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Home My WebLink About3210 DELAWARE PL - Building PermitsJobAddress: 3210 DELAWARE PL Status: ISSUED Suite: Applied: OS/11/2005 Vicinity: REAR OF PROPERTY Issued: 09/21/2005 Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Conslruction: V-N Parcel Number: 13910310 Zoning: App�icant: • JIM BIZZELL Address: 2130 NATION AV COSTA MESA, CA owner: AKERSTROM, STAFFAN AND TRACY Address 3210 DELAWARE PL COSTA MESA, CA Coniractor JIM REPAIRS Address: � � 2130 NATIONAL AV COSTA MESA, CA Zip: 92627 Phone: 714-404-8377 2ip: 92627 Phone: 714-434-7284 Zip: 92626 Phone: (714)404-8377 License: 771363 ISSUED BY: � Arch : Eng: BENJAMIN IONESCU Address: Address: 160 W FOOTHIIL PKWY Phone: SUI7E 705-206 Phone: 714-267-6561 CORONA,CA Zip: License: 92682 License: 65482 SCOPE OF PERMIT ADD 634 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: ADD A NEW MASTER BEDROOM, BATH AND A FIREPLACE, ICBO #3507. CONVERT�EXISTING 3 BEDROOMS, 2 BATHS S.F.D. TO A 4 BEDROOM, 3 BATH S.F.D. PLANNING: iOT SIZE = 6,650 SQ.FT. . . . F2ESIpENCE = 1,834 SQ.FT. GARqGE = 432 SQ. FT, DRIV�WAY=450 � LOT COVERAGE = 2,716 SQ.FT. (41 %) OPEN SPACE = 3,934 SQ.FT. (59°k) REAR YARD COVERAGE = 17 %(132 SQ.FT./1,200 SQ.FT.) Plah Check: $359.68 Permit: $553.35 SMIP Res: $4.01 SMIP Com: $0.00 Othec $0.00' Inspection: $0.00 Total: $917.04 FEE SUMMARY Calc Valuation: Claim Valuation: ;�� 'r '�� PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 20• 0 ACCESSORY Front 0. 0 Rear 11-6 Rear 0-0 LeR 5-0 Right 5-0 Lek 4 0 Right 0- 0 540,101.60 50.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremems under Califomia statutes and related regulatlons. (Ord. No. 92-28, § 7, 12-21•92) � EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or�abandoned tor a penod of 180 days. 1/ INSPECTIONS: In order for the work authorizetl under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspectlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 za+aae (aroo� WORKERS'COMPENSAnONDEG�AnON: I hereby effirtn under penelty of perjury one ot the tollowing tleclaratlons: � ❑ I heve entl wlll melntein e cetli�bete ol conseni to selhlnsure for workers' compensetion, es provided tor by section 3700 0l the Lebor Code, for ihe peAormance ot the �k for which ihis permlt Is issuetl. be n insurance, es recryiretl by sectlon 3700 0l the Lebor Cotle, for the pedortnanca oi the work for whlch ihis pefmit is issuetl. end policy number ere: r�(� p POlicy,Number:.��/!/.��"' �n 3U � !, � valued a( one hundred dollars ($100) or less.) ❑ I ceRity that in Ihe peRormanca ol the work tor which ihis permit I5 issued, I shall not employ any person in any manner so as �o become sub�ect to the workers' compensatlon la of Celifomla, end egrae Ihat if I should become sub�ect to the workers' compansation provisions oi Sectlon 3700 oi Ihe Labor Cotle, I shall forthwit� wmply with thes rovision;('� A ApPlicanfSlgnaWre: �� pete:'"""�: -/��-�-0� WARNIN(3: FAILURE TO E URE WOPKER C PENSATION COVERAGE IS UMAWFLL AND SHALL SU6IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TOONE HUN�RED TFiOUSANDDOl1ARE(5 ,000),INADDmIXJTOTHECOSTOFCOMPENSATION,DAMPGESASPROVIDEDFORINSECTIIXJ3lO60FTHELABORCODE,INTEREST,ANDATTORNEY'SFEES. LICENSEDCONTRACTORS DECLAAATION: I hereby aflirtn that I.am licensetl u�}�6 ovi 'ons of C�apter 9(commancing with Sectian 7000) of Division 3 of the Busin nd PJ9fessions C°�e, antl my license is in full force'and eNect. Lic. a 1 �,CI�R'�:� t1�G'f•Pl$ 1 OontrecfoYs'Slgneture:— - a Q� ('Date: --� ^ a. "U � CONSTRUCTION LENDING AGENCY: ❑ I hereby aMirm that Ihare is a consWction lending egency for the pedormance ol the work br w�ich Ihis Oertnit is issuetl. (Sec. 3097, Civil Code). Lenders Neme: Lender's Atltlress: Signeture: OWNER•BUILDER DECLARA710N5: Da�e: 1 hereby eHirm ihat untler penalry of perjury t�at I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business end Professions Code: Any ciry or wunry which requires e permit to consWct, elter, improve, tlemolish, or repair eny structure, pnor to its issuance, also requires tha epplicant for such pertnit to lile e signed statement that he or she is licensetl pursuam to Ihe O�oNslons ot t�e Contrectors IJcense Lew (Chapter 9(commencing with Sedlon 7000) oi Divislon 3 of the Business antl Profeuions Code) or thet he or she is exempt theretrom and the basis lor the elleged exemption. Any violatlon ot Section 7031.5 by eny applicent for e pertnit subjects t�e epplicent to a civil penalry m not more ihan fiva hundred dollare ($500).): ❑ I, as owner of tha properry, or my employees with weges es thelr sole compensetion, WILL DO T}IE WORK, and Ihe structure is not Intentletl or oMeretl lor sala (Sec. 7044, Business and Profeuions Code: The Contractors License Law tloes not apply lo an owner of property who builds or improves thereon, and who does such work himselt or harsetl or throug� his or her own employees, provitletl ihat such improvemenis ere not intended or oHered for sale. If, however, the building or improvement is sold within one year oi completioq the owneo-builder will have the hurden of proving that he or she ditl not build or improva for purpose of selaJ. • ❑ I, es owner of the property, am EXCLUSIVELV CON7AACTING WITH LICENSED GONTRACTORS to construct the prolact (Sac. 7044, Business entl Professions Catle: The contrectors LJcense Lew does not epply to an owner ol property who bullds or Impmves thereon, and who contrects for such pro�ect with e contractor(s) license pursuem ro t�e CantraG�ors License Laws.). ❑ I em exempt under sec. Business and Professions Cotle tor this reason: Signature: Date: Owner ID verilied by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Vedticatlon ot Ownership by (type oi document, i.e. - property taz bill or tleed�: DIVISION OF INDUSTRIAL SAFET' PERMIT CERTIFICATION: ❑ I hereby cartlty ihat no excavation five (5) or more feet in tlepi� Into which a person is requirad to descen4 will be mede in connection with work euthorizetl by this permii, antl ihat no building sir�cture, scattolding, telsework, or demolltion or dismaniling thereof, will be more �han thirty-six (36) teet high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, Title e, Calllomla Atlminis«ative Code). ❑ As ownervbuiltler, I will not emp�oy anyone ro do work which would requira e pertnit from Ihe Division of Intlustnal Sefety, as noted ebove, unless such person hes a permit to da such work from the division. Signature: Date: Division af Indusinal Safery Permit Number: CER7IFICATE OF COMPLIANCE AND AUTHORIZATON OF EMRY: I certity under penelry ot perjury that I have read this epplication and state Ihet the information given is correct I egree to comply wlih all sta�e laws and ciry ordinances rela�ing to Duilding construc�ion, entl authonze representetives of Ihe Ciry of Costa Mesa to enter upon Ihe ebove-descnbed property for inspectlon purposes. I agrea not to occupy or ellow occupancy of any building authorized by this permit until fnal inspection. Of Legal COOE I. INSPECTION TYVE 1616 Fiaed System Final Fire Pre�ention 1266 Pool Spa Finel 200 Flnfll Re-Rool 201 Final BIocWRetaining Wall 202 203 Final Fectory Fire Place Final Sign 204 Final Demolition ¢eg u�s � �/ Date � '�5 (Dete--- � COOE� INSPECl10NTYPE 206 Final Mechanical 20B Final Plumbinq 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Apprwal 222 Final Si�a 250 Final Building/Occupancy Qeie u�e�s � DEPUTY 1 INSPECTIuN SERVICE INC. 25121 DE SALLE ST, LAGUNA HILLS, CA 92653 1- 800 - DEPUTY 1-1 - 8Q0 - 337 - 8891 S—��t10lo �n/l " DEPT. OF BLDG. & SAFETY CITY OF Cvs'i14—vt�l{r�SiE) COUNTY OF SPECIAL INSPECTION REPORT Building Pertnit No�B� � 007,SL-�� Job. No. Date �- 3�U� Job Indentification / Address A- kf,� M�v"�^�l �� ` 32�-U—'L�_t.,/IiA%,AlL''�fiP � G MM General Contractor / Address .� � w� (�-�'�`'�°'� Sub - Contractor / Address �^ Structural Engineer / Address � Aroh. REINFORCED CANCRETE MASONRY HI-TENSILE BOLTING CHEMICAL PRESTRESSED CONCRETE WELDING GYPSUM CONCREfE OTHER 1 oRre�asr�erou 1 DESCRIPTION OF WORK INSPECTED 1 DATE —b' ��Id" ►ACS'7, bF 20< � '� (�.�.✓lf3f 2x 5 �„_, „ � . ' - tM - +�l fz: � � x � ¢t s- Z. 5 P�i- �5 _ rM �z-5 ii. " �Vf�LS�Zfr �2� OT � Time In � Time Out I I Grout � lAormr Concrete � Bloek ou — Denstty a� lropeetmno b�sad on a m+ntrnum or � noure a over a �wur. - e nouro. minimurR My Irmpeetla� ezlerW6+g past the noon Irour rr81 be Wlted �a Q hour �,Imum. m etlmuon, anr �rmpsetlw+ e�e�+e wet en e naa pa rfod� or SawNay 6ispeetlon w01 be btlled et tMm eeM e helf. ATTORNEY'S FEES - If arry action at law or in equky is brtwgM bo enforce or irrterupt the terms of this Contrect, tlre preveiling party shall be erditled tc reasonable attomey's fees, cas5 and necessary disbursemer� in addition b any other relief to which such parly maybe erttltled. �..,�/n'�/ SPECIAL INSPECTION REPORT Inepeetor's Neme: �-+F `"'`"�/ ��— Inspaetor's Stgnaturc: LD. No. � ��3�'� �� ; has been filed and tt states that tlie above work to the best of hisTher Imowledge canpGes with the ptovisions of the Un'rfortn Building Code and meets epproved plans end specifica ' ns. a��cr�,iy s � Approved by: �� By: �� (714) 754-5273 • Fax (714) 754-4856 • wvm.ci.costa-mesa.��sCTRICAL PERMIT 77 FAIR DRIVE, GOSTA MESA, CA 92626 Job Address: Suile No Vicinity: 3210 DELAWARE PL ADDITON Parcel Nunmber: 13910310 ,4pp�icant: BIZZELL, JIM Address: 2130 NATIONqL AV ,Phone: (714)404-8377 COSTA MESA, CA .� - Zip 92627 Owner. AKERSTROM, STAFFAN AND TRACY ^ Address 3210DElAWARE PL ,COSTA MESA, CA , . , . Contractor JIM REPAIRS �" Address: 2130 NATIONAL AV ISSUE FEE ` Temp service test Res. alc package New Res (1-2 units) � .. New Res (3+units) Pool I Spa �. Lighting FiMs Recept Outlets Switches Non Res Appl Res Appl" �� ' Service to 200a Service to 1000a Service over t000a Motors to 1hp . Motors to 10hp Motors to SOhp , Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole COSTA MESA, CA Phone: 714-034-7284 - � �� Zip: 92626 - t � � � Phone: (714)404-8377 Zip: 92627 License: 771363 SCOPE OF PERMIT EIECTRICAL pERMIT FOR ADD 434 S.F. TO EXISTING S.F.D. Status: ISS U E D Applied: 09/21Y2005 Issued: 09/21/2005 ISSUED BY: � � V' �__� REF#:805�-00754 - - WORK TO INCLUDE: tO IIGHTING FIXTS, 10 RECEPT OUTLETS, 6 SWITCHES AND RELOCATION,OF, 1 SERVICE PANEL. - � � ' � �� - � Quantity $23.50 " $0.00 $0.00 $0.00 $0.00 $0.00, $11.00 $11.00 $6.60 $0.00 $0:00 $30.50 $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 r 0 0 0 10 10 6 0 0 1 -. 0 0 ,' 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 R � . Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up,to 10 kva/kw .................up to 50 kvalkw :................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Cow Volt Wiring System / Ckt Misc. Conduit � � - � Misa Conductor .'- � Cirws-( gen or ride) Circus (mech ride or lights) � � Christmas Tree Stand . Fireworks Stand Other�EleciricafFee � Investigation Fee Plan Check Fee Reinspection Fee Quantiry $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 $0.00 • 0 $0.00 0 $0.00 0 $0.00 - 0 $0.00 0 $0:00 $0.00 $0.00 $0.00 TOTAL CACCULATED PEES §ffi.60 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period ot 180 days.� % � INSPECTIONS: In order for the work authorized under ihis permi� to be considered legal, such work must comply with all applicable codea,�and all required Inspections and final approval must be obtained. Failure to obtain inspections and tinal approval will result in the axpiration of this permit. IFOR INSPECTIONS CALL: (714) 754•5626 � 2a46d6 (NW) WORKERS'COMPENSAnON DECLARAnON: �- - I heieby aHirm under penalry of periury one of tha following declarations: ❑ I have antl wlll maintein e certificete of consent to self-Insure tor workers' compensatlon, es prodded tor by seclion 3700 of the Labor Code, tor the peAortnance of Ihe �work for whlch this partnit is issuetl. I have antl will maintain workers' compensation insurence, as required by section 3700 of 1he Labor Code, for the pedormence of the work tor which this permit is issued. My_workers' pej�-sation 1 u nce rner entl policy number ere: (�(�Q / p Carrier. =� � ��f� � Policy.Nu��1��vQ,�Q( �( �. ane hundretl tlallers ($f00) oNess.) ❑ I certih/ that in Ihe pertortnance oi iha work for which this pertnit is issued, I shall not employ any person in any menner so as to become suble� �01he workere' compensation I oi Celifomla, and gree thet ii I should become sub�ect ro Ihe workers' compensetion provisions of Section 3700 of ihe Labor Code, I shall fotlhwlt� comply with Ihe e p ovisions.1D �� p Applicem�Signa}ura:� ` nlit� \ Y A�[fi^ Date:._ -�"`� • a 1^-Q S WARNINO: FAILURE TO E UPE WORKERS' 1 NSATIpJ CAVERAGE IS UNLAWFUI PND SHALL SIIBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOIXJE HUNDRED THOUSANDDOLLARE($ ,000),INADDITIIXJTOTHECOSTOFCOMPENSATION,DAM4GESASPROVIDEDFORINSECTION3')OfiOFTHELABORCODE,IN�EREST,ANDATTOHNEV'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby a%irm ihat I am forca entl eHed: Lic.`k _ ContrectoCs Signature:. ,�,��-_ of Chapter 9(commencing with Section 7000) of Division 3 of the,Busine antl rofessions Code, and my license is in full CClass q ?. �� y.�C oaca / 9_,,� t-o r CONSTflUCT10N LENDING AGENCV: ❑ I hereby aHirtn that there is a consWction lentling agency for the pertortnance of ihe work for which Ihis pertnit is issued. (Sec. 3097, Civil Cotle). Lendefs Neme: Lender's Address: Signeture: OWNER-BUILDER DECLAiiATIONS: Date: I hereby alilrm the� untler penelty of perjury ihat I em EXEMPT FROM 7ME CONTRACTORS LICENSE LAW for 1he following reason (Sec. 7031.5, Business and Professions Cotle: Any city or counry which reQuires a pertnit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for suc� pertnit to file a signetl st m�N �hat he or she is Ilcensed pursuem ro the provisions ot ihe Contracmre License Law (Chaptar 9(commencing with Sectlon 7000) of Division 3 ot the Business antl Pr itlns Code) or thet he or she is eaempt iherefrom end the basis for the alleged exemption. Any violation of Section 7031.5 by any applicent for a partnit subjects the eppl a civil penalry W not more than five hundred dollars ($500).): ❑ I, as ownar of th openy, o�my employees with weges as their sple compensation, WILL DO THE WORK, and ihe strucWre is not intentletl or ofleretl for sale (Sec. 7044, Business �Professions Code: Tha Con�rectors License LB w does not apply Io an owner of property who builds or improves ihereon, antl who does such work himsel� or herselt or ihrough his or her own employees, provided lRat such improvemenis ere not intendetl or oflered tor sale. If, howevar, Ihe building or improvement is sold within one year of completion, ihe owner-builder wiil heve ihe burden of proving t�at he or she ditl not build or improve tor purpose of sale.). ' ❑ I, as owner o� ihe property, am EXCLUSNELY CONTRACTING WITH LICENSED CONTRACTOHS to consimct the project (SecJ044, Business antl Professions Code: The coniractors License Lew does not apply to an ownar of pmpetly who builds or improves theraon, and who contracis for such project with a contractor(s) license pureuant to the Coniractors License Laws.). ❑ I em exempt under sec. Signature: Ownar ID veritietl by dnver's license. ❑ Ves ❑ No Business and Professions Code tor Ihis reason: Verification of Ownership by (rype of document, i.e. � property tax bill or deed): Driver's License No. Date: E:pires: DIVISION OP INDUSTRIAL SAFETY PERMIT CERTIFICATION: � I hereby rertify [hat no excavation five (5) or more feet in tlepth Into which a person is required lo descend, wiil be made in connection with work euihonzed by this pertnit, and that no building siructure, scaffolding, lalsework, or demoli�ion or dismantling ihereof, will be more ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, iitle 8, Celifornia Administrative Code). ❑ As owner-builder, I will not employ anyona to do work which would require e pertnit from the �ivision oi Industrial SeteN, as notetl above, unless such person hes a parmit to do such work from ihe division. Signature: Date: Division of Industnal Safery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND A1JT}IORIZATION OF ENTRY: I certity under penalty of perjury ihat I have read t�is application antl state Ihat the infortnation given is correcl I agrae to comply with all stace laws and clry ordinances releting to building consimction, end authorize representatives ot the City of Costa Mesa to enter upon the ebove-descnbed property for inspection puryoses. I agree not to occupy or allow occupancy of any building authonzetl by Ihis permit until linal inspection. CQDE t. INSPECTONTYPE 1616 Fizetl System Flnal Fire Prevention 1266 Pool Spe Final 200 Finel Re-Roof 201 Finel BIocWRetaining W ell 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition _ Date � Ipl CSQ�� INSPECTIONTVPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Finel Building/Occupency PAIE It�Lfl q^t2-a6 c�� (714) 754-5273 • Feu (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFiNE, GOSTA MESA, GA 92626 Job Address: 3210 DELAWARE PL Suile No Viciniry: ADDITON Parcel Number: 13910310 nppliwnt: BIZZELL, JIM Address: 2130 NATIONAL AV COSTA MESA, CA MECHANICAL PERMIT Phone: (714)404-8377 Zip: 92627 Owner: AKERSTROM, STAFFAN AND TRACY Address: 3210 �EIAWARE PL - � Phone: 714-434-7284 Zip: 92626 COSTA MESA, CA Contractor: JIM REPAIRS Address: 2130 NATIONAL AV COSTA MESA, CA Phone: (714)404-8377 Zip: 92627 License: 771363 SCOPE OF PERMIT MECHANICAL PERMIT FOR ADD 434 S.F. TO EXISTING S.F.D. REF#:BOS-00754 Status: ISSUED Applied: 0921Q005 Issued: 09/21/2005 ISSUED BY: ��%�� RR WORK TO INCWDE: 1 REPAIR/ALT COOLING/HEAT, 1 GAS PIPING, 1 FACTORY fIREPLACE AND 1 VENT FAN/SINGLE DUCT. ISSUE FEE Inst FAU <100 k BTU Insl FAU >100 k BTU Repair I Alt CoolingMeat Inst / Rep. Recess Wall Htr Refriq Sys <100 k BTU Retrig Sys >100 k BTU Gas Piping Factory Fireplace � Hood w/Mech Exhaust VAV Box Vent Fan I Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocale Appl Vent AirHandlers< 10000cfM AirHandlers> 10000cim Floor Fumace Floor or Suspend Heater $23.50 50.00 50.00 $13.70 $0.00 $0.00 $0.00 $6.15 $10.65 $0.00 $0.00 $7.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Repair I Alt Absorblion Unit Repair / Alt Refrigerati0n Unil Ventillation System Evaporative Cooler Commercia l Incinerator Domestic Incinerator Comoressors / Absomtion Svstems Uplo3hpl100kBTU 3To15hp/500kBTU 15 To 30 hp I 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Up to 3 hp 3To15hp 15to30hp 30 l0 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTALCALCULATEDFEES COMMENTS / SPECIAL CONDITIONS ' Quantity $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 80.00 E61.25 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia 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 suspe� •or abandoned for a period of 180 days. INSPECTIONS: In ordgr for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell requlred Inspactlona and final approval must be obtained. Failure to obtain inspections antl final approval will result in the exp'iration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2aa&a81�) WORKERS' COMPENSAYION DECLARATION: I hereby aHirtn untler penalry ol perjury orre of Iha tollowing declarations: ❑ I eve entl wlll maint6in e cartificate at consent to self-Insure for workers' compensatlon, as provitlea for by sectlon 3700 of the Lebor Code, �or the paAortnence of the ork for which ihis p@�� s issuatl. ',l6have antl will melntain workers' compensation insurence, es requiretl by sedion 3700 of tha Labor Code, far the pedortnance of the work br which this pertnit is issuetl. � My wa w ipe�n4atlon rencef rtier and poliry num�er ere: ��/].� Q/ �Cartle� �� IZ.. ��.�-Aa PdicyNumber.�rL2��"7�U0 � / (nrls�secf/on neetl not be comp/eted I! the pertnit /s veluetl et one hund�ed dollers (5100) or /euJ �� -�- � ❑ I cetlify that in the eRa�ence of the work for which this pertnit is luuetl, I shell not employ a�y person in any manner so as to hecome subject to the workers' compensation le 5 f Celifomia, and egree that if I shoultl become sub�ect ta t�e workers' compensetion provisio Section 3700 of the Lebor Code, I shall farthwith tAmply with the 0 oNsions. �/� _ ApplicanfSlgnatuie: � �� Date:� - �� d� WARNING: FAILURE T SE URE WORKERS' COMP SATION COVERAOE IS UNIAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINPL PENALTIES rW D GVIL FlNES UP TO IXJE HUNDPED TTIOUSANDDOLLARE( ,OW)�INADDITIONTOTHECOSTOFCAMPENSATION,DAMAGESASPflOVIDEDWRINSECTION3]OBOFTHELABOqCADE,IMERESi,MIOATTORNEV'SFEES. LICENSED CONTRACTOqS DECLARATION: I hereby eMirm ihet 1 am brce�end eHect. Lla a _ i Contractofs SigneWre: at Chapter 9(commencing with Section 7000) oi Division 3 ol.�he.Blsi s and Professio?� Code, and my license is in full �Cless�k__� �GVqrl ;c oa�a:� a�Ah o CONSTRUCTON LEN�ING AGENCY; ❑ I hereby eflirtn that there Is a consWction lending agency for the pedortnance of ihe work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lendefs Adtlress: Signeture: Date: OWNER-BUILDER DECU��1T10NS: I hereby eHirtn Ihet under penelry of perjury ihat I em EXEMPT ROM THE CONTRACTORS LICENSE LAW for ihe lollowing reason (Sec. 7037.5, 8usiness antl Professlons Cotle: Any ci or county wl]�+ require . " to con�r, improve, demolish, or repair any structure, prior to its Issuanca, also requires the applicam for such pertnit to file e sipn qf�pement 1 a or s i etl purs� oi � provisions of Ihe Contracrors License Law (Chapter 9(commencing with Section 7000) oi Division 3 of ihe Business q P��g sslons C Oe) or ihaYh'd y'§ra is exe?�p�tfi,' irom end the basis for the ellegetl exemptlon. Any violelion ol Section 7031.5 by eny applicant for e pertnit subjects tH Iltant to e dh�'penalry Mi7o R�ore than Iiv4�u�reA tlollars ($500).): IC.e �� F:'Y p:F' .. ✓.- ' ❑ I, es owner,of the property, or my employees with weges as thelr sole compensetion, WILL DO TME WORK, and the siructure Is not intentletl or otterad tor sele (Sec. 7044, Business entl Professions Code: Tha Coniractors License Law does not epply to an owner of Droperry who 6uilds or improves thereon, antl who does such work himsetl or herseN rn ihrough his w her own empbyees, provitled thel such improvemenis sre not iMentled or oHeretl tor sale. N, howave�, iha building or improvement is sold within one yeer o� completion, the owner-builder will heve ihe burden of proving Ihat he or she tlid not build or improve for purpose of sale.). ' ❑ I, es owner oi the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct tha project (Sec. 7044, Business and Professions Code: The conirectorS Licensa Lew does not epply to en owner ot propetly who builtls or impmvas thereon, and who contrads lor such project with a contractor(s) license pursuant to the Contrectors License Lews.). ❑ I em exempt under sec. Business antl Professions Code tor this reason: Signalure: Daia: Owner ID verifiatl Dy tlriver'Slicense. ❑ Ves ❑ No Orivefs License No. Expires: Verification ot Ownership by (ryPe ot dxument, i.e. - pmperty tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICA710N: ❑ I hereby cartity Ihet no excavation tive (5) or more feet in depih into w�ich e person Is required to tlescend, will be metle In connection with work authonzed by ihis pertnit, and lhat no building struciure, scaHoltling, telsework, or demolition or tlismantling Ihereoi, will be more than thirty-sla (36) teei high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Califomia Adminisiretive Cotle). ❑ As owner-buildar, I will not employ anyone to do work which woultl require e permit from the Division ot Indusirial Sefery, es notetl ehove, unless such person has e permlt to do such work irom the division. Signature: �ate: Divislon oi Intlustnal Sefery PermitiJumber: CERTIFlCA7E OF COMPLIANCE AND AIJTMOH¢ATON OF ENiRV: I cenity undar penalry of perjury ihat I have read Ihis application antl state that the intortnation given is correct. I agree to comply With ell state laws end ciry ordinances relating to building consiruction, end eulhorize representatives ot ihe City of Cos�a Mesa to entar upon Ihe ebova-descnbed property far inspection puryoses. I agree not to occupy or allow occupancy of any building authonzetl by t�is permit unlil final inspection. CODE I. IHSPECTONTYPE PAIE UIINJSLS 1616 Fiaed System Final Fire Prevention 1268 Paol Spa Final 200 Finel Re-Roof 201 Flnal Block/Retainin9 Wall 202 203 Finel Fectory Fire Place Final Sign 204 Final Demolition COOE I INSPECTION TYFE 206 Final Mechanicel 20B Final Plum6ing 210 Pinal ElecMwl 212 Final Fire Preveniion 220 Final Plenning Approval 222 Final Slte 250 Fina� Building/Occupancy QSSE II�L@ 9- i,� -c�b (77b) 754-5273 • FH%(714) 754-4856 • wwW.CI.COS�O-rt1038.C8.U3 77 FAIH UHIVt, GOJIA MG5A, GF y26Lti PLUMBING PERMIT JobAddress�. 3210 DELAWAREPL Suite No Vicinity: ADDITION Parcel Nunmber: 13910310 Applicanc BIZZELL, JIM Address: 2130 NATIONAL AV COSTA MESA, CA Phone: (714)404-8377 2ip: 92627 Owner: AKERSTROM, STAFFAN AND TRACY Address 3210DELAWARE�PL � COSTA MESA, CA Phone: 714-434-7284 Zip: 92626 Contractor. . JIM REPAIRS Atldress: 2130 NATIONAL AV "� PhonO'' �04-8 � COSTA MESA, CA Zip: 92627 License: 771363 SCOPE OF PERMIT P,LUMBING PERMIT FOR ADD 434 S.F. TO EXISTING S.F.D. Stalus: ISSUED Applied: 09/21/2005 Issued: 09/21/2005 ISSUED BY: �-� / � REF#: BOS-00754 . WORK TO INCLUDE: 1 BATHTUB, 1 GAS (1-0 OUTLETS), 1 SHOWER, 1 WASH BASIN SET, 1 WASTE AND VENT SYSTEM. 1 WATER CLOSET (TOI�ET) AND 1 WATER HEATER/VENT AND 1 GAS REPIPE FOR LINE COMING FROM GARAGE TO METER4 ND METER TO BACKYARD FOR FIRE PIT. FEE SUMMARY � . AMT QTY � :; ' � -. - ' , , AMT � QN � .: AMT QTY ISSUE FEE ;-- $23.50 Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 BaGkflow irrigation $0.00 0' Landscape Irrigation $0.00 0 Swimming Pool 50.00 0 BaGkflow Preventer � $0.00 0- P-Trap $0.00 0 Trap Primer . 50.00 0 Bathtub � $9.80 1 Pressure Regulator 50.00 0 Urinal 50.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) 50.00 0 Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkilow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank �� $0.00 0 Wash Basin $0.00 0 Dishwasher . $0.00, 0- Sewer Cap for Demo $0.00 0 Wash Basin Set $9.80 1 Drain, Floor $0.00 0. , Sewer Connect $OAO 0 Waste and Vent System $9.80 1 Drain, Rainwater $0.00 0- ` Sewer Private Line � $0.00 0 '� Water Closet (Toileq 59.80 1 Dra�n,Roof $0.00 0 Shov✓er g9.80 1 WaterHeater/vent 512.30 1 Dri�king Fountain $0.00 0 Sink, bar $0.00 0. Water Piping (Inst or Rep.) 50.00 0 Expansion Tank $0.00 0 . Sink, commercial ,_� .$0.00 0- Water Re-pipe $0.00 0 Gas Earthquake Valve�-��. $0.00 0' . - Sink,�Floor , $0.00 � 0- WaterService $0.00 0 Ga5 (1-4 outlets) -$6.15 1 Sink, kitchen 50.00 0- - Water Softener $0.00 0 Gas (Over 4 outlels) 50.00 0 Sink, service/mop " $0.00 0 OTHER $0.00 Gas Repipe $0.00 0- " Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK 50.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0,00 0 TOTAL CALCULATED FEES: 590.95 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply wi[h all applicable handicap access requiraments under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241•92) EXPIRATION: This permit shall automaticalty e�ire and become void N work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for lh0 work euthorized under this permit to be considered legal, such work must compty with a�l applicable codes, and all requlred Inapeetlona and final epprovel must be obtalned. Failure to obtain Inspections and final approval will result in the ezpiration of ihis permit. FOR INSPECTIONS CALL: (774) 7545626 zaeo-ee (5�ou) WORKERS'COMPENSATON DECLANAnON: , - I �ereby affirtn untler penalry oi perjury ona of the following declarations: ❑ I hava end will maintain a certifica�e of consent to self-Insure lor workers' compensation, es pmNded lor by saction 3700 of the Lebor CoOe, lor ihe pertormence of the � work for which �his p8rmii is issuetl. Carrier: cpmpensetlon Insurance, as requiretl �y section 3700 oi Ihe Lebor Code, tor Ne rtonnanca ot the work far wMUi this pertnit is iuued. rpnce carner end policy number are: � Po; -- �6�q c�n � a��i i! the permif Is valued et one hundretl tlollars ($100) or less.) ❑ I certify that in the partormance of lhe work for w�ich ihis permit is issued, I shall not employ any person in nner so es to become subject to tha workers' 'on I of CaOtomi a egree that II I should become subject to the workers"comp visions oi Sectlon 3700 oi the labor Code, I shell forthwlth comply with e rovision I�% � licent e: . +�7� Date: L L—�2 � WAPNING FAILURE TO E UFE WORKER CC A NSATION COVERAGE IS UNLAWFUL PND SHALL SU&IEGT AN EMPLOYER TO CRIMINFL PENALTIES ANO CIVIL FlNES UP TOONE HUNORED T}KKISANDOOILARE(S .OWj,INADDITIONT THECOSTOFCOMPENSATION,DAMAGESlSPROVIDEDFORINSECTION3�O60FTHELABORCODE,INTEREST,PND/TTORNEI"SFEES. LICENSED CONTRACTORS DECLARAnON: I hereb licensed under provisions ol Chapter 9(commencing wit� Sectlon 7000) Didsion 3 of the Busina antl Professions Code, end my license is in full rce ----_ic. p 1�`�� o'� n N l� ignamrxy �� e; ' 1 '/ Z�o S_. CONSTRUCTION LENDING AGENCY: ❑ I hereby eflirm thet there is a constmction lendinp eqency tor ihe pedormance of ihe work for which this permit is issuad. (Sec. 309J, Civil Cotle). Lentlers Neme: Lentlers Atltlress: Signature: Date: OWNER-BUILDEH DECLARATIONS: 1 hereby aMirtn ihat under penelry of perjury Ihet I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW lor ihe tollowing reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or counry which requires e permit to consiruct, alter, improve, demolish, or reDair any structure, pnor to its iuuance, elso requires Ihe epplicant for such permil to lile e signed stetement that he or she Is Iicensetl pursuent to ihe provisions of ihe Contractors LJcense Lew (Cheptar 9(commencing with Sectlon 7000) of Division 3 of the Busineu end Professions Code) or Ihat he or she is exempt iherefrom anA the Cesis for Ihe elleged exemption. Any violation of Seclion 7031.5 by any applicant for e pertnit su6jecis Ihe applicant to a civil penalry oi nol more than five huntlretl dollars ($500).): ❑ I, es owner of iha property, or my �mployees with wages es Iheir sole compensatlon, WILL DO THE WORK, and ihe swcWre is not intentletl or oflered for sale (Sec. 7044, Business and Professions Code: The Coniractors License Law dces not apD�Y �o an owner of proDertY who builds or improves Ihereon, and who does such work himseN or herseN or through his or her own employees, pmvided thet such imp;ovemems ere not Intended or otterea for sale. If, howevar, Ihe building or improvement Is soltl wlihin one year of completion, �h�aowner-buil�e� will he Ibe'�bur�en of pryoving ihet he or she tlitl not �uild or improve tor purpose of sale.). • ❑ I, as owner ol lhe properry, em�C CLU VELV TRAC��_ T� LICENSED CONTRACTORS to construct the project (Sec. 7044, Business end Professions Code: 7�e contraaors LicenseL� not ap� en owngf�'�erty who builds ar Impraves thereon, end who con�rects lor such proJact wl�h e comrector(s) license pursuant to the Contredor3 ��a Lews� �� ❑ I am exempt under sec. Business antl Professions Code for this reason: SignaWre: Date: Owner ID verllied by drivar's license. ❑ �es ❑ No Drivers Ucense No. E:pires: Verilication ol Ownership Dy (type oi documem, i.e. - property tax 6ill or deed): DIVISION OF INDUSTRIAL SAFETV PEAMIT CERTIFICA710N: ❑ I hereGy certify ihat no ezcavation tive (5) or more feet in tlepth into which a pereon is required to descend, wlll be made in connection wlih work euthonzetl by Ihis pertnit, and Ihat no building structu�a, scaflolding, falsework, or demolition or dismantling thereot, will be more Nan thirty-six (36) leet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tille B, Calitomia Atlminisirative Code). ❑ As awner-builder, I will not employ enyone to da work which woutd require e permit from the Division ol Indusirial Sefery, es noted ebove, unless such person hes e pertnit ta do such work from the division. SignaNre: Date: Division of IntluSlrial Safety Permit Number: CEHTIFlCATE OF COMPLJANCE AND AIJTHORIZATON OF ENTRV: I cenity under penalry of perjury that I have read this application and state ihat the informatlon given is corr�l agree to compty with all state (aws end ciry ordinances relating to builtling constructlon, end authodze representatives of the City of Cosfa Mesa to enter upon the ebo escnbed properry for inspeclion purposes. I agree noI to acupy or allow occupancy ot any builtling au�horized by this permit until final inspection. GOUE �. INSPECTIONTYPE . 1618 Fizetl System Final Fire Prevention 1266 Pool Spe Final 200 Final Ra-Raof 201 Finel BIocWRetaining Wall , 202 Final Fectory Fire Place 203 Final Sign 204 Final �emolition ' �2 —� 2 ate �QQ�a INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Eletlrical - 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Finel Building/Oaupency� o�TE It�eLS . , Q (� �nL (714) 754-5273 • Fa�c (774) 754-4856 • www.ci.costa-mesa.��s MBING PERMIT �� FAIq DRIVE, COSTA MESA, CA 92626 .lobAddress: 3210 DELAWARE PL Suite No Vicinity: ADDITION Parcel Nunmber: 13910310 Appliwnt: BIZZELL, JIM Address: 2130 NATIONAL AV COSTA MESA, CA Phone: (714j404-8377 Zip: 92627 owner: AKERSTROM, STAFFAN AND TRACY Address 3210 DELAWARE PL COSTA MESA, CA Contractor: JIM REPAIRS Adtlress: 2130 NATIONAL AV COSTA MESA, CA Phone: 714-434-7284 Zip: 92626 Phone: (714)404-8377 2ip: 92627 License: 771363 SCOPE OF PERMIT PLUMBING PERMIT FOR ADD 434 S.F. TO EXISTING S.F.D. REF#: BOS-00754 Status: ISSUED Applied: 0921I2005 Issued: O9Rt/2005 ISSUED BY: � WORK TO INCLUDE: 1 BATHTUB, 1 GAS (1-4 OUTLETS), 1 SHOWER, 1 WASH BASIN SET, 1 WASTE AND VENT SYSTEM, 1 WATER CLOSET (TOILET) AND 1 WATER HEATERNENT. ISSUE FEE Backflow irrigation Backflow Preventer � BathWb Clarifier System Connect pce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater - Drain, Roof Drinking Fountain Expansion Tank Gas EaAhquake Valve Gas (1� outlets) Gas (Over 4 outlets) Gas Repipe - Gas Service Interceptors (Grease, Oiq Interceptors (Sand Aulo ) AMT $23.50 $0.00 $0.00 59.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $6.15 50.00 $0.00 $0.00 $0.00 $0.00 � FEE SUMMARY AMT LaundryTub/Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 fl) $0.00 Receptors $0.00 SepticTank $0.00 Sewer Cap for Demo $0.00 Sewer Conned 50.00 Sewer Private Line $0.00 Shower 59.80 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen 50.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 �N 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS SumpPump Swimming Pool Trap Primer . Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr BkOow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping Qnst or Rep.) Water Re-pipe W ater Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION TOTAL CALCULATED FEES: �, AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $9.80 59.80 89.80 $12.30 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 E90.95 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Cali(ornia statutes and regulations. (Ord. No. 92-28, § 7, 72-27-92) / EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is for a period of 180 days. INSPECTIONS: In order fo� the work authorized under this permit to be considered legal, such work must comply with all requlred Inspeetlona and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe w FOR INSPECTIONS CALI; (714) 7545626 zaa�ae (flroo) � 0 0 0 0 0 0 0 1 t 1 1 0 0 0 0 abandoned �le codas, end all of this permit. WORKERS'COMPENSAnON DECLARAnON: I hereby effirtn untler penelry of perjury one of the tollowing tleclaretions: � ❑ ave end will meintain e certificate of consent to self-Insure tor workers' compensatlon, es provided for by section 3700 0l Ihe Labor Cotle, for tha perlormance of Ihe wOrk lor whiCh t�15 permit Is 15suBtl. �I-hava antl will maintain workers' co nsation insurence, es required by seqion 3700 af tha Lebor Cade, for the peAortnance of ihe work for which tNs pertnit is issuetl. '' My work �jompensaUon Insiy6n�Certler nd policy num6er ere: Q c� Carrier:`� " ��T7if'�a '�v�-0� Policy`Numbe-r:"�� 1�� L�� ' (lhis section ne d nof be crompletetl7! Ihe OBrmif Is veluetl et ane hundred dallers ($f 00) or Iess.J �y—� -- . ❑ I certiM1/ �het in t�e eAortnence of ihe work lor which this permit is issued, I shall not employ eny person in any manner so es to hecome sub�ect to the workers' compensatlon la f Celifomle, tl eBree that if I shoulA become sublect to Ihe workers' compensatlon provlsions of Sectlan 3700 of the Labor Code, I shall forihwith camply wit� these r visions. � Q f� �. Appllcent�SlBneture: �Dete: + ��t •^�O'� �dJ WARNINO^FAILURE TO S URE WORKERS' COMPENSA VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINQ PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE (E1 ,OW), IN AODITIONTOn7E CASTOF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 3]OB OF THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm that I am Iicensi� u er,proX Isions ot Chapter 9(commencing with Section 7000) of Division 3 of ihe Busine nd �PJofessions e, end my license is in full fo�ce,enC�eNect: Lic. q /) �(0 5 Cless.q, � •`t-�'NZlt/� Canlractofe�Signatur" e: i�.�+�� _ Date: —O i T�� /' �— CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn thet there Is a consWction lending agency br the Dedormance ot the work for which this permi� is issue0. (Sec. 3097, Civil Cotle). Lendafs Name: Signeture: _ OWNER-BUILDER DECLARATONS: Lender s Atldress: Date: I hereby eHirtn Ihet under penelry ol per�ury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business end Professions Cotle: Any ciry or counry which requlres e p9�i1 to consiruct, alter, impmve, demolish, or repair any sirucWre, pnor lo its issuance, elso requires the epplicant for such pertnit to file e signed stetement that he or she Is IlGensed pu u to tha provisions of the Contractars Llcense Lew (Chapter 9(cammencing wllh Sectlon 7000) ot �ivislon 3 of t�e Busineu entl Profeulons Code) or Ihe1 he o� she therefrom and t�e basis tor tha allaged eaemption. Any viWation of Sectlon 7031.5 by any applicent for a pertnit subje pllcant to e civll penelry of not more '� ndred dollars ($500).): , ❑ ,owner oi Ihe property, or my employees wll,�+ag es thelr sole compensa�ion, WILL DO TME WORK, end the siructure Is not Intended or oHered tor sele (Sec. �; Business and Professions Code: The ContrectorS;License Law dces not apply to an owner of properry who builds or improves thereon, anC who does such work himself or hersalf or through his or �er own employees, provided that such improvements ere not Intended or oNeretl lor sala. If, however, the building or improvement is sold within one year of wmpletion, ihe owner-builder will heve the burtlen oi Oroving that ha or she did not builtl or improve for purpose ol sale.). � ❑ I, es owner of the property, em E%CL1ISIVELY CONTRACTING WITH LICENSED CONTRACTORS to construcl the project (Sec. 7044, Busines9 and ProfesSions Cotle: The contrectors Licanse Lew does not apply to an owner ol property who �uiltls or improves Ihereon, antl who conirec�s for such proJect with a coniractor(s) lice se.pureuant to the CoNractors License Lews.). 's�t�'t.� „� ❑ I a ex�pt unde��,g,�g�a �"? '� ,jy�, Business and Professions Code for this reason: SiqneNre: _ �" � — Data: Ownar ID verified by driver's license. ❑ �es ❑ No Driver's License No. Expires: Venfication ol Ownership �y (type oi tlaume�4 ��e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cehify ihet no excevatlon five (5) or more teet in depth into which a person Is requlrad to descentl, wlll be mede in connaction with work authorized by this permil, antl Iha� no builtling siructure, SwHolding, lelsawork, or demolition or tlismantling iheraof, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Titla B, Calitornia Atlministw�ive Code). ❑ As owner-builder, I will not employ enyone to do work which would require e pertnit trom Ihe Division of Intlusirial Salery, es noted abova, unless such person has a permit to do such wo�k from the dlvision. Signature: Date: Divisian of Industrial Salery Pertnit Number: CEHTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTAY: I certify under penalry of perjury �het I have reed this epplication and stale Ihat ihe information given is wrrec�. I agree to comply wi�h all state lews end ciry ordinances relating to building consiruction, end eu�horize represeniatives of the Clry ot Casta Mesa to enter upon Ihe above-describad properry for inspection purposes. I agree not to occupy or allow occupancy of eny building euthonzed by �his permit until tinal inspection. GODE /. INSVFCTIONME Qd� IL�LSi SQ.PEL INSPECTIONTYPE 1616 Fi:etl System Finel Fire Prevention z06 Final Mechanical 1266 200 201 202 203 204 Paol Spe Final 208 Final Plumbing Finel Re-Rooi 210 F�Eleciriwl Finel BIxWRetaining Well 12 inal r Preve 'on Finel Fettory Fire Place ' el P nni r Finel Sign 222 Final Site Final Damolition � ,� Date 250 FinelBullding/OCcupency �g � ��ia� �sa-sz�3 • Fax (714) 754-4856 • www.c�.�os�a-mesa.��LDING PERMIT Jobqddress: 3210 DELAWARE PL Sufte: Vicinity: REAR PROPERTY LINE Primary Occ: ParcelNumber: 13910310 Applicant: JIM BIZZELL Address: 2130 NATIONAL AV Type of Construction: Zoning: COSTA MESA, CA Owner: AKERSTROM, STAFFAN AND TRACY Address 3210 DELAWARE PL COSTA MESA, CA Contrecror: JIM REPAIRS Address: 2130 NATIONAL AV COSTA MESA, CA Zip: 92627 Arch : Addregs: Zip: Phone: License: Phone: (714)404-8377 Zip: 92627 - : , Phone: 714-434-7284 2ip: 92626 Phone: (714)404-8377 License: 771363 Eng: Address: SCOPE OF PERMIT CONSTRUCT 4' HIGH, 65 L.F. RETAINING WALL ALONG REAR PROPERTY LINE. REF.: BOS-00754 FEE SUMMARY - 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 70/04Y2005 Issued: 10/042005 ISSUED BY: / Phone: License: Plan Check: $0.00 Calc Valuation: ss,soo.00 Permit: $97.25 Claim Valuation: So.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 � Inspection: $D.00 Total: $97.75 PLANNING & ZONING SETBACKS MAINSTRUCTURE Front 0-0 Rear 0-0 Lefl 0-0 Right 0-0 ACCESSORY Front 0- 0 Rear 0- 0 Lefi 0. 0 � Right 0- 0 PARKING Existinq: 0 Re uired: 0 Pronosed: 0 - NOTICE: 7he work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 7, 12-27-92) EXPIRATION: This permit shall autanatically expire and become void if work is rwt commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inppections end finel approval must be obtained. Failure to obtain inspec�ions and final approval will result in Ihe expiration of Ihis permit. FOR INSPECTIONS CALL: (714) 7545626 !4464fi (N00) WORKERS'COMPENSAnONDECLARAnON: I heraby afrirtn under penalry of peQury one of the iollowing tleclarations: � ❑ I have and wlll maintain e certificeta of con5ent ro self-Insure for workers' compensalloq es provided for by section 3700 of ihe Lebor Cotle, for the pertormence of the work for which ihis permit is Issuetl. „ �1 have antl will mainWin rkers' compansallon Insurance, as required by sectlan 3700 of,(he Lebor e,.tor Ihe peAormance ot the work for which this pqrtnit Is Issued. My worcknr5 co pensat�.C°n�� Insurenc carriar and pollcy number ere: '�++ v+I " y,� (� /1�� ,r� p� Carrier. l��P \.�.A,Q1 � � ,� 4 RolicyN38�tier.S`��—I W X' � / � .(This sectio�eed nof be comp/etetl i/ the permit 15 valuetl e( one hundred dollars ($100) or less.) ❑ I cetlity ihat in th pertortnance oi lhe work ior which this permil is issued, I shell not employ any person in eny manner so as to become subject ro the workere' compensallon la oi Californla,�d egr e that If I sh uld become sub�ecl to the workers' compensallon provislons of Section 3700 0l the Labor Code, I shell torihwiih comply with thes ovisions. � ��Y _ c_ AppliceniSignBWre: Dale: � �% 7 WARNINO: FAILURE TO E RE WOPKERS' C EN A �ON COVERAGE IS UNLAWFUL AND SMP1L SUBJECT AN EMPLOYER TO CRIMINAL PENALTtES AND qVIL FlNES UP TOIXJE MUN�RED TMOUSANO DOLLARE (51 ,000), IN ADDITION TO TME COST OF COMPENSATION, OAMAGES AS PROVI�EO FOR IN SECTION 37060F T1E IABOR CODE, IMEREST, AND AT70RNEY'S FEES. LICENSED CONTRACTORS DECLAAATION: I hereby ettirm Ihet I em lorce and eHect. Lic. N_ Contrectors Signeture: of Chepter 9(commencing with Section 7000) ot Division 3 oi Ihe Busin nd Professlons Code, antl my license is in tull � Cless q � n/!0 Date: / � � �1 -- l�. CONSTRUCTION LENDING AGENCV: 0 I here6y aHirtn �hat Ihere is e cons�mction lending agency for fhe peAormance of ihe work for w�ich this permit is Issuad. (Sec. 3097, Civil Code). Lendefs Neme: Signa�ure: _ Lender's Atltlress: Date: OWNER-BUILDER DECLARA710NS: I hereby aHirm that under penalty of perjury ihat I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW br ihe following reeson (Sec. 7031.5, Busineu end Professions Code: Any ciry or counry which reQuires e pertnit �o consiruct, alter, improve, demolish, or repeir eny stmcWre, prior to its issuance, elso requires iha epplicant for such pe�it b file e signetl stelement ihat he or she Is Iicensed pursuent to Ihe provisions ot ihe Contractors LJcense Lew (Chepter 9(commencing wlth Sectlon 7000) oi Dlvlsion 3 o� the Business entl Profeuions Cotle) or thet he or she is exempt therefrom antl ihe besis for the elleged exemption. Any violetion af Section 7037.5 by any applicant for e pertnit subjecis the epplicant to a civil penelry ol no� more than flve hundred dollers ($500)J: ❑ I, as owner of ihe properry, or my employees with wages as their sole wmpensetion, WILL DO THE WORK, end the structure is not Intentletl or oltered lor sale (Sec. 7044, Business antl Professions Cotle: The Conirectors License Law tloes not apply to an owner of properry who builtls or improves thereon, and w�o tloes such work himself or herseli or Ihrough his or her own employees, pravided thet such improvements ere not intendetl or ottered for sele. If, however, lhe builaing or improvement is sold within ona year ot campletioq the owna�-huiltler will have Ihe 6urden of proving that he or she did aot bulltl or improve ta purpose ot sele.). ' ❑ I, as owner ot the property, em E%CLUSIVBLY CONTRAC7INC WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business entl Prolessions Code: The coniractors License Lew does noi apply m en owner oi property who builds ar improves �hereon, end who coniracts lor such project with e comractoqs) license pursuant to ihe Contractors License �ews.). ❑ I am exempt under sec. Business antl Professions Code for �his reason: Signature: Date: Owner ID verified by dnvers license. ❑ Ves ❑ No Driver's license No. Vanfiwtion ot Ownership by (rype of tlocument, i e. - property Iex bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMR CEATIFICATON: Expires: ❑ I hereby cenity that no excavatlon five (5) o! more teet in depth into which e Oerson Is required lo descend, wlll be mede in wnnectlon with work euihonzetl by this permit, antl Ihat no building siructure, swNolding, telsework, or demolition or dismantling ihereof, will ba more �hen ihirry-siz (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Celifomia AAministrative Cotle). ❑ As owner-builtler, I will not employ enyone to tlo work which would require e pertnit trom the Division of Industnel Sefery, as noted ebove, unless such person hes a permit to do such work irom the division. Signature: Date: Division ot IndusMal Safery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTTIORIZAnON OF ENTRY: I cenity under penelty of perjury that I have reatl t�is ap0liwtion and state ihat the intormetion given is wrtect. I egree Io compty with all state lews and ciry ardinances relating lo building construction, end euihonze representatives of Ihe City ot Costa Mesa to enter upon ihe ebovadescnbed property for inspection puryoses. � egree not to occupy or ellow occupanty ol eny building authorized by this permii until fnal inspection. COOE I, IHSGECTONTYPE 1616 Fi:etl System Final Fire Prevention 1266 Pool Spa Finel 200 Final Re�Roof 201 Final Blxk/Reteining Well 202 Final Fectory Fire Place 203 Finel Sign 204 � Finel Demolition � �. � .tul. a /I�� / . .,.,ul LODE� INSPECTIONTYPE 206 Finel MechanlWl 200 Final Plumbing 210 Finel Elecirical 212 220 Date (0-�f - f�� Date Finel Fire Preventlon Final Planning Approval 222 Final Site 250 Final euiltlingiOccupency o�re II�L4 12�� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX Sf7 COHTA MEBA. CALIFORNIA Fo� Applieanf io Fill In Complefely TYPE OR PRINT BUILDING ADORESS 3210 Delalvare Place COSTA MESA GALIFORNIA E. 17th St. TEL. Z�CS'd NO. Carlson 8C TEL. ■BTATE _.�___ TEL. NO. OP � BHTOACK LINH PROM ' I LEFT S� I RIGHT S� DESCRIPTION OF WORK I x II.._�e._,�..I II......_,,. NO. OF G ROOMS V I HER¢BY AGItNOWL6DOC THAT 1 XAVE RPAD TXi9 APPLAGTION AND 6TATH THAT THH ABOVH 19 GOIiNEGT AND AGR¢E TO COM- PLY WITH ALL CIiY OROINANCEB AND BTATE LAWS REGULATINO BUILD�NO CONBTiUC}l� / �% BIGNATURE OF ��{/��-- PERMI7TEF /` AUTHORIZED AGENT �ke &�olegrove� IIIC• �+,�� s� �JU� 111960 G1�ift� D�T, C(TY OF (X➢STA P,9� APPLICATION FOR PERMIT BUILDING For Office Use Only R8C81PT NO. �Epp11L 1{p •7/1f E .G�* 'l REC81V[D BY I OA�CB�j'j.D I OATC 18SU8 oit� o LD 11❑ l 11. BUILDING ADDRESS COSTA MESA. CALIFORNIA FIRE ZONING ZONE NO.OP B¢ OF � ` PLAN9 111LOIN L80AL _ � _ THH �MOUNT BHOWN UNOBp VALUATION 19 POR THE PIIRpOSE OF 88TABL18HING A PERNIT FC8 ONLY. � s 14,179 PLAN CHECK $ 17 • TOTAL FEE g Sl• F 4