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Home My WebLink About866 DARRELL ST - Building Permits� CITY OF COSTA MESA BUILDING DIVISION 77 FAIR qRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BC08-00573 PERMIT TYPE: B COMBO STATUS: ISSUED Sub Type: RES_RRIP DATE ISSUED: 12/15/2008 ISSUED BY: RMD .loB ADDREss: 866 DARRELL ST CM Suite/Unit: APN: 42236223 _ , .. . . Zoning: � _ � � � � � Vicinity: THROUGH OUT HOUSE '. Primary Occi .R-3 ' Const Type: SQ. FT: 0 Valuation: $4,000.00 SCOPE OF WORK: REVISION'TO PERMIT ON 02/24/09 TO INCLUDE A COPPER REPIPE ; CITY REHAB PROJECT AT AN EXISTING SINGLE-STORY SFD: WORK TO INCLUDE REPAIR/REPLACE KITCHEN DOOR IN KlTCHEN, DRYWAlL WORK IN LIVING ROOM, REPLACE WATER DAMAGED FRAMING MEMBERS I1V BATHROOMS, EXTERIOR FRONT AND REAR ENTRY DOORS, REPAIR AND REPLACE LIKE FOR LIKE PATIO FRAN1E15 LIGHT FIXTS, 5 SWITCHES, 1 OUTLET, 3 P-TRAP, 1 SNOWER, 1 KITCHEN SINK, 2 WATER CLOSETS, 1 BATHTUB, 1 DUCT FOR MICROWAVE EXHAUST. OWNER: DERBY, PATRICIA ANN ' -� - - Address: 866 DARRELL ST � ' .. �� Unit: Phone: � �. - , �. , City/State/Zip: COSTA MESA, CA , � � " � � � APPLICANT: MERRICK,.GEOFFREY�� - - '��, �"Address: "387 W BAY ST � � " � � � `" " Phone: 7�4369-4002 . � , , . . - City/State/zZip: COSTA MESA, CA - � cON7Rnc7oR: MERRICK PLUMBING AND REMODELING License No. Phone: 714369-4002 Address: 387 W BAY STUnit: Cell: . � - ' City/State: COSTA MESA, CA � ARCHITEC7: � � '. �� ' License No: � � ENGINEER: - License.No. COMBINATION PERMIT FEE SUMMARY '< Building Plan Check: $0.00 BuildingFees: � � �� $9725� Electrical Fees: ' : � ' $46.60 Mechanical Fees: $34.15 Plumbing Fees: $68.60 SMIP Residential: $0.50 � SMIP Commercial: g0.00 � Bldg Std Admin Fund ?? TOTAL FEES: $247.10 "Refer to tee receipts for all fe�s paid for proJect 802626 : _. ��U15�� . � � -. Unit: : .ZipCode 92627 " PHONE: PHONE: 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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 fnal approval will result in the expiration of this permit. COOE/. INSPECTIONTYPE �RTE IN7ITIALS COOE/ INSPEClIONTYPE 0 INTITIALS 1676 Fizetl System Final Fire prevention 206 Final Mechanical � -C�� 1266 Pool Spa Final 208 Finat Plumbing � Z � 200 Final Re-Roo( 210 Final Electrical 201 Final BIak/Retaining Wqll 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site �/� .� � 204 Final Demolition 250 Final Building/OCcupancy : � WORKERS' COMPENSATION DECLARAT� I hereby aKrm under penalty o( perjury one of the following tleclarations: ❑ I have and will maintain a certificate of consent to self-Insure for vrorkers' compensation, as provided for by section 3700 of the Labor Cotle, for [he performance of the work for which this permit is issued. ❑ I have and vrill maintain workers' compensation insurance, as required by section 3700 of lhe Labor Code, (or [he peAortnance o( the work (or wfiich this permit is issued. My workers' compensation Insurance carrier antl policy number are: arner. ��-- �(TIJs sectiwr neetl no� De wmple(ed Athe pemM is valve0 af one ��ritlre0 tlollars (StW) w less.) �Policy,Nu . � I certify Ihat in the performance of Ihe 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 become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. �� 4- C��/ App4�an� Sigy Wre Date �. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARS ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS OECLARATION: I hereby aHirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) o( Division 3 of the Business and Professions Code, and my license is in full force and e/fl�ect. � Lic�#. .��.i.7� i(1 � (O CYas_,5'#+>�,._I_> �� _ C�v L�( ,. J� .Z �,� �+� (> �/ ��ConVaclorSSignaWre �ale � �`3`tYk. CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrm tha[ Ihere is a construction lentling agency for [he peAormance of the work fa which this pertnit is issued. (Sec. 3097. Civil Code). Lender's Name: Lender's Address: SignaWre OW NER-BUILDER DECLARATIONS: I hereby aKrm that untler penally of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 703L5, Business and Protessions Code: Any city or counry which requires a permit to construct, alter, improve, demolish, or repair any s�rucNre, prior 10 i[s issuance, also requires the applicant for such permit to (le a signed statement that he or she is licensed pursuant to Ne 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 therefmm and the basis for [he alleged eaemption. Any violation of Section 7037.5 by any applicant for a permit subjects the applicant to a civil penalry of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as Iheir 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 lo an owner of property who builds or improves thereon, and who does such vrork himself or hersel( or through his or her own employees, provided that such improvements are not intended or offeretl for sale. If, however, lhe building or improvement is sold within one year of completion, the ownerbuilder will have lhe burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS ro cons[rucl the project (Sec. 7044, Business and Professions Code: The cont2ctors License Law dces not apply to an ovmer of property who builds or improves thereon, and wfio contracls for such prqea with a contracta(s) license pursuant to Ihe Conlractas License Laws.�. ❑ I am exempt under sec. Business and Professions Code for this reason: SignaWre Da�e 305]-C6�3/Ol) �. �. Owner ID venfed by�cense. ❑ Yes r❑ No Driver's License No. Expires: Verifcation o( Ownership by (type of document, i.e. - property tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certdy that no excavation (rve (5) or more feet in depth into which a person is required to descend. will be matle in connecfwn with work authonzed by this pertnit, and Ihat no building strucWre, scaffdding, (alsewnrk, or demolition or tlismaniling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Gry 2, M 2, Sec. 341, Ttle 8, Califomia 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 (rom the Oivision. Appllcanfs SignaNre Da�e Division ot Industrial Safety Permit Number _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the appliwnt or present or future builtling occupant neetl to fle and certify a Business Plan for emergency response to release or lhrea[ened release of a hazardous ma[erial? ❑ Yes ❑ No (Section 25505 of the Cali(omia Health antl Safery Code requires, with some exceptions, lhat a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time tluring a reportetl year a quantity of hazardous materials equal ro or qreater than a weighl of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperaWre and pressure). 2. Does or will the applicant or present or fuNre building occupant need to file a regisiration fortn for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Heallh antl Satery 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 matenals equal to or grea[er than a weight o( 500 pountls, or a volume ot 55 gallons, or 200 cubic feet of compressed gas at standard tempereWre and pressure). 3. Does or vnll the applicant or present or future building occupant need to prepare an RMPP (Risk Management antl Prevention Program for acutely hazardous malerials)7 ❑ Yes ❑ No (Section 25534 of the Califomia Health and Sa(ety Code provides tha[ Ihe Costa Mesa Fire Department may require the preparation, certification and fling with [he Fire Department of an RMPP by businesses which are requiretl to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently requiretl, has Section 25534 of t�e Cali(ornia Health antl Safety Code been fully complied with? ❑ Yes ❑ No 5. Oces or will the applicant or present or fuWre builtling occupant require (or [he vrork which is �he subject of Ihis application a permit for such consVuction or modification from the South Coast Air Qualiry Management District or from any other air pollulion control tlislrict or agency7 ❑ Yes ❑ NO (Secfan 65850.2 of the Califomia Govemment Code requireSlhat the requested information be fumished on applications for non-residential builtling permits�. 6. Will any part of t�e facility to be constmcted under Ihis permit be within 1000 (eet from the outer boundaries ot a school? ❑ Yes ❑ No Qf yes", the facility must meel the requirement of Sections 25534 and 42303 of the California Heallh and Safety Code). Z If a pertnit from the South Coast Air �vality Management District oi other air polWtion control distric[ or agency is required for the work which is the subject of this application, have all of the disclosures presciihed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf "yes", attach certificate of compliance from the appropriate air pollution control oKcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of peijury the information given above is correcl I agree to comply with all state laws and ciry ortlinances regarding Hazardous Materials and Emissions. SignaWre Daie CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty oi perjury that I have read this application and state that the information given is correct I agree [o comply with all slate laws and city ordinances relating to building construction, and authorize representatives of the City o( Costa Mesa to enter upon the above-descnbed property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until fnal inspection. S�gnawre of Legal Ovmer Oa�e �i � o2.a`��v �tiwror.nuino�zeanoai�wm �J ��.Da�.^-`� � ' � � M CITY OF COSTA MESA Ncighborhood Improvement Program Final Work Write Up 02/19/09 Name: Patricia Derby Prooertv Address: 866 Darrell Street Home Phone: 949-548-6882 Work Phone: N/A All work is ro be done per City of Costa Mesa Building, Planning and Public Works Codes. In order to establish standards of quality, the detailed specifications may refer to a certain product by name and/or from a major manufacturer. This procedure is not to be construed as eliminating from competition o[her products of equal or better quality by other manufacmrers. The Contractor shall furnish the list of proposed desired substitutions prior to signing the contract. All items listed on the work description, unless o[herwise specified, shall include aIl patching and finish work, including trim, hardware, patching and finish pain[ing and/or staining. The Contractor is responsible for all permi[s, fees, City business licenses, plans, etc. City of Costa Mesa Standard Rehabilitation Specifications applies to all items lis[ed on work description. Worl: Description: I. Plumbing: Remove existing plumbing pipes. Provide and install copper piping sized to meet 2007 California Plumbing Code requirements. Patch, prime and paint walls (per owner's preference). Ob[ain all required permifs from fhe Building Depar[ment to startina work. TOTAL $5,000 $5,000 I have reviewed the above work description and understand that any changes, additions or deletions shall have prior approval by the City of Costa Mesa Neighborhood Improvement Personnel. Signamre of Property Owner Da[e Signa[um of Contractor Date � CITY OF COSTA MESA � BUILDING DIVISION 77 FAIR DRIVE, COS7A MESA, CA 92626 •(714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BC08-00573 PERMIT.TYPE: B COMBO STATUS: ISSUED Sub Type: RES_RRIP DATE ISSUED: 12/15/2008 -._ ISSUED BY: RMD �oa a,00Ress: 866 DARRELL ST CM, . . Suite/Unit:-:>, APN: 42236223 ' .,;Zoning ��, - Viciniry: THROUGH OUT HOUSE-' � P�imary Occ' R-3 ConstType: �.:t:� SQ FT.: ' 0 � jValuation:, $4,000.00 �. I:. .::. k ;,...., ' \'�.: SCOPE OF WORK: CI7Y REHAB,PROJECT AT AN EXISTING SINGLE-STORY SFD. WORK TO INCL"UDE REPAIR/REPLACE KITCHEN DOOR IN KITCHEN; DRYWALL WORK IN LIVING ROOM, REPLACE WATER DAMAGED FRAMING MEMBERS IN BATHROOMS, EXTERIOR FRONT;AND REAR ENTRY DOORS,:REPAIR AND REP.6ACE LIKE FOR LIKE PATIO FRAMEI5 LIGHT FIXTS, 5 SWITCHES, 1 ' ,;, '� — .�,, - - _ ` OUTLET, 3 P-TRAP, 1 5HOWER; 1_'KITCHEN SINK, 2:WATER CLOSETS; 1 BATHTU6, 1 DUCT: FOR MICROWAVE EXHAUST. OWNER: DERBY, PqTRICIA ANN„`�� Address: 866 DARRELL ST � t -' � Unit: Phone: �;; , . •: Crty/State/Zip: COSTA MESA, CA � �"' �,r '; - '�� , . , . ... . ,. _. — r. .' APPLICANT: MERRICK�,-GEOFFREY�:�� - �Address; 387 W BAY ST _ , - . `--Unit: : � Phone: 714369-4002 , � � ��City/State/zZip:� COSTA MESA, CA � �- �" ' . � . "_ :.. . ` .i;� CONrRAC70R: MERRICK PLUMBING AND REMODEGING • License No. 802626 Phone: 714-369-4002' Address � 387 W BAY STUniE: ��. CeIL City/State: COSTA MESA„CA ., f ;�ZipCode 92627 � � , _. ., -. . .. .. ARCHI7EC7: - ' License�No: �. � - ��-BHONE: ' ENGINEER: Licen3e�No. , .-, . - PHONE: `} COMBINATION PERMIT FEE SUMMARY '' � Building Plan Check: $0.0Q . � °. Building Fees: "^� ? �$97.25' Electrical Fees: '�� $46.60_ � - - , , .� .,.', -", Mechanical Fees: ��,-�� $34 15 �` : �� . '� - ., � Plumbing Fees: $58 80 ' SMIP Residential: $0.50 - .. SMIP Commercial: $0.00 TOTAL FEES: $237.30 "Refer to fee receipts for all fees paitl for project .� NOTICE: The work authonzed by this permit shall wmply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) ' EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. � INSPEC710NS: !n ader for the vrork authorized under tbis permit to be considered le9al, such work must comply wilh all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval vrill result in the expiration of this permit. COpEt, INSPECTIONTYPE 1818 Fixed System Final Fire Prevenlion 1266 Pool Spa Final 200 Final Re-Roof 207 Final BIocWRetaining Wall 202 Final Factory Fire Pldce 203 Final Sign 204 Final Demolition UATE INIIML COOE/ INSPEL710NTYVE 206 Final Mechanical 208 210 212 220 Final Plumbing. Final Electncal Final Fire Prevention Final Planning Approval 222 Final Site 250 FinalBuiltling/Occupancy onre iNnnus WC52KERS' COMPENSATION DECLARATI� I hereby aKrm under penalty of peryury one of t�e tollowing declarations: � I have and will mainlain a certificate of wnsent to self-Insure for workers' compensation, as provitletl for by section 3700 of the Labor Cotle, for the peAormance of the vrork for which this permit is issued. ❑ I have and will maintain v.orkers' cwnpensation insurance, as required by section 3700 of the La 6ode,—fa the peAortnance of the work for which ihis pertnit is issued. y vrorkers' compensation Insu ance carrier and policy number are: Camer: (Thissediw� EecnmdefeCFf�e isvalueeatmehuiwieecbnars(StOo)aless) Policy Number: � I certify lhat m t p Ao r`nance of the work for which this permit is issued, I shall not e loy any perSon.Lany manner so as to become subject to the xrorkers' Go pensation laws of Califom=a, and agree that if I should become subjecCto the workers' compensation�provisi0ns of Section 3700 0( the Labor Code, I,sliall forthwith coF�ply with (H�e provisioi�5-r_ /� �...............�n...,._... .....__ .J WRRNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4FtS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby afflrtn that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, antl my license is in full force antl effect. J� litr# � ��%�%uZ�o Class#'(� �i� /`��%`� �'(J —�%1�' . nlraclo/s$ignaWre �Date CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm lhat there is a consWctbn lending agency (or the peAormance of the v.ork for which this permit is issued. (Sea 3097, Civil Code). Lender's Name: Lender's Address: Signalure Oale OW NER-BUILDER DECLARATIONS: I hereby affirm thal under penalty of peryury ihat I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to conswct, alter, improve, demolish, or repair any sWcture, pnor to its issuance, also requires the applicant (or such permit ro fle a signetl statement that he or she is licensed pursuan[ to the pmvisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of lhe Business and Professions Code) or [hat he or she is ezemp� Iherefrom and lhe basis for the alleged ezemption. Any violation of Section 7031.5 by any applicant for a pertnit subjects ihe applicant to a civil penally of not more than fve hundred dollars ($500).): ❑ I, as owner o( the property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, and the slrucWre i5 not in[ended Or offered (or sale (SeG. 7044, BuSiness and Professions Code: The Con[ractors License Law Cces not apply to an owner of property who builtls or improves thereon, and who tices such work himself or herself or through his or her own employees, providetl that such improvements are not intended or offered for sale. If, hovrever, the building or improvement is sold within one year of wmpletion, the ovmer-builder will have [he burden of provinq that he�or she did not build or improve for purpose of sale.). . �� . ❑ I,�as owner of Ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conswct lhe project (Sec. 7044. Business antl Professions Code: The contractors LiCenSe Law dces nol apply lo an ovmef of property wfio builds or improves thereon, and who contracls for such project with a contractor(s) license pursuant to the Coniraclars License Laws.). ❑ I am exemp[ under sec. Business and Professions Code for [his reason: SignaWre Date J09A6 (3/Ol) � , � , ��, Owner ID venfied by �ense. ❑ Yes ❑ No Driver s License No. Expires: • Verifiwtion of Ownership by (type of document, i.e. - property tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or mae feel in tlepth into which a person is required to descend, will be made in connectbn with work authorized by this pertnit, and [hat no builtling slrucWre, scaf(dtling, falsework, a demolilion or dismantling thereof, will be more [han [hirly-six (36) feel high. (Chap. 3.2, Grp 2, M 2, Sea 341, Title 8, Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which vrould require a permitfrom Ihe Division o/Industnal Safety,as noled above, unless such per5on has a permi[ to tlo such work from lhe division. AppiwnCs SignaWre Division ot Industrial Sa(ety Pertnit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will �he applicant or present or fulure building occupant neetl to fle antl certify a Business Plan (or emergency response to release or Ihreatenetl release of a hazardous material? ❑ Yes ❑ No (Section 25505 of Ihe California Health and Safety Code requires, with some exceptions, tha[ a Business Plan be �led with lhe Cos[a Mesa Fire Departmen[ by every business which has at any one time dunng a reportetl year a quantity of hazardous materials equal to or greater than a weight o! 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 ro fle a registration form for acutely hazartlous materials? ❑ Yes ❑ No (Section 25533 of [he Cali(omia Health and Safery Code, with some exceptions, requires regisiration with the Costa Mesa Fire Department by each business which at any one time has on hantl a quantity of acutely hazardous matenals equal to or greater than a weigh[ of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at slandard temperature and pressure). 3. Does or will the applicant or present or fuNre builtling occupanl need to prepare an RMPP (Risk Management and Prevenlion Program for acu[ely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safery Code provides that the Costa Mesa Fire Department may require ihe preparation, certification antl filing wi[h the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Departmen[. 4. If an RMPP is presenlly required, has Section 25534 0! lhe Calitornia Healih and Safery Code been fully complied with? ❑ Ves ❑ No 5. Does or will Ihe applicant or present or fuNre building occupant require for the work which is [he subjec[ of this application a permit for such construction or modifcalion from Ihe South Coast Air Qualily Management Oistric� or (rom any other air polWtion control dis[rict or agency? ❑ Ves � No (Section 65850.2 of the Calitomia Govemment Code requires thal lhe requested intortnation be fumishetl on applications fa non-residential builtling pertnits). 6. Will any part of the facility to be cons[ruc[ed under this permit be within 1000 (eet (rom the outer boundanes of a school? ❑ Yes ❑ No (I/'yes", the facility mus[ meet the requirement of Sections 25534 antl 42303 of the Califomia Health and Safety Code). 7. If a permit from the Sou�h Coast Air Quali[y Management Districl or other air polWtion conlrol disUict or agency is required for the work which is the suhject of this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf yes", attach certificate of compliance from the appropriate air polWtion control officer). � � -� CERTIFICATE OF COMPLIANCE: I certify�ihat under penalty of perjury the infortnation given above is cortect. I agree to comply with all state lavrs and city ordinances regarding Hazardous Malerials,antl Emissions. .�� SignaWre Date � CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury Ihat I have reatl ihis applicalion antl state that the information given is covecL I agree to comply with all state lavrs and ciry ortlinances relating to building consWction, and authorize representatives of [he Cily of Costa Mesa [o enter upon ihe above-described property for inspection purposes. I agree not to ocwpy or allow occupancy of any building authorized by this permit until final inspection. � � � SignaWreof egalOwn ) Date /� '/.�0% , -A G/orAut�onzedAppbcant �Date � �, P.IANDATORY MEASURES SUMMARY: RESI DESCRIPTION L �Page2 of2) MF-1R � Enfortt- Spafe Conditioning, Water Heating and Plumbin� System Dleasures: (con[inued) 5. Insolaiion must be proiteird from damaee, ineludine ihat due to sunligfit, moismrc, equipment maimenance, and wind. 6. Insulalion for chilled �ealcr pipine and re�iigerant suctinn pipin¢ indudcs a vapor re�arJani or is enclmed emircly in Z Solar ��ateo-heating systems/colleclors arecerti('icJ by the Solur Rating and Ceniliuutlun Coryoration. • yli0(m): DuctsandFans All ducLc and plenums installed, seuleJ and insulated ta meet the reyuiremtnl ofthe CMC Seclions 601, 602, 603, 601, 60J and SVWndard 6-5; supplyair and rewm-afr ducls and plenums are insulated Io a minimum installed levcl o( R-02 or enclosed entirely in conditioned space. Openings shall Ix sealed wilh ma�lic, ta�x or olher duc4closunrt system thal meets Ihc ypplicablc reyuircmems of UL I S I, UL 181 A, ur UL I81 B ar aerosol scal.mt lhat meels lhc rcyuiremenu oNL 723. I( 2. Bui�ding cavitics, suppon platlorms' Por air handlers, and plenums defned or constructed with materials other than sealed shcet metal, duct board or Ilexibk duct shall nut be used (or convcyin_ conditioneJ air. Buildine cavities and support pla�(orms may conWin ducls. Duc�s ins[aIIeJ in cavilies anJ support plm(orms shall nol be eompressed Io caus'e rcddadons in thc cross-scclional area o((hc duct>. 3Joints and seams of duct sys�ems and their cumponenls shall not be seaied with cloth back rubber adhesive duct tapes unitss such tape i> used in combinmion �cith mastic and draw bands. 4. ExN�ust Can sys�cros havc back dmll or au�umatic dampers. 5. Gra�'i�)' �'en�ilaling ryslems serving condilioned spatt huve ei�her aulomatic or reaJily acttssible, manually operaleJ 6, prolectwn ot Ins'ulation. InSWat�nn s'hall be protectetl liom Jumage, including Ihat due �o sunlight, maisture, equipment mmNenance, and wind. Cellular foam ins'ula�ion shall be protecmd as abovc or puinted with a coaling �huf is water retardant and pro�ides shieldine fmm solar radiation �hal can cause deerada�ion of Ihe material. 7. FleYible ducis cannof have porous inner cores. § I 14: F'ool and Spa Heabng Systems and Equipmcnt. I. A lhermal e(liciency �hai complies wilh �he Appliance F(�iciency Regulalions, on-o11�s�cilch mounted ou�side of lhe he:dee weathemmof uoera�ins ins�mclions. no ekclric rcsislancc heatine and nn nilni IivM 2. Sys�am is Installed with: a. at Icast 36" of pipc bcnvern �ilter and hcalcr for future solar heating b. ��'er for outdoor pools or ouidaor spas 3. Pool sy9em has Jirectional inle[s and a circulation pump time switch. $ I li: (»s fircd fan-type centml (umaces, poal hea�ers, spa hcalers or houschold buminK pdot IighL (Gxcep(iun: Non-eleclrical cnokin¢ appliantts with pilot < §IIS(i): CoolRool'materialmeelsspecifedcriteria no es�aenaai ��gnang:ir�easures: § Ii0(k) I: IIIGH EFPICACY LUMINAIRES O'fI lER "I�I IAN OU'iDOOR HIU: camain oniy high effcacy lamps as outlined in Table I i0-C, and do not coNain a medium screw base socAet ([:A/E26). Ballast for lamps 13 waus or greuter are ele�«onic and have an output freyuencv no less than 20 kHz g UO(k)�: HIGH EFFICACY LUMINAIRES - OUTDOOR I IIU�. comain only high eHicacy lamps as outlined in Table I50-C, IuminairehasfacloryinsfallcdHlDballast d Ii0(k)1: PertnaneNly fnstalled luminaires in kimhens shall be high efficacy luminaires. Up l0 50 percent o(the wauaec, as determined in § UO (c), of'permanently insmlled luminuires in kitchens may be in luminaira that are nol hieh e(ilcacy lumina�res, pmvided Ihat Ihese luminaires arc contmlled by swilches separa�e (mm Ihose conimlling Ihe high ef�icacy luminaires. SUO(k)3: Permanwtly insl.�llcd luminaircs in balhmoms, garages, laundry rooms and Wility rooms shall be high cfficacy lumina�res. OR arc control Icd by an occupam sensor(s) certified to comply with Seclion I 19(d) tha[ does not W m on aumm+dcallv or have an always on option. ' $Li0(k)a: Permanently inslalled luminui�es locuted other than in kitchcns, ba�hrooms, garages, laundry room5, and utilfry moms shall be high ef�lcacy luminaires (e�eepl close�s Iess ihan 70ft'): OR are contmlled by a dimmer s�citch OR are comrolleJ b}' an acupant sensor Ihat cnmplies �ci[h Section I 19(d) lhat does not Wm on aWomalically or ha�'e an ahcays on op�i�n. § I i0(A)7: Luminaires Ihat arc recessed into insulared ceilines are approved (or zero dcafance insulation cover QC) and are certilied airtfeht lo ASTA1 G2R3 and IabcleJ at air tiEht (AT) ro less �han 2.0 CFAI ai 7� Pascals. § 150(k)6: Luminaires providing ou�door Iighiing and permanemly moumed to a residenlial building or ro othzr buildings on the same lo[ shull be high eflicacy lumin�ires (noi ineluding ligh�ing amund swimming pool��caler feuWresor olher Article 630 localions) OR are commlled by occupaN sensors wiih imegral phoro control certified Io comply ��'ilh Section I 19(d), $ I50(k)7: Ligh�ing (or parkine lots fur 8 or more vehides shall have lighting that complies with Sec. 13U, 13Y, and Id7. Liehtine (or parAine earaees (or 8 or more vehicles shall hare lieh�ine �hm complies with Stc. 130 131, and W6. § UO(k)R: Permanemly inUalled lighting in Ihe enelored, namd�celling spuces' of low-rise msiJeNial buildine5 ��'iih four or more d��<Iling uni�s shall be hieh c(ficacy luminaires OR are controlled by occupant sensor�s) cenifieJ Io coinply with Scc�inn I19(dl. �0� �� V� C ResidenlinlCompfianee Fornrs , December7005 I\ �- ` � � • Name: Patricia Derby � CITY OF COSTA MESA Neighborhood Improvement Program Final Work Write Up 11/18/08 Home Phone: 949-548-6882 Propertv Address: 866 Darrcll Street Work Phone: N/A All work is to be done per City of Costa Mesa Building, Planning and Public Works Codes. In order to establish standards of quality, the detailed specifications may refer to a certain product by name and/or from a major manufacturer. This procedure is not ro be construed as eliminating from competition other products of equal or better quality by other manufacturers. The Contractor shall fumish the list of proposed desired substiwtions prior to signing the contract. All items lis[ed on the work description, unless otherwise specified, shall include all patching and finish work, including trim, hardware, patching and finish painting and/or s[aining. The Contractor is responsible for all permits, fees, City business licenses, plans, etc. City of Cos[a Mesa Standard Rehabilitation Specifications applies to all items listed on work description. Work Descri tion: I. Electrical Service: Upgrade electrical service panel to 200 amps to meet current electrical code requirements. Install 2 additio�al outlets in the living room and 3 additional outlets in the kitchen (owner will decide locations). Obtain all required ermits from the Buildin De artment. 2. Smoke Detectors: Provide and install smoke detectors in each bedroom (3). Kitchen: Remove existing wallpaper. Preq prime and paint walls/ceiling in kitchen. Owner to choose color of painL Remove exis[ing cabinets. Replace all modular, 42" high kitchen cabinets, install solid counter tops, back splash, replace free-standing gas range with double oven (brand to be General Electric or equal), microwave hood, and wall oven. Faucet to be American Standard or equal material not to exceed $125. See attached desiQn per owners' preference. Remove existing ligh[ fixtures and install 6, 5" fluorescent ligh[s with dimmer swi[ch. Install [ask lighting underneath the cabinets and over sink. Remove existing kitchen floor. Per industry standards, provide and install new tiled flooring. Owner to select style and rype of tile. Material allowance for tile not ro exceed $6 per sq. ft. Remove and replace kitchen"door and lock leading to rear yard. Remove and replace existing ki[chen window. Provide and install new Superior or equal, dual glazed vinyl window. Obtain all required permits from the 4. Living Room: Relocate existing ceiling fan [o cen[er of living room. Provide and install ceiling fan wi[h remo[e control, flush [o ceiling. Ceiling fan not to exceed $ I50. Per owner's preference. Install 9,new,5"—recessed=lights, white trim, with separa[e_dimmers in dining/living room. Remove„cap�and+drywalLto�cover exis[ing he�er. Prep, prime and paint walls/ceiling. Obtain all required ��"1 J $2,800 $19,000 $2,000 i. � � �< . � � ' N � 5. Front Bathroom: Remove and replace existing tiled flooring. Per industry s[andards, provide and install new tiled Flooring. Owner to select sryle and type of tile. Material - allowance for tile not to exceed $6 per sq. ft. Provide and install new water:closet; ( f aanity; fauce[ and medicine cabinet. Faucet to be American Standard or equal materiatt— � no[ to exceed $125. Replace existing recep[ac _le.with GFCI adjacent to vanity. Provide and install�4�new.recessed�ligh[swi[h�dimmer. Obtain all required permits from the Building Department � $3,000 6. Rear Bathroom: Remove existing, provide and install new�watercloset, vanity, faucet and medicine cabinet Faucet [o be American S[andard or equal material no[ [o exceed $125. Replace exis[ing receptacle wi[fi.GECI? Provide and install tiled flooring. Owner to select style and rype of tile. Material allowance for tile not to exceed $6 per sq. ft. Provide and install'4 recessed-lights�with dimmer. Relocate existing liglit fixturel (owner to specify location). Remove and replace ezistin� porcelain bathtub. ylnstall acrylic shower walls.;Remove exis[ing wall paper. Prep, prime and pain[ walls/ceiling. Replace any and all water damaged�framin`g members.iProvide and install new shower $4,500 valve. Obtain all re uired ermits from the Buildin De artment. 7. Flooring: Remove and dispose of existing carpe[, pad, and damaged tack strips, e[c. Provide and ins[all lamina[e Flooring throughout house (exclude kitchen and bathrooms). Material not to exceed $5 per square fooL Owner to choose color and style. S[ate Ihe approxima[e footage needed to complete work s uare foota e). $6,400 8. Bedrooms: Remove existing wallpapec Prep, prime and paint walls and ceiling. Owner to choose colors. Remove and replace ceiling fan�with remote conhol in master bedroom only (flush to ceiling). Light 1fixture/fan not to exceed $ I50 (per $2,200 owner's reference . 9. Exterior poors: Remove and replace front entry.and rear enhy screen doors. Provide and install new firont entry door (owner to choose color and styles of doors), thresholds and trim moldin�. $500 10. Interior poors: Replace 6 interior doors throughout s.f.d. with 6 panels, pre-hung doors and hardware. Sand, paint (owner to decide on color), replace thresholds and aim molding. $1,200 I 1. Patio Frame: Remove and replace exterior patio frame. Stain or paint [o match exis[infl trim owner to decide color . Ob[ain all re uired ermits. $ I,000 12. Trees: Remove existing trees located at rear of property (owner to specify which trees). Grind down stump to be level with rear yard landscaping. Stump to be treated wi[h herbicide or applicable growth inhibitor. Remove roots. Trim back front and rear yard vegeta[ion (owner [o specify which trees). Dispose of all $3,000 debris. TOTAL $45,700 I have reviewed the above work aescnption antl untlerstantl tha[ any changes, atltliLons or tlele[ions shall have pnor approval by [he City of Costa Mesa Neighborhood Improvement Personnel. Signature of Property Owner Date Signature of Contractor Date ti N � CITY OF COSTA MESA Neighborhood Improvement Program Final Work Write Up 11/18/O8 Name: Patricia llerby Pronertv Address: 866 Darrell Street Home Phone: 949-548-6882 Work Phone: N/A All work is to be done per City of Costa Mesa f3uilding, Planning and Public Works Codes. In order to establish standards of quality, the detailed specifica[ions may refer to a certain product by name and/or from a major manufacturec This procedure is not to be construed as eliminating from competition other products of equal or better quality by o[her manufacmrers. The Contracror shall furnish the list of proposed desired substimtions prior to sianing [he con[ract. AII items listed on [he work descrip[ion, unless o[herwise specified, shall include all patching and finish work, including [rim, hardware, patching and finish painting and/or s[aining. The Contracror is responsible for all permits, fees, City business licenses, plans, etc. City of Costa Mesa Standard Rehabili[ation Specifications applies to all items listed on work description. Work Descri tion: Estimate: I. Electrical Service: Upgrade elechical service panel to 200 amps to mee[ current electrical code requiremen[s. Install 2 additional outle[s in the livin� room and 3 addi[ional outlets in [he kitchen (owner will decide locations). Obtain all required $2,800 ermits from the Buildin De artment. 2. Smoke Detectors: Provide and install smoke detectors in each bedroom (3). $100 3. Kihhen: Remove existino wallpaper. Prep, prime and pain[ walls/ceiiing in ki[chen. Owner to choose color of paint. Remove existing cabinets. Replace all modular, 42" high kitchen cabinets, install solid coun[er tops, back splash, replace free-standing gas range with double oven (brand to be Gencral Electric or equal), microwave hood, and wall oven. Fauce[ [o be American Standard or equal material no[ [o exceed $125. See attarhed desiQn ner owners' nreferrnce. Remove existing light fixtures and install 6, S' fluorescen[ can lights with dimmer switch. Install [ask liah[ing underneath [he cabinets and over sink. Remove existing kitchen floor. Per industry s[andards, provide and install new [iled flooring. Owner [o select style and type of tile. Ma[erial allowance for tile not to exceed $6 per sq. ft. Remove and replace kitchen door and bck leading [o rear yard. Remove and replace existing kitchen window. Provide and $19,000 install new Superior or equal, dual glazed vinyl window. Obtain all required permits from the Buildin De artment. 4. Living Room: Relocate existing ceiling fan to center of living room. Provide and install ceiling fan with remo[e control, flush [o ceiling. Ceiling fan not to exceed $ I50. Per owner's preference. fnsfall 9 new 5" recessed lights, whife h'im, with separate dimmers in dining/living room. Remove, cap and drywall [o cover existing hea[er. Preq prime and pain[ walls/ceiling. Obtain all required $2,000 ermits from the Buildin De artment. M M 5. Fron[ Bathroom: Remove and replace existing [iled flooring. Per industry s[andards, provide and install new tiled flooring Owner to select style and type of tile. Material allowance for tile not [o exceed $6 per sq. ft. Provide and install new water closet, vanity, faucet and medicine cabineL Faucet [o be American Standard or equal material not [o exceed $125. Replaee esis[ing receptacle with GFCI adjacent to vaniry. Provide and install 4 new receSsed lights with dimmer. Obtain all reqoired permits from the Building Department $3,000 6. Rear Bathroom: Remove existing, provide and install new water close[, vanity, faucet and medicine cabinet Faucet ro be American Standard or equal material not to exceed $1 �5. Replace existing receptacle with GFCI. Provide and install [iled Flooring. Owner to selec[ style and type of [ile. Material allowance for tile not to exceed $6 per sq. ft. Provide and install 4 recessed lights with dimmer. Relocate existing light fixture (owner m specify location). Remove and replaw exis[ing porcelain bathtub. Install acrylic shower walls. Remove existing wall paper. Preq primeand paint walls/ceiling. Replace any and all water damaged framing members. Provide and install new shower $4,500 valve. Obtain all re uired ermits from the Buildin De artment. 7. Flooring: Remove and dispose of existing carpet, pad, and damaged tack strips, etc. Provide and ins[all laminate Flooring throughout house (exclude ki[chen and bathrooms). Material not to exceed $5 per square foot Owner to choose color and style. State the approsima[e footage needed [o complete work ( s uare foota e). $6,400 8. Bedrooms: Remove existin� wallpapec Preq prime and paint walls and ceiling. O�mer to choose colors. Remove and replace ceiling fan with remote conYrol in master bedroom only (Flush to ceiling). Light fixture/fan not to exceed $I50 (per $2,200 owner's reference). 9. Exterior poors: Remove and replace fron[ entry and rear entry screen doors. Provide and install new front entry door (owner [o choose wlor and sryles of doors), thresholds and trim moldin�. $500 10. Interior poors: Replace 6 interior doors throughout s.f.d. with 6 panels, pre-hung doors and hardware. Sand, pain[ (owner to decide on color), replace thresholds and trim molding. $1,200 i 1. Pa[io Frame: Remove and replace exterior patio frame. S[ain or pain[ to ma[ch existinQ trim (owner [o decide color). Obtain all re uired ermits. $1,000 12. Trees: Remove existing trees located at rear of property (owner to specify which trees). Grind down smmp to be level wrth rear yard landscaping. Stump to be treated wi[h herbicide or applicable growth inhibitor. Remove roots. Trim back fron[ and rear yard vegetation (owner to specify which trees). Dispose of all $3,000 debris. TOTAL $45,700 �� RES1D1 Project Title �� WS-SR At least 50% of the total rated watta�e of permanently installed'luminaires in he kitchen;°mus['• in luminaires that are high efficacy luminaires as defined in Table I50-C. Luminaires Ihat are not high efficacy mus[ be switched separately. Ki[chen Lighting Schedule. Provide tl)e following informa[ion for aIl luminaires to be installed in kitchens. = Hi�h Efticacv Watts or '�,.�L-. Yest� No❑ __�� x�� _ �_,� ln%/.S-6� or Yes 0 ❑ x = c� or �/Kc��-��- <-awp KY �� Yes No ❑ _��_ x � _ / Z '� or ' Yes p ❑ x = or r(x<'r o<<-�..'+- ( v s�� Yes No ❑ j'jj x .� _ �( E� or To[al: A: � Z "� B: COMPLlES IFA > B Rules for Determining Residential Kitchen Luminaire Wattage Other Wat[s No ❑ Screw Base Sockets §130(c�1 (Not containing permanently installed ballasts) The maximum relamping rated wattage of the luminaire, as listed on a permanent factory-installed label (luminaire wattage is not based on type or wattage of lamp that is used). Permanently or Remotely Insta�led Ballasts §130�c) 2 The operating input wattage of Che rated lamp/ballast combination based on values published in manufacturer's catalogs based on indepentlent testing lab reports. Line Voltage Track Lighting (90 through 480 volts) §130(c) 3 1. Volt-ampere (VA) rating of the branch circuit(s) feeding the tracks; or 2. For tracks equipped with an integral current limiter, the higher of; • The wattage (or VA) reting of an approved integral current limiter controlling the track system or • 15 watts per linear foot of the track; or 3. For tracks without an integral current limiter, the higher of; • 45 W per linear foot of the track or . The total wattage of all of the luminaires included in the system. Low Voltage Track Lighting (less than 90 volts) §130(c) 4 Rated wattage of the transformer feeding the system, as shown on a permanent factory-installed label Other Lighting §130(c) 5 (Lighting systems that are not addressed in §130 (c) 1�) The maximum rated wattage, or operating input wattage of the system, listed on a permanent factorv inStalled label, or published in manufacturer's cataloqs, based on independent testina lab reoorts. EXAMPLE RESIDENTIAL KITCHEN LIGHTING WORKSHEET Projec[ Title Date WS-SR Kitchen Lighting Schedule. Provide the following information for all luminaires to be installed in kitchens. Fligh Efficacy Luminaire Type (y/n) Watts x Quantiry = HiGh Efficacy Watts or Other Watts CFL-1 Yes 26 x 5 = 130 or MR-16 No .i.i x 2 = or 110 x = or x = or x = or Total: A: /30 B: I10 COMPL/ES /FA>_ B Yes a No ❑ Residen[ial Compliance Forms December 100� �� witr!- s,�,ps�: �Qu y� , �P ,��,r 3r�s�L � LoC ; � s✓AlC. i �� . q`'., , > This ae �� - � ( �� (� � w �. ��o �-o�s73 �-�U �t S -c_ c�'�� `� P�`" ��g �i0� .6 (�2 > � �`� . 6"� sr,��, Q 'rTs Z��—{ �!6 � Ly o .�. �y��,s�� ^� �� K.6 El0(�- Tr� /�' i p��.2 DIVlS10N OF B�IL'ISING SAFETY CI7Y OF COST ESA ��IAPP D c�_�r_ � � � �P�`CL'- i 3 �J�__.�_�� I �EnS and �ifiCaApns MUS7 bE kBpt 0111h15 j06 at 8A tirtM!5 2M 7113ICI arges oi a te2ibns on same wilhput wMten p0mi55ipn hom Ih2 DrviSq� d Cdy ot c,q.fe Mesa. �� s �` � ��sc� sc.apg �F w�'c� �i �(�e�-.�ve � r2e��C'rg t�xxi�sh�5 �a-hb ca.BZ , n-0 FiGS K� � RR-F�f� Ti�s �i.� �'f ( a C, f r� � �� CITY OF COSTA � 1GSA PLANNING DIVI�;ION SUBIECT TO BLDG. D�f�.PT. ItEG. NOTE: ADDITIONS, DFLIiT10Nti. OR CORRECTIONS SIiALL 13G APPROVED BY THE PLANNING DIV. 9y� . �'_/ ,/ //% iS{l. �� . T T�T'. / / �/� The s1e�4pirignliMsyiaya��t3esiNsaUer+�SHA6L-NQLbe Geltl w.pe�t oCfu.he en� of tlie violation o� any proJisions ol any Ciry ot Casta Mesa OrAinance anNor $tetp la�r. 71rese plens and permit sliall expue Dy limdation artd become nW! anC vatl A iha b�rp a w01k i6 no10011111B11C6d 8tld II66ABIIIBd 8dN6 pBf CBC SeG 1055 wIIMI 18(ld8y5 d�. �y � CITY OF COSTA MESA BI/ILpING DIVIS/ON . � i � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Fax p14) 754-4856 • www.ci.costa-mesa.ca.us - f °.�� FOR INSPECTIONS CALL: (714) 754-5826 . . _ PERMIT NUMBER: P09-00035 PERMIT TYPE PLUM STATUS: ISSUED ApN: 42236223 DATE ISSUED: 02127/2009 , ISSUED BY: KJB ^ .. _,_ � �,. ; �� , ` ;.- i .;1,' .� - . JOB ADDRESS: 866 DARRELL STiCM ;. ; Sutte/Unit vicinity: .�. < .... � R, SCOPE OF WORK: COPPER REPIPE FOR.KITCHEN AND 2 BATHROOMS ONLY REF: B,C08 00573 FOR ADDITIONAL WORK AT SITE. RE-PIPE FEE PAID,UNDER BC08�-00573. ISSUE FEE ONLY FOR � � THIS PERMIT DUE TO CHANGES REQUESTED PER CONTRACTOR. HOUSING PROJECT �."� i � � s ,; O NER: DERBY, PATRICIA ANN' ' , Address: �� _'' 866 DARRELL ST ._ �� PHONE: --' :�+ ` ;, ..�-��f- � City/State/Zip'-�-��..COSTA'MESA CA : �� ' �' � APPLICANT: MERRICK PLUMBING AND REMODELING Address 387 W BAY ST `�. � r., ; PHONE: 714-369-4002 . Ciry/State/zZip: COSTA�MESA,CA _ '"•k��.��3 a _ .. ,, .. .. . . .. _ . .. _..... , . . . . . . , ,... C4NTRACTOR MERRICK PLUMBING AND REMODELING -� ��License No. - 802626�-'�,. ' Adtlress: 387W�BAYST �:-� � � � - � - �� ' � " �' -- PHONE: �-714-369v1002 ;'� City/State: COSTA�MESA,'CA�� . ,,ZipCode. 92627,�, ; ,, ,,. CELL: � � � � +. • -� � .,.... �. . . . . . : . �.-�. ... ,... _ . ,.- - , -•- �- ' � - - -: i..a . � . , ARCHITECT: LicenseNo. � � ': P,HONE�-:�� ENGINEER: � LicenseNo. _ ,_ � - ' .pHONE.:�-� � ' . "y. i;: . -.. �, � . ':. . -'�:; �� ,:' : ,:, � �, � . PLUM8ING PERMIT FEE SUMMARY ' �:: . . , ,. PLAN CMECK FEE. r� , `'' ,$0.00' PERMIT FEE:k .' • ,:$23.50 TOTAL FEES: • ::fi!v`D!AL WGRK. $23.50 , '`}:�`.r:', � N4710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) � � EXPIRATION: PERMIT EXPIRES 180 DAYS FROM pATE OF ISSUE OR DATE OF LAST INSPECTION. , �� , 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 flnal approval must be obtained. Failure lo obtain inspections and final approval will result in the expiration of this permit. � CObE t iesvecnoqm� � iennni CODE/ INSPECTIONTYPE .. ._. �T ;' ,_ I_ "_V `� NI 717ULS ��1618 Piaed System Final Fire Prevention 206 Final Mechanical � i� � ,�I 1266 Pool Spa Final 208 Final Plumbing �' l 200 Final Re-Roof �.20� Final Block/Relaining Wall 202 Final Factory Fira Place 203 Final Sign 208 Final Demolition 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSite 250 Final Buildinq/Occupancy � WORKERS' COMPENSATION DECLARATION: . ' I hereby aKrm under penalry of perjury one of the following declaratlons: . ❑ I hava and will maintain a certificata of consent to self-Insure for workers' compansation, as provided tor Dy section 3700 ot the Labor Code, for the pedormance o( the work for which this permit is issued. ❑ I have and will maintain workers' canpensation insurance, as required by section 3700 of the Labor Code, for ihe peAortnance of the v,ork for vfiich this permit is issued. My vrorkers' compensation Insurance carner and policy number are: Carrier: /This sedm necd nd Oe m�np'efetlsNe pemt4 s va�uM af we huiMretl C�Bars (St00) a leu.) Policy Numb ' I certify Ihat in the pertortnance of the work for which this permit is � sued, I shall not employ any person in any manner so as to become subject to the workers' compensation lavrs of Califomia, and agree that if I should become subject to the workers' compe�sation provisions of Section 3700 of the Labor Code, I shall rthwith comply with these pronvisio is. v ! OOlipnl's Signalure Dale WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 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 Oivision 3 of the 6usiness and Protessions Code, and my license is in full (ojrce and eftect. Lic. # �� Z (/L� _ Class # r� i/�-t__/� � 21 �— Convanor's Signalure a�e CONSTRUCTION LENDING AGENCY: ❑ I hereby affum that there is a consWction lending agency for the pertormance of ihe woAc fv which Ihis perl�it is issuetl. (Sec. 3097, Civil Code). Lender s Name: Lender's Address: Sigrelure OWNER-BUILDER DECLARATIONS: I hereby affirtn tha[ under penalty of peljury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which requires a permit to constmct, alter, improve, demolish, ol repair any s[rvclure, prior to iis i5suance, also requires the applican[ for Such pertnit to file a signed statement that he or she is licensed pursuant to Ihe provisions of the Contractors License Law (Chapter 9(commencing wi�h Section 7000) of Division 3 of the BuSiness and Professions Code) or Ihat he or she is exemp[ therefrom an0 the basis for the allege0 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 ovmer of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and Ihe structure is not intended or offered for sale (Sec. 7044, Business and Protessions Code: The Contraclors License Law does not apply to an owner of property who builtls or improves thereon, and who dces 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 buildin9 or impr0�ement is sold within one year of completion, the owner-builder will have the burden of proving that he or she tlid 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: 7he contractors License Law dces rrot apply to an ovmer of property who builds or improves thereon, gnd who contracis (or such project vrith a coniracta(s) license pureuant to the Contractors Ucense Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: SignaWre 3059-d6(3/0]� Owner ID veriFied by drive� _.�cense. ❑ Ves ❑ No Driver's License No. Expires: Verification of Ovmership by (ty0e of tlocument, i.e. - property tax,bill or tleed): � DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: � - �. ❑ I hereby certify ihat no excavation (rve (5) or more feet in depth into wfiich a person is requiretl lo descend, will be matle in connection vrith v.ork authorizetl by this pertni�, and �hat no building stmcture, scaffdding, falsework, or demoli�ion or tlismantling [hereot, vrill be more than thirty-s& (36) feet high. (Chap. 32, Grp 2. Art 2, Sec. 341, T�le 8, Calitomia Adminis[rative Code). ❑ As owner-builder, I will noi employ anyone to do work which vrould require a permit fmm the Division of Industrial Safety, as noted above, unless such person has a permit to do such vrork from Ihe division. ApDlicanfs Signalure Division of Intlustrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuNre building cecupant neetl to file antl certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of ihe California Heallh antl Safety Cotle fequires, wilh some exceptions, tha[ a Business Plan be (letl 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 [o or grea[er l�an a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressed gas at standard temperature and pressure). 2. Does or will Ihe applicant or present or (uWre building occupant need to file a registration (orm for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 ot the Califomia Health and Safety Cotle, with some exceptions, requires regislralion vrith Ihe Costa Mesa Flre Department by each business which at any one time has on hantl a quanlity of awtely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas at slandard temperalure and pressure�. 3. Does or will the applicant or present or future building occupant neetl lo prepare an RMPP (Risk Management antl Prevention Program (or acutely hazardous materials)? ❑ Ves ❑ No (Section 25534 of ihe California Health antl Safery Code provides that the Costa Mesa Fire Department may require the preparation, certifcalion and filing with the Fire Department of an RMPP Dy businesses which are required ro regisler acutely hazardous malerials wiM the Fire Department. 4. If an RMPP is presently required, has Section 25534 0( lhe California Health and Safe[y Code been fully complietl with? ❑ Yes ❑ No 5. Does or will the applicant or present or fuWre building occupant require for the work which is the suDject of this application a permit for such conslruction or modifica[ion (rom the South Coast Air Quality Management District or fmm any other air pollution control district or agency? ❑ Yes ❑ No (Section 658502 of the Califomia Govemment Code requires that Ihe requested infortnation be fumishetl on applications fa non-resitlential building pertni�s). 6. Will any part of the facility lo be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No Qf'yes", Ihe facility must meet the requirement of Section5 z5534 and 42303 of the Califomia Heallh and Safely Code). 7. If a permit from the South Coast Air Qualiry Management DisMct or other air pollution control disvict or agency is requiretl for the work which is the subject of this application, have all of the disclosures prescnbed by Calitomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If'yes", allach ceAificate of compliance from the appropriate air pollution control oKcer). � � � . � � CERTIFICATE�OF COMPLIANCE: I certify lhat under penalty of perjury:lhe information given above is covect I agree to, comply with all state laws antl city ortlinances regarding Hazartlous Materials and Emissions: � � SlgnaWre CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and stale that ihe information given is correct I agree to comply with all state laws and ciry ordinances relating to building construction, antl authonze representatives of ihe City of Costa Mesa to eNer upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permi[ until final inspection. . . �SgnaWreofLegalOvmer(5) ale � (/�J\ p� � � �Olor Aut�onieC Applicam Dale CITY OF COSTA MESA ' ' BIIILDING DIYISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(�14) 754-5273 • Fax (714) 754-4856 • www ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: E09-00063 ' PERMIT TYPE ELEC STATUS: ISSUED APN: 42236223 DATE ISSUED: 03106I2009 , '';"ISSUED BY: BJK ' ' JOB ADDRESS: 866 DARRELL ST, CM `� ` Suite/Unit : Vicinity: SVS AT LEFT SIDE SFD _ , , f SCOPE OF WORK: HOUSING REH � � ,AB PROJEC7 j� - ��~� . . y � �.� � : CHANGE-OUT AN ELECRICAL SERVICE AT THE�.EEFT SIDE OF AN EXISTING SFD. 1 SVS TO 200A =' �* ` REF: BCO&00573 !F' ,. `x�"t�� 'rr _ -;; y , � - _ , � OWNER: DERBV, PATRICIA"ANN' Addresr... � 866DARRELL�ST �UmL'�•. �.,�:t PHONE: � � .`- ,��-,�-`� � �"City/State/Zip:. ,�'..,COSTA.MESA CA -� . , s ��y � 5 F...: . . •� . � � +'��, APPLICANT: GIACONE,�DOMINIC �' - Address: 26'1617THST�UnitUNITC �' PHONE: 714-969-3164 ��.�='� "�y�; ,`�,, ,,,,, ,, ,,,,CitylState/zZip::.�.:HONTINGTON�BEACH;�CA ?+° ., „ ...- -. , . .:.... . _. . . , , .,,.. ,. ;� y .._r . :.; : . .__.- . -, . . � . . � - - �� '- ' : .:, GONTRACTOR: DOMINIC THE ELECTRICIAN � �-- - - � � - - „ License No. ` 836576 � � Address: 261617THSTUnit:UNITC ��- ir� PHONE:� :7 City/State: HUNTINGTONBEACH CA- ` �'� , ,' ---��_ � �'-=� ' ZipCode:-9. .., ,� � . - . _. ... ..- , `-- CELL: .;5..' . ... . . ... . . . ELECTRICAL PERMIT.FEES Electrical Plan Check Fee '�� $0 00 ""� ': Electrical Permit Fee: ; ; $54 00. � ' Reinspection Fee ', $0.00 TOTAL FEES '$54.00. � ,- ".. ,',, � � ' 969-3164 ''� t8 '' - 9 NOTICE: The work authorized by this Dermit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) �� - EXPIRATION: PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. . . . INSPECTIONS: In order for the vrork authorized under this permit to be considered legal, such work must comply with all appliCable codes, and all �equired Inspections and final approval must be oblzined. Failure to obtain inspections and final approval will result in the expiration of this permit. SeQOEi. ixsv�cnaxrrre . . 1876 Fixed System Final Fire Prevenlion 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRelaining Wall 202 Final FaUory Fire Place 203 Final Sign 204 Final Demolition � ixmu�s C0� INSPEL710NTYPE 206 Final Mechanical 208 Final Plumbing 210 212 220 222 250 Final Electrical Final Fire Prevention Final Planning Approval Final Site Final Building/Occupancy o�g ixnnu � � WORKERS' COMPENSATION DECLARATION: ' I hereby aKrm untler penalty ot perjury one of the follovdng tleclarations: ❑ I have and will maintain a ceAificate of consent to self-Insure tor vrorkers' compensation, as provided for by section 3700 of the Labor Code, for the per(brmance of the work for which this permit is issuad. � � �9 6`� I have antl will maintain workers' compensation insurance, as required by sectbn 3700 of the Labor Code, for the peAormance of the v.ork for which this pertni[ is issued. My workers' compensation Insurance carner and policy number a!re: �Cartier J'%%�� 7/.///% (iha secfbn neeE nof be cwnyelM elhe peimi s vaWell at one hurMmtlWllars (StQ�) a less.) Po�icy.Number: �Q.i/� ZQ�/Z`tl ❑ I certify lhat in [he performance of the work for which [his permit is issued, I shall not employ any person in any manner so as to become subject to the vrorkers' compensation laws o( California, and agree that it I should bewme subject to the workers' wmpensation provisions of Section 3700 of the Labor Code, I shall lorthwith com vrith these pmvisions ��nm's 5�9remre a�e b . WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensetl untler provisions of Chapter 9(commencing wilh Section 7000) of Division 3 of the Business and Professions Code, antl my license is i2n full force and effect. Licl.# ✓�� Class�# � O �--�J b� �' S Cont2Ct0(s SignaWre �Oale— CONSTRUCTION LENDING AGENCY: ` ❑ I hereby affirm that there is a consWction lending agency fw the perfortnance of [he vurk fp wfiich this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender'S Adtlress: OWNER-BUILDER DECLARATIONS: I hereby affirtn thal under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW (or the (ollowing reason (Sec. 703L5, Business and Profe55ions Code: Any city or county which requires a permit to consWct, alter, improve, demolish, or repair any strucWre, pnor to its issuance, also requires the applicant for such pertnit to file a signed statement that he or she is licensed pursuant lo the provisions ot ihe Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business antl Pro(essions Code) or lhat he or she is exempt therefrom antl �he basis (or the alleged exemption. Any viola[ion of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than (ve hundred dollars ($500).): ❑ I, as owner o! [he property, or my employees with wages as their sole compensation, WILL DO THE WORK, and Ihe struclure is not intended or offered for sale (Sec. 7044, Business and Protessions Code: The Contractors License Law dces not apply to an owner o( property who builds or improves lhereon, and who does such work himself or herself orthrough his or her own employees, provided that such improvements are not intended or offered for sale. If, �owever, ihe building or improvement is sold within one year of completion, ihe owner-builder will have the burtlen of proving that he or she did not build or improve for purpose of sale.). , . ❑� I, as owner of the property, am EXCLUSIVEI:Y CONTRAC7ING WITH LICENSED CONTRACTORS to construct the pmject (Sec. 7044, Business and Professions Code: The wnt2ctor5 License Law dces not apply to an rnvner o( property who builds or improves thereon, and who cont2cts for such prqect wi[h a contractor(s) license pursuant lo Ihe Contractors License Laws.).. ❑ I am exempt under sec. Business and Professions Code for Ihis reason: 3051-66(3I01) Owner ID verifietl by drivets ��cense. ❑ Yes ❑ No Driver's License No. Expires: - Verifca[ion of Ovmership by (type o( documenl, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � � ❑ I hereby certify ihat no excavatan frve (5) or more feet in tlepth into wfiich a person is required to descend, will be made in connectbn with work authonzed by �his permil, and that no building sWcture, scaF(dding, falsewoB, or demolition or dismanHing thereof, will be more than ihirty-six (36) feet high (Chap. 3.2, Grp 2, Art 2, Sec. 341, Ttle 8, Califomia Atlministrative Code�. ❑ As owner-builder, I vnll not employ anyone to do vrork which would require a permit from lhe Division oF Industrial Safety, as noted above, unless such person has a permit to do such vrork from the division. Applicanl's Signature Date Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building xcupant neetl [o file antl certity a Business Plan for emergency response to release or threatened release of a hazardous matenal? ❑ Yes ❑ No (Section 25505 0� the Califomia 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 quantiry of hazardous materials equal to or qreater than a weight of 500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressed gas a[ standard temperature and pressure). 2. Does or will the applicant or preseN or (uture buildinq occupant need to fle a registration fortn for acutely hazartlous matenals? ❑ Yes ❑ No (Seclion 25533 0( the California Healih and Safely Code, with some exceplions, requires registretion with the Costa Mesa Fire Department by each business which at any one [ime has on hand a quantity of aculely 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 a� standartl temperature antl pressure). 3. Does or will ihe applicant or present or fuWre building occupaM need to prepare an RMPP (Risk Management and Prevention Pmgram for acu�ely hazardous ma[erials)? ❑ Yes ❑ No (Section 25534 of the Cali�omia Health antl Safety Code provides that the Costa Mesa Fire Department may require the preparalion, certification and fling with [he Fire Department of an RMPP by businesses which are required ro register awtely hazardous materials with [he Fire Department. 4. If an RMPP is presently requiretl, has Section 25534 of Ihe Cali(omia Healih and Safety Code been fully complied vrith? ❑ Yes ❑ No 5. Does or will lhe applicant or present or (uwre building occupant require for lhe work whiCh is Ihe 5ubject of Ihis application a pertni[ fOf SUCh COnStfUclion or motlifcation (rom the Soulh Coast Air Quality Management Disirict or from any other air polWtion control disMct or agency7 ❑ Yes ❑ No (Section 658502 of the Califomia Govemment Code requires that the requested intormation be fumished on appliwtions for rron-resitlential builtling pertnits). 6. Will any part of the taciliry to be consWc[etl under Ihis pertnit be within 1000 feet from the outer boundaries of a school? ❑ Ves ❑ No pf'}ies", the facility must meet the requirement of Sections 25534 and 42303 of the Calitomia Healt� antl Safety Code). 7. If a permit Gom the South Coast Air �ualily Management District or other air polWtion conhol district or agency is required for the wnrk which is the subject o( this application, have all o( ihe disclosures prescribed by California Heallh and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf "yes", attach certificate of compliance from the appmpriate air pollution coMroloKcer). ' � � ' � •�� CERTIFICATE OF COMPLIANCE: I�certify that under �penalry of perjury the information given above is covect. I agree to complyynth all state laws and ciry ordinances regarding Hazardous Materials and. Emissions. � , SignaWre ' Oa�e ' - CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury Ihat I have read this application and sWte Ihat the information given is correct. I agree lo comply with all state laws and cily ordinances relating [o building consiruclion, antl au[horize representatives of [he Cily of Costa Mesa to enter upon the above-0escnbed _property for inspection purposes. I agree not to occupy or allow occupancy of any building authonzed by this pertnit un[il final inspection. . . SignaWreofLegal eqs) �a � � �obof AnG/orAut�onzetlAppliranl. � ale.�� . OWNER Pt7IS1OL ESTAL'ES DATE 9-5-5(� JOBADDRESS 8E�6 Jy,ppell Street BUILDINGPERMITNO. �3�JZl GENERALCONTRACTOR S, V, I�Iunsalcer VAWE $ ��J6.�� oT 77 s�ocK TRACT 2873 Single Res. w,latt, gar. GROUP I g J TypE V ZONE R� FIRE DIS7RICT 3655 PERMITSISSUED INSPECTIONS DATE SUBCONTRACTOR DATE I NUMBER Footina Trench Y�e�✓S 9^� �' Foundation Formsand Gradeto Plumbing, Rough to Slab " Plumbing, Rough Complete Pole Wiring, Rough //Gry%j (•/6�i� � �'- � �.�.Zd• �%� -C� S� . �.�7 .3 � ..,..- Heatina. Rou9h < i'Yl L.°S /t//� ic �,..n 0�il%0 .. R- /"Y-. �G � 5/ i�U — Hause sewer, st. /p � j p"//6 6/F-�l,� �"`�C t: •.- /p � y_,C 6 %� 9.i '— Tank o esspo �/j7 � S /D / � �i'�„Ga. , � �7- CoEA /O� �f'i �� %� 9.0 — a.ln OuYx e�..� � � � �.i..' �� P Plumbing,Final,FixturesComplete}Y��$ �1�2i Plumbing, Fin,al GasTest / S�� V9�5 �2';�,� Wirinu. Final .CCil�� i� ii.. FORM 210 3M 10�•v5 ►osta Mesa Building Department APPLIGATION FOR PERMIT ► P.o.g°=3'' .4R.�5 �UILDING 'f COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN Receipt No. Permit No. ss P �O .4 -` L � �o � Costa Mesa, ri�011118, Receive by Date Rec'd. Date Issued st - �j � �� S � St. // c. "` /'✓ ' fj Building Address � � _'p T �- � ES CostaMesa,California Architector � Engineer Address � c�ou . �//.� Zone Lic. ach Metes and Bounds) No. of Bldgs of Lot /_� Jj %OG Naw on Lot 0 of No.of No.of ;ting Bldg. `—� � Fa}��Iles I Rooms iackLinefrom / RearYard ,2,�-' [e�niRfronh .lrli S:wev...w _ . New Addition .....y .... / Size �Q/'�/ Rooms �- Stories Exterior Wall I Roof CORRECTIONS Covering �� Covering / APPR,QVa�s Use of New / ' Foundation Location Inspector � Date Building � —�/ /L A< = L ir Forms, Materials, /'e� �y Under-PlnNng � �✓-- Freme: Fire Stops, Bracing, Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply Lath. Int - with all City Ordinances and State Laws regulating building construction. �ath. Ext Signatureof � Permittee i �' �/-l..P�� . , _ �� Plaster, InL Authorized Agt. - , p,� plaster, Ext Valuatian Permit Fee $ ,� a._- Masonry Reinforoed $ �'��; j GO TotaCheck $ '--"' ga�d Beam J c:i't_ Fee �� FINAL RM R09 10-05 D. G. & 5. NER BLACKR[1RN� ROBERT M. DATE �-28-E B ADDRE55 fi6Fi Darrell StrePt BUILDING PERMIT AP No. LOT TRACT FIRE ZONE VALUE INSPECTIONS Signar�re Dote GROUP .T TYPE SOIL �.�, �-1� �UGI.VI'l l RXI.I VR ROUGH PLUMBING PROP. $WR. LINE � HOUSE SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AN� AIH C01 UNOERGROUND U P ROUGH WIRING TRENCHES � FORMS FLOOR SYSTEM BONO BEAM � STE SHEATHING FRAME ANO FLASHING � i PLASTER, BROWN COAT ciuei HEATING. VENT., REFRIG. �� 27978 �COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. 80% 1200 � C09TA MESA, CALIFORNIA 92626 I Far Appticanf to F1Y In Comple�aly TYPE OR PRINT a��Na �� A-� ��L(. �T ADDRE84 COSTA MESA, CALIFORNIA � w du �:1Z i� GRlACR LIX[ fROY NO. 01 �LOO�. NOW ON lOT DESCRIPTION OP WORK NO.OP � HXTERIOR WALI � / O �� a'i cf-�i: � xEnear wcecnow�.eoos Tx r�e n R AND sTATB TH�T TN6 AGOVt 1� CORRHC' � PLY WITX ALL cITY OPDIMANCU AND iL BUILDINO CONBTRYRIO)l.�• � �uinortrz¢n watrrr APPLICGTION oFc 27�7°-�,00 95r �*a•*•3:00 APPLICATION FOR PERMR BUILDING For Offico Uss Only n�ci�rteo. r ' ZONING ZON6 MO.OF Y6tO�N[W �j 2_t PLAIU 7j OU�LDINO 1%�TIU nucn�moh I�c'r �%�Tra�.� L�?'.� A.P.NO. ( �� S1 L� ZJ N0T6: NO 6AV6 OV[RXAN6 BHALL BH Ll88 THAN YARDBAPPROVHD MAIN BUILDINO vwn. ti 0 YARD9 MPROV 6D I , AGCEIISORY BUILDINO owre e PRvv6 ^-- DATS �� i.�I - i � a w � so. ar. � � TN8 AMOUIR GXOWN UNDCR VRLVATION 16 POR TH8 1 �UpP098 OP f8T/�BLIBNINO A PCqMIT F88 ONLY. ; VALUATION � .r� � /� � PERMIT FEE J �— p 0 s w 0 �