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Home My WebLink About486 16TH PL - Building PermitsOWNER LINNONa J. W. � � DATE 7_i5-55 JOBADDRESS (ySG ZGtYI P].BCE BUILDINGPERMITNO. ZS3G GENERALCONTRACTOR Tminn++. R. .Tnv � VAWE $ l9_(1!1!1_M L INSPECTIONS Footing Trench i Foundation Forms and Grade to Heating, Rough Heating, Final � Sewer, Hnuse � Sewer, St. Seotic Tank or Cesspool L ng, In u �p Plastering Plumbing, Final. Fixtures Com � Plumbing, Fin.al Gas Test Wiring, Final � Occupancy �/ c�,._.... •ii n r- u i cnn i GG BLOCK TVPE V IDATE TRACT SUBCONTRACTOR / FIRE DISTRICT 1S(111 PERMITSISSUED DATE I NL1M81 (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa: BUILDING PERMIT �� FAIR ORIVE, COSTA MESA, CA 92626 Job Address: 4$6 16TH PL Suite: Vicinity: ROOF Primary Occ: R3 Dwellings/ Cong Res <10 Type of Construction: V-N Parcel Number: 42515206 Zoning: Applicant: BLEDSOE, MATT Address: 63 VIA PICO AVE . � STE 433 SAN CLEMENTE, CA-� Owner BARTON, MACY Address 486 16TH PL � - � . , . �COSTA MESA, CA � �" Contractor: `OZONE'ROOFING Address:, 63 VIA'PICO AVE � - � STE 433 - ' , SAN CLEMENTE, CA Zip: 92672 Arch : Phone: (949) 3666597 Zip: 92672 ; . Phone: � ' Zip: 92627 . . - Phone: (949)366-6597 �License: 758431 Eng: � ISSUED BY: SWtus: ISSUED Applied: 04/73/2005 Issued: 04/13/2005 Address:� � � � Address: . . � � ��Phone: � ' � , Phone: , Zip: ' - ticense: License: , SCOPE OF PERMIT TEAR OFF EXISTING ROOFING, RESHEATH WITH'1/2�CDX PLYWOOD, INSTALL 30#'FELT, UNDERLAYMENT, & REROOF WITH 30 YEAR COMP SHINGLES (27 SQ). � � �' .- - � � � � Plan Check: $0.00 Permit: $181.25 SMIP Res: $1.00 SMIP Com: $0.00 Other: $0.00 Inspection: ,$0:00 TotaL• _ $182.25 FEE SUMMARY Calc Valuation: Claim Valuation: -.�.z:� � . ,_ � SETBACKS MAIN STRUCTURE Fronl 0- 0. � Rear 0- 0 ACCESSORY Front � 0-0 '� � Rear 0-0 PARKING Existinq:�' � o �� - Requi2d: ,o PLANNING & ZONING Left 0- 0 Left 0- 0 Pr000sed: � 0� Right 0- 0 Right 0- 0 �- sto,000.00 s�o,000.00 NOTICE: The work authorized by ihis permit shall comply with all applirable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 7, 72-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in Ihe expiration of ihis permit. FOR INSPECTIONS CALL: (714) 754-5626 :cso�no law� WORKERS'COMPENSAnON DECLApAnON: ' I hereby eNirtn under penelty oF perlury ane ot the tollowing decleretlons: ❑ I heve end will meintein e cer�ificate of consent to sell-Insure lor workers' compensatlon, as provitletl for by section 3700 of the Labor Cotle, for the pertortnance of the work for which ihi5 pertnil is issued. g I!have antl will maintein workers' cnmpensetion insurance, as required by section 3700 of the Labor Code, for the pertormance ot Me woB for which this permit is issued. My,workars' compans� n Insu nce carrier and pollcy number ere: \1 C� e[ue�'r-. �� TC A f� l� P' Numherstc9l �r�� —�[.(76 '1 (Th/s secNon need not be complet ll the permit is valued at one huntlre� dollers (8100) or /ess.J ❑ I cetlify that in the perfortnanGe of the work for which Ihis permil is Issued, I shell not employ eny person in any manner so as to become subjed to the workers' compensetlon lews ol C liton�ie, and a e�t Ii I houltl become sub�act b the workers' compansation provisions of Section 3700 of the Labor Code, I shell forthwith comply with ihese pro ' i . , /' APPIi�c�SigriaNre: �w) � i/ ^.i7� �(�('/1Q� �' WARNING: FAILURE TO SECU E WORKERS' COMPENSHTIIXJ COVERAOE IS UNL4WFUL AND SNALL SU&IECT AN EMPLOYER TO CRIMIN L PE ALTIES AND qVIL FlNES lIP TOONE HUNpRED TIIOUSANDDOLLARE(5100, ),INADPITIONTOTHECOSTOFCOMPENSATION,pAMAGESASPROVI0E0FORINSECTION�O60FTHElABOqCODE,INTEfiE5T,ANDATTORNEI^SFEES. LICENSED CONTRACTORS OECLARATION: I hereby aHirtn �ha icensed under provisions ot Chapler 9(cammencing wi�h Sec�lon 7000) ot Dlvision 3 oL�� BVs.ine55 antl Professions Code, antl my license is in full forceandettect.� Q 6Ja557Y$J� G3�1 c aoror Si n� eN,'�re:.ra— r�� t 11 9 � � �� C�Y�O) O CONSTAUCTION LENDING AGENCY: ❑ I hereby aflirtn that there is a constmction lending agency tor the OeAormance of Ihe work for which this permit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lender's Aatlress: Signature: Data: OWNER-9UIlDER DECLARATIONS: I hereby aHirm thet under penalry o1 perjury that I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for ihe following reason (SecJ031.5, Business antl Professlons Cotle: Any ciry or counry which reqUires e permit to construct, elter, Impmve, demolish, or repair any stmcture, prior lo its issuanca, also requires the applicant for such pertnit to file e 5igned stetement ihat he a! she Is Ilcensed pursuent to the provlslons ol tha Conirectors Llcense Lew (Chepter 9(tOmmencing wiih Section 7000) of Division 3 of the Business entl Pmfessions Code) o� that ha or she is ezem0� �herelrom end Ihe besis for the elleged ecemptlon. Any violetlon of Section 7031.5 by any applicant for a partnit subjects the applicent to a civil pena�ry of not more then five hundred dollers ($500).): � ❑ I, es owner ot ihe properry, or my employees wlth weges es ihelr sole compansatlon, WILL DO THE WORK, and the structure is not intentlatl or oflered for sale (Sec. 70d4, Business and Professions Code: The Contrecbrs License Lew does not apply to en owner of property who builds or improves thereon, and who dces such work himsetl or herseN or Ihroug� Ms or her own employaes, pmvided that such Improvements are not intended or oHered for 9ale. If, however, the building or improvement is sold within one year ol completion, the owner-builder will have ihe burden of pmving that he or she did not build or improve Por purpose of sale.). ❑ I, es owner of ihe properry, em EXCWSIVELV CONTRAGTING WITH LICENSED CONTRACTORS to construct Ihe prolect (Sec. 704d, Business and Professions Code: Tha contreclors Licensa �aw tloes not eppty to en owner ol property who builds or improves Ihereon, and who contracis for such proleci with a contracror(s) license pursuent to the Contractors License Lews.). ❑ I am exempt untler sea 8usiness antl Pmtessions Cotle br ihis reason: Signeture: Date: Owner ID venfietl by drivefs license. ❑ �es ❑ No Drivers License No. Veriticetion of Ownerehip Dy (type o� document, i.e. - property tas Dill or tlee0): Expires: DIVISION OF INDUSTRIAL SAFEY�' PERMIT CERTIFICATION: ❑ I hereby certity thet no excava�ion five (5) or more feet in deplh into which e person is required to descen4 will be made in wnnection with work authonzea by fhis permit, and that no building sw�iure, scaBolding, talsework, or demolition or dismantling ihereof, will he more Ihan Ihirty-siz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Calilomia Admini5lretive Cotle). ❑ As owner-builder, I will not ertiploy anyone to tlo work w�ich would require e pertnit from the Division of Industnal Safety, as noted ebove, unless such person has a permit to do such work irom tne division. Signature: Dala: Division of Industnal Safety Pertnit Number: CERTIflCATE OF COMPLIANCE AND AUTHORIZATON OF EN7RY: I cenify under penalty ol perjury I�at I have read Ihis application and stale ihat ihe informalion given is correct. I egree to comply wlih ell s�ate laws and city ordinances releling to building consiruction, end authorize represenlalives of I�e Cily of Casca Mesa lo enler upon t�e above-tlescribeG property for inspec�ion puryoses. I egree not to occupy or ellow occupency of eny �uildinq euthorized by this permil until linal inspection. CO�E I. INSPECTIDN TYFE 1fi16 Fixed System Final Fire Prevention 1266 Pool SOa Finel 200 Final Re-Root 201 Final BIocWRetaining Well 202 203 Final Fectory Fire Place Finel Sign 204 Finel Demolition D�TE INi�iU�9 COPE I INSPELTION TYPE 206 Finel Mechenical 208 Finel Plumbing 210 Final Elec�ricel 2/2 Final Fire Preventlon 220 Final Planning Approval 222 250 Final Site Final BuildincyOccupancy pzu�r,�rm.��-] Job Address: 486 16TH PL Suite No Vicinity: Parcel Number: 42515206 Applicant: OWNER-BUILDER Address: Owner: BARTON, MACY Address: 486 16TH PL . COSTA MESA, CA Contractor: O W N E R-B U I L D E R Address: MECHANICAL PERMIT Phone: Zip: Phone: Zip: 92627 ` Phone: Zip:' License: 000000 SCOPE OF PERMIT ADD 690SF TO THE 1ST AND 2ND FLOOR REF. B04-01084 1 FAU UNIT a100K BTU AND 1� BATHROOM VENT FAN. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Nl Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <700 k BTU Refng Sys >700 k BTU Gas Piping , Factory Fireplace � . Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers . Smoke Dampers Inst or Relocate Appl Vent �" Air Handlers < 10000cfrn Air Handlers > t0000cfm � Floor Fumace � Floor or Suspend Heater $23.50 $14.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 FEE SUMMARY " Quantity „ Status: ISSUED Applied: 11/23/2004 Issued: 11/23/2004 ISSUED BY: Repair / All Absorbtion Unit . Repair / Alt Refrigeration Unit Ventillation System - � Evaporative Cooler Commercial I nci nerator Domestic Incinerator Compressors / Absorption 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 / Over 1,750�BTU Boilers Uplo3hp 3To15hp . , , _ �15 l0 30 hp - � - ' 30 to 50 hp , � - Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee - � Reinspection Fee , � ic Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $D.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 $Q.00 $0.00 TOTAL CALCULATED FEES $45.55 NO710E: 7he work authorized by this permit shall comply with all applicable handicap access raquirements under CalNornia statules and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This pertnit shall automatically expire end become void II work is not commenced withln 180 days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be consideretl legal, such work must comply with all applicable codes, and ell requlred In6pectiona end flnel epprovel must be obtalned. Failure to obtain inspections and final approval will result in ihe ezpiration of this permit. FOA INSPECTIONS CALL: (714) 7545828 zaaas �eroo� WORKERS'COMPENSAnON DECLARqnON: . . I hereby ettirm undei penalry of perjury one of the tollowing dedaretions: " ❑ I'heve antl will meintaln a certificete at consant to self-Insure tor workeis' compensation, es pmvided foi hy section 3700 at t�e Lebor Cade, for the pertormence of the work for whlch this pertnit is 155ued. ❑ I have entl vnll meintaln workers' compensation in5urence, e5 reduiretl by section 3700 of Ihe Lebor Code, for Ihe pedortnance of 1�8 work for whiU this pertnit is issuea. My workers' compensatlon Insurence cartier and policy number ere: Certier. Polity Number: (Th/s secNon need not be canp/eted i! the permit is valuer/ et one huntlretl ddfers ($100) or Iess.J ❑ I certify thet in the performence oi the work for which this permit is issuetl, I shall not employ eny person in any mennor so es to �ecome subject to tha workers' compensation laws ol Califomia, and egree that it I shoultl become subfect to Ihe workers' compensatlon provislons of Sectlan 3700 of the Lebor Code, I shall fonhwith comply with Ihese provisians. Applicam SignaWre: Date: WARNINO: FAILURE TO SECURE WORKEiiS' COAAPENSATION CAVERAOE IS UNLAWFUL ANO SHALL SUBJECT AN EMPLOYER i0 CFIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNORED TFKKISAND OOILAqE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PfiOVIOED FOR IN SECTION 3108 OF THE LABOH CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I em licensetl untler provislons ol Chapter 9(commencing with Sectlon 7000) oi Divislon 3 of the Business antl Pmfessions Code, and my license Is in full force and eflecL Lic. N Class N Contrecmfs Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby eHirm that Ihere is a conswction lentling agency tor the pedormance ot Iha work for which this pertnit Is issued. (Sec. 3097, Clvil Code). Lenders Neme: Lendefs Atltlress: Signature: Date: OWNER-BUILDER DECLARA710N5: I hereby eNirtn t�at under penalry ot perjury ihel I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Businass entl Professlons Cotle: Any ciry or counry wNch reqmres e permit to construct, elter, improve, Oemolish, or repeir any structure, prior to its Issuance, elso requires the applicant lor suc� permit to tlle e signed sletemem thet ha or she is licensed pureuent to Ihe provislons oi the Conirectors Licanse Lew (Chepter 9(commencing with Sectlon 7000) of DlNslon 3 ai Ihe Business antl Professions COde) or that he or she Is eaempt therelrom antl tha besis for the allegetl e:emptlon. Any violetion a� Sectlon 7031.5 by flny applicant for e permit subjects the eppllcent to a clvil penelty of not more ihan (ive huntlretl tlollers ($500).): ❑ I, as owner of Iha property, or my employees with wages es Ihelr sole compensatlon, WILL DO 7HE WOfiK, and the slructure is not Intended or ottered for sale (Sec. 7044, Business and Professions Code: The Contrectors License Law does not apply to en owner of proDerty who builds or improves Iheraon, end who does such work himself or herseN or through his or her own employees, proviUetl �ha� such Improvements are not intended or offared lor sale. If, however, ihe building or improvemenl Is soltl " hin one yeer ol completion, the owner-builder will heve the burden of proving that he or s�e did not build or improve lor purpose ot sale.). ' I, as owner of ihe property, em EXCLUSIVELY CONTRACTING WI7N LICENSED CONTRACTORS to construct the prqect (Sec. 704d, Business end Profeulons Cade: The contrectors License Law does nat eppy to an owner ol property who bullds or improves tharean, end wha conirecis for such project with e contractor(s) license pursuer�lo tl� Contractors License Lews.). ❑ I am eaemp n sec SignaNre: .L Owner ID ven etl by tlrivers Verification o Owners�ID by Business and Professions Cada for Ihis rea5on: ❑ Yes ❑ No Drivefs License ment, i.e. - property ta�c bill or deetl): Expires: l9F, DIVISION OF INDUSTRIAL SAFETY PEflMR CERTIFICATON: ❑ I here6y certity thet no excavation five (5) or more feet in depth Into whlch e pereon is requiretl to descend, will be made In wnnectlon wlt� work euthorized by this pertnit, antl Ihat no bulltling strucNre, scaftolding, falsework, or demolition or dismamling thereof, will De more then thirty-six (36) tee� high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Celilomia Administretive Code). ❑ As owner-bullder, I will not employ enyona to do work whlch would require e parmit trom Ihe Divislan of Industrial Sefery, es noted ehove, unless such pereon hes e permit to tlo such work from ihe division. Signature: Dale: Division of Industriel Satety Partnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF ENTRY: I cenity under penalry of perjury ihat I have read this application and state that the infortnation given Is wrrecL I egree to comply with all state lews and city ordinances releting to building consiruction, end euthorize represenletives ol the Ciry of Coste Mesa to enter upon Ihe ebove-described property far inspection purposes. I egree not to occupy or ellow occupenty of any building authorized by lhis permit until finel inspection. COOE I, 1616 1266 Flaed System Final Fire Preven�ion Pool Spe Finel 200 Final Re-Rooi 201 Final Block/Retalning Well 202 Flnel Fedory Fire Place 203 Finel Sign 204 Final Demolitlon � I�LSi�RiiilCl4j COOE 1 INSPECiION ttPE 206 Finel Mechanical 208 Finel Plumbing 210 Finel Elec�riWl 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 . FinalBuilding/Occupency �_� ml. • • � , .� � � Job Address: 486 16TH PL Suite No Vicinity: Parcel Nunmber: Applitant: Address: Owner: 42515206 OWNER-BUILDER BARTON. MACY Address 486 16TH PL � COSTA MESA, CA ConVactor. Address: ISSUE FEE Temp service test Res. a/c package � New Res (1-2 units) New Res (3+unl4s) Pool I Spa Lighting Fixts Recept Outlets Swilches Non Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Motors to thp Motors l0 10hp Motors lo SOhp MotOrs t0 100hp Motors over 100hp Communication drops OWNER-BUILDER ELECTRICAL PERMIT Phone: 2ip: Phone: Zip: 92627 Phone: . Zip: License: 000000 ISSUED BY: Status: ISSUED Applied: 11/23/2004 Issued: 11123/2004 SCOPE OF PERMIT ADD 690SF TO THE 1ST AND 2ND FLOOR - - 3 LIGHTS, 16 OUTLETS, 4 SWITCHES, 1 SERVICE UP TO 200 AMP; 1 VENT FAN UP TO 1 HP AND 1 MISC. CONDUIT. � � � REF 804-1084. $23.50 $0.00 $0.00 $0.00 $0.00 50.00 $3.30 517.60 $4.40 50.00 $4.75 $30.50 $0.00 $0.00 50.00 so.00 $0.00 $o.00 50.00 $0.00 Quantity 0 0 0 3 16 4 0 1 1 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway./100ft Standing Sectlon Misc ElecMcal Equipment Transformers up to 1 kva/kw ..............:.up l0 10 kva/kw .................up to 50 kva/kw , .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misc. Conductor Circus ( gen or nde) Circus (mech ride or lights) Chnstmas Tree Stand � Fireworks Sfand Other Electrical Fee � Investigalion Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 ; 0- $0.00 , 0 30.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 50.00 0 $18.20 1 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 50.00 NOTICE: The work authorized by this permit shall compiy with all applicable hantlicap access requiremenis under Calitornia statutes and related reguiations. (Ord. No. 92•28, § 1, 12-21-92) EXPIRA710N: This pe�mlt shall automatically expire and become void if work is not commenced wlthin 180 days, or If work is suspended or ebandoned for a period of 180 days. INSPECTIONS: In order for the work euthorized under this permlt to be considered legal, such work must comply with all applicable codes, and all requlred Inapectiona end flnal epprovel must be abtained. Feilure to obtain inspections and final epproval will result in the expiratlon of ihis permit. FOR INSPECTIONS CALL: (714) 7545826 a...�.:ic�,� �n WORKERS'COMPENSATION DECLARATION: . I hereDy eMirm under penalry oi perjury one ot the IWlowing deUaretions: • . - ❑ I heve end will meinteln e ceNfiwta of consent to sell-Insure lor workers' compensatlon, es provldetl tor by sectlon 3700 at the Labor Code, tor Ihe pertormenca of the work for whlC� thl5 pertnit is issuetl. ❑ I �ave antl wlll mainlaln workers' compensatlon insurance, es required by sectlan 3700 of the Lebor Coda, for Ihe pertormance of the work tar which Ihis pertnit is issued. My workars' compensatlan Insurance wrrler entl pollcy number ere: Cerrier: Policy Number: (Thls sec(lon neetl no! be comp/efed il fhe permit is veluetl ef one hundretl dallers ($ f 00) or /e55.J ❑ I certity Ihel In Ihe peAortnence ot the wark lor w�ich Ihis pertnit Is issueQ 1 shall not employ eny person In eny manner so as ro become subjec� to Ihe workers' compensetlon laws ol Califomia, entl agree thet It I s�oul0 become su6ject to t�e workers' compensatlon provlslons of Sectlon 3700 of Ihe Lebar Catle, i shflll forthwith comply wilh �hese provisions. Applicent Signeture: Dete: WARNIN�: FAILUHE TO SECURE WOFiKERS' COMPENSATION OOVERAGE IS UNL4WFUL M'D SHALL SU&lECf rW EMPLOVER TO CRIMINA� PENPLTIES AND QVIL FlNES UP TO ONE HUNDRED THOUSAND DOLLFRE (5100,000�, IN ADDfT10N TO THE ODST OF COMPENS4TIp1, DNMGES AS PIiWIDED FOR IN SECiION 908OF TME LABOR COOE, INiEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirm Ihet 1 em Iicensed under provislons ot C�apter 9(commendn8 wilh Sectlon 7000) ol Divlslon 3 0l t�e 8uslness end Professions Cotle, and my Ikense is in full torce antl eBect. Lic. a Class a Comrectar's Signeture: Deie: CONSTRUCTION LENDING AGENCV: ❑ I hereby eHirtn that t�ere is e construction lending egency lor ihe peAormence of the work tor which t�is pormit Is Issuetl. (Sec. 3097, Civil Cotle). Lender's Name: Lendels Aadreu: SignaWre: Dete: OWNER-BUILDER DECLARATIONS: I hereDy etllrtn Ihat under penelry oi perjury ihat I flm E%EMPT FROM THE CONTRACTORS LICENSE LAW tor !he lollowing reason (Sec. 7031.5, Businass antl Prolessions Cotle: Any city or county which requires a permit to wnstruct, elter, Improve, demdish, or repeir eny siructure, prior to its Issuence, elso requires lhe ep0��a�� or such permlt to lile e signetl statement Ihat he or she is Iicensed pursuant to t�e provisions oi the Conirectors Llcense Lew (C�apter 9(commencing with Section 7000) ot Division 3 ot Me Busineu entl Professions Cotle) or that he ar she Is e:empt therelrom entl ihe besis tor t�a ellaped exemption. Any violatlon of Sectirn 7031.5 by flny epplicant for e permit su��ects the epplicant to e chnl penalry of not more Ihen fiva hunAretl Aollars ($500).): ❑ I, es owner of [he properry, or my amplayees vrith wapes as their sWe campensatian, WILL DO THE WORK, entl the siructure is not intended or otteretl br sale (Sec. 70d4, Business end Professions Cade: The Contrectors Llcense Law daes not appty to en owner ot property who builds or impraves therean, and who does such work hlmsoli or herself or ihrough his or her own employees, pravided thet such improvemenis are not Intended or offered lar sale. H, however, the builtling or Improvement is -sold within one year of completion, the awneo-Guiltler will �ave the burden of proving that �e or s�e tlid not build or improve lar purpose of sale.). ' �, as owner ol l�roperty, em EJCCLUSIVELY CONTHACTNG WITH LICENSED CONTRALTORS to conswCt Ihe prqect (Sec. 7046, Buslness antl Prof855ion9 Cotle: The coNr tors License Lew does not epply to en owner ol proparty who builds or Improves thereon, entl who contracis for such proJect wilh a comrector(s) license pursu to JYf� C�qntractors License Lews.). ❑ I Bm exe nd se Signature: Owner ID var' ied by dnvers Verificailon i Owners�ip by Business end Professians Coda tor this reason: ❑ Yes� ❑ No Drivers License No. nent, i.e. - property Iex blll or Oeetl): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON: Expires: ❑ I hereby ceNty that no excavation tive (5) or more leet in depth into w�ich e person is requiretl to descentl, wlll be mede in connection with work authorizeE by ihls pertnit, entl Ihat no builAinq siructure, scaXoltling, lalsework, or demdition or dismaniling �hereot, will ba more t�an thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 3dt, 71t1e B, Califomia Atlministretive Cada). ❑ As owner-builder, I will nat employ enyone to Oo work w�kh would require e pertnil lrom the DiWsion at Intlustnel Sefery, es noteA e6ove, unless suc� peraon hes e pertnit to tlo such work Irom the tlivi5ion. Slgnature: Date: Divislon ot Industdal Safery Pertnit Number. CERTIFlCATE OF COMPIIANCE AND AUTHORQA710N OF EMFiY: I certity under penelty oi perjury that I heve reatl t�is aDD�ication and state Nat the intortnetlon given is carrect. I egrea to comply with all slate lews antl Gry ordlnances relating to builtling conslructlon, end eulhorize representatives ot the Ciry of CaSte Mese to enter upon the ebove-tlescnbetl properry for inspection purposes. � egree nat to occupy or allow occupancy of eny building euthorized by this permit until final inspectlon. LODE t. IMSVECTIONTYPE V 1618 Fixetl System Final Fire Preventlon 1288 Paol Spe Final 200 Finel Re-Roof 201 Final BIocWRetaining Well 202 Final Factory Fire Placa 203 Final Sign 204 Final emolition PLff. ��j �Qf�,( INSPECTIONTYPE 206 Flnel Mechenical 208 Flnel Plumbing 210 Finel Electrical 212 Flnal Fire Preventlon � 220 Final Planninp Approval 222 Final Site 250 Finel Bullding/Occupency PAg IIi�EL9 � � � e� W (714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 486 16TH PL Suite No Vicinity: Parcel Nunmber: 425152p6 Applicant: OWNER-BUILDER Address: Owner: BAR70N, MACY Address 486 16TH PL COSTq MESA, CA Co ntractor: O W N ER-B U I L D E R Address: Arch / Eng : Address: PLUMBING PERMIT Phone: Zip: Phone: Zip: 92627 Phone: Zip: License: 000000 Phone: Zip: License: ISSUED BY: Status: ISSUED Applied: 11/23/2004 Issued: 11/23/2004 SCOPE OF PERMIT ADD 690SF TO THE 1 ST AND 2ND FLOOR REF 804-01084. . 1 BATHTUB ANDN SHOWER COMBO, 1 ROOF DRAIN, 1' GAS (1-0) OUTLETS, 1 WASH BASIN, 1 � . � TOILET AND 1 WATER HEATER . ISSUE FEE BackFlow irrigation BackFlow Prevenier Bathtub � Clarifier System Connect pce,Soda,etc) DenWl Units Dishwasher Drain, Floor Orain, Rainwater Drain, Roof Drinking Fountain AMT $23.50 SD.00 50.00 59.80 so.00 50.00 50.00 $0.00 $D.00 50.00 $9.80 $0.00 FEE SUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landscape Irrigation $0.00 0 P-Trap $0.00 �1 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors 50.00 0 Septic Tank $0.00 0 Sewer Cap (or Demo $0.00 0 Sewer Connect $0.00 0 � Sewer Pnvate Line $0.00 1 Shower $0.00 0 Sink, bar - $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 �SumpPump. Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater I vent Water Piping (Inst or Rep.) AMT $0.00 $0.00 50.00 50.00 50.00 $0.00 89.80 50.00 $0.00 59.80 312.30 50.00 an 0 0 0 0 0 0 1 0 0 t 7 0 N0710E: The work authorizetl by this permit shall compty with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92•28, § 1, 1241•g2) EXPIRATION: This permit shall automatically explre and become void II work is not commenced wlthin 180 deys, or If work is suspended or abandoned fo� a period of 180 days. INSPECTIONS: In order for the wark authorized untler this permit to ba considered legal, such work must comply with ell applicable codes, and ell requlred Inepectiona end flnal approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this pertnit. FOR INSPECTIONS CALL: (71q) 754-5828 2uBd8 (8�W) WORKERS'COMPENSAnON DECLAHAnON: , _ I hereby ettirtn untler penalry of perjury one o1 the fdlowing tleGaretions: � '� ❑ I heve entl will mainteln a cenificate oi wnsent to selt-Insure lor workars' cnmpensation, es provlded tor by section 3700 of the Lebor CoOe, for Ihe pertormence of the work for which this parmit is issued. . ❑ I have enC wlll malntaln workers' cortpenSaUon insurence, as requiretl by sectlon 3700 olihe LaDor Code, for the pertortnance of the work far w�ich Ihis pertnit is issuetl. My workers' wmpensatlon Insurence carrler and policy numbar ere: Carrier: Policy Number: (Th/s sectlon neetl no! be comp/efed 1! fhe permlNs velued ef one hunLrod dollers ($100) or less.) ❑ I cenify t�et In t�e peAormance of Ihe work tor which Ihis pertnit is issueq I shall not employ eny person in eny manner so es to bewme su0ject lo the workers' wmpansatlan laws at Calitomia, enE egree that il I shoultl Eecome sub�ect to Ihe warkere' wmpensatlon provlslans of Sectlon 3700 of the Lebor Code, 1 shell forthwiN comply with these Orovisions. Applicant SlpneWre: Data: WAHNINQ: FAILURE TO SECURE WORKERS' CDMPENSATIIXJ COVEMGE IS UMAW FUL AND SHPLL SUBIECT AN EMPLOYER TO CRIMIWIL PENALTIES AND CML FlNES UP TO ONE HUNDRED THOUSPND DOLIARE (5100,000). IN ADqTION TO THE C46T OF COMPENSATION, DAAUGES AS PROVIDED WR IN SEGTIpJ 3%080F THE LABOR CODE, IMEREST, AND ATTORNEY u FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm that I am Ilcensetl untler proNslons of Chaptar 9(commendn9 wlih Sectlon 7000) of Dlvision 3 at the Business entl Pmtessions Cotle, entl my Ilcense is in NII �OfCO BOtl BHBC�. LI0. M (�i1095 % Conhectore Signeture: Dete: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn thet there is e construction lending egency for t�e peAormance of ihe work Por which ihis permit is issued. (Sec. 3097, Civil Code). Lentlefs Name: LentleYs Atldress: Slpnature: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn that under penalry ol perjury Nat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reesan (Sec. 7031.5, Business end Professions Code: Any ciry or counry whic� requires a permit lo construct, eltar, improve, tlemolish, or repair eny sWCWre, Drior lo its issuence, also requires Ihe applicant tor such permil to lile e slgnetl stetement Ihat he or she is IlcenseA Oursuent 10 the provisions of the Contractors License Lew (Chepter 9(commenGng wlt� Secllon 7000) of Divlsion 3 of the Business end Pmfeuions Code) or Ihet he or sha is eaempt therefrom anA t�e besls for the alleged exemption. Any violatlon oi Sectlon 7031.5 by any appliwnt for e pertnit subJects the applicant to a civil penalty of not more Ihan live hundred dollers ($500).): ❑ I, es owner at Ihe properry, or my employees wit� wages as thair sole compensation, WILL DO THE WORK, end the siructure is not Intentled or offered for sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law does noi apply to en owner of proparty who 6uilds or improves thereon, and who does such work himsalf or herselt or through his or her own employees, provitletl thai such impmvemems era nat Imendetl or oHered tor sale. If, howevar, the buildinp or Improvement Is sold within one year of comple6on, ihe owner-builder will have Ihe burtlen of proving that he or she ditl not build or improve for purpose of saleJ. • I, es ownar ot the propery, am EXCLUSIVELY CONTRAC7ING WI7H LICENSED CONTRACTORS to construq the project (Sec. 7044, Business antl Professions COCe: The comractors License Lew tloes not eppty to an owner ol properry who builAs or ImO�a�es thereon, end who conirects br such project with e contractor(s) license pursu�nt lo�e Cpntractors License Lews.). /etl Dy tlrlveYs liCen Ownershlp by (rype Business and Prolessions Code for this reason: c� � No I.e. - property Iea bill or deed): UIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON: ❑ I hereby cerlify ihat no excavetion flve (5) or more leet in dept� into which e person Is requlred to tlescena, will ba made In connection wlih work euthonzed by this permlt, end ihat no 6uiltling s�ructure, scaXolding, lalsework, or tlemdition or tlismantling thereol, will be more then thirry-six (36) feel hip�. (C�ap. 32, Grp 2, Art 2, Sec. 341, Tltle B, Calllamia Administretive Cotle). ❑ As ownerbullder, I will not employ enyone to Oo work which would require e permit from the DlNslon of IndusMel Sefery, es noted ebove. unlesa such Derson hes e permit to do such work from the Givision. Signature: Date: Division ot Intlustdel Selery Pertnit Number. CERTIFlCATE OF COMPLUWCE IWD AUTHORQATON OF ENTRV: 1 ceNty under penalry ot perjury thet I have read this epplicatlon entl state ihat ihe infortnalion given L5 correct. I egrae to compty with all state laws entl ciry ordinances relating to building constructlon, entl euthonze representetives of the Ciry af Coste Mesa to enter upon ihe ebove-descnbed praperry tor inspeMion purposes. I agree not to occupy or allow ocwpanty ot eny building au�honzed by this permit until �inal inspection. cooe r. 1616 1288 Fixetl System Final Fire Prevention Pool Spa Final 200 Finel Re•Roof 201 Flnel BIocWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Finel Demolilion Qdg �� IliI�Lfl I� CODEI �xsveenoNrrve 206 Finel Mechanical 20B Finel Plum6ing 210 Final Electricel 212 220 222 zso Finel Flre Praventlon Final Plenning Approval Finel Site Finel BuildingiOccupency QAff II�LS .Y � � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 486 16TH PL Suite: Viciniry: M Parcel Number: 42515206 npplicant: SKAUG, JIM Address: 250 CLIFF DR LAGUNA BEACH, CA Owner: BARTON, MACY Address 486 16TH PL . COSTA MESA, CA Contractor: Address: Zip: Zoning: Phone: 949-584-6934 Zip: Phone: Zip: 92627 Phone: License: ISSUED BY: S1atu5: ISSUED Applied: O6/14/2004 Issued: 11/23/2004 nrch : , Eng: HAROLD LARSON Address: - - � Address: 1437 GLENNEYRE '' - Phone: . . Phone: 949-497-5203 � LAGUNABEACH Zip: • License: 92651 , License: C33222 SCOPE OF PERMIT ADD 690 SF. TO AN EXISTING SFR. 1ST FLOOR IS 377 SF AND WILL BE A FAMILY ROOM. 2ND FLOOR IS 313 SF AND WILL BE A GAME/MUSIC ROOM AND BATHROOM WITH AN INTERIOR SPIRAL STAIRCASE. ALSO INCLUDES 85 SF DECK WITH�LATTICE COVER AND 93 SF SOLID COVER AT ENTRY . - - - � " � ' � � - ` � Plan Check: $504.89 Permit: $776.75 SMIP Res: $6.81 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,288.45 . SETBACKS.�� MAIN STRUCTURE Front � 20- 0 ACCESSORY Frant 0- 0 PARKING Existino: � a Rear 10- 0 Rear 0- 0 Required: ,4 FEE SUMMARY , Caic Valuation: Ssa,oso.ss Claim Valuation: , $o.00 PLANNING & ZONING Left & 0 � Righ� � 10- 0� Lek . 0-.0 Right 0- 0 Propased: 0 � '� NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned for a period ot 180 days. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapeetions end final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545628 MB 48 (NW) WORKERS' COMPENSATION DECLARATION: � �- ,. � _ I hereby aflirm under penelty of perjury one o� the lollowing tleclaratlons:` . ' ' ' � ` ❑ I have and wlll malntein a cenificate of oonsent to sel4lnsure br workers' compensatlon, as Orovided for by sectlon 3700 of the Lebor Code, for ihe pedortnance ot the work for which this pertnit Is Issued. . ❑ I have antl wlil maintain workers' compe�satlon insurance, as requiretl by secfion 3700 of Ne laDor Code, for the pertortnance of the work for which this p0rtnit is issued. My workero' compensetlon Insurance cerrier and poliry num6er ere: Cerrier: Policy Number; (This sectlar need nof be comp/etetl iI Ne pe�it 75 ve/ued e( one hundred dW/ers (3f00) or IessJ ❑ I certiy thet in the peAormance of the work for w�ich ihis partnit Is issued, I shall not employ any person In any mannar so as to become subiect to the workers' compensation laws of Celifomia, aM agree Ihat II I should become sub�ect lo the workers' compensatlon proNsions of Sectlan 3700 of Ihe Labor Cotle. I ahall torthwit� comply wit� these pmvisians. Applicent Signature: Date: WMNING: FFILURE TO SEWFE WORKERS' COMPENSATION COVEMGE IS UNLAW FLL AND SMALL SUBIEGT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000), IN FDOITION TO T�1E CQST OF COMPENSATION, DAMFGES 0.S PROVIDED FOR IN SECTIIXJ 3]OB OF THE UBOR CADE, IIdrERES�, AND NTTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aMirm ihat I am licensed under provis�ons oi Chapter 9(commencing wlih Section 7000) ot Division 3 0l ihe Buslness antl Professions Cotla, and my license Is in full torce and eNea. Lic. q Class x Cantrectofs Signeture: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirtn Ihat ihere is e construction lending egency for Ihe pedormance of ihe work for which this permit is issuetl. (Sac. 3097, Civil Code). i Lendefs Neme: Lendels Address: �, Slgnalure: Date: OWNER•BUILDER DECLARATIONS: I hereby affirm that under penalry of perjury tnal l am E%EMPT FROM THE CONTRACTOHS LICENSE LAW tor the lallowing reason (Sec. 7031.5, Business end Professions Cotle; Any ciry or counry which requires a petmit to construct, alter, improve, demolish, or repair any sWcture, ptlor to Its issuance, also requires the applicant for such pertnit to tile a signetl stetement ihat he or she is IicenseA pursuam to the provisions ol the Comraaors License Lew (Chapter 9(wmmencing with Sectlon 7000) ot Dlvislon 3 ot the Business antl Professions Code) or ihat he o� she is e:empt Iherefrom entl the Desis tor the alleged exemption. Any vloletion of Saction 7031.5 by flny epplicent for e permit subjects the ep0�iwnt to e civil penalry of not more than Ove hundred dollars ($500).): ❑ I, es owner of the property, or my emplpyees with wages as iheir sole compense�ion, WILL DO THE WOFiK, and the siruclure Is not Intentled or oHered for sale (Sec. 7044, Buslness and Professions Gode: The Contractors Licensa Law does not apply to an owner of property who builds or Improves ihereon, and who does such work himself or herseN or through his or her O�+n employees, provitletl thet such Improvemenis ere not In�ended or ottered for sale. If, however, the building or Improvemen� is sol �Ihin ona year oi completion, ihe Owner-builder will have ihe burden of proving that he or s�e tlitl not Guild or Improve tor purpose of sale.). I, es owner ot the properry, am E%C W5IVELV CONTHACTING WITH LICENSED CON7RACTORS to consirucl I�e pro�eq (Sec. 70a4, Business and Prolesaions Code: The conirectors License Law tloes not epply to en owner ot pmperty who builds or Improves thareon, end who contracts tor such pmject wlih e contrector(s) license pursuanjto the Contractors License Lews.). ❑ I em exemp nd se SignaWre: Owner ID ve' ieC by tlrivefs licen: Veniicatlo i Ownership by (rype Business anA Professions Code lor this reeson: ❑ Yes ❑ No DriveYs License nent, i.e. - pwperry ta�c bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMR CER7IFICATION: Explr85: O'hi ❑ I hereby certity Ihat no exwvation five (5) or more feet In depih inio which e person is required to descend, wlll be metle in connection with work euthorize0 by Ihis permit, end thal no builtling structure, sCettolding, talsework, or tlemolition or dismantling thereoi, will be more Ihen thirry-six (36) fee� high. (Chap. 3.2, Grp 2, Art 2, Sec. �341, Tltle 8. Celtlomla AtlminisUative COda). ❑ As owner-builder, I wlll not employ anpne to da wark whic� would require e pertnit trom the Division of Industnel Sefery, es notetl ebove, unleu such pereon hes e permit lo do such work irom the division. Signeture: Date: Division ot Industrial Sefery Permit Number: CERTIFlCATE OF COMPLJANCE AND AUTHORIZATON OF ENTRV: I certify under penalry ot perjury that I have reaA this application and state that the intormatlon given is correct. I egree to comply with all state lews entl ciry or0inances relaling to builtling construction, end emhodze representatives of t�e Ciry of Costa Mesa to enter upon the above-described propeAy for inspection purposes. I agree not to acupy or ellow occupancy of eny building euthonzed by this permit until finel inspection. CODE I. INSGEC710NTYPE V 1616 Fixed System Final Fire Prevention 1266 Pool Spa Finel 200 Final FB-Roof 201 Final BIocWRetaining Wall 202 203 Final Factory Fire Place Final Sign 204 Final �emoli�ion oeg li�e�s Date ii z � aie CO�EI INSPECTIONTYPE Qd¢, I�ELB 206 Finel Mechanical 208 Finel Plumbing 210 Finel Electrical 272 Final Fire Preventlan 220 Final Planning Approval • 222 Final Site /� � 250 � FineIBUIIGing�Occupency � (714) 754-5273 • Fax (714) 754-4856 Job Address: 486 '16TH PL Suite: Vicinity: CITY OF COSTA MESA , eua��N6 oms�oN DEVELOPMENT SERVICES DEPARTMENT PERMIT ParcelNunmber: 42515206 npp�icant: BUTTERMORE, LYELL Address: BUILDING PERMIT Zoning: Phone:; 760-0498 Zip Owner: BARTON, MACY AND ELIZABETH Address 486 E 16TH-PL � COSTA MESA,CA ContraCtor: Address: Phone: , Zip: 92627 �' Phone: � ,�/ 899-00205 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 02/12/1999 Issued: 03/08/1999 Zip: License: , nrch : LTELL BUTTERMORE Eng: Address: 560 SEAWARD RD � . � � � Address: � , � . � Phone: . . Phone: CORONA DEL MAR CA � Zip 92625 - License: C16327 Zip: License: SCOPE OF PERMIT 272 MASTER BEDROOM ADDITION AND NEW F/P IN MSTR BDRM AT REAR OF EX. SF RESIDENCE. REMODEL MASTER BATHROOM. Plan Check: Permit: SMIP Res: SMIP Com: Otliec Inspection: Total: $256.59 $394.75 $3.00 $0.00 $0.00 $0.00 $654.34 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existina: 2 NOTES: Rear 10- 0 Rear 0-0 Required: 2 FEE SUMMARY . , PLANNING 8 ZONING Left 5- 0 Left 0- 0 Pr000sed: 0 Calc Valuation: Claim Valuation Right 0-0 Righl 0- 0 $30,000.00 $30,000.00 EXPIRATION: Thls permit shell automatically expire end become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inepectlona end flnel epproval must ba obteined. Failure to obtain Inspections end final approval will result In the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 754-5828 0 WORKERS' COMFENSA710N DECLARATION: I hereby eHirm untler penalry of perjury one ot the following tleclaretions: ❑ I heve entl will melntaln e certlflcate of consent to sel�-Insure tor workers' campense0on, as provitletl for by sedlon 3700 of Ihe LebOr Code, for �he peAortnence af t�e work fof which this Dermil is Issued. . ❑ I heve end will melntein workers' compensetion insurence, es required by section 3700 of Ne Lebor Code, for Ne pertormance ot the work for which Nis pertnit is Issued. My workers' compensation Insurance cartier end policy number ere: Carriar: Pollcy Number: (Thls secNon nsed nof be comp/ered i/ fhe pertnit is ve/uetl et one hundred dollars ($700) ar less.) ❑ I certiy that in t�e pertormance oi the work for which this permit is issuetl, I shall not employ any person in any manner so es to become subject to the warkars' compensetlon lews ot Celifomla, and egree Ihat il I shoultl become sub�ect to the workers' compensation provisions of Section 3700 ot the Lebor Code, I shell fanhwlth comply with these pmvislons. Applicant Slgneture: Dete: WARNING: FNLURE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNLAWFUL AND SMALL SUBJEGT AN EMPLOYER TO CFiIMINAL PENFLTIES M1D GVIL FlNES UP TO ONE HUNDRED TMOUSAND DOLLARE (E100,000), IN ADDfiION TO THE �ST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3'7060F THE LABOR CODE. IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirtn that I em Iicensad under provisions of Chepter 9(cammencing wiih Section 7000) oi Division 3 of t�e Business and Professions Code, anA my license Is in full fome anC ettec4 Lic. N Class x Contrectors Signeture: Date: CONSTRUCTION LENDING AGENCY: ��, ❑ I hereDy elfirm thet there is e consirucGon lending epency for Ihe pertortnance of the wark for which this permit is issuetl. (Sec. 3097, Civil COCe). Lendefs Neme: Lendels Address: Signeture: Dete: OWNER-BUILDER DECLARATONS: I hereby eMirtn Ihat under penalry of perjury thet I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions Code: Any City or county which requlres a permlt lo conStNtt, alter, Improve, demolish, or repair eny Slructure, D�ar to its issuence, elgo requires the applicant for such permit ta lile e signed stetement that he or she is licensed pursuant to ihe provisions oi the Contrectors License Lew (Chapter 9(commendng with Secllon 7000) of Dfvislon 3 of the Business and Professions Cotlej or �het he or she is exempt Iheretrom end the basis for the alleged exempiion. My violation of Sectbn 7031.5 by eny applican� for e permit suD�ects the epplicant to e civil penalry af not more than five hundretl Oollars ($500).): ❑ I, as owner ot ihe properry, or my employees wlth wapes as their sole campensatian, WILL DO THE WORK, and the siructure Is not Intentletl or offered For sale (Sec. 7044, Business antl Protessions Cotle: The Cantrectors License Law does not appy to an owner of propery w�o hulitls or improves thereon, end who does such work himself or herselt or through �Is or her own employaes, provlded tha[ such Improvemenis are not Intended or oflered for sele. II, however, Ihe bullding or Improvement Is solC within one year oi canpletlon, the owner-builder will have the burden oi proving thet he or she tlitl not builtl or improve for purpose oi sala.). ❑ I, es ownar ot ihe properry, em EXCLUSIVELY CONTFiACT1NG WfTH LICENSED CONTRACTORS to consWd tha project (Sec. 7044, Business end Professions Code: The contrectore License Law does not epply to an owner of properry who builds or impmves ihereon, and who contrecis tor such pro�ect with a comrectar(s) license pursuant to tha ContreMors LJcense Lews.). xem�p��nder sec �4y Business and Protessions Code for t�is reason: IgneWre� %Y/.«.� . �� ary�. 3 S 5 4 D venlled by tlrivers license. / es ❑ No D� s License � �Ires 9 9 Vediicetlon of Ownership by (type ol document, I.e. - pmperty ta�c blll or Aeed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hareby ceNiy thet no escevetlon five (5) ar more faet in tlepth Into w�ich e person is raquire0 to tlescenQ wlll be metle In connectlon with work euthodietl by t�is pertnit, entl Ihet no bullding slrucNre, sceNolding, felsework, or demolition or tlismantling t�ereof, will ba more ihen thirty-six (38) feet high. (Chep. 32, Gry 2, An 2, Sec. 347, Title 8, Caltlomle Aaministretive Cade). ❑ As owner-builder, I will not employ anyone to do work which woultl requlre a pertnit from Ne Division of Intlustnal Sefery, es noted a6ove, unless suc� person �es e permlt to do such work tmm Ihe division. Signature: Date: Division of Industrial Setery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZATON OF ENfAY: I certity under penalry of perjury that I have reatl this epplication end stete thet ihe information given is conect. I egree to comply with ell stete lews entl ciry ortlinences releting to builtling construction, end euthonze representetives of the City of Coste Mesa to enter upon ihe above-descnbed pr9peny tor' sDectio es. I egree not to occupy or allow occupanq ot any huilding authonzed by t�i p� iG T ntil final inspection. '��,,,� . 3�9 Signeture Of L er(s) a AndOr Autharizatl ApD�iwn� Date (�� pISPECf10NME pA7E 7818 Fizetl System Flnel Fire Prevention 1288 200 Pod Spe Finel Flnel Re-Raof 201 �� Finel BIocWReleining Well 202 Flnel Fectory Flre Poece 203 Flnel Slgn 204 Flnal Demolitlon z�+s+s It��S GppF2 wsvecnoxrme I 20fi FInelMec�anical\ 208 Finel Plumbing 210 Finel Electdcal 212 Finel Fre Prevenlion 220 Flnel Planning Approval 222 Final Site 250 Final Builtling/Occupenry � �� . CITY OF COSTA MESA BYILDIN6 DIYISION DEVELOPMENT SERVICES DEPARTMENT PERMIT ERMIT NUMBER M99-00'I 05 (714) 754-5273 • Fex (714) 754-d856 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 4H6 16TH PL Suite No Vicinity: Parcel Number: 42515206 Applicant: BARTON, MACY Address: 486 16TH PL COSTA MESA, CA owner: BARTON, MACY Address: 486'16TH PL COntractor: .y Address: ArchlEng: Address: COSTA MESA, CA Phone: 714-760-0498 Zip: 92627 Phone: Zip: 92627 Phone: Zip: License: � Phone: Zip: License: � SCOPE OF PERMIT ADD 2725F REF 899-00205, 1 ALTER HEATING DUCT SYSTEM, 7 GAS PIPPING AND1 FACTORY FIRE PLACE. 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 Vent Fan / Single Duct � Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> 70000cfm Floor Fumace Floor or Suspend Heater $22.00 $0.00 $o.00 $12.25 $0.00 $0.00 $0.00 $5.50 $9.50 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 4uantity 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY -- - . • / Repair / Alt Absorbtion Unit Repair / Alt Refngeralion Unit Ventillation System Evaporative Cooler � Commercial Incinerator Domestic Incinerator Compressors / Absorotion Svstems Upto3hp/t00kBTU , 3To15hp/500kBTU � 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU � � ' Boilers Up to 3 hp 3To75hp 15 to 30 hp 3010 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Status: ISSUED Applied: 03/0811999 Issued: 03/08/1999 Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 E49.25 EXPIRATION: This permit shall aUtomatically expire and become void if work is not commenced wlthin 180 days, or ff work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the Work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepecticna e�d fi�al approvel must ba obtained. Faflure to obtain inspac[ions and final approval wlll rflsult i� the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATON DECLARATION: I hereby eMirm under penelty ai parjury one ot the tollowing tleclarations: ❑ I heve end wlll meinlaln e certificate of consent to self-Insure for warkere' compensatlon, es provided far by sectian 3700 of Ihe Labor Cotle, for the perfortnence oi ihe work lor whlch Ihls partnit is iuued. ❑ I heve end will meinteln workers' compensation insurence, as requiretl �y section 3700 of Ihe Lebor Code, for tha perfortnance ot Ne work tor which ihis pertnit Is issuetl. My workers' compensetlon Insurence cerrier entl policy number ere: Cartier: Policy Number. (Th/s sec0on nee0 nof be comp/efetl i! t�e permit is ve/uetl et one hundred dollers ($100) or less.) ❑ I certify that in the peAortnance of the work for which this pertnit is issueA, 1 shell not employ any person in any manner so as lo become subject to the workers' compensetlon laws of Celitomia, entl egree ihat it 1 should become subjecl to the workers' compensellon Orovlslons of Sectlon 3700 ot the Labor Catle, I shell forthwith comply wiN Ihese proWsions. Applicent Signature: Date: WARNINO: FAILURE TO SECURE WORKERS' GUMPENSATION COVERAGE IS UNLNWFUL AN� SWLLL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNDRED TilOUSFND OOILARE (5100,000), IN ADDffIIXJ TO THE COST OF dJMPENSATION, DMUGES AS PROVIDED FIXi IN SECfION 31O60F THE IABOR CODE, IMEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eflirm thet I em Ilcensed under provisions of Chepter 9(commencing with Sectlon 7000) oi DlNsion 3 ot the Business end Professians Code, end my Ilcense is in full torce and etfecL Lic. # Class a Coniractors Signeture: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirtn that there is a construction lending egency for the pertortnance of �he work for which Nis pertnit Is issued. (Sec. 3097, Civil Code). lentleYs Name: Lendefs Address: Signawre: Date: OWNER-BUILDEH DECLARATIONS: I hereby eflirm that untler penelry of pe�ury that I am E%EMPT FROM THE COMRACTORS LICENSE LAW tor the follawing reason (Sec. 7031.5, Business anO Professions Code: My ciry or counry which requires e permit to conswct, alter, Improve, tlemolish, or repair eny structure, pnor to i4s issuance, elso reqWres Ihe epplicant tor such pertnit to tile e slgnetl statement t�at he or she is Iicensed pursuent to the Drovlslons of the Contreclors License Lew (Chepter 9(cammencing with Sectlon 7000) of Divislon 3 of Ihe Business end Pmtessions Code) or that he or she is exempt iherefrom antl the basis br t�e ellegetl exampllon. Any violalion.ot Section 7037.5 by eny eppllcent for a pertnit subjects the epplicant to e clNl penalry of nat more Ihen Ilva hundretl tlallare ($500).): ❑ I, as owner of the D�operry, or my employees with wages as thair sale compensation, WILL DO 7ME WORK, antl �he siructure is not Intentletl or otFeretl for sale (Sec. 7044, Business and Professions Code: The Cantrectore License lew Ooes not eppty to en owner ot property who builds or Improves Ihereon, end who tlaes such work hlmself ar herself or through his ar her own employees, praWded Ihet such improvemenls ere not Intentled or oHeretl for sale. II, however, Ihe Duiltling or Improvement is sold wlthin one year of completlon, t�e owner-builtler will heve t�e burden ol proving Ihat he ar she did nat bulld ar improve for purpose of sale.). ❑ I, as owner of the property, em EXCLUSIVELY CONTRACTINa WITH LICENSED GONTRACTORS to construd the project (Sec. 7044, Business entl ProFessions Cotle: The contrectors License Lew tloes not apply to an owner of properry who bullds or Improves ihereon, end who contrecis for such project with e contractor(s) Iicense pursuant to the Contrectors License LewsJ. � I em exemp Signature: �1�( Owner ID verifietl sec. Ilcense. � No Busineu and Professions Cade for this reason: oaie: 7 ¢ 9 9 Drivefs License No. � Ezplres: �o e 9 Venfication of Ownership by (rype at document, i.e. - properry tex hill or deed): DIVISION OF INDUSTRIAL SAPE7Y PERMR CERTIFICA710N: ❑ I hereby certly thet no excavetion tive (5) or more teet in depth Into which e person Is required 10 descend, wlll be made In connection with work euthorized by ihis pertnit, end that no hullding siructure, sceflolding, felsewark, or demolitlan or dismantling ihereot, will be more then thirty-slx (38) feet hlph. (Chep. 32, Grp 2, Art 2, Sec. 341, Ttle B, Callfomie AtlministretNe Cotla). ❑ As owner-bullder, I wlll not employ enyone to do work which would requlre a permlt irom ihe Division ot InOusirial Sefery, es notetl ebove, unless suc� person �es e permlt to do such work from the division. Signature: � Date: Division oi Indusirial Safery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTFiOFiQATON OF EMAY: I certify under penalry of perjury lhat I have read this eppllcatlon end stete Ual the informalion given is wrrect I agree to comply wlth all stele lews end ciry oMinences relating to building construction, end authonze representatives ol ihe City o1 Coste Mesa to enter upon Ihe above-descdbed D�oPe for insp�" ion Durposes. I agree not to occupy or allow occupency of any builtling authonzed by this pertnit until linel Inspedion. .<.�� C�., /t� 3�B�Y S IgnaWre Of Legel Owner(s) Date AnNOr Authorized Applicent CppE I. INSPECTIONTYVE �g �ALS 1616 Fl:etl System Finel Fire PrevenUon 1288 200 201 202 203 Pool Spe Flnal Flnel Re-Rooi Final BIxWRetelning Wall Finel Fectory Fire Plece Finel Sign 204 Finel Demolltion zauae FppEj INSPE[TONTYVE 208 Finel Mechenicel 208 Finel Plumbinp 210 Final Electdcal 212 Final Fire Prevenlion 220 Flnal Planning Approval 222 Fnel Site 250 FinelBuilding/Occupancy � -6 b-99 ��;c�� q�� CITY OF COSTA MESA evno�N6 �nr�s�oN � DEVELOPMENT SERVICES DEPARTMENT �� PERMIT PE UMBER P99-00'I 54 (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 486 16TH PL Suite No Vicinity: Parcel Nunmber: 42515206 Applicant: BARTON, MACY Address: 486 i6TH PL COSTA MESA, CA Owner: BARTON, MACY Address 486 16TH PL Contractor: Address: ArchlEng: Address: COSTA MESA, CA PLUMBING PERMIT Phone: 714-760-0498 Zip: 92627 Phone: Zip: 92627 , Phone: Zip: License: Phone: Zip: License: �.-- SCOPE OF PERMIT ADD 272SF REF 899-00205 1 BATHTUB & 1 SHOWER. . '�� . i ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect Qce,Soda;etc) Oental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptors (Sand Auto ) AMT siz.00 $0.00 $0.00 $8.75 $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 so.00 $0.00 QTY 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARX- = - AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receplors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Conned _ $0.00 � Sewer Private Line $0.00 Shower $8.75 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS Status: ISSUED Applied: 03I08/1999 Issued: 03/0811999 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-0) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Insl or RepJ Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 so.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 TOTALCALCULATEDFEES: $39.50 an 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 EXPIRATION: This pertnit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work aulhorized under this pertnit to be considered legal, such work must comply with all epplicable codes, and all requlred Inepeetlons and final approval must be obtained. Failure to obtain Inspectlons and final epproval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545628 WORKERS' COMPENSA710N DECLARATION: I hareby aHirtn under penalry of perjury one of the tollowing tlecleretions: � ' ❑ I heve end will meimein e centlicete ot consent to self-Insure tor workers' compensetion, es provided for by section 3700 oi the LaDor Cotle, tor the Dertortnence oi ihe work for which this permit is 15sued. ❑ I heve antl wlll maintain workers' compenseNon insurence, es required by secUon 3700 of the Labor Code, for t0e pertormence of the work for which Nis pertnit is Issued. My workers' compensatlon Insurence caMer antl palicy number ere: Cenier: Policy Number: (T)ris sec6'on nesd not be cromp/etetlll (he perm/t Is ve/uetl ef are hundred dollers (S 100) oi less.) ❑ I certify thet in the peAormance of the work for which this pertnit Is Issuetl, I shell not employ eny person in eny manner so as to become subject to Ihe workers' compensetion lews af Califomle, and egree thet If I should become subject to the workers' compensetion provisions of Section 3700 ot the Labor Code, I shell fanhwlth comply with these provisions. Applicenl Signeture: Date: WARNINQ: FAILUPE TO SEWRE WOFKERS' COMPENSATIIXJ COVERAOE IS UNLAWFUL AND SNALL SU81E4T AN EMP�OYEfl TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO qJE HUNDRED TNWSAND DOlL4flE ($100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDE� f-0R IN SECTION 37060F THE LABOR CODE, IMEREST, AND ATTORNEVS FEES. LICENSED CONTRAC70RS DECLARATION: I hereby eflirtn that I em licensed undar provislons ot Chepter 9(commencing with Sectlon 7000) of Divlslon 3 of the Business end Professlons Coda, end my license is In full force entl eHacL Lic. s Cless p Coniractors SignaNre: Da�e: CONSTRUCTION LENDING AGENCV: ❑ I hereby effirtn thet Ihere is a constructlon Iending egency for the peAortnance of Ihe work far which this permit is Issuatl. (Sec. 3097, CINI Cotle). Lender's Name: Lendefs Address: SignaNre: Date: OWNER•BUILDER DECLARATIONS: I �ereby ettirtn ihet under penalry ol per�ury Ihet I em EXEMPT FNOM THE CONTRACTOHS LICENSE LAW far the following reason (Sec. 7031.5, Business anA Professions Code: Any ciy or couny whic� requlres e permit ro construcl, alter, improve, demolish, or repalr flny structure, prior to its issuance, elso reQuires ihe applicant tor such pertnit to fla e signed statement that he or ahe is Iicensed pursuent to Ihe provislons of Ihe Coniraaors License Lew (Chapter 9(commencing with Section 7000) ot Divislon 3 of Ihe Business and Professions Cotle) or ihet he or she Is exempt Ihereirom entl the Desis for ihe ellegetl evemptlon. Any Nolation of Sectlon 7031.5 by eny epplicant for a pertnit subjects Me eppliwnt to e cidl penalry of not more Ihan five huntlreC tlolWrs (5500).J: ❑ I, as owner of t�e properry, or my employaes with wapes es f�elr sole compenselion, WILL DO THE WORK, end the structure is not Intended or oflered for sale (Sec. 7044, Business and Pmtessians Code: The ContraMora License Lew tloes not eppy to an owner oi praperty wha builtls ar improves thereon, end who tloes such wark hlmself or hersett or through his or her Own employee9, proNEed thet suc� Improvement5 ere not IntendBC or oftered for 5ale. tl, �owever, Ne building or Improvement is soltl within one yeer of completion, the owner-buildar will have the burden ot proving t�at he or she tlid not build or improve for puryosa oi sale.). ❑ I, es owner of the praperry, em EXCLUSIVELY CONTAACTING WIT}1 IICENSEO CONTAACTORS to construct the project (Sec. 7044, Business and Professions Code: The contrectors License Lew tloes not appty to en owner of property who Duilds or Improves thereon, and who contracls tor such pro�ecl with a contrenor(s) / ense pursuant to the Contredors License Lews.). ❑ I exem�pt� %u �tler sec. Buslness end Pmlassions Code for lhis reasoy ign re: �l'(—c.1 �— Dat � � ner ID verifled by drivefs license. Yes ❑ No Drivers LitenSe No. / Ezpir : t 8 Venfcation af Ownership by (rype of dxument, I.e. - properry tac CIII or tleed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATON: ❑ I hereby certify that no excevetlon five (5) or more feet in depth Into whic� e person is requlretl to tlescentl, will be mede in connedlon wlth work eu[hohzetl by Ihls permit, end that no bullding sirucNre, eceRoltling, felsework, or tlemditlon or tlismantling thereof, will be more then ihirry-sia (36) leet high. (Chep. 32, Grp 2, An 2, Sec. 341, Title B, Cellfomle Adminisiretive Cotle). 0 As owner-bulider, I wlll not employ anyone to tlo work which woultl require e permit Irom Ne Division of Intlustrial Sefery, es noted ebove, unless such person hes e permit to do such work from ihe division. Signetura: Data: Divlslon of Intlusirlal Setery Pertnit Number: CEHfIFlCATE OF COMPLUWCE AND AUIHORQATON OF ENTAV: I certify under penelry of perjury thet I heve read Ihis appliw�ion flnd slate ihet the iniortnetion given is conect. 1 agree to comply with all stete laws end ciry ordlnances releting to builtling construction, and euthorize representatives of lhe Ciry o1 Cosle Mesa to enter upon the ebove-tleuribed roperty for insp ctlon purposes. I apree not to occupy or allow acupanc.y ot eny builtling authorized b this pertnit until final inspection. 3�/�s �' re ner(s) e And/Or AUNorized Appllcant Date COOE 1. INSPECTIONTYVE 1816 Fizetl System Finel Fire Preventlon 1266 Pod Spe Flnel 200 Flnel Re-Roo1 201 Finel Block/Reteining Wall 202 Finel Fectory Fire Plece 203 Final Sipn 204 Finel Demolitlon zea54e ,, '' ueg u�e�s couu msvernoNme 206 Fnal Mechenical 20B Final Plumbing 210 Flnal Elecldcel 212 Final Fire Preventlon 220 222 250 Final Planning Approval Final Site Finel 8ullding/Occupancy �.i .uu. : �� , Costa Mesa Bnilding Department APPLICATION FOR PERMIT ' � � 171 EAST 20th STREET 5C�[� g U 1 L D l N G 9 � � �--f COSTA MESA. CALIFORNIA • . ' ' . ' ' F. � « - . � . . � w . . _ , . . • . �' - � . -' _._ � ; - LL . u _ ' c u .' • J ` . � .� ' . _ � . � . � . Q J � ' ` , � 6 _ . . ' a . . . . a cosid. - JUL 1 4-55P�ncsa S�G� ,rrtr:�33.no - � � ��=• � \ ' . — ' ' . � _ i . � . . - _: �. �� •- . - — '� ` � .. �• • � � ``4 / Streek . ' . • '�' ' . , PLOT PLAN � . � . Show location and distances from , property Ilne and between huildings ,` y � -.: � � .` - - ' . � ,' . , ' `� .. � .- . . ' � . ... •.�, � ` ,-. . � `� '� ` � ` ,. 1:.. . , , . � w - _ . � . .. , , , . � .- � __ . - - - - - ., . . , ,__ - - - - ... . . : � -- - - - - ---- -- . .. ,. � . - -- -- � _ __ , . . _. _ - _ . . '.. • - . ; -- - - - - - - � _ _._ .. � - - .-, . _., .:_� , , - ---- - -. ,,. � . - - �' 39193 t�'� -8-74�A��OD z�sF ��*5.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 A LI ATION FOR BUILDING PERMIT Far App/icant to Fill in Completely R C I V TE ECEIVED D TE ISSUED BUILDING ,c + .� � � ADDHESS G P RMIT NO OWNER P. d R A•P• NO. � Z� I MAIL BVILDING Z . p ADDRE55 ADDRE55� � � � a U CITV NOL Q TRACT � 4 LOT p BLOCK ZZ Q CANSTRUGTION W O N LENDER � am J � BFANCH �� J N OwNER IC m J ADDRESS 'VALUE ' J m ARCHITECT .— TEL. Ci 1: $ N OR ENGINEER V Q FIRE W 2 ADDRESS � ZONE YPE GROUP � w o APPROVED JO CONTRACTOR L(f,(/E UI BV DATE - - m Z J Q ADORESS � W w TEL ZaNE NO.OF USE OF NEW Z� CITV NOj �i� �� P�� 2 BUILDING �(%A � O STATE CITV 1'ARDS APPFOVED VARDS APPROVED y 2 IIC. NO. LIC. NO. `- MAIN BUILDING ACCESSORV BUILDING 7O (FROMGLSTREET) ' S12E / �♦ NO.OFBLDGS. A OF LOT � NOWONLOT ROM^��C�. FT. USE OF E%ISTING BIDG. C O FT F SIZE OF ' ��• � NO.OF �J[/JQ� Z NEWBLDG. O ROOMS `— STORIES' L.SIDE FT. FT. EXTERIOR WALL ROOF �'+....� V COVERING /L�� .0 COVERING � �I //� REAR FT. � FT. � , J VSE OF BUILOING AND WORK TO BE PERFOR ED DISTANCE BET. BET. MAIN & a MAIN BLDGS. ACCE55. BLDGS. a Q R. vH` DATE O / G.U.P. �'+ APPROVED � APPROVED LQ _ _� v� � . Z �A� O p VI heteby acknOwl¢dpe tha[ I heve reetl thie eppllcation antl atata p = that the abova intormation is corract entl aprea to comply with � � ell laws ragulatinp builtlin8 �onrtruction, anG I s�ell not employ eny person in violetion of ffie workmen's compensatlon laws of i{��` y ffie Sta[e of Celifomie. � O \��+' m zI hereby cartify that I em properly licensatl as a contractor untler SQ. FT. O the State of Californla Businezs antl Professions Cotle, Dlvisicn 3, THE AMOUNTSHOWN UNDER VALUATION IS FOF C�eptar 9, anC thot auch licansas a�e In full torce antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: Q am axampi from the provisions of the 5[ate of Californle Buainass VALUATION antl Protassione Cotl IvisiOn 3, C apter 9. � m PERMIT FEE $ � �'��.,�� u"-- ' $IB^atura o m Parmltteer $ $a PLAN CHECK $ E � `o Authorizetl Apant �e-..� LL TOTAL FEE $ CITY OP COSTA M�SA BUILDINC SAI•tiTt DEPARTt9EYT CERTIFICATIOP7 As the undersigned, I am fully aware of the responsibilities a, owner builder. I hereby certify that Uie personnel licted below, who are presently perfonaing work at /��6 ��6 �� f��1Cf . C'�57�+ /+�fsA are employed by me. I will withhold Social Secutity deductions, State and Federal income taxes. They are also covered by Workr�en's CompensaCion Insurance as prescribed Uy the State laws of Califoxnia. Ii/4'� S ADDRESS Date _/l�� V� "— �� OCCUPATION � � — Signed:, �Jy��i��c„%� Z Address:��6 6 T'� «1�-L� C-��.S %A �1 L-Ssl (714) 754-5273 • Fau (714) 754-4858 Job Address: 486 16TH PL Suite No Viciniry: Parcel Nunmber. 42515206 npp�icant: BARTON, MACY Address: 486 16TH PL COSTA MESA, CA Owner: BARTON, MACY Address 486 16TH PL Contrador. Address: ISSUE FEE Temp service test Res. alc packa9e New Res (7-2 units) New Res (3+units) Pool I Spa Lighting Fi�Rs Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over 700hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole COSTA MESA, CA _ CITY OF COSTA MESA BYILDING p/VISION DEVELOPMENT SERVICES DEPARTMENT PERMIT ELECTRICAL PERMIT Phone: 714-760-0498 Zip: 92627 Phone: Zip: 92627 Phone: Zip: License: SCOPE OF PERMIT ADD 272SF REF B99-00205, 1 LIGHT, 1 OUTLET AND 1 SWITCH. 522.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1.00 81.00 $1.00 $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 $0.00 Quantity FEE SUMMARY Temp Dist System I Lighting Busway /100 ft Standing�Seclion Misc Electrical Equipment Trensfortnere up to 1 kva/kw ............:..:up to 10 kva/kw .................up to 50 kvalkw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Eledrical Fee Investigation Fee Plan Check Fee Reinspedion Fee � 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 03/08/1999 Issued: 03/0811999 Quantity 50.00 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 50.00 0 50.00 0 50.00 50.00 $0.00 50.00 TOTAL CALCULATED FEES E25.00 COMMENTS / SPECIAL CONDITIONS EXPIRATION: ThIs pertnit shall automatically expire and bacoma void if work is not commenced within 180 days, or if work is suspended or abandoned for a period ol 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 requlred Inepeetlona end flnel epproval must be obtalned. Failure to obtain Inspectlons end tlnal approvel will result In the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545828 WORKERS' COMPENSATION DECLARATION: I hereby eifirtn under penalry ol perjury one oi t�e tollowing declarations: ❑ I heve end wlll mflintaln e certificete of con;ent to self-Insure tor workers' compensetion, es provitletl tor by sectlon 3700 01 Ihe LeDor Catle, tor the pertortnence�oi ihe work for which this pertnit Is Issued. - ' ❑ I heve end will meintein warkers' compensalion insurence, as required by seclion 3700 of the Lebor Catle, 1or iha peAortnence of Ne work for whiU Nis pertnit Is issugd. My workars' compensetion Insuranca carrler and policy number ere: Cerrler. Policy Number. (/h!s secNon need nof be com0�ered i/ the permlf Is ve/ued et one hundred dollers ($100) or IessJ ❑ I certity ihat In the perlormance of the work for which ihis pertnit Is issuetl, I shall not employ eny pereon In eny manner so es to become sub�ect to the workers' compensetlon lews at Celifornie, end egree ihat If I should become subjea to the workere' compensetlon provisions of Secllon 3700 of the Le6or Code, I shen torthwith comply wl�h Uiese provislons. ApDlicant Slgnature: Oete: WAHNING: FAIUIRE TO SECURE WORKERS' COMPEN3ATIIXJ Q�VEMGE IS UNLAW FUL AND S W1LL SUBJECT AN EMPLOYER TO CRIMINPL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED THOUSAND OdlARE (5100,OW), IN MDfTION TO THE �p$T OF COtdPEN$ATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 3i080F T/E LABOR CODE, INfERE$T, AND ATTOfiNE`f5 FEES. IICENSED CONTRACTORS DECLAqA710N: I here6y eftirm ihat I am licensed under provisiong ot Chepter 9(commencing with Section 7000) of Division 3 ot the Business antl Professions Cotla, antl my license is in full force end ettect. Lic. % Cless p Cantradafs Signeture: Dete: CONSTRUCTION LENDING AGENCY: � ❑ I hereby ettirtn thet there is a wnstruction lending egency tor the pedormence ot the work toi which this permit is luuetl. (Sec. 3097, Cidl Cotle). LenOerS Name: LenGer'S Atldress: Signeture: Data: OWNER-BUILDER DECLARATIONS: I hereby eHlrtn that under penalry oi perjury Ihat I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Buslneu and Profeulons CoOe: Any dry ar counry which requlres a permit to canstruct, elter, Improve, demollsh, or repair eny sWclure, pnor to its luuance, also requlres the epplicant 1or such pertnit to file e signetl stetement Ihat he or she Is licensed pursuant to the proNsions oi the Contrectore Llcanse Lew (Chepte� 9(commencing wlth Section 7000) of Dlvision 3 of Ihe Business and Professions CoOe) or ihet he or shq is eaempt therefrom and Ihe basis for ihe alleged exemplion. Any violation of Section 7031.5 by eny epplicant for e permit subJecis Ne ap0��ent to e civil penelry at not more then five huntlred Aollars (5500).): ❑ I, es owner of the property, or my employe45 with wages es their sole wmpensatlon, WILL DO TTIE WORK, and the siructure is not intentletl or otFered for sale (Sec. 7044, Business and Professlons Code: The Contrectors Llcense Lew does not apply to en owner of properry who builtls or improves thereon, antl who does such work hlmseli or herself or through his or her own amployeas, pmvitled that such improvemenis ere not Intentletl or oiFeretl Por sale. tl, however, t�e bullding ar Improvement Is sold within one year ot completion, the own�r-builder will have Ihe burtlen of proving Ihat he or she did not build or Improve for purpose of sale.). Q I, as ow�r W tha p�operty, am EXCLUSIYELY CONTAAC7ING Wl7H LICENSED CONTAACTOAS to consVuct fhe projecl (Sec. 7044, Business and Professions Cotle: The comredors License Lew tloes not epply to en awner ot properry who builtls or Improves therean, end who contrecls for such project wlth e contrector(s) licensa pursuant to ihe Co ct License Laws.). exem t der s ,� y 4 Business end Professions Code tor this reason: natur 2 9 S ID verifietl by dn ers license. Ves ❑ No Driv s Licens o. /� Expir s: P 9 5 Vedflcellon of Ownership by (rype ot tlocumem, I.g. - properry tex bill or deetl): �IVISION OF INDUSTRIAL SAFE7Y PERMIT CEqTIFICATION: ❑ I hereby ceN1y that no ezcavatlon five (5) br more feet in tlepih imo whlch a person is reqWretl to tlescan4 wlll be mede in connectlon with work euthorizad by ihis pertnit, end Ihat no �ullding structure, scettolding, lelsework, or demoliNon or dismantling Ihereof, will be more ihen thlrry-six (36) teet hlgh. (Chep. 32, Grp 2, Art 2, Sec. 341, T1tle B, Califomia Administretive COAe), ❑ As owner-builder, I wlll not employ anyone tp do work whlch would requlre e pertnii iram ihe Divislon of Indusiriel Sefery, es note0 ebove, unless such person has e pertnit to do such work from the divlsion. SignaNre: Date: Division of Industnal Safery Permit Number: CEHTIFlCATE OF COMPLIANCE AND AUTHORIZqT10N OF EMAY: I certify under penalty of per�ury t�et I have reed ihis epplicatlon end stete Iha� ihe Infortnetian given is correct. I egree to comply with all stete laws end ciry ordinances releting to building construdion, end aut�odze representatives of the Ciry of Costa Mese to enler upon the ebove-tlescribed p perty far Inspec0on pu o ree not to occuDY a� allow occupanq ot any bulltling euthorized by ihis permit until tinel Inspection. � � � �9�' �1 Signeture Ot Legal e'r(s) � And/Or AUNorized Applicent Date COOF �. INepEC1WNTYPE 1616 Fixed System Flnal Fire Prevention 7286 Pool Spe Fnal 200 Finel Re-Rooi 201 Finel BIxWRetaining Wall 202 Finel Feclory Fire Plece 203 20C 2at&d8 Final Sign Finel Demolltlon �ff �� COUE I INSPECTION TYPE 206 Final Mechanicel 208 210 212 Finel Plumbing n Finel Eleclrical AS k4 �` � Final Fire Preventlon 220 Final Planning Approvel 222 FInaI5lte 250 Finel Bullding/Oaupan�y CAg II{�l19 `%.�-/-��