HomeMy WebLinkAbout2851 CORVO PL - Building Permits�
(714) 754-5273 • Fax (714) 754•4856 • www.ci.costa•mesa.��LDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2851 CORVO PL
Suite:
Vicinity: KITCHEN
Parcel Number: 13933403
Applicane HOOFE, PAUL
Address: 242 E 19TH ST
COSTA MESA,'CA � �
Owner: HOKANSON; FRED TR�
Address 2851 CORVO PL , -� -
� COSTA MESA, CA
Convacror. OW N ER-BU I LD ER
Address: , �
Zip:
Arch :
Address:
Zonin9: R1 R1
Phone: 949-642•9748
Zip: 92627
Phone: '
Zip: 92626
Phone: '
License: 000000
- Eng:
- Address:
Status: ISSUED
Applied: 09/16/2003
Issued: 09/16/2003
ISSUED BY:
' Phone: . � � ' Phone:
Zip: . , � ' License: License:
SCOPE OF PERMIT
INTERIOR KITCHEN REMODEL REPLACING DRYWALL (TO 5/8")�ON WALL'AND CEILING IN AN EXISTING SFD.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other.
Inspection:
Total
$0.00
$153.25
$0.80
$0.00
$0.00
$0.00
$154.05
SETBACKS �
MAIN STRUCTURE Front 0- 0. Rear 0- 0
ACCESSORY Front 0- 0 Rear 0- 0
.
PARKING Existin : 0 Re uired: 0
NOTES:
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
Se,000.00
5s,000.00.
�
�
NOTICE: The work authorized by this permit shall comply with all applicable handicap eccess requirements under California statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become vold if work is not commenced withln 780 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this parmit to be considered lagal, such work must comply with all applicable codes, and all
requlred Inapections end finel epproval must be obtalned. Failure to obtain inspections and final approval will result in tha expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaae-as �aroo�
WORKERS' COMPENSATION DECLAHATION: _
I hereby eflirm untler penalry of perjury one oi the following tleclaretions:
❑ I heve end wlll maintain e certlflca�e of wnsent ro seli-Insure Por workers' wmpensetlon, es provideG for by sectlon 3700 of Ihe Labor Code, for Ihe peAormence o1 the
work for which t�is permit is Issued.
❑ I heva entl wlll malntain workers' oompensaUon insurance, as requiretl by 5ection 3700 of Ne Labor Code, for Ne peAortnance of Me wark for whkh Nis pertnit Ls IssueO,
My worke�s' compensatlon Insurence carrier entl pWicy num0er ere:
Certier.
(inis si
J� � 1 certity �det in ihe pertormance of'
compensetlOn 18w9 01 CBIItO ,
comply wi�h �hese provi .
Applican� SlgnAtura:
WARNIN(3: FAI�URE T RE WORKERS'
T/qUSAND DOLWRE (S10D,000�, IN ADDITIOF
Pdiry Number.
�ermlt /s vaNeO t ne �untlretl tlollars ($100) or less.)
/�
�or whi this ertnil Is iuued, I shall not employ any person In eny manner so as b e 5ubject to the workers'
egrae that If shoul me sub�ect to Ihe workers' campensetion provisions ot Sa n 37 of ihe Labor Code, I shall lonhwlth
r
Date: d �
E IS UNUWFUL AND SHALL SU9IECT AN EMPLpYER TO MINAL T1E5 AND dVIL FlNES UP TO ONE MUNDRED
JTHE OFCOMP SATIqJ,DAMAGESASPROVI�EDWRINSECTIIXJ3]OBOFTHELABORCODE,IPREREST,ANOATTORNEY'SFEES.
LICENSED CONTRACTORS DECLARATION: '
I hereby efllrm Ihat I em Ilcensed under provlslons of Chapter 9(commencing with Section 7000) of Dlvision 3 of lhe Business and Professlons Cotle, end my Ilcense Is In full
torce entl eflecL Llc. q Class 8
Contractors Signature: De�e:
CONSTRUC710N LENDING AGENCY:
❑ I hereby 6Nirtn that there is a consfruction lentling agency for iha pertortnance of the work tor which ihis pertnit is issued. (Sec. 3097, Civil Code).
Lenders Neme� Lender's AOtlress:
Signature: Data:
OWNER-BUILDER DECLARATIONS:
I hereby emrtn thel under penelry of perjury that I am EXEMPT FROM THE CONTAACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professlons
Code: Any Gry Cr county whiiF requlres a permil to construct, elter, Improve, demolish, or repelr eny sirucWre, pdor to its issuance, elso requires iha epplicent tor such pertnil
b ttle a stgfred atalemertt thet he or she Is Ikensetl Dursuant to tfia pmWsions oi the Contraaora License Law (Chspter 9(commencinq with Seclion 7000) ot Dlvlsfon 3 of tl�a
Business entl Prolessions Cade) or that he or she is exempt therefrom end the basis lor ihe alleged exemption. Any violation of Seclion 7031.5 by eny epplicant for e pertnit
suJb'°cts ihe epplicent to e civil penalry ol not mare Ihan frve hundred dallars ($500).):
�,I, es own9� ol Iha properry, or my employees with wages as iheir sole compensatlon, WILL DO 7HE WORK, end ihe struqure is not intentled or oXereG for sale (Sec.
7044, Bus��ess and Professions Code: The Contractors License law tloes nol apply to en owner ot properry who builds or improves thereon, entl who Ooes such work
himselt or herself or thmugh his or her own employees, provided that such Improvemenis ere not Intended or oHared for sale. If, howeve4 Ihe building or improveme�l Is
soltl withi� one year of completion, the owner-b ' er will have the Ourden ol provinp that he or s�e did not build or improve for purpase oi sele.). �
❑ I, as owner of the pmperty, am EXCLUSIV Y NTRACTING WIT}f IICENSED CONTRACTORS ro conslruct the project (Sec. 7044, Buslness and Profassions
Cotle: Th0 contrectore Lice w doe not ep ly to an owner ol properry who bullds or Improves thereon, entl who conirects for such prqect wlih e conirectar(s)
license pu�suent to ontractors Lic6nse La s.).
❑ I em exem der sec. /
Signatura:
Owner I venfied b dnver's lic� e. V
Verlflcetian ai Ownership by (type at dacumenL i.e.
❑
Business and Professions CaOe lor this reeson:
tex bill or deed):
DIVISION OF INDUSTRIAL SAFE7Y VERMR CERTFICA710N;
Driver's Llcensa No.
Date:
Expires:
❑ 1 hereby certlly that no excavation Me (5) or more fee� in dep�h into whlch e person is requlred to descend, will be mede in cronnectlon with work euthorizetl by this
pertniL s� thal fw bui{ding st'uctuie, swflolding, falsework, or demWilion w tlismani{i� ihereW, wiil ba more than thirty-Six (36) feat high. (Chep. 32, Gry 2, Ari 2, Sec.
341, Tiile B. Calitomia Adminlstrativa Code).
❑ As ownew6uilder, I will not employ enyone to do work which woultl require e permit irom the Division of Industrial Safey, es noted ebove, unleas such person hes e
permlt to do such work irom Ihe tlivision.
SignaWre: Date:
Dlvlsion of InduS��el Sefery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHOR¢AT10N OF ENfiiY: I cenify under penelry ol perjury that I have read ihis applicetion antl state Ihet the Inlormation given Is
correct. I egree to comply wit� ell stete laws entl ciry ortlinences releting to bullding constructlon, end eutharize representatives of the Ciry of Coste Mesa to enter upon ihe
above-descrlbed p�aparly lor inspectian purposes. I agree no� to ocGupY or allow occupency oi eny building authorized by this permit until finel in5pection.
COOE t. 1tl5Pt�L4N.IYPE QAg ItQ�L@
1616 Fixetl Syslem Final Fire Preventlon
1268
200
Pool Spe Finel
Finel fie-Rooi
201 Flnel Bla�elaininp Well
202 Finel Factory Fire Place
203 Finel Sign
204 Final Damolition
f�QQE,( INSPECTONTYVE
206 Final Mec�enical
20B Finel Plumbing
210 Finel Elecincal
212 Flnal Flre Prevenlion
220 Flnal Planning Approval
222 Final Site
250 Finel BuIlGinq/Oaupency
Pd� ItiiIDAL&
,. . _, . � . __. _ . _.. ,. . _, . _ . .--- ......._..---._ ...------
Job Address: 2851 CORVO PL
Suite No
Vicinity: KITCHEN
Parcel Nunmber: 13933403
Applicant: HOOFE, PAUL ",
Address: 242 E 19TH SP -
COSTA MESA, CA -
�, � " ,
%�,. . _
Owner: HOKANSON, f RED TR
Address � 2851 CORVO Pl "
COSTA MESA. CA
Contractor: OWNER-BUILDER
Address:
� � Arch / Eng :
' � Address:
PLUMBING PERMIT
Phone: 949-642-9748' .
Zip: " 92627 ,
Phone:
Zip: 92626
Phone:
2ip:
License: 000000
Status: ISSUED
Appl ied: 09/16/2003
Issued: 09/16/2003
ISSUED BY:
Phone:
Zip:
License:
' SCOPE OF PERMIT
�. � � INTERIOR KITCHEN REMODEL REPLACING DRYWALC (TO 5/8") ON WALL AND CEILING IN AN
� � , EXISTING SFD. '
� �, 1 KITCHEN SINK _ � -• �- � . � " �
' REP: 803-01575 ,. , � ,, .
ISSUE FEE
Backflow irrigation
Backflow Preventer �
Bathtub
Clarifer System
Connect pce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
AMT �TY'
$23.50
$0.00 0
$0.00 ' 0
$0.00 ` 0
$0.00 0
$0.00� 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
FEESUMMARY
AMT QTY
� Laundry Tub / Washer 50.00 0
Landscape Irrigation $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 .
Septic 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
SumpPump
Swimming Pool ,- ' �
Trap Primer - , �
Urinal
Vacuum�Brkr BkFlow(1-4)
Vacuum Brkr BkFlow(5+)
Wash Basin
Wash easin Set
� Waste and Vent Sysiem
Water Closet (Toilet)
Water Heater / vent
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
���. INSPECTIONS: In order for the work authorized under this permit [o be considered legal, such work must comply with all applicable codas, and all
requlred Inspeetions end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
, FOR INSPECTIONS CALL: (714) 7545626
zaae�as 16�00)
WORKERS' COMPENSATION DECLARATION: �
I hereby affirtn untler penalry oi per�ury ane oi Ue Idlowing dedarations: '
❑ I heve entl wlll maintain e certlficate of consent to self-Insure br workers' compensation, as proWdetl for by section 3700 ot the Labar Code, tor the pedormence o1 the
wark tor wnlc� NIs pertnii is Issued.
❑ I have and w��� maintain workers' wmpensa6on insursrxa,. equl� by sectlon 3700 of 1ha Lebor Cotle, for the pertortnflnce oi the work for whkh Nis pertnit lv issued.
1
My worker9' compensetlon Insu�ence cartler and polw�-r(umber e
Cerrier:
(This sectlar
Pdicy Number.
or /ess.)
�'�. I certily the� �� the pertormenCe e�rk for which t 5 D�it Is issued, I shall not employ eny person In eny manner so as tq'6ecom�.subject to Ihe workers'
compensetlon laws of Cell a, e,M egrae Ihet If I ultl ecome su6�ect m the workers' campensatlon pmvisions�e�6 3700y(the Lebor Cotle, I shell torthwith
comply witb t�ese pro ons.
Applicem SignetUre: - � Date: ��/� S
WARNINO: fAILURE TO SECU E WORNER$' COI.�G N9A � MGE I UNUWFUL AND SNALL SUBIEGT AN EMPIAYER TO C IMINAL P TIES AND pVIL FlNES UP TO ONE HUNDRED
THOUSANDWLLARE(5100.0OO�,INADDITIONTOTHE TOFCOMPENSATIIXJ,DAMAGESASPROVIDEDFORINSECTIqJ3]O60FTHEUBORCODE,IMEREST,ANDATTORNEI"SFEES.
LICENSED CONTRACTORS DECLARATION: '
I hereby aHirm tha� I em Ilcensed under provislons of Chapter 9(commencing wlth Section 7000) of Dlvlsion 3 oi the Buslness and Protessions Code, and my Ilcense is In lull
torce flnd eMect. llc. a Class #
ContractoYs SigneWre: � Dete:
CONSTBUCTION �ENDING AGENLV: �
❑ I hereby eMirtn Ihel lhere Is e construction lending egency for ihe performence ot t�e work tor which Nis partnit is Issued. (Sec. 3097, Civil Code).
Lentlers Name: Lender's Atldress:
Signature: Date:
OWNER-BUILDHA DECLARATONS:
I hereby eHlrtn iha� under penalry ot perjury that I am EXEMPT FROM TNE CONTRACTORS LICENSE LAW for ihe tollowinq reason (Sec. 7031.5, Business entl Professions
Code: My dry or counry which requires a pertnit to wnstruct, eltar, impro�e, demolish, or repeir eny slruMure, pnor to its issuance, fllso requires the epplicant tor suc� permit
to file e signed stetement that he or she Is Iicensed pursuent to ihe pravi5�ons oi the Contredom LJcense Lew (Chepter 9(cammencing with Sectlon 7000) 0� DlWsion 3 ai Ihe
Business end Pro�essions Code) ar that he o� she is ezempt therelrwn entl the basis lor Ihe elleged exemption. Any violetlon af SecUon 7031.5 Dy any epplicent for e pertnit
subjecls the eppll�em �o e ciNl penalry at not mora then Me huntlred dollars ($500).):
❑ I,�es owner ol Ihe Oropeny, or my employees wlih wages as iheir sole compensatlon, WILL DO THE WORK, entl the struclure is not Intendetl or oHered for sale (Sec.
70d4, Business entl Professlons Cotle: The Contradors License Lew does not epply to en owner ot pmperty who builds or improves thereon, and who tloes such work
himself or herself or Ihrough his or her own employees, provitled Ihat such improvements ere not intendetl or oflered for sele. It, however, the building or Improvement Is
sold within one yeer of completion, the owner-builder will have the burden ol proNng that he or she did not build or improve �or purpose oi sele.). •
❑ I, as owner ol the propeey; em�.EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to construct iha project (SecJ044, Buslness end Prolessions
Catle: 71ie COMrectors Licen � does uoi e ply to an owner ol property who bullds or Imp�oves thereon, entl who coniracts for such project wlih e contrector(s)
license pureuant to ihe rectors Lice � s.).
❑ I am eaempt un sec � ' Business and Professions Cotle lor this reeson:
Signature:
Owner ID ve ietl qydn eIs licen / Ve ❑ No Drivefs License No. Expires:
Vedticstfon of Ownersfiip by (type oi e ment, f.e. - property ten bill or deatl):
DIVISION OF INDUS7RIAL SAFETY PERMIT CEHTIFICATION:
❑ I hereby ceA��y t�at no excavatlon frve (5) or more feet in depih into which e person Is requlred to tlescend, will be matle in connection wlih work authorized by ihls
parmit, end tha� no Duiltling structura, scaHolding, falsework, or demolition or dismanlling �hereof, will be more than Ihirry-six (38) feet high. (Chep. 3.2, Grp 2, Art 2, Sec.
341, Tllle B, Celitomia Atlministretive Code).
❑ As owner-bu��der, I will not employ anyone to do work which would requlre e pertnit Irom Ihe Divisian of IndusMal Safety, es noted above, unless suc� person hes e
permit to do such work from Ihe tlivislon.
Signature: Date:
Division oi IntlusMel Satery Pertnit Number.
CERi1FlCATE OF COMPLIANCE AND AUTHORQATION OF EMRY: I ce under penelry oi perjury ihat I have read ihis application and state thet tha Infortnetlon given Is
correct. I egree to comply wlth ell stete lews end ciry ordinences relating� o ulltling constructlon, end euthodze represenlatives of Ihe Ciry of Coste Mesa lo enter upon t�e
abOve-descnbed p�apetly tor inspectlon puryoses. I agree not to oc�y,6i low occupancy ot eny building authorized by ihis permit until finel inspection.
COOE �. �ySQESII4tlSYPE Q� lt�l,4
7616 Fixetl Sys�em Flnal Fire Prevention
1266
200
201
2a2
203
Pool Spe Final
Final Re-Roof
Finel BIxWRetaininp Well
Final Fec�ory Fire Place
Finel Sign
204 Final Demolltion
CODE 1 INSPECTIOX TYVE
206 Final Mechanical
20B Finel Plumbing
210 Finel Eleclriwl
272 Flnal Fire Preventlan
220 Final Plenning Approval
222 Final Sita
250 Finel Building/Occupanq
�g ��
i.'1'.ii-O�i i1�
, �
(714) 754-5273 • Fax (714) 754•4856 • www.cl.costa-mesa.ca.us
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicank
Address:
2851 CORVO PL
KITCHEN
13933403
HOOFE,PAUL
242 E 19TH ST
COSTA MESA,�CA
Owner: , HOKANSON, FRED TR
Address " 2851 CORVO PL �
COSTA MESA, CA
Contractor: O W N E R-B U I LD E R
Address:
ISSUE FEE
Temp service test
Res. a/c package�
New Res ('I-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 t000a
Motors to 1hp
Motors l0 10hp
Mo[ors to SOhp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel l0 200a
Phone: 949-642-9748
Zip: 92627
Phone:
Zip: 92626
Phone:
Zip:
License: 000000
// hAIM UFilvt, 1:V51A MtJ/t, l./'. aCOCo
Status: ISSUED
Applied: 09/16/2003
Issued: 09/16/2003
�
ISSUED BY:
/
SCOPE OF PERMIT
INTERIOR KITCHEN REMODEL REPLACING DRYWALL (TO 5/B") ON WALL AND CEILING IN AN
EXISTING SFD. ' � - � -
12 LIGHT FIXTURES, 6 OUTLETS, 2 SWITCHES, 1 SUB PANEL TO 200A. REF: 803-01575
523.50
50.00
$0.00
so.00
50.00
30.00
$1320
$6.60
$2.20
$0.00
30.00
$0.00
$0.00
50.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$30.50
�uantity
0
0
0
12
6
2
0
0
0
0
0
0
0
0
0
0
0
1
FEE SUMMARY
Temp Dist System / Lighting
Busway/100ft
Slanding Section .
Misc Electrical Equipment
Transformers up to 1 kva/kw
................uP to'10 kva/kw
.................up to SO�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 or nde) �
Circus (mech ride ar lights)
Christmas Tree Stand
Fireworks Stand
Other ElecMcal Fee �
Investigation Fee
Plan Check Fee
Quantity
50.00 0 .'
$0.00 0
$0.00 0
$0.00 0
$0.00 , 0
$0.00 0 .
50.00 0 '
$0.00 0
$0.00 ' 0
$0.00 0
50.00 0
$0.00 0
$0.00 0 "
$0.00 0
$0.00 0
$0.00 � 0
$0.00 0
$0.00
$0.00
$0.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21•92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or If work Is suspended or abandoned
for a period of 1 BO days. �
INSPECTIONS: In order for the work authonzed under this permit to be considered legel, such work must comply with all applicable codes, and ell
required Inspeetiona and tinal approvel must be obtained. Failure to obtain Inspectlons and final approval will result In the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
2446-a8(8/00)
WORKERS' CaMPENSATION DECLARATION: � �
1 hereby efrirtn under penalry of perjury ona of the tollowing tleclaretlons:
❑ I heve entl will maintain a cartificate oi consent lo sell-Insure lor workers' compensatlon, es provided for by sedlon 3700 0l ihe Le�or Code, tor ihe pertormence of Ihe
work fOr which ��i5 pertnii is issued.
❑ I heve entl will malntain workers' compensation Insurence, es reqWretl Gy sectlon 3700 ot ihe Lebor Catle, for Ihe pertomfance o} the work for which thls pgrtnit is iswed.
My worNers' compensallon Insurance carder entl pollty numDer are:
Cerrier:
�(Thi section need not be complete011 the permif !s ve/ued et a
I certily ��et in Ihe pedormenca oi ihe work for which this
compensetlan laws of Celltomia, and egr � f I shau4
compty Wlth these D�ovisians.
Applicent Signeture: i
WARNIN(3: FAILURE TO SE WORKE0.5' COMPENSA COVEF
Ti0U5AND Dq1ARE (S10D.000), IN ADDRIONT07HE CDST OF OOMF
Policy Number:
100) oNess.J
shell not employ eny person In any manner so es to be me s ject to the workere'
ojhe workers' compansatlon provislons of Sectlon of Lebor Code, I shall lonhwlth
/ oete: • � � �
W D SHALL SU6IECT AN EMPLpYER TO CRIAU TES MID CML FlNES UP TO ONE NUNDRED
5 AS PROVIDED FOH IN SECTION 3]OB OF THE UBOR �DE, INTEREST, AND /TTORNEI^S FEES.
LICENSEO CONTAACTOqS DECLARATION: �
I hereDy attirm that I em licansed untler provisions of Chapter 9(commenGng wit� Section 7000) oi Divislan 3 ot Ihe Business and Professions Code, entl my Iicense is in tull
lorce end etteGt Lia N Cless a
Contrectofs SlgnaNre: Date:
CONSTRUC710N LENDING AGENCV:
❑ I hereby eftirtn Ihet there is a consiruction lentling agency tor I�e peAortnanca of the work lor which Ihis Oermit is Iuued. (Sec. 3097, Civil Code).
LentleYs Name: Lentler's Address:
SignaNre: � Date:
OWNER-BUILDER DECLARATIONS:
I hereby eflirtn Ihet under penelry oi perjury �het I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tar che following reason (Sec. 7031.5, Buslness end Professions
Cotle: Any ciry or counry which requires a permu to construct, alter, improve, demolish, or repair eny structure, pdor ta ILa issuance, elso requlres ihe applican� for such pertnit
to tile e slgned stetement that he or she is Ilcensetl pureuant to the provislans at the Comrecrors License Lew (Chepter 8(commencing vrith Section 7000) of DMs�on 3 ot ihe
Business end Prafessions Code) or-lhet �e or she Is exempt therefmm entl Ihe besis for the elleged exemption. Any Wolation o1 Section 7031.5 by eny appllcent for e pertnit
�sub'ecLs Iha epplicant to a clvil penelry ot not more than five hundretl tlollers (5500).):
1, es owner oi Ihe properry, or my employees wlih wages es Ihelr sola compenution, WILL DO TNE WORK, and Ihe structure is not intendetl or olfered lor sale (Sec.
7044, BUslness arM Professions Code: The Contractors License Lew does not appiy to an owner of properry who builds or Impmves Ihereon, antl w�o does such work
himself or harself or Ihrough his or her own employees, proNOetl ihet such fmprovements ere not Intende0 0� oflerad tor sele. H, however, Ne building or Imprwemant is
sold within one year of completion, lhe ownerbuildar will heve Ihe burden ot pmving that he or she did no� build or improve for purpase of sale.). �
❑ I, es owner of the properry, am E%CWSIVEI,Y CONTRACTNG WI7H UCENSED CONTAACTORS to construct the projed (Sec. 7044, Business antl Professlons
Code: The contractors licanse lflw Aoes npf appty to en owner ai prapeny who builtls or improves ihereon, end wtro contracls tw such prqect wtt� a comrectrn(s)
license pursuent to ihe Contractors Lice� Lews.). � �
❑ I am exemp� unde
Signature:
Owner ID nfletl by tlrivers Ilcep
Vetlfi on of Ownership by (type
8usiness end Professions Code for this reason:
's ❑ No Orivers License
i.e. - properry te< bill or Caed):
Evpires:
DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATON:
❑ I hereby Certity thet no excavatlon five (5) or more feet in tlepth into which a person Is required to descend, will be made in connection with work euthorizeA by Ihis
pertnit, ePd that no builOing siructure, scettdCing, falsework, or demdition or dismantling thereof, will ba more than Ihlrty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, 71t1e 8, Gellfomia Administrative Code).
❑ As owne�-builder, I vrill not employ anyona to do woAc whbh would require e pertnil from the Divislon ol Indusiriel Sefery, as noted ebove, unless such person �as e
pertnit ta do such work from ihe division.
SignaNre: Date:
D{vis{on o1 Induslrial Satery Permit Number.
CERTIFlCATE OF COMPLIANCE AND AUTHORQATION OF EM�RY: I certlfy under penalry of perjury Ihet I have reatl this epplication end state thet the Infortnation given Is
correct. I egree �a �mply with ell stete laws and ciry ordinan�s relaGng to builtling conswction, end euthotlze representaGves of Ihe Ciry of Coste Mesa to enter upon the
ebove-descnbed property tor inspectionpuryoses. I agrae np�(o accupy or ellow occupancy ot eny buildinp eutl�orized by Ihis permit until final inspectlon.
cooe �. ���_� ��noNmve
7616 Fiaetl System Final Fire Preveniion
7266 Paol Spe Flnal
200 Finel He-Root
QSjF �� COpE� INSPECTIONiYPE
206 Flnal Machanical
208 Final Plumbing
2t0 Finel Elactrkal
201 Flnal 9�akR7eteining Wall 212 Flnal Fire Preventlon
202 Final Gectory Fira Place z20 Final Plenning Approval
203 Final 5�Bn 222 Finel Slie
204 Final Demolition 250 Final Builtling/Occupancy
� 5
� Date
PAIE Iti�L:
� iv� �
DECLARATION OF AUTHORITY
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS
Street Address: �� J � � O lZ C� G
Bldg. Permit #
This Permit #
AP Number:
I(we), /�/ O/C/72/t/�S� /� , dedare that I am the Owner of Title of the above
referenced real property, and that I(we) hereby authorize:
Name: 1 � � " �' / ��'� _ T�phone Number. 1 ( �5� � ` z — �� L `�
3treet Address: z 7 Z G� ��7 S�
/City: �l�/ ' � tate: ( �/ �-- Lp / L���
to obtain pertnits in my behalf, as owner/builder, for
at the above referenced property.
v�
2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Workers
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa
Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the Ciry of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury thal lhe foregoing is true and correct. . z�S—( �d ,�.CIO ��
l• ^7 /�
Executed this � day of S�� J� � 20 �, at l_ US'�% :�L 5✓�— , Califomia.
PrinlName: ��L�� ������'/"rSGi`-/
SignaWre: _. �bZ�' 3 S7S�
Date: �j�
Note: This aufhorization does not grent authorization to perfortn the work as owner,
it solely provides for limited power of attnmey to secure this permit in any behalf.
O199d6 (rev.11/00)
OWNER FLETCf�R JOSEPfi DATE J�
e JOB ADDRESS 2 51 CAI'VO Pl. BUILDIA'G PER11iIT N0. 2
\ GENGRAL CONTRACTOR Owner-Builder VALUE $ 1%10.00
\ AP No. 1 - -0 LOT TRACT FIR� 'LONE 3 DESCRIPTION OF WORK Det.
� INSPECTIONS Signature AT� GROUP J TYPE III ZONE A
�// c
G� ����G� �"� SUBCONTftACTOR DATE�ITS P
� � 22552
� �
COSTA MESA BUILDING-SAFETI' DEPARTMEM
• P.O. BOX 120� COSTA MESA� CALIFORNIA 9RE20
�For ApplleaM ro FIII In ComplNdy
TYPE OR PRINT
VJ eETBALK LIN6
GOSTA MESA, CALIFORNIA
%asf/�� F"��rch
��- T6L ^�
'� �—
DESCWP710P1 OF WORK
WALL
1 H61168Y 11CRNOWL[DOt TIUT.t MAV[ IWp'/N�� A��LIGTON
ANC BTAT6 TMAT TM� ApOV[.IB CORA[CI' ANO A011[[ TO COY.
PLr w�Try ALL CITY ORDINANCi� A�1D �TAT� {AYY� R[OYtATINO
em�oina coNerxurnop.
816NATUR! Or �•J� Q�t�AJ
PHRMITTB�
'✓
AUTXORIZ[DAQ[NT l��y��
FEE RECEIVED
JUL G 1964
FINANCE DEPT.
A►PLICAT�ON FOR PERMR ESR
SUILDING
POI OHIC� UH Of1IY
ZONING
�,..,e� � � 2 � r� yoa�
A.P.NO. I � / -33y-o3
NOTB: NOEAVBOVHRHAN08HALLBHLd88THAN
YARDB MPROVlD
MAIN BUILDINO
tOM C/L fTR[[Tl
VM. �
YARDB MPROVHD
ACCBIISORV BUILDINO
Z8 � Cf�
�f
�.
./ �
M. —�
t
� — r�r.---_
eer. MwiH e
AGCE89.BLDOB.
DATB
7
TX[ IIYOYMi /NOWN UNO6P VAWIITON �G IOH TM8
�YRPOGI O! iRAGL10XIN0 A P8pY1T Iii OHLY.
VALUATION
��'� PBRMITFE6 ��
s / ��O TOTkLPEE I ,
^�' �\ `+ ,
�� ;�: �.5��.�
.�-�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 9f7 C08TA ME9A. CALIRORNIA
For Applieanf fo Fill In Comple+ely
TYPE OR PRINT
BUILDING
ADDRESS C� R O L�
�jf�G� / COSTA MESA. CALIFORNIA
IMAIL .. 16�J1 MlIIOTC'd Di'1VE
ADDRESS
�bsta Mesa NE,`•K
rirv
Mesa Verde Bytilders Ina.
1653 Minorca
�`�7No. 181269 No:Ki 9-0395
s�ze 7500 Sa.Ft. � N°;.,°�..B1DO9 0
nr � nT
86TBACK LIN6 FqOM �]
CEMER oP eiREET 50 REAR YARD G
61DE YARD I LEFT 5 I RIGHT 5
DESCRIPTION OF WORK
- - - I x II ----- -- I II --- '
IayeLOiNG I.00O SQ.FtiNO.OF 7 �r..emal
e..nuc
Standard Plan No. 800 C
I HERbBY ACKNOW GE THAT i HAVE REAO THIB PPLIC
AND BTATE THAT H ABO IS CORR T NU AGR ¢ TO
PLV WITN ALL CI �FiDIN NCEB AND TAT LAW6 U
BUILDINO CONB tl 1 N.
81GNATURE OF , �
PERMI7TH
AUTNORIZED AG T
� RECE(�ED� j�
�u� 3 i isst /
FINANCE DEPT.
APPLICATrO�FbTR PERT"vfiT
BUILDING
For Offiee Use Only
neceier Ho. ,p��,Ir,qNo�
tl ll �G
er � on'�g aecerveo I o�re isgueo, _
AODRE55 OCi C/ /
COSTA�MESA. CALIFORNIA .
FIRE
ZONE TYPE GROUP
APPROVED
BY DATE
ZONING
zoxe NO. OP uae ov xew Ji.e 7a..., .
� ( I PLAN9 2 BUIIDINO� ��*��, ,
�e°�e�o,,,,u �7' L/ Til Y6o9
uxe ar.� r
� FT.
'S FT.
�__
ZS FT. IN. .
k/i " DATE 7/Zll �I
�_P - /�'�a �,
�i � �.�Y
Attached garage l,70 Sq.Ft.
THE AMOIINT BHOWN UNDER VALUATION IS POR TH¢
PUfiP09E OF ¢9TABLISHIN6 ♦ PERMIT FEE ONLY.
VALUATION
C
/ � /`�/ ERMIT FEE $ ' �`
!i �j
$ � PLAN CHECK � / / � • 5
iOTAL FEE $ ���i � •S
F
0
u