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Home My WebLink About356 16TH PL - Building Permits� � CITY O � COSTA MESA (.��'TpMFq BUILDING DIVISION >�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(774) 754-5273 • Fax (714) 754-4856 • www costamesaca.aov °y�+�o� FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BC11-00417 PERMITTYPE: B COMBO STATUS: ISSUED Sub Type: RES_ALT DATE ISSUED: 10/1312011 ISSUED BY: RMD �oe aooaEss: 356 16TH PL CM APN: 42519219 Vicinity: Const Type: V-B Zoning: , , SQ. FT: 2566 SuitelUnit: Primary Occ: Valuation: $182,277.90 SCOPE OF WORK: ADDITION TO A 1-STORY DUPLEX, UNITS "A" AND "B" TO ADD A NEW 2ND FLOOR AND ADD 805 SF ATTACHED GARAGE. EXISTING UNIT "A" IS 710 SF; ADDED SQUARE FOOTAGE WILL BE 1,412 SF; TOTAL SQUARE FOOTAGE FOR UNIT "A" WILL BE 2,122 SF, EXISTING UNIT "B"IS 710 SF; ADDED SQUARE FOOTAGE WILL BE 349; TOTAL SQUARE FOOTAGE FOR UNIT "B" WILL BE 1,059 SF. ADDITION IS A NEW SECOND STORY; UNIT "A" WILL OCCUPY 1ST FLOOR AND A PORTION OF 2ND FLOOR; UNIT "B" WILL BE 2ND FLOOR OCCUPANCY ONLY. 2 FAU @ OR < 100K BTU, ALTER/REP DUCTING, KITCHEN HOOD, 2 FACTORY FIREPLACE, 3 VENT FANS, 2 REFRIG SYST @ OR <100K BTU, 25 LIGHT FIXTS, 30 OUTLETS, 25 SWITCHES, 5 COMM DROPS, 2 BATH TUB, GAS OUTLETS (1-4), 2 SHOWERS, 3 WASTE/VENT, 3 WASH BASIN, 3 WATER CLOSET, 1 WATER PIPING, 1 LqUNDRY TUB/WASHER. REF: DR-11-O6 OWNER: GEYER, JOHN AND ELIZABETH Phone: 949-262-2912 APPLICANT: GEYER, JOHN Phone: 949-262-2912 Address: 356 E 16TH PL CirylState2ip: COSTA MESA, CA Address: City/State/zZip: CONTRaCTpR: CAMRON EN7ERPRISES INC License No. 935955 Phone: 949-262-2912 Address: 17 CALVADOSUnit: Cell: Ciry/Slate: NEWPORT COAST, CA ARCHITECT: JULIE CHAMBERLAIN ENGINEER: JAIK CH01 AND ASSOCIATES COMBINATION PERMIT FEE SUMMARY Building Plan Check: Building Fees: Electrical Fees: Mechanical Fees: Plumbing Fees: SMIP Residential: SMIP Commercial: Bldg Std Admin Fund TOTAL FEES: license No.C22332 License No.S2049 $948.06 $1,458.55 $109.60 $150.50 $196.25 $18.23 50.00 58.00 $2,889.19 UniC Unit . ZipCode 92657 PHONE:949-274-1985 PHONE:949-951-2522 regulations. (Ord. No. 92-28, § 7. 12•21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for lhe work authorized under this permit to be considered legal, such work must comply vnth all appliwble codes, and all required inspections and final approval must be obtained. Failure to obiain inspections and fnal approval will result in the expiretion of this permit. CO�E /. INSPECPON tYPE 1616 Fixetl Syslem Final Fire Preventi0n 1268 Pool Spa Final 200 Final Re-RooF 201 Final qlock/Retaining Wall 202 Final facfory Fire Place 203 Final $ign 20d Final qemolition Iq7[ N R 4onE� INSPEC710NTVPE 206 Final Mechanicai 208 Final Plumbing 210 Final Elecvical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy Q07E �NTI71RL5 �3� WORKERS' COMPENSATION DEGLARATION: I hereby aKrm under penalry of pe�ury one of the lollowing declarations: � ❑ I have antl will maintain a certifcate of consent to sel4lnsure (or workers' compensation, as provided tor by section 3700 0( Ihe Labor Cotle, for the pertormance of the work for which this permit is issued. ❑ I have and will maintain vrorkers' compensation insurance, as required by section 3700 of the Labor Code, for the peAormance of �he work for which Ihis permit is issued. My workers' compQnsation Insurance carrier and policy numher are: /- � Carrier.� �/� hG/�l.Cf" (This secAon nee0 nW ba mm/pktetl a-ttre7 ce-7mM is reh�eCat wre nulMretl a�9ers (f f001 or kssJ Policy Numher: ��Cn��/ / ❑ I certiry that in the pedormance of the vrork (or which this permit is issued, I shall not employ any person in any manner so as lo bewme subject lo ihe worker ' ion laws o( Califomia, and agree that it I should � becom ject to e wo ers' ompensation provisions of Section 3700 of th abor Cod hall fo comply with these pr/ovisioMns. � 1� % S'�/ Appliton ignaWre Oote WARNING: FAIIURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SUBJECT 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 IP.BOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRAGTORS DECLARATION: I hereby aKrm that I am licensetl under pmvisions of Chapter 9(wmmencing vrith Section 70Q6)-o(.Division 3 of Ihe Business and Professions Code, and my licens �s5n ul i � and eHect. t Class # � �� Com aYs Signawre � Date CONSTRUCTION LENDING AGENCY: ❑ I hereby affrtn that there is a wnsWction lending agency for the peAortnance of the work for wliich this permit is issuetl. (Sec. 3097, Civil Code). Lende/s Name: Lendels Address: SignaWra Date OWNER-BUILDER DECLARATIONS: I hereby aKrm that under penalty of Oerjury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for the tollovnng reason (SeG. 7031.5. Bu5ine55 antl Professions Code: Any city or counry which requires a permit to wnstmct, aller, improve, demoli5h, or repair any slructure. prior to its issuance, also requires the appliwnt for such permit to file a signetl stalement �ha� he or 5he is licensed pursuant to Ihe provisions ot �he Contrectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt Ihere(mm and the ba5is for the alleged exemption. My violacion of Seclion 7031.5 by any applican� (or a permit suhjects Ihe applicant to a civil penalry ot not more than fve hundred dollars (5500).): ❑ I, as owner ol the propeM• or my employees vrilA wages as their sole wmpensation, WILL DO 7HE WORK, antl the struclure is not intended or oHered for sale (Sec. 7044, Business antl Professions Cotle: The Contractors License Law does not appry to an owner of property who builds or improves ihereon, and who does such vrork himself or herself or through his or her ovm employees, provitletl thai such improvements are not iNended or offered for sale. If, however, Ihe huilding or improvement is sold wilhin one year of completion, the owner-builtler will have the burden ol proving thai he or she did not build or improve for Ourpose o� sale.). ❑ I, as owner of the property, am E%GLUSIVE�Y CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The wntractors License Law does not appty to an owner of pmperty who builds or impmves thereon, and who contracts for such pmject with a contractor(s) license pursuaM to ihe ConVacto2 License LawsJ. ❑ I am exempt under sec. Business and Professions Code for this reason: SiB�awre 305]�46 (3I0]) Owner ID verified by driver'S IiCense. ❑ Ye5 ❑ No Oriver's License No. Expires: Ven(cation ol Ownership by (rype of document, i.e. - Droperty tax bill or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION: ❑ I hereby certily ihat no exCavation fve (5) or mo�e fee� in depth into which a person is required to descend, will be made in connection with work authorizetl by ihis permit, and ihat no building sWCWre, scattolding, falsework. or Oemolition or dismantling thereof, will be more than thirry-su (36) (eet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Califomia Atlministrative Cotlej. ❑ As owner-builder, I will not employ anyone to do work which would require a permit fmm the Division of Industnal Satety, as noted above, unless Such per5on has a permit to do such vrork from �he divi5ion. Appliwntb Signature Date Division of Industnal Safety Permi( Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will ihe applicant or present or (uture building occupant neetl to file antl certiy a Business Plan for emergency response to release or threatened release o/ a hazardous material? ❑ Yes ❑ No (Seclion 25505 of the Cali(ornia Health and Sa(ery Code requires, vnth some exceptions, that a Business Plan 6e filed vrith the Costa Mesa Fire Depariment by every business which has at any one time during a reported year a quantiry of hazardous materials equal to or greater Ihan a weight o( S00 pounds, or a volume of 55 gallons, or 200 cubic feet ol compressetl gas at stan0artl temperaNre antl pressure). 2. Does or will the applicant or present or fuWre building occupant need to file a registralion form for acutety hazardous materials? ❑ Yes ❑ No (Section 25533 of the Calitornia Health and Safery Code, vrith some eaceptions, requires registralion wi�h �he Costa Mesa Fire Department by each 6usiness which at any one time has on hand a quantity o( acutety hazardous materials equal lo or greater than a weig�t of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of wmpressed gas at standartl temperaWre and pressure). 3. Does or will the applicant or present or (uWre building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazartlous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health antl Safery Code pmvides that the Costa Mesa Fire Department may require the preparation, certification antl fling wit� the Fire Depariment of an RMPP by businesses which are requiretl to reBister acutety hazardous matenals with the Fire Department. 4. If an RMPP is presenty requiretl, has Section 25534 of ihe Califomia Health antl Safery Code been fulty complied vrith? ❑ Yes ❑ No 5. Does or will the applicant or present or fuNre builtling occupant require for Ihe vrork which is the subject of this application a permit br such consiruction or modi(cation from the South Coast Air Qualiry Management District or from any other air pollution control tlistnct or agency? ❑ Yes ❑ No (Section 658502 of the Califomia Govemment Cotle requires ihat lhe requested infortnation be fumished on applications for non�residential building pertnits). 6. Will any part of the faciliry to be consWcted untler this permil be within 1000 feel from Ihe outer bountlaries of a school? ❑ Yes ❑ No (It'yes', the facili�y must meet the requirement of Sections 25534 and 42503 ol the Calilornia Health antl Satety Code). 7. II a permit from the South Coast Air Oualiry ManagemeN DisMct or other air pollulion conUol disMct or agency is reQuired (or lhe vrork which is the subject ot this application, have all of the disclosures prescri6ed Dy Califomia Health and Satety Code Seclion 42303 been matle? ❑ Yes ❑ No 8. (If'yes', attach certifcate of compliance from the appropriale air pollution control oKcer). CERTIFICATE OF COMPLIANCE: I certity that under penalry of perjury the intormation given above is correct. I agree to comply vrith all state laws antl city ordinances regarding Hazardous Matenals and Emissions. siqozWre oate CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penalry of perjury that I have reatl this application and slate that [he information given is correcL I agree ro comply wilh all slate laws and city ordinances relaling to building construction, and authorize representatives of Ihe Ciry of Costa Mesa to enier upon the above-describetl property (or inspection purposes. I agree not to occupy or allow occupancy of any building au�horized b� i mit until fnal inspeclion. Si reofLe wner(s) Da:e /�i J3-��_ MG/or A rizetl Applicanl Dale ....�.... . . _ ,v, � . .. ' � �� ,�,: \ _J NEWPORT-MESA UNIFIED SCHOOL OIS7RICT CERTiFICA7E OF COMPl1ANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 ANO AB 181 To: (✓} City of Costa Mesa ( ) City of Newport Beach { ) Counry of Orange Applicaht: CGtM�� jt1 io-iJ-Goiiio2:lr-, r'%i USER : F;S t1�'? 7�p�5��4� s l �1 �j �D(P strid Receipt No. � I I -avN i 7 Plan Check No. Address: l/ 1/tilv��(,rr�� )v�1/"Yv� r � ou��T �.�- �1 �l/rJ / TelephoneNumber: � I� v`v�� J I L TracVParcel and Lot Number(s): �'I ZS � �� 2 ' ��'j Location ot Project: 3s� �� Number o/ Square Feet of: Residen0al Space Commercial and Industrial Space CommerciaNndustrial Project is: (Check One) _ Warehouse R8D _ Movie Theater _ Mini-storage _ Heavy IndusVial _ Regional Shops _ Light Industrial _ This project is exempt because ��f �51.84 xS.30 � Motel Bank _ Neighborhood Shops _ RacqueVHealth _ Hotel Medical Olfice Oifice Park This certifies that the above-named Developer/Appficant has paid school faatity 53080 and 65995. The Build'mg Pemi� for this square footage in this proposed d Checks are to be made payahle to Newport-Mesa Unified School Distriet. AuC�orhad The above representatlon as to square footage is We. Appticant aprees true, then this certificate shall automatically tertrinate and the appry�A: Date: �� '"�/ Ta,�� , � �-I U .2 � Total Preschool Auto Repair Hospital Large Ofice 016ce Bldg. RestauraM FastFood comptiance wiM Govemment Code sections nent may now be issued by your jurisdic8on. detemrned that such representations are not shall be notified. . r . � '1 Job Address: Suite No Vicinity: 356 16TH PL KITCHEN AND BATHROOM UNIT A AND B Parcel Nunmber: 42519219 Applicant: KAYLOR, GLENN Address: 356 E 16TH PL COSTA MESA, CA " Owner. KAYLOR; GLE�NN _. Addrpss 356 E 16TH PL � ' � COSTA MEBA, CA, ,' Contractor: Address: ISSUE FEE Temp service tesl Res. a/c package New Res (1-2 un�ts) New Res (3+uni�5) Pool / Spa Lighting Fizls Recept Outlets Switches Non Res Appl Res Appl , Service to 200a Service to 1000a Service over 1000a Motors to 1hp � Motors l0 10hp Motors to 50hp Motors to f 00hp ' Motore over 100hp Communiwtion drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole OWNER-BUILDER Phone: 949-212-5721 Zip 92627 Phone: 949-212-5721 Zip: 92627 Phone: Zip: License: 000000 status: ISSUED Applied: 01l302007 Issued: Ot/30l2007 ISSUED BY: �Xp � � � g�� SCOPE OF PERMIT ELECTRICAL PERMIT TO LEGALI2E A BATHROOM AND KITCHEN REMODEL TO UNITS A AND B FOR A DUPLEX. WORK TO INCLUDE THE CHANGE OUT, ADDITION AND RELOCATION OF 15 LIGHT FIXTS, 30 OUTLETS AND 8 SWITCHES. 823.50 $0.00 $0.00 $0.00 $0.00 50.00 $16.50 $29.30 $8.80 $0.00 � � ;$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ' $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QuanUty 0 0 0 15 30 B 0 0 0 '0 0 0 0 0 0 �0 0 � 0 0 0 , 0 0 FEE SUMMARY Temp Dis� System / Lighting Busway/100fl Standing Sedion Misc Eledriwl Equipmen( Transtormers up to 1 kvalkw ................up to 10 kvalkw .................up to 50 kva/kw .................up to 100 kvalkw � ..................over 100 kvalkw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspeclion Fee Quantlty 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 50.00 TOTAL CALCULATED FEES 578.10 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under regulations. (Ord. No. 92-28. § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if H Por a period ot 1 BO days. statutes and related is suspended or abandoned INSPECTIONS: In order for the work authorizetl untler this permit to be consitlered legal, such work must comply with all applicable codes, and all requiretl Inspeetlons antl flnal epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 znasas (srool �J WORKERS' COMPENSATION DECLARATION: � I �ereby aHirm under penalty oi perjury one of the following tleclarations: ❑ I have end Will maintain a ceniliwte ot consent to salf-Insure for workers' compensation, es provitlad for by section 3700 of ihe Labor Code, for ihe performance of ihe work lor whiGh �his pertnit is is5ued. ❑ I have and w��l maintain workers' compensation insurence, as required by section 3700 of the Labor Code, �or the pertortnance of the work br whkh Nis permit is issued. My workers' wmpensation Insurence carrier and policy number are: Carriar: PWiry Num6er: (This section need �ot be comp/etetl i/ the permit is valuetl ef one hundretl tlollars (5100) or less.) rtily.that in Ihe pertormance of t�e work tor which this permit is Issuetl, I shell not employ any person in eny menner so as to bocome subject to the workers' ipensetlon laws of Calitomia, and agree thet il I should become sublect to Iha workers' compensation provisions ol Section 3700 of Ihe Labor Code, I s�ell lorihwith iply wlih Ihese Or isRi n�s. Signeture: / — Date:- - I ' � S - U � �FNIWRE TO SE URE WOPKEPS' COMPENSATION COVERAGE IS UNLAWFUL AND SHPLL SUBJECT PN E� YER TO CRIMINAL PENALTIES AND CIVII FINES UP TO QYE HUNORED ) pOLLARE �E100,000), IN ADDITION TO TME COST OF COMPENSATION, DAMAGES AS PROVIpED FOR IN SEGTIIXJ 3]O60F THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES. LICENSEO CONTRACTORS DECLARATION: I herehy alfirm Ihet I am licensetl untler provisions of Chapter 9(commencing wilh Section 7000) of Division 3 ot the Business antl Prolessions Cotle, and my license is in tull torca and eflect. Lic. N Class x Comrac�ols Signe�ure: Date: CONSTRUCTON LENDING AGENCV: ❑ I hereby aNirl� that there is a construction lentling agency lor the performance ol the work for which this pertnit is issuetl. (Sec. 3097, Civil Cotle). Lenders Neme: Lentler'S Address: SigneWre: Date: OWNER-BUILDEF DECLARATIONS: I hereby eflirm ihat under penalry oi porjury fhet I em EXEMP7 FROM TNE CONTRACTORS LICENSE LAW br ihe following reason (SecJ031.5, Business antl Professions Code: Any ciry or counry which reQuiros a Dermit to constmcl, alter, impmve, demolish, or repair eny stmcWre, p�or to its issuanca, elso requires tha applicant for such permit to lile e signed statement that he or she is Ikensetl pursuant to the pmvislons ol ihe Contrectors License Law (Chapter 9(commencing with Section 7000) of Divislon 3 of Iha Business and Profeuions Cotle) or that he or she is exempt therefrom and t�e basis for ihe alleged exemption. Any violation of Section 7031.5 by any applicant tor a permit w6jecis ihe applic9�� o e civil penalry of nol more than five hundred dollars ($S00).): �'%^`I'as owner o� the pmperry, or my employees with wages es Iheir sole compensation, WILL DO TME WORK, antl Iha siructure I5 not inianded or oHered lor sale (Sec. 7044, Business end Professions Code: The Coniractors License Lew does not apply to an owner of property who builas or improves thereon, and who tloes such work himself or he�self or Ihrough his or her own employees, provitled that such improvements are not intended or oHeretl br sele. If, however, ihe huilding or improvement is sold wit�in otle yaar of comple�ioq the ow�er-builtler will heve the hurtlen ot proving that he or she did not 6uild or impmve tor purpose of sale.l. ❑ I, as owner o� ihe propeny, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to cons�rucl ihe project (Sec. 7044. Business and Professions Code: The contracbrs License Law tloes not apply en owner ol property who builds or improves thereon, and who contracis for such projeci with a comrador(s) license pursuenl to the Contredors License Lawy� ❑ I em examp � er se � Busineu and Pmfessions Code lor this reason: Signeture:.- OwnerlD venf by dnver's license. Ves ❑ No L_DrivafsYicense No. � '� � Veriliwtion of Ownership by (�ype ot tlxument, i e. - pmparty Iax bill or deed): � -io DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity that no excavation five (5) or mora teet in depih inm which e person is required to descenq wlll be matle in connection with work authorizetl by Ihis permit, antl tl+et no builtling sWcture, scaHolding, falsework, or damolition or tlismantling thereof, will be more than ihiny-six (36) leet higR (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, California Atlminisiretive Coae). ❑ As owner��uiltler, I will not employ anyone to tlo work which would reQuire e permit irom the Division ol Intlustriel Selety, as noted above, unless such person has a permit to do such work fwm Ihe tlivision. SignaWre: Date: Division ol Industn2l Salery Permit Number. CERTIFICATE OF COMPLIANCE AND AURiORIZATION OF ENTRY: I certity under penalry oi perjury iha� I have read this epplication antl sla�e Ihat ihe informa�ion given is wrrect. I agree to compl wiM all state laws end ciry ordinances relaling to builtlinq consiruction, and emhonze representalives of Ihe Ciry of Costa Mesa to enter upon ihe ebove-described prOpe t/o�V� insp�Gwn'ptiryoses. � agree nol to occupy or allow occupancy of any builtling authonzed by Ihis permit until final inspection. / _.�_._ '_' ' � y2.�1-U"� SignaWre Of,Legal Owner(s) �� Date-"-' And/Or Authorized Applicent Date CQOE �. �jp�Qyj1'PE 1616 Fixetl System Final Fire Prevention 1266 Pool Spe Final ' 200 Finel Re-Roo� 201 Final BIocWReteining Wall 202 Final Factory Fire Place 203 20a Finel Sign Final DemO�ition P� ItIIlilSLi CODE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Pravention 220 Final Planning Approval 222 Final Site 250 Finel Building/Occupency 4A� INIITIALS Job Address: 356 16TH PL Suite No Vlcinity: BATHROOMS FOR UNITS A AND B Parcel Nunmber: 42519219 Applicant Address: Owner: Address Contractor: Address: KAYLOR,GLENN 356 E 16TH PL COSTA MESA, CA ' KAYLOR; GLENN . 356 E 16TH PL � . COSTA MESA, CA, OWNER-6UILDER Phone: 949-212-5721 Zip: 92627 Phone: 949-212-5721 Zip: 92627 Phone: Zip: License: 000000 Stdtus: ISSUED Applied: 01I302007 Issued: 01I302007 ISSUED BY: EXPL ED y o`d pA'1'E SCOPE OF PERMIT PLUMBING PERMIT TO LEGALIZE A BATHROOM AND KITCHEN REMODEL TO UNITS A AND B FOR A DUPLEX. � � � WORK TO INCLUDE THE CHANGE OUT, ADDITION AND RELOCATION OF 2 BA7H7UBS, 2 SHOWERS, 2 WASH BASINS AND 2 WATER CLOSETS. ISSUE FEE Backflow irrigation Backilow Preventer � Balhtub Clarifer System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drein, Rainwater Drein, Roof , _ . �` . Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oiq Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 519.60 $0.00 $0.00 $0.00 50.00 50.00 50.00 $0.00; $0.00. $0.00 $0.00 $0.00 so.00 so.00 $0.00 50.00 $0.00 oiv � FEESUMMARY AMT Laundry Tub / Washer $0.00 Landscapelrrigation �$0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors 50.00 SepticTank $0.00 Sewer Cap tor Demo $0.00 Sewer Conned 50.00 Sewer Private Line $0.00 Shower $19.60 Sink, bar - $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop 50.00 Spa (private) 50.00 Spa (public) $0.00 � 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 , COMMENTS / SPECIAL CONDITIONS Sump Pump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $19.60 $0.00 50.00 $19.60 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 so.00 $0.00 50.00 TOTAL CALCULATED FEES: 5101.90 an 0 0 0 0 0 0 2 0 0 2 0 0 0 0 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 tor a pe�iod of 180 days. INSPECTIONS: In ordgr for the work authonzed under this permit to be considered legal, such work must comply �all applicable codes, and all requlred Inspections end flnal epproval must be obtained. Failure to obtain inspections antl final approval will result in the expiration ot ihis permit. FOR INSPECTIONS CqLL: (714) 7545626 2448d8 (fl/W) WORKERS'COMPENSATONOECLAFiAnON: I hereby eHirm untler penalry ol perjury one of lhe following tleclarations: ❑ I heve end will maintain e ceriiticate ot consent to selbinsure lor workers' compensetlon, es provldetl for by section 3700 0l ihe Labor Code, tor the pertormence ot the work for which �his permit is issuetl. � I heve end will rnaintain workers' compensation insurance, es requiretl by section 3700 of the Labor Code, for the peAormance of ihe work for w�ich [his pertnit is issued. My workars' cor�pensetion Insurance carrier end policy number are: Carrier. Policy Numbar. (fhis section need no� be complefed il fhe permi! is valued et one hundretl dollars ($100) or lessJ I certity that in tqe comply wi�h theSe of the work for which ihis pertnit is issued, I shall not employ eny pereon in any mannor so as to become subject to Ihe workers' , antl egrae thai il I shoultl become sublect to the workers' campensation pmvisions ol Section 3700 of the Labor Code, I shall forthwith v 7 Applicant�SipneNre--' �jraie: I 'Z�7� T WARNING. FAILURE TO SEWRE WORKERS' OOMPENSAiiqJ COVERAGE IS UNLAWFUL ANp SHALL SUBJECT AN EMPL09ER TO CRIMINAL PENAI.TIES AND CIVIL FlNES UP TOONE HUNDRED THOUSAN� DOLL4RE (5��.�). IN ADDRION TO iHE WST OF COMPENSAiipJ, DAMAGES AS PHOVIDEO FOR IN SECiION �Ofi OF THE LABOR CODE, IMEREST, RNp ATTORNEV'S FEES. LICENSEO CONTRACTORS DECLARATION: I hereby ettirm that I am licensetl untlor provisions of Chapter 9(commencing with Seclion 7000) ol Division 3 of the Business and Protessions Cotle, and my license is in tull force and eHect Lic. U Cless a Contrectofs Signature: Date: LONSTAUCTION LENDING AGENCY: ❑ I here6y attirm Nat there is a conslruction lending agency lor Ihe peAormance of the work for which this permit is iss�ed. (Sec. 3097, Civil Code). Lenders Neme: Lender's Adtlress: Signature: Dete: OWNER•BUILDER DECLARA710NS: I hareby attirtn that ontlar peneNy o1 periury that I am EXEMPT FROM THE CONTRACTOAS LICENSE LAW tor ihe foltowing reason (Sec. 7031.5, Buslne5s antl Protessions Code: Any Ciry or coW�y which requires e pertnit to construct, aller, improve, demolish, or repalr eny slrucNre, prior �o its issuance, also requires �he applicaN lor such permit to tlle a signetl stetement t�et �e or she is licansed pursuant to Ne provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) ol Divislon 3 of the Business end Profess�ons Code) or thet he or she is ezempt therefrom entl the basis Por Ihe ellegetl exemption. Any violation of Section 7031.5 by eny epplicant tor e permit subjects the applicant to e civil penalry of not more than tive huntlrea tlollars ($500).): 0"'I, es owner of the property, or my employees wi�h wages as �heir sole compensa�ion, WILL DO TME WORK, entl Ihe slmqure is no� intentletl or ofleretl lor 5ale (Sec. /7044, Business and Professions Code: The Comractors License Law does not apD�Y �o an owner of propeny who builds or improves thereon, antl who does such work himselt or harse�� or ihrough his or her own employees, provided that such improvemems era not intendetl or ottered br sale. If, however, ihe builtling or improvement is soltl within one year of completioq the owner-builder will �ave the hurden of proving that he or she tlid not builtl or improve for purpose ot saleJ. ❑ I, es owner of the property, em EXCLUSIVELY CO AC71NG WITH LICENSED CONTRACTORS to constmct I�e project (SecJ044, Business and Professions Catle: Ttie contractors License Lew does not ap o an owner of praperty who bulltls or Improves thereon, antl who contrecis br such projec[ with a contractor(s) license pursuant �o ihe Con�rectors License sJ. ❑ lem Owner ID verified by d��er's license. Ven�ication ol Ownership by (�ype o� Business antl Professions Code lor �his reason: Ves ❑ No i.e. - propeny taa hill or tleetl): Dd ars License No. �,,.,,,_'__' e�` DIVISION OF INDUSYRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certiy tpat no eacavation five (5) or more feel in depth into which a person is requiretl to dascentl, will be made in connection with work authorized by this permit, and that no building strucWre, scaHolding, falsework, or demolition or aismantling Ihereol, will be more lhan thirty-six (36) feet high. (C�ap. 3.2, Grp 2, An 2, Sec. 341, Title B, Cali�omla Admini5irniive Code). ❑ As awner-builtler, I will not employ enyone to do work which woultl require a permit Irom the DiWsion of Intlustrial Safety, as noted above, unless such person has e permit to tlo sucP work trom the tlivision. Signeture: Date: Division ot Industrial Sefety Permit Numbor: CERTIFlCA7E OF COMPLIANCE AND AUiHORIZA710N OF EMRV: I cenity untler penalry of perjury ihat I hava read Ihis application and state ihat ihe information given is correci. I agree to comply wi�h ell sleto laws end ciry ordinances relating �o building consimaion, and euthonze representatives of ihe City oi Cos�a Mesa to enler upon the ebove�described propp ��spec' n purposes. l agree oot to occupy or allow occupancy of any buiWing auttwrized by this parmit until final inspectbn. � —Z�+—� � �SignaWre�Ol.legal Owner(s)__. .... � .. . ��,,.Dat�.� _ AnNOr Aulhonzed Appliwnt Date cooe �. iNsrecnaNnre i616 Fixed Sysiem Final Fire Prevention 1266 Pool Spa Fin�l 200 Final Re-Rool 207 Final BIocWRetaining Wall � a' 202 Final factory Fire Placa 203 Finel Sign 206 Finel Demolition jl� � CODE� INSPECTIONttPE 206 Final Mec�anical 208 Final Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupency �g It� �� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIYE, GOSTA MESA, CA 92626 Job Address: 356 16TH PL Suite No Vicinity: BATHROOM FOR UNIT A AND B Parcel Number: 42519219 Applicant• KAYLOR, GLENN Address: 356 E 16TH PL , COSTA MESA, CA � ' owner: , KAYLOR, GLENN . Address: ; 356 E 16TH PL � , � �� COSTA MESA,�CA � Contracmr: OWNER-BUILDER ' Address:�. - MECHANICAL PERMIT Phone: 949-212-5721 Zip: 92627 Phone: 949-212-5721 Zip: 92627 Phone: Zip: License: 000000 StaWs: ISSUED Applied: 01/302007 Issued: Ot/30/2007 ISSUE EXY1 ED a� ox � DA� ° ; SCOPE OF PERMIT MECHANICAL PERMIT TO LEGALIZE A BATHROOM AND KITCHEN REMODEL TO UNITS A AND B FOR A DUFLEX. ' , WORK TO INCLUDE THE CHANGE OUT OF 2 VENT FAN/SINGLE DUCT ISSUE FEE Inst FAU <100 k BTU /� Inst FAU >100 k BTU Repair/Alt Cooling/Heat Inst / Rep: Recess Wall Htr � Refrig Sys <100 k BTU Refrig-Sys >100 k BTU . . Gas Piping , Factory Fireplace � Hood w/Mech Exhaust VAV Box VentFan/Single�Dud � � Appliance �- - - ��\ Fire Dampers - Smoke Dampers Inst or Relowte Appl Vent ". Air Handlers < 10000dm � Air Handlers > 10000cFm ' � Floor Furnace " Floor or Suspend Heater � Quantlty . $23.50 $0.00 0 $0.00 0 $0.00 0 $0.00 '`0_ $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $14.50 2 $0.00 0 50.00 ,0 $0.00 � 0 $0.00 �'0 � so.00 � o �.' $0.00 ;0� - $0.00 . 0 �. ; . $0.00 '. 0 r P Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillalion System Evaporative Cooler Com me rcial I ncinerator Domestic Incineretor Comoressors /Absorotion Svstems Upto3hp/100kBTU 3 To 15 hp ! 500 k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp I Over 1,750 BTU Boilers Upto3hp 3To15hp 15to30hp 3010 50 hp Over 50 hp Other Mechanical Fee , � Investigation Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 50.00 50.00 70TAL CALCULATED FEES 538.00 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related regulations. (Ord. No. 9248, § 7, 12-21-92) / EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work i�spendetl 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 Inspeetlone and final epproval must be obtained. Failure to obtain inspections antl final appioval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zaas�ae lsroo� �� WORKERS'COMPENSAnON DECLARATION: I hereby aflirm untlar pa�alry of perjury one of the following declarations: ❑ I have entl will ma��ein a certificeto ot consent to self-Insure for workars' compansetion, as provitled for by section 3700 of the Lebor Code, for the pertormence of Ihe work for which Ihis permi� is Issued. ❑ I have antl will maintain workers' crompenution insurance, as required by section 3700 of Na Lehor Code, for the pertormanca of tha work tor which this pertnit Is issuea. My workers' compensation Insurence carrier and policy number are: Cerrier. Policy Numbec (This section neetl not be complefetl if ihe permit is vaiuetl at ona hundretl tloliars l$100) or less.) 'Q`�11.cetlity�thet in the performence of Ihe work for which this permit is issuetl, I shall not employ eny person in eny manner so as to become subject to ihe workers' ��compensetlon laws of C fomle, end e rae thet if 1 should become subject to I�e workers' compensation pmvisions of Section 3700 of the Labor Code, I shell fonhwith comply wy_ith thesB p�a si n 'ApP�nt Signeture: �D��':.. . �/ � Z�/ � U �. �,.�—^ :1 / ; . WARNING: FAILURE TO SECU WORKERS' Q7MPENSATION COVERAGE IS UNLAWFUL AND SHRLL SUBJECT Ml EMPLOYER TO CFIMINAL PENALTIES M1D pVIL FINES UP TOONE HUNORED T1i0USAND DOLLAFE (St W.000). IN ADDITIIXJ TO THE COST OF COMPENSATION, DNMAGES AS PRpVIDED FOR IN SECTION 3]O60F iHE LABOR COpE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby aHirm t�at I aM licensed under provisions of ChaO�er 9(commencing with Section 7000) ol Division 3 0l ihe Business and Prolessions Code, and my license is in full fOrte end eRBCL LIt. N Class M Comractors Signawre: Dare: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirm ih0t there is a construction lending egency br the peAormanca of the woM for which this permit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lendefs Addres;: Signalure: Date: OWNER-BUILDER DECLARA710NS: I hereby aHirm that untler penelty of porjury ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe lollowing reason (Sec. 7031.5, Business entl Professions Cotle: Any city or county which requires e parmit to construct, alter, improve, demolish, or repair any stmcture, prior lo Its issuance, also requires ihe applicant tor such permit to file e sig�etl slatemaM thst he or sha is licensetl pursuant to ihe provisions ot lhe CoMredors Licensa Ww (Chepter 9(cammencing with Seclion 7000) ot Divlslon 3 oi ihe Business e d Professio�s Code) or Ihat �e or she is ezempt therefrom and ihe basis for the allegetl ezemption. Any violetion ot Section 7031.5 6y any applicant for a permit sub�ects.the applicant t0 e civil penalty of not more than five hundred tlollars ($500).�: �.�as owner ol the Properry, or my employees with wages as their sole compensation, WILL DO THE WORK, end the siructure is not intentlad or offered tor sale (Sec. 7044, Business end Professions Coda: The Contractore License Law tloes no� ap01y to an ownor of property who builtls or improves thereon, and who does such work himseN or herself or Ihroug� his or her own employees, provided that such improvements ere not intendetl or oXerad for sale. If, however, the huilding or improvement is sold within ono year ol completion, the owner-builder will heve ihe burden of proving thal he or she tlid not builtl or improve for purpose of sale.). ❑ I, as owner of Ihe property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conslruc� the projeci (Sec. 7044, eusiness and Professions Code: Tha conlreC�ors License Lew tloes not apply an owner of pmperty who builtls or impwves Iheraon, and who coniraCts for such project wiih a contractor(s) license pursuant to the Conirectors Licanse Laws ❑ lam pwnerlD ve�atl Dy tlriver's license. Venfication of Owners�ip Dy (type of Business antl Professions Cotla lor this reason: �s ❑ No i.e. - propeny tax 6ill or deetl): DIVISION OF INDUSTqIAL SAFETY PERMR CERTIFICATION: ❑ I hereby cetlity iha� no eacavation tive (5) or more feet in depth into which e person is requiretl to descend, will be mede in connection wit� work authonzad by this permit, antl t�et nP Duilding slructure, scaHolding, falsework, or demolition or dismantling thereof, will ba more then thirty-sia (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Calitornia Administretive Cotle). ❑ As ownervbuiltler, I will not employ anyone ro do work which would require a permit Irom ihe Division of Intlusirial Safety, as noted above, unless such person has e permit ta tlo such work irom the tlivision. Signature: Date: Dlvision of lntlustrial Setaty Parmit Num6er. CERTIFICA7E OF COMPLIANCE AND AUTHORIZATON OF ENTRV: I cenity under penalry of porjury ihat I have read this application and state that the information given is correcL I agree to comply with all state laws and ciry ordinances relating to building consiruction, and euthonze representatives of ihe Ciry of Costa Mesa to enter upon ihe ebove-descnbetl property �or' p t urposes. I agree not to occupy or allow occupancy of eny building aulhorized by this permit until tinel inspection. _ _ _ �� 2H�� ' SignatureAf.Leqai Owner(s)-' � -- � � � /Dale--� C „ _-" AnNOr Authorizetl Applicant Date CODE �. INSPECTONTYPE 1676 Fixed System F�nal Fire Prevention 1266 Pool Spe Final 200 Finel Re-Rool d 201 Final BIocWReteining Wall 202 Final Fectory Fl�a Place 203 Finel Sign 20a Final DomWltion pa¢, �$ �QQf,! INSPECTONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BWftll�g/Occupency pAg INim�lS � , a � � 4 , , (7t4) 754-5273 • Fax (714) 754-4856 • www.ei.coste•mesa.c��LDING PERMIT 77 FAIM UHIVt, GVSIA MCSA, GA 92fi2ti JobAddress: 356 16TH PL Suite: Viciniy: DUPLEX PrimaryOcc: R-3 Dwellings/CongRes<f0 Parcel Number: 42519219 Applicant: ESQUIVEL, MAYELY Address: Owner: KAYLOR, GLENN Address 356 E 76TH PL � � COSTA MESA, CA, Contractor.�-OWNER-6UILDER " � . Addre'ss_ . �/.�� - . i C j;_ i , , � i /�.� . , '/ ' ��j "�% Zip: �� 'i „ %/ .'Arch : � i ;"� Address: - , ' � ' . � ZiP� � , Phone: License: Type of Construc@on: V-N Zoning: INSTALLATION OF A NEW 8AY WINDOW IN AN EXISTING \ � � i � � Plan Check:� ' ' Permit: , SMIP Res: SMIP Com: ' Other:, ' Inspection: ,Total: , $25.19 $38.75 $0.50 $0.00 $0.00 $0.00 $64.44 ,� SETBACKS MAINSTRUCTURE Fmn,t �'0-0 Rear 0-0 ACCESSORY �,. Front��0;0. �=-r .Rear 0-0 . ,� PARKING�� Existina: p-"> Reaulred: 0 , � � � - , �� . ; ." �, � Phone: 949302-6149 Zip: Phone: 949-212-5721 Zip: 92627 Phone: � • License: 000000 Eng: Address: ISSUED BY: EX �R� � DA'� . � Phone: License: Status: ISSUED Applied: 09/112006 Issued: 09/112006 COPE OF PERMIT . ' ' IROOM AND REBUILD AN INTERIOR WALL SEPARATING A DUPLEX. � FEE SUMMARY , Calc Valuation: si,000.00 Claim Valuation: s�,000.00 PLANNING & ZONING � LeN 0- 0 Right 0- 0 , . Lek 0-0 �-� . �Right ,�0-0 , � Pr000sed: 0 - ��: � : ,� �i / '' . ,,� � �' NOTICE: The work aulhorized by thi& permit shall compy with all app�lcable handicap accesa requirementa under Calilomla statutes and related regulations. (Ord. No. 92-28, § 1, 12-27,92) EXPIRATION: This pertnit shall automaticalty expire an0 become vold it work ia not commenced wlthin 180 days, or If vrork is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, end ell requlred Inepectlons end finel approvel must be obtained. Failure to obtain inspections and final epprovel will result in the expiration of thls pertnit. FOR INSPECTIONS CALL: (714) 7545628 zuere �eroo� WORKERS' COMPENSATON DECLARATION: I herehy aHirtn untler penalty of perjury ane ol the tollowing deGarations: ❑ I �ave end will mainiain a certifiwte at consent to selt-Insure tor workers' compensatlon, es proNtletl tor by secllon 3700 of the Lebor Code, for ihe pertortnence o} Ne work lor wniU this permil Is Issuea. . ❑ I heve efM wN mantein workers' cdnpensetlpn insurerxa, az requlretl by section 3700 of Ihe Lebor CoOe, for the pertormence ol Na work fw whkA this pertNt Lq Issuetl. My workers' compensatlon insurance cartler end poliry numDer era: Certier. one or Iess.J Policy Number: ��-} I certlly Ihet in Ue perfortn ce t Ihe work lor which ihig pertnit Is issued, I shell not employ eny person in any mflnner so es to bocome subjecl to the workera' , compensetlon laws of Cal omia, tl egree thet It I a�oultl Eecome sub�ect Io Ne workers' compensatlon proNslons of Sectlon 3700 of Ihe Lebor Cotle, I s�all foMwlth comply with ihese r ' as. 'AppIIB_eri)l� Slpne� Oat�� — �� WARNIN�:FAILURETOSECUREWOHKE 'COMPENSATIONCpVERAGEISUNUWFULANOSWLLLSUBJECTANEMPLOYERTOCRIMINALPENALTIESIWDpVILFlNESUPTOONEHUNDRED TMOUSAND OOLLARE (E100,000), IN ADDRION TO THE COST OF COMPENSqTION, UMMOES AS PROVIOED WR IN SECfION 3108OF THE UBOR COOE.IMEREST, AND FTTORNEI"3 FEES, LICENSED CONTRACTORS DECLARATION: I �ereDy aNlrm t�at I em Ilcensetl under proNsians of Chapter 9(commendng with Sectlon 7000) of DMsian 3 of the Business an0 Prolessions COAe, and my license Ig in full force enE etlect. Llc. a - Cless a Contractols Signewre: Date: CONS7RUCTON LENDING AGENCY: ❑ I heroby eHirtn Ihet thare is e construalan Ien71n0 epenq for Ihe peAortnance ot ihe work for which Ihis permit is issuetl. (Sec. 3097, Civll Code). Londor's Nema: LendeYs Atltlross: Slpnetwe: Dete: OWNER•BUILDER DECLARATIONS: I hereby eXirtn t�a� untler penalry oi per�ury that I em EXEMPT FROM 7HE COHTRACTORS LICENSE LAW for ihe lollowing reason (Sec. 7031.5, Business and Professions Cade: Any dry or counry which requires e permit to constmcl, alter, improve, demWis�, w repair eny structure, prior to its Issuence, elw reqWres the applicant tor sucli peimit to tile e sipned atetement ihat he or she Ls Ikensetl pursuent to the provisions of the Cantrectors License Lew (Chapter 9(commendng wIN Sectlon 7000) of DMsim 3 of the Business and Protessbns Catle) w Net he or s�e I5 exempt theretrom antl Ne beSU for the elleged exemptlon. Any NoleUan ot Section 7031.5 by eny epplkent for e pertNt w Is the epplicant lo a civil penalry W nat more Nan tive huntlred ddlars ($500)J: - , es owner ol ihe property, or my employees wlth wages es �heir sole compensatlan, WILL DO THE WOHK, and the structure Is not intentletl or oNered for aele (Sec. 044, Business end Protessions Code: The Contreciors License Law does not appty to en owner of property who builtls or improves Ihereon, entl who tloes such work �Imselt or heraell or through his or her awn employees, proviCetl thet suc� imprwemenis are nat intentletl or otlered for sala. II, �owever, Ne building or Improvement is eoltl within one year ot wmpletion, the owneo-buiider will have ihe burden oi proving that �e or she did not builtl or improve tor puryose of sale.). ' ❑ I, es owner oi Ihe property, am EXCLUSIVELV CONTRAC7ING WfiH LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Buslness end Professions Cotle: The contwcrore License Law does not eppty to an owner ol propeny w�o builtls or Imprwes thereon, and who wntracts for such prqed wlih e comreqor(s) license pursuent to the�CS'Rr�ctors �cense Lews.). eusiness and Prolesslons Cotle for this reason: ID verlfletl by driv�fs licer�e. ❑ Ves Verlllcatlon ot Ownership by (rype ol document, I.e. - properry tac bill or tleed): DIVISION OF INDUSTRIAL SAFETV PEHMR CER7IFICA710N: ❑ I hereby certity thet no eacavetlon INe (5) or more feet In tlepih into which e person is required to tlescentl, will be mede in connection with work euthorizetl by thb pertnit, and thet no building suudure, 9cettdding, falsework, or demditirn or tlbmantling Uereof, will be more then thlrty-six (38) leet Ng�. (Chap. 3.2, Grp 2, Art 2, Sec. 341, T1tle B, CelHamis AtlminlsiratNe Cotle). ❑ Ae owner-builder, I will not employ enyone to do work which woultl require e Dermil from Ihe Dlvlsion ot Industrial Safory, es noted ebave, unless such person hea e permlt to tlo suc� work trom t�e tlivision. SlpneNre: De1e: DIvI510n of Indusidal Safety Permit Number. CERfIFlCAIE OF COMPLIANCE AND AUTHORVJITON OF ENTAV: I certity under penalry of pe�ury that I �ava reatl this epplicetlon entl state ihat the intortnaUon given is conact. 1 agree to compy with ell stete lews erM dry ortlinances relating to huilding construction, and euthorize represantatNes ot Iha Clry of Costa Mesa lo enter upon Ihe eDove-described praperty for inspection purposes. I egree not to occupy a ellow oxupenty of any building authorizetl by Nis pertnit unlil finel inspection. cooe �. INSPECTIONTYVE 1878 Flxetl System Final Fire Prevention 1268 Pool Spe Final 200 Finel Re-Roof 201 Final Block/Relaining Well 202 203 204 Flnal Fectory Fire Place Flnel Slgn Flnal Demolition � � CODE 1 INSPECTION TYPE 208 Final Mechenicel 208 Finel Plumbing 210 Finel Electricel 212 Finel Flre Prevention 220 Finel Planning Approvel 222 Final Site 250 Finel Buildinp/Occupency �oefa D � =� � � _ � � °: DECLARATION OF AUTHORITY I BIdg.Permit# FOR AGENTS OF PROPERTY OWNER This Permit # TO APPLY FOR PERMITS StreetAddress: )�� I-�.T�I- P L C�s`�t-�.Es-� � l�'} APNumber. 1. I(we), � I r N IV l�-%1 \Y I 111L , declare that I am the Owner of Title of the above referenced real property, and thal I(we) hereby authorize: Name: N�-lE� �J�U�V�� TelephoneNumber: ��-�'I �D�ILI �q Street Address: � � � l �� l � City: WJI ll N�J!\ State: � Zip: (�� to obtain pertnits in my behalf, as owner/builder, for at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Workers Compensatlon Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State ot Califomia laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree lo indemnify and hold the City of Costa Mesa and its employees or offcers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of pery'ury that the foregoing is true and correcL � Executed this �_ day of ��LY I'CJ�r L4�JLJ�L— 20� , at C��`�?T NCG� , California. P_rint-Plame: l, f N N I� ��'� /'� Signature: ��,�7 �I - I 1 - D 6 Note: This autFmriza6on does not grant authorization to perfortn the wnrk as owner, 8 solely provides for limited power of attomey to secure this pertnil in any behalf. W]4a6 pev.11/00) � � �.1.�_�`"?.1..`�.`��c,_. .... ___.. �,� � � ��,1" N 1 {�p��., ,; �,h,c,n��c �fiY wfn�oo-c.; UND��- E�Si avaF . �CP-CJ-( W tN(�CM7 No �vT�^'�,, f � IOf,1l Z� I� ' F i � ; t ; l,ftU nlo� ��1 • • (� ��,c��M �ivisioN or nun_�irvc sni�t:rv CITY OF COSTA MESA APPROVI?U , 9Y _Da7o � I L I Th set ot plans and specifications MUST 6c k.ept on Ihis job -n all limc; arnJ it i; unlawful Ic e any chang?s or al�eration; on sarne vnlhoN writlen �rrmision Irum ihc. urn,on ol8uildv�y en Salety, Clry cf Cos�a PAesa. /.�6 _��T rJ (�v Th stamping of this plan and specihcations SHALL T � Idfo „c�u or t, bc• an appm�ia of he violation ol any provisionz of cny Gity ol Cosla Ide;a Ordmrmcc andlr,r Staic lav: Th se plans and permil shali erpire by limitation and Gecomc� null and vo�d tl ihr,� I�- w is nol commenced and maintained aclroe per UBG �3G3 (d� vnlhn 120 days ol L �V IN�1� � �i ��' • ' , • • �_ i:.- � �� J: - o t �l �` ` �' 'C r� . i',_. . . M1 t � � 1 , ' ? y . . �,l.,i!4'1{ {..`_ . . �' ' ,:P;'i'�: . � ��)`i �'..�.. ��: �I •�=�i,:..:. � APPRrJ��D c�Tv or• cos�n nu�sn PLANNJN(', DIVfS10N SUBIECTTO6I_DG. J�NT kF �`OT6: ADDITIONS, pELrTI'r. uR CORkEC7-)p:\�S.SI1,1r ; i,. APPROVHD131'THI�PLA�\,��1;�(� � � }'. 1�.�;1:: � ^,, OwNER NOONAN ED aoa annx�ss 3 6 1Gth P GENERAL CONTRACTOR Ow AP. No.117-273-02 LOT INSPECTIONS TRACT � DATE JUL 2 5 �960 FIRE ZONE SUBCONTRACTOR VALUE NO. 1t-1-60 OCCUPANCY ��if' IIZ-��i% I I Form 210—SM-11- � J 59 5-B P , .11692 � • �L1.�32 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COBTA MEBA, CALIFORNIA For Applicani fo Fill In Completely TYPE OR PRINT BUILDING �!`6 ^/b / �Q AODRESS V �/� COSTA MESA. CALIFORNIA Z � ARCHITECT TEL. NO. OF BIaG9. BBTBACK LINC PROM / �NTeR oF BTRBBT / / � REAR YARD �$ / �i 61DE YARO IEFT .S I I RIGHT DESCRIPTION OF WORK tlU1LU11VG NO. OY SIZE �� " � ROOMS EXTERIOR WALL ROOF GOVERING .i COVERII U88 OF BUILDI G AND WORK TO BE FIRE LE6AL �� a�,��-�r � .:.�a° "y i-�� Ff i�r��'CE DEPT. APPLICATI �N OR PERMIT�rSA eui�c�ws For Office Use Only PECEIPT NO. PEpMIT_NO. � � /� MESA. �AL NO.OF USE OF NEW PLANB � a�ILOING ��-l� � T�,�: ! /_�� ICENTER LINE BT.) A�PPROVEO,II . J . /��i �� n 1 HEPEBY AGKNOWLEDGE THAT 1 AVB READ TH19 APPLIGTION THE AM� T 6HOWN UN VALUATION I6 FOq THE AND BTATE THAT TXE ABOVE ORPEGT AND A6REH TO COM- pURP09 OF EBTABLIBHING A PERMIT FEE ONLY. PLY WITH ALL CITY OFiDINAN AND BTATE LAWB ftEOULATNG BUIlDINO CONBTRUGTON `/v�_/ VALUATION �f 91GNATURE OR / L/�.[�� PERMIT FEE $ PERMITTE �� ////// � $ /� � PLAN CHECK $ -�� AUTHORIZED AGENT / TOTAL FEE � �' , � � � '73�s� COSTA MESA BUILDING DEPARTMENT , P.o.eox3n COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN 356 �.16th Place COSTA MESA. CALIFORNIA OWNER rv1LGRO�1'il ION CO.� INC. MAIL 11933 Stanton Blvd.� ADDRE55 ��: �ECEi�� R a�� c FINANCE� DEPT. � J J ' ^�r�r nF �OSTR 41Fc, APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY rc aEccivco o<rE issuEo -7 i_. FP - n tnr cirv ��eim� California TNoTW 3-3135 IqDDRD1ss ' ARCHITECT LIC. oR EN^NEER No. COSTA MESA. CALIFORNIA CONTRACTOR T. P. Gregg CITY N�o nooaessu933 Stanton Blvd.� N��+� 3-3135 �EGwL oEscniviior+ rypT 13 BLOCK TRACT 3�5 A.P. NO. 5'zE 52.85 x 135.07 OF LOT SETB<CN LINE FROM COt CENTER OF STREET J ��.�F e�°��.None NOW ON LOT REAR VARD 5S� S�DE YARD �O RIGHT �`� LEFT DESCRIPTION OF WORK NEW A ALTERATION IAOOITION REPAIR MOVING IIDEMOLISH siiEo�� 29 x 57 Ro°or°Hs 8 sroRies �- EXTERIOR WALL ��CCO ROOF (!nmr STATE TMAT TNE RBOVE IS CORqECT NO QTV OROINnNCES <ND STIT[ L�� TION. � / SIGNATURE OF �' / � AUTHORIZED AGENT COMPLV WITX PLL ILDING CONSTflVC� VALUATION DATE CORRECTIONS PERMiT FEE S �a � g /�/ ��_ PLAN CHECK 8 �b � TOTAL FEE 5 � �' ��