HomeMy WebLinkAbout3177 COLLEGE AVE - Building Permits��ia� �sa-s2�a • Fax (714) 754-4056 • www.ci.costa-mesa. BUILDING PERMIT
Job Address: 3177 COLLEGE AV
Suite:
Vicinity: GARAGE WAI.L
Parcel Number: 41814521
Applicant: RAMIREZ, VICTOR
Address: 961 W 76TH ST
UNIT D
C.M. CA
Owner: HUEBNER, EVELYN S TR
Address 3177 COLLEGE AVE
Zoning: R2 R2
Phone: 949-548-9969
Zip: 92626
Phone:
COSTA MESA, CA ' Zip: 92626-2641
Convactor: PACIFIC COAST WEATHERPROOFING
Address: 981 W 18TH ST
UNIT D Phone: 949-548-9969
C.M. CA
Zip: 92626 License: 699611
Arch :
Address:
Phone:
Eng:
Address:
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Status: ISSUED
Applied: 06/15/2004
Issued: 06/15/2004
Phone:
Zip: License: License:
SCOPE OF PERMIT
REPAIR GARAGE WALL DUE TO VEHICLE DAMAGE. SCOPE OF WORK TO INCLUDE: MINOR FRAM�NG, DRYWALL, LATH AND PLASTER.
Plan Check: $0.00
Permit: $69.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $69.75
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEESUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Righl 0- 0
$z,000.00
S2,000.00
NOTICE: The work authorized by this permit shatl comply with all applicable handicap access requiremenis under Calitornia 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
tor 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 inspeetions 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
2446�46 (6/W )
WORKERS'COMPENSAnON DECLARATON:
1 hereby ettirtn under penalry af perjury one of the lollowing declaretions:
❑ I hava anC will maintain a cetlificate of conseN to self-Insure Por workers' com0ensetion, es provitle0 tor by section 3700 of the LeDor Code, br the peAortnence of the
work for which this permi� Is a5uetl.
Y ve flntl will maJp� orkers' Gompe i'nSUrence, as reQu' by section 3�00 of Ne Lalwr Code, For Ne perfortnance ot the woM br which Nis pertnit is issued.
M workers' coeTptl a o ns�cp carner a oli number
Carrier. [ VL , Policy Number.
(This section need no( be completetl il the permiNs valued et one huntlretl tlallars (5100) or less.) ���
❑ I certify Ihat in Ihe pertortnance of the work tor wl'c lhis pertnit is issued, I shall not employ any person in any manner so as to becoma subject to the workers'
wmpensation laws oi Celi orn egree H ou ecome subject to the workers' compensation provisions of Sectlon 3700 of Ihe Lebor Code, I shall torthwith
comply with these provisi � _' _ l /��
Applicant Signature: Date: «
WARNING: FAILURE TO $ECURE W (ERS' COMP GE IS IINIAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSAND DOLURE (E100,000). IN FODITION TO TME COST OF COMPENSATION, OMMGES AS PROVIDEO WR IN SECTION 3]O60F THE UBOR CODE. IMEREST, AND AT70RNEVS FEES.
LICENSEDCONTRAC70R5
I hereby eflirm ihat I em Iicen:
torce antl eflect l.ic. q
Contrectofs SiqnaWre: _
CONSTAUCTION LENDING AGENCY:
wilh Section 7000) of Division 3 of the Business entl Prolessions Code, enA my license is in tull
Cless #
Date: � n � � L /. /l�
❑ I hereby aHirm Ihat thera is e construction lending agency for Ihe pedormance of the work for which ihis permit is issued. (Sec. 3097, Civil Cotle).
Lenders Name: Lentler's Atltlress:
SignaWre:
Oefe:
OWNER•BUILDER DECLARATIONS:
I hereby aNirtn that untler penalry of perjury t�et I em E%EMPT FROM THE CONTRAC70R5 LICENSE LAW for the following reeson (Sec. 7031.5, Buslness entl Professlons
Code: Any city or county which requires e permit m construc�, alter, improve, demolish, or repair any strucWre, prior to its issuance, elso requires the epplicent for such permil
ta tile e signetl statemem t�ec he or she Is Ilcensetl pursuant to the provislons of ihe Contrecbrs License Law (Chepter 9(commencing with Sectlon 7000) of Dlvlslon 3 of iha
Business end Pmfessions Code) or thet he or she is exempt therefrom and the basis Por ihe alleged exemptioa Any vlolation ot Section 7031.5 by any appllcant lor a permit
sublects the epplicant to a civil penelty oi not more than five hundred dollars ($500).):
❑ I, as owner of ihe property, or my employees wllh wages as iheir sole compensation, WILL DO 7ME WORK, antl the structure Is not intentletl or olfered lor sele (Sec.
7044, Business and Professions Code: The Con�ractors License Lew dces not apply to an owner of property who builds or improves thareon, entl who does such work
himself or herself or through his or her own employees, provitletl that such improvemanis are not intended or oflered for sele. If, however, the bullding or improvemem is
sold within one year of completioq the owner-builder will have ihe 6urtlen of proving ihat ha or she did no� build or improve for purpose of sale.).
❑ I, as owner oi the property, em E%CLUSIVELV CONTRAC7ING WITM LICENSED CONTRACTORS to con5trucl Ihe project (Set. 704G, Busine55 and Profession5
Cotle: The contrec�ors Llcense Lew tloes not apply lo an owner of pmperty who bullOs or improves Ihereon, and who contracts for such project with e contwctor(s)
license pursuant to t�e Contractors License Lews.).
❑ I am e:empt untler sec.
Slgnature:
Owner ID venlied by dnvefs license. � Ves ❑ No
Business end Professions Code for this reason:
Verification of Ownership by (type ol dwumem, i.e. - property taz bill or tlead):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICA710N:
DriveYs License No.
�ate:
Expires:
❑ I �ereby cenity Ihat no ezcavetion tive (5) or more teet in depth into which e person is required to descenq will be made in connection with work euihorized by ihis
permit, and thet no building structure, scaflolding, talsework, or demolition or dismantling ihereot, will be more than thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Tille 8, Califomia AdminiSVative CoAe).
❑ As owner-6uilder, 1 will not employ enyone to tlo work which would require e permit from the Division of Indusirial Safery, as notad ebove, unless such person hes a
permit to do such wark tmm the division.
Signature: Date:
Division of Industnal Satery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AllTHORIZA710N OF ENTRY: 1 cenity under penalry ot perjury that I have read ihis application antl sta�e Ihet iha information given is
correct. I egree to wmply wllh ell stete laws entl ciry ortlinences relating to building construction, and authorize represenWtives of ihe Ciry of Costa Mesa to enter upon the
ebove-describetl propehy tor inspection puryoses. I egree not to occupy or allow aapancy ot any buildng authorized by ihls permit untii iinal inspection.
qOpE I, INSPECTIONTYiE (
1676 Fixed System Final Fire Prevention
1266 Pool Spa Finel
200 Final Re-Root
201 Flnal BIaWReiaining Well
202 Final Factory Fire Place
203 Finel Sign
204 Finel Demolilion
Q� INTff1AL5
COpE� INSPECTIONTYPE
206 Final Mechanical
20B Final Plumhing
210 Final Electriwl
212 Flnal Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/OCtupenCy
-ZY-o
. . .. . . .. . ^++..-..�n. . r -. . , . v . .. v .,y... , . s . .. .
�J•�e-is'rn ♦ -y�iuY
' BUILDING AND SAFETY DIVISION
� �� �� G�yk .f1SE DAMAGE INSPECTION REPORT �/'
O ' S� (Required Prior To Permit Issuance) ,
Address: � � � � CO ���SP �' � � Unit: ����0
, Owner. ��iiA � `�Y�j !� �i/ -'
Owner's qddress (if different from above): 7���' S�y� �1,7 �— h,�os
Street } City
� Structural permit required.
� Repair or replace as necessary. ,
❑ Plans required. �/ ,/ � �, �
Comments: li� ✓1�/. U'l.�.w a{� f' 7"a Cr��Gl �!� ,-O � ��4/
� / . .. i✓ • � V.\ l
' �L
❑ Electrical permit required.
� Repair or replace as necessary. �
Comments:
State
❑ Plumbing permit required.
❑ Repair or replace as neoessary.
Comments:
❑ Mechanical permit required.
❑ Repair or replace as necessary.
f:nmmwnic•
A�
l A� Y G� I�Pp/�- �' I/ O`I 7/�/- �s`/- S6/T
Inspector Date Phone
\
16Y2�66 Triplica�e: Original-0wner, Yellorv-Conlraior, Pink-BuilOing Oivisian � �
CITY OF COSTA MESA
° BUILDING p1VIS/0N
+ �
� DEVELOPMENT SERVICES DEPARTMENT " 898-00771
� PERMIT PERM�T NUMBER
��
(714) 754-5273 • Fax (714) 754-4856 gUILDING PERMIT n FAiR DRIVE, COSTA MESA, CA 92626
Job Address: 3177 COLLEGE AV
Suite:
Vicinity:
Parcel Nunmber: 41$14521
App�icant: THORSON, CLIF
Address:
owner: HUEBNER, EVELYN S
Atldress 3177 COLLEGE AVE
COSTA MESA,CA
Contractor. EARL'S PLUMBING INC `
Address: 01526 NEWPORT BL
Zoning: R2 R2
Phone:
Zip:
Phone:
Zip: 92626 �.
Phone:
COSTA MESA CA Zip: 92627
License: 217657
Arch / Eng : � .
Address: ' � �
Phone:
i
� Zip:
. � License:
SCOPE OF PERMIT
REMODEL EXISTING MASTER AND 1/2 BATHROOMS. REMOVE AND
REPLACE EXISTING SHOWER/BATH ENCLOSURE
Plan Check: $0.00
Permit: $11225
Other: $0.00
Inspection: $0.00
Total: $712.81
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0. 0
Rear 0-0
Reauired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
LeR 0- 0
Proposed: 0
Status: ISSUED
Applied: 05/06/1998
Issued: OS/06/1998
Calc Valuation: so.00
Claimed Valuation: Ss,ess.00
Right 0-0
Right 0- 0
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
tor a period of 1 BO days.
INSPECTIONS: In order for the work authorized under this pertnit to be considered legal, such work must comply with all applicable codes, and all
requlred inepaetione end final epproval must ba obtained. Failure to obtain inspections and final approval vrill result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 754-5626
WORKERS' COMVENSATION DECLARATION:
I hereby eHirm under penalty of perjury one o11he following tleclarfltions: . •� �
❑ I heve antl wlll meintein e certificete of consent �o seli-Insure for workers' compensation, es provitletl for by sectlon 3700 ot the Lebor Code, far t�e performance of the
work far which �hi5 pertni� is issued.
� I have end wlll meintain workers' compensaGon insurance, es required 6y section 3700 oi ihe Lebor Code, for Ne perlortnance of the work fa which Mis pertnit is issuetl.
My workers' compensation Inwrence cartler anA pollcy number ere:
�caMe�: S'i�'�-rc �WYO PolicyNumber. /�1`f 3ro i-9�
(Thls secNon need nof be mmpleted U fhe perm/t is valued at one hundretl tlollars ($100) or Iess.J
❑ I cerlity thel In iha pertortnence of Ihe work tor which this pertnit is issueq I shall not employ any person In any manner so es to become subject to the workers'
campensatlon lews of Celifomla end egree et if I should become su6Jec1 to the workers' compensatlon provlslons of Section 3700 0l Ihe Lehor Catle, I shall fotlhwlth
' comply wlth Ihese pmvision . t�//
AppllcantSlgneture: � Date: JL�`'/ �
0
WARNING: FNLURE TO SECURE WORNER ' COMPENSATION ODVERFOE IS UNLAWFUL ANO SHALL SUBJECf AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNORED
TIIOUSAND DOILFRE (5100,000), IN ADDRION TO THE CQST OF COMPENSATION, DMNGES AS PROVIDED FOR IN SECTION 37080F TME LABOR COOE, INTEREST, PND ATTORNEI"S FEES.
F�
LICENSED CON7RAC70R5 DECLARATION:
I hereby eNirtn thet 1 em licensed under proWsions at Chapter 9(commencing wlih Section 7000) of Division 3 at t�e Business and Professions Cotle, end my license is in full
rorce and eHect. uc. x l G G} Class x e�o, �,�G . t� , UL_
Contrectofs SigneWre: Date: '�2�( /sF �'
CONSTRUCTION LENDING AGENCV:
❑ I heraby aflirm ihat ihere is a consiruction lending egency for the perfortnance of the work tor which Ihis permit Is Issued. (Sec. 3097, Civll Cotle).
Lenders Name: Lendefs Address:
Signeture: Date:
OWNER•BUILDER DECLARATIONS:
I hereby eHirm ihel under penalty of per�ury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW lar t�e following reason (Sec. 7031.5, Business end Professlons
Code: Any ciry oi counry whic� requlres e pertnit to construM, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permlt
to flle e signetl stetemem that he or she Is Ilcensed pursuant lo Ihe provislans ol t�e Contreclors LJcense Lew (C�apter 9(commencing with Section 7000) ol Division 3 of the
Busineu and Professions Code) or ihat he or she is exempt therelrom end Ihe 6asis for ihe alleged exemption. Any violation oi Sectlon 7031.5 by any eppliwnt tor e permlt
sublects Me epplicant to e civil penelry ot not more Nan five hundred dollare (5500).):
❑ I, es owner of Ihe property, or my employees wlth wages as �heir sole compensation, WILL DO THE WORK, entl the structure is not Intentled or otfered for sale (Sec.
7044, Business antl Professlons Cotle: The Contrectors Licensa Lew does not appy ro an owner ot properry who builds or improves iheraon, and who does such work
hlmseN or hersetl or t�rough his ar her own employees, provlded ihat such Impravements ere not Intentletl or oHered for sele. If, however, the building or imp�ovement Is
soltl within one yeer of completlon, the owner-bulltler wlll heve tha burtlen ol provinq that he or she dltl not build or improve tor purpose of sele.).
❑ I, as owner oi the properry, em E%CLUSIVELY CONTRACTNG WfTH LICENSED CONTRACTORS to construct tha prolec� (Sec. 7044, Business end Protessions
Cotle: TTe contractors License Lew tloes not apply to en owner ot properry who builtls or Improves thereon, entl who contrects for such pmject with a coNractor(s)
license pursuant ro the Contractors License LewsJ.
❑ I am exempt under sec. Business end Prafessions Cade lar this reason:
SlgneNre: Date:
Owner ID verified by dnver's license. ❑ Ves ❑ No Drivefs License No.
VeAticatlon of Ownership by (rype of document I.e. - properry tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
Expires:
❑ I hereby cenity Ihat no excavetlon tive (5) or more teet in depth Into which a pereon is requiretl to tlescenA, wlll be metle In connectlon with work aut�orize0 by ihis
pertnit, antl ihet no building slrucNre, scafloltling, telsework, or demolition or dismantling thereof, will be more then thirry-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle 8, Celifomia Adminisiretive Code).
❑- As owner-builder, I will not employ enyone to do work which would requlre a pertnit trom iha DlNsion of IndusVlal Setery, as noteA ebove, unless such person has e
permit to do such work from t�e Civision.
Signature: Date:
Division ot Industnel Safety Permit Number:
CERTIFlCATE OF COMPLJANCE AND AUTHORQATION OF EMAV: I certity under Denalry of perjury thet I heve reed ihis appliwtion anG stete Ihat the iniortnation given is
wrrect. I agree to wmply with all steie laws end ciry ortlinences relaGng to builtling wnsWction, and autharize representalives ot Ihe Clry ot Costa Mesa to enter upon the
ebove-describetl property for inspecGon purposes. I egree not to occupy or allow occupanq of eny 6uilding authorized by this pertnit unlil final inspeIXion.
�D�^ n SigneNre Oi legal Owner(s) ��G /� � Date
�Gl� �
And/OrAuthodzed Applicant Dete
cooe �. INSVECTIONTVVE " ' pdiE I�ALS
1676 Fixetl System Final Fire Prevention
1268 Pool Spe Final
200 Finel Ra-Roof
201 Final BIocWRetaining Wall
202 Final Fadory Fire Place
203 Final Sign
204 Final Demalition
zaaae
eooe� wsrecnoxrne
206 Final Mechenical
200 Final Plumbing
270 Final ElecMcel
212 Final Fire Preventlon
220 Finel Plenning Approval
222 FInelSile
250 Final Building/Occupency
GAff It�ELS
CITY OF COSTA MESA
Bun��N� oms►oN
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
P98-00351
PERMIT NUMBER
(714) 754-5273 • Faz (714) 754-4856 77 FAIR DRIVE. COSTA MESA, CA 92626
PLUMBING PERMIT
,lob Address: 3177 COLLEGE AV
Suite No
Vicinity:
Parcel Nunmber: 41814521
Applicant:
Address:
Owner:
HUEBNER, EVELYN S
HUEBNER, EVELYN S
Address 3177 COLLEGE AVE
COSTA MESA,CA
Contractor: EARL'S PLUMBING INC
Address:
ArchlEng:
Address:
01526 NEWPORT BL
COSTA MESA CA
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 ouNets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oip
Interceptors (Sand Auto )
AMT
$22.00
$0.00
$0.00
$8.75
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
aTY
Phone:
Zip:
Phone:
Zip: 92626
Phone:
Zip: -- -92627 . .
License: 217657
Phone:
Zip:
License:
SCOPE OF PERMIT
REMODEL EXISTING MASTER AND 1/2 BATH.
FEE SUMMARY
Laundry Tub / Washer
Landscape Irrigation
P-Trap
Pressure Regulator
Process Piping (per 10 ft)
Receprors
SepticTank �
Sewer Cap for Demo
Sewer Connect
Sewer Pnvate Line
Shower
Sink, bar
Sink, wmmercial
Sink, Floor
Sink, kitchen
Sink, service/mop
Spa (private)
Spa (public)
AMT"
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$8.75
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
COMMENTS / SPECIAL CONDITIONS
Status: ISSUED
Applied: 05I06/1998
Issued: 05/O6/1998
Sump Pump
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)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOIATION
PLAN CHECK
REINSPECTION
TOTAL CALCULATED FEES:
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$8.75
$0.00
$0.00
$77.50
$0.00
so.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$65.75
QTY
0
0
0
0
0
0
1
0
0
2
0
0
0
0
0
EXPIRATION: This parmit shall automatically expire and become voitl if work is not commenced within 180 days, or if work is suspended or abandoned
tor a period of 180 days. .
INSPECTIONS: In order for the work authorized undar this permit to be consideretl legal, such work must comply with all applicable codes, and all
requlred inepeetlone and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECIARATION:
I hereby aHirtn unCer penelry oi perjury one of the Following tledaretlons: . � � •• -
❑ I heve end will mflintein e certiflcete of consent to setl-Insure for workers' compensatlon, as provided tor by section 3700 oi t�e Lebor Code, for Ue pertortnance of the
work for whic� this permlt Is IssueC.
(,J I have entl will meintain workers' compensation insurance, es requiretl by section 3700 of ihe Lebor Code, for the peAortnance of ihe work for which this permit is issued.
My workers' compensatlon Insurence cartier antl pollcy number ere:
Cartler. 5'I'RTr �UN7J PolicyNumber. ��'� �SO�—C/�
� (Th/s secNon need not be completed I/ fAe permit is valued ef one bundretl dollars ($100) or /ess.)
❑ I certily that In the pertortnance of Ihe work for which Ihis pertnit Is issued, I shall not employ any person in any menner so es to become subject to the workers'
compensetlon laws ot Califomla, entl egree thet H I shoultl become sub�ed to the workers' compensation proWSions ot Sacllon 3700 ot Ihe Labor Cotle, I shall forthwlih
comply wIN t�ese provislo �/ n/ /�
Applicant Signature: �� � L.bf,.�---- Date: �/f' /7 �
WARNINO: FFILURE TO SECURE WO RS' COMPENSATIIXJ COVERAGE IS UNUWFUL AND SHALL SUfl1ECT Ml EMPLOYER TO CRIMINAL PENALTIES AND dVIL FlNES UP TO ONE HUNORED
THOUSAND OOLURE (5100,000). IN ADORION TO THE COST OF COMPENSATION, OFMAGES AS PROVIDED FOR IN SECTION 31080F THE LABOR CO�E. INiEREST, M!D ATTOFNEY'S FEES.
LICENSED CON7RACTOHS DECLARATION:
I I hereby eHirm ihat I em Iicensed under provlsions of Chapter 9(commencing with Section 7000) of Oivision 3 of the Business and Prafessions Code, end my license is in tull
�( torce antl ettecL Lic. a 1 T7 G"� Class x C 20 , C 3 C� 13 , C I L
Conirectofs Signeture: � ..� �,T�i/�r--� Date: �'//. /4 ?
CONSTRUCTION LENUING AGENCY:
❑ I hereDy aKrm ihat there is a construction lentling egency for iha pertortnance of the wark for which Ihis pertnit is issued. (Sec. 3097, Civil Cotle).
Lendefs Name: Lentlefs Address:
Signeture: ' Dete:
OWNER-BUILDER DECLARAT10N5:
I here6y eHirtn that untler penelry ot perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reeson (Sec. 7031.5, Busineu entl Professions
CoCe: Any ciry or counry w�ic� reqWres a pertnit to construct, alter, impmve, demolish, or repair any structure, pdor to Ils Issuence, also requires ihe applicant for such pertnit
to file e signetl stetement that he or sha Is IicenseA pursuant to t�e D�ovislons of t�e Contrectors License Lew (Chapter 9(commenGng with Sectlon 7000) of DiNsion 3 of the
Business end Protessions Code) or thel he or she is a:empt therelrom entl the basis lor the elleged exemption. My violetion of Section 7031.5 by any epPlicant for a pertnit
sub�ecls ihe epplicaN to e civil penelry ot not more Nan fve hundretl tlollere ($500).):
❑ I, es owner oi Iha property, or my employees wit� wages as Ihelr sole compensetion, WIIL DO THE WORK, entl the atmcture is not imendetl or ottered far sale (Sec.
7044, Business end Professlons Cotle: The Contrectors Llcense Lew does not epply to en owner of property who builds ar Improves thereon, entl who tloes such work
himself or herselt or t�rough his or her own employees, provlded ihet such improvements are not intentled or olferetl for sale. H, hawever, the building or Improvement is
soltl w%hin one year of completlon, Ihe owner-builder wlll heve the burtlen of proving t�et �e or s�e did not build or improve for purpose of sale.).
❑ I, es owner of ihe properry, flm EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct iha project (Sec. 7044, Business end Prafessions
Cotle: The cantrectors License Lew does not epply ta en awner al properry who bullds or impmves thereon, entl wha contrects for such proJect wlih a coniredor(s)
Ilcense Oursuant to tha Contrectors Licensa Laws.).
❑ I am exempt unCer sec. Business entl Professlons Code for this reason:
Signeture: Date:
Owner ID verified by drivefs license. ❑ Yes ❑ Na Drivers License No.
Vediicatlon o1 Ownership by (type of document, i.e. - properry tau blll or deed):
Ezpire5:
UIVISION OF INDUSTRIAL SAFETY PEHMR CERTIFICATION:
❑ I hereby ceNiy ihet no excavetion live (5) or mora leet In tlepth into whic� e persan Is requireA to descentl, will De made in conneclion with wark euthorized by this
pertnit, an0 Ihet no bullding structure, swNoltling, lalsework, or damolitlon or dismentling thereat, will be more than thirry-six (36) teet high. (Chap. 32, Grp 2, Atl 2, Sec.
3d1, Title 8, Celltomia Adminlstretive CoAe).
❑ As owner-Duiltler, I wlll not employ anyone to tlo work which would require a pertnit Irom Ihe Division ot Industrlel Setey, es notetl ebove, unless such person has a
permil to do such work from Ihe division.
Signetura: Dete:
Division ol Indusinel Safery Permit Number:
CERTIFlCATE OF COMPLIANCE ANU AUiHORVJ1TiON OF EHTRV: I certity under penelry ot perjury Ihat I have read this applicaiion and state thet the intortnetion given is
correct. I egrae to comply with ell state laws and ciry ordinances releting to building consiruction, end authonze represenietives oi the City of Casta Mesa to enter upon �he
ebove-descnbetl properry for inspection purposes. I agrea no� to occupy or allow occupancy of eny building euthorized by this permit until tinal inspection.
Owneqs) s/C /g � oa�e
Applicent �T Date
CODE /. IxSPECTIONTYPE PAIE I�15
1616 Fixed System Finel Fire Prevention
1266
200
201
202
203
Pool Spa Final
Flnel Re-Roof
Flnel BIacWReiaining Wall
Finel Fectory Flre Place
Flnel Sign
204 Flnal Damoliiion
2aa8de
CODE� INSPECTONTYPE
206 Finel Mechanical
208 � Finel Plumbinp
210 Finel Electncal
212 Final Fire Preventlon
220 Finel Planning Approvel
222 FinalSite
250 FnalBulltling/Occupency
OAIE It1�dL4
• �• �
� �
0
> _
:
J��
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
F98_00���
PERMIT NUMBER
(714) 754-5273 • Faz (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
Address
3177 COLLEGE AV
41814521
THORSON, CLIF '
HUEBNER, EVELYN S
3177 COLLEGE AVE
COSTA MESA,CA
Contrector: EARL'S PLUMBING INC
Address: 01526 NEWPORT BL
Arch I Eng :
Address:
ISSUE FEE
Temp service test
Res. alc package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixls
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to t000a
Service over 7000a
Motors to 1 hp
Motors to 10hp
Mo[Ors [o SOhp
Molors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
i
� �UO R K
�� � l�ec(
COSTA MESA CA
$22.00
$0.00
$0.00
$0.00
50.00
50.00
50.00
$2.00
50.00
$0.00
$0.00
50.00
50.00
30.00
$0.00
50.00
so.00
50.00
50.00
so.00
$0.00
50.00
50.00
$0.00
50.00
l,�O. S
�� � �5
Phone:
Zip
Phone:
Zip: 92626
Phone:
Zip: 92627
License: 217657
Phone:
Zip
license:
SCOPE OF PERMIT
REMODEL EXISTING MASTER AND 1l2 BATHROOMS.
Quantity
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Buswayl700ft
Standing Sedion
Misc Electrical Equipment
Transformers up to 1 kvaBw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misa Conduil
Misc. Conductor
Circus ( gen or nde)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Status: ISSUED
Applled: OS/O6/1998
Issued: 05/O6/1998
Quantlty
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES 524.00
COMMENTS / SPECIAL CONDITIONS
�1eve2 �� o« �. Co�frc�cfo�
���,-, f
�Y �i�fc�K��
EXPIRATION: This permlt shall automatically expire and becnme voitl il work is not commenced within 780 days, or if work is suspended or abandoned
for a pedod of 180 days.
INSPECTIONS: In order for the work authorized under Ihis permit to be considered lega�, such work must comply with all applicable codes, and all
requlred Inepeetiona entl finel epprovel must be obtained. Failure to obtain inspections and final approval will result in the axpiration of this pertnit.
FOR INSPECTIONS CALL: (714) 7545828
WOFiKERS'COMPENSA710N DECLARATION:
I herehy ettirm unOer penalry of perjury one oi the tdlowing tledaretions: � • •� �
❑ I have end wlll meinteln e cenificate of consent to setl-Insure for workere' compensetlon, es O�a�detl for by aectlon 3700 0l ihe Lebor Cotle, for the peAarmance of Ne
vrork tor which Nis pertnit is issued.
❑ I heve a�W wi0 meintein woifcers' comDensation Insurence� es reQuiretl by seclion 3700 oi Ihe Lebor CaAe. for ihe peAarmence of the work fw whkh this pemtit Is issueA.
My workers' compensa0on Inwrence cartler and poliry number ere:
Certler: Policy Number.
(m�s secnon need nof be comp�ered i! me permtrls va�ued et one nundred dalars (Stoo) or less.)
❑ I certify ��et In Ihe peAortnance at Iha work tor which Ihis pertnit is issueQ I shall not employ eny Derson in eny manner so as to become subJect to the workers'
compensetlon lews oi CellforNa, end egree that tl I shoultl become sub�ect b tha workers' compensation provisiow ot Sectlon 3700 of the Le6ar Code, I shell lonhwlt�
comply wlth these provislons. �%
Appllcant5lgneture:� ��� �La<.--- De(pn s�� /�l �
WARNINO: FAILURE TO SECURE WORK RS' C/JMPENSATION �VERAGE IS UMAWFUL AND SMALL SUBJECf AN EMPLOYER TO CRI INAL ENALTES NND CIVIL FlNES UP TOONE NUNDRED
TIqUSrWD DOLL�IRE (SI00,000), IN AODRION TO TNE COST OF GUAIPENSATqN, Q4M4GE5 0.5 PitOVI�ED FO{i IN SECiION 37080F TNE UBOF CODE, INTEREST, AND ATTORNEYS FEE$,
LICENSED COMRACTOHS DECLARATION:
I hereby eHirtn thet I em Ilcensed under proNsions of Chapter 8(cammenUng wl�h Section 7000) ol DlWslon 3 af Ihe Business and Professlons Cade, enA my licersse I5 in full
force end eflecL lJc. a Cless k
COMractora Signeture:.. " Date: �, i G S c�
CONSTRUCTION LENDING AGENCY:
❑ I hereby effirtn Ihet Ihere is e consiructlon lendinp egenq for the pertortnenca ol Ihe work for w�ich this pertnit Is issuetl. (Sec. 3097, Civll Cotla).
Lentlers Name: Lendefs Atltlress:
SlgneWre: Data:
OWNER-BUILDER DECLARATIONS:
I hereby altirm thet untler penalty of perjury NaI I em EXEMPT FROM THE CONTRAC70R5 LICENSE LAW tor the tollowing reasan (Sec. 7031.5, Buslneu end Prolessions
COEe: Any ciy or counry which requires a partnit ro wnsWct, elteq improve, demolish, or rapair eny slructure, pdor to Its Iuuance, elso requlres lhe eppllcant for such permit
to flle e slgned stetement Ihat ha or she is Iicensed pursuent ro the provisians ol Ne Contrectors Llcense Lew (Chepter 9(commenUng wlih Section 7000) ot DMslon 3 0l ihe
Business and Professions Code) or ihat �e or she is exempt Iherefrom end the basis lar Ihe ellepetl examptlan. Any violetlon of Section 7031.5 Dy eny eppllcant far a permit
sub�ecla the epplicant to e cFAI penalry oi noi more than fiva hundred dWlars (SSOOj.):
❑ I, as owner of Ihe properry, or my employees wlih weges as their sde compensation, WILL DO THE WORK, and the sirucNre is not inientletl or oMered for sale (Sec.
7044, Business end Protessions Code: The Contractors License Law Coes not appty to en owner oi properry who builds or Improves ihereon, enG who does such work
himsetl or hersetl or through his or her own employees, provlEed ihat such improvements are not Imended ar affered for sale. If, however, the builtling or Improvement is
soltl within ona year af completion, tha owner-builtler will have Ne burden ot proNng Ihat he or she tlitl not Dulld or imprwe br purpose oi sale.).
❑ I, es awner oi Ihe pmperty, am EXCLUSIVELY COHTRACTING WITH LICENSED CONTRACTORS to wnsWct ihe pmjact (Sec. 7044, Business an0 Professions
Code: TTe contrectors License Law does nm appty ro en owner oi pmperty who Duiltls or Imprwes thereoq entl who contracls for wc� pro�ect with e contracror(s)
Ilcense pursuant to iha Contractors Licensa Laws.j.
❑ I am exempt unCer sec. Business and Professions Code for this reason:
Slgnelure: Date:
Owner ID verilied by driver'Slicense. ❑ Yes ❑ No Dnvers License No. Expires:
Veriticetlon oi Ownership by (type of document, i.e. - D�oDerry lex bill ar deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hereDy certly Ihet no exwvatlm IWe (5) or more teet in Cepth into whlch e person is requiretl ro tlescenq will be meae in conneqlon wlth work euthotlzed by thLa
pertnit, end that no bullding structure, sceHdtling, IelsewoAc, or tlemdition or dismaniling thereol, wlll De more then thirty-su (36) teet �Ip�. (Chep. 32, Gry 2, M 2, Sec.
341, Title 8, Celifomie AAminlstretive CoCe).
❑ As owner-bullOer, I wlll not employ enyane to do work which woultl require a permii tmm Ne DMslon of Industriel Selery, es notetl above, unless such person has e
pertnit lo do such work irom t�e tlivision.
Signeture: Date:
DlWsion af Industdel Sefery Permit Number.
CERTIFlCATE OF COMPLIANCE AND AUTHOROATON OF ENTHY: I certify under penelry of perjury thet I heva reed Ihis epplication and siate Ihat ihe inlortnetion given Is
cortect. I egree to comply with all state laws erk dry ordinances releting to building consiruction, end authorize representatives ot the Ciry oi Costa Mesa to enter upon Ne
abovadexribetl property tor inspection purposes. I agree not to otcupy or ellow occupency ot eny bullding euthoAzed by �his permit until linal inspeclion.
Signature Ot Legel Owner(s) Date
/d.�..���--- b ��/9c
' AnNOr Authorized AODlicent ��' DBte
COOE I. INSPECiIONTYVE
1616 Flxed System Flnel Fire Preventlon
1286 Pool Spe Finel
200 Flnel Re-Rool
201 Flnal BIocWRetaining Wall
202 Final Fectory Fire Plece
203 Final Sign
204 Flnal Demolltion
zaaeae
�j[ �{,j yppE� INSPECTIONTYPE
206 Finel Mechenicel
20B Finel Plumbing
210 Flnel Elecidcal
212 Finel Fire Prevention
220 Flnel Planning Apprwal
222 Final Site
250 Flnel BullOing/Occupancy
GAiE It�AlS
. � , ���os r EE RECEIVED
GOSTA MESA BUILDING-SAFEfY DEPARTMENT Lot#' � �n{1 (�J}
P.O. BOX 91] COSTA MESA, CALIFORNIA plan# 320 rI �1y,��Cl �.
For Applicant fo Fill In Complefely APPLICR71C1N�Oft'PEHh117'E$A
.. �• TYPE�(�R „FRINT G.n 1 BUILDING
BUILDINO For Office Use Only
ADDRESS ������rb°r—Hlvd�.
X[CEIPT NO. �6'q,MIT O.
COSTA MESA. � CALIFORNIA ' �
necei er o a eiv �� �egeq96
OWNER H' rbor Hall o e H
MAIL HQX �66 BUILDINO
AODRESB
ADDRE88 y/ y�`/�
TEL. ZONE TYPE l� GROUP I
CITY SSIl'fia, AT1S NO. � �2�
ARCHITEGT Ray Levanas TELOR�7OZO BrPROVED DATE
OR ENGINEHR NO. '
ZONING
ADDRES9 2 Via � OI"f0 N t Bch �
Z [ NO.OP Ue[OPNB
Lifeti,me Residential Bldg Cor PUNB� euaoincw ,
CONTRACTOR
�o.� �� r
ADDRHCY BOX z066 oeacnirtion
Santa �Y18 A. P. NO. ~ ✓ ✓
CITY
208676 � NOTE: NOEAVHOVERHAN68HALLBELE95THAN
STATE TE�. 9_z2p4 90" TO BIOE 8 REAR P. L.
LIQ NO. NO.
SIZE - ' No. Op BLOae. ALLOW6D f U. B. C. REOUIREM6NT)
OF LOT ZO X HO ( nOW ON lAT O
YqR�S MPROVED YARDSAPPROVED
USE OF none MAIN BUILDIN6 ACCE590RY BUILDING
EXISTING BLO6.
(FROMGLSTREETI �
BETBA<K LINB FROM FRONT � FT. FT.
CENTER OP BTPBET T REAR YARDZS �lO ��
SI�EYARDI LEFf O I RIGHT O R.SIDE O FT. ��/ Ff. .
DESCRIPTION OF WORK L.51DE FT. D Fr.
I xxll I II I e�.e 9G �. G� � fl � �'
EXTERIOR WAL ROOF APPROV D
COVERING 'EUCCO COVEHINO RO BY
USE OF BUILDING Af�D WOftK TO BE PbRFORMED
�� �� o bld
with ��J'� construction garage
//D� 6�
1 HEREBV ACRNOWL8Da8 THAT 1 XAVe FEAD THI9 �PPLICATION THC AMOUNT
ANO 6TFT8 TXAT THH ABOVE 18 CORHCCT ANO AORHE TO COM� PURP098 OP
PLY WITH ALL CITY OHOINANC88 �ND 8TAT8 �AW9 q80t1LATINO �/(�LUATION
BOIL�INO CONBTPYCfION.
61GNATUREOP �
PERMITTE s / ^
AUTHORIZfiD ABHN I �� ��
DATE � � I O " � .
,
¢
U
/ �
�p „ a
, � � N
R VALUAT�ON 19 PON THE �
O F PERMIT PE9 ONI.Y. O O
�'// 0 �
MITFEE $ /�-- j 0
m ,
N GHECK S �/— L'
¢
/ ^J 0
/.L FEE $ (� iJ r LL