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Home My WebLink About3281 COLORADO LN - Building Permits(714) 754-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Addregs: Suite No Vicinity: Parcel Nunmber: ApplicanC Address: Owner: Addr�ss 3281 COLORADO LN 13906722 JANK, MIKE 3281 COLORADO LN CM,CA ELECTRICAL PERMIT Phone: 208-818-5833 Zip: 92626 HOLLOWAY,SHELLY & JANK, MIKE 3281 COLORADO LN CM,CA Convactor: OW N ER-BU I LDER Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+unit5) Pool / Spa Lighting Fizts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 7000a Service over 1000a Motors to 1hp Motors to tOhp Motors to SOhp Motors to t00hp Motors over 100hp Communication tlrops Sub panel to 200a Phone: 208-818-5833 Zip: 92626 Phone: Zip: License: 000000 SCOPE OF PERMIT 1 CONDUIT, 1 SUBPANEL, 15 SWITCHES, 24 OUTIETS, 4 LIGHTS. 3/18/04: SUPPLEMENTAL PERMIT TO ADD 10 CAN LIGHT FIXTURES $23.50 $0.00 30.00 $0.00 $0.00 $0.00 $15.40 $16.50 524.92 $0.00 $0.00 $0.00 $0.00 50.00 50.00 so.00 50.00 $0.00 50.00 50.00 $30.50 Quantity 0 0 0 14 15 24 0 0 0 0 0 0 0 0 0 0 0 � FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Slanding Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Voll Winng System / Ckt Misc. Conduil Misc. Conductor � Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Omer Electrical Fee Investigation Fee Plan Check Fee Status: ISSUED Applied: 02/23/2004 Issued: 02/23/2004 ISSUED BV: �uantity $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 50.00 0 $0.00 0 S0.00 0 50.00 0 50.00 0 $0.00 0 50.00 50.00 so.00 NOTICE: The wOrk authorized by ihis permit shall comply with all applicable handicap access requirements under Cali(omia 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 1 BO days. INSPECTIONS: In order for ihe work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required inapeetlona and finel epproval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration ol this permit. FOR INSPECTIONS CALL: (714) 754-5626 zaosaeldoo� WORKERS'COMPENSATIONDECLARAnON: I hereby BHirm under penalty ot perjury one ot ihe tollowing declara�ions: ❑ I have and will meintain a cenificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Lebor Code, tor ihe pertormence of the work for which this permi� is issuetl. ❑ I have entl wiil malntain workere' compensa[ion insurance, as requireU 6y sectlon 3700 oi the Lebor Code, for ihe peAortnance of ihe work for which this permit is Issued. My workers' compensation Insurance carriar antl policy number are: Cartiec Polity Numbec (This section need no( be comp/etetl il (he pertni( is valued ef one hundretl dWlars (S I00) or less.) LYi�pZiv thet in the pertortnanc¢.e the work for w�ich this permit is issued, I shall not em oy any pe on in e y manner so es to become subject to t�e workers' �� pensatlon lews ol Calilornia, ntl a ree t ii I should become sub act to ihe worke ' com a ation vislons ol Section 3700 0l the Labor Cotle, I shell fotlhwlih 9 I P comply wilh Ihese provisio s. �qr� Applicant SlgnaNre: ' � /U Q Date: WARNING: FAILURE TO SE R O(ERS' �MPENSATION COVERAGE IS UMAWFUL AND SlUflIE AN EMPLOVER TO CRIMINAL PENALTIES PND GVIL FlNES UP TOONE MUNORED TKKISlWD00LLAqE(5100. DITIONTOTHECOSTOFCO!APENSATIIXJ,DAMNGESASPPONDEDWRINSECTION31080FTHELABORCODE,IMERESi,PNDATTORNEI"SFEES. LICENSED CONTRACTO� DECLARATION: I hereby attirm thet I em lic sed untlar provisions of Chapter 9(commencing wilh Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force an0 eMect. Lic. a Class M Comractors Signature: Dete: CONSTRUCTION LENDING AGENCY: ❑ I hereby aMirm thei �here is a conswction lending egency for the peAormance of ihe work for which this permit is issued. (Sec. 3097, Civil Code). Lentlefs Name: � Lendars Atltlress: Signature: Date: OWNER-BUILDER DECLMATIONS: I hereby attirm ihat untler penalry of perjury that I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the lollowing reason (Sec. 7031.5, Business entl Profeulons Cotle: Any ciry or counry which requires a permit to consiruct, alter, improve, demolish, or repair any strucWre, pnor to its Issuance, also requires tha applicaN for such permit to lile a signetl stetement ihat ha or she Is Iicensed pursuant to the proNsions o1 ihe Coniractors License Law (Chapter 9(commencing with Seclion 7000) ol Division 3 ot the usi end Pmfessions Code) w that he or she is exempt theretrom antl the Oasis for Ihe alleged eaemption. Any violetion of Section 7031.5 6y any applicant for e pertnit �ects e epplicant to e civil penalry of not more then tive hundretl tlollers ($500).): es owner oi Ihe property. or my employees with weges es t�eir sole compensation, WILL DO THE WORK, and ihe structure is not intentled or oHered tor sele (Sec. 7044, Business and Professions Code: The Comractors License Law does not apply to an owner of property who builds or improves Ihereon, and who tloes such work himseH or hersaH or through his or her own employees, provitled that such improvemenis are not intended or oHered for sele. If, however, the building or improvement is sold within one year ot completion, the owner-6uilder will heve ihe burdan of proving that he or she did not build or improve tor puryose of sale.). ' ❑ I, as owner of tho pr erty, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sac. 7044, Business and Professions Cotle: The contr ars icense Lew tloes not apply to en owner of propeny who builds or impmvas thereon, end who comracts tor s h project ith a coNractor(s) license pursuan to the ontractors License Lews.). ❑ I em nd sec. Business and Professions Coda for �his reason: Signature: Dat : Owner ID ven ied by dnv license. ❑ Ves ❑ No Drivers License No. �� Expires: Ventication ol Owners ' (rype of tlocument, i.e. � property tex bill or doed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON: ❑ I hereby cehity thai no excava�ion five (5) or more feet in depih into which e person is required to tlescend, will be maAe in wnnec�ion wi�h work authorized by this pertni6 end that no building structure, scaHoltling, falsework, or demolition or dismantling Ihe�eot, will be more than Ihirry-six (36) faet high. (Chap. 32, Grp 2, A� 2, Sec. 341, Ttle B, Celifornia Atlministrative Code). ❑ As owner-bullder, I will not employ enyona to do work which would require e Dermit fmm the Division of Indusidel Sefety, as noled above, unless such person hes e permit to tlo such work from the division. Signature: Date: Division of Industrial Sefeiy Permit Number. 1 Will Ihe epplicam or presem or tuture building wcupem need to file end cenity a Business Plan tor emergency response to releese or threatened release ot e harartlous meteriel? ❑ Ves ❑ Na (Section 25505 of the Califomia Healih and Safery Code requires, with some eaceptions, Ihet e Businass Plen be filed with Ihe Coste Mesa Fire Depariment by every busineu which hes et any one time tlunnq a reDortetl year e quantity ol hazerdous materials equal to or greater than e weighl of 500 pountls, or a volume of 55 gallons, or 200 cuhic teei of wmpressed gas a� s�andard temperature and pressure). ........................................................................................................................................................................................................................................................................................... _ .......................................................................................... 2 Does or will ihe eppliwnt or presen� or future building occupent neetl to file a re9istration torm for ecutely hazartlous materials? ❑ Ves ❑ No (Section 25533 0l Ihe California Health and Safery Cotle, with some e:ceptions, requires registretlon with the Costa Mesa Fire Oeperiment by each buslness which at any one time has on hend a quantiry ol acutely hezerdous meterials equal to or greater than e weight of 500 pountls, or e volume oi 55 gallons, or 200 cuhic teet ol compressed gas et standard temperaNre and pressure). .._ ....................................................................._................................................._................................__............................................................_......................................................._.............._....._...................._.............._................._.............. 3 Does or will the ep0licant or present or future building occupant need to prepare an FiMPP (Risk Management end Prevention Program for awtely hazardous matenals)7 ❑ YB5 ❑ No (Section 2553d of ihe Calibmia Healih antl Safery Cotle D�ovides that ihe Cosia Mesa Fire Department may require ihe preparation, certification and filing with the Flre DeDertment ot en RMPP bV Dusinesses which ere requiretl to re9ister acutely hazartlous meterials with ihe Fire Deperiment. a u en HnnYr is presenay reqwrea, nas secuon zss:fa oi tne cauromia neeim ena sarery coae oeen tuuy compuea wnn�t .......................................................................................................................................................................................................................................................................... 5 Does or wlll the epplicam or O�esem or tuWre building occupant require for the work which is �he subject of I�Is �plla Irom tha Sauth Coest Air Ouelity Manegement Distdcl or Irom any other eir pollution contml tlistnct or egency7 Ve: (Section 658502 of the Califomia Governmem Code requires that the requested information be furnished on applicatior ......................................................................................................................................................................................................................................................................... 6 Will any part of the feciliry to ba consiructed untler t�is pertnit be within 10001eet from ihe outer bountlanes of a school (If "yes', �he faciliry must meet ihe raquirement of Sections 25534 antl 42303 of iha Califomie Heelth end Setary Cotlo). .......................................................................................................................................................................................................................................................................... 7 If e permit Irom the South Coast Air Oualiry Manegement Distnct or othar eir pollutian control district or egency is applicatlon, heve ell ot Ihe disclosures prescnbed by Celifomia Health entl Safery Code Section 42303 been metle? [ far non-residential No or Qf yes', ettech certifiwte of compliance from the eppropnete air polWtion coNrW otticer). CERTIFICATE OF COMPLIANCE: I certity tha� untler penalry of perjury the infortnation given ebove is correct. I egree to comply with all state laws end dry ortlinances regartling Hazardous Materiak and Emissions. Signature: Date: CER7IFlCATE OF correcL I agree to ebove-describedC SOOE 1, INSPECTIONTYVE 1616 Fixed System Fin Fire Prevention 1266 Pool Spe Final 200 Finel Re-Roof 201 Finel BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition DRIZATON OF ENfAY: I c ity under antl cii rdinances relati to building ises gree not to pGtup or Ipyv oc V 7al Owner(s) ed Applicem Q�f. ��a � of perjury ihat I have read this epplication and state that ihe iniormation given is �ction d authonze representetives of Ihe Clry of Cos�a Mesa to emer upon ihe of building authonzetl by this pertnit until �inal ins0ection. Date Date CODEI INSVELTIONTYPE Qsff, �$ 206 Final Mechenicel 20B 270 212 220 222 250 Final Plumbing —��/.��/�—,/—� Final Elecirical � � � . Finel Fire Prevention Final Planninp Approvel Final Site . _ _ _ Final Builtling/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Viciniry: Parcel Nunmber: 3281 COLORADO LN 13906722 Applicant: JANK, MIKE Address: 3281 COLORADO LN CM,CA ELECTRICA� PERMIT Phone: 208-818-5833 Zip: 92626 Owner: HOLLOWAY,SHELLY & JANK, MIKE Address 3281 COLORADO LN Contractor: Address: ISSUE FEE Temp service test 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 1000a Service over 1000a Motors to 1hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communicalion drops Sub panel to 200a Pole Light Pkg Sign Circuits CM,CA OWNER-BUILDER Phone: 208-818-5833 Zip: 92626 Phone: Zip: License: 000000 SCOPE OF PERMIT t CONDUIT, 1 SUBPANEL, 15 SWITCHES, 24 OUTLETS, 4 LIGHTS. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $4.40 $16.50 $24.92 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $30.50 $0.00 $0.00 Quantity -- 0 0 0 4 15 24 0 0 0 0 0 0 0 0 0 0 0 1 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 7 kva/kw ..:.............up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misc. Conductor Circus ( gen or nde) . Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical fee Investigation Fee Plan Check Fee Reinspection Fee Status: ISSUED Appiied: OZ23/2004 Issued: 02/23/2004 ISSUED BY: 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 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 50.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. . INSPECTIONS: In order for the work authorized under this permit to be considered lagal, such work must comply with all applicable codes, and all requlred Inspectlons and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of this permit. FOR INSPECTIONS CALL: (714) 7545626 2448-48(fl�00) WORKERS' COMPENSATION OECLARATION: � ' I hereby aftirtn under penalry ot perjury one oi ihe tollowing declarations: ❑ I hava entl will mainiain a ceniiicate of consent to selt-Insure lor workers' compensatlon, es pravitled tor by section 3700 of the Labor Cotle, for the peAormance of the work for which Ihis permit is issuetl. ❑ I heve flnd wlil maintain workers' compensation Insurance, as required by section 3700 ot the Labor Gode, tor Ihe pedortnance of �he work tor whlch this pertnll Is Issued. My workers' compensation Inwrenca carrier entl policy num�er are: Cartier. Policy Number (This section need not be cromplered i! the peimit is veluetl al one hundred dollars ($f 00J oi less.) ❑ 1 certity thet in the pertormance ol the work tor w�ich this permit is issued, I shall not employ any person in any manner so as to become subject to Ihe workers' compensailon lews oi Celifomia, and egree Ihat If I shoultl bewme su�ject to the workers' compensetion proWslons ot Section 3700 of the LeDor Code, I shell torthwit� comply with Ihese provLsions. Applicent Signeture: Dete: WARNING fAILURE i0 $ECURE WORKERS' COMPENSATION COVERAOE IS UNLAWFUL AND S/IFLL SUBJECT AN EMPLOVER TO CRIMINAL PENALilES AND pVIL FINES UP TOONE HUNDRED THOUSAND DOLL4RE (5100,000), IN ADDRION TO iHE COST OF CQ'APENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 37060F THE LABOR CODE, IMEREST, AND AiTORNEY'S FEES. LICENSED CONTRAC70RS DECLARATION: I hereDy eNirm �hat I am licensed under provislons of Chepter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle, end my license is in full force and eHact. Lic. N Class N Contrector's Signatnre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that thera is a cronstruction lending agency for Ihe peAormance of ihe work for which �his permil is issued. (Sec. 3097, Civil Code). Lentler's Name: Lendels Atltlress: Signeture: Date: OWNER-BUILOER DECLARATIONS: I here6y eHirtn Ihel untler penalry af perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor t�e following reason (Sec. 7031.5, Business entl Professions Code: Any ciry or counry which requires a pertnit to construct, alter, impmve, demolish, or repair any structure, pnor to its issuance, also requires the applicant for such pertnit to file e slgned stetement ihat he or she Is Ilcensetl pursuent to the provislons of ihe Comrectors License Lew (Chapter 9(commencing with SecHon 7000) ot Divislon 3 of Ihe Business end Professions Code) or Ihat he or she is eaempt therefrom and the basis for Ihe elleged ezemption. Any violation of Section 7031.5 by eny epplicenl for e permit sublects �he applicant to e civil penalry of not more then five hundred tlollars ($500).): ❑ I, es owner ol the properry, or my employees with weges es their sole compensation, WILL DO THE WORK, antl the structure is not Intended or oHeretl for sale (Sec. 7044, Business end Professions Code: The Contractors Licensa Law does not apply to an owner ot pmperty who builds or improves �hereon, antl who does such work himself or herself or �hmugh his or her own employees, provitled that such improvemenis are not Intended or oHeretl for sale. If, however, Iha building or improvement is sold within one year of complation, the owner-builder will have ihe burtlen of proving that he or she did not build or improve for purposa of sale.). • ❑ I, es ownar of the properry, am EXCLUSIVE CONTRACi1NG WITH LICENSED CONTRAL70R5 to construct the project (Sec. 70d4, Business end Prolessions Cotle: The contractors License Ww does t e ly to an awner ot property who builtls or Imprwes Ihereon, antl who contracts tor such project wlih e coniractar(s) �liten5e pursuan� �o ihe COniracjoJSlice e Le s.). �j � � � � Business and Professions Code for Ihis reason: Ox�R&1'f6 verifled Gy dnvefs license. ❑ No D v�t'e Li ense No. i Venfication ol Ownership by (type of tloc �' t, i.e. - propeny tex bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cenity that no excava�ion five (5) or more fee� in depih into which e person Is required to descenq will be made in connectlon wlth work euthorized by this permit, end thet no building swcture, sceHolding, talsework, or tlemolition or tlismantling ihereof, will be more ihan thirty-sis (36) feet �igh. (Chep. 32, Gry 2, Art 2, Sec. 341, Ttle B, Califomia Administrative Goda). ❑ As owner-builder, I will not employ enyrone to do work which would require a Dermit irom ihe Division of Indusirial Safety, es noted above, unless such person has e permit to do such work tmm the division. SignaWre: Divislon ol Industnel Safery Pertnit Number: Date: 'ARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WIII Ihe applicem or present or fuNre building occupam need to file and certily a Business Plen lor emergency response to release or threatened release of e hazardous matenal9 ❑ Ves ❑ No (Section 25505 of ihe Celifornia Healih and Sefety Code roquires, with some exceptions, ihet e Business Plan be fiied with ihe Coste Mesa Fire Depahment by every business which has at any one time during a reponed year a quan�ity of hazardous materials equal �o or grea�er ihan a weight of 500 pounds, or e volume of 55 gallons, or 200 cubic feet at compressad gas at standard temparawre and pressure). ............................................................................................................................................................................................................................................................................................................................................................................. Does or will ihe epplicant or present or future building acupant need to lile a registretion brm lor acutely hazartlous matenals9 ❑ Yes ❑ No (Sectlon 25533 ot Ihe CalHornia Haalth entl Safery Cotle, wlth some exceptions, requires registratlon with the Costa Mese Fire Depertment by each business which at any one time has on hand e quantity ol acutely hazardous materiels equal to or greater then e weight of 500 pounds, or a volume of 55 gellons, or 200 cubic feet of CAffID�955Btl qa5 e� S�entlaftl �BmDBtBiufe Bntl pfessufe). or wm tne appucam or present or prepare an (Section 25534 of tha Califomia Healih end Safery Code provides ihat the Costa Mesa Fire Depatlment may require the preparation, cenification end tiling with the Fire Depertment ot en RMPP by businesses which are required to register acutely hazardous materlels wlih Ihe Fire Department. ..................................._.................................._...._""._.......__...._._......................................_.._....................._._._...................._.__..................................._...................... ................_....... .........._............._.............._............._ 4 II en RMPP is presently required, has Section 25534 of ihe Celifornia Health entl Safery CoAe been tully complietl vnthl ❑ Yes ❑ No ................................................................................_..—_"..................................._.__.................._._..........................__..........................._....""'__.........._...................._......................_..............._.............._................_. 5 Does or wlll tha applicanl or presenl or luture building occupani require for thB work which is the subject of this a plication a permit for such construction or modification Imm Ihe South Coas� Air Ouality Manegement Distdct or imm any other air polWtion convol distdct or agenry7 � Ves �J No (Section 658502 of ine Celifomia Govemment Code requires that tha requested informetion 6e Wmished on applications tor nomresidential building permits). ......................................................................................................................................................................................................................................................................................................_.............................................................._.............. 6 Will any pan ol the faciliry to ba constructed under this pertnit be within 1000 taet from the outer bountlanes of a school7 ❑ Yes O No Qf "yes", the tacility must meet the requirement of Sections 25534 antl 42303 of Ihe Celifornia Health and Safety Code). ........................................................................................................................................................................................................................................................................................................................................................................................ 7 II 9 permlt from Ihe South Coast Air duelity Manegement District or other alr pollutlon control tllsirict or egency is requiretl tor the work which is the subject of ihis applicatlon, �eva all of the disclosures prascribed by Califomla Health antl Safery Code Section 42303 been matle? ❑ Ves ❑ No ................................................................. _................................... _................................................................................................................................................................................................................................................................................ 8 pf yes", ettech certificate ot compliance from the eppropriate air pollution contml oHicer). CERTIFICATE OF COMPUANCE: I cenity thet untler penelry of perjury Ihe informetion given above is correcL I agree to comply with all stete laws and ciry ordinances regardinA Hazerdous Materials antl Emissions. Signature: CERTIFICA7E OF CO PLIANCE AND cofrec�. I egree lo com wJt¢ 911 slah COUE I. 7616 1266 200 201 202 203 204 Date: 710N OF ENTRV: I certity und penelry of perjury that I have read this epplication and state that the information given is ,1� ordinances relatin to buii ng cons ction, end euthodze representativ of the 'ry of Cwta Mesa to enier upon the egree not to occup or allo acup cy of any building authorized b this ertnit unti inel inspection. Z o � Zt/ ,� �nar Da e olicant / Da�e INSPECTIONTYY� Q�jf IN QQp$� INSVECTIONTYPE Q�F INTRIpLg Fized System Final Fire Prevention ZO6 Final Mechanical Pool Spe Flnal 208 F' al Plumbing Finel Re-Roof 270 al Electric Final BIocWRetaininq Wall 7 I venti Final Factory Fire Place 220 Final Planning Approval Final Sign Final Demolition 222 Final Site 250 Final Building/Occupancy (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, GA 92626 BUILDING PERMIT Job Address: 3281 COLORADO LN Suite: Vicinity: Parcel Number: 13906722 a.pp�icant: JANK, MIKE Address: 3281 COLORADO LN Zoning: Phone: ZOS-Bi8-5833 CM,CA Zip: 92626 Owner: HOLLOWAY,SHELLY & JANK, MIKE Address 3281 COLORADO LN CM,CA Contractor. QWNER-BUILDER Address: Zip: Arch : - Address: Phone: Phone: 208-818-5833 Zip: 92626 Phone: License: 000000 Eng: Address: Status: ISSUED Applied: 02/23/2004 Issued: 02/23/2004 ISSUEDBY: .�!' `._ �T � �� _� Phone: Zip: License: License: SCOPE OF PERMIT REMOVE AND REPLqCE WITH THE SAME SIZE AT THE SAME LOCATION IN TWO BEDROOMS , OFFICE ROOM, LIVING ROOM AND KITCHEN ROOM. REMOVE DAMAGED EXISTiNG SIDING AND REPLACE WI7H HARDY BOARD. IfJSTALL PULL DOWN ATTIC STAIR CASE. Plan Check: $81.41 Permit: $125.25 SMIP Res: $0.60 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $207.26 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Franl 0-0 PARKING Existin : 0 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 ss,000.00 ss,000.00 NOTICE: The work auth4rized by this permit shall comply wi�h all applicable handicap access requirements under Califomia statutes and related regulatlons. (Ord. No. 92-28, § 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 suspended or abandonetl for a period ot 1 BO days. INSPECTIONS: In order for lhe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepectiona and finel epproval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this pertnit. FOR INSPECTIONS CALL: (71q) 7545828 �aae�e leroo) WORKERS' COM�A(SATION DECLARATION: , � I hereby etti4n undar y5nalty of perjury one ol ihe following declarations: ' � ❑ I have entl will meintain e certiticete of consent to selt-Insure tor workers' wmpensetion, es provided tor by section 3700 oi �he Lebor Code, for the pe�ormanco oi the work tor which ihi5 permit is issuetl. ? ❑ I heve and will maintain workers' compensation insurance, as requiretl by sectlon 3700 ot Ihe Lebor Cotle, for the performance of the work tor which Nis pe�mit is Issuetl. My workers' compensatlon Insurance carner entl policy num�er are: Carrier. Policy Number: (TAis section need no( be complefed il Me pe�mit is velued ef one hundred dWlars (3100) or Iess.J ❑ I certity Ihet in the performance of tha work for which this pertni� is issued, I shall not employ any pereon in any manner so es to become subject to the workers' wmpensatlon laws oi Califomia, end egree thei If I shoultl become suDiecl Io the workers' compensaiion pmvisions ot Sectlon 3700 of the Labor Code, 1 shall forthwith comDly wilh these provisions. Applicant Signeture: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAYJFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAI. PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE CAST OP CAMPENSATIQY, DAMAGES AS PROVIDED FOR IN SECTIQV 3]O60F TME LABOF CADE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eNirm that I am licensed under proNsions of Chapter 9(commencing with Section 7000) of Division 3 of tha Business ena Prolassions Code, and my licanse Is in full forca end ettect Lic. A Class a Contraaots Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm ihat Ihere is a constmction lending agency for the pedormance ot lhe work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lender's Nema: Lender's Atltlrass: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirtn that undar penalry of perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Busineu end Professions Code: Any ciry or counry which requires a Oermit to consWct, alter, impmve, demolish, or repair eny structure, pnor to its issuence, elso requires the epplicant For such permit to file a si8nea statement ihat'he;or�s �h�e is licensed pursuant to lha provisions of Ihe Contrectors IJcense Law (Chapter 9(commencing with Section 7000) oi Division 3 ot I�e Business end Professions CoAej df itiaLlye.or she Is exempt theretmm and the Easis tor the ellaped eaemption. Any Wolation ol Sectlon 7031.5 by eny applicant lor e permit subjecis Ihe epplicent lo a�ciJibpe�5el�f rro-�t�rti��t�aryfive hundred dollars (3500).): ❑ I, es owner oi ihe properry, or my employBe_y�vithvweges as iheir sole compensatlon, WILL DO THE WORK, antl the strucmre Is not intended or oRered for sale (Sec. 704a, Business and Professions Code: The C6n�'ractors License Law does not apply to an owner of property who builds or improves thereon, antl who tices such work himself or hersetl or ihiough.his,or her own�employees, provided ihat such improvements are not intentletl or oHeretl for sala. If, however, Ihe building or impmvement is sold within one year of completion, the�oviner-builder will have ihe burden ot proving ihat he or she did not build or improve for purpose of sale.). ' ❑ I, as owner oi ihe properry, am E%CLUSIVELV CONTqACT1NG WITH LICENSED CONTRACTORS to construct the prolett (Sec. 7044, Business and Professions Cotle: The conVactors Llcense Lew tloes not epply to en owner of property who builds or Improves Ihareon, entl who contrects lor such prqect with a c ntractor(s) �license pursuant to ihe Comra�rs License Lews.). � � Business and Professions Code lor this reason: Owner ID vedfletl by tlrivers liiedse/"`� Verilice�ion of Ownership by (typepl daumenL i.e. - property taz bill or deod): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N: ❑ I hereby certity thet no excavation five (5) or more feet in tlepth into which e person is requireA to descend, will be made in conneclion with work authorized by this permit, antl ��ai no Duilding strucNre, scallolOing, talsework, or demolition or dismantling ihereof, will be more ihan thirty-six (38) leel high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltla e, California Administrative Code). ❑ As owner-builder, I will not employ anyona to tlo work which would require e permit from ihe �ivision of Indusirial Salety, es noted ebove, unless such person hes e permit lo do such work irom ihe division. Signetura: Division oi Intlustrial Sefety Pertnit Number: Date: Will Ihe epplicant or present or future builtling occupant neetl to file antl cenity a eusiness Plan tor emergency response m release or threatened release of a harartlous meterlal7 ❑ Yes ❑ No (Section 25505 0l the Calitomia Health entl Safery Cotle requires, wit� some esceptions, that a Business Plan 6e filed with ihe Coste Mesa Fire Depariment by every business which has a� any one time tlunng a reponed year a quantity ot hazertlous materials equel to or greater Ihan e weight of 500 pounds, or a voluma of 55 gallons, or 200 cuDic feet of compressed gas at standard temperature end pressure). ................................................................_............................................................._._..........................................................................................................................................................................._...............................................__........ Does or will the applicant or present or fuWre builtling occupant need to file e registration tortn for ewtety hazardous materials7 ❑ Yes ❑ No (Sectlon 25533 of the Calitomia Health end Salety Cotla, with some exceptlons, requlres regisiretion with the Costa Mese Fire Department by each business which et eny one time hes on hend e quantiry ot ecutely hezertlous metenals equal to or greater than e welght ot 500 pounds, or e volume of 55 9allons, or 200 cublc feet of COmpfBssetl ges ei stentlafd IempefelUre end pte55ura). 3 Does or will the applicant or presant or tuWre bullding occupant need to prepare an RMPP (Risk Management and Prevamion Program for acutely hazardous melerials)7 ❑ Ves ❑ No (Section 25534 of the Califomia Health and Safaty Code provides ihat tha Costa Mese Fire Deperimen� may require the preparation, certification and tiling with the Fire Depertment oi an RMPP by businesses which ere required to register ecutely hazertlous materials with the Fire Depertment. .............."_................................._..............................__._..._........................................_.._......................_................................_............................._—._........................ ..............__...... ....._.........................._............._.............._ 4 If en RMPP is o�esently required, has Section 25534 oi ihe Califomia Health end Setery Code �een fully complied wilh7 ❑ Ves ❑ No : or wlll the epplicent or present or IuWre builtling occupant reqWre tor Ihe work which Is lhe subject ot this a plicalion ep�ermit lor such construction or Ihe Souih Coes[ Air Oualiry Managemem Distnct or irom eny other air polWtion wnirol tlistrici or egencyt � Ves �J No ;ion 658502 0l the Calitomie Govemment Code requires that the requested inlortnation be tumishetl on applications for non-residential builtling permits). .............................................................................................................................................................................................._.................................................................. ....................... ...................................... my pan of the faciliry to be constructed untler this pertnit be within 1000 teet from Ihe ou�er boundanes ot a school9 ❑ Ves ❑ No 35". Ihe facility must meet ihe fepuifemenl at Seclions 25534 antl 42303 of Ihe Califomia Health and Safery Cotle). ............................... ............Y .............9...........................................................P_.........................................................9.....� ...........q...................................._................................... �ermit from the South Coest Air Qualit Mane ement DisMct or other alr olWtion control tlistrict or e en is ra uiretl tor tne work which is the s� atlon. have all of the disclosures o�escribetl bV Calltomia Heallh end Safery Cotle Sectlon 42303 been matle? ❑ Yes ❑ No CERTIFICATE OF COMPLIANCE: I cehify thet under penalty of perjury ihe Inbrmetion given above is correcL I agree to comply with ell state laws end ciry ordinences regarding Hazardous Matenals entl Emissions. Signature: Date: CER7IFICATE OF COMPLIANCE AND AIlTM RIZATON OF EMRY: I ceniry under penelty of perjury that I have read this eppJication entlf tate that the intormetlon given is correCt. I agree to compty with all stet law antl iry ordinances relating to building wnsiruction, and euthonze represenWti 65 ot ��e C1y of Costa Mesa to en�er upon Ihe ej&d ropeRy fo ' p ose egree not to occupy or ellow occupancy of eny building authorized by ih' permi� unY� yinal �i ection. L v NT \ Sig at Of L a�,9 te CQUE I, INSVECTIONTYVE 1616 Fiaetl System Final Fire Prevention 1266 Pool Spa Finel 200 Finel Re-Rooi 201 Finel Block/Retaining Well 202 Final Fedory Fire Place 203 Finel Sign 204 Finel Demolition jt/yjE IMIPRLS �,Qyf�( INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy PeIE Iti�LB . (7�a) �5a-52�3 • Fax (774) 7yi-4856 •�wiw.ci.wsta-mesa.ca.us 77 hAIH UHIVt, GV.1I A MtJF, GA `J2ti2ti lob Address: 3281 COLORADO LN Suite No Vicinity: Parcel Nunmber: 13906722 Applicant: JANK, MIKE Address: 3281 COLORADO LN COSTA MESA, CA Owner: HOLLOWAY,SHELLY Address 3281 COLORADO LN CM,CA Contractor: OW NER-BU ILDER Address: Arch / Eng : Address: ISSUE FEE BackFlow irrigation Backflow Preventer Bathtub Clanfier System Connect (Ice,Soda,etc) Dental Units Dishwasher Orain, Floor Drain, Rainwater PLUMBING PERMIT Status: ISSUED Applied: 03/18/2004 Issued: 03/18/2004 ISSUED BY: Phone: 208-818-5833 Zip: 92626 Phone: 208-818-5833 Zip: 92626 Phone: Zip: License: 000000 Phone: Zip: License: SCOPE OF PERMIT REMOVE AND REPLACE WITH THE SAME SIZE AT THE SAME LOCATION IN TWO BEDROOMS , OFFICE ROOM, LIVING ROOM AND KITCHEN ROOM. REMOVE DAMAGED EXISTING SIDING AND REPLACE WITH HARDY BOARD. INSTALL PULL DOWN ATTIC STAIR CASE. 7 GAS REPIPE REF:804-00407 AMT 523.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $O.OD $0.00 50.00 FEE SUMMARY orv nnnT Laundry Tub / Washer $0.00 0 Landscape Irrigation $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect 50.00 0 Sewer Private Line $0.00 QTY 0 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (foilet) AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 30.00 an 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21•92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work Is suspended or ebantloned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapectiona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon ot lhls permit. FOR fNSPECTIONS CALL: (714) 7545626 2ats�ae �eroo� WORKERS' COMPENSATION DECLAHA710N: ' I hereby eHirm under penelty oi perjury one of the following declaretions: ❑ I have entl will mainlein a cartitiwte of consent to self-Insure tor workers' compensation, es providetl br 6y section 3700 of Ihe Labor Cotle, tor the peAormence ot the work for which Ihis permit is issuetl. ❑ I have and will meintain workers' compensation insurence, as required by section 3700 ot Ihe Lebor Cotle, for �he peAormance of the work tor which this pertnit is IuueC. My workers' compensation Insurance carrier entl policy number are: Cartier. Policy Number: (This secfion need not be comp/eted i/ the ermit is valued a( one hundred dollars (5100J or /ess.) / certily that in the pertormance the w rk for which Ihis pertnit is issued, I shall noi employ any Oerson in any manner as to ecome suhject to the workers' compensetlon laws oi Calif mi , end eg ae that II I uld become subject to the workers' crompenSaUon provisions of ction 00 of the LeDor Code, I shell forthwith comply with thesa provisi � Applicent Signature: Date: WARNINO: FAILURE TO SECUR WOfiKER SATION CAVERAGE IS L AND SHALL SUBJECT AN EMPLOYER TO C P NAL I AND GVIL FlNES UP TOONE HUNDRED TFIOUSANDDOILARE(5100.0OO�.INADDITI THECOSTOFWMPENSATIIXJ,OAM4GESPSPiiOVIOEDFORINSECTION31060 E RCODE,IMEREST,ANDATTORNEY'SFEES. LICENSED CONTRACTORS DECLAR"ATION: I hereby altirm that I am Ilcensed under pmvislons oi Chapter 9(commencing with Section 7000) of Division 3 of the Business and Pmfessions Code, entl my license is in full force entl eHecL Lic. q Class q Contractors SignaWre: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aflirtn Ihat ihare is a construction lending egency tor lhe pertortnance of �he work for wNch t�is permil is iuued. (Sec. 3097, Civil Code). Lender's Name: Lendefs Addrass: Signature: Date: OWNER•BUILDER DECLARA710NS: I hereby aHirm thet under penelry of perjury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW tor t�e following reason (Sec. 7031.5, Buslness end Pmfessions Code: Any clty or counry which requires a permit to conslrucL atler, improve, demolish, or repair any simcWre, prior to its issuance, also requires Ihe epplicant tor such permit to file a signed stetement that he or she is Ilcensetl pursuent to lhe provisions af the Cantrectors License Lew (Chepter 9(commencing with SecHon 7000) ot Division 3 of the Business entl Professions Code) or that he or she is ezompt t�eretrom antl Ihe basis tor the ailegetl ezemption. Any violation of Section 7037.5 by eny epplicent for e permit �su �ects the apPlicant to e civil penalry of not mora ihan five hundred dollars ($500).): I, es owner ol ihe properry, or my amployees wlih weges as iheir sole compensetion, WILL DO TME WORK, end the strucWre is not intentletl or oHeretl for sale (Sec. 7044, Business and Professions Code: The Conirectors License Law does not apply to an owner of property who builds or improves ihereon, and who tloes such work himself or herself or thmugh his or her own employees, pmvidetl that such impmvements ere not Intendetl or oNered for sale. It, however, the building or impwvement is sold within one year of comD�etion, the owner-builder will have the burden of D�oving ihat he or she did not build or improve for purpose of sele.). � ❑ I, es owner ot �he property, am EXCLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS �o conslruci �he projeci (Sec. 7044, Business an Professions Code: The contractors License Lew tloes not appy to an owner oi pmperry who 6ulltls or impmves thereon, antl who contracts for such p �ect with contwctor(s) licanse pursuant t he Comractors License Lews.). ❑ I em ezem t dar se . Business antl Professions Cade lor this reeson: P Sionat� ..� .. : Date: -� . Owner ID venfied b e license. ❑ Yes ❑ No Driver's License Y Venfication ol Own sh' by (type of documem, i.e. - propeny tax biil or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify that no excavation tive (5) or more feet in depth Into which a person is reqWred to descend, will be made in connection with work authonzed by this permit, and that no building siructure, scaflolding, talsework, or tlemolition or tlismantling ihereol, will be more ihan thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Tltle 8, Celifornia Administraiive Cotle). ❑ As owner-builtler, I will not employ enyone to do work which would require a permit irom ihe Division of Indus�nal Safery, es notetl above, unless such person has e permit to do such work from �he division. Signature: Division of Intlustnal Safety Pertnit Number: 8 Date: W ill t�e epplicaN or present or IUNre building occupent need to file end certify a 0usiness Plan tor emergenry response to releese or threateneA releese oi e hazartlous matariel7 ❑ Yes ❑ No (Section 25505 of ihe Celifomia Healih and Safety Cotle requires, wilh some exceptions, thet a Business Plan be tiletl with ihe Coste Mese Fire Depenment by every business which hes at any one time tlunng a reported year a quamity of hazardous materials equel to or graater Ihan a weight of 500 pountls, or a volume ot 55 galions, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................................................................................................................................................................................................................... ....................... ................................................... Does or will Ihe eppliwnt or present or tuture builtling wcupem need to file a registration torm for ecutely hazartlous matenals7 ❑ Ves ❑ No (Section 25533 0l Ihe Califomia Healt� antl Setety Cotle, with some e:ceptions, requires registreHon with ihe Costa Mesa Fire DeDaRmeni by eac� business which at any one Nme has on hantl a quantiry of acutety hezerdous meterials equal to or greater than e weight oi 500 pounds, or a volume ol 55 gellons, or 200 cubic teet of compressed gas at stendard temparature and pressura). ............................................................................................................................................................................................................................................................................................................................................................................. Does or will Ihe applicant or present or tuture building occupent neetl to prepare an RMPP (Risk Manegement and Prevention Program tor acmely hazardous materials)7 ❑ Yes ❑ No (Section 25534 ot the Califomia Healt� and Safery Code pmvides that tha Costa Mesa Fire Depariment may require ihe preparation, certification antl filing with the Pire Departmem ol en RMPP by businesses which ere required ro register ecutey hazartlous materials with the Fire Depanmem. ..........'_' ........................__........................._...............................................................................__........................__.._............................"'...................................................._................_.................._.................._...............'_ If en RMPP is presently required, �as Section 25534 of the Celilomia HeaIN antl Safery Cotle been lully complied with? ❑ Yes ❑ No ................................................................................................................................................................................................................................................................................................................................_....................................__. Does or will the epplicent or present or future building occupant require for ihe woB which is ihe sublect of Ihis a plication a ermit for such construction or modification trom the South Coest Air Dualiry Menagement Distdct or tmm eny other air polWtion control tllsMct or egenc�/! � Ves � No (Section 658502 of the Califomia Govemment Code reQuires thet the requested infortnation be fumished on applications for non-residential building pertniis). .............._............................._..........................................................................._............................._.........................._......................................_..._...................................... ........_............. _....................__................_._.............._.. W III eny pan oi the facility to be consiructed untler �his pertnit be within 1000 fee� �mm �he outer boundanes of e school? ❑ Yes ❑ No Qf "yes", Ihe feCiliry muSi meet the requirement ol SeCtions 25534 entl 42303 of ihe Califomia Heelih and Safery Cotle). .............................................................................................................................................................................................................................................................................................................................................................................. tl a permit irom the Soulh Goast Air Quality Menegement District or other alr pollutlon control district or egency is required tor the work which is Iha subject of this eoollcutlon. have all of the tlisclosures orescrl6ed bv Cellfornia Health and Satetv Code Sectlon 42303 been made7 ❑ Ves ❑ No CERTIFICATE OF COMPLIANCE: I cehify that untler penalry of perjury the information given ebove is correct. I a9ree to comply with ell state laws and ciry ordinances regertling Hazardous Materials antl Emissions. SigneWre: Date: CER7IFlCATE OF COMPLIANCE MiD AUTH IZATIO OF ENTRV: I certiry un r penalry perjury ihat I have read this apP�ication and state that ihe information given is correci. I agree ro comply 1h state lew nd c' rtlinances relaling to buii ng cons tion, end euthonze representatives of ihe Ciry ot Casta Mesa to enter upon Ihe above-descnbed prope in pection pu ose gree not to ocCupy or allo occupan of eny builtling authonzed by Ihis permit until final inspaction. ner(s) y � Date /� d/ r Authorizetl Applicant Date CODE I. INSPECTIONTYPE V 1616 Fixed System Final Fire Prevention 1266 Pool Spe Final 200 Finel Re-Roof 201 FInaI8lock/Retaining Wall 202 Final Fectory Fire Place 203 Finel Sign 204 Finel Demolition Q�7f, INTRIALS �f,d INSVELTIONTYPE 206 Final Mechanical 208 Final Plumbing 270 Final Elecirical 212 Final Fire Preventian 220 Final Planninq Approval 222 Final Sita 250 Final Building/Occupancy PA7E nrmu�s � 3281 COLOFtADO LN uxr: TURNER, HLAINE P FLOOD: AE-37 "�'' TURNER, JEAN C 1533 WINCHELL ST MPL.M411XOADDFE59: ST PAUL,MN 55106 urcxrtEcr on �¢n: IICN OA EN0:81WPES9: uc. w_ uxr: C0N1"10T0"'""'� PARK ROOFING CO INC ( 714 ) 793-8170 CONf111CTORSYNWq 670G STANTON AVE "0°"�'° BUENA PARK CA 1CN0' 256217 90621 °NTi ucwseo corrtn�crons oEcun�noN: i iw.W .n:m wb. v.wy a�.y mm i a, r�.�.e �« d c 'v m (m'rvn<^v�G weh Senion 1aao) d Diwian 9 d Ns B�man entl Pmladoru Coda. and mY 4aw u m Iu0lace W. CITY OF COSTA MESA — BUILUING PERMIT PERM NG: H 084890 PERMIT NO: B 08489b PLAN CHECR NU: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH JOB DESCRIPTION : INSTALL 25 YR COMP SHINGLES OVER 1 LAYER SQ FT: 3,500 CLAIM VALUE: 3,500.00 CALC—VALUE: 3,500.00 GROUP OCC: R-3 /U-1 COMMENTS: SMOKE LETECTORS REQUIRED if vf iFiE iF iE iE ik if iF iF iF if iE if if iF if iF if if if if iF if iF if if iF if if iF ik iE if if iF iF if iF if ik iF iE if if iF # if if if if iE if ih if if if # if iF iF ii ii if ih if tif if if iF iE iE iFiE 3f if iE iE Z O N I N G R E Q U I R E M E N T S S E T H A C K S cmuc.No.: . uc.euss: ue.No.: ______ C39 256217 EXP• ------ MAIN BUZLDING ---------- --------- ACCESSORY BUILDING --------- / f7�� V„� FRNT: FT IN REAR: FT IN FRNT: FT IN REt1R: FT IN om.: % L�. c«.�.ea.� � LEFT: FT IN RGAT: FT IN LEFT: FT IN RGHT: FT IN O EP BUILDER DECIAN�TON: I haeb/ effvm u�dr DaWY d pm�r/ iM I vn memp M1om Ne CaV'eCm liaw tmi �w tlr dbwiq rum ISetlon'l0�1.5 Bueiiw� end PNwacN Cade: MVW a oduaV wtidi npwo e V�i lo awwf. eEb. Lnpova. demdeh.anperertyslrictua.p'nbm'vauerce,ehonpimmiMepp4renttorachpamitoNeea��eEawamNtlmheaeM PARKING REQ: PROV; PARCEL: 13906722 ZNE: REF NO; u tim�ued WmxM Io Ne prw�u'vn d Ns Wmeadan limn+e lar+ �CMpr 9(mnunmvp wM Saaun 1aao) d Gveion 3 d ib p LANN I NG NOT ES > -� Bua'vwv end Pralm'vn Cadal a ��m M o eM u ezemq ihsdmn W the basa la tla elepeC memPion. MV violmion d Seaian � �m�sMmrv�VO�+��«eo«mdwbpusme.od�+m.dao�ManumaewnrweMod�eamev+l`�D. itifiEif3t3t3t3fMitiFiEikiEititjt;fit3t3titMit3kifiEiPiEiEitiEifif�eiEieit;tit�tititiF3EiFitiFit;t3E3F;fi:ifx�;fitifitifitifiF;tiFiEitifitififitifit�eifitiF ❑ I.mowewWtMquDu�YamY�oM�v.rhw+WeatMi�obmmV��.wiTEolheMvkendlheawmaeerci"vuaMW ordleraAlureeN(SectonlOu.B�mveMPmlme'anCade:TheCaurmonLiwelvwdommlepdytoenoxnerdproperry D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N�T S V/10 bll�f Of TY�� IIXldI. YIQ P�D OCOO tllf�l Yq�( �YIIf000f hMtl� IX I�V W�11i �10 R 11Bf OMI Y11�O�tl. pIOM� 1119� WC�1 .. �c„aa'�., „on�„..�n.� ,�wn"�'.«'a�.�"e bma�o'.a:i°��in.""�"�. w�.`�""`a`�P�"��'�" ZONING APPROVED BY DATE: p i. m o�« a m. awMr. � a.avwr od+�.u:�o wn w�»a �o-.�a. m w,m�a m. waa lseao� rou. e�:�..oa . piWevom Code: TM Cwaroem Licmae law dom nol �py b an mxar d papany Mn bWlds a L�wm ttraan end xfio B U I LD Z NG AP PROV ED H Y : UAT E; wmreen tar wdi p9�+� wnn a ovureeMe) �ieanasd a�uem �o �he taaerm� lirana leW. ❑ ��ax�q�d>;<no�: e.eP.c..�«up�se�: APPLICATION ISSUED BY: DATE: 7F7i�i� oete: Muw: iFiFifififlfiflFiFiF�FiEitiEififififififiFiF te w ifiFKifiFiFiFi4ifiF r ifiF iaone.eo-��.n�tym.�iemewmewena��danwwme�wu�mmem.dWu�wdmenesmnyCoaessao�.uws.zesu,ene LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y 255J1. uq Nei I a enY Mura dntin0 �wb T/ wil na (mcle ons) neeE b oomON xvA ud mta mds� erA �M �Ww�xrc� br ap«mulamrulw.tianamodJreiionkomiM�i ue�y v�prrom0iprb.WvdxuielaonqiutlioneppFeiioroeroevemqtmmNees pro�.iawn.. omu: �wuwn: WORKER'S COMVEN9ATION DECLAN�TIOH: 1 Mreby elfim� unEm perWly W pajury ane d �he btloxi�q detlereiuns: � I hew enE wil meinlew e carl�' me W omeent lo eell+mun lor wwkss eanpwiwion. n po+iESE lor by 6eNm J)00 d �M lebar COEe, la IM pala�menw d Ne Mak la wlic� Ni� peniw b Wued. ❑ inw.�a.um.w�.��r�ro��....�.a�.ders.n�a�aodm.�n«coa..b.m.wro�w.dm. X won� ro� .nKn in�. ommu ie h.�,ee. Mr �.«�e�.• �wowo�, �,�. w�« .m oa�n ��e..,.: c�..: u�,r.�nra T�icnnn�ir EXPIAES P"'� Nem°� �-g�.�d 3,?.9-4 0 5/ O 1/ 9 8 (T�is eMim mad wr Ds rnnPW�C r iMY�t e b ara Mrdnd dotlan Rim/ u/mJ � I cerlh' �lui m Ne D�wmerre d ilr wark la whfeh iAb W�b u uawtl. I NeY nol amWq' M' Vd� In enY mww w u lo become wEj«f to tM woM1xe' canprmtian Ie�w d Cefdarie. eed ep�ee N�Nm yif hI tlnM berone wbptl to �M xorlmn' comD�ion mision d Ssalon a100 d �hs leEa COM. l ku4tm�rNn aomY `�pov��e o � L Mcr�: ' ( J� �y�-- W bp:F�Nunb��cunrvoA�r�'mrpnutlonror�rp�ls��rw,.ne.,mlwe/.cr.n.roror.roalM�.lpwrua.ne HI Hir� ip ro aw n�ntlrM Ihouund Ed4n fifCq000A N W!Ilbn ro lM cwt ol carryw�tlM Aurrq�u u provMM ror In s.�no� �ns o� m. �.eo. coa, �nM.c w.mm.r'. r.... CONSTIIUCf10N LENdNO �6ENCY: I Aerab� elfum under pwWiy d per''vy IMt ihan u e m�q�wion Isnd"vq epency lar iM pmiamenw d IM nak lor M�h ihe M�� u'vawE (SWian JO�. CH. LI. LENDER'S NAYE LENDEP'S ADDPE39: � cenih �het � haw ned Nu eeN�� eM ew �Mi tM eEow'udamuion u mnea.l e{yaa w oomW r.vn e0 Nf' xtl mue+yadinviou enE etme laxs nlmM w dukiq wmmimm ud hareh' eiW¢� nAa�� M ih'v ary bWw w� Na ebwa�msaiarG p�opery �IX impetlwn W�pueaa. I JODI WE'd1HERBEE � � (515�i6.WP) WIN�-BiuldMdSdeiYf3rw�-We:Cmmy-AGV��:Rnk�ievs+»:Gdtlxuod�Nesm HLDG PMT PERMIT 87.25 PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING . ; 50 SMIP/NON—RES PLAN - ISSUE FEE ' BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAIL DUE TOTALS----> 87.75 0.00 -- ' 0.00 87.75 87.75 .00 REVENUE DIVISION TO'IALS--> COLLECTED: 87.75 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GAADING PLAN—CHECK 87.25 .50 if iE iE if if iF iF iF if iF if iF i! 1F iE 1f if 1E if 1f 1f if if 1E 1F if if iF if iF iE ie iF if iE iF if if 1f'1F if if'1F')f'k if 1f'If if 1E �If if �f M if if iF df !f's4 iF if 3F iF if if �E iE iF 1F iFlf i*Yr if if iE iF i't I N D I V I D U A,L .F E E B R E A K D O W N TYPE �]TY D E S C R I P T I O'-N UNIT COST TOTAL COST SFR 3500 REROOF HY VALUE RESIDENTIAL NOZONE 1.00 3,500.00 END"OF FEES �i-2o-:9�7/�l:e: :�:/t57.1: . . ' :wri ,:J:]..'��cpu�. �Giv.A. uvV�}[�-yJ'S 'QNSTNUCTION AND PLANNING 'PROVALS Permit # (emporary Electrical Service or Pote 2. Soil Pipe�Undrgrnd. _ -3:�ElectriCal Conduit Utility-Undrgrnd. ;�.'4cEleMrical Conduit�Uridrgrnd. '. 6. Steel Rel�farcement � '�`.G•' Electrical UFER'Grnd. - _7.=Footings ' � . '8: Foundation ' 9. Water P�Pe�Undrgrad. 10. Structu�al Floor System � 11 . PrqpertY Sewer Line & House fqnnectior 72. Sev,�er Cap 13. Roof D�ains �14. Rough Plumbing, T5. Rough Electricai-Conduit = 7,6. Rough Electric lNiring, � 77. Rough Wiring SiQn 18. Rough Electrical=T Bar Ceiling t9. Rou9h Heating & Air Conditioning 20. Etou� Fa�CtorjGFiiepl�ace ^;,; � 21. Dutts, i� Stru¢fute:: .. . - � 22. DuCts; Vet�tilaI;�ngf } 23. Gas Pipe�Rough & T st =, � 24. Roof �rariiing" _= � -''' 25. RoofShesthirtg . , 26. T�-BaF Ceiling (Struct6ral) & Mropbcoat 27. �rame 2nd. Flashing �� . ��•x • 28. Lathinc� &'Siding � ; ' -. - r 29. Insulatiort� .�' •- y J ' 30. Drywall N ilirnj ^ � � r1 � .- � 31. Plaster Brown Coat A: •.- f 32. Electrical�Power M �t�rF�nal • 33. �ina1',EVectric _ ` • , �_ 34. Final'l-leating & Air Conditioning .. � . 35. Finai GasiGipe:Test ' -• ." � 36. Hoodror Canopy � ' y 37. F.inaY Factory Firepface� - -- � � 38. Final'Plumbing �� J - - _ . c : .1 39. Water�Service-Finai !' � 40. Gas Service-Final • ' � 41. So1ar pomestiGFinaf` � 42. BackfloW P�eventer .. ' 43. Backflo�v Irrigation ; _ ' 44. Landscape IrriGation�System ' � " r. 45. Sound Attenuation k 46. Handicap Regulations - �- 47. HNAL STRU�TURE & BUILDING 48. F_INkL PLANNING + + 49. Electiic Releaig to Etlison 50. Gas fq.elease to �Southem Califor�ia Gas G 51. CERTIFICATE OF OCCUPANCY Date POOL & SPA Date Inspector AppROVALS Permit # 52. Pool & Equipment location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure 7est 57. APPROVAL TO COVER•GUNITE 58. Electrical Conduit-Undrgrnd. � 59. Gas Pipe, O UndFgrnA., Test 60. 8ackwash Lines, P�Trap, O Undrgmd. 61. APPROVALTO�DECK 62. Backwash & ReCeptor•Final 63. Heater & Vent-Final 64. Plumbing System - Fina4 65. Electrical�Final 66. Solar System-Finat. � 6�. Fencing & Access Approval . 68. APPROVED FO,R PLASTERING 69. POOL/SPA SYSTEMS F1N.4L FIREDEPT REQUIREMENT � ' i �APPROVAI,,S, �, ; Peiinit #�_� ( - � ' 70. tlnderg4our�({ fjy�dro ' --i- , �� 71. Product Piping Cj�6as ❑ Oil � � � ' 72. Undergr0�nd Fjush ' i ' � �� . 73;j Undergrnd. Stoi�@ye Tink Ci Gas ❑ Oil ' ' 74, Overhead Hydrol _ � - � � %� Dry Ghefaical _ ; •,� ! 76. Dry Stanilpipe ^.' f - ' - ��, 77..j FIXED�,V�TE4�;xINAL . • � �' 7� FIRE PREV. FINT}L �= r" . i� � WEALTH�DEP'�. REQCIIREMENT � i. �� 79: FINAL INSAECTtON + j I . � - _ �_ � �k "BO�FOOD CERTIFI�'ATE I$SUED_, i _J.- � . v . �7 /� N6ies: y-� f0�j.�� '' C:6�i1/"Gfi(f(> ' ' � (,✓i�t� �/o /l�vkv � pF ��t/s%% I I � ''1 � �� • � r S � � - . , . i � � .. 'J .) � � t - E -� - . .� . . ' � - � ��'1 r 4 I ' ` � 1 � � � ' f � . - 4 � � - k � �� • c.' - , � . _ �. � - - ,� - _. _ . . _ , . . . - _�.�� S . R Date � Inspector Lot 73 , rR 37zz 1 )€�� .COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. 90X 817 C06TA MEBA. CALIFORNIA For Applieanf io Fill In Complefely TYPE OR PRINT � MAIL l 6TATE COSTA MESA CALIFORNIA K S� E DEVELOPMENT CO.� ING. TEL. �X�OO IRREG �E� RECEi�� s�-r�'3—b FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only ev o�re iasuso COSTA MESA, CALIFORNIA ZONING ZONH I NO. OP I U8H OP NE� R�1 PLAN� BUILD�NO 4J LH6AL - oeecxiarioN �t 73� `�'aCt Ho, or etnaa. � xow o� wr w. n. ruo. none / a 9- 0 aera�cK uwe raor 5� � REAR YARO 20' CENTHR OP 9TR[¢T 61�E YARD I LEFT . 1�� I RIGHT , O' DESCRIPTION OF WORK � BUILDINC. �� SF NO. OF 6 SIZE ROOMS EXTERIOR WALL I ROOF ROCK COVERING LOVERING 8tt � 2 �- USE OR BUILDING AND V✓�RI((TO B8 PERFORMED -- SINGLE FAMILY ESI C AND ATTACHED GARAF,E PLAN 3-BR I H¢H¢BY �GKNOWl.8D68 TM�T � HAVB HBAO TNI6 APPLIWT�ON TM6 AMOUM BNOWN UNDER VALUATION IB FOR TH! AND eTATL THAT TH6 AB�VC I8 CORPER AND �OR88 TO CON- pURP08¢ OP EBTABLI6XING A PBRMIT PE¢ ONLY. PLY WITX ALL CITY OROINANCE9 AND 8TA W8 R80ULATINO ou�tDlrvo coxBTwycTloN. VALUATION �� _' 81GNATURE O '. � �� // �// �y PERMIT FEE S PERMITI'H $ /�� /` pLAN GHECK $ �Q' �/ Al17HORIZED AGENT _ �y �,