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Home My WebLink About2917 CLUB HOUSE RD - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: �L'J'17' CLUB HOUSE RD Suite No Viciniry: Parcel Nunmber: 13942103 Applicant JORDAN, RONY ISSUED BV: Address: '17611 WEBSTERST_--�,�.,,/'�/:-� „ . _� . ,_ � � � � � �-�. ��" . = " Phone: (949)552-6289 i :_ �- = IRVINE, CA-, -" � - - _ Zip: 92614 � ; � ; ( ' � /_ i � �/ �`�-,, � . .. f � , \\ : Owner.� �;--LEWIS, R99P}EY A TR � � �� j Address /-2971 CLUB HOl�1SE�RD� �� _- '��!Q� y4� �i , � - . Phone: , � ' COSTA MESA,.CA Zip: 92626-4706 �; , � Contracror: � BUIL'T ON THE ROCK CONSTRUCTION ' � Address: r'17611-WEBSTER ST - • _. � �, � ' � . , . . , .� ��_Phooe: (949)5526289�',, ' " ' -IRVINE; CA ' - , � � Zip: 92614 •� . �� _ , ' �--= �� License: 528944 Status: ISSUED Applied: 11/19/2002 Issued: 11/19/2002 pAy�+r.�_ � �v`. :� � '� � ,�:. �> . � ` `.A � � . .. ,i � � ` i �., `, ��;A� ��/i� , �i�� . . ,. ``, .� ' -; ` _ �, �' V � � _ _` . ` , ' � - .- SCOPE OF. PERMIT � •-• o-r;,-.� '� 1 % " • � 1 � � �/ � ELEC PERMIT FOR 7 EXTERIOR RECESSED LIGHTS IN�CONJUNQTION�WITH;REPAIRS TO ROOF��EAVES ' ,� � � � .. & NEW FACIA 80ARD;�PARTIAL REROOF TO AN EXISTING SFD. �� - - ' - -� - � i . . ' REF: 802-01894 � -' ' � ; .. . - . ''� . . . . � �7 , � � _ l i - . �' , , , � ' , .. . ,- � ��. - ,, ., . _ - , , , . � �,A . � . .��'1`i :._ , ri i _-� ,' i � �� -��.:. � � FEESUMMARY �' y'=. � ��,�, � ; `, ' Quantiry � Quantity,' % !�' - �'. , ISSUE FEE „ A�� ` $23.50 � Temp Dist�System / Lighting � �-� $0.00 0;� �' � � -� � Teinp service test �.� $0.00 Busway /700 ft' � .. �$0.00 , 0, � � � � � ,',' � Res>a/cpackage. . $0.00 �; StandingSection $0.00 ,- 0"�� . � . NewRes,(1-2units).; , $0.00 0 w�; �Misc.ElectricalEquipment '$0.00 ��„�0 ,,'., New Res (3.units) $0.00 0 �:f--- . Transfortners up to 1 kva/kw $0.00;,- '- 0 � � ...,,. , � " ; Pool / Spa �� ` �� `�$0.00 0 - ... ..'.up to'��0 kva/kw $0.00�� 0 i -';� � Lighting Fixts� , • , �-$7.70, �, __;, 7t - � - " Recept Outlets: `. . � $0.00 � 0 � • ' " Switches �� ;'�$0.00'� � 0 - Non Res Appl .`\ ,/ = $0,00 . �'D_ . . Res Appl � . '�' $0.00; -. �' . 0= "�.-. Service to 200a ��, � $0.00 � _. 0 � ' . , Servlce to 7000a �� ' � , $0.00 0 � Service over t000a ' $0.00 . � 0 Motors to 1hp ��, $0.00, � " „`0 ' ' - Motors to 10hp � $0.00�- 0 � � . ' Motors to 50hp $0.00 ; 0 , Motors to 100hp $0.00 � - � 0 Motars over 100hp $0.00 b� -. � -- Communication drops $0.00 0 �� - Sub panel to 200a $0.00 0 � ........:.up to 50 kva/kw,>,+`� �; � $0.00 � 0! - " -, .....�......:..up"to 100�kva/kw-� . �$0.00 0� ' %; �j�� .. ..over 100 kva/kw �� $0.00�� 0 �- ' � Low,�oltage Equipme�t � � � � $0.00��<%; d % � �� - Low,Volt Wiring System / CkC� $0.00 ;`, �� 0 � �� MiSaConduit , �-$0�.00',� 0'�i� Misc: Conductor � � $0:00 ,' 0 /� Circus ( gen or ride). �, ,�„$0.00� -. i 0� -Circus (rtSech rid'e oi,lights) ' " $0.00'� % 0 � Christmas Tree Stand' � � "$0.00'� 0 �FireworksStand ' -;,��'�..$0.00 0 � OtherElecidcal Fee,�� ' � " $0.00 .Investigation Fee $0.00 Plan Check Fee $0.00 CE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related lions. (Ord. No. 9248, § 7, 1241-92) ATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned riiod of 180 days. �- :TIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all i Inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. iPECTIONS CALL: (714) 7545626 ro� WORKERS'COMPENSAnON DECLARAnON: — — I hereby aHirm untlar panalry of perjury one oi �he following tleclarations: ❑ I heve antl wlll maintein e cenificate of consent to selt-Insure for workers' compensetlon, es provided for by section 3700 of ihe Lebor Cotle, for the pertormance oi the work for which this pertni� is issuetl. � I have and will mai tain Wo pe anon insurence, as required by section 3700 of ihe Labor Code, for tha pertormance oi the work for which ihis permit Is issued. My work sation ance mer antl policy number ere: I ,f�,.�,/�/�� Carner: �m� �� PolicyNumher _�tX(/11(J'i'T (This sectlon need not be completeU il the permif Is valued at one huntlred tlollers ($700) or less.) ' ❑ I cenity that in t pe rmence of the work for whicl7I'�his pertnit is issuetl, I shall not employ eny pereon in any manner so as to become subjea to the workers' compensetion I ws o CaIRo Aa, antl e9ree at it I I�ould hecome sub�ect to tha workers' compensetlon provisions of Section 3700 of the Lebor Code, I shall forthwith cnmply with th se vi5io �. p7 Applicam Signeture: � Date: f/ /�/ /i�OL WARNING: FAIWRE TO SECURE RKERS' CqAPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO C I INAL P NALTIES AN� CIVIL FlNES UP TOONE HUNDRED TIqUSANDDOLLARE(5100.000), ADDITIONTOTHECOSTOFCAMPENSATION,DAMAGESASPROVIDEOWRINSECTION3]O60FTHELABORCOOE,IIJrEREST,ANDATTORNEI"SFEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm that I am Ilcen undef,p vi 'ons of Chapter 9( ommencing with Section 7000) oi Division 3 of ihe Business d Professions Code, entl my license Is in full force and ettecL Llc. W �l Cless q Conlrector's Signa�ure: Date: CONSTRUC710N LENDING AGE V: ❑ I hereby attirm ihat t�ere �s a construcNon lending agency for ihe pertormance ot the work for which Ihis permil is issued. (Sec. 3097, Civil Cotle). Lentler's Name: Lender's Adtlress: SignaNre: Date: OWNER-BUILDER DECLARATONS: I hereby aHirtn ihat under penalry of perjury thet I am EXEMPT PROM THE CON7RACTORS LICENSE �AW for the following reason (Sec. 7031.5, Business end Professlons Cotle: Any ciry or county which�requves a permit to construct, alter, improva, demolish, or repair any sWcture, pria to its issuance, elso requires the appiicant 1or such permit to file a signed stetement itiet he o,she��is licensetl pursuent b lhe provisions of the Contractors License Lew (Chepter 9(commencing with Sectlon 7000) ot Division 3 oi the Business end Pmfessions Code)�or ihat�he or she is exempt therefrom and the basis tor the alleged eaemption. Any violation of Section 7031.5 by any applicaN for e pertnit su6jects Ihe applicent to e civil pe'nelry of rioPmore �tfie�.five hundred dollars ($500).): �t .i:. ❑ I, es owner of the propeRy, or my employees,with wages es Iheir sole compensation, WILL DO TME WORK, and the siruc�ure is not intended or oHeretl for sale (Sec. 7044, Business antl Professions Code: The Coritractors License Law tloes not apply to an owner of propeny who builds oi improves Ihareon, and who does such work himself or herself or through his or her own employees, provitled that such improvements are not intendad or oNered for sale. If, however, ihe building or improvement is soltl within one yeer of completion, �he ownei,-builder will have Ihe burden of proving that he or she did not build or imp�ove for purpose of sale.). � ❑ I, as owner of tha properly, am E%CLUSIVELV CONTRAC7ING WITH LICENSED CONTBACTORS to consiruct the project (Sec. 7044, Business and Professions Cotle: The conirectors Ucense Law tloes not epply to an owner of property who builds or Improves Ihareon, end who contrects tor suc� project with a comrector(s) license pursuant m the Contractors License Laws.). ❑ I am exempt under sec. Business end Professions Code for this reason: Signeture: Date: Owner ID verifietl by tlnvers Ilcense. ❑ Ves ❑ No Drivefs License No. E:pires: Vedfication of Ownership by (type of tlocument, i.e. - pmperty tax bill or daetl): DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION: ❑ I hereby ceriity Ihat no eXcavetion tive (5) or mora teet in tlepth into which e person is requlred to descend, will be matle In connec�ion with work euthorized by this permit, and ihat no building structure, scaHolding, talsework, or demolition or tlismantling Ihereof, will be more �han thirty-sia (36) fae� high. (Chep. 32, Grp 2, Ah 2, Sec. 341, Ttle B, Califomie Adminis�retive Cotle). ❑ As owner-builtler, I will not employ anyone to tlo work which woultl require a permit fmm fhe Division ot Indusirial Safety, as notetl ebove, unless such person has a parmit to do such work t(om Ihe tlivision. Signature: Division ot Industnal Satery Pe�it Number: Date: :ARDOUS MA7ERIALS AND EMISSIONS CERTIFICATON: Will ihe epplicant or pres nt or future builtling occupant naed to fila entl certity a 8usiness Plan tor emergency response to release or threatened release of a hazerdous ma�enel7 ❑ Yes � No (Section 25505 of Ihe Califomie Health antl Safety Code requi�es, with some exceptions, that a Business Plan be filad with ihe Costa Mesa Flre Depariment by every business which has et any one time dunng a reported year a quantity oi hazardous metenals equal ro or greater ihan a weight of 500 pounds, or a volume of 55 gallons, uoes or win Ine eppiicam or presem or nmre ounaing wcupam neea m nie a regisiratlon torm for acutely hazertlous matenals? LJ ves �,J No (Section 25533 of Ihe Cali�omia Health antl Safery Cotle, with some axceD�ions, requlras ragisiretlon with the Costa Mese Fire Department by each buslness which at eny one lime hes on hantl e quantiry of ecutety hazartlous materials equal to or greater ihan a weight ot 500 pountls, or a volume oi 55 gallons, or 200 cu61c feet of compreued gas at stantlard temperaNre and pressure). ......................................................_................................................................................................................................................:..................................................................................................................................................................... Does or wlll the epplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? (Sectlon 25534 of the Califomie Health and Safery Cotle pmvides that the Costa Mesa Fire Depanment may requii Department ot en RMPP by Dusineues which are required to register acutely hazardous matenels with the Fire Dep�� .................................................................................................................................................................................................................................................................... 4 If an RMPP is presently required, has Section 25534 of the Califomia Health end Safety Cotle been fully complietl wi .................................................................................................................................................................................................................................................................... 5 Does or will ihe applicant or present or future builtling wcupant requlre tor the work which is the subject ot this a F � from the South Coast Air Qualiry Manegement District or from eny other air pollution control disirict or egency7 �' (Saction 658502 of the California Government Code requlres thet t�e requested information be tumished on applica' ..................................................................................................................................................................................................................................................................... 8 Wiil any pan of the facility to be cons[ructetl under ihis permit 6e wifhin 10001eet irom the outer poundanes ot a sch� Qf'j�es", ihe faciliry must rtiee� ihe requirement oF Sedions 25534 and 42303 of ihe Califomia Health and Safery Cotl ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 7 tl a permit from the South Coest Air Dueliry Menegement District or other aIr pollution control distnct or agency epplication, have ell of Ihe tlisclasures prescnbetl by Callfomia Healih and SafeN Cotla Section 42303 been matle? the preparetion, certificatlon and filing with ihe Fire ment. ............................................................................................................... 1 ❑ Yes ❑ No .............................................................................................................. ation a pertnit tor such construction or modification s LJ No ns for nomresidential building pertnits). � B Qf yes", anach certificafe o� compliance from ihe eppropriate air polWtion contml otticer). CERTIFICATE OF COMPLIANCE: I certify that under penelry o� perjury the ialo�metioa given above Is coaect. I agree to comply with all state laws antl ciry o�dinancee regarding Hazardous Mate�ials antl Emissions. SignaNre: Date: CERTFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTAY: I certify under penalty of perjury Ihat I have read ihis epplication and state that ihe infortnetion given correct I agree to comply with all stete laws entl ciry ordinences releting to building consiruction, antl authonze rapresentatives ot ihe Ciry of Coste Mesa to enter upon I ebove-descrj68C�propery fo( inspection purp�ses. I§(ree nol lo accupy or allow occupancy of eny building authonzetl by �his permit until tinal inspec�ion. cooe r. 1616 Fl:etl Syslem Flnal Fira Pravention 1266 Pool Spa Final 200 Final Re-Roof 201 Finel Black/Reteining Weil 202 Final Factory Fire PIaGe 203 Final Sign 204 Final Damolition Pdg LIZQTJ�$ �1 INSPECTIONTYPE ta 206 Final Mechanical 20B Final Plumbing 210 Final ElecVical 212 Final Fire Preventlon 220 Final Planning Approval 222 FinalSite 250 Final Builtling/Occupancy IL11iG1111 August 12, 2005 CITY OF COSTA MESA P O. 80% 1200 - 77 FAIR DRIVE • CALIFORNIF 02628-1200 DEVELOPMENTSERVICES DEPARTMENI BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION Mark E Lewis Trust 2917 Club House Rd Costa Mesa CA 92626-4706 PERMIT NUMBERS: FOR: PROJECT ADDRESS: B02-01894 Repairs 2917 Club House Rd., Costa Mesa Our records indicate the above listed permits were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of your last inspection for the project and additional fees will be required to finalize expired permits. According to our records, the permits listed above have not had an inspection for a period exceeding 180 days. If you have a signed inspection card indicating an inspection was conducted within 180 days from the date of this letter, please contact this office so we may correct our records. If you need to request an inspection please call our Inspection Request Line at 714-754-5626. If you wish to request an extension, requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of compfetion. If you do not have an approved final inspection, your permits will expire on August 26, 2005. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The accuracy of records affecting your property is our goal and we appreciate your working with us to resolve lhis matter. Sincerely, � ��r'�� U � . i � l' �� ,�� Mary�Jane Weidenkeller Office Specialist II cc: Built On The Rock Construction -� 17611 Webster St Irvine CA 92614 Building Division (714) 754-5273 • Code Enforcemem (�14) 754-Sfi23 • Planning Division (714) 754-5245 FAXf7141754-4856 • TDDl7141754-5244 • �wra.ci.cosia-mesa.Ca.us r � ♦ (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 �ob Address: �T/ CLUB HOUSE RD Suite: Vicinity: Parcel Number: 13942103 Zoning: R1 R1 Appiicant: JORDAN, RONY ISSUED BY: Address: 17611 WEBSTERST _ ",., .-� `"- � - �. ' , .. � �', . -�. ". Phone: (949)552-6289 `. �. � IRVWE CA�'/��; _- - ��.� . Zip: 92614 � -� , /.V'��' � . � i , _ \ `. Owner. LEWIS;',F�6BAl�YA-TR, �� ' Address !2911�CLUB.HOUSERD'� " - _ - -. _� ` ��' =�� ,� ' �� / , . -/ . �; . � Phone: _ � � ��, COSTA MESA, CA -- Zi : 92626-4706 � � � � , , . , P ,�� _ � Contractor. �BUILT,ON'THE ROCK CONSTRUCTION .' Address: 17611lWEBSTER ST - - . �� I . , " Phone: (949)552-6289 . " . IRVINE; CA . Status: ISSUED Applied: 11/19/2002 Issued: 11/19/2002 ,�,� � . i , � r �� ,'. . �.' _. :, ; `,� . -- Zip: 92614 . License:' 528944 . - � � , ..;�,\. ��, Arch� : . �,% � Eng: ' , . �` � , Address: - � ' � �, � _ . Address. � . �� . � . � �, . . : � � �� -� Phone:� . , '� .�� ._ . ,�� . , _ �..i/ Phone: t . �,�� .; � ' � ,i '��,, - -,� � � : _ � � _ . . �, .'". , , . `ZIp: ' , ', � � License: �� -� `License: ,. � i��; � i� . . � ,. _ _ � . . / ." /'�`':-,", _-}� �r�� SCOPE OF�PERMIT,- r,.- ; ��,� '�' � FRAMING REPAIRS TO ROOF EAVES & NEW FACIA BOARD`IN CONJUNQTION'_WITH A'PARTIAL�REROOF TO AN EXISTING SFD.,WORK TO ' AL50 INCLUDE REPAIRS TO THE DRYWALL IN�BACK OF A WASHER/DRYER IN THE GARAGE�. 2400 SQ OF ROOF (T/O OF.SHAKE, 1/2" CDX, � 1 LAYER 30# FELT, APPLY , =( , . � �,i ! , "40-YAR ASPHALT SHINGLES). � � ��' , � j �� r �' �' ' �� . �.i � ,- -� ' i, . , . . _ .. -. . _,� ti ,�''�%_��.d!: -- .-� � , i - cti r— - , FEE,SUMMARY i� _ : /; � , . , �PlanCheck:'�� $0.00 ,% . CalcValuation: ;�,'� ,�� ,_'S�,000�oo Permit: � $139.25 ClaimValuation:`�'; S�,000.00 �,��SMIP�Res:. ��;$0.70 � - � '/ SMIP�Com: � ��$0;00 ' ` �'r ., � ,- � i �` Other. � �$0.00 � ,.�>'� i ;� � � , � � Inspection: $0.00� � ''' - ! � % �` ' �� - � �� t - � , " .� ' - �� %�' i� Total $139 95�� " ' % ' � � `� �:". - ; � Cr"� � ' ` � -�- '%:' %�`1j , �, �� " � PLANNING & ZONING - � '' ' ; . SETBACKS � � � � " " ��_'. � V`` : , 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 �ARKING Existinq: 0 Required: - 0. Pr000sed:-�%0 . he work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related �Jrd. No. 9248, § 7, 12-21-92) � This permil shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned 180 days. : In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all ctiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. )NS CALL: (774) 754-5626 WORKERS' COMPENSATON PECLARA710N: � - I herehy effirtn under penalry of perjury one of the following decleretions: . � ❑ I have and will maintain e Gertificate of consent to selbinsure for workers' compensation, es provitled Por by section 3700 of the Lebor Cotle, for iha pertormance oi ihe work for whlch thi5 pefmit 15155uetl. � I heve and will maintain wolkers' compensation insurance, as required by section 3700 of Ihe Lebor Cade, For the pertortnance of the work tor whlch this pertnit Is issued. M wo ansano sur nce wrrier and olic number ere: %�J�r/', CerrierY � � ' P Y PolicyNumber: J(��U"7 `-/� (Th/s section need not be cromplB�ed l� fhe permil ls valuetl al one hundred dollers ($100) or less.) ❑ I certify �hat in ihe p mance of ihe work for v}hich t�is permit is issued, I shall not employ eny person in any manner so as to become subject to �he workers' compensation law oi alitomie nd egree ih Plf I s 4oultl become subject to the workers' compensation provisions of Sac lon 3700 of the Labor Code, I shall forthwith comply with thes pro sions. /a1 / Applicant Signeture: Dete: �� I / / � WAFNINO: FAILURE TO SECUHE W ERS' COfdPENSAT�ON fAVERAGE IS UNLAWFUL AND SMALL SUBJECT AN EMPLOVER TO CRIMI AL PE LTIES AND GVIL FINES UP TO pJE HUNDRE� TFIOUSAND OOLI.ARE (5100,000), IN UTION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDEO FOR IN SECTION 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 here6y affirm ihat I am li �ys n r a iisions of Chapter larce and ettacL Lia # �� Contraaor's SlgnaNre: with Section 7000) oi Division 3 of lhe Busines d Professions Code, and my license Is In tull Class a � i ___.. Date: � � /IA� CONS7RUCT10N LENDING AGENCu ❑ I hereby aHirm Ihet ihere is a consiruction lentling agency for the peAormance oi the work for which Ihis permit is issued. (Sec. 3097, Civil Cotle). Lentlefs Neme: Lender's Atltlress: Signature: Dete: OWNER-BUILDER DECIARATIONS: I hereby eflirtn theGu'ntler.penelry of perjury ihat 1 am EXEMVT FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (SecJ031.5, Business antl Professions Cotle: Any ciry or�counry,which�raquires e permit to construc�, alter, improve, tlemolish, or repai� eny stmcture, pnor to its issuance, elso requires Iha epplicant tor such pertnit to flle e signed steterrmentithePhe,ortstie is'llcensed pursuant to the provlsions of the Conbactors License Law (Chapter 9(commendng with Section 7000) of Divislon 3 of ihe Business anC Professions CBde)ror thet Fie or'sFe is exempl thereiram end ihe basis for the elle9ed exemption. Any violation of Section 7031.5 by any applicant for e pertnil subjecis ihe applicant to a civil penalry o� notmore ihan five hundred tlollare ($500).): ❑ I, es owner of the properly, or my employaes with wages as thelr sole compensatlon, WILL DO THE WORK, end Ihe siructure is not intended or oHered tor sale (Sec. 7044, Business and Protessions Code:iTha Coniractors License Law does not apply Io an owner of property who builds or improves thereon, end who does such work himsetl or heiseif or through his or hei own employees, provided thet such improvemenis ere not Intended or oHered for sale. If, however, tha building or improvement is sold within one year of comPletion, ihe owner-builtler will have ihe burden oi proving Ihat he or she ditl not build or improve for purpose of sale.). � ❑ I, as owner of the property, am EXCLUSIVELY CON7RACTING WITH LICENSED CONTRACTORS to consirucl tha project (Sec. 7044, eusiness and Protessions Code: The contrectors License Lew tloes not epply to an owner ot praperty who builds or Improves thereon, end who contracts for such project with a cornraaoQs) license pursuant to ihe Cootractors License Laws.). ❑ I am exempt under sec. Business end Protessions Cotle for this reason: Signature: Oate: Owner ID ventletl by driver's license. ❑ Ves ❑ No Drivers License No. Eapires: Vedfication of Ownership by (rype oi document, i.e. - property ta: bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIi CERTIFICATION: ❑ I hereby certify ihat no exca�etion five (5) or more feet in depth into which e person is required to descend, will be made in connection wllh work authonzed by lhis permit, and that no builtling siructure, scattoltling, faisework, or demolition or tlismantling thereof, will be more ihan thirry-six (38) fee� high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, California Atlm�nisirative Code). � As ownerbuiltler, I will not employ enyone to do work which woultl require e permit tram the Oivision ot Industnal Safety, as notetl e6ove, unless such person has e permit to do such work frort� �he division. Signature: Data: Division of Intlustnel Safety Pertnit Number: MAZARDOUS MATERIALS AN� EMISSIONS CERTFICATION: 1 WIII the epplicant or present or tuture building occupent neetl to file and certify a Business Plan for emergency respo�se to release or ihreatenad releese ot e hazertlous meterlell ❑ Ves ❑ No (Section 25505 of Ihe Califomia Health and Safety Cotle requlres, with some exceptions, that e Business Plan be flled with Ihe Coste Mesa Fire Department 6y every busineu which has at any one time tluring a reported year a quantiiy of hazardous matenals equal to or greater �hen a weight of 500 pounds, or a volume ot 55 gallons, or 200 cubic feet of compressed gas at standard temperaWre and pressure). ....................................................................................................................................................................................................................................................................................................................................................................................... 2 Does or will the applicant or piesent or future building occupant need b tile a registretion form for acutely hazardous materials7 ❑ Ves ❑ No (Section 25533 of ihe Calitornla Health and Safety Cotle, with some eaceptions, requires registretion wIN the CaSta Mesa Fire Deparimenl by each business which el any one time has on hand a qUentlry of acutely hazardous meterials equal to or greater ihen e weight of 500 pounds, or a volume of 55 gellons, or 200 cubic teet a� compressetl ges at stantlard lemperature and pressure). .................................................................................................................................................................................................................................................................. 3 Does or will Ihe aGplicant or present or future builtling occupant need to prepare an RMPP (Risk Management and P ❑ Yes ❑ No (Section 25534 of tha Califomia Healih and Setety Code provides Ihat Ihe Costa Mesa Fire Departmen� may requii Depertment of an RMPP 6y puslnesses whlch ere requiretl to register acutely hezardous me[erials with the Fire Dep� ................................................................................................................................................................................................................................................................... 4 If en RMPP is presently required, has Section 25534 of the Califomia Heelih and Satety Code been fully complietl wi ................................................................................................................................................................................................................................................................... 5 Does or wlll Ihe applicant or present or future 6uildinq acupant requlre for ihe work which is the subJect oi ihis a,pp irom the South Coest Air Quality Manegement Distnct or from eny other air polWtion control disMct or egency7 LJ' (Section 658502 ot the Califomia Govemment Code requires that the requested informetion be furnishetl on applica� ..................................... . ................................................................................................................................................................................................... 6 W ill any part of Ihe taciliry to ba consWcted under this permlt be within 1000 feet from the outer bountlaries of a schi (If'yes", lhe facility must medt Ihe requirement oi Sections 25534 and 42303 of Ihe Califomia Healih antl Safery Cotl .............._..............................................................................................................................................................................................................................,.................... 7 If a pertnit from the Soulh Caast Air Qualiry Menagement Distnct or other eir polWtion comrol tlistrict or egency appliwtlon, heve all of Ihe disclosures prescnbetl 6y Calitomla Health antl Safery Cotle Section 42303 baen matle7 the preparation, certification end tiling with the Fi ment. ......................................................................................................... 7 ❑ Yes ❑ No ....................................................................................................... ation a permit for such constmction or modifice s LJ Na ns for non-residentiel building parmils). ............................................................................................ ....... 17 ❑ Yes ❑ No No 8 Qf'j�es", ettach certificate of complianca trom the epproPnate air pollution control oMicer). CERTIFICATE OF COMPLIANCE: I cetlity that under penalry oi perjury iha intormation given ebove is correcL I egree to comply with all state laws and city ordi regarding Hazardou5 Materials antl Emissions. Signeture: Dete: CERTIFICATE OF COMPLIANCE 4ND AUTHORIZATON OF EMRY: I certity under penalty ot perjury that 1 have read Ihis epplicalion end state that the infortnatio� carrect. I agree to comply with all state laws and c'ty ortll�ances relating to builtling construction, and authodze representativas ot tha Ciry of Costa Mese to eMei ahove-�eSCSibed property for inspection purposes�agree not to occupy or ailow occupency of any building authorized by this permit until tinal inspaction. CODE �. INSPECTIOIITYVE Q� 7616 Fixetl System Final Fire P�evention 1266 200 201 202 203 266 Pool Spe Final Final Re-Root Final BIocWRetaining Wdll Final Factory Fire Place Final Slgn Final Demolition INTRIALS CODEI INSPEMIONTYPE . 206 Final Mechanical 20B Final Plum�ing 210 Final Elecirical 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy August 12, 2�05 CI'I'Y OF COSTA MESA F.O BO% 1200 • 77 FFIR DRNE • CALI'rORNIA D2628-1200 DEVELOPMENTSERVICES DEPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION Mark E Lewis Trust 2917 Club House Rd Costa Mesa CA 92626-4706 PERMIT NUMBERS: B02-01894 FOR: Repairs PROJECT ADDRESS: 2917 Club House Rd., Costa Mesa Our records indicate the above listed permits were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of your last inspection for the project and additional fees will be required to finalize expired permits. According to our records, the permits listed above have not had an inspection for a period exceeding 180 days. If you have a signed inspection card indicating an inspection was -- conducted within 180 days from the date of this letter, please contact this ofFice so we may correct our records. If you need to request an inspection please call our Inspection Request Line at 714-754-5626. If you wish to request an extension, requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of completion. If you do not have an approved final inspection, your permits will expire on August 26, 2005. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The accuracy of records affecting your property is our goal and we appreciate your working wilh us,to resolve this matter. Sincerely, �V�� . �� , �� =`�. �'-� � Mary Jane Weide�keller Office Specialist II cc: Built On The Rock Construction 17611 Webster St Irvine CA 92614 Building DiviSion (714) 754-5273 • Code Enforcemeni (7�4) 75G-5623 • Planning �ivi5ion (714) 7545245 FAX f714) 75a-i856 • TDD (714175a-5244 • wwa,ci.msta-mesa.ca.us �OWNER STROCK� J. D. � DATE 6-3-63 . � JOB ADDRESS 2917 C1Ub HOUSE Rd. BUILDING PERMIT N0. 19757 - GEN�RAL CONTRACTOR Santa Ana Tent & Awning VALUE $ �75.00 r AP No. LOT 23 TRACT �+3�11 FIRE 'LONE UESCRIPTION OF NORK A1umCanQpy_ _ INSPECTIONS TYPE SUBCONT1i.ACPOR 10757 . �� s�5� �tCOSTA MESA BUILDING-SAFEfY DEPARTMENT P.O. BO%91] C08TA MEBA� CALIFORNIA For Applican► ►o Fill In Complately TYPE OR PRINT COSTA MESA. CALI � MAIL c�Tr ��uT�'-F`NF]' .'. LIG. NO. ``� �(� ]j �'"r NO. f\ I S� O�-F 9 I SIZE � 1� � �� No.ope�oae. OF LOT �O -U NOW ON LOT USE OF EXISTING BLDO. BETBACK LINC FROM ( � 1 ' � I cErvTEa oF BTaEei - p REAR YARD i n 1 �1 SIDEYARDI LEF7' � I RIGHT' -0 ' ' DESCRIPTION OF WORK BUILDING � ��' 1��NO.OF SIZE � ' ROOMS EXTERIOR WALL I ROOF GOVERING GOVE �U56 OF BUIL�INC AND WORK TO B � HEREBY ACKNOWLEDaH THAT I HAVE PEAO TXIB APPL�GTION ANO 9TATE THAT THfi BOV6 IG CORHECT AND AOREE TO COM- PLY WITH ALL CITY O INANCHe ANG BTATB L�W9 p8Gi1LATING B W LDI NG CONSTqUCTI SIGNATURE OF � PERMITTE AUTHORIZEDAGENT j .. �. yy.�) Ri__� FE RECE�IUED dO N 3 19631 fNANCE DEPT. - APPLICATION �7R'v�n�tOSTA MESA BUILDING For ONice Use On1y RCClIPT NO. I P[RM�T NO. ZONING �8 / NO. OF UeE OF NI /'/ Fl..�N! y BUILOINO l �°�o,.�,�� L � � �- 3 � NOTE: NO EAV E OV ERHANG SHALL BE LE6S THAN 90" TO SIDE @ REAR P. L. EAVES : ALLOWED �U.B.C.REQUIREMENT'. YARDSAPPROVED YARDSAPPROVED - MAIN BUI��ING ACGE650RYBUILDING (FROMC/LBTREETI , F � VAR. # BET. MAIN @ AGCE55. BLI DATE �1�-`�/'�//'1T/64.��1.(/�Ci '%t/ ✓.�f�--YJ m THE AMOUNT SHOWN UNOEfl VALUATION 19 FOR THE ��', PUHPOSE OR 6BTABLIBXINO A PEFMIT PEE ONLY. 0 VALUATION �� ' � m 0`Y pERMITFEE $ � � � � m S ,� PLAN CHECK $- p Y � oG c � TOTALFEE � g �� szs2 ; <�, CO�fA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 9f7 COBTA MEBA. CALIFORNIA For Applieanf fo Fill In Complefely TYPE OR PRINT BUILDING/1 /: ,^7 � .. � / I _ ✓1 MESA. CALIFORNIA 8 MAIL , 6ETBACK LIN6 FROM .� n l NO. OF BLDa6. NOW ON LOT OF WORK I B,�v DING /��O e�ne�i� BUILDING �'^V�i�-fi�QI�YD67� �4�y� itAAdt9�:5� APPLICATION FOR PERM17 Bui`uiN� For Offiee Use Only RECEIPi NO. �AI)�pi� BY COSTA MESA. CALIFORNIA 20NE� � I NO.OF �I �158 OF N PLANB BUILDING LEDAL � _ „ ' �-y„ YARDS APPROVED � (CeNTCR LINC 8TJ �.(�f � �v � ur i�+ �� 1 HEREBY ACKNOWLEOGE THAT I XAVE READ THI9 MPLICATION ANO 8TATE THAT THE A60VE IS GOHREGT ANO AGREE TO COM- PLY WITH ALL CITY ORDIfiANCEe ANO BTATE�LAWB REGULATING Bl11LDIN0 CON6TRIlCTiOM. / / " _ _ ��^ SIGNATURE OF �' � /� ■ AUTHORIZED AGENT p — /SS � �� — 5�.�`/" � THE AMOUNT BHOWN lIN R VALUATION IB FOP THE PIIRP09E OF, E9TABLIBHINp A PERMIT FEE ONLY. VALUATION J � I. PERMI7 FEE $ Vi % ` N $/� �✓ / PLAN CHECK � 3j 5 n F C TOTAL FEE /� LL