HomeMy WebLinkAbout238 FAIRWAY PL - Building Permits(774) 754-5273 • Fax (714) 754-4856 • wWw.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber.
Applicant
Address:
Owner:
Address
Contractor:
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fizts
Recepl Outlels
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to thp
Motors to tOhp
Molors to 50hp
Motors to 100hp
Motors over 100hp
Communication drops
238 FAIRWAY PL
REAR SFD
43921308
GREGORY, JpHN S
238 FAIRWAY PL
COSTA MESA, CA
GREGORY, JOHN S
238 FAIRWAY PL
COSTA MESA, CA
OWNER-BUILbER
Phone: 949-722-8146
Zip 92627-4612
Phone: 909393-8655
Zip: 92627-0612
Phone:
Zip:
License: 000000
Staws: ISSUED
Applied: 02/17/2005
Issued: 02/17/2005
ISSUED BY:
.' " • Mti J,
- � - � {'yy,
,.( .�,�ry�� �
SCOPE OF PERMIT
CONSTRUCT A 332 SF IN-GROUND GUNITE POOL 8 38 SF SPA. AT THE REAR OF AN EXISTING
SFD.
1POOUSPA
REF:BOS-00296
$23.50
50.00
30.00
30.00
$0.00
$49.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
30.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
t
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / �ighling
Busway/100 k
Standing Section
Misc Electncal Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misa Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Qaantity
50.00 0
50.00 0
30.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
50.00 0
$0.00 0
$0.00 0
$0.00
$0.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 9248, § 1, 72-21-92)
EXPIRATION: This permit shall automatic811y expire and become void it 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
requlred Inapectiona and finel approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiratlon of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2aa646 (6/W)
WORKERS'COMPENSAnONDECLARAnON:
I �ereby aHirm under penalry of perjury one of ihe following daclarations:
❑ I have antl will maintein e certificeta ol consent to self-Insure for workers' compensetlon, as provided for by section 3700 0l the Labor Code, for the pertormence of tne
work tor which this permi� is issuetl.
❑ I have and will maintain workers' compensatlon insurance, as required by section 3700 ot the Lebor Code, Por t�e pedortnance ol tha work for which this pertnit is issued.
My workers' compensatlon Insurence carda� entl policy number are:
Carder.
veluetl af one
or/ess.)
Policy Number:
�;% I certily that in the peAortnence oi the wark tor w�ich this pertnit is issuetl, I shell not emplay eny person in any menner sa es to 6ecome su6ject to the workers'
�' compensation laws ol G' omia, entl egree thet il I shoulC bewme sub�ect b the workers' compensation pmvisions oi SecUon 3700 of Ihe Labor Code, I s�all forthwith
compry wiN these pr isio s. Z�/ �/O �
� re: D�1»
WA NING:FAILURETOS (ERS'COMPENSATIONOJVERAGEISUNLAWFULANDSMALLSUBJECTANEMPLOVERTOCR� PENPLT SAN�GVILFlNESUPTOONEHUNORED
THOUSANDDOLLARE($1 ,000),INADDITIdJTOTHEC0.STOFCOMPENSATION,�AMAGESNSPROVIDEDFORINSECTIIXJ31060FiHELABORCODE,IIJrEREffi,ANDATTORNEYSFEES.
LICENSED CON7RACTORS DECLARATION:
I horeby eNirm ihat I am licensed under provisions of Chapter 9(commencing with Sectlon 7000) of Divislon 3 of ihe Business antl Professions Code, end my Ilcense Is in full
tome end aflect. Lic. q Class a
Conirector's Signature: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aMirtn that there is a construction le�ding egency for Ihe pertormance ol ihe work for w�ich Ihis pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lenders Address:
Signeture: Date: i
OWNER-BUILDER OECLARATIONS:
I hereby eflirtn Ihat under penalry ot perjury thet I em E%EMPT FROM THE CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Protessions
Code: Any ciry or counry which requires e pertnit to construc6 alter, improve, demolish, or repeir eny structure, prior to its issuence, also requires the epplicant lor such pertnit
to file e slgne tatement that he or she is Ilcensed pursuant to the provisions of the Coniredors License Lew (Chapter 9(commencing with Section 7000) of DlNslon 3 of the
Busine Professions Catle) or t�et he or she is exempt therefrom and the 6asis br the ellegetl e:emption. Any violetlon ol Section 7031.5 by eny epPlicant for a permit
subj the epplicantlo a civil penalry of not more ihan tive hundred dollers (5500).):
I, es owner of the property, or my employees with weges es their sole compensetion, WILL DO THE WORK, antl ihe sirucWre Is not intentled or otteretl tor sala (Sec.
7044, Business and Protesslons Code: The Contractore License Law dces not epply lo en owner ot properry who builds or improves thareon, and who does such work
himself or herself br thmu'gh his or her own employees, proviaetl that such improvements are not intended or oHered for sala. H, however, ihe building or improvement is
soltl within one year oi comple6on, ihe ownB�-buildar will heve Ihe bwden ol proving that he or she did not build or improve lor purpose of sale.). �
❑ I, as owner af the property, am EXCLUSIVHLV CONTRACTING WITM LICENSED CONTpACTORS to construct tha proJect (Sec. 7044, Business end Professlons
Code: The comractors License Law does no� epply to en owner ot propeny who bullds or Improves Ihereon, and who comracts for such project with e contractor(s)
liten5e pur5uant to lhe Contrector5 Lltense �ews.).
❑ I em exe der sec. Business end Prolessions Code for lhis reason:
lure:
Owner ID verifi vers license. Ves ❑ No D: ,er�s'�._L' e se No. `'
Verificetlon ol nership by (type ol documem, i.a. - properry Iax 6ill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CBA7�FICA710N:
❑ I hereby cenify that no excavation tive (5) or more teet in tlepth into which e person Is requlred to descend, will De made In connectlon with work authorized by ihis
permil, and that no building structure, scaMolding, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) teet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, Califomia AtlmlNstretive CoOe). �
❑ As ownerv6uilder, I will not employ anyone to do work which would require a permit imm the Division ot Industriel Selery, as noted ebava, unleu such person hes a
permit lo do such work from the division.
Signature: Dete:
Division ot Indusirial Satery Permit Number:
CERTIFlCA7E OF COMPLIANCE AND AU7HORWITON OF ENfHV: I cenity under penalty of perjury that I have read this application and state ihat ihe infortnation given is
wrrect. I egree Io comply wi�h ell state lews end city ordinances rela�ing to building consWction, end authonze representetives ol the Ciry of Cosia Mesa to enter upon Ihe
abova-desc' r pa y for inspection Ourposes, � egree not to occupy or ellow occupency ol eny building authorized by this per il until final inspec�ion.
2 i;�/�s_
namr�eJiOrv�ner(s) ° "sate'�"
And/Or Authonzed ApPlicant Date
COQE 1. INSPECTIONTYPE
161G Fized System Final Fire Prevention
126G Pool Spa Final
200 Finel Re-Roof
201 Finel BlwklRetaini� W all
202 Final Factory Fire Place
203 Finel Sign
204 Final Demolition
PAIE lt�dl@
400E� INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electricel
212 Final Fire Preve�tW�
220 Final Planning Approval
222 Final Site
250 Final Building/Occupenry
PL� U�LS
r 1 ��t�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626
Job Address: 238 FAIRWAY PL
Suite No
Vicinity: REAR SFD
Parcel Number: 43921306
npp�icant: GREGORY, JOHN S
Address: 238 FAIRWAY PL
COSTq MESA, CA
Owner: GREGORY, JOHN S
Address: 238 FqIRWAY PL
COSTq MESA, CA
Contracror: O W N E R-B U I L D E R
Address:
MECHANICAL PERMIT
Phone: 949-722-8146
Zip: 92627-0672
Phone: 909393-8655
Zip: 92627-4612
Phone:
Zip:
License: 000000
Status: ISSUED
Applied: 02/17/2005
Issued: 02/17/ 005
ISSUED BY:
SCOPE OF PERMIT
CONSTRUCT A 332 SF IN-GROUND GUNITE POOL & 38 SF SPA. AT THE REAR OF AN
EXISTING SFD.
1 INST FAU > t00K BTU
REF: BOS00296
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair / Alt Cooling/Heal
Inst / Rep. Recess Wall Htr
Refng Sys <100 k BTU
Refng Sys >700 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
Air Handlers > 10000cfm
Floor Furnace
Floor or Suspend Heater
$23.50
$0.00
$18.20
$0.00
$0.00
30.00
$0.00
$0.00
$0.00
$0.00
50.00
50.00
50.00
$0.00
S0.00
$0.00
$0.00
$0.00
$0.00
50.00
Quantity
FEE SUMMARY
Repair / Alt Absorbtion Unit
Repair / Alt Refrigeralion Unit
Ventillation System
Evaporative Cooler �
Commercial I ncinerator
Domestic Incinerator
Compressors / Absorotion Systems
Upto3hp/.t00kBTU
3 To 15 hp / 500 k BTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp I 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Uplo3hp
3To15hp
15to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Imestigalion Fee -
Plan Check Fee
- ,. O.
�. ?'.. .n� ' �
��.� .+-�...' .
� ' .
..c-.�-.. �..ri" i 1
„ ,
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
N0710E: The work authorizetl by Ihis permit shall comply with a!1 applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-g2) '
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 1 BO days, or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapectiona and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626 . /
2446-bfi(fl/00)
WORKERS' COMPENSA710N DECLARATION:
I hereby ettirm untler penalty ol perjury one ot the tollowing tleclarations:
❑ I heve end will maintein e certiticete of consent to sell-Insure tor workers' compensetion, es pmvided tor by section 3700 0l the Lebor Code, lar the pertortnance of Ihe
work for w�ic� this permit is issuetl.
❑ I have entl will maintaln workers' mmpensation insurance, as requlrad by section 3700 0l the Labor Cotle, for Ihe pertortnance ot the work for which this permit is issuetl.
My workers' compensatlon Insurance wrner antl policy num6er ere:
Carriar: Policy Numbec
(This tlon need nof be camp/efetl i! the permit is va/ued et one hundred dollers ($ f00) or less.)
�
I certity that in the Dertormance ol ihe work for which Ihis permit is issued, I shell not employ any person in eny manner so as to become sublect ro the workere'
compensetlon laws ol Iitomia, end egree that It I should become sub�ect to the workers' compensation provlsions ot Section 3700 of the Lebor Code, I shali torthwith
coinplywit�these ovi
'_ eanl'SignaWre: �; �// �%/C%S
WARNINO: FAILURE TO WOFKERS' WMPENSATION CqVERAGE IS UNLAWFUL AND SMP1L SUBJECi AN EMP OYER TO C�NAL PE ilES ANO CIVIL FlNES UP TOONE HUNDRED
TFIOUSAND OOILARE � .00O�, IN ADDRION TO iHE COST OF CAMPENSATION, OAMAGES AS PROVIDED FOR IN SECf10N 3'!OB OF THE UBOR CODE, IMEREST, AN� ATTOFNEV'S FEES.
LICENSED CON7RAC70RS DECLARATION:
I hereby eflirm that I em licensetl untler provisions of Chapter 9(commencing with Sealon 7000) ot Division 3 of ihe Business and Professlons Code, entl my license is in full
force and ettect. Lic. a Class a
Comractors Signeture: Date:
CONSTRUCTON LENDING AGENCV:
❑ I hareby aNirtn that Ihere is a construction landing egency for �he pedormanca ol the work br which Ihis pertnit is issued. (Sec. 3097, Civil Code). ,
Lentler'S Neme: Lentlels Adtlress:
Signaturo: Date:
OWNER-BUILOER DECLARATIONS:
I hereby effirtn Ihet under penalry ot perjury that I am EXEMPT FqOM THE CONTRACTORS LICENSE LAW tor the lollowing reeson (Sec. 7031.5, Busineu end Professions
Cotle: Any ciry or counry which requires e parmit ro construc�, alter, Improve, demolish, or repair any strucWre, pnor to its issuanca, also requires the applicaN for such pertnit
lo file e signed statement ihat he or sha is licensed pursuant to the provisions ot ihe Contractors License Law (CheO�er 9(commancing with Sectlon 7000) oF Dlvision 3 oi ihe
Business en Brofesslons Code) or that he or she is exempt therehom entl tha 6esi5 lor the elleged exemption. Any vloletion ol Sectlon 7031.5 6y any applicent tor e permit
subject epplicant to e civil penalry of not more t�en tive �undred dollers (5500).):
� I es owner oi Ihe properry, or my employaes with weqes as ihelr sole compensatlon, WILL DO THE WORK, antl ihe structure Is not intentled or oHered for sale (Sec.
7044, Business and Professions Cotle: The Contrac�ors License Lew does not apply to an owner of property who builds or Improves thereon, end who does such work
hlmself or he�s^;; c• �hrough his or her own employees, provided ihat such improvements are not Intended or oHeretl for sele. If, however, Ihe building or improvameM is
sold'within one yeer o; .:ornpletion, ihe owner-builder will have the burden of proving �hat he or she did not build or improve for purpose of sale.). �
❑ I, as owner of the�pmDerty, am EXC WSIVELV CONTRACTING WITH LICENSED CONTRACTORS b construct the prolect (Sec. 7044, Business and Protessions
Code: The conirectors Llcense Lew does not apply to en owner ol property who Oulltls or improves thereon, entl who wntracis lor such pmjeq with a contrecror(s)
license pursuant to the Conirectors License Laws.).
❑ I am axe pt r sec. Business antl Professions Code for this reason:
9�� rgr
Owner 10 ve' atl tlnve s icense. ❑ Yes ❑ No DriV�e"�'j .�i7"c �cnsa�No.. �
Venfication t nership by (rype ot document, i.e. - properry tau bill or daed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certity t�et no excavation five (5) or more feet in depih into which e person is required to descentl, will De made in connection with work authorized by this
permit, end that no builtling sirucNre, scalloltling, lelsework, or demolition or dismantling theraoi, will he more than thirty-siz (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title B, Callfomia Atlministrative Code). .
❑ As owner�builder, I wlll not employ enyone to do work which would require e permit irom the Division of Indusidel Safety, es noted ebove, unless such persan has a
pennit to do such work from ihe division.
Signature: Date: _ _
Division ot Industnal Satety Permit Numbec
CER7IFlCATE OF COMPLIANCE AND AIffHORVA710N OF ENTRY: I cenity under penalry ot perjury that I have read this epplicetion and state Ihat the information given is
correct. I ogree to comply wiih all state laws antl city ordinances relating to building construction, and auihorize representatives of ihe Ciry of Goste Mesa to amer upon the
ebove-described prop r ins ection purposes. I agree not to occupy or ellow acupancy of any building authonzed by �h' permity ntil final inspection.
2%i7/b �
gnallu�pq4Dufien�l- � 1:5 • ata
AndiOr Authorized Applicant Date
CODE 1. INSPECTIONTYPE
1616 Fized System Final Fire Prevention
1266 Pool Spe Finel
200 Finel Ra-Rool
201 FIneI BIocWReteining Wall
202
203
204
Final Factory Fire Place
Final Sign
Final Demolition
Qdjf, f�¢ 1C�U� INSPECTIONTYPE
206 Finel Mechanical
208 Finel Plumbing
210 Finel ElecMcal
212 Finel Fire Prevenilon
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
(714) 754-5273 • Fa�c (714) 754-4866 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 238 FAIRWAY PL
Suite No
Vicinity: REAR SFp
Parcel Nunmber: 43921308
Applicant: GREGORY, JOHN S
Address: 238 FAIRWAY PL
COSTA MESA, CA
Owner: GREGORY, JOHN S
Address 238 FAIRWAY PL
COSTA MESA, CA
Contractoc
Address:
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
Clarifier System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Ezpansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
OWNER-BUILDER
PLUMBING PERMIT
Phone: 949-722-8146
Zip: 92627-4612
Phone: 909393-8655
Zip: 92627-4612
Phone:
Zip:
License: 000000
Staius: ISSUED
Applied: 02/17/2005
Issued: 02/17/2005
ISSUED BY:
.. t �
_.gY. _ .
r �r ;y"b-
SCOPE OF PERMIT
CONSTRUCT A 332 SF IN-GROUND GUNITE POOL & 38 SF SPA. AT THE REAR OF AN EXISTING
SFD.
1 SWIMMING POOL, 1 PRIVATE SPA
REF: BOS•00296 . _
AMT
$23.50
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
FEESUMMARY
QTY AMT -QTY
Laundry Tub / Washer $0.00 0
0 Landscape Irrigation $0.00 0
0 P-Trap $0.00 0
0 Pressure Regulator $0.00-.- 0
0 Process Piping (per 10 ft) $0.00 ' 0
0 Receptars $0.00 0 '
0 Septic Tank $0.00 0
0 Sewer Cap for Demo $0.00 0
0 Sewer Connect $0.00 0
0 Sewer Private Line $0.00 0
0 �Shower $0.00 0
0 Sink, bar $0.00 0
0 Sink, commercial $0.00 0
0 Sink, Floor $0.00 0
0 Sink, kitchen $0.00 0
0 Sink, service/mop $0.00 0
0 Spa(private) $3025 �-.1
0 �Spa (public) $0.00 0
SumpPump
Swimming Pool
Trap Pnmer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toileq
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
AMT
$0.00
$60.75
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall aUtomatically expire and become void if work is not commenced within 180 days, or 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
requlred Inspections and final approval must be obtainetl. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626 , /
24a6-46(6/00)
WORKERS' COMPENSATION DECLARA710N: '
I hereby attirtn undar penalty of perjury one of Ihe following declarations:
❑ I have and will maintaln e ceniticete ot consent to self�lnsure for workers' wmpensation, as providetl tor by section 3700 of the Lebor Code, lor the pedormance of the
work for which this pertnit is issueA.
❑ I have and will maintain workers' compensation insurance, as raquired by section 3700 of the Labor Catle, for Ne pertortnance of tha work Por whiU Nis pertnit is issued.
My workers' compensation Insurance carner and policy numher are:
Carrier:
(This s�
ane
Policy Number:
or less.)
�'4 I certify that in the pertortnenca of the work for which Ihis permit is issued, I shall not employ any person in eny manner so as lo become subl� �o �he workers'
l compensation laws ol C fomia, end agree that if I should bacome subject to Ihe warkers' compensation provi5ions of Sectlon 3700 oi Ihe Labor Code, I shall forthwith
comply with these pr isi s. / �
Ap�i�aa�igne70r`e: _- oat.� 2/ ! i /OS
u
WARNI G FAILURE TO S E�N R�f S' C616� ATION CAVERAGE IS UNLAW FUL AND SHALL SUBJECT AN EMPLOVER TO CRIMI AL PENAL ES FNO CM� FWES UP i0 qJE HUNDRED
THOUSAND DOLLARE (5100,000�, �F77�DITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIOED FOR IN SECTION 3]O60F THE L4BOF CODE, INTEREST, AND AiTORNEI"S FEES.
IICENSED CONTRACTORS DECLARATION:
I here6y aNirm that I em licensetl untler provislons of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Professions Code, antl my license is in full
force end ettect. Lic. # Cless N
Contrector's Signemre: Dete:
CONSTRUCTION LENUING AGENCY:
❑ I hereby aNirm thet fhere is a constmction lentling agency for ihe peAormance of the work br which this permit is issued. (Sec. 3097, Civil Cotle).
Lentlers Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
1 �ereby aHirtn thet under penalry of perjury Ihat I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Protessions
Code: Any city or county which requires e permit fo construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such pertnit
to file a �Igned statement that he or she is Ilcensed pursuant to the pmvisions of the Contractors License Lew (C�epter 9(commencing with Section 7000) ot Division 3 of the
Business and Professions Cade) or that he or she is eaempt theretrom and the basis tor the allegad exemption. Any violetion of Section 7031.5 by any applicant for a pertnit
subjecis ihe epplicant to a civil penalry of not more ihan five hundred dollars ($500).):
�][�" � as owner of Ihe properry, or my employees with wages as iheir sole compensation, WILL DO THE WORK, end the strucWre is not intentled or ottered for sale (Sec.
"-7044, Businass and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves ihereon, and who does such work
himsalf or herselt or through his or her own employees, provided that such improvements are not intended or oHered for sale. If, howevar, ihe building or improvement is
sold within one year ot completion; the owner-builder will have ihe burden of proving that �e or she did not build or improve for purpose of sale.). �
❑ I, es owner of the property, am EXCLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to construct the projact (Sec. 7044, Business and Professions
Code: Tha contractors License Law tloes not apply to an owner of property who builds or Improves ihereon, and who contracis for such project with a contractor(s)
liconse pursuant b the Comractors License Laws.).
❑ I am e�mAt undet sec.
Business and Professions Code for this reeson:
�rivefs licens� ❑ ves ❑ No
Ownership by (type of daument, I.e. - property tac 6ill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cehity ihat no excavetion five (5) or more teet in depih into which a person is required to descend, will be mede in connec�ion with work authorized by ihis
permit, and that no building stmcture, scaflolding, talsework, or demolition or dismantling ihereof, will be more then ihirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title 8, CeliPornia Adminlsirative Code). �
❑ As owner-builder, I will not employ anyone to do work which would require a permit fmm the Division of Indusiriel Sefety, es noted ebove, unless such person has e
permit �o tlo such work from tha division.
Siqnawre: Date:
Division oF Intlustrial Safety Permit Number.
CERTIFlCATE OF COMPLIANCE AND AU7HORVATON OF EN7RY: I certiry under penalry of perjury that I have reatl this application and state that the iniormation given is
correct. I egree to comply with ell stete laws and ciry ordinances relating to builtling consiruction, and authorize representatives of t�e City of Costa Mesa to enter upon the
above-described prop ection ur oses. I agree noi to ocwpy or allow occupancy of any building authonzed by this yermit u I final inspection.
2//��d�
ignatur LegelOwner(s) � dDate,
i�
And/Or Authonzed Applicanl Date
COpE t. INSPECTONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spe Final
200 Final Re-Roof
201 Final BIocWRetaining Well
202 Final Factory Fire Place
203 Finel Slgn
204 Finel Demolition
u�rE ixrm��
cooe� wsvecnoxnre
206 Final Mechanical
208 Final Plumbing
210 Final Eleciricel
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupency
o�re ��
I�AC.l1�� ��
ISS
p�a� �sa-sz�s • Fax (714) 754-4856 • www.c�.cos�a-mesa.���LDING PERMIT
,labAddress: 238 FAIRWAYPL
Suite:
Vicinily: SIDE OF PROPERTY LINE
Parcel Number: 43921308
Applicant: GREGORY, JOHN S
Address: 238 FAIRWAY PL
COSTA MESA, CA
Owner: GREGORY, JOHN S
Adtlress 238 FAIRWAY PL
COSTA MESA, CA
Contractor: OWN ER-BUILDER
Address:
Zip:
Arch :
Address:
Zoning:
Phone: 949.722.8146
Zip: 92627-4612
Phone: 909-393-8655
2ip: 92627-4672
Phone:
License: 000000
Eng:
Address:
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 10/17I2002
Issued: 10I18/2002
ISSUED BY: �
Phone: Phone:
Zip: License: � License:
SCOPE OF PERMIT
CONSTRUCT SOLF, 6' HIGH BLOCK WALL ON THE RIGHT SIDE PROPERTY LINE SETBACK 20' FROM THE FRONT PER CITY STANDARDS.
Plan Check: $25.19
Permit: $38.75
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
inspection: $0.00
Total: $64.44
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0. 0
PARKING Existinq: 0
NOTES:
Rear 0- 0
Rear 0. 0
Re uired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0. 0
Lefl 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0- 0
s�,000.00
so.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (OM. No. 92-28, § 1, 12-21-92)
EXPIRA710N: This permit shali automatically exp(re and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inepectlons and final approvel must be obtained. Failure to obtaln inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALI: (714) 7545626
2aaaael�oo)
WORKERS'COMPENSAnON OECLARAnON: �
I hereby aHirm under penalry ol perjury one of the following declaratlons:
❑ I heve end will meintain e c9h���cate of consent to self-Insure br workers' compensation, es O�o�tled lor by section 3700 oi Ihe Lebor Cotle, for the peAormance of the
work lor whlch this permlt i5 Lssued.
❑ I have entl wlll maintein wwNers' compensation insurer�ce, ss requiretl by SecUon 3700 oi ihe lahor Code, for Ihe peAortnance ol Ihe wwk lor which tftls pemtit Is issuetl.
My workers' compensatlon Insu2nce cartier arM polity num�er ere:
Carrier.
no!
or less.)
Policy NumDer.
_� ( cenily t�el In Ihe pertortnance ol tha work tor which Ihis pertnit Is issued, I shall not employ any person in eny manner sa es to becwne suD�ect to Na workers'
compensatlon laws ol Celifomia, and agrae that il I should become sub�ect Io the workero' compensetion provlslons oi Sectlon 3700 0l ihe Lebor Code, I sha111oMwlth
comptywiththese visions. � �
F �p�p,��lkam�5lgneN.�ra:� Dele: �� �� O�.
ARNINW G: FAILUqE TO O�ERS' COAV�I ATION COVEMOE IS UMAWFUL AND SWLLL SUflIECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED
THOUSAN�DOLLARE( ,OO�,INAPDIiIqJTOiHEWSTOFCOAIPEN5AT10N,DAMAGESASPROVIDEOFORINSECTION3]OBOFTHEUBORCOOE,IMEREST,ANDAITORNEY'SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirm ihat I em licensed under provisions of Chapter B(commencing wlth Section 7000) ot Division 3 of ihe Business ond Professlons Code, and my license is In full
iOfCB 0fld BHBCI. UC. M CIB39 N
Gomrectofs Signawre: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eflirm thet ihere Is a cwistrucGon lentling agency br Ihe pedormanco of the work br which this permit Is issued. (Sec. 3097, Civil Cotle).
Lentler's Neme: Lentlefs AAdress:
Sipnature: Oate:
OWNER•BUILDER DEGLARA710N5:
I hereby eflirm t�et untler penalry ot perjury thet I am EXEMP7 FROM THE CON7RAC70R5 LICENSE LAW for t�e tollowing reason (Sec. 7031.5, Business end Professlons
Code: Any city or counry which reGuires e pertnit to consWct, fllter, imprwe, demdish, or repair eny sirucWre, pdor to its issuence, elso requires ihe appliwnt tor such permit
to ille e signetl stetement thet he or she is licensetl pursuent to the provisions ol the Contrectors License Lew (Chepter 9(commenUng with Section 7000) of D'Msion 3 of the
Business and Professions COAe) or lhat he or sha is axempt tharefrom enC Ihe besis for the elleged exemption. Any violetlon ol Sectlon 7031.5 by any epPlicant for a permit
sublecis ihe epplicant lo e dvil penalry af not more than live hundred tlollers (5500�.):
❑ I, es owner af Ihe propeny, or my employees wilh weges es lhelr sole compensatlon, WILI DO TME WORK, and the structure is not Intendetl or ottere0 for sele (Sec.
7044, Business and Professions Cotle: The Coniractors License Lew does noi epply �o an owner of propehy who builds or improves ihereon, and who does such work
hlmself or herself or lhrough his or her own employees, provided ihat such impmvemenis are not intended or oMered tor sele. If, �owever, Ihe building or Imprwement Is
soltl wi�hln one year ot completion, the owner-builtler will have the burden of proving that he or she did no� builtl or imD�o�e for purpose ol sale.).
❑ I, es owner ot the pmperty, Am EXCLUSIVELY CONTRACTiNG WITH LICENSED CONTAACTORS to construct ihe project (Sec. 7044, Business and Professions
Cotle: coniractors Llcense Lew does not appy to an owner ol proparty w�o builCs or impmves Ihereon, entl who contrects br such project wi[h a contractor(s)
_ li se.pursuent to the CoNrectors License Lews.).
Busine55 Bnd Professians Code for �hi5 reeson:
Owner ID ve ' ie� drivers licens� Yes ❑ No
VedllcaHon a ersNp Dy (type ot Oaum �.e. - property tax hlll or tleetl):
DIVISION OF INDUSTRIAL SAFET' PERMI7 CER7IFICATION:
❑ I hereby certlty that no excevetion Me (5) or more teet in tleD�h Imo which e parson is requireA to descend, wlll be matle In connecUon with work authodzeE by thLn
permlt, and that no bullding 5��ucture, sceilolding, lalsework, or tlemolition or tlismantling thereot, will be more than Ihirry•six (38) teet �Ig�. (C�ep. 32, Grp 2, AM1 2, SeC.
337, Title B, Celllomia Atlmin�stretive Code).
❑ As owner-bullder, I will nol employ enyrone to da wark which woultl requlre a pormil Irom Ihe Division ot Intlusinel Safery, es notetl ebove, unless such person hes e
pormll lo do such work Irom �ha divislon.
Signature: Dato:
Dlvision o� Industrlal Solaty Permil Number.
CERTIFlCATE OF COMPLIANCE AND AUTHORVATON OF ENTAY: I cenity under penalry of perjury thet I heve reed this epplication antl state that Ihe Informatlon given is
correct. I agree to compty wlth ell state laws end dry ordinences relatlng to builGing construction, entl eNhodze representatives af tha Clry of Costa Mesa to enter upon the
abave•described pro erty br insp�ctlon Quryases. I agree not to occupY or ellow occupency ol eny �uilding euthorized hy�� pprmit u til line�pection.
'SignB)'uF" CegalOwnerSb) ����lpate '
" AnNOr Authonzed Applicent Oata
COOE �. INSPECTIONTYPE
1816 Flxetl System Final Fira Prevenilon
1286 Pool Spe Finel
200 Final Re-Root
201 FInaI8locWRetaining Well
202 Final Fectory Fira Place
203 Finaf Sign
20d Final Demolition
P� I[{�l@
�7'�/'
�QQE2 INSPECTION TYPE
206 Final Mec�enical
208 Finel Plumbing
210 Finel Elocirical
212 Finel Fire Prevention
220 Final Planning Appro�al
222 Finfll Slte �
250 Finel BulldindOccuoern
PAIF ItlD�dlffi
• T}flS SI�TQi LS FOR INFORMATfONAL WRPQS6
ONLY. APPIJGM LS RFSPONSIBLE FOR PROVIDIIJG
AN ACCURATE REPRESFNI'ATION OF 1}�Qt PROPERTY
QJ CASE 7HE Sl-lAPE AND SIZE DO N07 ODRRFSPOND
WIfH THE INFORMA170N PROVIDID ON 7}ffS SFffiEl'.
i
�
T
C
16
1
��� —d� %U 7
• SOLD WALLS/FFNCFS BEIWEIN 2'�6• k 6' QJ FIDGtfI' SHALL
BE SEI'BAIX AT IFASf 10' FROM FRONf' PROPFRIY LINE.
• 90LID WALiS/FFNQ�S SFIALL N07' S%�D 2' 6' IIJ k�IC}fC
WII}�I10 OF'It� FROM PROPFRTY IlNE �10T NRB IINE7.
• VERffY DLSTAN� FROM NRB TO PROPEfC�Y LINE
AND SfiOW ON P[AN. VERIF7Gl10N FROM li� Q7Y5
ENCINFFRNIG DIV6fON S REQU6tED. ULL (711) 754Si�3
POR IIJFORMATfON.
�.tttt`L.Y tl 1li� (•�f �..' ,'
� nr rrcT ,.-.. _ Ti�'„ -o��r'.,...,. _ ' -
�IIVIW
PLANNING DIV. E APPRv'Fil R.V
L;. BLDG. DEPT, REG ...s,j� fJ ,.!
�
�P.�/�7 2 CA
0
n�sse 4����
--- -- � ����.
' ditisYts�sNi�
d ��i�
RE90ExfF
�1.�.LJ
�
�i J '
i
�(�
I" M9IFNQ
N� �
1
1
lU
f�
OVE
8
Co4�
�
t
��
RC90EMCC �
""""'""""'" I
_ �
_ �3� �'U��STREET
�Q(.�-GQ.
BLOCK WALL LAYOUT FOR BUILDING PERMIT
PLANNING DIVISION
�6
��
,r I
'� I
TYPICAL 6�� CONCRETE BLOCK FENCE
Cemem Coping Optianal �
C�annel8bck With 1�3/8�
Hori:onul Top ol all
Fencn
For Fence� 5' ar less
Ven. Bars 3/8"¢ at 4' �0" O.C.
For Fences HigAer Than 5'
Vert. Ban 3/8"Q at 32" O.C. �
Fill Cells Solid With Grou1
Where $Ieel OCcun
Rnninrcing Sleel $hall
Cunlorm �o Sec.A�15�39
A.S.7.M.
All S�eel to be Lapped
24" or to Code
NATUHALGRADE
TWO 7/8"d BARS �-1
CONTINUOUS TOV I
6 BOTTOM y_�
HOQIZSTEEI MUST BE T1E01N
PLACE AT TIME OF TRENGH
INSVECTION.
a
0
a z
V '-
�
Y W
R I
a
> z
e
i �
.�
yA 'U ry
_ en - -
�-►— W IDT F
� SEE CN�
L BE�OW
o ^ I
�+—•--� '�', �
^ �
_ �•
WIOTH
THICKNES$ .
OEPiH OF EARTHTOOTH
SPACING OF EARTHTOOTH
14
10"
24"
12'
.. [' � �- ,
a: ;
=00TING�'RE�UIREMENTS CHART
' 5
�" :' � . 14" .
:i " 10"
20"
- 14� .
�U��D��l� DI 7 �.7I��
12"
9`
16"
16'
GENERAL- NOTES
MORTAR: p�e part Plastic Cement, and
Three Parts Sond
GROUT: One Port Cemenf Three ana
One Holf Ports �and
COPING: One Part Ctmeot, Three
Parfs Sond
CO!vCRETE: Wen Mned C2-I/2:3-I/2
Mar of 7- I/2 Gal;cns of
Watar Per Sack ol Cemenl
GROUT MAV BE POUREU FROM THE TOV
OF TME FENCE IN CELlS WHERE STEEL
OCCURS.
CELLS AND AREASOF NOHIZONTAL REIN
FOHCEMENT SHALI BE CIEAR, CLEAN 6
FREE OF ALL MORTAR DEBR15, ETC.
11,.�' [4RTHTCOTH
V. fHE ME�GTN Of �ENCE
�IOW BOTTOM O� iOGT�NG
SCALE: I/2�� = I
12"
8"
12�
16'
(714) 754-5273 • Fa�c (714) 754-4856 • www.Ci.Costa-mesa.Ca.uS 77 FAIR DRIVE, COSTA MESA, GA 92626
BUILDING PERMIT
Job Address: 238 FAIRWAY PL
Suite:
Vicinity: NEW FRONT PORCH & NEW PATIO @ REAR
Parce� Number: 43921308
App�icant: GREGORY, JOHN
Address: 238 FAIRWAY PL
COSTA MESA, Cq
Owner: GREGORY, JOHN
Address . -238 FAIRWAY PL
COSTA MESA, Cq
Contracror: OWN ER-BU I Lb ER
Address:
Zip:
Arch :
Address:
Phone:
Zoning:
ISSUED BY:
Phone: (949) 548-8828
Zip: 92627
Phone: (949) 548-8828
Zip: 92627
Phone:
License: 0
Eng:
Address:
Status: ISSUED
Applied: 04/23/2001
Issued: 04/23I2001
Phone:
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT NEW 99 SQ FT PATIO COVER ATTACHED TO REAR OF EXISTING SINGLE FAMILY RESIDENCE AND 65 SQ ,
FT FRONT PORCH. ' �
Plan Check: $54.11
Permit: $83.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $137.86
�. � ;� �
SETBACKS� � �.
MAINSTRUCTURE Front 20-0
ACCESSORY Front 0- 0
PARKING Existinq: o
NOTES:
Rear 11- 0
Rear 0- 0
ReQuired: 0
FEE SUMMARY
PLANNING & ZONING
Left 74-6
Left , 0- 0
Pr000sed: 0
Calc Valuation:
Claim Valuafion:
i
� ��'. �
� %�/
i
Right` 10-0 . %
Right 0- 0
$2,643.68
so.00
NO710E: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92•2B, § 7, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void iF work is not commenced within 180 days, or il work is suspended or abandoned
for a periotl of 780 tlays.
INSPECTIONS: In order tor fhe work authonzed under this permit to be considered Iegai, such work must compty with all applicable codes, and all
required Inapectiona and finel approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration.of this permit.
FOR INSPECTIONS CALL: (714) 7545626
244W8(fi/00)
WORKERS'COMPENSAnON DECLARATON: �
I hereby aXirtn under penalry o� perjury one of ihe following tleUarations: �
❑ I have end will meintain a certlliwta ot consent to sell-Insure for workers' compensetion, es proWtled tor by section 3700 of the Lebor Coda, br the pertortnance o1 the
work for which this Dertnit is issuatl.
❑ I have entl will maintain workers' compensaGon Insurance, as required by sectlon 3700 ot Ue Lebor Cade, tor tha padortnance of the woAc for which Ihis permit is Issued.
My workers' compensation Insurence wrrier entl policy number are:
Cerner. Policy Number.
(Th/s sec(ion neetl not be canpleted i/ the permit is valuetl at one hundred dollars (5700) or less.)
❑ I certily Ihat in the perlormance ot ihe work for which Ihis permit is issued, I shall not employ eny person In any manner so as to become su6ject to the workers'
compensetion laws of CB�Ifomla, antl agrea Ihat if I s�ould become subjact to the workers' compensation provisions of Section 3700 oi ihe Labor Cotle, I shell forthwith
comply with these Dmvisions.
Applicnnt SlgneNre: Data:
WARNRICv FAILURE TO SECURE WORKERS' COMPENSATION CAVERApE IS UNLAWFl/L AND SHALL SUflIECT AN EMPLOVER TO CRIMINAL PENALTIES AND dVIL FWES UP TOONE HUNDRED
THOUSAND DOLLAqE (5100,000�, IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O6 OF THE IABOF CADE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aftirm that I am licensdd untler provisions oi Chapter 9(commencing wlth Section 7000) ol Divislon 3 ot che eusiness and Professions Cotle, antl my license is In full
force and eHecL Lic, a Class N
Contractors Signature: Dete:
CONSTRUCTION LENDING PGENCY:
❑ I hereby aHirtn thal there is a consiruction lending agency for ihe peAormance of ihe work lor which ihis parmit is issuetl. (Sec. 3097, Civil Code).
Lentlels Name: Lendefs Adtlress:
SignaNre: _
OWNER-BUILDER DECLARATIONS:
Date:
I hereby etfirm t�et under penalry oi perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Busine5s end Proleulons
Code: Any ciry or county which requires e pertnit to construct, alter, improve, tlemolish, or repair eny strucWre, pnor to its issuance, also requires ihe epplicaN for such permit
to tile a signa statement that he or sha Is licensed pursuant to the provisions of the Comracrore License Lew (Chepter 9(commencing with Saclion 7000) ot Divislon 3 of t�e
Business Protesslons Coda) or that he or she is eaempt therefrom and the basis for the alleged exemption. Any Wolation oi Section 7031.5 by eny applicant tor a pertnit
subje he eppllwnl to a civil penalry ot not more ihan five hundred tlollars ($500).):
I, ias dwner of the properiy. ar my employaes with wages as iheir soie compensation, WILL DO 7HE WORK, and Ihe simcNre is no� intended or oNered for sale (Sec.
---7044; Business and Pmf�ssions Code: The Contractors License Law does not apply to en owner ol property who builds or improves thereon, antl who does such work
himself or herself or IhroUgh his or her own employees, provided ihat such improvements are not In�ended or oHered for sale. tl, howaver, the 6uilding or improvement is
sold within one year ot completion, the owner-builder will have the burtlen of proving ihat ho or she did not build or improve for purpose of sale.).
0 I, es owner ol ihe property, am EXCWSIVELV CONTRACTING WIiH LICENSED CONTRACTORS to consWct the pmject (Sec. 7044, Business and Pmfessions
Coae: ihe contractors LiCanse Law tloes not eppiy �o an owner o1 property who bullds or improves Ihereon, antl who coniracis tor such project with a conhectorjs)
liconse pursuant to ihe Coniractors License Laws.).
❑ lem
Owner ID ven
Verifl[etlon of
Business and Protessions Code br this reeson:
license. ❑ ves ❑ No
by (type of document, i.e. - pmperty �ax blll or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIGICATION:
�ers Licanse No. _�
❑ I horeby certify Me� no ex��ation five (5) or more taet in depih into which e person is requlre0 to descend, will be made in wnnection with work authodzed by this
permit, antl t�at no builtling sirucNre, swftolding, talsework, or demolition or dismentling �hereot, will ba more �han ihirry-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
34i, Ttle B, Calitomia Atlministrative Code).
❑ As owner-builder, I will not employ anyone to tlo work which would require e permil irom ihe Division ol Industnel Safety, as noted above, unless such person hes a
permit to do such work trOm ihe division.
Signature: Date:
Division ot Induslnal Sefe�y Permit Number:
CERTIFICATE OF COMPLIANCE AND AU7HORIZATIONOF ENTRV: I certify under Oenelty of perlury ihat I have �ead this application antl state �hat the inlormetion given is
correct. I agree to comply with all s�ate laws end ciry ordinances relating to building consiruction, and euthodze representatives of ihe City of Costa Mesa to enter upon Ihe
above�describ tl property for inspe ie pases. I agree not to occuDY or ellow occupency of eny building authorized by this permit until finel inspection.
� Signature Ot Lega. wner Date }
qnNOr Authorizad Applicam Date
CO�E I, INSPEtnoNiYVE
1616 Fixed System Final Fire Pravention
1266 Pool Spe Final
200 Final Re-Roof
201 Finel BIocWReteining Wall
202 Final Fectory Fire Place
203 Finel Sign
204 Final Damolition
o"re' ItIIID�LS
�� �
//���J• / ���' 7/
y00E� INSPECiIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Finel Electrical
212 Final Fire Prevention
220 Finel Planning Approval
222 Final Site
250 Final BuiV
IIdIE
�
�im.
6
S�,w�
�, ��Y
1
�
m
�►Rw�Y �c�
rOi
� ji� 'P �.� � 9cM-� = �I6 = i -o
,
'• "= ;.
. -
�.
. �.
�� n
�a 71�11���
CITY OF COSTA MESA
PLANNING DIV.
SUB ECT TO BLD . DEPT. REG.
6YG�4��G�G�'ZI� I/neTr 1� �22
NOTE
� ADDITIONS, DELETI�NS, OR CORRECTIONS SHALL
BE APPROVEDi13Y THE PLANfVIN� DIVISiON
`^— -._. - - _ _
Mc 8 Mrs. John Gregory
238 Fairway Place
Costa Mesa, CA 92627
'; � �tion i �an+ ��cY1
23`d �cz'�rvx� YI.
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DNISION OF BUiLDING SAFE7'Y
C1TY OF COSTA MESA
APPROVED
�r f/►� c o�e 4_I� I
� ;xis sel ot plens 8nd spedtkalion.s MUST be kept on Nis job al all times and fl is w
�{.l(7Tf�� �r^keanyd�angesaallereliononsamewAlbWwriltenpem�ssiaifromlheDNisanoi
�d Salery, C)ty of Costa Mesa.
he stert�ping af this plan and spa!tifiratiau SHAII NOTba held to permil orto be an,
_ . fthe'{' .. �
vw atron ot any provisions of any Ciry oi Cost2 Mesa OMmance anNor ,
*ese c�ar:: and permit sheli e�ire bp f'unila�ron and bscome nu� and void if the 1
l5 OC? CQ!f!fqP�-(?r�?�� moi+f.fnnA?,.1=�n u� I.IPn �o�� IA1 Wlth�r} 1Q� (�c�'F 0�
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"I 201t�s,R00F CONNECTION
DETAILS
CONT,
LEDGER
CONT.
LEDI
ID BLOCK
i/2�� DIA. X 5�� LAG SCR
AT 32��� O.C.
DETAIL I
CR B CL ��TECO��
�RIPS OR JOIST
�#ANGER
rfR
3Ig° DIA. X 5�� LAG SCR.
nT �g" o.c.
DETAIL 2
,Ot�OR LIGHT WEIGHT ROOFS
ONLY CONNECTION DETAILS
2��X FACIA-MIN.REQ.
RAFTER
APPROVED METPL
HANGER
DETAIL 3
��r.,�Pn�tar .
sm�rrcFs n�.urir�tar
BUILDI�IG Sl1FEPY DIVISION
OWNER: �To}'�n G���
AODRESS� 234, ��rwc�� PL
CONTRACTOR: �N�bUi�o�2.
AODRESS�
RAFTERS
CARPORT, PORCH OR PATIO
NOT SUPPORTING CEILING
SIZF. SPACING SPAN
2"x4" 12"O.C. 9'-6"
16" S'-0"
24" 6'-6"
32" 6'-0"
48" 5'-0"
2"x6" 12" 16'-6"
16" 14'-6"
24" 12'-0"
32" 10'-6"
48" .8'-0"
2"x8" 24" 15'-6"
32" 13'-6"
48" 11'-6"
4"x6" 24" 17'-0"
32" 15'-0"
36" 14'-0"
4"x8" 24" 21'-0"
32" 19'-0"
36" 18'-0"
48" 16'-0"
4"x10" 32" 22'-0"
36" 21'-0„
48" 20'-0"
72�� 1��_0��
PATIO COVER
TYP. PLANS
DATE � `�/'��J��
PHONE � �`�'����gz$
LIC. N0.
PHONE:
RAFfERS APPROVED FOR
LIGHT WEIGHT AOOF COVER OF gUILDINC PERMIT
LATH, FIBERGI,ASS, ALUM,
By Da[e
SIZE SPACING SPAN
2"x4" 16"O.C. 9'-6"
24�� 8�_���
32" 6'-6"
48" 5'-6"
2"x6" 16" 16'-6"
24" 14'-6"
32". 12'_0"
_ i.on ,n�_nu
24" 19'-0"
32" 15'-6"
48'S 13'-6"
HEADERS
LIGHT WEIGHT ROOF ONLY
� POST SPACING
6 � -0��
4x6 9'-0"
4x8 12'-0"
4x10 15'-0"
CARPORT,
4x6
PORCH OR PATIO
POST SPACING
$ � _0'�
8' -0��
10'-0"
12'-6"
GENERAI. NafES:
1. These plans must be
kept on [he job at
all time during
constructian.
2. All feaming [o be
Douglas Fir N� �
grade minimum.
3. Raf[ers may not
a[tach to facia ex-
cept for l0�roofs
as shown on details;
2Qlysroofs mus[ use
a cantinuous ledger
attached as shown
on details Jilt�r`2.
4. LLght weigh[ roofs
may attach to facia
for 14' span max.,
spans over 14 must
use a continuo�s
ledger as shown in
detail 1�3.
� �UU �19�U
NOTE� SHOW AND DIMENSION PROPOSED
PATIO COVER AND YARD AREAS
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FOR POST- BEAM
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� WOOD FLOOR
CONSTRUCTION
SIDE ELEVATION
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PLOT PLAN I CONSTRUCTION DETAILS
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(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DfiIVE, COSTA MESA, GA 92626
BUILDING PERMIT
Job Address: 238 FAIRWAY PL
Suite:
Vicinity: NEW SWIMMING POOL & SPA
Parcel Number: 43921308
Applicant: GREGORY, JOHN S
Address: 238 FAIRWAY PL
COSTA MESA, CA
Owner: GREGORY, JOHN S
Address 238 FAIRWAY PL
COSTA MESA, CA
Contractor: O W N E R-BU I LD ER
Address:
:'�'
Arch :
Address:
Phone:
Zoning:
Phone: 949-722-8146
Zip: 92627-4612
Phone: 949-722-8146
Zip: 92627-4612
Phone:
License: 000000
Eng:
Address:
Status: ISSUED
Applied: 02/17/2005
Issued: 02/17/2005
ISSUED BY:
�- �';
" a S
� �, :� � bL` 6L� 9•e—=
���
-:� �`,.�—"'��.`�-T
Phone:
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT A 332 SF IN-GROUND GUNITE POOL & 38 SF SPA. AT THE REAR OF AN EXISTING SFD.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
$320.29
$492.75
$3.50
$0.00
$0.00
$0.00
$816.54
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0-0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0-0
$35,000.00
$35,000.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements 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 780 days, or if work is suspended or abandoned
for a period of 180 days.
INSPEC710NS: In order for Ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626 /
2aasas (sroo) ( _
WORKERS'COMPENSAnON DECLARAnON: �
I hereby attirm under penalty ot perjury one of the following declarations:
❑ I have and will meintain a certificate of consent m self-Insure for workars' compensation, as provided for by section 3700 of ihe Lebor Code, tor ihe pertormence of the
work for w�ich this permit is issuetl.
❑ I have antl vnll meintain workers' compensation insurance, as requiretl by seIXion 3700 ot the Lehor Cade, for ��e perfortnance of the work for which this pertnit is issuetl.
My workers' compansation Insurance carrier antl policy number are:
Carner: Policy Numbar:
(This�Soction need not be completed il the permit is velued at one hundred dollars ($100) or /ess.)
!� I cetlify ihat in the pedormence of the work tor w�ich this percnit is issuetl, I shall not employ any parson in any manner so as to bacome subject ro the workers'
compensetion laws of Califomia, and egree ihat If I should 6ecome sublect to the workers' compensation provisions oi Section 37 0 of the Lebor Code, I shell totlhwith
camply wi�h ihese v' n5.
A�,-,r�,�s� �„re: ��- 2�i 7 o S
WARNING: FAILURE SE WOFKERS' CAMPENSATI DVERAGE IS UNLAWFUL FND SHALL SU&IECi AN EMPLOYER TO CRIMINQ PE LTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSANDDOLLA ($1 , f,�NA�DITIONTOTHE. TOF('qN,PENSATION,DAMAGESASPROVIDEDFORINSECTION310fiOFTHEL4BOqCODE,IMEREST,ANDATTOflNEV'SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm ihat I am licensed under provisions of Chapter 9(commancing with Section 7000) of Division 3 ot �he Business and Professions Code, and my license is in full
fome and effecL Lic. # Cless N
Comracbr's SignaNre: Date:
CONSTRUCTION LENOING AGENCY:
❑ I hereby aHirm that there is a constmction Iending agency for the pedormance of the work for which ihis permit is issue0. (Sec. 3097, Civil Code).
Lenders Name: Lendefs Adtlress:
Signeture: Date:
OWNER-BUILDER DECLARATONS:
I hereby aHirm ihat under penalry ot perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Protessions
Code: Any city or county which requires a permit to constmct, elter, improve, demolish, or repair any structure, prior to its issuance, also requires ihe epplicant for such permit
to tile a signed statementlhat he or she is licensed pursuent to the provislons of the Contractors License Law (Chapter 9(commencing with Section 7000) ot Division 3 of the
Busineu endp� ofessloris.Code) or Ihat ha or she is exempt theretrom end the basis for the alleged e:emption. Any violetion oi Section 7037.5 by any epplicant for a parmit
suhj t�pplicant to e cl�ll penzliy of ribt more than five hundred dollars ($500).):
�� I, as owner of the pmperty, or my employees with wages es their sole compensetion, WILL DO THE WORK, and the simcture Is not intende0 or oHered for sale (Sec.
7044, Business and Protessions Code: The Contractors License law does not apply to an owner ot propeny who builtls or improves thereon, and who does such work
himself or herself or through his or her own employaes, pmvided ihat such improvemems ere not intended or oHered for sale. If, however, the building or impmvement is
sold within one year ot completion, the ownerv6uiltler will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I, as owner of t�e property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the proleci (Sec. 7044, Business and Professions
Code: The coniracmrs License Law Aoes not apply to en owner ol property who builds or Impmves Nereon, end who coNracts lor such project with e contractor(s)
license pursuant to the Comractors License Lews.).
❑ I am e under sec. 8usiness end Protessions Code for this reason:
iuie:
Owner ID ve fied ver's license. Ves ❑ No Dn�sL'fCBn567No:�-�
Vedfication o ership 6y (type of tlocumen6 i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
� I hereby certify that no excavetion five (5) or more feet in depih into which a parson is requlred to descend, will be matle in connection with work authonzetl by �his
pertnit, antl that no building sirucNre, scaHolding, falsework, or demolition or dismantling thereoi, will be more than thirty-six (36) teet high. (Chap. 32, Gry 2, Ah 2, Sec.
341, Title B, Californie Administrative Code). �
❑ As owner-builder, I will not employ enyone to do work which would require e permit irom the Division oi Industrial Safery, as noted above, unless such person hes e
pertnit to do such work from the division.
Signature: Date:
Division of Industdal Safery Permit Numbec
CERTFICATE OF COMPLIANCE AND AUTHORIZATON OF ENTRY: I cenity under penalry of perjury ihat I have read ihis application and state that the informa�ion given is
correct. I agree to comply with all state laws and city ortlinances relating to building consWction, and authonze representatives of the Ciry of Costa Mesa to enter upon the
ebove-descnbed y �or inspection purposes. I egree not to occupy or allow occupancy of eny 6uilding authorizetl by this ermit u� I fi�al��pection.
2 l -7 (�S
Signature • a:Owne g1 • le,
AnNOr Authonzetl Applicant Date
COOE �. INSPECTIONTYVE
I616 Fixed System Final Fire Prevention
7266 Pool Spa Final
200 Final Re-Roof
201 Finel Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
RTE 11L1RIAL5
. (� 1 � %i.
E 1 INSPECTION TYPE
20fi Final Mechanical
208
210
212
220
Final Plumbing
Final Electrical
Final Fire Prevention
Final Planning Approval
222 Final Site
250 Final Building/Occupancy
onre IIR�LdLS
� � � 5ar� c�. �orion
Specinl /nspectron Sernices
6232 Kiowa Road • Westminster, CA 92683
Joint Cettified
ICBO Rc�inforced Concrete
ACI Concrete Field Tech
I.icen�e #0_S�Rfii
Ph 714-895-1344
Fax 714-899-5684
Mobile 714-309-7304
L-maingnAiowaQa verizon.net
Insured
REGISTERED INSPECTOR'S DAILY REPORT �ob No. Da(e._ 8 DS rme
TYPE OF ❑ Reinforced concrete ❑ Structural Steel Assembly ❑ Quality ConVol
INSPECTION ❑ Post Tensioned Concrete fr.l Gunite ❑ Epoxy
REpUIRED ❑ Reinforced Masonry ❑ Shot crete ❑ Other
o ress „8�, !��-� - � City /1
'�.:' = M rT �._----� C...O
JoD Name " Permit�Na I sueG By _
I ,.�;c�1.%3o,s.; 2 �—"
� . _ .. _ .,,,
7ype af SirucNre Arc iTi �i"���
Ma[enal Descnption (rype. gratle, soume) Ergineer
G �
Contractor O
/� �
Inspec�Or(s) Name Subcontractor
� �
TESTS PERFORMED
TYPE OF SAMPLE SLUMP �UANTITY IN SET ADDITIONAL REMARKS ON SAMPLES
5
/
INSPECTION SUMMARY -LOCATIONS OF WORK INSPECTED, 7EST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROCaRESS, REMAqKS, ETC.
INCLUDES INFORMATION ABOUT - AMOUNTS OF MATERIAL PLACED OR WOqK PERFORMED, NUMBER, TVPE 8 1DENT. NO'S
OP 7ES7 SAMPLES TAKEN: STRUCT, CONNECTIONS (WELD MADE H.L BOLTS TOROUED) CHECKED; ETC.
'y - �
— 5
r J
O�Svi¢.5
, � �
CONTINUED ON NE%T PAGE � PAGE � OF_�
OF
TIME IN I TIME OUT I pEG. HOURS I O.T. MOUflS I SAMPLES
All inspections basetl on a minimum of 4 hours antl over a hours - 8 hour
minimum.
� � � -r � _ _ — � qpprwe0 Cy
NO AGENCV Prqect SuperintenEent
WHITE - CITY'S COPY, CANARY - ACCOUNTING COPY, PINK - INSPECTOR'S COPY
�� .. 'v .. . `
Job Address_
Name_��
Residence Address
Laboratory �
Address � �e
=CIAL INSPECTOR REGISTRATIOh
Number tY Jt�et
(„Fl�s �,.�� �'A S?�81
City State Zip
All ticenses listed below must be currently valid and legible copy(s) and must be attached to this registration.
DISCIPLINE
CONCRETE
DUCTILE MOMENT
RESISTING FRAMp
REINF00.CING STEQL
PRESTRESSING STEEI
WELDING
HIGH STRENGTH BOLTING
STRUCTVRAI
MASONRV
REINFORCED GVPS4M
CONCRETE
INSULATING CONCqETE
SPRAVE� ON FIRE
GROOFING
PILINGS, DRILLED PIERS,
CAISSONS
SPECIAL GRApING,
E%CAVATION OR PI�LING
SPECIAL CASES
UNUSVALNA2Aq05
L.A. COUNTV
�!�
L.A. CITV I ORANGE COUNTY I OTHER
�!
I hereby certify that I am qualified by training and experience to perform the inspections for which I hold
the above Iisted Sp�cial Inspectors licenses, and will provide all certifications required by the City of Cosia Mesa.
I will inspect and c�rtify the following procedures:
I will certify not only to the job conditions but that they are in conformance with the approved plans. If at
any time, progress occurs on the above mentioned job relating to my area�s) of responsibility, without my knowl-
edge or approval, 1 Will stop the jobs progress immediately with notification in writing to the job superintendent
and notify the Bui�ding Division of the situation. A record of my tests and/or inspections as agreed to above will
be available upon request by the Building Division. Upon request I will submit a complete package of testing and
inspection results. A letter certifying satisfactory completion wil�e pr�ovide�yy-me�pon completion.
This registration is accepted and approved by:
(Plan Check Engineer)
Official)
(Date)
CMF1068�46 W�Ite-BuiltlinqDivision; Canary-SOeclallnspectar; Vink•Oeveloper
�s:�
� , . �
t . � y R�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.c��ILDING PERMIT n FAIR DRIVE, COS7A MESA, CA 92626
Jobnddress: 238 FAIRWAY PL
Suite:
Vicini[y: DETACHED
Parcel Number: 43921308
App�icant: GREGORY, JOHN S
Address: 238 FAIRWAY PL
COSTA MESA, CA
Owner: GREGORY, JOHN S
Address 238 FAIRWAY PL
COSTA MESA, CA
Con tractor: O W N E R-B U I LD E R
Address:
Zip:
Arch :
Address:
Zoning:
Phone: 949-722-8146
2ip: 92627-4612
Phone: 90&393-8655
Zip: 92627�612
Phone:
License: 000000
Eng:
Address:
Status: ISSUED
Applied: 12/15/2003
Issued: 12I15I2003
��
�� i
•- r/
EXTENSION
ALLO D
PER_� �
EXPIRES 9/o a
Phone: Y� !� � � J,�� Phone:
��V� .
Zip: License: �A License:
SCOPE OF PERMIT
REPLACE GARAGE SIDING AND STUCCO. ADD NEW PLYWOOD SHEAR P,SNELS TO EXISTING WALLS AND REPAIR EXISTING FRAMING.
Plan Check:
Permil:
SMIP Res:
SMIP Com:
Other.
Inspection:
$0.00
$125.25
$0.60
$0.00
$0.00
$0.00
Total: $125.85
SETBACKS
ACCESSORY
PARKING
NOTES:
Front 0- 0
Front 0- 0
Existinq: 0
Rear 0- 0
Rear 0- 0
Re uired: 0
FEESUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
ss,000.00
36,000.00
NOTICE: The work authorized by thig permit shall comply with all applicable handicap access requiremenis undar Califomia statutes and related
regulalions. (Ord. No. 92-28, § 1, 12-21•g2)
EXPIRATION: Thls permit shall automgtically expire and become vold it work Is not commenced within 780 days, or if work is suspended or abandoned
lor a period of 180 days.
INSPECTIONS: In ordar tor the work aulhorfzed under this permit to be considered legal, such work must comply with all epplicable codes, and all
requlred Inepeetiona and final approvel must be obtained. Failure to obtain inspections and final approval will result in the axpiration of ihls permit.
FOR INSPECTIONS CALL: (714) 7545628
zaaa+e �eroo�
WOHKERS'COMPENSAnON DECLARAnON: � � '
I hereby eHirm under penalry of perjury one ol Ihe fWlowing declarations:
❑ I heve entl will meintain e cenificete of wnsem lo selbinsure tor workers' compensatlan, es provitletl for 6y section 3700 0l Ihe Labor Cotle, tor the peAortnance ot the
work tor which this permi� is issuetl.
❑ I liave antl will malntain workers' compensaUon insurance, es required by section 3700 of tha Lebor Code, tor Ihe peAortnance of Ne work for whkh this pertnit is iswed.
My workers' compensation Insurence wrtier end palicy number are:
Carrior. . policy Number:
(This tlon need no( be corqp�eted i! the permil ls valued e( one hundred dollers ($100) or /ess.J
1 certity thet in Ihe peAoimance of tha work br which this pormil is issuetl, I shell not employ eny person in any manner so as to bocome subjact to Ihe workers'
compensation laws ol Califomia, entl apree Ihet If 1 should bewme sub�ect to the workers' compensation provislons of Sectlon 3700 0l t�e Lebor Cade, I shell forthwith
comply with these pro�iJj90 �2 j/� �03
Applicant Slpneture: %�% Dete: �
WARNINO: FAILURE TO S ORKER$' IPENSI1T10N COVEMGE IS UNL4WFUL AND SHALL SU&IECT PN EMPLOVER TO CRIMINAL PENALTIES AND CNIL FlNES UP TO ONE HUNDRED
THOUSAND DOLIARE (51 . 0�, �N ADDRION TO THE COST OF COMPENSATION, UMAqGES AS PROVIDED FOii IN SECiION 3"lOfi OF THE UBOR CODE, IMEREST, FND ATTORNEI"5 FEES.
LICENSEDCONTAACTORS DECIARATION:
I hereby eMirm ihat I am licensed under proNsions ot Chepter 9(cammencing wlt� Sectlon 7000) of DlNslon 3 of Iha Business entl Profossions Cotle, end my license Is in lull
force end eHect. LJc. p Cless k
Contrector's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eflirtn thet Nere I5 a constructlon lentling egency for lhe peAormance of the work for wNch �his permil is issuetl. (Sec. 3097, Civil Coda).
Lontlefa Name�. lsntlefs Atltlress:
SignaWra: Date:
OWNER•BUILDER DECLAHATIONS:
I herehy eilirtn thet untler pena�ry ot perjury that I flm EXEMP7 FROM THE CONTFiAC70R5 LICENSE LAW for the Iollowing reason (Sec. 7031.5, Business entl Professions
Coda: Any clry or wunry whicp requires e permit to construct, alter, improve, tlemolis�, ar re0eir eny swcture, prior to its issuance, elso requires Ne appllcaN tor such pertNt
to file a signed statement t�at he or she Is licensetl pursuant to Ihe provisions of the Cantrectors License Law (Chapter 9(commencing wit� Section 7000) 01 Divisian 3 of t�e
Business end Professions Code) or that ha or she is exempt Itieretrom anA the basis for t�e elleped e:emption. Any violetlon of Section 7031.5 by any epplicant tor a pertnit
subjects the applicant to e civil penalry of not more than tive �untlred dallers ($500).):
❑ I, es owner ol ihe pmperry. or my amployees with wages es Iheir sole compensatlon, WILL DO 7HE WORK, antl ihe sWcture is not Intentled or oHeretl tor sale (Sec.
7044, Business antl Professions Code: The Contractors License Law tloes not appty to en owner of propeny who builtls or improves thereon, antl who does such work
himself or hersetl or ihrough his or her awn employees, provided Ihai such improvemenis ere not intended or oflered for sale. If, however, lhe building or improvament Is
sold within one year of cPmpletion, the owneo-builtler will hava the burden of proving ihat he or she tlitl not build or improve for puryose of sale.). �
❑ I, as owner of the O�operry. am EXCLUSIVELV CONTRAC7INC W17H LICENSED CONTRACTORS to constmct ihe project (SecJ044, Business and Prolessions
C e: The coniractors Licensa Lew Aoes noi appty to en owner oi pmperry who bulltls or Impmves thereon, antl who contracts lor suc� project wilh a contractor(5)
nse pursuant to the Goniractors License Laws.).
I am exe der sea� �^ r Business antl Pmlessions Cotle for ihis reason:
Signature: `_��-"� ��
%� Expires: L� Oy3
Venflcation ot Ownership by (rype o( documeni, I.ex�Properry ta�c bill or dee�:
w
DIVISION OF INDUSTRIAL SAFETV PERMR CERTFICATION:
i
❑ I hereDy certlty thet no e%��etion five (5) or more feet in depth into w�ich e person is required to descend, will be mede in connectlon with work euthodzed by this
portni�, enA thai no building structure, scaHolding, telsework, ar demdition or tlismantling thereol, wiil De more ihan ihirry-six (36) leet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title e, Celifomla Adminlstrative Code).
❑ Aa owner-bulltler, I wlll not emplay enyone lo tlo work which would requlre e permlt from the Divislon of Industrlel Setety, as notetl ebove, unleu such person has e
permit ta do such work from ihe divislon.
SignaNre: Date:
Divislon ol Industnal Satery Pe�it Number:
CERTIFlCAIE OF COMPLIANCE AND Al7THORIZA710N OF EMAY: I certiy under penalry of perjury ihat I have reatl this epplication antl stete that the infarmation given is
conect I egree lo compty with all state laws antl dry orAlnances releting to Guiltling constructlon, entl authonze represematives ol the Ciry ot Casta Mesa to emer upon t�e
ebova-tlescrlbetl p rry for ins ection puryoses. I egree not to occupy or allow occu0ency of eny building authonzed by this rmil un final inspeclion.
���;�'7 /2%i S �3
$I�aWre�hti.egalOwner(s) � Da�e
qnd/Or Authonzed Applicam Date
cooe �. �pecnoNivve
�6t6 Fiaotl System Final Fl�e Preventlon
1268 Pool Spe Finel
200 Finel Re-Rool
201 Flnel BIocWRetaining'Nall
202 Finel Fectory Fira PIaCe
203 Finel Slgn
204 Finnl Demolition
PAIE Itl�LS
CODE� INSPECTIONTVPE
206 finel Mechanical
20B Finel Plumb��g
210 Final Electdcal
212 Finel Fire P�eventlon
220 Finel Planning Apprwal
222
250
Finel Site
Finel Building/Occupancy
� I��
(714) 754-5273 • Fax (714) 754-4856
� CITY OF COSTA MESA
BUILDING DIYISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
Job Address: 238 FAIRWAY PL
Suite:
Vicinify: REAR OF EXIST. SFD.
Parcel Number: 43921308
npp�icant: GREGORY, JOHN
Address: 238 FAIRWAY PL
CA
COSTA MESA , , �
Owner: GREGORY, JOHN
Address 238 FAIRWAV PL
CA ', - � �.
�. COSTA MESA- � ' _ � . �
\
� �
Contractor: � �I/�Ju��-�.;
Address: � �-" - -
�'
Arch :
Address:
BUILDING PERMVT
Zoning:
-Phone: (909)393-8655
� Zip: 92627
NUMBER
77 FAIR DRIVE, COSTA MESA, CA 92626
Slatus: ISSUED
Applied: 08/24/1999
Issued: 09/22/1999
ISSUED BY: ��`� l
i '
- Phone; (909) 393-8655 � � , -
Zip: 92627- ` • � � ' �
` �; ��
Phone:
� Zip: . , License:
Zip:
, _�
� � Phone: � � � ,
License:
� Eng:
Address:
Phone:
� �.�License: +
SCOPE OF PERMIT
� ADD 686 SF MASTER BEDROOM , BATHROOM, AND LAUNDRY. ,
, FEE SUMMARY
Plan Check:. $459.39 Calc Valuation: '
Permit: . . $706.75 , „ - ,'.' � , i.,, - Claim Valuation:
SMIP Res: � $5.87 -� '
�� SMIP Com: ',� $0.00 ' � � �
Other. $0.00 �
Inspection; � $0.00 - _
t
Total: $7,172.01
SETBACKS
MAIN STRUCTURE Front 20. 0
ACCESSORY Front 0-0
PARKING ��existinq: 2
NOTES:
PLANNING 8 ZONING
Rear 20- 0 Lefl 14- 6
Rear 0- 0 Left 0. 0
Reauired: 0 Proposed: 0
Right 10- 0
Right 0-0
558,653.00
� - $o.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Orcl. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned
for a penod 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
requlred Inepeetions end flnal epprovel must be obtained. Failure to obtain inspections and final approval will resufl in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION OECLARATION:
1 hereby altirm untler penalry of perjury one oi ihe following declarations:
❑ I have and will maintain a certificate of consent to selt-Insure for workere' compensation, as provided tor by section 3700 ot the Lebor Code, for ihe peAormance ot the
work for whiCh �his permi� is issuetl.
❑ I have antl wiil maintain workers' compensation insurance, as required by section 3700 oi t�e Labor Code, tor ihe peAortnanca of tha work for which ihis pertnit is issuatl.
My workers' compensation Insurance carrier and policy num6er ere:
Cerrier: Policy Number:
(This section need nof be cromple(ed il the permit Is valued et one bundred dollars ($100J ar less.)
❑ I certify that In the pertormance of Ihe work for which this pertnit is issued, I shall not employ eny person in any manner so es to become subject to the workers'
compensation laws of California, and agree that ii I should bacome subject to the workers' compensation provisions of Section 3700 oi the Labor Cotle, I shall fotlhwith
comply with ihese pravisions.
Applicant SignaWre: Date:
WARNING: FAILUFE TO SECURE WORKEFS' COMPENSATION COVERAGE IS UNL4WFUL PND SHALL SUBJECT AN EMPLOYER TO CRIMINPL PENALTIES AND GVIL FINES UP TO ONE HUNORED
iHOUSAND DOLLARE ($100,000). IN ADDfTION TO iHE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECiION 31O60F THE LABOR CODE. IMEREST, AND ATTORNEYS FEES.
LICENSEO CONTRACTORS DECLARATION:
I hereby attirm ihat I am licensed under provisions ot Chapter 9(commencing with Sectlon 7000) of Division 3 of �he Business and Professions Code, and my license is in full
force and eHect. Lic. # Class #
Contrectors SignaWre: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm that there is a constmction lending agency for ihe performance oi �he work br which ihis parmit is issued. (Sec. 3097, Civil Coda).
Lendefs Name: Lentler's Adtlress:
SignaWre: Date:
OWNER•BUILDER DECLARATIONS:
I hereby eNirm that untler penalry of perjury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5, Business and Professions
Code: Any ciry or county which requires a permit to construct, alter, improve, demolish, or repair any sWcture, prior to ils issuance, also requires t�e appliwnt br such permit
Io file a signed statement thet he or she is licansed pursuan� to the provisions of the Coniractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 oi Ihe
Business antl Professions Cotle) or ihat he or she is exempt therefrom and ihe basis for iha alleged exemption. Any violatlon oi Section 7031.5 by eny epplicant for a permit
suD' cts the applicant to a civil penalry oi not more than five huntlred dollars (5500).):
� I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and ihe siructure is not intended or ottered for sale (Sac.
7044, Business and Professions Code: The Conirectors License Law does not epply to an owner of property who 6uilds or improves thereon, and who does such work
himself or herself or through his ar her own employees, provided that such improvemenis are not intentletl or oHered for sale. If, howaver, ihe building or improvement is
sold within one year of completion, tha owner�builtler will have Ihe burden of proving that he or sha did not build or improve for purposa of sale.).
❑ I, as owner oi the property, am E%CLUSNELY CONTRACTING WITH LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business and Professians
Code: The contractors License law does not apply to an owner of property who builds or improves ihereon, end who contrects tor such project with a coniractor(s)
license pursuant to lhe Comractors License Laws.).
❑ I am ez�pt untler
Owner ID ver�e/1 by dnver'S
❑ Ves ❑ No
Business and Professions Code for this reason:
oate: e'-7 Q�l
DnvefS Licen58 No. Expires: %J Z3 O�
Venfication ofbwnership by (rype bf documenL i.e. - property ten bill or deetl):
OIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation tive (5) or more feet in tlepih into which a person Is required to tlescend, will be made in connection with work authorizetl by t�is
permit, antl ihat no building sWctura, scaflolding, talsework, or demolition or dismantling ihereof, will be mora than thirry-six (36) teet high. (Chap. 32, Grp 2, Ar12, Sec.
347, Ttle B, Californla Atlministrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a pertnit from the Division of Intlustrial Safety, as noted above, unless such person has a
permit to do such work irom the division.
SignaWre: Date:
Division of IndusMal Safety Permit Number.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF EMAY: I certify under penalty ot perjury that 1 have read this application and state that Ihe information given is
correct. I agree to comply with all state laws and ciry ordinances relating to 6uilding construction, and auihorize representatives of the Ciry ot Costa Mesa to enter upon the
ebove-descnbed property tor inspaction purposes. I agree not to occupy or allow occupancy of any building authorized by thisp ertnit until tinal inspection.
�I/ Z z��i9
SigneNre Ot Lega m � Date
And/Or Authonzed Applicant Date
COOE �, INSPECTIONTYPE
1616
1266
Fixed System Finel Fire Prevention
Pool Spa Final
200 Final RB-Roof
201 Final BIocWRetaining Wall
202 Final Fectory Fire Place
203 Finel Sign
204 Final Demolitian
2a46-d6
F�F INTIf1AL5
CODEt INSPECTIONTYGE
206 Final Mechanical
20B Final Plum6inq
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Oaupancy
A�TF, INTRIRLS
VALUE
AP.No.119-12i—OB LOT THACT FIRE ZONE
INSPECTIONS I DATE I GROUP �T
SUBCON7RACTOR � PERMITSISSUED .
OCCUPANCY
Form 410—SM-11-59 5•B P
� • 11653
11�'053
COSTA MfSA BUILDIN6-SAFETY DEPARTMENT
P, p. BOX 917 C08TA MEBA. CALIFORNIA
For Applieanfi fo Fill In Complefely
TYPE OR PRINT
BUILDING • ���� �
ADDRE68
COSTA MESA. CALIFORNIA
� MAIL
■ 81ZE
NG
� USE
T
FROM
TEL.
NOy.
THL.
NO. OP ltDG6.
DESCRIPTION OF WORK
��� / I ROOF
(( COVERiI
AND WORK TO BE
C���
■A1
; i E �ECI�i�lv�
FINANCE DEPT.
CiTY OF COSTA 69ESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
neceirr No. ne�
COSTA
FIRE
Y�
�
�ONING '
— I NO. OP I UBE OF NEW
PLAN6 BU�LOING
��.� 3 S
oescairTiorv
A. P. NO. //_�_� 3 ��
YARDS EVES
APPROVED ALLOWED
ICeNreP LINe er.> . /� �
_ �; o
1 HLR89Y ACNNOWIPDGe lXAT 1 HAVB RGAD THIB APPLIGTION THg AMOUM 9HOWN UNOER VpLUATION �8 POq TMH
AND HTATB THAT TX8 /�BOY6 19 CORACCT AND AORE6 TO COM• pUFP086 OF 88TABLIBHING A nERMIT P¢8 ONLY.
PLY WITM ALL CITY OIiDINANCEB Ml� BiATB UWB R60ULATINO
Bu1tDtNa CONeTRu N. VALUATION
81GNATUR6 OF �� G�� PERMIT PEE B
PERMITTE %J �{f j�
S/ �/� � PLAN CHECK $
AUTHORIZED ACENT � � �
TOTAL FEE