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Home My WebLink About2717 CIBOLA AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, GA 92626 Job Address: 2717 CIBOLA AV Suite No Vicinity: INTERIOR REMODEL Parcel Nunmber: 14164415 Applicant: WALWORTH, MALCOLM Address: 713 S AGATE ST ANAHEIM, CA Owner: WONG,IRENE Address 2717 CIBOLA AVE COSTA MESA, CA Contractor: M W ENTERPRISES Address: 713 S AGATE ST , ANAHEIM,CA Arch / Eng : Address: ISSUE FEE BackFlow irrigation BackFlow Preventer Bathtub Clarifer System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater PLUMBING PERMIT ISSUED BY: Phone: 714-240-4071 Zip: 92804 Phone: 949-302-1122 Zip: 92626 Phone: 714-240-4071 Zip: 92804 License: 796697 Phone: Zip: License: Status: ISSUED Applied: 03/13/2003 I ssued: 03/13I2003 SCOPE OF PERMIT REMOVE WALL IN LIVING ROOM TO OPEN AREA OF KITCHEN, DINING AND KITCHEN AREA. ADD BEAM AT OPENING. REMODEL OF INTERIOR TO INCLUDE ADDITION OF A 3/4 BATHROOM. MISC ELECTRICAL, PLUMBING AND MECHANICAL WORK ALSO. PLUMBING TO INCLUDE: 7 SHOWER, 1 KITCHEN SINK, 1 DISHWASHER RELOCATE, 1 TOILET AND 2 SINKS. AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 FEESUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landscape Irrigation 50.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 k) 50.00 0 Receptors $0.00 0 Septic Tank $0.00 1 SewerCapforDemo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 QTY 0 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Waler Closet (Toilet) AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.60 $0.00 $0.00 $9.80 QTY 0 0 0 0 0 0 2 0 0 1 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-26, § 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 tor ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapeetione and }inal approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of ihis permit. FOR INSPECTIONS CALL; (714) 7545626 2446-4618100) WORKERS' COMPENSATION DECLARATION: . I herehy ettirm untler penelty of perjury one ot the following tleclaretions: _ ❑ I heve end will maintein a cenificate of consent to self-Insure lor workero' compensation, es provitletl for by sectlon 3700 of the La6or Code, lor the pertormence of the work for which this permit Is issuetl. . ❑ I have end will maimain workers' rqmpensation Insurance, es requiretl by sectlon 3700 ot the Lebor Cotle, for ihe Oedortnance of the work for which this pertnit is issued. My workers' compensation Insurance carder and pollcy number ere: Carrier: Policy Number. (This section need nat be campleted I! tha permit is valued et one huntlretl tlallers ($100) oNess.) cenity Ihat in tha peAormance ol the work for which t is permit is Issuea, I shell not employ eny person in eny manner so as to become su6ject to the workers' compensetion I� s ot Celify�I e, dyg� ee thaD t I uld bac e sub�ect to Ihe workars' wmpensa�ion provisions ot Sectlon 3700 oi ihe Labor Code, I s�all forthwith complywithih�'Se,jH�o(d��—i I Y� ApplicaniSignewre: ,6�� L�! C�/�� Date: �� I� �—i WARNINO: FAIIURE TO SECURE WORKERS' COMPENSATION COVERAGE I$ UNLAWFUL PND SHALL SU91ECi AN EMPLOYER TO CRIMINAL PENALTIES AND CIVII FWES UP TOONE HUNDRED TMOUSAND DOLLARE (5100.000), IN A�DRION TO THE COST OF COMPENSATION, DAMAGES AS FROVIDED FOR IN SECiION 31O60F THE LABOR WDE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I herehy aNirm that I am Ilcensetl+�°�9�' ' v I f C er ommen�f g with SecNon 7000) of Division 3 of ihe B force and ettect. Lic. q�� //�_.0 Class a Contracbfs Signeture: V�6�Q,I% , i.! i, Dete: _ and my license is in tull CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn that there is a construction lending egenty tor the pertormance ol the work lor which ihis permit is issued. (Sec. 3097, Civil Cotle). Lendefs Neme: Lendefs Address: Signature: OWNER-BUILDER DECLARATIONS: Date: I here6y eMirtn thei under penelry of perjury Ihet I am El(EMP7 FROM 7ME CON7RAC70RS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires e permit to construct, alter, improve, demolis�, or repair any sWcture, pnor m its issuance, also requires the applicant for such permit to file a signed statement thet he or she Is licensed pursuent to iha prodsions of the Contrectors License Lew (Chepter 9(commencing with Section 7000) ot Division 3 of the Business entl Professlons Cotle) or t�at he or she is exempt therefrom end the basls for the alleged exemption. Any violation of Saction 7031.5 by any applicant for e permit subjects the epplicant to e civil penalry ol not more than tive hundretl tlollers (5500).): ❑ I, es ownar of t�e pmperty, or my emplayees wlth wages es thelr sole wmpensation, WILI DO THE WORK, entl the sWCNre Is not imentletl or ottered for sale (Sec. 7044, Business and Protessions Coda: The Coniractors License Lew does not eppy to an owner oi property who builds or improves Ihereon, and who tices such work �imself or herseli or through his or her own employees, providetl that such improvements ere not Intanded or oMered for sale. If, however, Iha builtling or improvement is sold wit�in one year of completion, the owner-builder will have the burden ol proving that he or she did not build or improve for purpose of sale.). � ❑ I, as owner oi the property, am EXCLUSIVELV CONTRACTNG WITM LICENSED CONTRACTORS to construct tha project (Sec. 7044, Business and Professions Cotle: The contractors License Lew does not epply to en owner at pmpeny who �uiltls or improves thereon, end who contracis br such pmled with a contractor(s) license pursuant to ihe Contractors License Lews.). ❑ I am exempt under sec. Busineu end Professions Code br Ihis reason: Signa�ure: Date: Owner ID verifiad by drivers liten5e. ❑ Ves ❑ No DnvefS LiCense No. Ezpires: Venfication of Ownership by (rype ol dxumeni, i.e. - property tax blll or deed): DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby cenity that no exwvetlon ilve (5) or more feet in tlepth into which a person Is required to dascend, will be matle in connection with work authorizetl by ihis permit, entl that no builtling sirucWre, scattolding, lelsework, or demolition or tlismantling thereol, will be more ihan thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Ti�le 8, Califomia Atlminisirative Code). ❑ As owner-builder, I will not employ enyone to do work whic� would require e permit from ihe Division of Industrial Safery, es noted above, unless such person hes e permit to do such work from ihe division. Signature: Date: Division ot Indusirial Safety Permit Number. CERi1FlCATE OF COMPLIANCE AND AUiHORVA710N OF ENTAV: I certify under penalry ot pe�ury Ihat I have read this application and stata that the infortnation given is correct. I egree Io wmply with all state laws end city ordinances relating to building const�uciion, antl authorize representatives ot the Giry ol Casta Mesa to enter upon the abova-descnbed property lor inspec�ion purposes. I egree not to occupy or allow occupancy ot any building authorized by ihis permit until final insDection. i �f{'� •1,� � �I �%/,a _//./r _�! . /iir .• COpE �. INSPECTIONTYPE 1616 Fixetl System Final Fire PrevenUon 1266 Pool Spe Finel 200 Final Re-Roof 201 Flnal Block/Retaining Wall 202 203 Final Factory Fire Place Finel Sign �E � �. : ��t��1� COOEI INSPECTION7YPE � 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site � 204 Final Demolition ` 250 Final Building/Occupancy [�F INf11UL$ S-�D-o3 � pia) �sa-sz�3 • Fax (�ia� �sa-aass • www.ci.costa-mesa.ca.us 77 FAIR �RNE, GOSTA MESA, GA 92626 JobAddress: Y%'Ii CIBOLAAV Suite No Vicinity: Parcel Number: 14764475 npp�icant: WALWORTH, MALCOLM Address: 713 S AGATE ST ANAHEIM,CA Owner: WONG,IR�NE Address: 2717 CIBOLA AVE COSTA MESA, CA Contractor: M W ENTERPRISES Address: 713 S AGATE ST ANAHEIM, CA MECHANICAL PERMIT Phane: 774-240-4071 Zip: 92804 Phone: 949302-1122 Zip: 92626 Phone: 714-240-4071 Zip: 92804 License: 796697 ISSUED BY: Status: ISSUED Applied: 03/13/2003 Issued: 03/13I2003 SCOPE OF PERMIT 1 ALT. DUCT SYSTEM AND 1 VENT FAN /SINGLE DUCT IN THE BATHROOM, 1 KITCHEN HOOD. ISSUE,FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Boz Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000c(m Air Handlers > 10000dm Floor Furnace Floor or Suspend Heater 523.50 50.00 $0.00 $13.70 $0.00 $0.00 $0.00 $0.00 $0.00 $10.65 $0.00 $7.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEESUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler Commerci al I ncinerator Domeslic Incineralor Compressors / Absorption Systems Upto3hp/100kBTU 3 To 15 hp / SOO k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15ta30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investiqation Fee Plan Check Fee Reinspectian Fee Quantity $0.00 0 $0.00 0 $0.00 0 $O.OD 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 $0.00 $0.00 TOTAL CALCULATED FEES $55.10 NOTICE: Tha work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-20, § 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 ihis permit to be considered legal, such work must comply with all applicable codes, and all required Inspeclions 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) 7546626 zacee(waa) WORKERS' COMPENSATION DECLARATION: � ' I hereby e%irm under penalry of perjury one of ihe following declarations: ❑ I have and will maintain a certificate ot consent to self-Insure for workers' compensatlon, es provided for by section 3700 of ihe Labor Code, tor the pedortnance of Ihe wOrk tor which lhis permil is i5sued. ❑ I have and will maintain workers' compensa�ion Insurance, as required by sectlon 3700 of ihe Labor Code, for ihe pedormance of ihe work for which this pertnil is issued. My workers' compensailon Insurence carner antl policy num6er are: Carner: " Policy Number: (This section need nof be complefed i! the permit is veluetl af one hundred dollars ($100) or less.) ❑ I certiry ihat in ihe peAormence oi the work for which this pertnit is issuad, I shall not employ any person in any manner so es to become subject to the workers' compensatlon laws of Calilornia, and agree I�at if I should become sub�act to the workers' compensation provisions oi Section 3700 of ihe Labor Cotle, I shell forthwiih comply with these provisions. Applicent Signeture: Date: WARNINO: FAILURE TO SECURE WOFKERS' COMPENSATION CqVERAGE IS UNLAWFUL AND SHALL SUBJEGT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVII FlNES UP TOONE HUNDRED TFIOUSANO DOLLARE (St W,OW), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIOEO FOR IN SECTION 31O60F THE LABOR CODE, IMEREST, AN� ATTORNE`fS FEES. LICENSED CONTRACTORS DECLApATION: I hereby aflirtn Ihet I am licensetl under provisions of Chapter 9(commencinq with Section 7000) oi Division 3 of Ihe Business antl Professions Code, end my license is in full I�orce antl eNect Lic. M Class q ' Conirector's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I here6y aHirtn ihat there is a conswction lentling agency for the pertormance of the work tor which �his permit is issued. (Sec. 3097, Civil Code). Lender's Name: lender's Address: SignaWre: Date: OWNER-BUILDER DECLARATIONS: I hereby aflirtn Ihet under penelry of perjury that I am EXEMP7 FROM 7HE CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry whic� requires a pertnit to consiruct, alter, improve, tlemolish, or repair any sirucNre, prior to its issuance, also requires the applicant for such pertnit b file a signed statemant thet ha or she Is licensed pursuant to ihe provisions of lhe Contrectors License Law (Chapter 9(commencing with Section 7000) ot Division 3 of the Business antl Protessions Code) or thet he or sha is ezempt therefrom and the basis tor the alle9ed e:emption. Any violation of Section 7031.5 by eny applicant tor a permit subjects the applicant to e civll penalty of not more then five hundred dollars ($500).): ❑ I, as owner of Ihe property, or my employees with weges es Iheir sote compensation, WILL DO TT1E WORK, antl the sWcture is not intentletl or ottered for sale (Sec. 7044, Business and Professions Code: The Contractors Licensa Law does no� apply to an owner ot property who builds or improves thereon, and who does such work himself or herselt or through his or her own employees, provided that such improvemenis are not intentletl or oHeretl tor sale. If, however, Ihe building or improvemen� is sold within one year oi completion, the owner-builder will have ihe burden of proving Ihat he or she did not 6uild or improve for purpose ot sale.). ' ❑ I, as owner ot Ihe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: Tha coniractors License Lew does not apply to an owner of property who builtls or improves Ihereon, end who coniracts for such pmiect with a conlractoQs) license pursuant to the Comracbrs License Laws.). ❑ I am exampt untler sec. Business and Professions Code tor �his reason: Signature: Date: Owner ID venfied by tlriver's license. ❑ Yes ❑ No Drivers License No. Venfiwtion ot Ownership by (type of tlocumem, i.e. - property tax bill or deed): Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATON: ❑ I hareby certify iha� no excavation tiva (5) or more �ee� in dep�h into which e person is required to tlescend, will be made in connection with work authorized by this permit, and that no building stmdure, scaHolding, taisework, or demolition or dismantling thereof, wiil be more than ihirty-six (36) teet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, Califomia Adminisiralive Cotle). , ❑ As owner-builtler, I will not empioy anyone to tlo work which would require e pertnil irom ihe Division of Industnal SefeN, as noted above, unless such person hes a permit to do such work from ihe division. Signeture: Oate: Division oi Industrial Safery Permit Number. CERTIFlCATE OF COMPLIANCE AND AUiHORIZA710N OF ENTRY: I certily under penalty oi perlury that I have �ead ihis epplication and state that ihe information given is correct I agree to comply with all sta�e laws and city o�dinances relating to building constmction, and euthorize represen�atives of the Ciry oi Costa Mesa m enter upon the above-described property for inspection purposes. I e9ree not to occupy or allow occupancy ot eny building authorized by this permit until final inspection. Signature Of Legal Owner(s) And/OrAuUionzed Applicant COpEN, INSPECTIONTYVE � 1616 Fixed System Final Fire Prevenlion 1266 Pool Spe Final 200 Final Re-Roof 207' FinaI8lwWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Pinal Demolition QQj� IN I UEN INSVECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecincal 212 Final Fire Prevention 220 222 250 Final Planning Approval Finai Site Final Building/Occupancy Date Date (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 1ob Address: 2717 CIBOLA AV Suite No Vicinity: INTERIOR REMODEL Parcel Nunmber: 14164415 Applicant: WALWORTH, MALCOLM Address: 713 S AGATE ST ANAHEIM, CA Owner: WONG,IRENE Address 2717 CIBOLA AVE COSTq MESA, CA Contractor: M W ENTERPRISES Address: 713 S AGATE ST . Arch / Eng : Address: ISSUE FEE BackFlow irrigation BackFlow Preventer Bathtub Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater ANAHEIM, CA PLUMBING PERMIT Phane: 714-240-4071 Zip: 92804 Phone: 949302-1122 Zip: 92626 Phone: 714-240-4071 Zip: 92804 License: 796697 Phone: Zip: License: Status: ISSUED Applied: 03/13/2003 Issued: 03/13/2003 ISSUED BY: �' / ` �� SCOPE OF PERMIT REMOVE WALL IN LIVING ROOM TO OPEN AREA OF KITCHEN, DINING AND KITCHEN AREA. ADD BEAM qT OPENING. REMODEL OF INTERIOR TO INCLUDE ADDITION OF A 3/4 BATHROOM. MISC ELEC7RICAL, PLUMBING AND MECHANICAL WORK ALSO. PLUMBING TO INCLUDE: 1 SHOWER, 1 KITCHEN SINK, 1 DISHWASHER RELOCATE, 1 TOILET AND 2 SINKS. AMT s2a:so $0.00 $0.00 $0.00 $Q.00 $0.00 $0.00 $9.80 $Q.00 $0.00 FEE SUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landscape Irrigation $0.00 0 P-Trap $0.00 0 Pressure Regulalor $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 1 Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 QTY 0 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.60 $0.00 $0.00 $9.80 QTY 0 0 0 0 0 0 2 0 0 7 N0710E: The work authorized by this permi[ shail comply with all applicable handicap access requirements under Calitomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2C4fi-46IN00) � WORKERS' COMPENSA710N DECLARATION: � I hereby eflirtn untler penalry oi perjury one oi ihe following tleclarations: ❑ I have antl will maintain e certificete of consent b self-Insure tor workers' compensation, es provided tor by section 3700 oi the Labor Cotle, for Ihe peAormance of the work tor whiCh Ihis permit is issuetl. , ❑ I heve end will meintain workere' compensa�ion insurance, as required by section 3700 of Ihe Labor Code, tor the perfortnance of �he work for which Ihis pertnit is issued. My workere' compensatlon Insurence carrier and policy number are: - Carner: Policy Number: (Th/s section need nat be complefed il the permit is veluetl af one hundred dollers ($ f 00) or less.) ,. 81 I certity that in ihe Aormance iha w k for which his p it is issue I shall not employ any person in eny manner so as to become subject to the workers' �� com ansetlon le of Calitor nd e thet ii I s oul come su t b Ihe workers' com enseNon rovisions of Sec{Ion 370 oi the Labor Code, I shall forihwith comply with the e ions //)7 P P P Appllcent Signature: �� r/� � . Dete: �/ f a� � WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL ANO SHALL SU6IECT AN EMPLOVER TO C MINAL NALTIES AND CIVIL FWES UP TOONE HUNDRED THOUSAND DOLLARE ($100,000), IN A�DITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLAHATION: I hereby aflirm that I em force an0 eHect Lic. N ConirectoYs Slgnature:� of Chapter 9(commencing with Section 7000) of Division 3 of ihe Business,ao� P'ofesslons Code, antl my license is in full � cless a L � . � .. Date: �� CONS7RUC710N LENDING AGENCY: ❑ I hereby aflirm ihat Ihere is a consiruction lending agency for the pedormance ol ihe work lor which this pertnit is issuetl. (Sec. 3097, Civil Cotle). Lendefs Name: Lender's Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby aflirtn thet under penalry ot perjury that I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any structure, pnor to its issuance, elso requires ihe applicant tor such pertnit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Lew (Chepter 9(commencing with Section 7000) of Division 3 of the Business and Professlons Gode) or thet he or she is e:empt therefrom and the basis for the allegetl exemptlon. Any violation of Section 7037.5 by any applicant for a pertnit subjects Ihe epplicant to e civil penalry of not more than five hundred dollars ($500).): ❑ I, es owner of Ihe property, or my employees with wages es iheir sole compensatioq WILL DO 7HE WORK, end the stmcture is no� intended or oHeretl for sale (Sec. 7044, Business and Professions Cotle: The Coniractors License Law does not apply to an owner oi property who builds or improves thereon, and who does such work himself or herself or ihrough his or her own employees, provided ihat such improvemems ere not Imendetl or oRered for sale. N, however, �he building or improvement is sold within one year of completion, the owner-builtler will have ihe burden of proving Ihat he or she did not builtl or improve for purposa ol sals.). � ❑ I, as owner of the property, am ERCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (Sea 7044, Business and Protessions Cotla: The contrectors License Law does not apply to an owner of propetly who builtls or Improves thereon, end who contracis for such projed with a coniractor(s) license pursuant to ihe Contrectors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reeson: SignaWre: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Verificetion oi Ownership by (type of document, i.e. - propeny tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I hereby cehity ihat no excavation five (5) or more feat in depth into which a pereon is requi�ed to tlescentl, will be made In connection with work authonzed by this permit, and Ihat no building sirudure, swftolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title B, California Atlminisirative Cotle). , ❑ As owner-builder, I will not employ anyone to do work which would require a permit irom Ihe Division of Indusinal Safery, as noted a6ove, unless such person has e permit to do such work irom Ihe division. Signature: Date: Division of Intlustrial Sefary Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF ENTRY: I cetlity under penalry ot perjury that I have read this epplication and siate that the information given is correct. I egree lo comply with all state laws antl ciry ordinances relating to building construction, and authonze representatives of the Ciry of Costa Mesa to enter upon ihe above-descnbed propetly tor inspection purposes. I agree not to occupy or allow acupancy of any building authorized by Ihis permit until final inspection. 57 tur Ot al w �� /� O� Data / And/Or Authorized Applicant Date COUE I. INSPECTIONTYGE PAIE ��T�p� 1616 Fixed System Final Fire Pravention 1266 Pool Spa Final 200 Finel Re-Roof 201 Final Block/Retaining Wall . 202 Final Factory Fire Place � ' 203 Final Sign 204 Finel Demolition ' ' ' COOE I INSPEC710N TYGE 206 Final Mechanical 208 Final Plum6ing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site ��250 Final�Building/Occupancy �ATE IIRI11 � � (714) 754-5273 • Fau (714) 754-4856 � www.ci.costa-mesa.ca.us 77 FAIR OFiIVE, GOSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Viciniry: Parcel Nunmber: 2717 CIBOLA AV 14164415 ApplicanC WALWORTH, MALCOLM Address: 713 S AGATE ST ANAHEIM, CA Owner: IRENE,WONG Address 2717CIBOLAAVE COSTA MESA, CA Contracmr: M W ENTERPRISES Address: 713 S AGATE ST ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlels Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over t00hp Communicalion drops Sub panel to 200a Pole Light Pkg ANAHEIM, Cq .Phone: 714-240-0071 Zip: 92804 Phone: 949-302-1122 Zip: 92626 Phone: 714-240-4071 Zip: 92804 License: 796697 SCOPE OF PERMIT 76 LIGHTS, 14 OUTLETS, 12 SWITCHES, AND 1 RESD. APPLIANCE $23.50 $0.0p $0.00 $0.00 $0.0p $0.00 $17.6D $15.4D $13.2p $O.OD $4.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 16 14 12 0 1 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 k Standing Section Misc ElecVical 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 Syslem / Ckt Misc. Canduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Olher Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Status: ISSUED Applied: 03/13/2003 Issued: 03/13/2003 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 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $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. 9248, § 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 tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446a6 (NW) WORKERS' COMPENSATION DECLARATION: I hereby ettirm under penalty of perjury one of the following declarations: � ❑ I have and will meintain e certificate of consent to salf-Insure tor workers' compensation, as provided for by section 3700 of the Lebor Cotle, for the peAormance of Ihe work for which this permit is issuetl. ❑ I have antl will maintain workers' compensation insurance, as required by section 3700 of Ihe Lebor Code, for the pedortnance of �he work tor which Ihis partnit is issued. My workers' compensetlon Insurence carrier antl policy numDer ere: Carrier: policy Number: `(This�n need nof be complefed il the permit is velued af one hundred dollers ($100) or less.) � I certify t�et in the pertormanca oi ihe work for which this ermit is is ed, I shall not employ any person in any manner so as to become subiect to the workers' com ensetlon lew oi C ifor en rQe ihat it sh becom b ect to Ihe workers' com ensa[ion rovisions of Sac�io 3700 of Ihe Laboi Code, I shall forthwith Applicent Slg elture:es� on 9�JE �� , P Date: �� I L3 �� WARNING: FAILURE TO $ECURE WORKERS' COMPENSATION COVERAGE IS UNUWFUL AND SHALL SUBJEC� AN EMPLOVER TO CRIMINAL PENALTIE$ AN CIVIL UP TOONE HUNDqED THOUSAND OOLLARE (5100.000), IN NDDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED F-0R IN SECiION 3]O60F THE LABOq CODE, IMEREST, AND ATiORNE1"5 FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn Ihat I am licensetl force and eflect. Lic. A Contractor s Signatwa:� 7000) of Division 3 of ihe Business Class N _ Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirm ihat there is a consiruction lending agency for the pertormance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Cotle). Lender's Neme: Lender's Address: Signature: Data: _ is in full OWNER-BUILDER DECLARATIONS: I hereby aftirm thet untler penalry ot perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business ana Protessions Cotle: Any ciry or county which requires a permit to consiruct, alter, improve, tlemolish, or repair any structure, prior to its issuance, elso requires the applicant for such permit ro file e signed statement thet he or she is licensed pursuent to ihe provisions of the Comrecrors License Law (Chapter 9(commencing wilh Section 7000) of Division 3 of t�e Business end Professions Code) or that he or she is exempt therefrom and the basis tor the allegetl exemption. Any violation of Section 7031.5 by eny applicant for a permit subjecis ihe applicant to e civil penalry of not mora than tive hundretl tlollers ($500).): ❑ I, es owner of the properry, or my employees with wages as their sole compensation, WILL DO THE WORK, antl the sirucNre is not imentlea or oHerad for sale (Sec. 70a4, Business and Professions Cotle: The Contractors License Law does noi apply Io an owner ot property who builtls or improves thereon, antl who does such work himseli or herselt or through his or her own employees, provided that such improvements are not intended or oflered for sala. tl, however, the builtling or improvement is soltl wit�in one year of completion, ihe owner-builder will have the burden ol proving that he or she did not build or improve for purpose ol sale.). � � I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS b construct tha project (SecJ044, Business and Protessions Cotle: The comractors License Law does not apply to an owner of pmperty who builds or improves ihereon, antl who contracis br such project wiih a coniractor(s) licensa pursuent to ihe Coniractors License Laws.). ❑ I am exemp� under seC. Signature: Owner ID veritied by tlrivet's license. ❑ Yes ❑ No Business and Professions Code for ihis reason: Verilicetion ot Ownership by (type of document, i.e. - praperry taz bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICATION: Driver's License No. Date: Eapires: ❑ I hereby cetlify thet no eacavation five (5) or more feet in tlep�h into which e person Is required to descend, will be made in connection with work authorized by ihis permit, end ihet no builtling siructure, scattolding, falsework, or demolition or tlismantling Ihereof, will be more ihan Ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ti�le 8, Celifomia Atlministrative Code). ❑ As owner-builtler, I will no� employ anyone to do work which would require a pertnit from ihe Division of Indusirial Safery, es noted abova, unless such person has a permit to do such wark trom the tlivision. Signature: Date: Division ol Industnal Safety Permit Number: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTfiV: I certity under penalry of perjury that I have read Mis application end state that the information given is correct. I egree Io comply with all stata laws and city ordinances ralating to builtling consimctioq and authorize representatives ot ihe Ciry of Costa Mesa to enter upon �he above-described property tor inspection purposes. I aqrea not to occupy or ellow occupancy of any building authorized by Ihis permit until finel inspec�ion. � i / / /. v��/�� .�'�� , ,.. _ .. - COUE L INSPECTIONTYPE - PATf. INTRIALS 1616 Fised System Final Fire Prevention 1266 Z�I�I Pool Spe Finel Final Re-Roof 201 Final Blak/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition DEA INSPECTONTYPE � 206 Final Mechanical 20B Final Plumbing 210 Final Elecirical 212 final Fire Prevention 220 Final Planning Approval 222 Final Site 250 FinalBuilding/Occupancy •- L PRTE INfiTIALS (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.cBUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2717 CIBOLA AV Suite: Vicinity: INTERIOR REMODEL Parcel Number: 14164415 Applicant: WALWORTH, MALCOLM Address: 713 S AGATE ST ANAHEIM, CA Owner: WONG,IRENE Address 2717 CIBOLA AVE COSTA MESA, CA Contractor: M W ENTERPRISES Address: 713 S AGATE ST ANAHEIM, CA Zip: 92804 Arch : Address: Zoning: R1 R1 Phone: 714-240-4071 Zip: 92804 Phane: 949-302-1122 Zip: 92626 Phone: 714-240-4071 License: 796697 Eng: Address: ISSUED BY: Status: ISSUED Applied: 03/13/2003 Issued: 03/13/2003 Phone: Phone: Zip: License: License: SCOPE OF PERMIT REMOVE WALL IN LIVING ROOM TO OPEN AREA OF KITCHEN, DINING AND KITCHEN AREA. ADD BEAM AT OPENING. REMODEL OF INTERIOR TO INCLUDE ADDITION OF A 3/4 BATHROOM. MISC ELECTRICAL, PLUMBING AND MECHANICAL WORK ALSO. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total $117.81 $181.25 $1.00 $0.00 $0.00 $0.00 $300.06 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existinq: o Rear 0- 0 Rear 0- 0 Re uired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 LeR 0- 0 Propased: 0 Calc Valuation: Claim Valuation Right 0-0 Right 0- 0 sio,000.00 $io,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become voitl 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 Inspectlona and final approval must be obtained. Failure to obtain inspeclions and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2d48�6fi1N00) WORKERS' COMPENSATION DECLARATION: . � I hereby aHirm under penelry of perjury one oi the following declarations: ❑ I have antl wlll malntein a certificate ot consent to sel4lnsure tor workers' compensatlon, as provided tor by section 3700 of Ihe Lebor Cotle, tor Ihe performance of the work tor which Ihis permil is issuetl. ' ' ❑ I have and will maintain workers' compensation insurance, as required by secfion 3700 of the Labor Code, for the peAormance of ihe work tor which this pertnit is issued. My workers' compensatlon Insurance carner and policy number are: Carrier: one orless.) Policy Number: I cartiy that in tha peAormance ol ihe work for which this permit is issued, I shall not employ any person in eny manner so as to become subject to the workere' compensation laws Calitorni � nd ee hat if I slloul coma si 4ct to the workers' compensetion provislons of Secti n 3700 oi the Wbor Cotle, I shall forihwith cOmply with these r�s. Applicant Signeture: i �j oe,a: -�� t� j a� WARNING: FAILURE TO SECUR WORKERS' CAMPENSATION COVERAGE IS UNLAWFUL AND SHPLL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AN� CIVIL FlNES UP TOONE HUNORED TFIOUSAND DOLLARE (§100,000�, IN A�DITION TO THE COST OF COMPENSATION, DAMAGES AS GROVI�E� FOR IN SECTION 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eNirm that I am force and eHect. Lic. e_ Gontractor's Signature: i (commencing with Section 7000) of Division 3 of the Business entl P�e ' ns � d my license is in full �' Cless # �ete: �7 1'3-. A�1 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirtn that there is a constmction lentling agency for Ihe pertormance of ihe work for which ihis peimit is issued. (Sec. 3097, Civil Code). LentleYs Nama: Lentler's Atltlress: SignaNre: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm that under penalty oi peryury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, 8usineu end Professions Code: Any ciry or counry w�ich requires a pertnit to consiruct alter, improve, tlemolis�, or repair any structura, prior to its issuance, also requires the applicant for such pertnit to file e signed statement t�et he or she Is Ilcensetl pursuant to the provisions of the Contractore License Law (Chepter 9(commencing with Section 7000) of Division 3 ot ihe Busineu and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation ot Saction 7031.5 hy any flpplicant tor a permit subjecis ihe applican� to e civil penel�y of noi more than five hundred dollars ($500).): ❑ I, as owner ol Ihe properry, or my employees with wages es iheir sole compensatlon, WILL DO THE WORK, end t�e siructure Is not intended or oHered tor sale (Sec. 7044, Business and Professions Code: The Contraciors License Law dces no� apply lo an owner of property who builtls or improves ihereon, and who dces such work himsetl oi hereelf or through his or her own employees, provided that such improvements ere not intendetl or oHered for sale. 16 howaver, ihe building or improvement is soltl within one yeer of completion, the owner-builder will have ihe burden of proving ihat he or she did not build or improve for purpose of sale.). ' ❑ I, a5 owner of the property, am E%CLUSIVEIV CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Protessions Cotle: The contractors License Lew does not apply to an owner of pmperry who huilds or Impmves ihereon, and who contracts tor such project with a coniredor(s) license pursuant to ihe Coniractors License Laws.). ❑ I am eaempt under sec. Signature: Owner ID verifietl by tlrivers license. ❑ Ves ❑ No Business antl Professions Code for ihis reeson: Verification of Ownership by (type of document, i.e. - property tax bill or daed): Driver's License No. Date: E:pires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cetlity ihat no excavatlon tive (5) or more feet in dep�h into which a person is required to descend, will be made in connection with work authonzetl by Ihis permit, end ihat no builtling s�ructure, scalloltling, talsework, or demolition or tlismantling �hereof, will be more ihan Ihirty-six (36) feet high. (Chap. 32, Grp 2, Ah 2, Sec. 341, Title 8, California Atlminisirative Cotle). ❑ As owner-builder, I will not employ anyone to do work which woultl require e permit from tha Division of Indusiriel Sefety, as notetl above, unless such person has a permi� to do such work irom Ihe division. Signature: Date: Division of Industrial Satery Permit Number: CERTFlCATE OF COMPLIANCE AND AIIT}iORIZA710N OF ENTTiY: I certiry under penalry of perjury thet I have read ihis epplication and state ihat the information given is correct I agree to comply wlth ell state lews and ciry ortlinances relating to huilding constmction, end authorize represen�atives oi ihe Ciry of Costa Mesa to enter upon tha ebove-descnbed properry for inspection purposes. I agree not to occupy or ailow occupancy ot eny building authorized by �his permit until final inspection. i �'�'[',r ��7/��L:= ." . �Q i!� � / .• COOE t. INSPECTIONTYPE 1616 Fi:ed System Final Fire Preveniion 1266 Pool Spa Finel 200 Final Re-Root 207 Finel BIocWRetaining Well 202 Final Fectory Fire Place 203 Final Sign 204 Final Demolition DATE INTITIALS � � � Dat� CODEI INSPECTIONTYPE � 206 Final Mechanical 208 Final Plumbing 210 Finel Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Sita 250 � Final Building/Occupency � �� B��Q COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 977 COSTA MEBA. CALIRORNIA For Applicanf fo Fill In Complefely TYPE OR PRINT ADORe�ss 2717 Cibola Avenue COSTA MESA. CALIFORNIA 3800 East Coast ARCHI7ECT OR ENGINEER M8CC0 Re81tV Co. Macco Realty Co. -SB-1 1 SIZE OR 34220 NO. OP B1D08, eeiawcK uxH nrtor 40 1 REAR YARD 28 � CCMHR OP HiACET SIDE YARD I LEFT S� 6" I RIGHT 5' DESCRIPTION OF WORK NEW I X II ALTERATION I R AOOITION ��1'6"x54'2" RooMs 6 �R WALL SCUCCO ROOF � JG (�. j.]nntl COVERING BUILDING AND WORK TO BE PEI „rp fi�_P�eosTr,iQa *;4�19.00 APPLICATION FOR PERMIT BUILDING For Offlce Use Only RBCHIPT NO. P8`1 �) � I DA � R8C61 /�� I • � Mnc BUILDING ADORH68 COSTA MESA. CAUFORNIA PIRE ZONE APPROVED ZONING ZO NO. OP U86 OP � ; v PLANB � HUILDIlw 6 osecninioH LOt %%� TrBCt A. P. NO. � YARDS EVES APPROVED ALLOW � ICHNT[P LINB 6T.1 p �/'^� lan 400- Livin Area: 1896 S.F. Garage Area: 483 S.F. I HBpHBY AGKNOWLLDOH TM�T I NAVE RBAO TN18 �1P4GTION 1H8 �MOUNT BHOWN lINOBR V�LUATION 19 POP THH AND 9TATH TNAT THH ABOVH IB COPR6CT AND AOR88 TO COM• pUHP08H OP 88T�pL19HIN6 • GBRMIT FHH ONLY. PLY WITN ALL c�rr onum.v�cee ANO @TATH LAW9 fi80ULATINO eU11Dlx0 CON9TRURION. VALUATION � / _ SIGNATIIRE OF PERMIT F8E $ G' PERMITfH Mesa Del Mar Develo ment Co. By: ^ , g ZO�ZHH.00 pLAN CNECK $ �� AUTHORIZED AGENT / , �� -�y`/ .� TOTAL RE8