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Home My WebLink About1113 DANA DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.oBeRLDING PERN�i�T rF-V IVE, COSTA MESA, CA 92626 JIL 11 Job Address: 1113 DANADR 11E��® ��V Status: ISSUED Suite: Applied: 07/10/2006 Vicinity: KITCHEN AREA [ Issued: 07/13/2006 Primary Occ: R3 Type of Construction: V-NPER Parcel Number: 41207422 Zoning: EXPIRES Applicant: ROA, MICHAEL Permit: $125.25 Address: 6681 MELBOURNE DR SMIP Com: $0.00 Other: $0.00 Phone: 714-903-2035 ISSUED BY: i1'J HUNTINGTON BEACH, CA Zip: 92647 Owner: NAFF, ANTHONY P Address 1113 DANA DR " Phone: -- COSTA MESA, CA Zip: 92626-1609 Contractor: Address: I Q - Phone: Zip: License: - Arch : Eng: F W ENGINEERING Address: Address: 68 BLUECOAT Phone: Phone: 714-832-0250 IRVINE, CA Zip: License: _ 92620 License: 2025 SCOPE OF PERMIT ADD 13SF TO SFD. WORK TO INCLUDE AN EXTENSION TO THE (E) KITCHEN. WORK IS A REVISION TO WORK PERMITTED UNDER B05-02423. PLANNING LOT SIZE = 7,300 SQ. FT. RESIDENCE+GARAGE = 2,184 SQ. FT. - - (E) DRIVEWAY = 136 SQ. FE ' LOT COVERAGE = 2,320 SQ. FT. - - - - - - - (E) REAR YARD COVERAGE = 19% (225 SQ. FT./1,180 SQ. FT) Plan Check: $81.41 Permit: $125.25 SMIP Res: $0.52 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 FEE SUMMARY; Calc Valuation: -$5,201.20 Claim Valuation: $5,000.00 Total: $207.18 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 8-6 Rear 10-0 Left 10-0 Right , 0-0 ACCESSORY Front 0-0 -Rear 0-0 - Lek 0-0 - Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 , NOTICE: The work authorized 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 inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2"646 (6=) r_1 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carder and policy number are: Carder: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify -that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compansatidn laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with these Provisi s -7 Applireant.Signeture'lrttar Dat/ =7 / �3/6% '=,F:AICURE TO SECURE WORKERS' PENSATI ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI SE �D CML RNES UP TO ONE HUNDRED DOIJ.ARE ($100,000), IN ADD TO THE COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31Ue OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lia k Class x Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation o1 Section 7031.5 by any applicant for a permit _subje the applicant to a civil penalty of not more than five hundred dollars ($500).): I,.aA owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ I em axe u der sec. Business and Professions Code for this reason: Signature:'-"' • Dated Owner IDVo fled by driver license. Yes ❑ No Driv?sem n i ? Explre`s: '///09 Verification of Ownership by (type of 0 ent, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California 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 during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................................................................................. -.............................................. ._.......................... ................. __......................... _.... .—.............................................................. _..-........... -_................ _........... _............... _........... _ 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of 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 of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire ...4..........I.f...a...n....Department. ................................................................................................................................................................................................................................................. .......................................................................................... R.MPPis presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .................................................................................. ............................................................................................................................................................................. .... ........ ....................................................................................... ...".............. ....... 5 Does or will the applicant or present or future building Occupant require for the work which is the subject of this ,application yPrrmlt for Such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ......................................................................................................................................................................................................................................................................................... .......................................................................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................................................................................................................................................................................................................................................................................................................................................ 7 II a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 8 (If 'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for in;p tion pu ses. I agree of to Occupy or allow occupancy of any building authorized by this permit until final inspection. l/l �L/Y/ 7//3/n6 Ignature 21 Legaf O_w/r! � /D 1 AndlOr Authorized Applicant Date CODE P. INSPECTION TYPE Qd1E INITIAL S CODE r INSPECTION TYPE PSIS INTRIA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final BIOcWRetaining 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 Applicant: NAFF, ANTHONY Address: 1113 DANA OR ,�.J COSTA MESA, CA Ph Zip: L; 66 ��r��ISSUED �� \ 2626 Owner: NAFF, ANTHONY P �f A lgt Address 1113 DANA DR III one 1'SJLJL0 ED r, COSTA MESA, CA "`&42626-1609 PER Contractor: OWNER -BUILDER Address: EXPIRES _ L---- Phone: Zip: License: 000000 Arch : Eng: FRANK WU Address: Address: 68 BLUECOAT Zip: Phone: Phone: License: SCOPE OF PERMIT ADD 54SF AT THE BACK, REMODEL KITCHEN, REMODEL BATHROOM IN 2ND FLOOR. Plan Check: $664.14 Permit: $1,021.75 SMIP Res: $10.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,696.39 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY PARKING Front 0-0 Existing: 0 Rear 0-0 Rear 0-0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0-0 Left 0-0 Proposed: 0 IRVINE, CA 92620 License: C2025 Calc Valuation: $105,000.00 Claim Valuation: $105,000.00 Right 0-0 Right 0-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and 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 aba 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; required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of FOR INSPECTIONS CALL: (714) 754.5626 244&68(&00) all C DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby aNlnn untler penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 / ✓I ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the penonnance of the work for which this peril is issued. My workers' compensation Insurance Carrier and policy number are: Carrier: r Policy Number: (This section need not be completed if the peril is valued at one hundred dollars ($100) or less.) I.certI that in the performance of the work for which this peril is issued. I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree that if I should b come subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these prov' i s. =pplicanbSignature:� � �Dete:•— WARNING:. FAILURE T URE WORKERS- COME NSATION C V G IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED ,THOUSAND DOLLARE (S100,000), IN ADDITION T E COST OF P ATION, DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE, INTEREST, AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. a Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Lew (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is Gold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions ode: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt _ undo, Business and Professions Cade for this reason: -Signature: i 3r O� Verification of Ownership by (type of document, i.e. - property tax bill or deed): _ DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Adminisbative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous me dal? ❑ Yes ❑ No (Section 25505 of the California 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 during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ......a....Ir..... resent_. r future building Occupant need to file a registration for for �� acutely materials?..... ��Yes �� No ......................................... ....... ..... .. 2 Does arm will the pp cant or p o utu 9 P 9 o ac y ❑ ❑ (Section 25533 of 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 of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................. _................... _....................... ......... _........ ............ _................................................................... ......................................... ................................................................................................... ....................................................... ................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Masa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .........._................_......................_............................._..........................................................................................._.................................___.............................w,ii........_..... ......................_........... _............ _......... ...._......._� 4 If an RMP. is presently requiretl, has Section 25534 of the Califomia Health antl SafetyCode been fully Complietl with? ❑Ves ❑.No 5 Does or will the applicant or present or building occupant require for the work which is she subject of this a plication app.Brit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? jJ Yes jJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residentla) building perils). ....................................................................................................................._.......................................................................___._.......................................__.._..._...................................._......_............_................................._...................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................. .......... ........................................... ....................................................................................................................................................................................... .............. ..........................................._................................................ 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ...................................................................... .................. ......................................................................................................................................................................................................................... _............................................ _................... _...... g (If "yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is 7ngAnd/Cr ll stateNorized ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the ction seree not to occupy or allow occupancy of any building authorized by this/permit un I final inspection. ature r(s) ' \_Date____ __ d/Or Auant Date LORI t INSPECTION TYPE PAIS INTMALS CODE INSPECTION TYPE RATE RSL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 .lob Address: 1113 DANA DR Suite No Vicinity: Parcel Number: 41207422 Applicant: NAFF,ANTHONY P Address: 1113 DANA DR MECHANICAL PERMIT Status: ISSUED ��y r 1iYJ `d 10/27/2006 Issued: 10/27/2006 EXTENS.- a a©� Phone: 714-241-9586 COSTA MESA, CA Zip: 92626-1609 Owner: NAFF,ANTHONY P & CHERYL J Address: 1113 DANA DR EX Phone: 714-241-9586 COSTA MESA, CA Zip: 92626-1609 Contractor: OWNER -BUILDER Address: Phone:' Zip: License: 000000 MIKE, 9 9 _ SCOPE OF PERMIT INSTALL FACTORY FIREPLACE, ANSI Z 21.88-2005/CSA 2.33-2005. REF.: M05-00795 MECHANICAL TO INCLUDE: 1 FACTORY FIREPLACE. FEE SUMMARY COMMENTS/ SPECIAL CONDITIONS NOTICE: The work authorized 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 Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7845626 e«wo {awr Quantity Quantity ISSUE FEE $23.50 Repair / Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $0.00 0 Repair/ Alt Refrigeration Unit $0.00 0 Inst FAU > 100 k BTU $0.00 0 Ventilation System $0.00 0 Repair/ Alt Cooling/Heat $0.00 0 Evaporative Cooler 50.00 0 Inst /Rep. Recess Wall Hlr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys <100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys >100 k BTU $0.00 0 Compressors / Absorption Systems Gas Piping $0.00 0 Up to 3 hp / 100 k BTU $0.00 0 Factory Fireplace $10.65 1 3 To 15 hp 1500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp 11,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp 11,750 k BTU $0.00 0 Vent Fan / Single Duct $0.00 0 Over 50 hp / Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to.3 hp $0.00 0 Smoke Dampers S0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers < 10000cfm $0.00 - 0 30 to 50 hp $0.00 0 Air Handlers > 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace 50.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee - $0.00 TOTAL CALCULATED FEES $34.15 COMMENTS/ SPECIAL CONDITIONS NOTICE: The work authorized 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 Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7845626 e«wo {awr DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued. 1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO TME COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license is in full force and effect. Lic. a Class u Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (Commencing with Section 7000) 01 Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Cade: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). c I es owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions r -Cotler The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt and 1 usiness and Professions Code for this reason: 7Signatum Dater O .� ;Owner 10 venfietl by driver's license. yes o (Drivers License No. Expires:. -�7 3/ OK Verification of Ownership by (type of d menu, i.e. - tax bill or deed) DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Data: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California 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 during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................. ... ........................................................................................ ... .............................................................. ............................................ ..................................... .................................................. -.............................. 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptlons, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..........................................................................................................................................................................._._....................................................................._..._.........._................................................................................................................. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ......................................................................................................................................................................................................................................................................................................................-.................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Ves ❑ No .................._..................................................................................tui(......... ildi.............cu_.................................................................................................oti-........................................................._................................................................fon.... 5 Does Or will the oast Air or present or future bulltling occupant require for the work which is the subject c this 2--p plication eLertnit for such oonsWction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .. . .......................................................................................................................__...._....................................._..._.................._.__.................._—.._......__....._........................................................................_..............._.................._ 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). .............................................. ...................... ... ................................................................ ........ ............................. _... _..................................... ................................................................................................... .............................................................. - 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................... ................ _.......................... _.._....................................................... _........................... __................................. __................. _..._........_.._........................................... _._.......................................................... _............... e (If "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is Correct. I agree to comply,with all state laws and city ordina ces relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above -de sarib d propert aF+ spectio poses. I a re n to occupy or allow occupancy of any building authodzed by this permit Uf til final inspection. - - tJ7 /15 Signature f LeO ta wne _ _ _ — 1 Dae 8 And/Or Authorized App Date CODE t. INSPECTION TYPE IiiTITIALS CODE( INSPECTIONTYPE DATE 1 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical 201 Final Block/Retaining Well 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 1113 DANA DRT sION Status: ISSUED Suite No EXTE1'� 1.� Applied: 12/29/2005 �L®� Issued: 12/29/2005 Vicinity: Parcel Number: 41207422 PER ISSUED BY: Applicant: NAFF, ANTHONY P EXPIRES Address: 1113 DANA DR Phone: 714-241-9586 COSTA MESA, CA Zip: 92626-1609 Owner: NAFF, ANTHONY P 4q Address: 1113 DANA DR Phone: COSTA MESA, CA Zip: 09 Contractor: OWNER -BUILDER Address: t one: License: 000000 "WSCOPE OF PERMIT ADD 54SF AT THE BACK, REMODE 'KITCHEN, REMODEL BATHROOM IN 2ND FLOOR. REF.: B05.02423 MECHANICAL TO INCLUDE: 1 REPAIRIALT COOLING/HEAT, 1 HOOD W/MECH EXHAUST, AND 1 VENT FAN. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair /Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $0.00 0 Repair /Alt Refrigeration Unit $0.00 0 Inst FAU >100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys <100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys >100 k BTU $0.00 0 Compressors / Absorption Systems Gas Piping $0.00 0 Up to 3 hp / 100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp 1500 k BTU $0.00 0 Hood w/Mech Exhaust $10.65 1 15 To 30 hp / 1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp / 1,750 k BTU $0.00 0 Vent Fan / Single Duct $7.25 1 Over 50 hp / Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers < 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers > 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $55.10 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized 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 inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. f FOR INSPECTIONS CALL: (714) 754-5628 :v 2""6 (6/00) DECLARATIONS Ah WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and policy number are: Carrier: Policy Number: (Thio section need not be completed if tha permit is valued of one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should bac me subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provision Applicant Signature: Date: 2/Z S /Z-0O� WARNING: FAILURE TO SECURE WORKERS' ODMPENSAjI iN COV S UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE T OF C TION, DAMAGES AS PROVIDED FOR IN SECTION 3 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: t hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 01 the Business and Professions Code, and my license Is in lull force and effect. Lic. 4 Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code), Lendefs Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he of she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). .�' I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of properly who builds or improves thereon, and who contracts lot such project with a conlISCIDt(s) license pursuant to the Contractors License Laws.). ❑ I am exempt and c. Business and Professions Code for this reason: Signature: Date: �2 ZOo Owner ID van by tlrver's Iicen . Ye No Drivers License No. � Expires: /� j[ coa- Verification of Ownership by (type of docu en e. No tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous materiel? ❑ Yes ❑ No (Section 25505 of the California 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 during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ......_........._._ .. ........................ _.......................................................................................... ....................... .....__...............................____.............................................. _.... _................... ......_......................__............._............___... 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of 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 of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...................................................................................._......................................................................................................................................................_........................._........................................._...._................................................................ 3 D �eor will the[] h❑e applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ......................................................................ui'r'..................................2.5-...................................................................................................................'1'y'......................................... ........................ ..o-.............................................................. 4 If en RMPP is presently required, has Section 25534 of the California Health antl Safety Cotle been fully complied with? ❑Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agencc y? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ........................................................................................................................................................................................................................................................................................ ........................ 6 Will any part of the facility to be constructed under this permit be within 1000 feat from the outer boundaries of a school? ❑Yes ❑ No (if 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .......................................................................................................................................................................................................................................................................................................................................................................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ................................... ............................................_..._............................-...........................................................__........ ............................ ............................................................ _.................. ..._................................... _........... 8 (It -yes-. attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cartity that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Data: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with 11 slate laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above"descdbetl petty; i ectio rpop, 11 not to occupy or allow occupancy of any building authorized by this permit until In inspection. /?�Zri/ZOO Signa re Of Legw era) Date And/Or Authorized Applicant Date CODE .• INSPECTION TYPE 2&U INTMALS CODE I INSPECTION TYPE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 6 T 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining 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 Buildmg/Occupancy IkA COSTA MESA, CA Zip: 92626-1609 Owner: NAFF, ANTHONY P Address 1113 DANA OR Phone: COSTA MESA, CA Zip: 92626-1609 Contractor: OWNER -BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT ADD 54SF AT THE BACK, REMODEL KITCHEN, REMODEL BATHROOM IN 2ND FLOOR. REF.: B05-02423 PLUMBING TO INCLUDE: 1 BATHTUB, 1 DISHWASHER, 1 FLOOR DRAIN, 1 ROOF DRAIN, 1 GAS (1-4 OUTLETS), 1 LAUNDRY TUBIWASHER, 1 LANDSCAPE IRRIGATION, 1 SHOWER, 1 KITCHEN SINK, 1 WASH BASIN AND 1 WATER CLOSET. COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized 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 abando ed 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�cpde�nd all required Inspectlone and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of flus permit. FOR INSPECTIONS CALL: (714) 754-5626 2aa646 (6roo) FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub /Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $14.80 1 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 1 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $9.80 1 Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $9.80 1 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $9.80 1 Drain, Roof $9.80 1 Shower $9.80 1 Water Heater / vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (1-4 outlets) $6.15 1 Sink, kitchen $9.80 1 Wafer Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $132.65 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized 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 abando ed 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�cpde�nd all required Inspectlone and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of flus permit. FOR INSPECTIONS CALL: (714) 754-5626 2aa646 (6roo) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby atlirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and policy number are: - Carder: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is is ued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo i , g that if should becom u ct to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pdwisiS. Applicant Signature: Date: 7/ `-�I?mo WARNING: FAILURE TO SECUR RKERS' COMPENSATI()1 COVERA UN AWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOUARE (5100,000), IN ADDITION TO THE COST OF COMPE I , DAMAGES AS PROVIDED FOR IN SECTION W06 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. a Class p Contractor's Signature: Data: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby allinn that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with Wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Cade: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her awn employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License laws.). ❑ 1 am exam p of s C. Business and Professions Code for this reason: Signature 1, 20O Owner ID verified by drivers li rise. s ❑ No Drivers License No. �� Expires: Verification of Ownership by (type of docu kt property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feel in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title S. California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Data: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building Occupant need to file and cenity, a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California 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 during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .......r...... _ ..r future buil..l^...occu ani n etl to file *are acut...j...ha,zardous.*......rials?............y..s ....... .......No_............................ .... ......... 2 Does or will the applicant o present orf d g p e g s at o form o e y ha ate ❑ 0 ❑ (Section 25533 of the California Health and Safety Cade, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 2DO cubic feet of compressed gas at standard temperature and pressure). .......................................................................................................................................................................................................................................................................................................................................................................................... 3 Does ❑ Yes or will th❑ap e plicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? (Section 25534 of the California Health and Safety Coda provides that the Costa Mesa Fire Department may require the preparation, codification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................................................................................................................................................................................................................................................................................................................................................................................... q If an RM PP is presently required, has Section 25534 of the California Health and Safety Cade been fully complied with? ❑ Yes ❑ No ........................................................................................................................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication opermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? L. Vas U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ._........ ...... _................ _........................................................ _......................................................................... _................................................... __._.__................................... ............__........._............... ._....................................._.... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ NO (If yes-, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ...................................._............................................................................................................................................................_..................................................................................:................................_............. the 1 f this 7 If a permit from the South Coast Air Ouality Management Distract or other eir pollution control district or agency is required for the work which is a subjec o is application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? . [:1 No..........................._.._............................_..........._._.............. ............ _.... 8 (11 yes', attach certificate of compliance from the appropriate air pollution Control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZAT10N OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct, I agree to complllth- 11 state laws and city ordinance relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described pr b ion pu o arty for ins a In N cupy or allow occupancy of any building authorized by This permit until fi el insp 77— Signature Of eg I Owner Date And/Or Authorized Applicant Date INSPECTION TYPE PAU Built 5 CODE T INSPECTIONTYPE BATF, IIWITTALS"" 1616 FixedSystem Final Fire Prevention 206 Final Mechanical Pool 1266 Pool Spe Final 208 Final Plumbing (�+ 200 Final Re -Roof 210 Final Electrical 201 Final Black/Retaining 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 Southvv A Inspection and Tc ing, Inc. 441 Commercial Way, La Habra, CA 90631 (562) 941-2990 • (714) 526-8441 • Fax (562) 946-0026 REGISTERED INSPECTORS'S DAILY REPORT SWIT Job No. Da e ❑ Reinforced Concrete ❑ Structural Steel Assembly -,p Quali y Control N ❑ Post Tensioned Concrete ❑ Fire Proofing �d� er ❑ Reinforced Masonry ❑ Asphaltss P rfl OF)�, 1 � Q) City OS�� LLJJ ' V `r \ Ari [f t Permit No. Issued By Type of Structure �-`' 1". RZ � G hor .J Architect /V\ s A< Material Description (type. grade. source) i , �O �!`I \/' `` /� 1 Engineer FQ��` N ! \v w v\ Contractor ( \ (�-� L ��LLL Inspector(s) Name �A (`i l ) I M l �I- Subcontractor TESTS PERFORMED TYPE OF SAMPLE SLUMP QUANTITY IN SET ADDITIONAL REMARKS ON SAMPLES INSPECTION SUMMARY — LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC. INCLUDES INFORMATION ABOUT -AMOUNTS OF MATERIAL PLACED OR WORK PERFORMED, NUMBER, TYPE & IDENT. NO'S OF TEST SAMPLES TAKEN: STRUCT. CONNECTIONS (WELD MADE H.T. BOLTS TORQUED) CHECKED, ETC. MM E M E "T c) 17 4 (Z-F—fJR �1--"O)(x o k onioC,s Ac t M 1; Kn N* DE PT VA P 1_ lk (A A N 'S CERTIFICATION OF COMPLIAN - I HEAEB,,CERfIFY THAT I HAVE OBSERVED TO THEEBEST OFM NOWLEDGE ALL OFTHE ABOVE REPORTED WORK;L1 IFSS OTHERWISE NOTED. I HAVE FOUND THIS lPRK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS, AND.APPLIPABLE SECTIONSOF THE GOVERNING BUILDING LAWS. rJ SIGNATURE OF REGI RED INSPECTOR \/ SPECIALTY NO. XAGENCY.� CONTINUED ON NEXT PAGE LJ PAGE OF TIME IN I TIME OUT I REG. HOURS I O.T. HOURS I CYLINDERS All inspections based on a minimum of 4 hours and over 4 hours - 8 hour minimum. In addition, any inspection extending past noon hour will be an 8 hour minimum. Approved by Project Superintendent WHITE - OFFICE COPY, CANARY - ACCOUNTING COPY, PINK - INSPECTOR'S COPY, GOLDENROD - JOB SITE COPY Southy ,t Inspection and R Ang, Inc. 441 Commercial Way, La Habra, CA 90631 (562) 941-2990 9 (714) 526-8441 • Fax (562) 946-0026 REGISTERED INSPECTORS'S DAILY REPORT SWIT Job No. Date TYPE OF ❑ Reinforced Concrete ❑ Structural Steel Assembly El Quality Control INSPECTION Post Tensioned Concrete ❑ Fire Proofing Other REQUIRED ❑ as ❑ Asphalt Job Addr ss 1113 (�)ANR City ��Tti MESA Job Name (y ' p \ ' Paic• ' C) rz-4 (-� I ed By Type of Structure n �r D l Arc i eV� Material Description (type. gra`d`e, source) Engineer -VWN \A -1 \hJ Contractor / ' ` 1.- Inspectors) Name (�Z fG') ` t, { ,^ w 1 ` 1 S N "'` v`l,` Iv` 1' Subcontractor TESTS PERFORMED TYPE OF SAMPLE SLUMP QUANTITY IN 4T ADDITIONAL REMARKS ON SAMPLES INSPECTION SUMMARY — LOCATIONS OF WORK INSPECTED, TEST SA PLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS; -ETC. INCLUDES INFORMATION ABOUT- AMOUNTS F MATERIAL PLACED OR WORK PERFORMED, NUMBER, TYPE & IDENT. NO'S OF TEST SAMPLES TAKEN: STRUCT. CONNECTIO S (WELD MADE H.T. BOLTS TORQUED) CHECKED, ETC. LAC,M OF "TNUZ pl RU(JS Wi-tN LPDX` FOR � A' S AtiO vLV�l, 010 wA,,r- � L CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE OBSERVED TO THE BEST OF WORK UNLESS OTHERWISE NOTED. I HAVE FOUNDT/PIIS V SPECIFIGAJ16NS, AND APPLICABLE SECTION$ OF THS G01 ALL OF THE ABOVE REPORTED WITHJT E APPROVED PLANS, SPECIALTY NO. /k AGENCY CONTINUED ON NEXT PAGE LJ PAGE OF TIME IN I TIME OUT I REG. HOURS I O.T. HOURS I CYLINDERS All inspections based on a minimum of 4 hours and over 4 hours - 8 hour minimum. In addition, any inspection extending past noon hour will be 0 8 hour minimum. Approved by Project Superintendent WHITE - OFFICE COPY, CANARY - ACCOUNTING COPY, PINK - INSPECTOR'S COPY, GOLDENROD - JOB SITE COPY AD-RISSOFAU11JI) : 1113 DANA DR UNIT: ONNEWHAIEIFIOION":DINH, ANH TUYET FLOOD: X L38 AODeM' 111 3 DANA DR COSTA MESA,CA 92626 ADPL. Mil ADMEM ARcxREc7 oa ENrntEEnn: DUC PHAM uG NO.: 0 wiLoam'sADDBEss:11770 E WARNER AV UNIT 228 F.V. CA 92708 CON11wTars"AME: CONTRACTOR'S MAJUND ADDRESS: UC. NO.: UNIT: LICENSED COMRACTORS DECLARATION: 1 hereby apnm undw pares, d ped.ry that I am hoe.sed undw prunsicm. of Chapter e (mmmamirq with Section 700(1) of Division 3 of IM Bustness ant Prdeasnn Dove, and my license is in lull brce test a"ect. crrY LIC. NO.: LIC. cuss: LID. NO, EXP: Date: C«wadon OWNER BUILDER DECLARATION: I hereby a. under penally of perjury that I we exempt ham the C«nmdm License law in, Ne folbw+q reason (Socio^ 7031.5 Business and Rmfeemom Code: Any sty or o mm y w ns,fir s a street to aonetruq, sitar, inprove. ewndeh, or repair arc/ svumra. prior to its issuance. ado n s,.irea IM applicant for ach owed to fib a aimed statement Nm M or eM b lioanse t pureua^t to the pr. of the Camnenw. U.. Lew LChopl« a (mmmendnp with Section 7000) of Division 3 of the Business ant Protm eiona Coda) or that he or ant is exempt th seh«n ant the basis f« Ne aAeped exam (ion. Arty violation d Section 7031.5 by wy aogiranl 1« a permit subjects the epgiumt to a civil pareHy of not moa Ihan five hundred dollen Lf5001).'� ❑ I. w owner of the popetty or W employees with wage as their Bole compensation, will do the work, and the wtuaure i ^d inle^dad ordlwMhasale(Sectio^7004.Busine PMsssions Cade: TMConnectorl seLewdoesnotappytowownedproperty wM While or improves thereon, ant who does such work himseH or Mnelf or Iho h his or her own employes e, woMid that such improrements we not intended or dlared for sal. H, however, IM W ibirq or improvement is add within ore year a oompbtkn, IM owrer4wilctw Will have IM When of snm, he « ant did ^ol WiM ne improve los the W,oss of sabl. I. as owshw of the papery. sen ezdusivay.1radnq wdh Dcanad conuan«a to oval the project (Sedion 7040. Bwnass seat Pmfessixw Cada: TM Co,tnet n liceme Law dose not apply to an owner of property who WHds or imgwee thereon sed whe oowacd for such prgeds w11h a mrmmor(e) framene punuem to the Cmlredars Lienee Law). ❑ 1 we ssw pl wdw Section: B. 8 P.C., b Ne reason: Data: 1 do Mnby Hy Nm em aware d uMenwnd the rewdremwna d Celiomb HaMh end Salary Cade Sections 25505, ?5533, sed 25530, ant Nw «any Mure WiKati Deepens will /wit red (deb ore) need to campN with veld oma mdse end the re0uiremants lar e perms IoroonslNdion w modifiutionhom IM Ai -D ieTiryl.�whegemeM Diddd. Rmidenlia oondnwtion eppicetiomere aumgirom Nese wovieions. Date: Appfi nt: WORKER'S COMPENSATION DECLARATION: 1 hereby asses order para ty d pwpey one of the loWnrm,, declerefwd: ❑ I have end wit marten a eenRwte d aonaent to ealinmua br waken'rongenmion, mprovided I« by Swebn 3700 d the labor epee. f« IM Dedpmsece d dha sew 1« wfitlh Dss pamhH a iaued. ❑ I have and w mantas it isara'asi. My ion uwnerhca, as reRuned nc owns 3700 d the Leber Code. io UW I>adarnhwae d IM work t« whish Ne permit b ushwd. MY workers' mmenaation'vmRamO carrier and oaEq number we: Cerner: Policy Number: (me aealan nednol be oomplwed r re mar is f« one Aundied dollen 141001 or h ss.1 ❑ I awfN that in Na ped«mwae d the woh 1« whish thio owed a ieahed, I shall cot wnpioy wry gxem in wY manrer e as to bec«re subpd to the woNwe' oomoweelion laws of CaM«nba we agree that H I should become aubjea W the workero' mmeneaian pmesion of Section 3700 of IM Labor Code. l dell foMwih comply wMh Nose provisions. Date: Appfram: WamlV: Fepuse b sass n workwa'rotnpwuetlon omnwRlM Is unlnWNI, eMalWl suAfsal an esnPfelAw Ip wlminw Panaltlas wet! ,Ml flow rpt to ane Nsl thousand do/4n (S104000A In sAClill as Ina roaf of rompsnweWn clan nal as wesIded Asn In swum 3706 of the Labor Code. /ntwest wel attomys fes. CONSTRUCRON LENDING AGENCY: I hereby entre urdw pemry of perjury that Ihsee is a mnm,osion lending epwo, lar Ne performwwe of IM wok f« wh'vih the perel'a esuad (Sedion 3 . CN. C). LENDER'S NAME: LENDER'S ADDRESS: I oenHy IN, I we owl this apphoshon ant dee that Ne above information is caned, l spree to campy weh all city and ooumy «dinenc�ea wd we lewd nblnp to WWnp cwmluctlon sed henebY e.Norea relxeeenwYve of the any to emw.twn IM shore-memionad property fw iaspedion p.noas3. ANH DINHNw/�h / $grimwedOwred « (5151 01,) WMa-Buibiq A Salary: Green-Fb; Canary-Appkam; Rnk-RaWenua; Goldenrod -Maser CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 086229 PERMIT NO: E 086229 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: ADD JOB DESCRIPTION : 308SF 1ST FLOOR ADDITION SQ FT: CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 / COdMrdMENEdTEsSE�EAP308SF 1ST STORY EAE"GAME ROOM" r*REr-B862E**iE**aE�EiE***sESE*sE+r+eitsrAeAESE**�*�E+E"rsP*x�E Z O N I N G R E Q U I 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 FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REO• PROV: PARCEL: 41207422 ZNE: REF NO: PLANNING N TES> > *iEk***if iE iE*hart*dt*dE irk it iE iE MSEit****MMdEkkiE dE iE iE irk*iE dE lEfEkiP*iE iF*****ihkiPk MiP********M*irk*irk iE iFk iE*kdPit 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 BY DATE: BUILDING APPROVED BY : APPLICATION ISSUED BY: LEGALIZATION:N BLDG PMT PLUMBING PERMIT PLAN ISSUE FEE BUILDING—DIV—> TOTALS ---- > FEE S/ USM M A R Y I' ELECTRIC ,'•MECHANIC FIRE 15 0.0 503 22.0,0 1 DATE: DATE 44�43`� #"E ±k*41fk 1EM STRUCTURAL SEGMENT:N SMIP/RES GRADING SMIP/NON—RES PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE 15.00 22.00 X0`:00 37.00 37.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 37.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 37.00 r K iFdf**K+r*if*�MMiE'sEiiMiriaiE'ir+Eii'*i%+E+r�iPMririErif iE'iE'ifKMii'iE'+r+eiL'*MiE'sEiE SEAS*iE'MMSP ii'iE'+r iE SEiE'*+EMiL'iEMii sr*ilM*iP'>c'iaM I N D I V I D U A L F'E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 3 FIXTURES LIGHTING 1 ST 20 ELE 9 RECEPT/OOTLET 1 -ST 20 ELE 3 RECEPT/SWITCH 1•.ST 20 END .OF FEES EA. 1.00 EA. 1,00 EA, 1.00 3.00 9.00 3.00 12-16-1997/11:03 A_1/t37.0 RCAT§:1:1-ITuilu..': PERiiIT o 086225 CONSTRUCTION AND PLANNING POOL a SPA ItDate APPROVALS Permit # Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement c�lectrica( urgjuit Utility-Undrgrnd. 54. Forms •4. Oectricat4!nduit-Undrgrnd. 55. Electrical Bonding C ^1 T eel Reinforcement 56. Rough Plumbing & Pressure Test ;"6..&ctrical tt*ER Grnd. 57. APPROVAL TO COVER-GUNITE fPootings 1: 58. Electrical Conduit-Undrgrnd. ,-r7R =8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-andrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sew6r Line & House Connection 62. Backwash & Receptor -Final 12. `S�wer Cap v 63. Heater & Vent -Final .113. Roof Drains t_- 64. Plumbing System •Final i4. Rough PlumhRg X 65. Electrical -Final 75. Rough Electrical -Conduit .. _ 66. Solar System -Final t46. Rough Electric Wiring 3(rq g8 67. Fencing & Access Approval -'/ ! X17. Rough Wir qg Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19.tpoup� HeptinS&Ai_tCondition' ng) V t al S•s' a- RJR(id igPTt;2EOUIREMENT r rrrr :.1 ^. ")1 D 0 T, ? >� -J "? APPR37VAf8+ PaTmit # '^ t 20.cnouph Fi�place S �K * 5 •^* . 5' jFactory 21.`6uctiratr LSEtur * �j 70.EUndergrwad 1tydro h •T+R.+ +�#r_ 22.;Duct3%y6ntilatinfJx t CJ O a.^ C? i^x 71. ProdU Tipingr as ( Oil •_ 23. Gas 9pe�f3oug%t & `st t M m t^ '•S 0 I � 72. Undergrpupd Et,}us •..T I b'^' 00 L, S* y: 24Aoof Framing sx n A, M '•�� 73! Undergrnd.StdA TaIOGas ❑Oil _ 25.,RooSheathin rn�; '� v 9 v; H ?: y N* '7 �p +: 74 Overhead Hydrg ;+ r 26.3-Bar'.Cei77ng (5truonural) & GaZoat * 0 :� "_'+* 75; Dry Chemical r;o + ^+M x T •. T Y. "" 27.sFrarita Flas�xc cR, hin +�.K •-IMCJ �` 76. Dry Sta �pl Pe¢. 28. Lathing Qi Siding C,. Gx4 O I I 777 FIXEDSYSTEM_FINAL' Ct 29. Insulatigq c i 7� FIRE PREV. F441- x> t' •F _ 30. Drywall Nailing CJ r. R-+ x _. i tr n-HEALTH'DEP•q. REQUIRfitVhFNT n n- r-• :) 31. Plaster Blowrt_boar' S ; t*'t I r* 79. FINAL r ECTTO 32. �Iectrica&ovyer Meier-�ioal I i fK SM FOOD CERTIFTCgTE IMED+ S _ 33. -Fina Elegy�}triC;r...,~�yy'•y, uX -; _17I " 'J : M - �T .�K •% I" r/•4 tT1n 34. `: in ,Heating Air.. ti0ning ggdi 35. Final Ga's�ipe=Te r4 x 36.±iood•or-canopy rp .c n xr+1 I i^ to -o At 'rtrn t,im 37. PinarFactory FirEal cR,�• x < 38. FinaTblumbin9 u m to I A: - ~ ✓ 39. Water Service -Final r. ` I a: ry f* ' = ` "' -I V1 40. Gas Service -Final 4 41. Solar Domestic -Final, p; Ar I Att rr `!o x %. 42. Backflow Preventer p,��. Pit W i- �0 ;... Backflow Irrigation t A* C N r43. x C o00 n) C * STI .J - 1t4. Landscape lrrlgation„System;)•�� p-; .g1 - x _ 4 .: �_ v <At u u , .: 45. and AnenVationtt ') •• •• * m itis c E'•~ '' 16. Handicap Regiilatiort,'9 p, r47. FINAL STRUCTURE & BUILDING F. 48.INQ} PLANNING�� "r } rj = r N t c49. '6lectiic Release to Edison Y t 'r V �0.6asfteleasetoSouthernCaliforniaGasCo * = ^00 1. CERTIFICATE OF OCCUPANCY - No. Date (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.usICAL PERMIT 77 FAIH UHIVE, U051 ME5A, GA 92525 Job Address: 1113 DANA DR Suite No Vicinity: Parcel Nunmber: 41207422 Applicant: NAFF, ANTHONY P Address: 1113 DANA DR COSTA MESA, CA E1 XTEN io ` Status: IS Applied: 12/29/20005 LpYVD Issued: 12/29/2005 EXP IRESUED BY" :5Ak: Phone: 714-241-9586 Zip 92626-1609 Owner: NAFF, ANTHONY P Address 1113 DANA DR Phone: COSTA MESA, CA I . 92626-1609 Contractor: OWNER -BUILDER 4Q� Address: Phone: Zip: 4qw License: 000000 SCOPE OF PERMIT ADD 54SF AT THE BACK, REMODEL KITCHEN, REMODEL BATHROOM IN 2ND FLOOR. REF.: B05-02423 ELECTRICAL TO INCLUDE: 20 LIGHT FIXTURES, 10 OUTLETS, AND 5 SWITCHES. Quantity ISSUE FEE $23.50 Busway /100 ft Temp service test $0.00 $0.00 0 Res. a/c package $0.00 Transformers up to 1 kva/kw New Res (1-2 units) $0.00 0 New Res (3+units) $0.00 0 Pool / Spa $0.00 0 Lighting Fixts $22.00 20 Recepl Outlets $11.00 10 Switches $5.50 5 Non Res Appl $0.00 0 Res Appl $0.00 0 Service to 200a $0.00 0 Service to 1000a $0.00 0 Service over 1000a $0.00 0 Motors to 1 h $0.00 0 Motors to 10hp $0.00 0 Motors to 50hp $0.00 0 Motors to 1 00h $0.00 0 Motors over 100hp $0.00 0 Communication drops $0.00 0 Sub panel to 200a $0.00 0 Pole Light Pkg $0.00 0 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 Intermed Pole $0.00 0 FEE SUMMARY Quantity Temp Dist System / Lighting $0.00 0 Busway /100 ft $0.00 0 Standing Section $0.00 0 Misc Electrical Equipment $0.00 0 Transformers up to 1 kva/kw $0.00 0 ................up to 10 kva/kw $0.00 0 .................up to 50 kva/kw $0.00 0 .................up to 100 kva/kw $0.00 0 ..................over 100 kva/kw $0.00 0 Low Voltage Equipment $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Misc. Conduit $0.00 0 Misc. Conductor $0.00 0 Circus ( gen or ride) $0.00 0 Circus (mech ride or lights) $0.00 0 Christmas Tree Stand $0.00 0 Fireworks Stand $0.00 0 Other Electrical Fee $0.00 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $62.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized 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 aban oned for a period of 180 days. t' OC a INSPECTIONS: In ordOr for the work authorized under this permit to be considered legal, such work must comply with all applicah`e; cod, ,and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration oft is permit. FOR INSPECTIONS CALL: (714) 754-5626 Z -4i{,11 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ 1 have and will maintain workerscompensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars ($100) or leu.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California and a that it l should eco ubject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provision . Applicant Signature: Data: 1212,-Z00 5 WARNING: FAILURE TO SECURE ORKERS' COMPENSAT) N COVE1 WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($10.000), IN ADDITION TO THE COST OF CAMP ATI DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and affect. Lic. # Class # Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction landing agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish. or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ I em exam c.Business and Professions Code for this reason: Signature: Date:5— Owner ID vs lied by drivers ti nse. e ❑ No Dtivers License No. /� Expires: _ / Z O X Verification of Ownership by type of If i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation two (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous materlal? ❑ Yes ❑ No (Section 25505 of the California 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 during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 goes or ....................._... .................._......................... willthe eppllcantor pras'e,nt.or.tutumbuildingOccupant needtofilea re istratt.o..;..l..o.[mforecutelyhazardousmalerials?❑Yes ❑No (Section 25533 of 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 of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....._ .......... _.......... _................ .............. _........................ _._................................................................................................................... .......................................................................................... _......... ...... .............................................. ................. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? Q Yes ❑ No (Section 25534 of the California Health and Safety Cade provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................... .......................................................... ................................................................................................................................................. _.............................................................................. ........................................................................ 4 I1 an RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? []Yes ❑ No ...._...._.._.___ ..................... ................ _............. ........._._._.............. ............................ __'... ... __............................................. _._.............................................................. __._.............. _.............. _......... ........ _............ _............. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a,,ppermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be lurnished on applications for non-residential building permits). .............. ................................................................._...................... .........._............._........................................._....___..._._..._.......................................__—...._............................. .__........ , 6 Will an ._..__ .............._............_._.............. y part of the facility to be constructed under this permit De within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (it'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................. .......... .................. _........... .........._....................... . .............................. _.._._.................................................................... ........ ___.................................... ._.._.............................................. ...._............... __....................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject o..this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No .......................................................................................................................................................................................................................................................................................................................................................................... ...g_ (It yes", attach certificate of Compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Data: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-describ prqpo r ins a ion p ses. ree not to occupy or allow occupancy of any building authorized by this permit until final inspection. gn lure Of 8i6Wner(s) Date And/Or Aulhonzed Applicant Date CODE L INSPECTIONTYPE gSIF IiiT. ALS CODE INSPECTION TYPE PdTE Its 1616 Fixed System Final Fire Prevention 206 Final Mechanical . 1266 Pool Spa Final 206 Final Plumbing I ' 200 Final Re -Roof 210 Final Electrical 201 Final Block/Relaming 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1113 DANA DR Suite: Vicinity: ROOF Parcel Number: 41207422 Zoning: R1 R1 Status: ISSUED Applied: 12/26/2002 Issued: 12/26/2002 Applicant: RON SELL FEE SUMMARY ISSUED BY: L ` Address: 18032 LEMON - $167.25 SMIP Res: SMIP Com: ,Phone: (714)528-1758 $0.00 YORBA LINDA, CA Zip: 92686 , Owner: NAFF, ANTHONY P Address - 1113 DANA DR - Phone: ' . ,,COSTA MESA, CA Zip: 92626-1609 Contractor: SELL ROOFING COMPANY Address: 18032 LEMON ' Phone: (714)528-1758 YORBA LINDA, CA Zip: 92686 License: 323842 Arch : . - Eng: Address: Address: Phone: - Phone: Zip: License: License: SCOPE OF PERM TEAR OFF EXISTING ROOF. INSTALL EAGLELITE, 50 YEAR; 2 30# FELT, OSB; 27 FEE SUMMARY Plan Check: $0.00 Permit: $167.25 SMIP Res: SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $168.14 SQUARES INCLUDES ATTACHED GARAGE. Calc Valuation: - $8,900.00 Claim Valuation: $8,900.00 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right . 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0. Proposed: 0 NOTES NOTICE: The work authorized 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 Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 !41646 (6/00) DECLAMATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury we of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. c❑ -)1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. l/�rkers' coat ati n Insy[arx:a car r and policy number are: _ / Cartier: Policy Number: �d 4 6 � Y (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify, that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, an that If I ould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. �99 Applicant Signature!-- �t Date: - L /� (_ 'd Z WARNING:.FAILURE-TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOI.LARE (SIOD,000), IN ADDIMON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: Lherebyaffirm that I InIicensed under pro= of, pier 9 (commencing with Section 7000) of Division 3 of.the.Business and Proles 'on ode, and my license is in full _force and effect: tic: M' Class 0- ) (,- ` 1 Contractors Stgnaturet? Date: �� ' -0 CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affinn that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors Ucense Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors Ucense Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, I.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet In depth Into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, Callfernla Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California 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 during a re orted year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o1 compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................ _........................... ................................ - 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑ ND (Section 25533 of 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 of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .......__..........................._.....................................................__.........................__......................................................_................................................................................................................................................................_.................................. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomla Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .............................................................................................................................................. ........................................................................................ .................................... ............................................................................................................... . 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................ .................. ........................I ....................... .............................. ................................................................................................ ........................................................................................................ ............................ I.......................... 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District ar from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ....................___....................._............................................._______._................._.__......................._._...................._.._.._.............................__.......................___............................................__..............___............_ 6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If . yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ....................................................................................................................................................................... .__........................... __.......................................... ........................................... ......................... _....................... _............................ ...... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No .................................................................-........................................................................................._...................................._............................................................................................................................................... ............................... _...... B (If yes', attach certificate of compllance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ig ure OI Leg i w, r / And/Or Authorized Applic nt� � / GDate�.-.1 CODE t. INSPECTION TYPE 2AIE IMIALS COD( INSPECiIONTYPE DATE LNTITIA� 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final-/�-,-//�— 208 Final Plumbing 200 Final Re-Roof210 Final Electrical 201 Final Block/Retaining Well / 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 y AgOREssa9MilkND_ 1113 DANA DR ONNERS NAMEIE KNONN DINH, ANH TUYET Amu: 1113 DANA DR COSTA MESA,CA ARCBREa"DIG NEER: DUC PHAM ARCKORENG'SADDRESS: 11770 E WARNER AV F. V. CONTRACTORS NAME CONTRACTORS MADRID ADDRESS: UNT: CITY OF COSTA MESA — BUILDING PERMIT FLOOD: X L38 92626 PERMIT NO: M 086230 PLAN CHECK NO: N CONSTRUCTION TYPE:.V—N PERMIT TYPE: MEC p UUNIT:_ 228 CA 92708 LIG NO.: UNIT: LICENSED CONTRACTORS DECLARATION: I hereby affirm under pesky, of pepry that 1 we licensed order povicws of Chapter e (Comme«vp wish Sedan 1000) of Oivuion 3 of the B.,ima Seel professions Code, and my tides n m IWI arcs eel elect. CRY LIC. NO, LIC. CLASS: LIC. NO.: EXP: Dale: Dadra t. OWNER BUILDER DECLARATION: 1 hereby alfum under Penaky d Penury that 1 an exempt from the Comretlm L ixenee law f« dr fdbwing ma.or (Semon 7031.5 Branae ad Pmteesiun. Code: Ary, Cry «courtly whi[h reduhes a pelmlf to mapud, offs, ttwpme, bmdth, or Spar ay structure, pace to Ya eeuenco, oto mouira the aPsitCadl Ip such pemd to So a it n -d sotelerm that M «she e lioemed pwmaal to the poneio^w of he Camomem Lianas Law (Chapter 9loommendnp vdth Sedition 7000) of Dation 3 of the Surinea add profession. Codel or that M or she n exempt th«Sham end the ban 1« Ole alleged exemption. Airy violation of Sedan 7031.5 by ea epPirnnt I« a pard euhjetls the aPpl awes to a cvg Pea9y of red mo« the the hundred ddlan (SCe(11). 1. ex owtw d the peoperyar my, empeyeee Sam wages a the sole mmperavh "Clo the work. end the Nawar a is not imerded «Meed for Sale ISe:tion 7044. Suvma ared Pmlessoa Code: The CmOecao« License lawdwe not ep*to a be add «opedy Saw bolds or hIPNAe (((peau. red wtlo does sad( well( nomad or herself «dYWgh Im or her mon eaLjMa, provided that SCh impovemets we not mletded or offered f« Sola. d. hoverr e. the Wildirp «Enpfpgnem u sold within one t yeof aonpMian, ted awner-0 neer will hove ted btW.n d tramp Mar She del nil Wild «impovw f« ted Wrpoee d aelel. I. Se. of the Pop". Sm exe4tavdy mraedely "Ah Ervned Commodore to muaoat the pd*e (Sedan 10x4, Bays wed professions Cade: The Cortmd«e limas Lew does tat epply to an owwr of papery who Wilde « improyes Il eeon Said Wes Candace for such papaw with S Coereaop) Iixonsed wasoutw to IM C«dred«s License law). non 0 1 sum asap under Seaton: B. & P.C., ler Mie e / Dow: Ci me 4C:�`dpL`6 I do he Me I SeVaimme'd lialtmdanbnd the eeeuhemeM of California tMMh and Selly Code Seabu 25505,15533. end gS534, Said that I «ey Mun WaldiN ooaaem NIM 1 At tat (cmle'orr) need to Comply Mh aid Seems miles and the meaWrme ede for e plead femoatmdon« meddawion haretheAk'ZSim 6ty�. aepement Distdd Rowderawl mnarWcn appkcatiom we exempt from here won Siam. Deter: Applicant WORKER'S COMPENSATION DECLARATION: I hereby where under peley d Pwimy pr d the fdbwie g detlaratixr: I have end colt merman S CedRade of careen lw. sed-inaem ler worked compenealion, a prided ke by Seaton 3700 of the Labor Code, f« the wdomrma of Or work f« whop Mt Perrot is rated, I have end wit reinter xorkede' mmpematcn inaurenu, m reOWred by Sedan 3700 d Me labor Coda, far ted perhamaae d 1M wok far which Mn permit I. towed. My waken' Compensation raters canter and poetry number ver: Carrier: Policy Number: (This sedbl sad mt W cpnpAaed 1 Ms peat n /« ow htmdmd do0en (5100) a AmJ I wetly Mw n Me [w a vertu e d to wok tke wares tat perm t and ori I Shat nil am Ploy end Pawn n any modes so m to Compos wonp to the workers' mmeof the two C l efI well and apses ted g I hones nisinr wblea to the waeken' wSnwtrwion f.ovnioSN d bedia 370o d the labor Code. I well lohwbh amply NIM Moa pmvnoa. Dote: APNeem: Waming: Falters M sScee worker' comrperastlon covezets Is onmwNl, and altwl ""let m SnNvloye to cvlmfaw Ps forei end dell fl. to to err h«rdcM thetwed ddW (SlCQ0O% M Wdldo to then cost .1 competator, detar9a a povlci ler In Sectio 3706 of Ms Lobar Code. Infers( sad efom-0 fee. CONSTRUCTION LENDING AGENCY: I hfirmnd ereby afuer prmedY d Porjey thel there t a conwrwcn loodkg Stacy or Ute wdad oar ce the work f« which the peal is; teued (Section 3097, Ch. C), LENDER'S NAME: LENDER'S ADDRESS: I Candy that I hove med this applialion ad awe Ihw the Shove idormetbn is Caned. I Sime to Comply whh et my eel County ordinenww Will state owe rea ng to Wildkq conwrvtlion and hereby authorize regaentmivas of her City to enter upon the abore-mentioned property, for inspaaionpapaas.ANH DINH /�/not N/tyre 0 . // _gen / Dwe: � (t�Agend'A _ mtl« (5151-4d.WP) WhaaBuddip 8 Safety; Greer-File;Calory-Appiwa; Pink-Rawuee: GOMomd-Nwse« ✓ - 6)oaso PERM NO: M 086230 GOVT: N SUPP: N PURPOSE: ADD JOB DESCRIPTION 308SF IST FLOOR ADDITION SQ FT: CLAIM VALUE: __ CALC—VALUE: GROUP OCC: R-3 / COMMENTS: 308SF ISTSTORYt"GAMEE E+RtOO+MRESEB86228 Z O N I N G R E Q U I 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 FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV: PARCEL: 41207422 ZNE: REF NO: PLANNING N TES> > ♦E dFMMdE♦E di df iFMMdE lE df df SE**df SFMNFMiF df it dFMdE df*%Mkdf dE NE NEMMMikdf MlE dE NE♦E iFk♦E*dE*iEMkREMMRF NE RE Sf NE iF dE SF*4iFMiF*iF**irk 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 BY DATE: BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: DATE: ***ifMNMMif if iE ikMkiE dtdEk kit dEdE if dEdE iEiE*iE SEilE �E it* LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N i BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT_ 12.25 251 SMIP/NON—RES PLAN ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 12.25 22.00 410.00 34.25 34.25 .00 REVENUE DIVISION TOTALS--> COLLECTED: 34.25 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK ,34':25 4♦Ek MiF dE iE♦f♦E iFMdFk♦f iE iFik MiEk*k*kiE if*if ifkkM M***iFiEdEM*k*k*iE**iE dE iF*Mk%iE iEiEM Mit iFiEk NE iF*iF iE iF dE MRF**iF NF 4it I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST 1, MEC 1 REPAIR/ALT HEATING UNIT/SYS W/CNTLS 12.25 12.25 END OF FEES 12-18-1997/11:87 AVQ4.25 FTPT8:01-017332 FIERNIT:086236 CONSTRUCTION AND PLANNING POO_ ,v SPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement T ",T,` lectrica`aduit Utility-Undrgrnd. 54. Forms S 4.� :w4.�E{ectricabConduit-Undrgrnd. _ 55. Electrical Bondingri ' '`45S�§teel ReV&cement 56. Rough Plumbing & Pressure Test S W6:¢1ectrical k1FER Grnd. I 57. APPROVAL TO COVER-GUNITE M 58, Electrical Conduit-Undrgrnd. ;:DriTootings 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water PipeZLJndrgrnd, 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61, APPROVAL TO DECK 11. _P.roperty Sevier Line & House Connection 10 t1 62. Backwash & Receptor-Final 12.ewer Cap-Final63. Heater & Vent t13. Roof Drains 64, Plumbing System - Final G4. Rough Plumb-hg x 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final %16. Rough Electric Wiring 67. Fencing & Access Approval 7. Rough Wir�Og Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19.ofioyghHejtipg&rAyi,fConditiloctiny .-.� K r_n rz S,-ir M FJ'R-EDfiPTr-tPEQUIREMEP4T,rte Y �:•tiDG rr, .r ti r APpPO`oLS� Permit # 20.ofto Pabtory FtFeplace I St S as: J 21.1•jjuc�'s, irii. tr&tu 70;-Undergr_oond tttvdro x r, ^ 22.:DuT, Ventilginglj t� a< O a �'< 71. ProdQtflipin as t7 Oil 23. Gas,PipOoa�h & - st t1S * ''t `< ,t; "� "'� " " 72. Undergseurd Mush z, , tr QO t; S T S�: iv 24Aoof Framing nA- M x: > x 3* 7j. Undergrhd.St(4 Tant ❑Gas ❑Oil 25. orifi Sheathin '' ` v g i t C (U# j 7. Overhead Hyds-pV r �.., T, y Gi =)* x 26.3-Ba.• Ceiling (St rail & Moh6coat r O Y 1:1y 7:6. Dry Ch9hical T to 27.grameanni� Flashi * w x 76. Dry Sta -� t pipeaH Z; ' 28. Lat Ing&Siding0* rx!- O � ` I ( �,e 77. FIXE"VSTENDFINIYL O � 29. InsulationS S :J �' ' '� S " 'r, Kf r 7 '7 A. FIRE PREV. F,1i\7pL • E^ • 30. DrywallPlailing .'J* �-+ .r S NHEALTH DEPT^REQUIIXEMENT _ ' 31. Plaster Fltow Co<;; S I t*tr :K t •�� * *; ' qc .• 79. FINALSPECRON * -_ < 32.-ElectricaE:Power Mgtsrknal t V x " Stt FOOD CERTIE]TATE 1S9UEf3 S • 33.-Pin O»: `'l I K 6]?El( '* I " f tes;n 11 M(; 7 O y FP x X • 34.=Fina He@-ting.$[ AiyCftpditiomn9 t- -x ;> I + ;. - > 35.-Finel Gas-Pipe'-Te-f r m nu xm .J 36.;}Ioo¢or_CanoPY•��s (l IxR) •-" r 37. Pinal'Factory Fire�rjcC" t f""•" F ,. . I. * 38. Fina ;Plumbing xr h7 ( :n k i to .. ��.try o c 39. Water Service-Final£ I x •- y y moi: I t<•, Y � 40, Gas Service-Final � -1 Vii:, E, ty ;; { f � EV- v5' ,� < '+ 41. Solar Domestic-Final-, », I s S 42. Backflow Pr%!Pnter* .0 43. Backflow lrr@'tion:t "r• * x r _ O r .t: 3 _n -r. + r .r 44.r-.andscapt Irrlpatio�t-System,]ct;� '7 c a: d :yx S S 'Dcr S F- ^ __ .� 45. Sound ATten t�ationt�" " � :T7 ^'• '%r °' Q 46. Randicap'Re46latiopsS I <m p n '47.-PINkL STR - TURE & BUILDING s F :t: 7 T F 48.�IN)'LPLANNING< F xr! c49. filectiic Release to Edison * Y ! ox 1 / -y ;,50. •Gas Release to Sout�ern Califo5 aGas co n D D` '51. CERTIFICATE OF OCCUPANCY No. Date 1113 DANA DR' DINH, ANH TUYET 1113 DANA DR COSTA MESA,CA UK. IUUUNI ADDRESS ARCNRECT OREN(Mim: DUC PHAM - acLoRENO.'s1 E55: 11770 E WARNER- AV F. V. CONMCTORS NAIO:: COMIXIrORSMNLM Aon. UM.. FLOOD: X L38 92626 M.M.: 0 UMT: 228 CA 92708 LIC. No: UM. LICENSED CONTRACTORS DECLARATION: I hereby wY order Pemby d Penury the I we [keened under praiaaw d Chepta S (mmmerxvq erth Seaun ]OW) a Division 3 d the Bowness and Professions Code, vol my limine is in U force enol effect. CRY LIC. NO.: LIC. Cuss: LIC. NO.: EXP: ._- Date: Cornea.: OWNER BUILDER DECLARATION: I thereby affirm under Penally of perjury that I an exempt from the Conlradae License Lew for the lolbw'vq resaon (Section 7031.5 Busnms and Prolessi0rs Code: Any CIY or county whkh raauim a Perms to aawn4t, eser, ion«ore. lemdish. «repel any sinwh". Prior le its issuance. Mo eswass the epplioad for such Perms to fie a signed Menem Nat M or end a ,smsa, sna am to the promds a the Comrade License Law [Chapter 9 (oommendng ash Section ]DDD) of DMision 3 of the 8u 71` end Praleanom Code) «that M «ahs w exempt Ihwenan and IM fouls for thealleged exemption. Any violation of Section ]031.5 by any epptned t«.Perms eubjecu IM epplicpm to a evil Deruly a nal mere Ores fore hudrod della" Ru00D. ❑ I,mownerdtM poPeny«my anpyeea ash wavessslhei sole mmPenWion. wanelM work, errdlM sMatunisnal nterdnd a aRered for aab (Section ]OW, Bosinen end Prdmabm Cods: TM Cairedon licwe Lew done rot eppyto m bwrord progeny wM Wide « as not i tMoon. and wfn done each woM1 Nm.el «MnN a tluagh his «M own wno one les. d Pomd Ihm erah impraremerer at not Mended or of in rob. r howe or, tine Witlirq or sn for the is sed wsmn oro rev a camdnion. the owner-0uilder will hew the Wman a prmvin9 he or ahs db not bdM or improv /« the Peryose d sae). I, m owU dtM I no endoad • we esd,.N*y nus deg with lioaneContrauct Mlears! tors Ia connre project (Section ]o. Business Prof.PrCoda: The Conned. _k onse Law done not apply to on . of property who wibe or improves tlsa on vol who contracts for suds projeda wen a corewon(i) licensed mraeml to IM Contractors License Lew). ❑ Ian ex�mIs ncler Secln: kh- . 8 P.C.. for thist1'yOX;� r Due: r 6nsss, Ido hereby med0y Out em save d and wdentmd tlM regdrerrrw d CaUpnis Ileegh and Sefoty Cods 3ectias 25505, 25533. end 2553e, and that I «arty Mon bugdeq amaeN ora / ora nal Idrois aro) nsad b mnnPll' wsh sect alae mar a1tl Ms tpanmema for ePemdlawnsbudianamndaWionhanlM /v�STi �mepemvd Didrid.R®dem®l oorirtrud'oneppimianse"memp hom0me pramiom. Dae: Apply son: WORKER'S COMPENSATION DECLARATION: I MreCy whine under Porshy of Perjury one of the fdfovdrq dedas ions: ❑ I here end wit maintakr a caniiute d mrrsenl to voRimm� for walkers' mnPenmtion, m po+ided t« by Sectiar 3]00 d IM Lobar Cada, for IM pedormenu d the work for wNch this Perms is issued. ❑ hew vol wit the parse My abn irMrrerru, n naubed for Sedian 3]00 d Os Lehr Code, la IM pad«mence d tM work f« whits Nis pemN b issued. My w«ken' (ernp«salon imwvae ranter end policy iamb« va: Center. Paltry Number. (RIs section need not ba asepleted i IM Pamir is for one huabed dopers /3/00/ or less.l ❑ m«tN 0u1 n Os pins eso s:e . IM wak 1« whish This Penns a. ural I shag t emptor ki a person in any manner a m Io ,stoma subject ri tee orf Sen' n 37M oftie leve d le, I wall end egos Mn i I hose beann subject to IM waryan' mmpansation pronixw d section 3]00 d the lab« Code, 1 a1re0 taNwbh oompy wvh those prw®ms. Dae: Applicant: W-nninq: F.H. so sane.. workMa' Carrasmu don Onre spa Is unbwM, ad shall seb/scl en employer to cdne'ral pareMes end dWl Pros W m ars hwrdred ti auxrM dollars ($100.0004 M aWlt/en ro Me most of m ani emaf/oM damages as Provided ror In Secdoe 370601 Me Lebo, COW, Irdaes4 end albmeV`s faro. CONSTRUCTION LENDING AGENCY: I hereby affirm under Penalty d Perjury that [here is e oonelndion laadkq si er for the performerae a the work for whits this pemU is issued (Section 308]. Ch. C). LENDER'S NAME- LENDER'S AMELENDER'S ADDRESS: I cw* lhm I Mw cad Mis mphosim end nate lha the ebws kdartnetion o coned, l ewe, la campy s ih a0 dry end muayanlnences end sate laws oletkq to WiNsq CanrnnUdKa vol hereby enhorae regesenrtag,es dthis dtyto ems, upon the above menfvred proPo y 1« inspedian Purposes. ANH DINH /_� z PnM {em,� A/ Date: grana A redo (St51e5.WP) WhAe-80tim 6 Selay. G.nt l`Be:Censry APplcem: Pink4aass: OdderuodAss,aor 7 /� IZ- CITY OF COSTA MESA - BUILDING PERMIT ! + oU PERM NO: B- 086228 PERMIT NO: B 086228 PLAN CHECK NO: 03297-97 L GOVT: N SUPP: N CONSTRUCTION TYPE: V -N PERMIT TYPE: SIR PURPOSE: ADD JOB DESCRIPTION : 308SF 1ST FLOOR ADDITION SQ FT: 5,693 CLAIM VALUE: 60,000.00 CALC-VALUE: 25,102.00 GROUP OCC: R-3 / COMMENTS: 308SF IST STORY "GAME ROOM" RE Rf RE RF*KKi3ii*iE*dE ii iEMK*kka!*****Se***iE iE ii RE d3*RE RE**k5E**it iF Rf*dF ip iEi3 irk RF***iEii**3P iFi3 dF ib**iE RF*dE*db dE 1313 Ri dF Z O N I N GS E R T E B Q A U C I K R S E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: 6 FT _ IN REAR; 10 FT IN FRNT: FT IN REAR: FT IN LEFT: 13 FT _ IN RIGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REPp• PROV: PARCEL: 41207422 ZNE: PDRL REF NO: PLANNING NOTES> CONSTRUCT 308 SF GAME ROOM IN REAR ON 1ST FLOOR- CONSTRUCT 3 >_85 StFT. BEDROOM OVER EXISTING GARAGE. HOA OK RECEIVED. RtkiE lr it le lr 1p lar+r+r+Exr:lE d6kiE 56 i+r+r**�rrx�riE*k+E�E+riErlr•l�*aE+r+��E it*�Rr*+e*�rfr•x**�EiEie*it*�r>tE it�E�L it*iE*�**x�E** D E V E.,1-0 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 APPROVEDBY DATE: l2 -j L% (C1 -j BUILDING APPROVED BY;,: DATE: APPLICATION ISSUED BY: hALD S-ii4 DATE! LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 358.75 2.51 SMIP/NON-RES PLAN 233.19 ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 361.26 0.00 1 233.19 594.45 783.60 -189.15 REVENUE DIVISION TOTALS--> COLLECTED: 361.26 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 358.75 i� 2.51 d3*M*k*MRf *iFif Ri irk tic d!*irk*R6**RF iE Rf*iE*SF**M*di iR33%MRE***irkM**RS RS***Ri RS*****df*i3*k*BEd(•*Si R6*dE**RE RS RE {(•M** I N D I V I D U A L' F E E B R E A K D O W N TYPE QTY D E S C R I P T I✓0 N UNIT COST TOTAL COST SFR 308 DWE-TYPE V -WOOD FRAME -GOOD 81.50 25,102.00 END OF FEES Ew X + 12-18-1997/11:C6 AiJ8361.26 Eie�l0 d'� . _,pfi PERMIT:086228 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOH .v SPA APPROVALS Permit # Date Inspector `1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe Undrgrnd. 53. Steel Reinforcement f c3�p�lectricaFConduit Utility-Undrgrnd. 54. Forms --4.< IectricatQnduit-Undrgrnd. 55. Electrical Bonding - Ss steel Re`Ktarcement 56. Rough Plumbing & Pressure Test _ 61,Electrical OER Grnd. ?1:� octings n 1-, 8. Foundation �gl� 57. 58. 59. APPROVAL TO COVER-GUNITE Electrical Conduit-Undrgrnd. Gas Pipe, 0 Undrgrnd., Test , 9. Water Pipe'%Indrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11 !Property Sewbr Line & House Connection 62. Backwash & Receptor -Final 12•`„$ewer Cap 63. Heater & Vent -Final M 3. Roof Drains 64. Plumbing System - Final �4. Rough Plumb�'Ing ell 65. Electrical -Final :15. Rough Electrical -Conduit 66. Solar System -Final Rough Electric Wiring 67. Fencing & Access Approval ,j 7. Rough Wirjng Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19.goyah H,gatipq &,Air Conditjoging ,-a ti M w F1,RE.DmEPTcS1EQUIREMENT APP�O' ES+=' Pe"rmit # ` :; - 20.=Ro17ggh FSctory FyZMlace I Sio uz< * 5 ='v ^ •:t .• •• 21.�ucrK Zs, iriStructub9� i H. St; x �• ,�* r. 70; -Underground Efydro 22.:-D ue"t3, VSntitSting.l.� i -� C or k. n �;: et 71. Prod, C{Pipingas`.7Oil 23. Gas`Pip�Ro h & st .... trt:• n1S O'J x tri w t. c". * S* 0 72. v * Undergi ,nd flush ., w o 24. Roof Framing * m * ✓ Y " * n 7�wUn rg hd.StSt, lank OGas ❑Oil 25.,Ro' She�athin �" 9 x• ,- v : ' v `� 7 ,'Ove6head Hydro„ 26.. T -Bar Ceiling,(Strt=ural) &-Mwocoat O ; O r �r r heroical �� 3 27 ` rar�ea't51 Fgshiq Hnn t,F ? 7r 76. Dry StajCdpipesy . 28. Lang&Siding0*AGF Ool � I 4 77. FIXEDS�STEfidPFINFcL'" z~ n 29. Insulatioq ..F., FIRE PREV. F,A(yAL r• 30. Drywall�Nailing :• z I c p.,. S :uWfALTM DEPT. REQUIREMENT r 31. Plaster BFnwn Coa♦ x S '�'`• s ! r 79. FINAL"PECTAON *. 32.41ectric&ovuer MIV'F1nal. _ rx Bfh FOOD CERTIFICATE IMEB T' 33AFin9l Elgtri ix T,I ¢ .,. �. N tes: ¢YOai�Y✓ G .- 34 jj int Heating;& Ai r#CondltioninngJ iz;` -: - ! j•: n < x� 35.'Final Gas Piptr-Test'' " " ' I` L 36. -;Hood or,§nopY x �T •- rte a :*: :`v * ^: .T+ 37. Final'Factory Firep$ce' 38..7FinAPIumb A h; 39. Water Service -Final*.: K fiJ \ .,u tzT77 # I ! t� :.: -• .n L rJ O ' 40.,,Gas Service -Final * R1 T'�. �i �Y I i-+`• �L Y' Q 41, Solar Domesftc•Final y 'I a_3 f `� J _ `, J- I 42. Backflow PrtventerK N ,y.a �� yam. � * .., �; m0'J J -y 43. Backflow Irrtg'ation' _ r 1� IL : ^ � lTI l G`i14.rLandscape Irrigating Systeme,;, •J �` T L. .ti v^,r,, V J .R Q f 1r. 0=: * S r ✓ 45. Sound Attenuation 1^ ,. '.46.'Hand icad'Re6ulatlops f .x -j7."�l LSTRUCTURE &BUILDING r�: ! '� _ r- E^ 48.�FINAL PLANNING". .. 7 *9. -Electric Flelease to Edison i t* . �; _'f'• �' "50.fias Reldise to Sou6ern Cali(orflla Gas Co S _ r+ * to 1.CERTIFICATE OF OCCUPANCY . Date FZ COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 [7ADDAEss508 Fill in Completely — Use Ink Only MAIL Properties Wes Development orp. 9th Street clrvNewport Beach, Ca. Now75-4g1 CONSTRUCTION 10V 10-77PAMSCto00 541* ***103.36 G APPLICATION FOR STRUCTURAL PERMIT RECEIVED BV IDATE RECEIVED neTc Isstucn BUILDING ADDRESS BRANCH oper ie$ e$ eve R menz OWNER 899 s 'Irl....... ADDRESS s Res. Atd. Gar, VALUE loo ARCHITECT OR ENGINEER Frank S an ler 0 FIRE T [TION IS FOR ADDRESS 2240 Newport Blvd.,ZONE VPE GROU �! ✓ CONTRACTOR OwnereV APPROVEDol m a DATE ADDRESS N TON 0 NO.OF? USE OF CITY N PLANS BUILDIN STATE CITYARDS JE APPROVED YARDS APPROVED LIC. NO. LIC.MAIN BUILDING ACCESSORY BUILDING 512E NO.(FROM C L EET) OF LOT NORON T. FT. USE OFEXISTING BLDG. FTSeparate permits are required forL. SIDEFT. FT. electric, plumbing and heating woREAR FT. FT. USE OF BUILDING AND WORK TO BE PERFODISTANCE BET. BET. MAINMAIN SLOGS. ACCESS BLOCS. ,inxrlp. family VAR. q1E .'1�r .. I , C.U.P. 90.��//��SF]FF DATE 1.�r yC.nl'IRtriin�. APPROVEOI /FYr / I hereby acknowledge that I have rthis appliceMon and state rmation that the above InfoIs torte antl agree to comply with all laws regulating building construction, and 1 shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I em properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I em exempt from the provisions of the State of California Business end Professions Code„Division 3, Chapter 9. Signature of Permittee pp Authorized Anent THE AMOUNT SHOWN UNDER VALU THE PURPOSE OF ESTABLISHING A PERM VALUATION PERMIT FEE E PLAN CHECK E s55,100 TAX $ TOTALPAID E m 'Irl....... o N [TION IS FOR m_ IIT FEE ONLY; m a N N 0 0 3.86 COSTA MESA BUILDING-SATTY PARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 :C -9-77" s°00 1_188 j*** 199.00 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED BV DATE RECEIVED DATE ISSVED BUILDING ADDRESS PERMIT NO. OWNER PZ _ A.P. NO. MAIL ADDRESS BUILDING // ADDRESS f TEL. CITY NO. TRACT LOT BLOCK CONSTRUCTION W A A PMOVING LENDER BRANCH OWNER ADDRESS E .S ARCHITECT TEL. OR ENGINEER NO - FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS TEL. CITY NO. ZONE NO. OF I PLANS USE OF NEW BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF BLD GS (FROMCILSTREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. FT Separate permits are required for L. SIDE FT. FT. REAR FT. FT. electric, plumbing and heating work. VSE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS, SLOGS. VAR. 46 DATE t C.U.P. # APPROVED APPROVED I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, And that such licenses are In full force and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: em exempt from the provisions of the State of California Business and Professlons Code, visiloon%3, Chapter 9. VALUATION PERMIT FEE $ Signature of S If PLAN CHECK TAX E $ _�; —0 -el elf//I G� Permittee ...r / $ TOTAL PAID S s Authorized Agent Gs: aa(Lc„/(f