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Home My WebLink About1120 CARSON ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1120 CARSON ST Status: ISSUED Suite: Applied: 09/292004 Vicinity: Issued: 09/29/2004 Parcel Number: 14169217 Zoning: R1 R1 Applicant: PHAM,HAO ISSUED BY: Address: 1120 CARSON ST Phone: 714-545-8224 COSTA MESA, CA Zip: 92626-2752 Owner: HO,PHAM Permit: Address 1120 CARSON ST $0.50 SMIP Com: $0.00 Phone: 714-545-8224 $0.00 COSTA MESA, CA Zip: 92626-2752 Contractor: OWNER -BUILDER Address: Phone: Arch : Address: Zip: License: 000000 Phone: Zip: License: Eng: Address: Phone: License: SCOPE OF PERMIT LEGALIZE REMOVED AND REPLACED ALL EXTERIOR WINDOWS WITH THE SAME SIZE AND ATTHE SAME LOCATION. BEDROOM WINDOWS SHALL COMPLY WITH 1997 UBC SEC. Plan Check: $0.00 Permit: $97.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $97.75 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 Rear 0-0 Rear 0-0 Required: 0 FEE SUMMARY Calc Valuation: $3,900.00 Claim Valuation: $3,900.00 PLANNING & ZONING Left 0-0 Right 0-0 Left 0-0 Right 0-0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days, or it work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authodzed 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 2418-0(6=) DECLARATIONS WORKERS' COMPFNSATIOIJ DECLARATION: I hereby affirm undo. penalty of perjury one of the following declarations: 1 ❑ 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: Carder: Policy Number: (This section need not be completed if 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 Califomia, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cade, 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 d ICO,ODOI. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION WOO OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirn 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. Lie. a Class 4 Contractors 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). Lenders 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. 7031S, Business and Professions Code: Any city or county which requires a permit to construct, attar, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) Or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit su chs the applicant to a civil penalty of not more than five hundred dollars ($500).): I, as owner at 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 Cade: 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.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am9r1fid r sec. Business and Professions Code for this reason: Signature: pate: drivers license. Yes ❑ No Drivers License No Expires: G C'7 - 7 I _ O Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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-bullder, 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 WIII 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 matedal7 ❑ 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). ...................._...............__._..._ p _.nt or ___..._...._...._._n formf.__................................................___........_.___._.....__ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous matenels7 ❑Ves ❑ No (Section 25533 of the Califomia 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 nand 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 Healthand Safety Cade provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire apartment of an ?MPP by businesses which are required to register acutely hazardous materials with the Fire Department. ...................................................................._......................__.............................__...__..................................................___.................................................................................................................................._.............._........._.........._........ 4 If en RMPP 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 ermn for such construction or modification from the South QOost Air Quality Management District or from any other air pollution control district or agency? Ves f NO (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .............................. ....................... .......................................... _............................................................ __.._....... __...................................................................................................... ............................_................... .........................._.............. 6 WIII any pan 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 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 Coda Section 42303 been made? ❑Ves ❑ No B —(dyes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. mat Owne �/ Data AC Y/ 24 X09' And/ r Authomel glipplIcalin�aate CODE f. INSPECTION TYPE PATE INITIAL CODE INSPECTION TYPE gds. INITTIALS 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 Well 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 t N tj 94X78 W)t'!; . 7ox�" 7ox3a" y(,jDiuG � Doo rt I I �DKWI I VjEDK+2 iiEi7R1� I � i I 3EoeM I r-tra-►EN 4 AEACE 70 X4+ MFS CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT �• PERMIT PERMIT NUMBER B98-02159 (714) 754-5273 • Fax(714)754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1120 CARSON ST Suite: Vicinity: Parcel Nunmber: 14169217 Zoning: R1 Applicant: NGYEN, DAN Address: Owner: TRAIN, TUONG X Address 1120 CARSON ST Contractor: Address: Arch / Eng : Address: Phone: Zip: Phone: COSTA MESA,CA Zip: 92626 Phone: Zip: License: Phone: Zip: License: R1 Status: ISSUE Applied: 12/02/1998 Issued: 12/02/1998 SCOPE OF PERMIT T/O EXISTING AND REROOF HOUSE AND GARAGE WITH COMA. SHINGLE, ROOF CERT ATTACHED TO PERMIT. NOTES 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 Plan Check: $0.00 Calc Valuation: $3,800.00 Permit: $87.25 Claim Valuation: $3,800.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $87.75 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES 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 permit is issued. My workers' compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pro Ions. Applicant Signet e:/ WARNING: FAILURE TO SECURE WOR S' 4PENSATION COVERAGEIS L4 LAND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND gVIL FINES UP TO ONE HUNDRED THOUSANDDOLLARE (5100,000), IN AD TO THE COST OF COMPENSO ON AMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: C/ I hereby affirm that I am licensedder 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. Y i Clau Contractors Signature: n Date !/ v CONSTRUCTIOPILENDING 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). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I em 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 permit subjects the applicant to a civ,1 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.). ❑ 1, 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, I.e. - properly 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 B, 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 Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 Pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and.pressure). ... .. ... .................................................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves ❑ No (Section 25533 of the California Health and Safety Cade, 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 boas 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 en RMPP 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 apemlit 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 Cade requires that the requested information be furnished on applications for non-residential building perrnits). .................................................................................................................................................................................................................................................................................... 6 Will any pert of the facility to De 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 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. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: _ Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. i Igr alure 01 Legal Ow r(s)Date 1%,/�1 �I r onzed Applicant mate CODE if INSPECTION TYPE DAIS CODE l INSPECTION TYPE DATE INTITIA .5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Rcof /z-7-` f (Tfjt4E:_� 210 Final Electrical 201 Final BlocWRetaining 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 2446-46 Proper Owner Contra) CITY OF COSTA MESA BUILDING DIVISION ROOF COVERING CERTIFICATION Permit No. bqqD ---Ozj'�j State Contractor License Number LP I h QX�e) 0 Classification I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the above address in conformance with Chapter 32, and Section 1704 of the latest adopted edition of the Uniform Building Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the manufacturer. ❑ I further certify that I am the owner of the property. (Owner -Builder permittee only). ❑ I further certify that I am: Owner of sole proprietorship company ❑ Full partner of the company ❑ Limited partner of the company ❑ Officer of the corporation I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this certification, which shall be binding on all successors or assigns of the company or corporation. I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building Division for acceptance. Received by Building Division By: Initial Date 099046 MW 9/97 Whir, - Building Div.; Canary - Co11,101,; Pints - Owner Company or Corporate (t -C _ 0'17- G U u-3 I j -b "A Printed or Typed Name PROJECT ADDRESS: 1120 CARSON ST UNII: OWNER'S NAME: URBAN, GEORGE E ADDRESS URBAN, BARBARA A 1120 CARSON ST COSTA MESA CA 92626 ARCNIENGINEER: (714)754-6A86 6 REG.NO.: ADDRESS: UNIT: PERMITTEE: GEORGE BRAZIL (71.4)535-7905 ADefless: 3022 N. HESPERIAN WY 101. SANTA ANA CA 92706 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7001 of Division 3 of the Business and Professions Cotle. and license is in full force and effect. CITY LIC �j 4 sr0111L" 143064 /GLAss:O-36 Date: i`5/� Signature: _ - _` _ _ _ y WORKERS COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C). POLICY ND.:PC947J25 EXP. DATE: 01/01/94 COMPANY:REpSgLIC ^ ❑ Certified copy is hereby lum➢shed. -4� Certified cOisfile he o Bolding Division,Date: 3 2 � _Applicant��V EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or less). I cantly that in the performance of the work [or which this permit is issued, I shall not employ any person in any manner so as to become subject to the WorkersCompensation Laws of California. Date: Signature: NOTICE: If, after making [his declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must Ienownth comply with such provisions or (Itis permit shall be deemed revoked. 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 (Section 3097, Civ, Q. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Cotler Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires theapplicant for such permit to file a signed statement that he/She is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business ,and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered fpr sale (Section 7044. Business and Professional Code: The Contractors' Stale License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself at 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 will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044. Business Elono Professions Code: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: CITY OF COSTA MESA — BUILDING PERMIT PERM.. NO; P 061504 PERMIT NO; P 061504 PLAN CHECK NO; N GOVT; N SUPP; N CONSTRUCTION TYPE; S—N PERMIT TYPE; PLU PURPOSE; O'iH JOB DESCRIPTION ; REPLACE 50GAL WATER HEATER SQ FT; CLAIM VALUE; CALC—VALUE; GROUP OCC; R-3 / COMMENTS; PLUMBING WORK ONLY Z O N I N G S F. T B A C K S R E Q U I R E M E N T 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 RGHT; FT IN PARKING REQ; PROV; PARCEL; 14169217 ZNE; REF NO; PLANNING NOTES> BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK > DUE TOTALS ---- > 7.00 20.00 0,00 27,00 27,00 .00 D E V E L O P M E N T S E R V I C E S ',tt E Q U I R E M E N 1' S ZONING APPROVED BY ELECTRIC MECHANIC FIRE SMIP/TOT GRADING DATE; 27.00 BUILDING APPROVED BY ; DATE; 3F## -k I N D I V I D U A L F E E APPLICATION ISSUED BY; TYPE QTY DATE; #################N-####i"'FTFSFTF R ,(X#�F�tXx XXft X#'�F# hiF��RiF��########0.# 1l• Nn• ## LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N BLDG PMI' PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 7,00 25% SMIP/NON—RES PLAN ISSUE FEE 20,00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 7.00 20.00 0,00 27,00 27,00 .00 REVENUE DIVISION TOTALS--> COLLECTED; 27,00 OVER/SHORT;00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING FLAN—CHRCK 27.00 #######################ih########?E#####.NN#####ii#76###N##N#################•#N3o 3F## -k 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 Dale'. Owner. I I do hereby cenity that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and PLU 25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Dale: Applicant: I hereby certify that I have read this application and state at the as ve information is correct. l agree to comply with all city and county ordinances and state laws relating to building construction: d hereby unit Oresentati es of Inis city to enter upon the above mentioned progeny for inspection rposes. Dart: Signature' ` Driver's License or Social Security p: 164146 Wife— Build mg: Green—Code Enforcement) Canary—AppllcarW Pink—Revenue: Goldenrod—Assessor I WATER HEATER AND/OR VENT END OF FEES l 7,00 7,00 CONSTRUCTION AND PLANNING Permits Date Inspector POOL & SPA APPROVALS Permit 0" Date Inspector -� -APPROVALS 1' Temporary Electrical Service or Pole 52. Pool & Equipment Location ?. So Pine Linda-nd. I - 53. S!eel Reinforcement 3 E.cctr ca' Cn'ou't UY r- - i 4. E'ectrical Condult-Uncirgrnd 5 54. 55. 56, Forms Electrical Bond ng Rough Plun-u.no g, Pressure Test y G. F.^ct7,cs'. L'FER Grnd 57, APPROVAL TO CCVFR-GUNITE I 7. Footings 56. Electrical Condud-Undrgrnd. B. Foundation 59. Gas P,pe, ❑ Undrgrnd., Test 9. !'.ater Rpe L'ddrgrnd. 60. Baekv.,ash Lincs, P-Trop. , Urcko•rd. 10. Structure' F'uor System 11. Property Sewer Line & House Connection 61. APPROVAL TO DECK 62. Backvia�h & Receplur-Final ~12. See:er CaP- 63. 64. 65. 66. - Heater &Vent-Fln;,� Plumbing System F nal Electrical -Final Solar System-Final I (- -� -t --. - _ 13. Roo' Drains r14. Rough Plumbing F 15 Rough Electrical-Conduit '.6. Rc..gh Eleelr,c `7iring 67. Funding & Aces. Anwovai - I -----_ '--- "�.7. Ro.:gh'.'; nen Sgn 68. APPROVED FOR PLASTERING 18. Rough Elvctr'ca'.T Bar Cell ng 69. POOL/SPA SYS rE.:S FINAL 19. Rough He„rlrg & Air Cp ^.u't,oring FIRE DEPT. REQUIREMENT APPROVALS Penmt II 20. Rough Frctory F'rep;ace 21. Ducts, in SV ucture 70. Underground Hydro 22. Ducts, VenWating -__- 71. Product Piping f 1 G.0 _7 Oil 23. G.: ?i R. Ro, gh & Test 2G. Roof Framing 72. Underground FI„s --- 73. Undergrnd.Storap; Tank 713as _:OI' 25. Roof Sheathing T 74. Overhead Hydro I 26, T Bar C-.;irg (Structural) & I, onccoat 75. _ Dry Chem�tal --I 27. Frame a.,A Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL -� 29. insu:at.o^ 78. FIRE PREV. FINAI- 30. D,y;.a G:+Ilmg HEALTH DEPT. REQUIRE:.iE•,' 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED l Notes: _ 31. Plaster S,D•ln Coat i 32 Electrc:.,. Povier Meter Fra: ' 33. Fi-ll Elrclrlc _ _ 34. Final Heating & Air Conditioning 35. Final Gas Pipe Test 36. Hood or Canopy 37 F,na! Factory Fvep'aee , 1 I 38. Final Plumbing 39. Water Service-Final 40. Gas Se,vme-Final 41. 42. Solar Domestic-Final Backflow Preventer 43. Backfior+ Irngat'on --II 44. Lar,dscapo Irnqation System -� ! 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ' 46 FINAL PLANNING r 1 49. Electric Release to Edison 50 Gas Release to Southern California Gas Co 51. No. CERTIFICATE OF OCCUPANCY Date 213 i0 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 917 COSTA MESA, CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT BUILDING ADDRESS a O , COSTA MESA. CALIFORNIA C ARCHITECT 1 I kl Z N SQ. FT. OR ENGINEER NO. 100 THEAMOUNT SHOW PURPOSE OF ESTAB ADDRESS 1 e 1 IB FOR THE FEE ONLY. Q REAR - �JFT. FT. NEW CONTRACTOR SLI' SIGNATOR OF PERMITTE ADDITIPON PERMIT FEE $ ' j ADDRESS 17 3 S r (� S AUTHORIZED AGENT �✓ CITY rc ) Cn DISTANCEBETS. STATE E IO LIC. NO. ✓ SIZE O V I BLDG9. OF LOT 1 MDVlN6 NOFB OW ON LOT DEMOLISH USE OF EXISTING BLDG. SETBACK LINE FROM Yom` D '1 CENTER OF STREET REAR YARD P VAR•# SIDE YARD) LEFT I RIGHT ! �3 DESCRIPTION OF WORK X SIZE ROOMS STORIES FEE RECEIVED JAN 17 ION FINANCE DEPT. ovri AP�`i� ( �F COSTA MESA A ION FOR PERMIT BUILDING For Office Use Only RECEIPT NO. p. q1 t N� O OY DATE RECSIYHD, 1� ODCA/TR ISSUED ZONING ZQN NO. OP USE PLANE BUII CCC i LEGAL /J rE: NO EAVE OVERHANG SHALL BE LESS THAN TO SIDE a REAR P. L. 'ES .OWED (U. B. C. REQUIREMENT) YARDSAPPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING Z N SQ. FT. I HEREBY ACKNOWLEDGE TNAT I AVE ANO STATE TH ABOV CO READ THIS APPLICATION CT AND AORHE TO COM. THEAMOUNT SHOW PURPOSE OF ESTAB NDER VALUATION IBHING A PERMIT IB FOR THE FEE ONLY. Q REAR - �JFT. FT. NEW ALTERATION SIGNATOR OF PERMITTE ADDITIPON PERMIT FEE $ ' j PLAN CHECK 5 /J��D S AUTHORIZED AGENT �✓ DISTANCEBETS. BET.ACCMAI TOTAL FEE $ zz,69 / (y BLDG9. REPAIR MDVlN6 DEMOLISH VAR•# DATE BUILDING ! �3 NO. OF SIZE ROOMS STORIES APPROVED EXTERIOR WALK. nl ROOF'^ `1^ `. _ I _ AP l' oATE'-� T_ V Z N SQ. FT. I HEREBY ACKNOWLEDGE TNAT I AVE ANO STATE TH ABOV CO READ THIS APPLICATION CT AND AORHE TO COM. THEAMOUNT SHOW PURPOSE OF ESTAB NDER VALUATION IBHING A PERMIT IB FOR THE FEE ONLY. Q R PLY WITH AL CITY O. ES AND BUILDING C CITY TATE LAWS REGULATING VALUATION 0 N SIGNATOR OF PERMITTE PERMIT FEE $ ' j PLAN CHECK 5 /J��D S AUTHORIZED AGENT �✓ TOTAL FEE $ zz,69 / (y