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Home My WebLink About3138 BARBADOS PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant Address: Owner: 3138 BARBADOS PL 13915203 GOMEZ, MADELYN 7502 WELLINGTON PL RANCHO CUCAMONGA, CA DERNBACH. THOMAS A ELECTRICAL PERMIT Phone: 800-793-4944 Zip: 91730 Address 7200 PASTEUR DR , Phone: LANCASTER, CA Zip: 93535 Contrector. LIGHTING ELECTRICAL SERVICE Address: 7502 WELLINGTON PL ISSUE FEE Temp service test Res. a/c package New Res ('I-2 units) New Res (3+uniLs) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 7000a Motors to 1 hp Motors to 10hp Motors to SOhp Motors to 700hp Phone: 800-793-4944 RANCHO CUCAMONGA, CA Zip: 91730 License: 773255 SCOPE OF PERMIT CHANGE-OUT OF AN ELECTRICAL SERVICE TO 100A. NO OTHER WORK AUTHORIZED WITH THIS PERMIT. ISSUED BY: Status: ISSUED Applied: 01/07/2004 Issued: 01/07/2004 AMENDED: 8/9/04. �EGALIZE ELECTRICAL WORK IN GARAGE. 2 LIGHT FIXTURES, 6 OUTLETS AND 3 SWITCHES. ' 523.50 $0.00 $0.00 $0.00 $0.00 $0.00 $2.20 $6.60 $3.30 30.00 $0.00 $30.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 2 6 3 0 0 1 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 k Standing Section Misc Eleclrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kvalkw ..................over 100 kva/kw Low Voltage Equipment Low Volt Winng System / Ckt Misa Conduit � Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other ElecVical Fee Quantiry $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within 780 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order (or ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inspeotlons 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 2466-46 (&00) WORKERS'COMPENSAnON DECLARAnON: � � I hereby eHirtn under penalry of perjury one of the following tleclarations: , ❑ I heve antl will malntain a cenHlwte of consent to self-Insure Por workers' compensatlon, es provided tor by section 3700 of Ihe LeDor Code, for ihe performance of the work fOr which �his pertnit IS Issued. ❑ I heve and will maintain woAcers' compensation insurance, as requireC by section 3700 of Ihe Lebor Code, for the perfortnance of the work for which this pertnit is issued. My workers' compensation Insurence carder entl pollcy number are: Carrier: Policy Number: (Thls sectlon need nat be completed il the permit is valued ef one hundred dollars ($100) or less.) ❑ I cenify ihat in the peAortnenca of Me work br which this pertnit is issued, I shall not employ any person in any manner so as to become subjacl to ihe workers' compensation lews of Califomia, and egree that iF I should 6ecome subject to the workers' compensatlon provisions ot Section 3700 of the Labor Cotle, I shell forthwith comply with these provisions. Applicant Signature: Date: WMNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHPLL SUflIEGT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED hKKISAND OOLURE (5100,000�, IN ADDRION TO THE COST OF COMPENSATIIXJ, OAM4GE5 AS PfiOVIOED FOR IN SECTION 31060F THE LABOR CODE, IMEREST, AND ATTOiiNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I heraby aHirtn that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the eusiness and Professions Code, and my force end ettect. Lic. # Class # Gontrector's Signeture: Date: CONSTRUCTION LENDING AGENCY: ❑ I herehy aflirm Ihat there is e constmction lending agency for the pedormance of �he work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Neme: Lender's Address: Signawre: Dare: is in full OWNER-BUILDER DECLARATIONS: I hereby aHirtn thet under penalty of perjury Ihet I am E%EMPT FFiOM THE CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business end Professions Code: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires tha epplicant for such permit to file a signed statement ihat he or she is licensed pursuent ro the pmvisions of the Contractors License Lew (Chapter 9(commencing with Seqlon 7000) oi DlNslon 3 ot the Business and Protessians Code) ar that he or she is exempt therefrom and ihe basis for the alleged eaemption. Any violetlon of Section 7031.5 by eny applicant for e parmit subjecis ihe applicant to a civil penalty of not more ihan fiva hundred dollars ($500).): ❑ I, as owner of the properry, or my employees with wages as thair sole compensatlon, WILL DO THE WORK, antl iha slrucWre Is not imentletl or oflered 1or sale (Sec. 7044, Business end Professions Cotle: The Contractoro License Law dces not apply �o an owner of property who builds or improves thereon, enG who does such work himself or herself or thmugh his or he� own employeas, provitled t�at such impmvements ere not intendetl or oNeratl for sale. tl, howaver, ihe building or improvement Is sold within one year of completion, the ownar-builder will have the burden of proving that he or she did not build or improve tor purpose of sale.). � ❑ I, as owner of the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRAC70iiS to construct Ihe project (Sec. 7044, Business and Professions Code: Tha contraciors License Law does not apply to en owner of property who builds or Improves ihereon, antl who coniracts for such project with a contrector(s) license pursuent to Ihe Coniradors License Laws.). ❑ 1 em exempt under sec. Signe�ure: Owner ID venfietl by tlriver's license. ❑ Ves ❑ No Bu5ine55 and ProieSsions Code lor ihis reason: Venfication of Ownership by (type oi ticeumem, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICA710N: Orivels License No. Oete: Evpires: ❑ I hereby certify ihat no excavation five (5) or mora feet in depth into which a person is required to descend, will be metle in connection with work euthonzed by Ihis permit, and that no building siructure, scaHolding, falsework. or tlemolition or tlismantlinq ihereof, will be more than thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sac. 341, Ttle 8, Celifornia Atlminisiretiva Cotle). ❑ As owner-builder, I will not employ enyone to do work which would require a parmit tmm the Division of Industnal Safery, as noted above, unless such person has e permit to do such work from Ihe division. Signature: Oate: Division ot Industrial Sefery Permit Number. CERTFICATE OF COMPLIANCE AND AU7HORIZATION OF EN7RY: 1 certity under penalty of perlury that I have read this application and state Ihet Ihe informa�ion given is corract I egree to comply with ell state laws end city ordinences relating to building construction, and authorize representatives ot ihe Ciry of Costa Mesa to enter upon the above-descnbed Droperty tor inspection puryoses. I agree not to acupy or allow occupancy of eny building authorized by ihis permit un�il tinal inspection. SignaWre Of Legal Owner(s) Date AnNOr Authonzed Ap0licant Date FOUE;1, INSPECTIONTYYE 1616 Fizetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Rooi 201 Final BIocWRetaining Wall 202 203 Final Factory Fire Place Final Sign 204 Final Demolition J�jg INTRIALS COOE� INSPECTIONTYPE 206 Finel Mechanical 208 Final Plumbing 210 Finel Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupency PBT� IMffULg ��/i�/I i I%�, (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: 3138 BARBADOS PL 13915203 GOMEZ, MADELYN 7502 WELLINGTON PL RANCHO CUCAMONGA, CA DERNBACH, THOMAS A Phone: 800-793-4944 Zip: 91730 Address 1200 PASTEUR DR Phone: LANCASTER,CA Zip: 93535 Contractor: LIGHTING ELECTRICAL SERVICE Address: 7502 WELLINGTON PL ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Motors to 1hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Phone: 800-793-4944 RANCHO CUCAMONGA, CA Zip: 91730 License: 773255 SCOPE OF PERMIT CHANGE-OUT OF AN ELECTRICAL SERVICE TO 100A. NO OTHER WORK AUTHORIZED WITH THIS PERMIT. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $30.50 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway/100ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to,10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Chnstmas Tree Sfand Fireworks Sland Other ElecVical Fee Investigation Fee Plan Check Fee Reinspection Fee Status: ISSUED Applied: 01/07/2004 Issued: 01/07/2004 ISSUED BY: Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 i 2448�48 (8/00) WORKERS' COMPENSATION DECLARATION: �' � I hereby aHirm under penalry oi perjury one ot the following declarations: ❑ I heve entl wlll maintain a cartificate of consent to self-Insure for workers' compensation, as provided for by section 3700 oi ihe Labor Code, for the pertortnance of the ��work for which Ihis permi� is issued. I have entl will maintain workers' compensetion insurence, e5 requiretl by section 3700 of ihe Labor Code, tor I�e pedortnance of ihe work tor which ihis pertnit is issued. My�yprke�ipompensation Insurance carrier and policy number ere: I n/''� J� �+j� Carner. ��S�i �i� �,{�Nl � Policy Numher. I LXV `�'" � ✓ (Tb/s section need nat be completed i! fhe permit is valued et one huntlretl tlallers ($100) oNess.J ❑ I certify that in ihe performence of the work for which this permit is issued, I shall not employ eny person in eny manner so as to become subject to ihe workars' compensetion lews o�qf Ce1lifomia, and agree ihat if I ghould become subJect to the workere' compensetlon provisions of Section 3700 of the Lebor Cotle, I shell forthwith comDly with these pr �is �ns� -/—' � I� I D 4 i /Y/�/� " O49 Applicent Signeture: �kur r '� Dete: WARNWG FAILURE TO SECUFE WOFKERS' MPENSATION CAVERAGE IS UNLAWFUL AN� SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSANO DOLURE (5100,000�, IN ADDITI O THE COST OF fAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]OB OF THE LABOR CADE, IMEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aXirm ihat I am license n r provis' ns of Chapter 9(commencing with Section 7000) ot Division 3 of the Business entl Professions Code, and my license is In tull fome antl eHect. Lic. M 1�� Cless k� Coniractor's Signatured, � - _ Date: � /' 1 CONSTRUCTON LENDING AGENCY: ❑ I hereby attirm Ihat there is a consiruction lending agency for the pedormance of the work For which ihis pertnil is issued. (Sec. 3097, Civil Code). LentleYs Name: Lentler's Adtlress: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby aAirm thel under penalry ot perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business end Professlons Cotle: Any ciry or county which requires a permit to construct, elter, improve, demolish, or repair any structure, prior to its issuance, elso requires the applicant for such permit ro fila a signetl statement that he or she is licensetl pureuent m �he provislons oi the Contractors License Law (Chapier 9(commencing with Section 7000) oi Divlslon 3 of ihe Business and Professions Cotle) or that he or she is exempt therefrom end ihe besis for the alleged e:emption. Any violetion oF Section 7031.5 6y any aDO�icant tor e pertnit sublecis ihe epplicent to e civil penalry of not more ihan (ive hundred dollars ($500).): ❑ I, as owner of ihe properry, or my employees with wages es their sole compensation, WILL DO THE WORK, anOlhe siructure is not intentletl or otterad for sale (Sec. 7044, Business end Professions Code: The Coniractors License Lew dces not apply to an owner of propeAy who builds or improves thereon, and who does such work himseN or herself or Ihrough his or her own employees, provided that such improvements are not intendetl or ofterad for sale. H, however, ihe building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she ditl no� build or improve for purpase of sale.). ' ❑ I, as owner of tha propery, am EXCLUSIVELV CONTRACTING WI7M LICENSED CONTRACTORS to construct the project (Sec. 7044, eusiness antl Protessions Gode: The contractors License Law tloes not appty to en owner of pmpeny w�o builds or improves thereon, antl who comracts tor such project wlth a comrector(s) license pursuent to the Gontrectors License Laws.). ❑ I am exempt untler sec. Business and Professions Code for ihis reason: Signature: Date: Owner ID veritied by driver's license. ❑ Yes ❑ No Drivefs License No. Verificetlan ot Ownership by (type oi document, I.e. - property taz 6i11 or tleetl): DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I hereby certify Ihet na excevatian five (5) or more feet in tlep�h into which a parson is required to descend, will be made in connection with work authorized by Ihis permit, antl ihat no building siructure, scaftolding, falsework, or demolition or dismantling Ihereof, will be more �han thlrty-slx (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Celifomia Adminisirative Code). � � ❑ As ownerbuilder, I will not employ anyone to tlo work which would require a pertnit irom the Division of Industnal Satery, as notetl above, unless suc� person has a permit to do such work from the division. Signature: Date: Division ot Indusirial Safery Pertnit Numbar: CERTIFlCATE OF COMPLIANCE IWD AUT110RIZATION OF ENTIiY: I certity under penalty of perjury Ihat I have reaC �his application and state that the infortnation given is correct. I aqree to comply with ell sta�e laws and city ordinences relating to building consiruction, antl au�horize representatives of the City ot Costa Mesa to enter upon the above-described properry tor inspection purposes. I agree no� Io occupy or allow occupancy of any building authonzed by ihis pertni� until final inspection. GOpE N, INSPECTIONTYPE 1616 Fized System Finel Fire Prevention 1266 Pool Spe Finel 200 Final Re-Rooi 201 Flnal BIocWReteining Well 202 Finel Factory Fire Place 203 Final Sign 204 Finel Demoli�ion I 7 Z�a`9 Date Q� �$ EQQE.( INSPECTIONTViE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Finel Flre Preventlon 220 Finel Planning Approval 222 Final Site 250 Finel Building/Occupency �: 1 .1111. ' C1R7 lJ'�"' � =�-:. �; s�� COSTA MESA BUILDING DEPARTMENT P. O. BOX 31� COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN COSTA MESA. CALIFORNIA MAIL nooaess IARCHITECT �OR ENGINEER SLll'ItY!?G' CONTRACTOR �ecnt LOT DESCRIPTION NO. A.P. NO. SIZE /� OF LOT Q�,! � USE OF E%ISTING BLDG. SETOACN IINE FROM BLOCK FEE RECEIUED `�(Y� c� a— i ��1- � � FINANCE' D�PT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING - FOR OFFICE USE ONLY r+cceiveo ev onre rxeceiveo o. S- " -� MA' TEI.. BUILDING NO. ADDRE55 ��c. COSTA MESA. CALIFORNIA NO. aTr uc. NO. _ TEL. NO OF BLOGS. NOW ON LOT CENTER OF STREET �G � REAR VARD ��) � RIGHT � � LEFT � 1 DESCRIPTION OF WORK NEW I X ALTERATION ADDITION REPAIR BUILDING SIZE � % EXTERIOR WALL NO.OF ROOMS K STORI ROOF ' COVERING Rrinlr STnTE THAT THE ABOVE IS CORRECT AND I�GREE TO CITV OF�INPNCES AND STRTE I�AW�EGUL� TION. SIGNATURE O� / PERMITTEE I AUTHORIZED AGENT FIRE ZONE zONE /\ �� APPROVED WITH RLL CONSTHU6 VALUATION PLi CORRECTIONS PERMIT FEE $ �D /�/ � PLAN CHECK $ $ � [o b TOTAL FEE $ L ypMJ OWNER SUNA2�iI.AND LAND CO• DATE 5-3-5% JOB ADDRESS 3138 Barbados Place BUILDING PERMIT NO. #L959 GENERALCONTRACTOR Owner BZCIT'. VAWE $ 1.�,686,�� LOT 29 BLOCK TRACT 23 ReS. W�8't't �8:'• GROUP I Sc J TYPE V ZONE Rl FIRE DISTRICT 5009 PERMITSISSUED INSPECTIONS DATE SUBCONTRACTOR DATE I NUMBER Foundation Forms and Grade to Rough Framing Plumbing, Rough to Slab Plumbing, Rough Complete Temporary Pole Wiring, Rough Heating, Rough Heating, Final / Sewer�l9yse //� L Sewer S Septic Tank or Cesspool Lathing, In Out Plastering % Plumbing, Final, FixtUreS Compl Piumhing, Final GasTest %.i� Wiring, Final Occupancy FORM 310 3M 10-v3 % , �. 99`72 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 317 COSTA MESA. CALIFORNIA fOR APPUCANT TO f/L[ /N COMPLETELY TYPE OR PRINT ADDRESS .� ��'�//—K.�OS COSTA MESA. CALIFORNIA � � ��.��.��:, �ARGHITECT LIC. OR ENGINEER NO. A�DRESS / / / 2 //� b�U� �JI/'' - �ESCRIPTION I NOT I BLOC�K_ I TF7AG — IA.P. NO. SIZE \ NO.OF BLOGS. OG LOT ,�/ NOW ON LOT USE OF EXISTING BLDG. I i2��//�%TO � SETBiICK LINE FROM CENTER OF STREET REAR YARp SIDE YAR� ILEFT IRIGHT DESCRIPTION OF WORK REPAIR I IIMOVING BUILDING NO.O SIZE ROON EXTERIOR WALL IROOF GOVERING COVE USE OF BUILDIN�'o�r� WOfi�,O� �!� � i )y � •/C� 1 HEREBY ACKNOWLEDGE TNAY I HAVE READ THIS qPPLICATION AN� STRTE THAT THE ABOVE IS COPRECT AND /GREE TO COM� PLY WITH ALL CITY Oq�INANO[5 AND STATE L 5 qEGULATING BUILDING CONSTRUC,yTION./ / � SIGNATURE OF�/ .( � ! �- PERMITTEE `I �L �Y/�.G�l \ _+�-� ` '_ __'. � 1' 1,/i�� i_�-. e�l�l�� a �'iiN"' JUL 2 4 lg� FIfV11NCE DEPT. GITY OF C��T". n�F�n APPLICATION FOR PERMIT BUILDING fox officF usE oNcy I NECEIPT NO. I PEg 4 7 2 RECENED BY I DATE RECEIVEO I DATE 195UED GOSTA MESA. CALIFORNIA APPROVED ZONING ZONE [�/ I p ANS I BUELDINGEW % � APPROVED ��O . ' (CENTER LINE ST.) l FRONT t —Gl FT. IN. R.SIDE 'C/ FT. IN. LSI�E � FT. IN. THE AMOUNT BHOWN UNDEF VALUI�TION I8 FOR THE PURPOSE OF ESTABLI6HING A PENMIT FEE ONLY. VA W ATI ON /� � VZ% PERMIT FEE $ „��• $ PLAN GHECK $ �� TOTAL FEE $ d'� i 06VNER HdNSF MNPI K. G. DATE %-2�-59 JOB ADDRESS �38 xarbados Place BUILDING PERMIT N0. 9972 GENERAL CONTRACTOR SllD2T'lOT' FBIIC2 VALUE � 12%.00 � AP. No. _ � LOT i TRACT FIRE ZONE DESCRIPT[ON OF WORK block W81,],_ INSPECTIONS DATE I GROUP .T TYPE V ZONE Rl. SUBCONTRACTOR Form 4 `