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Home My WebLink About3220 DELAWARE PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Viciniry: Parcel Nunmber: Applicant: Address: Owner: Address Contrector: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting FiMs Recept Outlets Swiiches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to SOhp Molors to 100hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuils Temp Pwr Pole Intermed Pole 3220 DELAWARE PL GARAGE 13910336 BROWN, DOUGLAS DEAN 3220 DELAWARE PL COSTA MESA, CA BROWN, DOUGLAS DEAN 3220 DELAWARE PL COSTA MESA, CA OWNER-BUILDER LE4ALIZE ELECTRICAL WORK 6 OUTLETS AND 1 SWITCH. $23.50 50.00 $0.00 $0.00 so.00 $0.00 $4.40 $6.60 $1.10 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quanlity 0 0 0 4 6 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ISSUED BY: Phone: 714-034-1385 Zip 92626 � c . 5�t`4i, \ �� : .Y � �, �i a �. Phone: Zip: License: 000000 :OPE OF PERMI IN GARAGE W/0 PE FEE SUMMARY Staws: ISSUED Applied: 11/O6/2006 Issued: 11/06I2006 .� � ' '1 ! k�i y I.� �Kj �� ;i "" M 1'�•�[k(M1. WORK TO INCLUDE:4 LIGHT FIXTS, Temp Dist System / Lighting Busway/100ft _ Standing Section Misc Electrical EquiPment Transformers up to 1 kva/kw ..:__._.....uA to 70 kvalkw .................up to 50 kva/Nw .................up to 100�kvaAcw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System I Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) Ciras (mech ride or lights) Christmas Tree Stand Fireworks Stand - � � Other Electrical Fee Investigalion Fee Plan Check Fee Reinspedion Fee �uantiry $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 80.00 0 50.00 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 50.00 0 $0.00 50.00 $0.00 $0.00 TOTAL CALCULATED FEES 535.60 - COMMENTS / SPECIAL CONDITIONS NOTICE: The work authori;¢� by this permit shall compty with all applicable handicap access requirements under Califomia stalutes and related regulations. (Ord. No. 92-28, § t, 12-21-g2) �` EXPIRATION: This permit shall automatically axpire and become void if work Is not commenced within 180 days, or if work is suspended o� abaMloned tor a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable cades, and all requlred Inapections and final epproval must be obtained. Failure to obtain inspactions and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545826 z«e.e �aw� WORKERS'COMPENSAnON DECLARAnON: . I hereby eNirm unGer Denalty ot perjury one of Ihe lollowing tlecleratlans: ❑ I have end wlll maintein e ceNNwte ol cansent to self-Insure lor workers' compensation, es providetl for by seqion 3700 of tha Labor Code, lor the pertortnance of Ihe work for which ihis permit i5 i55uetl. ❑ I hava and will maintain workers' compensetion Insurance, as required by section 3700 of the Lebor Cotle, for the partortnance of Ne work Por whicti this pertnit is issuetl. My workers' compensatlon Insurance cerder antl policy number ere: Certier: Policy Number. (This section neetl not be comp/eted 7( fhe permif is veluetl a( one hundred dollers ($ f00) or less.) - � I certify that in the pertortn e,ot t� r w nch th s p rtnit Is issued, I shell not employ eny person in eny manner so as to becoma suhject to the workers' compensation laws ol C fomla, end e [heCif sb 1 become sub�ect to the workers' compensation provisions of Secti .3700pppyyyttt he Lebor Cotle, I shall lorthwtlh comply� with ihese pr 5i�% ,_.� `// �� /O L antSl neture:—"' � �/ �o � / CJ IINO: FAILURE TO SECURE WORI 'RS' CAMPENSATIdJ CAVERAOE IS UNLAWFUL AND SMALL SUBIECT AN EMPLOVER TO CRI /LL PENNLTIES AND CIVIL FINES UP TOONE MUNDRED iANO DOLLARE (51 W,OW�, IN FODITION TO THE CO^uT OF COMPENSATION, OAM1LIGES AS PqOVIOED FOR IN SECTION 3]O60F THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn ihat I am licensatl untler provlsions ot Chapter 9(commencing with Sectlon 7000) oi Division 3 oi the Business antl Professlons Cade, antl my license Is In full force and eHect. Lic. q qass k ComrectoYs Signatura: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aMirtn Ihat there is e construction lentling agency tor �he pedormence ol the work for which Uis permit is issued. (Sec. 3097, Civil Code). Lenders Name: LentleYs AAdress: SignaNre: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirm that untler penalry ot perjury ihat I am EXEMPT FROM TFIE CONTFiAC70R5 LICENSE LAW tor fhe following reason (Sec. 7031.5, Business entl Professions Code: Any ciry or counry which requires e permit to construcl, elter, improve, demolish, or repair eny structure, prior to its issuance, elso requires the applicant br such parmit to tile a signed stetement that he or she Is Ilcensed pursuant to the provlslons af t�e Contractors LJcense Lew (Chaptar 9(commencing with Sectlon 7000) ai Divlslon 3 of ihe Business end Professions Code) or that ha or sha Is exempt t�erefrom and the basis lor ihe alleged exemption. Any violation of Section 7031.5 by eny applicant for e pertnit sublects the epplicant to e civil penally of not more then five hundred dollars ($500)J: ��1. as owner of ihe property, or my employees wl�h weges as Iheir sole compensatlon, WILL DO 7HE WORK, and the structure is not IntentleC or oftered lor sale (Sec. ✓ 7044, Business antl Professions CoCe: 7Te Contractors LJcense Law does not apply to en owner ot proDerry who builds or improves thereon, antl who does such work himself or hersetl or Ihrough his or her own employees, provided thet such improvemants are not intended or offered for sale. If, howaver, ihe building or improvamenl is soltl within one year of wmpletion, ihe owner�Duilder will have ihe burtlen ot proving ihat he or she did not build or improve lor purpose of sale.). ❑ I, as owner at the prope E%CLUSIVELV CONTAACTNG WITH LICENSED CONTRACTORS to construct the praject (Sec. 7040, Business end Professlons Code: The contractor e se Lew tl owner oi properry who bullds or ImO�oves thereon, anA who contracts for such project with e contractor(s) license pursuent to e mrector�,�� / / � ❑ I am axem t u er C. Businass antl Protessions Catla tor Ihis reason: P �Slgnat ru e -'� �/�G _. �� Owner ID verilied by tlriver5l' n56. V85 ❑ No DIVISION OF INDUSTRIAL SAFETY PERMIT GERTIFICATION: ❑ I hereby cenity that no excavation five (5) or more feet in deplh into which a person is requiretl Io tlescend, will be mede in connection with work authorized by this pertnit, end that no building siructure, scaflolding, lalsework, or demolition or dismamling Ihereof, will 6e more than Ihirty-six (36) leet high. (Chap. 3.2, Grp 2, A� 2, Sec. 341, T1Ile 8, Celifomla Atlminl5iretive Cotle). ❑ As ownerDuiltler, I will not employ enyana to da wark which would require e pertnit from t�e Division oi Industriel Sefery, as natetl ebove, unless such person hes e pertnit to do such work from �he tliWsion. Signature: Date: Division at Induslnal Safery Pertnit Number: CODE�. ixsvecrroxnrE 1616 Fixed System Final Fire Prevention 1266 200 201 202 203 204 Pool Spa Final Finel RB-Roof Final Block/Retaining Well Final Factory Fire Place Final Sign Final Demolition •n��cenn+� CODEt INSPECTIONTYPE 206 Final Mechanical 208 Finel Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Sita 250 Finel Building/Occupancy PSIE Ufl�l� I - 9 -aoo��1 (714) 754-5273 • Fax (714) 75V-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Jab Address: 3220 DELAWARE PL Suite No Vicinity: Parcel Nunmber: 13910336 Applicant PATRICK AXTELL Address: 188 L�XINGTON LN COSTq MESA, CA Owner: BROWN, DO�UGLAS DEAN Address 3220 DEIAWA IE PL COSTA MESA, CA Status: ISSUED Applied: 08/31/2004 Issued: 08/31/2004 ISSUED BY: Contractor: AXTELL CUSTOM CABINETRY Address: � 188 L�XINGTON LN Arch / Eng : Address: ISSUE FEE Backflow irtigation Backflow Preventer` � Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Orinking Fountain COSTq MESA, CA REMOVE 2 I SWITCHES. REF 804-01�, AMT $23.50 $0.00 so.00 $0.00 $0.00 $�.00 SQ.00 $0.00 $0.00 $0.00 $0.00 3Q.00 Phone: 714 7545406 Zip: 92626 Phone: Zip: 92626 Phone: 714 7545406 Zip: 92626 License: 734275 Phone: Zip: License: SCOPE OF PERMIT BEARING WALLS IN THE KITCHEN AREA.. INSTALL NEW LIGHTS, OUTLETS AND 1 GAS (1-4) OUTLETS. � � { FEE SUMMARY QTY AMT � Laundry Tub / Washer $0.00 0 Landscape Irngation , $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 k) $0.00 0 Receptors $0.00 0 SepUc Tank � $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 0 � Sewer Private Line $0.00 0 Shower ' � $0.00 0 Sink, bar $0.00 Qn 0 0 0 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool ,�� Trap Primer . - Urinal Vacuum Brkr-Bkflow(1-0) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set .. Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) r AMT $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Qn 0 0 0 0 0 0 0 0 0 0 0 0 N0710E: 7be work authorized by this Ipermit shall comply witb all applicable handicap access requirements under,Calitornia staNtes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) � ' f EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. ' INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectlona and (inal approval must ba obtained. Failure to obtain inspections and final approval will result in the expiration ot ihis permit. FOR INSPECTIONS CALL: (71q) 75q-5626 zaae-as f�voo) WORKERS'COMpENSAnONDECLARAnON: , I hereby eHirm untler Denalry ot perjury one oi Ihe following decleretions: ' ❑ I have end wlll maintain a certlNcete ot consent to selt-Insure for workers' compensatlon, es Orovided for by sectlon 3700 of the Labor Code, for the pedormance of the wark tor whlch this pertnit IS IuueO. ❑ I �ave and will maintain workers' campensetion insurence, as requiretl by sectlon 3700 of ihe Labor Code, for the perfortnance ot the wark tor whkh Nis pertnit is issued. My workers' wmpensation Insurence carrier antl policy number are: Certier: Policy Number: (ihfs section need no! be complefed i! the permif is velued al one hundred dollars ($100) or less.) ❑ I certify that In the performance of ihe work for which Ihis pertnit is Issuetl, I shall not amploy eny person in eny mennar so as to become sub�ect to the workers' compensetlon lews of Calitornle, end egree t�et Ii I should become sub�ect to the workers' compensetlon provlslons of Section 3700 of the Lebor Code, I shell forthwNh comply with these provisions. Appllcant Signelure: Dete: WARNINO: FAILURE TO SECURE WOPKERS' COMPENSATION COVEMGE IS UNLAWFUL AND SW1LL SUBJECT AN EMPLOVER TO CRIMINAL PENALilES AND CIVIL FlNES UP TO dJE HUNORED T110USAND DOIURE (SI00,000), IN ADDRION TO THE WST OF COMPENSATION, DAAMGES AS PROVIDED FOR IN SECTION 3708OF THE LABOR CODE, IMEFEST, AND /TTORNEI"S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby eHirm Ihat I am licensed under provisions of Chapter 9(commencing with Saction 7000) ot DiNsion 3 of the 8usinass and Protesslons Cotle, and my license is in full force en0 eHect. Lia A Class a Contrectofs Signatura: Da�e: CONSTRUC710N LENDING AGENCY: ❑ I hereby aflirm ihat Ihere is e constmction lending egency for the pedormance of iha work for which thls permit Is issued. (Sec. 3097, Civil Code). Lender's Neme: Lender's Adtlress: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby efllrm ihat untler penalry of peQury that I em E%EMVT PROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Buslness entl Professions Code: Any ciry or caunry which requires e permit to construct, elter, improve, demolish, or repair eny structure, prior to Its issuance, also requires Ihe epplicent for such pertnit to flle e signed stetement ihat he or she Is Iicensed pursuant to tha provisions ol the Conirectors License Lew (Chepter 9(cammencing with Sectlon 7000) of DlWsion 3 ot ihe Buslness end Profeulons Coda) or thet �e or she is exempt theretrom and t�e besis tor the alleged exemptian. Any Wolation oi Sectlon 7031.5 by any epplicent tar a pertnit sub�ects the epplicant to a civil penelry ol not more Ihan fiva hunared dollers ($500).): ❑ I, es owner oi Iha properry, or my employees with wages as �helr sola compensetion, WILL DO THE WORK, en0 ihe siructure is noi Intentletl or oHeretl tor sala (Sec. 7044, Buslness and Professlons Code: The CoNrectors License Law does not apply to an owner of properry who builds or improves thereon, end who does such work hlmself or herseli or through his or her own employaes, provided ihat such improvemenis are not Intendetl or oHeretl tor sale. If, however, Ihe bulltling or impravement Is � %s Itl within one year of comple�ion, Ihe owner-builtler will have ihe burden of proving that he or she did not builtl or improve for purpose of aele.). �I, es awner af tha properry, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct tha project (Sec. 7044, Business and Professions Code: The contractors icense Lew fd �'�ot apply to en owner of pmpeny w�o builds or improves thereon, antl who contracis for such project wit� a wniwctor(s) . liten5e pursuenl,CD lh Coniretim�t§JiSp WwS.). du(a!I exemPt naWr: / IDverifl I i Verllicetlon Owr Business end Pmlessions Code for Ihis reeson: �.T�ense. � es, ❑ No � or�vers uce e No. by (rype ot tlocumem, i.e. - property tex bill or DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify Ihat no exwvatlon five (5) or more teet in tlepth into which e person is required to tlescend, wlll be mede in connectlon wi�h work authodzed by this permi�, antl �hat no building siruciure, scaffoltling, talsework, or demoli�ion or tlismantling iheraof, will he more ihen ihirry-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltle B, Calilamia Administrative Code). ❑ As ownar-builder, I will not employ enyone to do work which would require e pertnit trom ihe Division ol Industnel Sefery, as notetl ebove, unleu such person has e pertnit to do such work from the division. Signature: Date: Division of Intlustnal Safery Permit Numbar: CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF ENTRY: I ceniy under penalry ot perjury that I heve read this application and state that ihe information given is correct. I agree to compl with all state laws entl ciry ortlinances relating to bulltling consWction, end euthodza representatives oi the Gry ol Costa Mesa to enter upon tha ebove-descnbed propejNy%tqj inspection pyrposes. I egree not to occupy or ellow occupancy of any building authorized by this permit until tinel inspection. [�7•1l1ICFi7i3S17i� 7618 Fixed System Final Fire Prevention 1268 Pool Spe Finel 200 Flnel Re-Roof 201 Final8locWRetaining Wall 202 Final Fectory Fire Place 203 Finel Sign 204 Final Demolition BDIE Ui�ELfl ie e� CO�E 1 INSPECTION TYPE 206 Flnal Mechanital 20B Finel PIum6ing 210 Final ElecMcal 212 Flnal Fire Prevention 220 Final Planning Approval 222 Final Site 250 FinalBuiltlingiOccupancy Q� IMIfIAlS l(i-�9-a7 � 08/�1/04 08/91/04 10:58 FAX 949 822 1889 Carlton M Sance & Freude TUE 10:37 FAS 7147404856 C1iY Cosca Mesa �er 6z2- IG'6� � DECLARATION �F AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APRLY FOR PERMITS BIdB� Permii# , , �jg PertTi(t # _ . , Sheet address: ��./-%P-T � AP Nw i;er- 1. I(we), � IJ�a1Lk1 ��j, wS �� Uw"1 , declare that I am the O e� ar of Title of the above �� refizren�d real Droperiy, and that I(We) hereby authodZe� Name: �Q7�'�Z Ji /%S�'�'�� Telephone NUmber. . ( � ' , / �-��0� Street Addresa: � Clry: ��5:� /��'� Stare: ��r . .... ZiC: �2�zG no obtaia permits in my behaif, as ownedbuilder, for at the &bove refarenced propelty, 2. Should any person DecoRle an employee engaged 111 the improv@ment of the p�opeRy, I(we) shali in r�dlately provide Workels Compensa5on Insurance coverage and cause a rs�tlifcate oi fhat Corerage to be Tiled with the Building C IVision of the Ciry of Costa Mesa, as requiretl by Sta�e of Califomia laws. 3. As owneNbullder in fact, ( undorstand and accapC ihet my �asponsibilities do not tran5fef [o any [ Iher psfson, company or corporation. 4_ I agree ro indemlllry and hold the City of Costa Mesa and its employees or officere hermlass from any � I i�m resulting in damege or personal inJury tn myself or any other paNes as a resutt of woric authonzed by the permils from the Gil� ��` Costa Mesa. 5. I deGare under the penally ot Perjury that the foYsgoing is true and correct. , Esecuted ihi9 ✓� � day of �S � 20 �, at ,�- �� I Y� Print N SigneL Date: Note: '1'hls aidhoriatian do� not grard autlwnzstion Eo perfortn the vmrk as owner, h�lely provfd2s fo� Itmi�ed power� af attamey to secure MLs perrnit in any hehaN. � OTS9<61�na.11b01 Galitomia. (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Viciniry: Parcel Nunmber: Applicant: Address: 3220 DELAWARE PL 13910336 � PATRICK AXTELL I 188 LEXINGTON LN COSTA MESA, CA Owner: BROWN, DOUGLAS DEAN Address 3220 DELAWARE PL COSTA MESq, CA ConVactor. Address: ISSUE FEE Temp service tesl Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 7000a Service over t000a Motars to thp Motors to 10hp Motors to 50hp Motors to 100hp Motors over t00hp Communication drops Sub panel to 200a OWNER-BUILDER REMOVE 2 I SWITCHES. REF 804-01! $23.50 $O.Op $0.00 $0.00 $0.00 $0.00 $7.70 $4.40 ; $2.2p ' $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $O.Otl i so.00 $0.00 $0.00 $0.00 $0.00 ELECTRICAL PERMIT ISSUED BY: Phone: 714 7545406 Zip: 92626 Phone: Zip: 92626 Phone: Zip: License: 000000 Status: ISSUED Applied: OS/37/2004 Issued: 08/31/2004 SCOPE OF PERMIT BEARING WALLS IN THE KITCHEN AREA. . INSTALL NEW LIGHTS, OUTLETS AND 7 LIGHTS, 4 OUTLETS AND 2 SWITCHES �uantity FEE SUMMARY Temp Dist Syslem / Lighting Busway /100 fl Standing Section , - Misc ElecMcal Equipment Transformers up to 1 kva/kw ................up t0 10 kva/kw .................up to 50 kva/kw � .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misc. Conductor Circus ( gen ar ride) Circus (mech ride or lights) Christmas Tree Stand ' Fireworks Stand Olher Eleclrical Fee �, Investlgation Fea Plan Check Fee 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 , $0.00 " ' 0 � $0.00 0 so.00 0 $0.00 0 $0.00 $0.00 $0.00 NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements under California regulations. (Ord. No. 92-28, § 1, 12-21-g2) EXPIRATION: This permit shall automatically expire antl become void ii work is not commenced within 7B0 days, or if work is sus{ for a penod of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considared legal, such work must comply with all appl requlred Inspeetiona and finel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiral FOR INSPECTIONS CALL: (714) 754-5626 2d46d6 (6/00) ielated abandoned �es, antl all permit. WORKERS'COMPENSAnON DECLARAnON: I hereGy afllrtn under penalry of parjury one ot t�e tollowing daclarations: ❑ I heve end will melntain a certiNcate of consent to self-Insure for workers' compenseilon, es provided for by sectlon 3700 of the Lebor Code, for 1he pertormence of ihe work for which Ihis pertnit is issuetl. ❑ I have entl will malntain workers' mmpensetlon insurence, as requiretl by sectlon 3700 of t�e Labor Code, for the peAortnance ot the work tor which this pertnit I5 Issued. My workers' comDensation Insurence cerrler antl policy number are: Cerder: Policy NumCer. ((hls section need not be comp/eted i! Ne perm/t Is valued et one huntlretl tlallan ($100) or Iess.J ❑ I cenity that in Ihe peAortnance ol the work for which this pertnit is issuea, I shall not employ any person in eny manner so as to become subject to ��e workers' compensation lews of Calitomia, end egree t�at It I should bewme subject ta t�a workero' compensation pmNslons oi SecUon 3700 of Ihe Lebor Catle, I shall forthwith compy wlth ihese Provisions. Applicent Signeture: Date: WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVEiiAGE IS UNUWFUL AND SHALL SUBIECT AN EMPLOVEF TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNDRED T1qU5AND DOLURE (5100,000). IN ADDITION TO THE WST OF COMPENSATION, DAAIAGES AS PflOVIDED FOR IN SECTIIXJ 3]060F TME UBOR CODE, IMEREST, qND ATTORNENS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I em licensetl under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Buslness entl Professions Cotle, end my license Is in full forca end ettect. Lic. a Cless N Contrectofs Signeture: Date: CONSTRUCTION LENDING AGENCV: ❑ 1 hereby eHirtn that Ihere is e construction lending egency tor the peAormance of the work tor which this permit is issued. (Sec. 3097, Civil Catle). Lentlefs Neme: Lendefs Address: Signature: Dele: OWNER-BUILDER DECLARATIONS: I hereby affirtn thet under penelty of perjury Ihet I em EXEMPT FROM THE CON7RAC70R5 LICENSE LAW for Ihe following reason (Sec. 7031.5, Buslness end Professlons Code: Any ciry or counry which reQuires a permit to consiruct, alter, impmve, demolish, or reDelr eny strucWre, pnor to its Issuance, also requires the appllcant for such pertnit to flle e 5igned stetement that he or she is licensetl pursuant to ihe provislons ol the CoNrectors License Law (Chepter 9(commencing with Sectlon 7000) oi Divlslon 3 ot t�e Business an0 Profeuions Cotle) or Ihal he or she Is exempt therehom end tha besis for tha elleged exemption. Any violetlon o� Saction 7031.5 by eny epplicent for a partnit sublecis ihe eppllcant m e civil panelty ot not more ihen five huntlretl tlollars ($500).): ❑ I, as owner of the properry, or my employees with wages as their sole compensatlon, WILL DO THE WORK, end t�e structure is not intentletl or oflered for sele (Sec. 7044, Business antl Professions Code: The Contracbrs License Lew tloes not apply to en owner ot property who builtls or impmves thereon, antl who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or ofleretl lor sale. tl, however, ihe building or improvement Is old within one year of wm0letion, t�e owner-builtler will have ihe burden ol proving that he or she tlid not build or improve for purpose of sale.). I, es owner of Ihe property, em EXCLUSIVELY CONTAACTNG WITH LICENSED GONTRACTORS to construct the projett (Sec. 7044, Business end Protesslon5 Code: The coNrectors License Law tloes not epply to en owner of Dmperty who builds or impmves thareon, end who wntracts for such pmject wit� e contrector(s) license pursuanpto jYjA Co�r fycrers�License Lews.). 0 8usine55 end Prola55ions Coda for Ihis reason: 6wnefl6ve�ad by dn`'ver'S liCense. "$:�es ❑ No Vedlication af Ownership by (type ol documen6 i.e. - property tex bill or deed): DIVISION OF INDUS7RIAL SAFEN PERMIT CERTIFICATON: ❑ I hereGy certity that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made in connection with work aut�odzed by this pertnit, antl that no huiltling structure, sceffolding, falsework, or demolition or dismantling thereoi, will be more than thirty-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Titla 8, Calilarnia Adminis�retive Code). ❑ As owner-builder, I will not employ anyone to do work which would requira e pertnit fram the Division ot Indusirlal Sefey, as notetl above, unless such person has e permit m do such work irom the divislon. Signature: Dete: Divislon oi Indusinal Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTAV: I certity untler penalry of perjury thai I have read this ap0�ication and state that the infortnation given is correcL I agree to comply with ell state lews and ciry ordinances relating to builUing consiruction, and euthorize representetives of t�a Ciry ol Costa Mesa to enter upon the ebove-descnbed property for inspection purposes. I agree not to occupy or allow occupancy of eny building authorized by this pertnil until final inspection. GOOE I, INSVECTIONiYPE 1616 Fixed System Final Fire Preventlon 1266 Pool Spe Final 200 Flnal Re-Roof 201 Flnel BIocWRetaining Well 202 Final Factory Fire Placa 203 FinelSign 204 Final Demolilion PAIf. INTRIRLS Sr00E1'� INSPECl10NTYVE 206 Final Mechanical 208 Final Plumbing 210 Finel EleCidcel 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 FinelBuilding/Occupancy Date �j /� / \ !/ �/—'�jl ate�� GaIF. I[�Lfl _ �.-G � �� .,i �+ lo.00 rn� aya acc loUy os��iroa �rtie 1o:a7 FA% 71A74048r .. . �e, 6 z 2 �. ,e6i CE 1LOR U 8 C1L9 Cosia Mesa �001 v �t'�� DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APRLY FOR PERM�TS Bidg. Permit3f , . This Permlt # _ _ _ Sheet AddfeSs: � L � � ��P-T � AP Nui i;er ��we� � �n �J }�[�� o{' LY� uS� �_, declare that I am the O �� er of Title af the ahove refcreneed real Droperty, and that I(We} hereby aufho�ize: Name: �47r/z !C �,JS�".C'GL _ Telephone Number. _ � � _ , Y�SyO� Stree[ ACdress: �i , c�ry: �aS7� ��1'� Stafe: C. rr _ Zip: �c�� Zd� m obtain pertniLs in my behalf, as ewner/6uilder, ior at the ebo�e reforen�ed propelty, . 2. Should any peBon �ecome 0� employee engaged In Ne impro�ement of the pmperty, I(we) shatl in r>Olately provide Workzls CnmQensation It�surance eovera9e and cause a ce�lltfcate of that caveraga To be 51ed with !he Buildin9 C i visia� of the City of Costa Mesa, as required py Sta�e oF Califomia laws. 3. As owner/bullder in tact, I undorstand and accept thet my �esponsibilities do nat traosfer to any r Iher patson, comDany or mrpordtion. 4. I agree to indemniry and hold ihe Cily of Costa Mesa and iis employees or officers harmless from any � 1 nm resulting in tlamage or parsonal inJury fn myself or any o[her paNes as a result of wo�k authorized by d�e pertnits hom the GiF ��`Cnsra Mesa. 5. I declare under the penalry of perjury that the fo�egoing is We and rnrrect. . Etc_culed this ✓� � day of �i l 20 �, at �-- � V I r� Pdnt � Signa+ Date: Note: 'I'hls aufhorietion tloes not grarrt aultwrizetion Co perfortn the wnrk as owner, R solely pmvldes for nmited pouer af attomey to secure this pem,it in any hehalf OT.va6 �nv,111001 Ca�ifqmla. (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us BUILDING PERMIT � JobAddress: 3220 DELAWARE PL i Suite: I Vicinity: � Parcel Number: 13910336 Applicant: PATRICK AXTELL Address: 188 LEXINGTON LN COSTA MESA; Cq Owner: BROWN, DOUGLAS DEAN Address , 3220 DELAWARE pL COSTA MESA, Cq - Contractor. AXTELL CUS70M CABINETRY Address: 188 LEXINGTON LN Arch : Address: 77 FAIR DRIVE, COSTA MESA, CA 92626 Zonin9: ISSUED BY: Fhone: 714 7545406 2ip: 92626 Phone: Zip: 92626 Phone: 714 7545406 _ COSTA MESA, CA Zip: 92626 � License: 734275 Eng: Address: Status: ISSUED Applied: OB/31/2004 Issued: 08/31/2004 � � � Phone: , Phone: Zip: , License: License: - SCOPE OF PERMIT REMOVE 2 NON BEARING WALLS IN THE KITCHEN AREA. . INSTALL NEW�LIGHTS, OUTLETS AND SWITCHES. Plan Check: $117.81 Permit: $18125 SMtP Res: $0.99 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $300.05 SETBACKS MAW STRUCTURE -Front 0- 0 ACCESSORY Front 0-0 � PARKING Existinp: o i ; NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0-0 � - �. �" Right - 0. 0 - ; ' NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Ca regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work for a period of 180 days. . INSPECTIONS: In ortler for ihe work authorized under this permit to be considered legal, such work must comply with � requlred Inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will resufl in ihe FOR INSPECTIONS CALL: (714) 7545626 2446d6 (fi/00) ', 5s,aso.00 ss,aso.00 statutes and related orabandoned �le codes, and all of this permit. WORKERS'COMPENSAnON DECLARAnON: I hereby aHirm under penalty of perjury one oi the following declarations: ❑ I heva antl wlll melntain a cenificete oi consent to selt-Insure br workers' compensation, es provided For by sectlon 3700 of the Lebor Code, for iha pedormance of ihe wodc tor which Ihis Dermi� is issuetl. ❑ I have end wiil maintain workero' compensation insurance, es required by section 3700 of Ihe Lebor Code, for ihe pertortnance ot the work for which this pertnit is Issuetl. My workers' compensation Insurence cartier antl pollcy number are: Cerrier: completed il the permit is valued et one hundred dallers ($100) or less.) Policy Number: f3' I certity that in ihe performance of th or �br which thi rtnit is issued, I shell not employ eny person in any menner so as to become subject to the workere' T compensetion lews of Calitornle, e� e�4 ihet If come sublect to the workers' compensatlon provislons ol5ection 3700 oi the Lebor Code, I shell fotlhwith � 'Ih ihese provisions. p�'� �'� _ �`' plicent Slgnetu : �.G� Da : e� � �� . URE TO SECURE VJORKERS' COMPE ATIqJ COVERAGE IS UNLAWFUL AND SHFLL SUBJECT PN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED T1qU5AND DOLLARE (E100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECiIpJ 3106 OF THE LABOfl COOE, IMEREST, AND ATiORNEVS FEES. LICENSED CONTRACTORS DECLARATION: 9(commencing wilh Section 7000) of Oivision 3 of ��usines�d Professions Code, and my license is in full CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn Ihat there is a constmction lendinq agency for ihe pedormance oF ihe work tor which this permit is issuetl. (Sec. 3097, Civil Cotle). Lenders Name: _ Lender's Adtlress: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby ettirm Ihat under penalty of parjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which requires a pertnit to consiruct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires ihe applicant for such permit lo file a signed stetement that he or she Is licensed pursuent to ihe provisions ot the Contractore License Lew (Chapter 9(commencing wllh Section 7000) of Dlvision 3 of iha Business antl Professions Code) or that ha or she Is exempt therefrom and the besis For ihe elleged exemption. Any violetion of Section 7031.5 by any epplicent tor a permit subjects the applicant to e civil penalry of not more Ihan tive hundretl tlollars ($500).): ❑ I, as owner of ihe properry, or my employees with weges es Iheir sole compensation, WILL DO THE WORK, antl ihe structure is not intentle0 or ottered tor sale (Sec. 7044, Business and Protessions Code: The Contrac�ors License Law does not apply to an owner of propeny who �uilds or improvas thereon, and who does such work himself or herselt or ihrough his or her own amployees, provided that such improvements are not intended or ottered tor sale. If, however, ihe builtling or improvement is sold within one yeer of completion, the owner-builder will have the burden of 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 consiruct the project (Sec. 7044, Business end Professions Code: The coniractors License Lew tloes not apply to en owner ot proparty who builds or improves thereon, antl who contracts for such pmjed with e comractor(s) . license pursuant to the Contractors License Laws.). � I am exempt under sec. Busineu end Pro(essions Coda tor this reason: Signature: Date: Ownar ID veritied by tlriver's license. ❑ Ves ❑ No Drivers License No. Vertlication ot Ownership by (rype of Document, i.e. - property taz bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N: Expires: ❑ I hereby certify Ihat no excavetian five (5) or more teet In dep�h inm which e person is required to descend, will be made in connection wilh work euthodzetl by this permit, and Ihet no building s�mcture, scaHolding, talsework, or demolition or dismantling thereoi, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Calitornie Administrative Code). ❑ As owner-builtler, I will not employ anyone to do work which would require e pertnit irom the Division of Industnal Safery, as no�ed ebove, unless such person hes e pertnit to do such work trom ihe division. Signature: Date: Division af Industriel Safery Permit Numbar: CERTIFlCATE OF COMPLIANCE ANU AllTHORIZA710N OF ENTRY: I certify under penalty of perjury that I have read this application entl state that the information given is correct. I agree to comply with all state laws and ciry ordinences relating to building conswction, and euthorize representatives of the Ciry oi Costa Mesa to emer upon the ebove-descnbed propeRy for inspection purposes. I agrea not to aapy or eilow wcupancy of any building authonzed 6y Ihis pertnit until final inspection. COOE I, INSPECTIONTYVE 1616 Fixed System Final Fire Prevention 1266 Pool Spe Finel 200 Final Re-Roof 201 Final Block/Retaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition p1jE INTRIALS CODE� INSPECTONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Eleciricel 272 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy I•L119 � I l-OH L`mL1F � OWNER ST] �JOB ADDRE55 �GENERAL C0� 10.139-11 L�_rECTIONS SOIL � GAS WATER Avenue LOT T ROUGH PLUMBING PROP. SWR. LINE � HOUSE CON. � $PRINNLING SVSTEM MISCELLANEOUS ROUGH HEATING ANO AIR CONDITIONIN6 TEMPORARY SERVICE OR POLE UNOERGftOUND � POWER � ROUGH WIRING TRENCHES � FORMS � STEEL REINF. FLOOR SVSTEM BON� 9EAM ❑ STEEL REINFORCE � SHEATHING FRAME AN� FLASNING LATHING - IN ❑ OUT n PL^STER,BPOWN COAT ITURAL, FINAL l�tnflNG. VENT., REFRIG. AND A.C., FINAL PLUMBING, fINAL AN� GAS TEST n DATE �_i�_ SUBCONTRACTOR 1 , 34818 ,,-� �a', oo�z2� = �-��t�5.ot COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant ro Fill in Completely qECE og� onTE F�iveo onT�`s��o_ BUILDING /1�., / � �) ADORESS��i �CJ� — �� _ /�% / PERMIT NO OWNER r�OY-C�_/,_�'7��=1'C'� 1S A•P.NO. //O — f� �S� ! MA I L BUILDING Z ADDRESS ..lJ%7—++'�-� � ADDRESS 3�ao DS LU �� a U CITV �, ��J NOL TRACT v LOT BLOCK ZQ CONSTRUCTION r, ON LENDER /V �h'��' am J � BflANCM � ,/ /6� J � \ OWNER ��y Q W AODRESS mm ARCHITECT \ \TE�. S � VAW3 �G _� �O a OR ENGINEER U Q 1 FIRE w 2 ADDRESS 20NE TYPE GROUP d W � APPROVED W Z CONTRACTOR � L/ � /� /c B� DATE m Z � /i // � �J J � ADDRESS . .5j � /�C L//U%'iK�l-f � W w ZON NO.OF USE OF NEW �p Z � TE.L�,� p�qryg� BUILDING CITY ��', ��J N_ y` /� i 6` W � STATE (- �� CITV � ��+RDS APPROVED VARDS APPROVED y Q LI0. NQ�',1 J / LIQ NO.l�G•„j � MAIN BUILDING ACCESSORV BVILDING 7O � i (FROMC/ISTREET) 512E NO.OF BLDGS. OF LOT NOW ON LOT R M FT. � FT. USE OF �./� EXISTNG BLOG. / � T. O�/ FT H SIZE OF �,(�� y� NO.OF Z NEWBLDG. 7•sC ROOMS STORIES LSIOE FT. FT. a E%TERIOR WALL ROOF � V COVERING COVERING �7EAR FT. � FT. J VSE OF BVILDING ANO WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & �' MAIN BLDGS. ACCE�. BLOGS. a Q / VAR.qW DATE O �}� l� �J �y � f� C.U.P. q/+ APPROVED y /i�/O %� L��t�/ APPROVED /� y� C� p.. z �• O VI hereby atknowletl8a that I have reatl [his epplication antl nsta � that the above informetion iz corract antl aB�ea SO comply w'�th � ell laws repuletinB builtlinp consvuction, end I shall not employ � any Oermn in violaiion of Me workman's compensation laws of y t�e Stata Of California. � m ? 1 hereby certify thet I am praparly licensatl es a contractor under SQ. FT. o Me Ste[e of Calitornia Business entl Professlons Code, Dlvizicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR � Chnpter 9, entl thet such licanma oru in full forco end effect, or I THE PURPOSE OF ESTABL6NING A PERMIT FEE ONLV: Q nm oxompt trom tho provislons o( tne Stnta ot Calltornia Business VALUATION entl Profossions Codo, Division 3, Chapter 9. 5�,� � PERMIT FEE $ � Sipno[uro O� �/ eJ O' 7 Permittea�f • � g'� �T� . m $ �� '� PLAN CHECK $ E �� `o /p y� LL Autho�i� x tl Agant [;�L �rL /V TOTAL FEE 5 � , � 12489 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 3f7 COBTA MEBA. CALIFOfiNIA For Applicanf io Fill In Compleiely COSTA MESA. CALIFORNIA OWNER New Y rl A�enue Pro�tie ADDRESS 419 E• 1%ti�1 Sti• CITY r05{-.8 +�cS3 NOJ ARCHITBCT C3�`1SO27 �'. TEL. � STATE NO. OP SETBACR LINE PROM CeNTeR OP eT1tEET � O t REAR YARD SI�E YARD I LEFf � � I RIGHT � DESCRIPTION OF WORK EXTERIOR WALL IROOF COVERING r COVERING C i USE OF BUILDING ANO WORK TO BE PERFOR! Sinele familv residence vrith FIRE 20NE APPROVED ZONE L66AL F t� �ttGEllIEL� .� �u� 1 i isso '�FINANCE OEPT, GITY OF GOSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only RECEIPi No. .1 reZpyrt,roq� .gF.•�v7 BY I DATE RECEIVED I DATE 188UED_ COSTA MESA. CALIFORNIA ZONING NO. OF t�. / I U6E OP � PLANB i BUILDING YARDS � APPROVEO ' ccerma uxa sr.> APPROVED EVES I HEPEBY ACKNOWLEDOE THAT � XAVE RlAD TX18 APPLlGT10N THE AMOUNT BHOWN UNDER VALUAiION IB FOR TH¢ AND BTATE THAT THE ABOVE IB CORRECT AN� AGRC2 TO COM- pURpO6E OP EBTABLIBNIN6 A e¢RMIT FEE ONLY. PLY WITH ALL CITY ORDyI�.NANCEB AND/`BTAT¢ I.�WB R¢pULATING SIGNATURE OF�u��/l�/ /�l/�QAA2. VALUATION I pERMiT FEE $ 3rJ• I' s 15,�45. AUTHORIZEO AGENT Bike � olegrove, InC. s 17. rc 0 4