The URL can be used to link to this page

Home My WebLink About3201 DELAWARE PL - Building Permits�� 12494 COSTA MESA BUILDING•SAFETY DEPARTMENT P. O. 60X S77 COBTA MEBA. CALIFORNIA For Applieanf fo F111 In Complefely TYPE OR PRINT BUILDING ____ .. _ _ n� _ _ _ COSTA MESA. CALIFORNIA ' ARGHITECT Carlson �: � �� '�J �� 111960 `�' FIPdANCE DEPT, f f�TY OF COSTA MESA APPLICATIO FOR PERMIT BUILDING For Office Use Only HEC8IPT NO. _vCRM4 NA. _ pY BUILDING ' AODRE85 COSTA MESA, CALIFORNIA E. i7tn st. ZONING ZON¢ �' I NO. OP U9E OF NEW 'd �g'�{ PLAN9 Bl1�LDING / TEL. . . .. . � _... �eaw� _ . _ _ ... _ i . . � BIZE . _ � NO. OP lLD69. 98TBACK 4N8 PROM ceMHR OP 6TneaT 66 � REAR YARD 60 � BIDE YARD LEFT Z.O� I RIGHT S� DESCRIPTION OF WORK 1 EXTHRIOR WA`L R COVHRING S'LllCCO C � USH OP BUILDING AND WORK YARDS ' APPROVED [cernen urve atJ MPROVED � EVES �ssu[os� b J Sin le £amilv residence with attached ara e. �n 20� 1 H6R80Y ACNNOWL8D08 TXAT I HAVH RBAD TX�B APPLIGTION 7HG AMOUM BHOWN UNOCH VALUATION 19 PON TH6 AND 6TATE TXAT THE ABOVB 19 COPRECT AND AOqH6 TO COM• pUPPOBC OP EBTABLIBHINO A P¢RM�T IEH OHLY. PLY WITM �LL CITY ONOINANC89 FND BTATH L.�W9 R80UUTINO OUILDINo CON6TRULT1oN. VALUATION HIGNATUflB O �G�� PERMIT FEE S 6• PERMITfH $ S6�].O].• PLAN CHECK S �-$• AUTHORIZED AGENT Dike Colegrove, I1jC• TOTAL FEE 54• -, " � 1.29�3 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 9f7 COBTA ME8A. CALIRORNIA For Appllcanf fo Fill In Complefely TYPE OR PRINT BUILDING 1 ennoevc � � � � � n /1 i / ...Af � Q . a CONTRAC70R ` ADDRE6S r CITY ' .J BTATE LIC. NO. OF LOT b G /� /� i use oF EXIBTING BLDG 68TBACN LJN6 PRON � NO. � I LEF'� I� ` I RIGHT � DESCRIPTION OF WORK EXTERIOR WALL GOVERING Use oP BUI4DIN 0 FEE RECE�6�,ED FINANCE DEPT. CITY OF COSTA PAESA APPLICATION FOR PERMIT BUILDING For Office Use Only HBCEIPT NO. PtRMIT NO. nEC81y� Y I pATE1t=C�VE11 DA/ , y (J ' -� BUII.DING ADDRE55 COSTA MESA. CALIFORNIA APPROVED � ZONING zo e / I no. or I use oF new P 19 �� BU�LDINO LE6Al � T J \ ' DHBCPIP�ION � �. A. P. NO. �N- 'LJ`—' YARDS EVES APPROVED ALLOWED � ` lC6HTCfl LINH BTJ �� FRONT FT. '— � 0 1 HfiR88Y .CCKNOV/�-EDOB THAT 1 XAVE RGD THIB APPLAWTION THg AMOUNT BHOWN UNDER VALUATION 19 FOR THE AND BTATE THAT TX6 ABOVE I8 COPR6R AND AGqE TO COM- pUPPOBH OP eeTqBLIeMING A PERMIT FEE ONLY. PLY WITN ALL CIYY RDINAN�B AN T8 LAWB IILATINO Bu1LDINo CONBTRu VALUATION � 81GNATURE OF ^ � PERMIT FEE S � PERMITTE � `/� / o . S / '1� � PLAN CHECK $ �� AUTHORIZED AG6NT � — � TOTAL FEE y OWNER DIx JOB ADDRESS INSPECTIONS 1 DATE T 0. OCCUPANCY Form 210—SM-11�59 S-B P SU6CONTRACTOR �.�s�/o�G 6 BUILDING PERn4IT NO. 12923 i, (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 3201 DELAWARE PL ��"�� Status: ISSUED Suite: Viciniry: 2ND FLOOR Applied: 06/17/2003 Issued: 05/05/2004 Parcel Number: 13910335 Zoning:��I .� � / c E �' Applicant R�"�.�i i Ei�c^: /�Q./(i/� y�Q ISSUED BY: / Address: 2970 HARBOR BL � SUITE 201 Phone: 714-662-5952 COSTA MESA, CA 2ip: 92626 Owner: WHITE-SPERLING, JENNIFER Address 3201 DELAWARE PL - Phone: 7I�1 ��—�� EX�ENSIOl�i COSTA MESA, CA Zip: 92626 Contractor: OWN ER-BU I LD ER Address: Zip: Arch : Address: Zip: Phone: License: 000000 Phone: License: t� �� -o� PER � �° �PIRES � Eng: CHARLES A JOHNSON JR Address: P O BOX 6284 Phone: 714-898-6180 GARDEN GROVE, CA 92846 License: 2537 SCOPE OF PERMIT ADD 938 S�. FT SECOND STORY TO AN EXISTING ONE STORY RESIDENCE. ADD 84 SQ. FT. BALCONY DECK OFF OF THE RETREAT AREA. SCOPE OF WORK TO INCLUDE: MASTER BEDROOM, MASTER BATHROOM, F2ETREAT AND STUDY. CONVERT ONE EXISTING BEDROOM ON FIRST FLOOR TO A FAMILY ROOM. EXISTING 4 BEDROOM WILI REMAIN A 4 BEDROOM DWELLING. EXISTING 2 BATHROOM WILL BECOME A 3 BATHROOM DWELLING. REF: ZA-03-36 . - . � � � 40%OPEN SPACE REQ., 71%PROVIDED. OVERALL BUILDING HEIGHT 22 FEET. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspectian: Total: SETBACKS $595.89 $916.75 $8.81 $0.00 $0.00 $0.00 $1,521.45 FEESUMMARY PLANNING & ZONING Calc Valuation: Sas,�os.za Claim Valuation: So.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 7247-92) EXPIRATION: �This permit shall automatically expire and become void if work is not commenced within 1 BO days, or it 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, antl all requlred inspections antl 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(fi/00) WOFKERS'COMPENSAnON DECLARAnON: I hereby eNirm untler penalry of perjury one of ihe lollowing declarations: ❑ I have and will melntein a cenificate ol consent to 5e11-InSure for workers' compensallon, a5 provided lor by 5ettion 3700 ot the Lebor CoAe, for lhe peAormence of the work for which this permii is issued. ❑ I have end will mainWin woAcers' compensation Insurance, as required by sectlon 3700 oi ihe Labor Code, for t�e peAortnance of lhe work for which ihis pertnit is issued. My workers' compensailon Insuranca carrier antl palicy number ere: Carrier: Policy Number: (This section need nof be complefed i! Ne permi! is valuetl et one hundred dWlers ($100) or less.) �j I cartity that in the pertormance ot the work 1 r which this pertnit is issued, I shell not employ any person in eny manner so es to become wbl� �o tha workers' �– compensation laws at Calitomia, a rae at it I uld become subjact to the workers' compensation provlslons ot Se tian 00 0l the Lebor Coda, I shall torthwith tomply with Ihese provi5ion5. � Applicant Signature: —�� Dete: WARNING: FAILURE TO SECUREWORKEAS' COMPENSATION COVERA 6yFyD1 WFUL PND SHAl1 SUBJECT AN EMPLOYER TO CRI,W I L P IALTIES PND CML FlNES UP TO ONE HUNDRED THOUSAND DOILARE (5100,000). IN ADDfTION TO THE WST OF COMPENSATION, DAM4GE5 AS PiiOVIDED FOF IN SECTION 3]OB OF THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm Ihat I em licensetl untler provisions of C�apter 9(commencing with Sectlon 7000) ol Divislon 3 0l ihe Buslness antl Prolessions Code, and my license is in full force and eflect. Lic. a Class x ContractoYs Signature: Date: CONSTRUC710N LENDING AGENCY: ❑ I hereby aHirtn that there is a construction lentling agency tor the peAormance of Ihe work for which this pertni� is issued. (Sec. 3097, Civil Code). Lentler's Name: Lentler's Adtlress: Signawre: Date: OWNER-BUILDER OECLARATIONS: I hereby eltirtn that under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe lollowing reason (Sec. 7031.5, Business end Professions Code: Any ciry or county which requires a permit to constmct, alter, Improve, demolish, or repair eny strucWra, pnor to Its issuanca, also requires the applicant for such pertnit to file a signed statament thet he or ahe is Ilcensed pursuent ta tha provisions oi ihe Contrectors License Law (Chepter 9(commencing with Sectlon 7000) ot �INslan 3 of the Business end Professions Code) or thet �e or s�e Is exempt therefrom end the besis for the elleged ezemption. Any violetion of Section 7031.5 by eny apP��ent for a pertnit subjects the epplicant to a civil penalty ot not more lhen tive hundred dollers ($500).): ❑ I, as owner ot Ihe properry, or my employees with weges es �helr sole compensatlon, WILL DO TME WORK, entl the structure Is not intended or otteretl tor sale (Sec. 7044, Business and Professions Cotla: The Contractors Licensa Lew does not apply to an owner of propeny who Duilds or improves ihereon, antl who does such work himself or herself or through his or her own employees, provitled ihat such improvements are not Intended or oNered for sele. If, however, ihe building or improvement is �sold within one year ot completion, the ownar-builder will have ihe burden of proving that he or she did not build or improve tor purpose of sale.). � I, es owne� ot the pmpetly, em EXCLUSIVELV CONTRAC7ING WITH UCENSED CON7RACTORS to consWct the projact (Sec. 7044, Business and Professions Code: The contrectors License Lew does not apply to an owner ol property who bullds or Improves thereon, entl who coniracts lor such pro�ect with a contractor(s) license pursuant to tha Contractors License Laws.). ❑ 1 em exempt ec. Business antl Protessions Code lor ihls reeson: Signature: ; Owner ID venfletl by tlriv s license. Yes ❑ No Orivers License No. E:pires: Z. Venfication of Ownership by (rype ot documeN, i. .- pmperty tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify ihat no ascavation five (5) or more fae� In depih In�o which e person is requlred to descend, will be mede in connec�ion with work au�honzed by fhis permit, end that no building sirudure, scaHolding, falsework, or tlemolition or dismanNing thereof, will be more then thirry-six (36) teet high. (Chap. 3.2, Gry 2, Ar12, Sac. 341, Title 8, Californle Adminisiretive Coda). ❑ As owner-builder, I will not employ enyone to tlo work which would require a permit from the Division ot Industriel Safery, es noted a6ove, unless such person hes e permit ro tlo such work fmm the tlivislon. SignaWre: Date: Division oi Industnal Sefety Permit Numbar. CERTIFlCATE OF COMPLIANCE AND AllT}10RIZATION OF ENTRY: I ceM1ity under penalry ol perjury that I have read this application and state that the intortnation given is correct. I egree b compy with ell stele laws end ciry ortllnances relating to building consiruction, and authorize representatives of !heee/// Ciry of Costa Mesa to enter upon the ebova-described prop or inspectio uryoses. I agree not tp oc� r ailow occupency of eny building authorizetl by this pe�jni�yr�(�'fjnpl inspection. l�S� Y Signature Ot Lega wner(s) � -� Data AnNOr Authonzed Applicant COUE I, MSPECTIONTYVE Qd¢, INTRIALS 1616 Fixetl Sys�em Final Fire Prevention 1266 Pool Spa Final 200 Flnel R8-Root 201 Flnel Block/Reteining Wall 202 Final Factory Fire Place 203 Finel Sign 204 Finel Demolition CODEt INSPECTIONTYYE 206 Finel Mechaniwl 20B Final Plumbing 210 Finel Electrical 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site 250 Finel Building/Occupancy PAg L� o- 2-od �� (714) 754-5273 • Fax (714) 754�4856 • www.ci.costa-mesa.ca.us 77 FA�R DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT . Job Address: Suite No Vicinity: Paicel Nunmber: Applicank Address: 3201 DELAWARE PL 13910335 RICHARD TAYLOR 7522 TALBERT AV . UNIT 3 � , HUNTINGTON BEACH; CA -. Owner: WHITE-SPERLING, JENNIFER Address, 3201 DELAWARE PL � . Phone: 714-841-6480 Zip 92648 . � � , . Phone: COSTA MESA, CA Zip: 92626 Contractor: MYLES CONSTRUCTION Address: 7522 TALBERT AV UNIT 3 . , ..HUNTINGTON BEACH, CA ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) . � New Res (3+units) Pool / Spa Lighting Fixts Recept Outlels Switches Non Res Appl Res Appl _ Service to 200a Service to t000a Service over 1000a Motors to 1hp Motors lo tOhp Phone: 714-841-6480 Zip: 92648 License: 576675 Staws: ISSUED Applied: 04/27/2005 Issued: 04/27/2005 ISSUED BY: SCOFE OF PERMIT;_ ADD 938 SQ. FT SECOND STORY TO AN EXISTING ONE�STORY RESIDENCE. ADD 84 SQ. FT. BALCONY DECK OFF OF THE RETREAT AREA. SCOPE OF WORK TO INCLUDE: MASTER BEDROOM; MASTER BATHROOM, RETREAT AND STUDY. CONVERT ONE EXISTING BEDROOM ON FIRST FLOOR TO A FAMILY ROOM. . EXISTING 4 BEDROOM WILL REMAIN A 4 BEDROOM DWELLING. EXISTING 2 BATHROOM WILL BECOME ��A 3 BATHROOM DWELLING. REF.: B03-01026� . �" ' - . ' ELECTRICAL TO INCLUDE: 15 LIGHT FIXTURES, 30 OUTLETS, 20 SWITCHES AND 1 SERVICE TO 200 AMPS. 523.50 $0.00 $0.00 $0.00 $0.00 $0.00 $16.50 - $29.30 $22.00 $0.00 $0.00 $30.50 $0.00 $0.00 $0.00 $0.00 Quantity 0 0' 0 15 30 20 0 0 1 0 0 0 0 FEESUMMARY Quantity Temp Dist System:/ Lighting . $0.00 '' 0 Busway /100 ft � � - - � ' ;'- $0.00 ' 0 Standing Section " " � .$0.00 � � 0 Misc Electrical Equipment , = �$0.00 �' 0 Tran`sformers up to t kva/kw'�: "$0.00 �' "0 ._._.........:up l0 10 kva/kw $0.00 � �0 .................up to 50 kva/kw ', $0.00 , 0 ..........._..:.up to.100 kva/kw �, $0.00 �. b� ..................over.y00kva/kw . $0.00 " 0 Low Voltage Equipment -50.00 0 Low Volt Nliring System / CkN ;.:� $0.00 0 Misc. ConduiC _ $0.00 0 Misc. Contluctor. . . $0.00 0 Circus ( gen or ride) $0.00 0 Circus (mech ride or lighls) 50.00 0 Christmas Tree Stand $0.00 0 NOTICE: The work aUthorized by this.permit shall comply with all applicable handicap access requirements under Califomia statutes and related .regulations. (Ord. No. 9238, § 1, 12-21-92) . 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 foca period of 180 days. INSPECTIONS: In order for the work �authorized under this.permit to �be considered legal..such work must �comply with all applicable codes, and all required Inapeetlons and final�approval must.be obtained. Failure to obtain inspections antl final approvel will result in the expiration of ihis permit. � FOR�INSPECTIONSCqLL: (714)7545828 zanseeldool WORKERS'COMPENSAnON DECLARAnON: � , . I hereby eXirm under penalty ot perjury one of the tollowing declarations. • ' '.. ❑ I have and will maintein a certiticate ot consent to selbinsure tor workers' compensetlon, es pmvitletl tor by section 3700 of the Labor Cotle, for the pertormence of Ihe work tor which`lhis permil i5 i55ued. ' ' . '' Q.�I have and will maintain workers' compensa�on insurence, as require0 by section 3700 of Ne Lebor Catla, for Ne perfortnanca oi the work for which Nis pertnit Is Iss�i� .--M1y worke '��m�pee?n7s.-a��ion Insu ence carner entl pollcy number are: / /c�/��7 Cerrier� � ��// `� �� Po��liy_Numtier.- ��` /G / '�� is.section nee no( be cromp/ef tl i! the permit is veluetl af one hundred dollars ($700) or less.) ❑ I certity �hat in the peAormance ot � rk br which this pertnit is issueQ I s�all not employ any person in any manner so as to �ecome subject to the workers' compensation laws of Calitomi gree that II I should become subjec� to Ihe workers' compensation provisions ot Section 3700 ot lhe Labor Code, I shall forthwith �ply,with Ihese pmvisi� j � Applicyen_t Signature:. � �' �Date:""'� �� T / i�--� WARNING: FAILURE TO SECUR WO¢ CERS' CAMPENSATION COVERAGE IS UNLAWFUT AN� SMALL SUBJEGT rW EMPLOYERTO CRIMINAL PENALTIE AND GVII FlNES UP TOONE Nl/NDRED TFKKISAND DOl1ARE (5100,000).yTADDRION TO THE W5T OF COMPENSAiION, DAM4GES AS PROVIDED WR IN SECiION 3106 OF THE L480R CODE, IMEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I herebv ettirm Ihat I em Ilcensed under Drovlsk CONSTRUCTION LENDING AGENCY: � � �� ❑ I hereby aflirtn Ihat there is a consWction Lenders Name: Signature: Section 7000) af Division 3 of the Code, entl my license Is In full egency for the peAormance ot the work tor which this pertnit is issued. (Sec. 3097, Civil Cotle). Lendefs Adtlress: Da�e: OWNER-BUILDER DECLARATIONS: I hereby aMirtn that under penelry of perjury that I em EXEMPT FROM THE CONTAACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business entl Professions Gode: Any ciry or county which requires a pertnit to construct, alter, improve, tlemolish, or repair any stmcture, prior to its issuance, elso requires the applicant for such permit to file a signetl statemem thet he or she is Ilcensea pursuant to the provislons of the Conirectors Licanse Lew (Chapter 9(commencing with Sectlon 7000) of Dlvislon 3 ot the Business end Professions Coda) or ihet he or she is exempt therelrom end the basis tor the allegeA e:emption. Any violation of Section 7031.5 by eny applicant tor e permit subjects the applicant to a civil penalty af not more ihen Ilve hundred dollars ($500).): ❑ I, as owner ol ihe property, or my employees with weges as their sole campensation, WILL DO 7HE WORK, an0 Ihe structure Is not interMed or otferetl for sale (Sec. 7044, Busineu and Professions Cotle: The Conirectors License Law does not appty 10 an owner of property who builds or improves thereon, and who tloes such work himself or herself or ihrough his or her own employees, provitled ihet such improvements ere not intended ar otteretl for sale. If, however, ihe building or improvement is soltl wit�in one year ol completion, the ownerbuiltler will hava t�o burden ot pmvinp ihat he or she did not build or improve for purpose of saleJ. ' ❑ I, as owner of the propeny, am EXCLUSIVELV CONTRALTING WI7H LICENSED CON7RACTORS to construct Ihe project (Sec. 7044, Business antl Professions Cotle: The contraaors License Lew does not epply to en owner ol property who bulltls or improves thereon, antl who wntraas for such proJect with a cantractor(s) license pursuant to Iha Conirectors License Lews.). ❑ I am ezempt under sec. Business antl Professions Code lor ihis reason: Signature: Date: Owner ID verilied by drivers licensa. ❑ Ves ❑ No Drivels License No. Expires: Venfication ot Ownerehip by (type of tlocument, i.e. � property tac bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATON: ❑ I hereby certiy that no excavetion live (5) or more laet in tlepth into which a person is required to descend, will be made in connection with work euthorizetl by this permit, and that no Duiltling sWcture, swttolding, lelsework, or tlemolition or dismantling thereot, will be more than Ihirty-six (36) leet high. (Chap. 32, Grp 2, Atl 2, Sec. 347, Title B, Califomia Atlministretiva Code). ❑ As awner-builder, I will not employ anyone to do work which would require e pertnit from Ihe Division ol Intlustrial Safery, as noted above, unless suc� person has e permit to do such work irom Ihe division. Signature: Division ot Industrial Salety Permit Number: Date: CER7IFlCATE OF COMPLIANCE AND AUTHORVATION OF ENTTiY: I certity untler penalry of perjury ihat I have read ihis applicalion and state ihat the information given is correct. I agree to comply wi�h ell s�a�e lews and ciry ortlinances relating to builtling construction, end authorize representatives o( t�e Ciry of Cosia Mesa Io enter upon Ihe above-deuriDed propeny for inspection purposes. I egree not to occupy or allow occupancy of any building authorized by this permil until final inspection. CODE �. 1616 ,zss 200 201 202 203 204 INSPEC� "• •,. � • Fixetl SjStem Final Fire Preventlon ' Pool Spa Final Final Re�Rool' � • ' � Final BIocWReteining Wall Final Factory Fire Place ' Final Sign Final Demo ition • • PAIE r �S� � 4Qjlf,li INSVECTIONTYPE � � 206 Final Mechanical , 208 Final Plumhing � 210 Final ElecMcal 212 Final Fire Prevention ' ' , � 220 ' Final Planning Appmval 222 Final Site 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 7544856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 3201 DELAWARE PL Suite No Vicinity: Parcel Number: 13910335 Applicant: Address: RICHARD TAYLOR ' 7522 TALBERT AV. � UNIT 3 HUNTINGTON BEACH, CA MECHANICAL PERMIT Owner: WHITE-SPERLING, JENNIFER Address: 3201 DELAWARE PL COSTA MESA, CA Contrador: MYLES CONSTRUCTION Address: 7522 TALBERT AV � UNIT 3 HUNTINGTON BEACH, CA Phone: 714-841-6480 Zip: 92648 � Phone: Zip: 92626 Phone: 714-841-6480 Zip: 92648 License: 576675 Status: ISSUED Applied: 04/27/2005 Issued: 04/27/2005 ISSUED BY: SCOPE OF PERMIT ADD 938 SQ. FT SECOND STORY TO AN EXISTING�ONE STORY RESIDENCE. ADD 84 SQ. FT. BALCONY DECK OFF OF THE RETREAT AREA. SCOPE OF WORK TO INCLUDE: MASTER BEDROOM, MASTER BATHROOM, RETREAT AND STUDY. CONVERT ONE EXISTING BEDROOM ON FIRST FLOOR TO A FAMILY ROOM. � EXISTING 4 BEDROOM WILL REMAIN A 4 BEDROOM�DWELIING. EXISTING 2 BATHROOM WILL BECOME A 3 BATHROOM DWELLING.-REF.: 803-01025- MECHANICAL TO INCLUDE: 1 FAU < 100K BTU, 1 REPAIR/ALT COOLING/HEAT AND 1 VENT FAN/SINGLE � ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k 9TU Refrig Sys >100 k BTU Gas Piping . Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Insl or Relowte Appl Vent $23.50 $14.80 $0.00 $13.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.25 $0.00 $0.00 $0.00 50.00 Quantity 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 FEE SUMMARY Repair / Alt Absorbtion Unit '�- Repair / Alt Refrigeration,Unit , � Venlillation SyStem ' ' �- Evaporative Cooler � . Commerciallncinerator ' � Domesfic Incinerator � � � � � Compressors / Absarplion Syslems Upto3hp/100kBTU � "3To15hp/,SOOkBTU �� . 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 7,750 k BTU Over 50 hp / Over 1,750�BTU Boilers -Up to 3�hp � � 3To15hp 15to30hp �� Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 /� NOTICE: The work authorized by this permit shall comply with all applicable handicap access �equirements under California statutes and related regulations. (Ord. No, g2-2B, § 1, 12-21-92) EXPIRATION: This permit shall automatically ezpire and become void if work is not commenced within 180 days, or if work Is euspended 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 Inspections and final epproval must be obtained. Failure to obtain Inspections and final approval will result in the expiretion o1 this permit. FOR INSPECTIONS CALL: (714) 7545628 � zwws (sioo) WORKERS'COMPENSATION DECLARATON: � � I hereby eNirm un0er penalty ot perjury one of the tollowing declarations: }' � , , . ' . . ❑ J have and will maintein e certitiwte of consent to sell-Insure lor workers' compensetlon, as pmvided br by section 3700 oi �he Lebor Cotle, for the pertormence ot the work tor which this permil is issued. - -� ❑ I have antl will maintain workers' compensatlon in5urance, as requireG by sec�ion 3700 of the Le6or Cotle, Por Ihe peAortnance of the work for which this pertnit is issuetl. My workers' compe tian Ipsurance er and olicy number are: / �j . Cerrier: 5�� Policy Number. ��6 / � � �`��_ (This sectiar need na! be comp/eted i! fhe permif is valued et wre hundred dollars ($100) or Iess.) ❑ 1 certity Ihat in Iha peAormance ot tlie work for which lhis pertnit is issued, I shall not employ any peroon in eny menner so es to 6ewme sublect to the workers' compensation laws of Calilomia, n r e that it I s�ould become subject to the workers' compensation provislons ot Saction 3700 oi the Labor Code, I shall forthwith comply with thesa provision�� /�. �/ _� ApplicaniSigneture: Dete: / /y/ /�S WARNING�.FNLURETOSECURE O RS'COMPENSATIIXJGUVEMGEISUNIAWFULANDSMALLSUflIECTANEMPLOVERTOCRI�NALTIESANDGVIL NESUPTOONEHUNDRED TVKKISAND OOLURE (5100,OW). IN�DITION TO THE COST OF COMPENSATIpJ, DAMAGES AS PfiOVIDED FOR IN SECiION �OB OF THE LABOR CODE, IMEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirm ihat I em licensed und ov3ic forca entl eHect. Lic. q ��!G Camractor's Signature: CONSTRUCTION LENDING AGENCV: � ❑ I hereby attirm ihat ihere is a consiruction lending agency for Lendefs Neme: Signature: OWNER-BUILDEfi DECLARAT10N5: with Section 7000) ol Division 3 of the Business end Profe Ions Code, and my license is in full � Cless p � � i _� Dete: � %J 7 �S peAormance of �he work br which this permit is iuuetl. (Sec. 3097, Civil Cotle). Lendefs Adtlress: - Date: I hereby affirtn Ihat under penalry of perjury thal I am EXEMP7 FROM TME CONTRACTORS LICENSE LAW tor Iha lollowing reason (Sec. 7031.5, Business end Professions Cotle: Any ciry or counry which requires e permit to construct, alter, improve, demolish, or repair eny structure, prior to its issuanca, elso requires the applicant for such pertnit to tile e siqned Slatement Ihet he or she Is Ilcensetl pursuent to ihe provisions oi the Conirectors License Lew (Chapter 9(commencing with Sectlon 7000) ot Didsion 3 of the Business entl Professlons Code) or that he or she is exempt iherelrom and ihe basis for the alleged exemption. Any vloletion of Sectlon 7031.5 by eny applicant for a Dertnit subjects the applicanl to a civil penalty of nat more ihan live huntlred tlollars (5500).): ❑ I, es ownar ol ihe property, or my employees wit� wages as their sole wmpenselion, WILL DO 7ME WORK, end Ihe structure is not intentleA or ottered for sale (Sec. 7044, Busineu and Professions Code: The Coniractors License Law dces not appty to an owner ot property who Duilds or Improves thereon, and who tloes such work himsell or �erself or through his a �er own employees, provided ihal such improvements ere not intended or oflared for sele. If, however, the building or imprwemant is sold wilhin one year of completion, the owner-builtler will have Ihe burden ot proving that he or she did not build or improve tor purpose of sale.). � ❑ I, as owner of the property, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to con5irucl the prolect (Sec. 7044, Busineu and Prolessions Catle: The contrectors IJcense Lew tloes not appty to an owner ol property who builds or Improves thereon, enA who contracts for such praject with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am eaempt under sec. Business antl Professions COAe lor this reason: Signature: Date: Owner ID verifietl by tlnver's license. ❑ Yes ❑ No Drivers License No. Expires: Verifiwtion of Ownership by pype of daument, i.e. - pwpeny tau bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity thet no excevatlon flve (5) or more faet in depih into which e person is required to descentl, wlll be mede in connection with work authorizetl by ihis permit, antl that no builtling sirucWre, scaHolding, IalsewoAc, or demolition or dismentling Ihereol, will be more �han thirty-six (38) teet high. (Chap. 3.2, Grp 2, Art 2, Sec. 3a1, Title B, Californla Atlministretive Code). ❑ As owner-builder, I will not employ anyone to do work which would require e permit irom ihe Division of Intlusirial Safety, es noted ebove, unless such person has e permit to tlo such work irom Me division. Signature: Date: Division ol Industnal Safery Permit Number: CERTiFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTAY: I certi(y under Denalty ol perjury tha� I have read this epplication and state �hat ihe information given is correct. I agree to comply with all sta�e laws antl ciry ordinances relating to building consiruction, and authodze representatives of the Ciry of Costa Mesa to enter upon the ebove-described pmpeny for inspection purygses. I agree not to occupy or allow occupency of any building authorized by �his permit until final inspection. COUE 1. INSPECTONTYVE %' ' "' ' 1616 Fixetl Sysiem Final Fire Prevention' 1266 Pool Spa Final 200 Finel RB-Rool ' 201 FInaI B1ocWRelaining Well 202 Final Pactory Fire Place 203 204 Final Sign Final Demolition . .n �g . pL - G�[� � 7 Date l�_� � � � D �e COOEI �INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 � Final Electrical • 212 Final Fire Prevention 220 ' Final Planning Approval 222 Final Site � 250 Final Building/Occupency � � 3 316 � � � (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT lob Address: 3201 DELAWARE PL Suite No Vicinity: Parcel Nunmber: 13910335 Status: ISSUED Applied: 04/27/2005 I ssued: 04/27/2005 ISSUED BY: ✓ Applicant: RICHARD TAYLOR . Address: 7522 TALBERT AV � � .. UNIT 3 HUNTINGTON BEACH; CA . . Owner: WHITE-SPERLING, JENNIFER Address 320� DELqWARE PL COSTA MESA, CA Contractor: MYLES CONSTRUCTION Address: 7522 TALBERT AV � � UNIT3� HUNTINGTON�BEACH, CA ISSUE FEE 8ackflow irrigation BackFlow Preventer Bathtub: , Clarifer System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Phone: 714-841-6480 � - Zip: 92648 - � � - � Phone: Zip: 92626 Phone: 714-841-6480 Zip: 92648 License: 576675 - ; . . . SCOPE OF PERMIT ADD 938 SQ. FT SECOND STORY TO AN EXISTING ONE STORY RESIDENCE. ADD 84 S�. FT. BAICONY DECK OFF OF THE RETREAT AREA. SCOPE OF WORK TO INCLUDE: MASTER BEDROOM, MASTER BATHROOM�, RETREAT AND STUDY. CONVERT ONE EXISTING BEDROOM ON FIRST FLOOR TO A FAMILY ROOM. - � � � � ' EXISTING 4 BEDROOM WILL REMAIN A 4 BEDROOM DWELLING. EXISTING 2 BATHROOM WILL BECOME A 3 BATHROOM DWELLING. REF.: 603-01026 � PLUMBING TO INCLUDE: 1 BATHTUB, 1 GAS (1-4 OUTLETS), 1 SHOWER, 1 KITCHEN SINK,-2 WASH BqSINS, 1 WATER CLOSET, AND 1 WATEF2 HEATER. .� FEE SUMMARY "- - AMT 'QTY _ _ . � ,AMT �QTY'� $23.50 . Laundry Tub! Washer � : $0.00. � 0 $0.00 0 � , �Landscapelrngation � 50.00 0 ' $O.Op 0 � P-Trap f0.00 0 �$9.80 : 1 Pressure Regulator $0.00 0 $0.00 �� 0 Process Piping (per 10 ft) $0.00 � 0 $OA� �' � 0 � � Receptors $0.00- � 0 $0.00 � 0 Septic Tank . $0.00 0 ' $O.OU 0 - Sewer Cap for Demo . $0.00 0. $0.00 0 Sewer Connect $0.00 - 0 $0.00 0 Sewer Private Line $0.00. . 0.� $0.00 0 Shower . $9.80 ' � 1 $0.00 0 Sink, bar � 50.00 0 $0.00 0 Sink, commercial $0.00 0 -�� Sump Pump ' -. " Swimming Pool � Trap Pnmer' Urinal . ' Vacuum Brkr Bkflow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin � , � Wash Basin Set . Wasie and Vent System - � Water Closet (ToileQ Water Heater / vent Water Piping Qnst or Rep.) Water Re-pipe AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.60 $0.00 $0.00 $9.80 $12.30 $0.00 $0.00 QTY 0 0 0 0 0 0 2 0 0 1 1 0 0 NOTICE: The work authorized hy this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is.not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. - INSPECTIONS: In order forthe work authorized�under this partnit to be considered legal, such vrork must comply with all applicable codes, and all required Inspectiona and final approval must be obtained. Failure to obtain inspectionsand final approval will result in the expiration of �Ais permit. FOR INSPECTIONS CALL: (714) 7545826 zeawe �croo� WORKERS' COMGENSATION DECLARATION: � � I hereby aHirm under penalty oi perjury one ol the lollowing tlaclarations: �. ❑ �I have and wil� maintain a certificate of consent to sell-Insure lor workers' compensetion, as provided for by section 3700 ot tha Labor Code, lor the pertormance of the work tor which this pertnii is issue0. ' � ' � ❑ I have and will maintain workers' compenSaGon Insurance, as raquiretl by section 3700 0l the Labor Catle, For Ne pertortnance ot Ne work tor whkh Ihis pertnit is issued. My workers' compensations_u�resn7�•ep c1—arrier a olicy nu bar ere: J'/�/� �^T�-� Carner. I� � I � Policy Number. Y 7 •-� (This section need�ted i! Me permif i valued et one hundred dollars ($100) or less.) ' ❑ I certity that in the peAortnance ot Irye wo or which this permit is issued, I shell not employ eny person in any manner so as to become subject to the workers" compensatlon laws ot Califomia, Rd e that if I shoultl bewme su6ject b the workers' compensation pmvisions ot Section 3700 ot the Lebor Code, I shall toR�wllh comply wi�h these provisions. // �J ApO�icant SignaNre: Date: `7 /�/��s WMNING:FAILURETOSECURE � KE COMPENSATIONCOVERAGEISUNLAWFULANDSHALLSIIBIECTANEMPLOYERTOCRIMIWILPENALTIESANDGVILFlNESUPTOONEHUNDRED THOUSAND DOILARE (5100,000). IN D TO THE COST OF COMPENSATION, OAMnGES AS PROVIDED FOR IN SECiIIXJ 31O60F THE UBOR COOE, INiEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm Ihat I em force end eflect. Lic. x Contrectors SignaWre: CONS7RUCTION LENDING AGENCV: . ❑ 1 hereby ettirtn thet t�ere is a construction Lenders Nema: SignaNra: OWNER•BUILDER DECLARATIONS: Seclion 7000) ot Division 3 of Ne B _ qass a Date: Code, end my license is In full agency for the peAormance of the work tor which this permit is issuetl. (Sec. 3097, Civil Code). Lender's Adtlress: Da�e: I herehy eilirm Ihat under penelry of perjury thet I am EXEMPT FROM THE CON7FiACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Protessions Cotle: Any ciry or counry which requires e permit to construct, elter, improva, tlemolish, or repair any structure, pnor to its issuance, elso requires the epplicant for such permit b file a signed stetement that he or she Is Ilcensetl pursuant to the pmvisions oi ihe Contrectors License Law (Chapter 9(commencing with Sectlon 7000) of Divislon 3 of Ihe Business entl Professions Code) or that he or she is exempl therefrom antl the basis for the alleged exemption. Any violation oi Section 7031.5 by eny applicant for e permit subjects the epplicant to e civil penalry of nol more Ihen tive hundred dollers ($500�.): ❑ I, as owner of ihe pmperty, or my emplayees wlih weges es their sale compensatlon, WILL DO THE WORK, an0 ihe slrucNre is not intended or ottere0 for sale (Sec. 7044, Business and Profeuions Code: The Contractors Licensa Law tices noi aDPly to an owner of properry who builds or improves thereon, antl who Ooes such work himseli or herselt or �hmugh his or her own employees, pmvided that such impmvemenis are not intended or oHeretl for sale. If, however, Ihe builtling or Improvement is soltl within one year of completion, ihe owner-builder will have ihe burden of proving that he or she did not builtl or improve for purpose of sele.). � ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct lhe project (Sec. 7044, Business and Profassions Code: The contrectors License Lew does not epply to an owner al property w�o builds or improves t�ereon, antl who contracts tor such project with a contrector(s) license pursuant to the Contractors License LewsJ. ❑ I am exempt under sec. Business end Professians Code for this reason: Signature: Date: Owner ID verilied by drivers license. ❑ Yes ❑ No Dnvets License No. Venfication ol Ownership by (rype of dacumeni, i.e. � praperty tac bill ar tleed): Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more leet in tlepth into which a person is required to descend, will be matle in wnnec�ion with work authonze0 by this permit, entl ihat no building swcWre, scattolding, lalsework, or demolition or tlismantling thereoi, will be more than ihirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ti11e 8, Calilornla Administrative Gode). ❑ As owner-builder, I will not employ anyone to do work which would require e pertnit trom the Division ot Intlustrial Safery, as noted ebove, unless such person has a permit to do such work trom the division. Signature: Date: Oivision ot Intlustnal Sefery Permit Number: CER7IFlCATE OF COMPLIANCE AND AIJTHORIZATION OF ENTRY: I cenify under penalry ot perjury that I have reatl t�is apDlication antl state t�at the infortnation given is corteci. I agree to wmply with ell sta�e laws and ciry orCinances ralating to builtling consWction, antl authorize represeniatives of Ihe Ciry ol Coste Mesa to enter upon Ihe ebove-descnbed proDerty for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until tinal inspection. COpE�, INSPECTONTYPE ' G 1616 Fixetl System Flnal Fire Pi 1266 200 201 202 203 Pool Spe Finel Final RB�Rool ' Finel BIocWRetaining Well Final Factory Fire Place Final Sign 204 Final Demolition �.1 um: �i11�lIFiJ3L[9:iftl� 206 Final Mechanical 208 Final Plumbing 210 ' Final Elettntal 212 Final Fire Prevention 220 Final Planninq Approval 222 Final Site 250 Final Building/Occupancy PAAIG II�EL9 ' ��ia� �sa-sz�a • Fax pia� �sa-aaes CITY OF COSTA MESA ' BUILDING DIV/SION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT JobAddress: 3201 DELAWARE PL Suite: Vicinity: HOUSE & GARAGE Parcel Number: 13910335 App�icant: SENTRY ROOFING CO Address: 3364 NEVADA AV COSTA MESA, CA , Owner: WHITE-SPERLING, JENNIFER Address 3201 DELAWARE PL , � COSTA MESA, CA Contrector SENTRY ROOFING CO Address: 3364 NEVADA AV COSTA MESA, CA Zip: 92626 Arch : Address: Phone: Zoning: Phone: (714) 751-7663 Zip: 92626 Phone: Zip: 92626 Phone: (714)751-7663 License: 487659 Eng: Address: PERMIT NUMBER B99-01979 v 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUE� Applied: 12/20/1999 Issued: 12/20/1999 Phone: Zip: License: License: SCOPE OF PERMIT REROOF - T/O, USE EXISTING SHTG, INSTALL 1 LAYER OF 30# FELT AND 25 YEAR ELK PRESTIQUE COMPOSITION SHINGLE ROOF. Plan Check: $0.00 Permit: $13925 SMIP Res: $0.66 SMIP Com: $0.00 Other: $0.00 inspection: $0.00 Total: $139.91 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existin : 0 Rear 0- 0 Rear 0- 0 Required: 0 FEESUMMARY PLANNING & ZONING Left 0- 0 LeR 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 $s,siz.00 $s,siz.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related re9ulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. - INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapectlona and tinal epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of �his permit. FOR INSPECTIONS CALL: (714) 754-5626 � { WOfiKERS' COMPENSATION DECLARATION: I hereby aHirtn untler penalty of perjury one of ihe following tleclarations: ❑ I have antl will maintain a certificate of consent to seN-Insure for workers' compensation, as provided tor by section 3700 of ihe Labor Cotle, for the pedormance of ihe work tor which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as requirad by section 3700 of ihe Labor Code, for the peAormance of the work for which this pertnit is issued. My workers' compensation Insurence carrier and policy number are: Carrier: Policy Num6er: (lhis sectian need not be campletetl i/ the permif is veluetl et ane huntlred dollars ($f00) or IessJ jTJ� certify that In the peAormance of the work for which this permit is issuetl, I shall not employ any person in any menner so as to become subject to the workers' compensation laws of alifo ia, and agree that �� should beco e subject to ihe workers' compensation provisions of Section 3700 of Ihe Labor Code, I shall forthwith comply with these pr isi� �j.�' �//�1" AppiicantSignature: Date: ��-'-7�L��/ � WARNING FAILURE TO URE WORK '�M NSATION CAVERA E IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FWES UP TO QYE HUNDRED THOUSANDDOLLARE�S100,000),INA�D IIXJT ECOSTOFCQNPENSATION,�AMAGESASPROVIDEDFORINSECTION3]O60FTHEL4BORCODE,INTEREST,ANDATTORNEV'SFEES. LICENSED CONTRACTORS DECLARA710N: I hereb affirm ihat I am lice/nsed un�dary rovisi s ot C}� ter 9 com ncin with Section 7000 of Division 3 ot ihe Busine�s an r ssions Code, and m license is in full force antl ettect. Lic. a��...P� L!n // p ( 9 � � Class a (! �� _ Y ContractoYs SignaWre: �� %Al� Date: � Z' Z1i — CONSTRUCTION LENDING AGENCV: ❑ I hereby attirm ihat there is a consimction Iending agency for the pertormance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lendefs Address: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby aHirm that under penalty ot perjury ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professions Cotle: Any city or counry which requires a permit to construct, alter, improve, demolish, or repeir eny stmcwre, prior to its issuance, atso requires the applicaM for such permit to file e signed statemeni �hat ha or she is licensed pursuant to ihe provisions of the Contractors License taw (Chap�er 9(commencing with Sec�ion 7000) of Divlsion 3 of ihe Business and ProFessions Cotle) or ihat he or she is exempf Iherefrom antl Ihe basis for ihe alleged exemption. Any vlolation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more ihan five hundred dollars ($500)J: ❑ I, as owner of ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or oHeretl for sale (Sec. 7044, Business antl Professions Cotle: The Contrectors License Law does not apply to an owner of propeny who 6uilds or improves thereon, antl who does such work himself or herself or ihrough his or her own employees, provided that such improvemenis are not imended or otteretl for sale. If, however, ihe building or improvement is sold within one year of completion, ihe owner-builder will have Ihe burden of proving ihat he or she did not build or improve for purpose oi sale.). ❑ I, as owner ol ihe property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions Code: The contrectors License Law does not apply to an owner of property who builds or improves Ihereon, and who contracts tor such prqect with a contrector(s) license pursuant to the Contractors License Laws.). ❑ I am exempt untlar sec. Signature: Owner ID verifietl by tlriver's license. ❑ Ves ❑ No Business and Protessions Code for �his reason: Verification of Ownership by (type of document, i.e. - property tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Driver's License No. Date: Expires: ❑ I hereby certify that no excavation five (5) or more teet in depth in�o which a person is required to descend, will be matle in connection with work amhorizetl by this permit, and ihat no building stmdure, scaFtolding, falsework, or demolition or dismantling thereoi, will he more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Calitornia Atlminisirative Code). , ❑ As owner-builder, I will not employ anyone to do work which woultl require a permit from �he Division of Indusirial Safety, as notetl ahove, unless such person has a permit ta do such work from the division. Signature: Date: Division of Industnal Safety Permit Number: CER7IFICATE OF COMPLIANCE AND AUTHORIZATION OF EN7RY: I cenify under penalty ot perjury that I have reed ihis application and state Ihai ihe information given is correct. I agree m comply with all state laws and ciry ordinances relating to building constmction, and authorize representa�ives of the City of Costa Mesa to en�er upon tha above-described property for inspection purposes. I a�qree not to ocwpy or allow occupancy ot any building authonzed by ihis pertnit until Ilnal inspection. CQpE t INSPECTIONTYPE 1616 Fixed System Pinal fire Prevention 1266 Pool Spa Final 200 Final Re-Rooi ' 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition zaas as QAjg INTITIALS /J� �. ii ///� Date �� J � ' Date '�— C� I INSPECTION TYPE 206 Final Machanical 208 Final Plumbing _ 210 Final Eieciricel 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy DATE INTffInLS