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Home My WebLink About3253 DAKOTA AVE - Building PermitsCITY OF COSTA MESA . BI/ILpING DIVISION i � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754•5273 • Faz (714) 754-4856 • www.ci.wsta-mesa.ca.us � ` FOR INSPECTIONS CALL: (714) 754•5826 ��A�' PERMIT NUMBER M08-00077 PERMIT TYPE MECH STATUS: APN: 13906609 DATE ISSUED: ISSUED BY: � . JOB ADDRESS: 3253 DAKOTA AV CM Suite/Unit: vicinity: .- . , - SQ. FT: 0 SCOPE OF WORK: REPLACE EXISTlNG FURNACE WITH SAME SIZE - 75,000 BTU. ISSUED 06/0312008 OWNER: ENNS, PATRICIA J � - . Address: 3253 DAKOTA AVE Unit: PHONE: � ' - � City/State/Zip: COSTA MESA, CA APPLICANT: TEJEDq, GEORGE �-� , . Address: '- 202 E STEVENS AVE Unit:UNIT G PHONE: 714•708.3664 � -- � . � -- City/State/zZip: SANTA ANA, CA CONTRACTOR: COASTAIRE � '- LicenseNo. 355425 ' � �^�.`'�r.�''x� Address: 202 E STEVENSUnit: UNIT G. . . PHONE: 714•708-3664 City/State: SANTA�ANA, CA � ZipCode:- 92705 - _ � � CELL: � MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: � � �$38.30 PLAN CHECK FEE: ' , $0.00 . ; INVESTIGATION FEE: • --,.$0.00 . .. , REINSPECTION FEE; � , � , "'$0.00 ' � TOTAL FEES: $38.30 ' �- « � :.�' 7� NOTICE: 7he work autborized by tbis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In ord2r for the vrork authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and�final approval will resull in the expiration of this permit. COpE1. INSPECTIONTYPE , OR IN RL CODE/ INSiEC710NT7E ) DATE INTITIAL 1616 Fixed System Final Fire Prevention 206 Final Mechanical C9 ' � - � � 7266 Pool Spa Final " 208 Final Plumbing 200 Final Re-Roof 210 Final Elactncal 201 Final BIocWRetainiqg Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy � WORKERS' COMPENSATION DECLARATION: I hereby affrm under penalty of perjury one of the fouowing dedara�ions: � ❑ I have and will maintain a certifcate of consent to self-Insure for workers' compensation, as provi0etl for Dy section 3700 of the Labor Code, for the peRormance of the vrork for which this permit is issuetl. I have and will maintain workers' compensation insurance, as requireC by ectan 3700 of the labor Code, for the peAortnance of the wnrk fw which this pertnit is issued. My workers' compensation Insurance carner and policy number are: —I Carriec �TG�� D4wf� ' (inuseci' n beromp'eted✓�!he1 �isvaluedatarenundmdcbnars(Ef00)wless) PolicyNumber: blSn /QS� ❑ I certify lha[ in the pertormance of the work for which ihis permit is issued, I shall not employ any person in any manner so as to become subject to the vrorkers' compensation lavrs of Califomia, and agree that if I should become subjecl to Ihe vrorkers' compensation pmvisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. � O�.�L � �_ �,�3 •a� A rams5ignaW Dale WARNING: FAIWRE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affrm that I am licansed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of lhe Business and Protessions Code, and my license is in tull force^and effect. ��[7-� Classtt C ��'O Lic. il � t _ � DQ onUadorS ure Dale d CONSTRUCTION LENDING AGENCY: ❑ I hereby affirtn that there is a constmction lending agency for the pedortnance of the �+ork f« which this permit is issued (Sec. 3097, Gvil Code). Lentler's Name: Lentler's Address: SiB^aWre OWNER-BUILDER DECLARATIONS: I hereby aKrm ihat under penalty of perjury that I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Busine55 antl Profession5 Code: Any city or county which requires a permi� to construct, alter, improve, tlemolish, or repair any sWCNre, prior to its issuance, also requires the applicant for such permit to file a signed statement tha� he or she is licensed pursuant to the provisions of the Contrectors License Law (Chapter 9(commencing with Section 7000) o( Oivision 3 of the Business and Professions Code) or thal he or she is exempt lherefrom and the basis (or the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant ro a civil penalty of not more than frve hundred dollars ($500).): ❑ I, as ovmer of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, antl the structure is not intentled or offered for sale (Sec. 7044, Business antl Professions Code: The Comractors License Law tloes not apply to an owner of property who builtls or improves thereon, and who does such work himself or herself or through his or her own employees, pmvided that such improvements are not intended or oHered for sale. If, however, the builtling or improvemenl is sold wilhin ona year 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 ovmer of lhe propeAy, am EXCLUSIVELY�CON7RACTING WITH LICENSED CONTRACTORS lo tonslmct the pmjec[ (Sec. 7044. Business and Professions Cotle: The contractors License Law dces not appy to an owner of property who builtls or impmves Ihereon, and who contracts for such project with a coniraclor(s) license pursuant to lhe Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code lor this reason: Owner ID verifed by dmc ise. ❑ Ves ❑ No Driver's License No. Expires: Verifwtion'of Ovmership by ([ype of document, i.e. - property tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: , ❑ I hereby certAy that no excavation five (5) or more feet in depth inlo which a person is requiretl to descend, vnll be made in connectbn with work autMrized by this pertnit, and that no building sWCNre, scafldding, falsewnrk, or tlemoli(ion or tlismantling thereof, vrill be more than thirty-six (36) lee� high. (Chap. 32, Grp 2, Art 2, Sea 341, Title 8, Califomia Administrative Code). ❑ As ovmer-builtler, I will not employ anyone to tlo work which would require a permit from the Division of Induslrial Safety, as notetl above, unless such person has a permit to do such work from the division. AOPlicanfs SignaWre Division of Indus[rial Satery Permit Number. _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuNre building occupant need ro file and certify a Business Plan for emergency response to release or threatenetl release o( a hazartlous matenal? ❑ Yes ❑ No (Section 25505 of the Cali(omia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time tluring a reponed year a quantity of hazardous materials equal to or greater than a weighl of 500 pounds, or a volume of 55 gallons, or 200 cubic leet ot compressed gas at stantlard temperature and pressure). 2. Does or will lhe applicant or present or future buildin9 occupant need to fle a registration form tor acu[ely hazartlous materials? ❑ Yes ❑ No (Section 25533 ot the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity o( acutely hazartlous matenals equal to or greater than a weight of 500 Dountls, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will [he applicant or present or future building occupanl neetl to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous matenals)? ❑ Yes ❑ No (Section 25534 of the Califomia Heallh antl Safety Code provitles Ihat Ihe Costa Mesa Fire Department may require the preparalion, certifcation and lling vrith [he Fire Departmenl of an RMPP by businesses which are required to register acutely hazardous materials vnth the Fire DepanmeN. 4. If an RMPP is presenlly required, has Section 25534 of lhe Califomia Heal[h and Safety Code been fully complied vnth? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject o( this application a permit (or such construction or modifcation fmm the Soulh Coast Air Quali�y Management District or from any other air polWtion control district or agency? ❑ Yes ❑ No (Sectbn 658502 of the Califomia Govemment Code requires that the requestetl informati0n be tumished on applications for nornresidential building pertnits). , 6. Will any part of Ihe facility to be constructed under this permit be within 1000 feet lrom Ihe outer boundaries of a school? ❑ Ves ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Cotle). 7. If a permit from the South Coast Air Quality Management Distdcl or other air pollulion conlrol tlistrict or agency is requiretl for the work which is the subject of this application, have all of the disclosures prescnbed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If'yes", attach cenificate of compliance, from the appropriate air pollution control oKcer). CERTIFICATE Of COMPLIANCE: I certi(y Ihat under penally o( perjury the information 9iven above�is cortect. I agree to comply with all state laws and city ordinances regarding Hazardous Matenals and Emissions. � SignaWre CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty ot perjury thal I have read this application antl state that the in(ormation given is correcL I agree to comply with all state laws antl city ordinances relating to building cons[ruction, and authonze representatives of the Ciry-of Costa Mesa to enter upon the above-tlescnbetl pmperty for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this pertnit until final inspec�ion. . SignaWreolLegalOwneqs) Date Slgnawre Da�e //^ 305'l�46 (3/0]) - X' D � OrA t10lize p1�Wn1 Ddte � 1 � � r JI 'I AOCII CI STA MESA C RUCTION PERMIT Addrea in all soaces within �eavy GorEer Ilnes an0 sign all aOProprlata Cechntions. �� T NO. TRACT NO. LOT NO. BLDG. NO. - �n TVPE OF CONSTRUCTION Phone (+p ❑ NEW ❑ ADD ❑ ALTERATION eSp� � ❑ REPAIR ❑ CONVERSION ❑DEMOLISH LiCense NO. � OTHER Address ___'._ -._.. _ __.... e ' "� 3 q Contractor(tf d �Qo ��in Ph�^e�1J7'Y�i TVPEOFPERMIT � AddfC55 '�p S. S S� Q,,.� ❑ GRAOING ❑ FOUNDATION ❑ STRVCTVRAL LICENSED CONTRACTOR DECLARATION - ❑ TENANT ❑ ELECTRI L �PIUMBING ❑MECHAI 1 h¢reDy affi�m that 1 am Iicen�tl untler provislons ol Gharter 9(wm- /� mentin9 with section ]000) of DlWzlon 3 oT the Business anA �OTHER o' oe '�� Aofazzions Cotlqe, antl my I��¢nse is In full forte antl ef(act. pROJECT DESCRIPTION LlcenseCiassJL� '�"°SC •�c/ Llcensallo.��/��`�� • ia -,r� � 5o..� _ '�ta Si9natur¢ - ORKERS'COMPENSATIONDECLARATION . OCCVPANCY CONSTRVCTIONTVPE harEby atfirm thdt I have d certl(ICate Of consent t0 self-InSure Or a VALUATION�ZONE r,artifiwte' of Workers' Compensation Inzurance, or a certltietl copy - thereof (Se<tion 3800, La�. C.), 5.., r� � � GRADING CU. VDS. ACRES PoIICY No.a2$.�'-/73- Y/ -�mPanY < TA u.n ❑ CerHtietl copy iz hereby tum�SheE. ' REMARKS: ' . . �. �Cnrtitletl copy Iz fHea with tqe city Builtling Divlslon. EXEMPTION FROM WORKERS' COMPENSATION DECIARATION ' - � ' ' - ' (This S¢<tiOn neetl not �e comp�etetl ILtha p¢rmit is for one huntlretl -. _ . . ... ._ SE3001 or Iess�. _ certlfy that m t�e perrorman�¢ of [he work fOr w�iGh tnis permit is Issuotl. I shall not emPloy any person in any manner so as to become �PLUMBING � PLAN CHECK' ' - subjecl to the Workers Compen�t�on Lawi of Glifomia. . Date Si9na[ure BATHTUBS SHOWERS NOTIGE: If after making this tleclara[lon, you shoultl become subject TOILETS VRINALS ' ' ro the Work¢r5' Compen5alion prOvisioni of the Labor Cotle, you mus[ forthwith comply witM1 such provisions or this permil shall be tleemetl LAVATORIES DOUBCE LAVS" ' ' revokad': - � , . , CONSTRUCTION LENDING qGENCV KIT. SINKS DISHWASHERS" I hereby'affirm that Inere i5 a �onstructlon lentling agency for the per- SERV ICE SINKS SVMPS ' "' " formdnt¢ ot the,work for which tni5 p¢rmit is issuetl (SeCtiOn 3097 Civ. C.). - . FLOOR SINKS � FLOOR DRAINS' '� LentleYs Name Lender's Atltlress DRINKING FOUNTAINS - OWNER BUIIDER OECLARA710N ' "- INTERCEPTORS CLARIFIERS� Lhereby affirm that I am eaempt trom.the ContractoYs License Law for the following reason'(Section 7031.5 Business'antl Professions Cotle: SWIMMING POOL � � PTRAP' ' ' �ny City or county which requir¢5 a permit to <onsbuct, alt¢q orove, tlemolish or repair any struclure, prior to It5 izsuance,-also re- ' yyqTER SERVICE ALTERATION - res Ihe appli�nt fOr such ONrmit t0 file a Signetl Stalement thaf he Iicensetl purSuanEto tne pwyisions of the Contractor'S license Law GAS SERV ICE OUTLETS � (Chap[er 9(commencing with Sectlon 7000) of Division 3 of tha Buziness antl Profess�ons COEe) or [hat he is exempt therefrom antl tho yyq7ER HEATERS ' BTU OVTPUT ' basli for [he allegetl exemptioq. Any violation of Sectlon ]031.5 by any applicznt for a permit sybjects [he applicant to a civll penalry SEWERCONNECTIONS �" - - " ol not more Ihan tive huntlreq tlollars (E500�. , ❑ I, as owner ot the pro0erty, or my employees wlth wages as [tielr SOLAR TANK � COLLECTORS' ' sole compenutian, will tlo the work, antl Ihe Structur¢ is no[ Intentlltl _ or of(eretl !or wle. (Section 70qq, gusiness antl Aolessions Cotle: T�e SOLAR PIPING SYS. COnbactor'S LiceOi¢ Law tloe5 nOt appty.to an owne� of d proPerty . . ,_.. ._ . - wno Duiltls or imOroves thereon, antl who tloes such work himself or ISSUE FEE lhrough his own employees, proviGed [hat zuch improvements are not Intentletl o� otferetl fOr sale. If� how¢ver, th! builtling o� ImprOv¢ment MECHANICAL PLAN CHECK is sold wi(hin one year ot compl¢tion, Ihe owner will have the burtlen of prOvin9 ne tlitl not builtl or Improve for the purpoSe of sale). HEATING $VSTEM 0-300,000 BTU ❑'I, as owne� ot th¢ property,'am exclu5iv<ly conVacting wilh qNDDUCTING - IicGnsetl wntraclors to constr4ct tne pwj¢Ct (Seclion ]044, BuSineiS 100,000'+ BTU antl Professions Cotle: The Co�tractor'S License Law tloGs not apply t0 an owner of property who bui�tls or improves thereon, antl who ton- REFRIGERATION 0-100,000 BTU . tracts trom suc� projects with a contractor(s) Iicesne0 pursuant to SYSTEM Ihe Contrattor'S License Law). 100,000 + BTV ❑ 1 am exempt untler Sec[ion � � B. A P. Q �or this BOILERS BTV reason Date Owner SVSTEM REPAIR, ALTERATION I hereby certifychat I have reatl tbis application antl state [hat the above EXHAUST SVSTEM MVLTIPLE iniormation is correcL I agre¢ to comply with all tl[y antl county ortlinances antl state laws relatine [o conSVuction. antl hereEy authorixe . 519nalt�e- "T�uvn.�`'�� D e �� Z" Drlvers' License or 55 � �SSVE FEE CMF 0865-46 White-Builtling; Cy�ary-Appliwnt; Pink-Actounting; Goltlenrotl-Assessor 7Tar �j � i � I . / - _ A.P. � ZONE PKG.SPACE REQ. STREET WIDTH SPECIAL CONDITIONS: PLNG.REF. PROVIDED PARK FEE E ELECTRICAL PLarv Cr+ECK GENERATOR 0�1"KW_1-30 KW _ TRANSFORMER APPLIANCE- 10�SOKW_SO+KW_ MOTORS 0-1'HP_1d0 HP _ (INC. SOLAR) 30-50 HP 50 � HP _ FIXTURES OVTLETS SWITCHES GAS TUBE SIGNS POLE LIGHTS � "� . PANELS ' MAIN -' SUB ' SERVICE AMP . . i_/o . 1�_ ISSUE FEE � � - � I I� APPLICATION APPROVED BV � - DATE - SUMMARV OF FEES BUILDING PERMIT E�- $MIP ' E '•� PLAN CHECK S PERMIT, , - ISSUANCE S PLUMBING E GRADING E PLAN CHECK S ' ELECTqiCAL S s PLAN CHECK E MICROFILM 5 MECHANICAL S TOTAL FEE S PLAN CHECK E LE55 AO- � VANCE PC E FINAL FEE E �� AU�NESSOFBUILqNG: 3 Z S 3 DAKOTA AV °w"E'"s"""E"'°a�`'": ENNS, PATRICIr� J "pOP� 3253 DAI(OTA AVE COSTA MESA,CA ww. �u�mc �oo�ss �NCNRECT ON ENC�NHH: �RCH.OF FNO.'S WUflE54: UNT: FLOOD: X 37 92626 uc. wo.: UNT: CITY OF COSTA MESA - BUZLDING PERMIT PERMIT NO: P 084260 PLAN CHECK NO: Z� O CONSTRUCTION TYPE: PERMIT TYPE: PLU JOH DESCRIPTION : REPLACE SEWER LINES CONiPRCTdYSNAME EMPIRE PLUMHING HTG/AC ( 714 )530-7320 CONINACTOASMAIIJNC 11381 WOODBURY ��+� G,G CA 1GN0' 652877 92643 u"T LICENSEU COMNRCTOFS DECL1flATI0N: I MreEy efl'vm uMer perely d perjury tlW I em licenaed uMm pram"vm d Cheqr 9 (mmmentlrq wnh Sectian )0001 d D'rveun 3 ot IM Buama+ enA Pmleasiona CaEe. enE mY �� u in hll lace enE elted. cmuc.No.: uc.cuss: C-36 uc.no.: 652877 P• �me � � � 15 �� ,�o,,� ,�I �r � %`/� � EN BUILOEA DECLANATION: 1 Mmby elfirm uMx penely d perjury ihel I em ewmq ham iM Conlradae Lievive lew tn tM lolbw'v�p remon (Sedion )031.5 Busvwae vM PMmebna Cade: AnY cry a oounly whiM iequires e pe�mn to mneo-ucl. alter. imprwe. Jemaloh, or ropei eny ewclure, pnor io na ewe�we, eho requirm �M appli�nt for euch pemin to fila e eqiwE etetemeM ihel M a eM n liceneed W�� Orovisione d �M Conlredore Licenee law �Cheplar 9(mmme��p wnh SeUion ]OW) d Orvbion � d ihs Buainen eM Prdeasions Coda� m thet M m eha ia examq Iharehom end ihe beaie for Ihe elbpeE e�emqion. My vobtion d 6eUion ]0�1.5 by eny epplicen� far e permil wbjeee the epplcent to e avil penelry d iwl more Ihen /He huMred dalle�s �55W�. � I,esownerMlhepropanyarmyempbyeecwlhwapeaeathetaolecampanae�im,willdolMwak.endthenrunuieomlintenEeE ar ollereE Im eele (SeMion 101d, Businawend PraMsons Code: The Conlreclon Licenes Lewdoee nol epptyban ownmd pope�y wM buJda or'unprovea �hmeon, eM xfw does e�ch xak himaeX w MneM or ihrouBh he a har own amployaea, pmviEeE Ihet euch improvameMs ua M imeedeC a Wered lor aeb. H. howavar. tM WiNi�p ar'vnpweman� b edd xnhin arYaar oi campbtion. Ns owmrbuiNx xill heve �M buNen d pwiep M or nhe did m� buiN « impwe 1« tM puipma W eeb�. ❑ �. e. o.o« d in. wowro. ��euwNr �vm:ro wnn �iceo,m �w,aec�ae io oo�.m,a m. wq� cseeo� rou. ai.m....m Prdestime code: TM Canirmae l'x.e +e law doee na MdY ro an owrcr d D�w�Y who buiMe «'vnV�'m Ihxean vd Wa comrecta lar wM pqeas wdh e cauretloNe) lir»naed W��t to tM Comreuas licen�e lew). � I em azamq uMm Saciion: B. 8 P.C., br Nia rmvm: Dete� �'^w: CLAZM VALUE: CALC-VALUE: i�l PERM NO• P 08416 GOVT: N SUPP: N PURPOSE: OTH SQ FT: GROUP OCC: R-3 / COMMENTS: X **��*****�*�*�rx�*�****�r��**�*******�r��r**+�+r+��*�r**�***�*�� c*��********� ��**** Z O N I N G R E Q U Z R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN £RNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL; 13906609 ZNE: REF NO: PLANNING NOTES> • i '1E'1f' iE 3E ik 3E iE jE 1F �f if� 3F ik �f if iF if'1E 3F �E 3E iF iE iE iE iE'1f if'IE'1E 1E'1E'1E'1E'1E jE �14 jF iE jE'N� 3f !E if'1F 3f if i6 iF if iF iE if iE iF 3F it �E iE if iE if 3F'1E iF iE dE iE iE iE if 16 jF 3F iE iE iF if ik 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 ZONING APPROVED HY . DATE; HUILDING APPROVEU bY : i eo nereW �+M mm i� e.ara a�a �.�ea+i�e me rec��.«�.��. a c��r'wnn .oe sdmy cod, s.a�. zsws, us�u. m,e L EGAL I Z AT I ON : N F E E S U M M A R Y 25534. enE tM1m I a eny INure buildirp oaupem xill / will nd (dmb me) nead ro mmpty wih vaiA tlete wEea eM Ihe reQuimmams lor epaimnlorconnvunianormoEificalionhwnthaAk u�6T7rerepementDimria.Raeidenlielm�Miud'oneppti�broereevemq/mmtlwes HLDG �%'i'1' F�LUMBING ELECTRZC MECHANIC o'°°"'°"' PERMIT 26 25 Dete: Avw�: 2 S 3 WOFKEfl'S COMPENSATION DECL/�PITION: I Mraby elfirm uMer panelly d perjury an d the bibwi�p Eedaraliom: P LAN f�`� �I hew vM xil meinten e cenifra�a d oonxnl b+eX�inwre br workms canpemmian, o pwidad Iw by Setlim 3M0 d IM lebor I S SIIE F EE _ 2 2. 0 0 cae..i«ms�na��wub..«kia..+:�mm��na��e. BUILDING-DIC > PERMIT ISSUE PLAN-CHECR TOTAL PAID DUE �Ihewerdxllmeimenxake�e'mmpen+elionimuraiu,mrpu'vadbySeabn3loodlMleborCode.lorthepe�vmercedlM TOTALS----> 26.25 22.00 ; 0.00 48.25 98.25 .00 work fa w1iM iliu parmn 6 asued. My woken' mmpeneNion nuurarca carts eed pdiry number ue: c�« CaT.rnnnn EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 48.25 OVER/SAORT: .00 Pa'�'"°'^"°° -6°—T�d�T�4�— O1 /O1 /98 HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECR (Thia seuion nee0 � be crompbfeC ] �re pemi) ia lw one huMreC Jdlars �SIOVI a bn.) 4 8. 2 5 - �1 cMily �he� in iM paAoimar�ca d tM xrork tor whkh �hie pa re ueE. I eMA m� employ eny pe�mn in em� men�r eo n �o �t� oma euMee m tM v.orkma' comPansetion levn M calil ie. e0ree tlal il I enouk became wM� to IM Morken' / m/nos��eoo wWa�= a Ge�+w� �ao m me �eew c i ienn � n�pN wnn inoea�yoy.a�+. DATE: (l DATE : 11 i'e�%iFiEiEifiEiE'N-ifiEifif ii� STRUCTURAL SEGMENT:N FIRE SMIP/RES GRADING SMIP/NON-RES �li'em/np: F�llun ro szuro woMeri rompwwtlon cav�rps 4 unlewNl, �rMalxll �ubHct en �mployer b eAMnel prultlu aiW clvll Aro� up ro one hundrsC tMuaaMl da/kn (SIOQOOOA In siWf/on yihs cwf ol rompawfbr4 demspu u provMM br In gxHon �1Q6 0l Ms Labor Code, lirtenst, end etrormy's Iwa CONSTNUCTION LENDINO AGENCY: 1 he�aby ellrtn uMer pe'ally d per'ryry Ihet �hma w e m�ut�uaion bnd'mp epe�xry la tlr perlormerce d iM xak la whiM Ih'n V�i e eeuad (Seaun �09). CM. CI. LENOEN'S NIW E: IENAEN'S ADDflE55: I ca�iy ihm I heve read Nis eppficeiion eM 9e�e thet �M eEove inlametion is mrtep. I epiee lo camply xilh dl ay enE oouMy adinenms end elme kwe mWiq W WiW'vg canslnwion end Mreby wMor¢e iepresantetivea M thia dy io entar upon IM ebwe-mamioneE qopery 1«ineo�ion vurpoeea. JIM EICHMAN n Pnn�,�ame �o 1„� W� li-�� 0�5? � b� c7 , � . _--... - -- ---.. (5151-IB.WP) W��o-&+ld�q 8 Selery: Oreee�Fb: Gnnery-App5renl: Rnk-Revenue: (ioldenrod-Neemn it �t iE iF 1e iF iE iE iE iE �E iE fE i! ik iE iF ik i! i! ik 1E iE iF if ik iE if iE it iE iE �E af.jFiE 3E �1E aE iE �E iE if �F it iE iE jE iF �1't 9E iE i4 iF iF iE iF it iE iE if it ik iE iF iE iE iE it iE �E iE ik �f i! iF if if iF I N D I V I D U A''L F E E H R E A K D O W N TYPE QTY D E S C R Z P T I O. N UNIT COST TO'PAL COST PLU 1 LAUNDRY TUB OR WASFtER 8.75 8.75 PLU 1 SINK, KITCHEN � 8.75 8.75 PLU 1 WASH BASIN 8.75 8,75 E � OF FEES I -/� � I r . ; i, �8-18-i997/10:34 NH/L48.25 RCPTN:01-C�10�72 PERt'i I T : 094260 CONSTRUC710N AND PLANNING . • �L & SPA ' - APPROVALS Permit # ' Date Inspector APPROVALS Permit # � Date Inspector 7, Temporary Electric8l Service or Poie 52. Pool & Equipment Location 2, Soil Pipe•Undrgrnd. . 53. Steel Reinforcement . 3. Electrical Conduit Utility-Undrgmd. . 54. Forms 4. Electricai Conduit�Undrgmd. 55. Electrical Bonding 5. Steel Reinforcement . - 56. Rough PVumbing & Pressure Test 6. Electricai UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings � 58. Electricai Conduit-Undrgrnd. • g, Fouridation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgmd. 60, Backwash Lines, P-Trap, O Undrgrnd. � 10. Structurai Floor System - 61. APPROVAL TO DECK i i, Property Sewer Line &!-louse Connection 62. Backwash & ReceptorFinai 12, Sewer Cap 63. Heater & Vent-Final 13. Roof Drains ' _ 64. Plumbing Sysrem -,Final � 74. Rough Plumbing . . - ' 65. Electrica6Finai � . � 15. Rough Electrical-Conduii .. - 66. Solar SY,stem�Final � 16. Rouyh Electric Wiring � � 6�. Fencing & Access ApProval 17. Rough Wiring Sign .68. AP?ROVED FOR PLASTERING 18. Rou�ah Electriral-T Bar Ceiling ' • �, 69�. POOUSPA SYSTEMS FINA� � � 19. Rouyh Heating & Air Conditioning � ' �FIRE DEPT. REQUIREMEN7 20. Rou9h Factory Fireplace 'APPROVRL,S Permit # 21, putts, in Svuaure 70. Underground Hydro 22. pucts, Ventilating � ' � 71. Product Piping O Gas (Q Oil 23. Gas Pipe-Rough & Test , � � �. 7z. Underground Flush 24. Root Framing � . 73�.. Uncieryrnd. Storaye Tvnk C Gas O Oil 25. Roof Sheathing . � � 74. Overhead Hydro � 26. i-Bar Ceiling (Structurall & Monocoat 75.. DrY Chemica4 27. Frame and Flashing . 76. �ry StandpiPe . 28. Lathing & Sidin9 ' � 77. FIXED SYSTEM FINAL " 29. Insu�ation , � � • 78. FIRE PREV. FINAL ' 30. PrYv�'all Nailing � • HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � , 7g, FINAI INSPECTION � 32. Electricai Power Nleter�Final S0. FOOD CERTIFICATE ISSUED i 33. Final Electric � Notes: �_ 9Q_R, ,� /,��,� � l /� 34. Pina1 Heating & Ai� Conditioning '' � 35. Final Gas Pipe�Test . � , - 36. Nood or Canopy 37. Final Factory Fireplace (� ,� 38. Final Pium6ing ' /�F�� ' � 39. Water Service�Finai � 40. Gas Service-Finai - 41. 9olar pomestic-Final : _. 42, 8ackffow Preventer - . • --43. 6ackfiow irrigation . ' 4�. Landscape Irripation System � 45. Sound Attenuation , . 46. Nandicap Regulations 47. f1NAL STftUCTURE & BW LD�NG � - �j . 48. FINAL PLANNING _ 49. Eleciric Release m Edison `�� ; ,,� • 50. Gas Release to Southern California Gas Co _.-, - 51. GERTIFICATE OF OCCUPANCY � " L'_. No. Date Applicant to till in all spaces excev� those witnin heavy bortler lines antl sign all appro0rlate eeclarations. CITY OF COSTA MESA PEFMIT NO. TRACT NO. LOT NO. BLD . . � ' � CONSTRUCTION PERMIT }J 7 P�oject Address 3 '> '3 .DAKO'iA F�V E' � � TYPE OF CONSTRUCTION � NEZN ADD ALTERATION REPAI R AppliCant'SMailingAddre55 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,# - bti EZanej/2I /FJ4 %�00 �,' di�oED /�� 7a5KUcraKl p w 7�JT>—(�E(�P DESCRIPTIONOFWORK � �� S �L' Owner i Name hone G� �7J?-� S Main Building:• Accessory Building: Z ��' S3 AIKOTA AYP� C�� HF`+� —� E O Address _/ TVPE OF PEqM1T LJ GRADING �❑�FOUNDATION ❑ STRUCTURAL T Ffont ' . N ArCh/Eng. � LiCenSe No. ❑ TENANT ❑ ELECTRIGAL �7YPlUMBING ❑ MECHANICAL B Reef � Address • � ❑ �OTHER A � N /�• C. HURPH� >Phone b�7—.52/S PROJECT DESCRIPTION 54. FT. OCCUPANCV K Right . . � G Contractor's Name n✓ - Addre55�mailing) �70%�� OAC�iQ/'/��%F�/%%F�4NN'> 9Z70% CONSTRUCTIONTVPE VALUATION$ S �eft R N E 3oPSZ ` ZONE GRADINGCV.VDS. ACRES p�ng.Ref.# Pefk.Fe25 $ n City Licanse No. �J LICENSED CONTRACTOR DECLARATION - ' Remarks: Pafking R2q./Pfovided � 1 hereby aftirm that I am licensetl untler provisions ot Charter 9(commencing q witn section ]000) of Dlvision 3 of tM1e Businezs ana Protessions Cotle, antl USe of Building: E _:,my Ilcense is in full tOrce anU eitecL � �t-�--Jcense CI :: - 36 ''` �icense No. 9� O PLUMBING FEES Planning Notes: � M € "Date Signature �/ �_._ � � g'er Sink Showers ' N WOHKERS'COMPENSATION DECLARATION T I he�eby af(i�m that I have a ce�tiflcate of consent to selt-insu�e o� d Certificate gackflow Preventer Service Sink � � � � S of Workers' Compensation Insurance, or a certi�ied. copy thereot (Settlon - - 3800, tab. C.) � � Backflowlrrigation SewerCap ELECTRICAL FEES Policy No. Company - 8 CerHtietl mpy is �ereby fumishetl. , Bathtubs Sewer Connection Automatic Washer Transformer ❑ 15-50 KW Certifietl copy is filetl with the city Builtling Oivision. ❑ 50+ KW oate Appiicant Clarifiers Solar Collectors Construction PoleSub. � EXEMPTION FROM WORKERS' COMPENSHTION DECLARATION Diihwa5her � n � � (This zection neetl not be completetl if tne permit is for one huntlretl (5100) or �� o( O Solar Piping �opking Unit Meter ❑up to 100 amps less) , I certify [hat In the performance of th¢ wo�k fo� which this pe�m�l i5 IssUetl, I Drinking Fountains $Oldf T3ftk Dishwasher � Meter Oover 100 2mp5 zhall no[ employ any person in any manner so as [o become subject to the � � ' Workers' Co pens t' n Laws ot Calitor a Floor Drains . Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel Date __-3�i��'�Si9nature �`G ��r�� . NOTICE: If,after ma<ing this tleclarafion, you shoultl bec e ubject to the FloorSinks Urinal ,Fan Workers' Compensation provisions of [he Labor Cotle, you ust forthwfth MotOrS 061 HP �1 %- 8 comply wtth such provisions or this permit shali ,be tleemetl revoketl. GasService Outlets Water Closet F.A.U. ,InaSolar 09-15 HP 016-15+ • CONSTRUCTION LENDING'AGENCV " "' . , I hereby affirm that there is a'construction lentling agency tor the performance Interceptors ' Water Heate�, Fixtures ' �� Microwave ' ' of the work for which this permit is issuetl� (Section 3097 Civ. C.) Lentler's Name , Kitchen SinK Water Service . Device Boxes �Pole Light Lentler's Atltlress ' LavatOries OWNER BUILDER DECLARATION ` ' ' � OUtlets . Range . I he�eby affi�m that I am exempt f�om the COntractor's'LicEnze Law to� the P—T�d ' ' following reason (Section 7031:5 Business antl Protessional Cotle: Any city or P - Switches Sign 'y;.T;;.ounty whlch requires a permit to const�uct, alte�, im0�ove, AemOlish o� repai� '�'iny St�UctU�e, p�io� to its issuance, also �equire5 the applicant f0/ Such pe�mit Roof Orains • Garbage Disposal Standing Sections ' '�to tile a Signetl Statement that he/she i5 IicenSEtl pufsuant to the pfovi5ion5 Ot the Contractor's License Law (Cbapter 9(commencing with Section ]000) of ' . Division, 3 of the Business antl Professions Cotle) or that he/she is exempt l .�/S�O.SA-1-- pZ 00 _ Generator �0.5 KW 05-15 KW Trash COmpactor [herefrom antl the basis for the allegetl exemption. Any violation of Section - 7031.5 by any applicant for a permit subjects tbe applicant to a civil pgi�s eetion Fee ' $ 3 . enalty of not more than five huntlretl tlollars ($500). P $25 laue Fee � I, as owner of the oroperty or my employees with wages as their sole MECHANICAL Reinspection Fee $25 luue Fee � $ 3 tompensation, will tlo the work, antl the structure is not intentletl or otteretl ' FEES for sale (Section 7044, Buiiness antl Pro(essional' Cotle: The Contractor's F PUBLIC SERVICES REQUIREMENTS: ' LiCense law tloes not apply to an own¢/ Of a p�operty who builtls o� imprOves � gOil2f ' ' HOOd Of' TYPe I ❑ - ' the�eon, antl `who tloes such work M1irnself/h¢rselt or through hi5 or h¢r own 2oning App�Oved By Date em0loyee5, provltletl that such Improvements are not intentletl or offeretl fo� DuCt - Und¢f CifOuOd Canopy Type I I ❑ - . sal¢. If, however, the builtling or ImprOvernent is soltl within one yea� of com- - Applit2tiOn ApPlOVed By DBtO pletlon, the owne� will �have the bu�Gen of prOving he/she tlitl not builtl o� Im- . rove for the purpose of sale). � Duct -$truc[ural Refrigeretion System Appliqtion Issued�By Date � I, as owner ot the pro0erty, am exclusively contracting with licensetl con- ❑p-100,000 BTU ❑100,000 BTU ' tractorsm construct the project (Section �044, Business antl Professions Cotle: Duct- Ventila[ing . � �SUMMARV OF FEES The Contractor's License Law tloes �not apply to an owner oi property who - BUILDING PERMIT $ ' SMIP ' $ ' builas or improves thereon, antl who contra<ts tor such projects with a con- Exhaust System ❑ Multiple ❑ System Repair/Alteration • tractor(s) Iicense pursuant to the Contractor's License Law). . PLAN CHECK , $� PERMIT ❑ I am exempt untler Section e. & P. C. tor this reason Firepl/Fact. BIt. ICBO # ' PLUMBI NG .$ '�SSUANCE '$, �� Da4e owner � � Heating System & Ducting ' PLAN CHECK � $ ENERGV �P.C. , $ ' I hereby certify that_I have.read thls apvlication antl state that tna above ❑P100,OOOBTU �t00,0006T ELECTRICAL � GRADING $ informatlon is correct. I agree to comply with all city antl county orAinances ' � � '$ � . antl state laws relatinq to builtling constructlon, an0 hereby authorize repre- PLAN CHECK $. MICROFILM i$ - sentatives of tnis city to-en[er upon the above-mentlonetl prop rty for � inspettlon pur s s. � ��[ MECHANICAL �$ TOTAL FEE ;$ 7- m0 Signature ' � Date � �r�� - i Drivars' License or 55 � Reinspection Fee $25 Issue Fae $ 3 � PLAN CHECK � !$ CMF 0865-46 rev.'7/g3 - White - BW Itling; Canary - Appliwnq Pink - Accounting; Goltlenrotl - Assessor - -' ' ' ' ' - � � - — --- - - ,�� . �, ., CONSTRUCTION AND PLANNIN� -- �OL & SPA � APPROVALS Permit# p�Z�1� Date Inspector qppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement . 3. Electrical Conduit,Utility-Undrgrnd. 54. Forms � ' � 4. Eler,trical Conduit-Undrgrnd. ' 55. Electrical Bonding , . 5. Steel Reinforcement � „ 56. �Rough Plumbing & Pressure Test � . 6. Electrical UFER Grnd. � 57. APPROVALTO COVER-GUNITE 7. Footings � ' .58. Electrical Conduit-Undrgrnd. 8. Foundation ,_ 59. Gas Pipe, O Undrgrnd., Test , 9. Water Pipe-Undrgrnd.' . , 60. Backwash Lines, P-Trap, O-Undrgrnd. � 10. Structural Floor System '_ ., 61.'APPROVALTO DECK 11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final 72. Sewer�Cap , 63.�Heater&Vent-Final 13. Roof Dreins � 64. Plumbing System - Pinal �� 14. Rough Plumbing � � 65. Electrical-Final , 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval � 17. Ftough Wiring Sign 68. APPROVED FOfi PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating ' 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. Roof Framing . . . 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) &�.Monocoat 75. Dry Chemical ' - 27. Frame and Flashing , 76. Dry Standpipe 28. Lathing & Siding .. 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall.Nailing HEALTH DEPT. REQUIREMENT 31. Pla;teF Brown Coat � 79. FINAL INSPECTION 32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final•Heating & Air Conditioning � 35. Final Gas Pipe-Test 36. Hood or�Canopy � � 37. Final Factory Fireplace � . 38. Final Plumbing ylr (�Q � 39. Wa[er Service-Final 40. Gas Service-Final 41. Solar pomestic-Final . ' 42. Bar.kflow Preventer . � 43. Backflow Irrigation � , , ' 44. �Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING - 48. Special Requirements Completed , � � - 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY . � � No. Date tG�pM�9 o, � > _ J °`�a� a°' (714) 754-5273 • Fax (714) 754-4856 Job nddress: 3253 . DAKOTA AV Suite No Vicinity: Parcel Nunmber: 13906609 Applicant NOCK, RON Address: 11612 KNOTT ST GARDEN GROVE, CA Owner: ENNS, PATRICIA J Address 3253DAKOTAAVE COSTA MESA,CA Convactor. NOCK PLUMBING Address: 11612 KNOTf ST GARDEN GROVE, CA Arch / Eng : Address: ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifer System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (7-4 outlets) Gas (Over 4 outlets) CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT WATER HEATER CHANGEOUT. AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PLUMBING PERMIT Phone: (714) 895-1246 Zip: 92841 Phone: 2ip: 92626 � Phone: (714)895-1246 Zip: 92841 License: 707775 Phone: Zip: License: SCOPE OF PERMIT Laundry Tub / Washer Landscape Irrigation P-Trap Pressure Regulator Process Piping (per 10 ft) Receptors Septic Tank Sewer Cap for Demo � Sewer Connect Sewer Private Line Shower Sink, bar Sink, commercial Sink, Floor Sink, kitchen Sink, service/mop AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Qn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PER NUMBER P00-00064 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 01/31/2000 Issued: 01 /31 /2000 ISSUED BY: 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 (Toilet) Water Heater / vent Water Piping Qnst or Rep.) Water Re-pipe Water Service Water Sottener OTHER AMT $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $12.30 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NOTICE: The work authorizad by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inapeetlone and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSA710N DECLARATION: I hereby aMirtn untler penalry of perjury one of Ihe lollowing tleclarations: ' ❑ I hava entl will meintain e certilicate ol rnnsent to sell-Insure for workers' compensation, as provided tor by sectlon 3700 0l the Lebor Code, tor the peAormance of the w rk�fpr which this permit is issued. �I.heve end will maintain workers' canpansation insurence, as required by section 3700 ot Ihe Lebor Code, for the pertortnance of the work lor which Ihis pertni� is issued. My workers' compensetion Insurance cartier ena policy number ere: �/' �Carner. � L-�I�� i`_� Po1lcyNumber:_ N��Y�Oi (This�section"need nof be cromple(ed I! (be peimit is valuetl e( are hunOred dollars ($100) oNess.) ❑ I certily Ihat in �he pertormance ol the work for which this permit is iuued, I shall not employ eny person in eny mannar so as to become subject to the workers' compensetion laws ol Celifomjarentlagr@e thet it houltl become subjeq to tha workers' compensation provisions of Section 3700 of the Lebor Code, I shall fonhwith compty with �hese provision,�. � J _ N'ARNINti;�FAILURE-TO SECIIPE WOFKEiSS' COMPENSATIOf75�1[F:fAGE IS UNL4WFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED TFIOUSAND DOLLARE (S/0D,000), IN ADDITION TO THE COST OF CAMPENSATION, DAM4GE5 AS PRWIDED FOF IN SECTIOtJ 3]O6 OF THE L4BOR CADE. IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm that I am licensetl under provisions of pter 9(commencing with Section 7000) of Divislon 3 of ihe Business entl Professions Code, and my license is in tull forceantleNect,Lirc.N�1 'i0�7`%7 �Classa� i��.'�� _____. CONSTRUCTION LENDING AGENCV: ❑ I hereby attirm ihat ihere is a construction lending egency for t�e pedortnance ot the work tor which this permit Is issuetl. (Sec. 3097, Civil Code). Lenders Name: Lenders Atltlress: Signature: Daie: OWNER-BUILDER DEClARA710NS: I hereby aHirtn that under penalry of perjury ihat I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a permil to consimct, alter, improve, demolish, or repair eny structure, prior to its issuance, also requires the applicaN for such permit to fita a signed statement Ihet he or she is licensed pursuent to the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Divlsion 3 of �he Business antl Professions Code) or that he or she is exempt t�erefrom antl the hasis for the allegetl e:emption. Any violation of Sectlon 7031.5 by eny applicant for a pertnit subjecis the applicant lo a civil penalry ol not more than five huntlred tlollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO TME WORK, antl the structure is not interitled or oHered for sale (Sec. 70M14, Business end Professions Code: The Contractors License Lew does not apply to an owner of propeny who builds or improves thereon, antl who does such work himsell or herself or through his or her own employaes, provided that such improvements are not intended or ottered for sele. If, however, ihe building or improvement is soltl within one year of completion, the owner-builder will have the 6urden of proving that he or she did no� 6uiltl w improve for puryose oi saleJ. ❑ I, as owner of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CON7RACTORS to constmct the prolect (Sec. 7044, Business end Professions Code: The contractors License Lew does not apply to an owner of property who builtls or improves ihereon, antl who coNrects br such pmject with a coniractor(s) license pursuant to the Contrectors License Laws.). ❑ I am exempt untler sec. Business and Professions Cotle for this reason: Signaturo: Data: Owner ID venfied by driver's license. ❑ Ves ❑ No Dnver's License No. Ezpires: Venfication of Ownership by (�ype of documem, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hareby certity that no eacavation tive (5) or more feat in depih into which a person is reQuired to tlescen0, will be matle in connectlon wlth work authodzed by ihis permi6 end Ihat no builtling swcture, scaflolding, falsework, or tlemolition or tlismamling ihereol, will be more ihan thirty-six (36) leet high. (Chap. 32, Grp 2, An 2, Sec. 341, T�le B, California Adminisira�ive Cotle). ❑ As owner-builder, I will not emDloy anyone to do work which woultl require a permit from the Division of Indusirial Sefety, as noted above, unless such person has a permit to do such work from the division. Siqnature: Date: Division of Industrial Salaty Permit Number: CERTIFICATE OF COMPLIANCE AND AUT}iORVATON OF EN7RY: I certify under penalry of perjury that I have read this application and state ihat the information qiven is correct. I agree to comply with all state lews antl ciry ordinances relating to building conswction, entl authorize representatives of the City of Costa Mesa to enter upon the ebove-descri6ed property for inspection purposes. I egree not to occupy or allow occupancy ol any building authonzetl by this permit until final inspection. COOE �, INSPECTIONTYPE p9j� IMIilALS 7616 Fixod System Final Fire Prevention 7266 Pool Spa Final 200 201 202 203 �Final Re-Roof Final BIwk/Retaining wall Final Factory Fire Place Final Sign 204 Final Demolition 24d6<6 Date ^ 1 '�s� '7)��, U :� {l (Date _ CODE� INSPECTIONTYPE �Q�F INTITIRL 206 Final Mechanical � � 208 Final Plumbing 210 Final ElecMcal 212 Final Fire Prevention 220 Final Planning Approval 222 Finai 5i�e 250 Final Building/Occupancy OWNER m� AS ATER SvSTEM LOT : MISCELLnNE0U5 ROUGN HEATING AN� �IR CONDITIONING TEMPORARV $ERVICE OR POLE UN�ERGROUNO [J POWER [] ROUGH WIRING iRENCMES � FORMS I STEEL REINF. EM BOHD BEapn ( I STEEL SHEaTHING FRAME ANO FLaSXING L>THING —� IN j � OU' PL/STER BROWN'COAi NEnTiNG.VENT.,FE�RIG.i PLUMBING, FIN4L 4N� GAS ELECTRIC, FIN�L BUILOING. FIN4L DATE g, BUILDING PERMIT N0. SUBCONTRACTOR F � k1 6. G � � S F G W F Q C :� Q 7 } ..1 C � 4 0 � a z W 2 3 � �=�c�95 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BQX 1201 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING�17 `.? e.��//�T—A `�' ADDRE55 OI/�JV /\. �� OWNER /T• �' � ' MAIL ��' GOf]RESS CITV L�Q��,�/�f //I CONSTRUCTION �� BRANCH ADDRESS �� TEL. �� ADDRESS � CONTRACTOR �� liDDRESS �� TEL. CITV —� NO. `� STATE CITY LIC. NO. •—� LIC. NO. SIZE NO.OF BLDGS. / OF LOT NOW ON LOT USEOF I)��. T�.._.�C� EXISfING BLOG. �C �� Separare permits are required (or electric, plumbing and heating work. USE OF UlLOING />ND WORK TO BE PERF�Oq MED 7fF'of 6'S<�'�x/6' S'[cotiP 8.6a.� {�t +��N/G� o.✓J'au77Y p.C.o�.E��LiN� n l ./nM.r.Md/ _PTE�B7. FEA�� WT%� FX+�%C I hareby ecknowledge thet I heva reatl Mis aOPliceNon and state ihat tha above infOrmation is correct and aB�ee to comply with oll laws regutating builtling construciion, entl I shall not employ any permn in violOtion of the workman's compansallon lews of the State of Califolnie. I hereby certify thet I em prop¢�ly lic¢nsad as a contreciar untler t�e State of CalifoYnie Businass antl Profeulons Code, Div(sion 3, Chaptar 9, antl that such Iicanses ere in tull forca antl effect, or I am exempt from tMa provlslons ot the Stace of California Business antl Professions Coda, Division 3, Chapter 9. Slpneture of , � Permittee Authorizatl Age �5�.;; �i��i�: �o��.�. .i� 154� E/�.1/7� 5oE'.C1�T!: i Fa;: r. �<r. �� I A APPLICATION FOR STRUCTURACPERMIT R BUILDING ADDRESS 3 � � TRACT �7 / Z LOT /L/W DATE NE NO.OF USE OF NE PLANS Z BUILDING VARDSAPPROVED VARDS MAIN BUILDING ACCESSC DISTANCE BET. I BET. MAIN MAIN BLDGS. ACCEffi. 81 VAR.� DATE TME AMOUNT SHOWN UN�ER VALUATION IS FOR 7HE PUflPC6E OF ESTABLISHING A PERMIT FEE ONLV: VALUATION PERMIT FEE § I O!% PLAN CHECK $ , $ �/ DO TAX $ ��Q TOTALPAID E �� 5� n m i m m N ] m � a n m m f U Lot 59 Tr 3722 �,��$� COSTA MESA BUILDI�G-SAFETY DEPARTMENT P. O. 60X 917 COBTA MEBA. CqLIFORN7A Fo� Applleanf fo FiII In Complefely TYPE OR PRINT � BUILDING COSTA MESA. CALIFORNIA � MAIL SIZE �+ OF LOT 6.)XI U6E OF EX16fING B G SHTB/�LK LINH /AOM TEL. NO. TEL. NO. OF BLDOB. O SO � ftEAR YARD ZS � 7�6'� IRIGHT 7�6��' tIPTION OF WORK - - eui�o�Nc No oF SIZE �. 1�%S ROOMS E1 STOF EXTERIOR WA�$'tllCCO ROOF Rock COVERING COVERING U88 OP BUILO�NG AND WORK TO +B�E PERFORMED P F "PCl and Attached Garage FEE R�CEI�ED �,. -��.4� FINANCE DEPT. APf�I,CA�T40�EQR IUt�R�11T BUI6DING For Office Use Only 0.ECEIPt NO. d (1{gpMlnM er COSTA MESA. CALIFORNIA FIRE ZONE APPROVEO ZONING ZONE I NO. OF I LIBE OP NEW R �l PUN9 2 Bt11LDING ' L80AL OHBCRiPTION T61}'. � T�'$C A. P. NO. 110ri2 YARD6 � EVES APPROVED ALLOWED ICBNTHR LINC BTJ _ APPROVEo U F iseueo att l0-l0-60 I HEHBBY ACKNOWLlOGB TXAT I HAVE pSAD TH18 APPLAGTION }„g AMOUM BHOWN UNDER VALUATION IB FOR TNH AN� 6TAT8 TH�T TH8 ABOVE IB COPRECT ANo AGftE6 TO COM- PYRP086 OF ESTABLI9HING A PERNIT FEE ONLY. PLY WITX A4 CITY OIiDINANCCB AND HTATE LAWB RE6UtATINO BUILotNa CONBTR aH, .. VALUATI�N /� SIGNANRE OF y�+CLTCy� PERMIT FEE $ ��/� PERMITTE %/ � �tQ� / / 6c�/l �f N S / % � PLAN CHECK $ !I � o AUTHORIZED AGENT !: /� o TOTAL FEE T 4