION : ELECTRIC FIXTURES REPLACEMENT SQ FT: CLAIM VALUE: CALL—VALUE: GROUP OCC: / COMMENTS: 1iEiEkN1O11OTHER WORK AUTHORIZED DREBY THI+SExPERMIT 4�ERE-#E77664 Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- DUE --------- 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 RE • PROV: PARCEL: 42606305 ZNE: REF NO: PLANNING N TES> END OF FEES > 4111E 1E 1E iE 1E 1E 1E 1E 1E 1E 1E**♦E1E*1E 1E 1E 1F*1E 1E iE 1E 1E 1E 1111♦f*1E 1E iE♦E iE 1E iE♦E 1F 9E*1E 1E iE SE 1E 1E iE 9E i1 iE 11*1EiE♦f iE it it iE 9F**1F 9E 1E 1E**1E iE ♦E *iE 1E 1E D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY BUILDING APPROVED BY APPLICATION ISSUED BY 44444444 44444 44 444 4 44 LEGALIZATION:N BLDG PMT PERMIT PLAN ISSUE FEE F E E S U M M A R Y PLUMBING ELECTRIC MECHANIC 40.80 503 4.50 DATE: DATE: DATE: 7F,ir STRUCTURAL SEGMENT:N FIRE SMIP/RES GRADING SMIP/NON—RES BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 40.80 4.50 0.00 45.30 45.30 .00 REVENUE DIVISION TOTALS--> COLLECTED: 45.30 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 14 45.30 ADDITIONAL EA. 444 444444 444 4 44 4 44 4 4 4 444 4 44444 4 4111E4 4.44 4444444 444444 4444444 4444 44 4444 444 44 4444 44 I N D I V I D U A L. F E E B R E A K D O W N .1 ST 20 TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 12 FIXTURES, LIGHTING 1 ST 20 EA. .75 9.00 ELE 20 RECEPT/OUTLET 1 ST 20 EA. .75 15.00 ELE 14 RECEPT/OUTLET ADDITIONAL EA. .45 6.30 ELE 14 RECEPT/SWITCH .1 ST 20 EA. .75 10.50 END OF FEES EXPIIRED DATE �7 7 G✓" " - CONSTRUCTION AND PLANNING POt_ .v SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53, Steel Reinforcement Electrical Conduit Utility-Undrgrnd. 54. Forms .z -4: Electrical Conduit-Undrgrnd. 55. Electrical Bonding - '5r Steel Reinforcement 56. Rough Plumbing & Pressure Test �•-§--Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE _7-. Footings 58. Electrical Conduit-Undrgrnd. 8. -Foundation 59, Gas Pipe, CI Undrgrnd., Test Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. u~9. -10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring SIZ ,(�✓ 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 & Ait Conditioning, - - -• FrRE_DEPT:REQUIREMERIT .. - APPVVALS Pg�mit #_L " 20. ;Rough F&ctorV Fireplace { r. _ 21. Duct;, in, -Structure- K c'-, * r 70. -Underground Hydro x - rr• 22. Ducts., VentilaEing s 71. Prod ut:'Piping,4�¢as Oil r✓ 23. Oas tripe -lough &-Test - '• �, T _ ^ - _ 72. Undergrauad Plush r. v 24. Roof �Fra- ming * "' ;,r j �-' ` 7�. Undergrt;d.Stch5j&TanP OGas ❑Oil ' - _ 25. &oo?ShBathing -:•e 74'. Overhead Hydrgc- 26. T-Bar-Ceilmg (Strbttvrall & Mdnocoat . =' -' 75, Dry Chetpical r•. 27. frame and Flashing;; 76. DryStarWpipet.-_ m - 28. Lathing &.Siding -' C 7ZFIXED SYSTEM FINAL- ''• �,- -- 1 : r 29, Insulation: r :; ;x 7 FIRE PREV. FINAL F r 30. Drywall Nailing = --HEALTH'DEP'i, REQUIftF,MEtXT r 31. Plaster B owrn.Coaf 79. FINAL kJPECTION , 32. Electrical -Power Meter -Final r 80: FOOD CERTIFIQATE ISSUED - 33. Finai'EleUric' .r 4 • ." .w; r Notes:' 34. �F_inal.Heating:8i Air Conditioning rr , ru - * o: r� r 35. Final Gas PipeTect - 36. flood or Eanopy x � � .. '. - - - - - 37. Final'Factory Fireplace 38. Final -Plumbing - • - "' ` J �- - 39. Water Service -Final" - F_• - a Q `? r•^ 40. Gas Service -Final •' 41. Solar Domestic -Final` , y -= _ - 42. Backflow Prevent@t - - 'w t=, 43. Backflow Irrigation 44. Landscape Irrigation System,; - c t, r i.: •' _ a 45. Sound A?tenuation - Y ` C 46. Handicap Regulations -- 1 47. FINAL STRUCTURE &BUILDING' - 48. FdNAL PLANNING •- i .� 49. Electric Release to Edison 17 50. Gas Release to Southern California -Gas Go - 51. CERTIFICATE OF OCCUPANCY No. Date