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HomeMy WebLinkAbout2873 REGIS LN - Building Permits `p aCITY OF COSTA MESA BUILDING DIVISION .,, .. DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER mmtimmer nits PERMIT 05-01847 ° _ .. (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.d3ltdLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2873 REGIS LN Status: ISSUED Suite: Applied: 10/14/2005 Vicinity: Issued: 11/17/2005 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 14156317 Zoning: Applicant: DANIEL HOBBS Address: 2873 REGIS LN Phone: 714-540-3440 ISSUED BY: COSTA MESA,CA Zip: 92626-4210 Owner HOBBS, DANIEL AND SUSAN : ' Address 2873 REGIS LN -- r e. -fie a " Phone "x,714-54,0 3440 '"- COSTA MESA;.CA - Zip: p 92626-4210 ry ', Contractor: OWNER BUILDER • ", Address F c t Phone: „* , License: 000000 A Arch '. RICHARD DAYTON Eng: • Address: 2900 SILVER LNn tr.," Address: NEWPORT BEACHCA ';a ?� ` Zip:, a92660 `e-l License C14287�'. * License: SCOPE OF PERMIT CONSTRUCT 243 SRADDITION TO AN EXISTING SINGLE-STORY SFD WITH A 200 SF REMODELx'OF THE EXISTING,RESIDENCE.WORK TO INCLUDE EXPANSION',OF THE EXISTING.MASTER BEDROOM/BATH WITH THE ADDITION ORA THE EXISTING KITCHEN WILL ALSO BE REMODELED ,, ti4 ' .e•-s4:4 , t .'L 3'BEDROOM 2 B THSFD WILL BECOME 4 BEDROOM 2 BATH RESIDENCE s s '� ''� • " • < FEE SUMMARY - w i Plan Check: $418.76..." 4 _ "Calc Valuation Permit• x$$644 25 ` --�- x Claim Valuation650,000.00 SMIP Res: `'4$5.00 � -� ; #5^ SMIP Corn. \“44 ,Other $0 00 a _ +a ? . Inspection $0:00‘04,.•: • <4_ Total $1,061i.,01 3: N a • PLANNING &ZONING SETBACKS -ss MAIN STRUCTURE Fronts 49 0 -r Rear 35 0 '�' Left 5 0 ', � Right r §�BOr� ' sc #7 r::r 4 ."gyp < < I- ACCESSORY Front .0 0T... • Rear -0-‘074-•' Left 0 0, 1' Right 0-0 PARKING Existing 24- Required:_ 4 Proposed. :, . NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statut _ 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 su ended 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 II applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in t xpiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 �^ 2446-46(600) _ DECLARATIONS { -� f WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. '❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: Is section need not be completed if the permit is valued at one hundred dollars($100)or less.) r ^' 1 ceNfy,that in the ance of work for which is rmit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation la (s of C Manila,aid gree the If I s,�Ould ecome subject to the workers'compensation provisions of Section 37 of the Labor Code,I shall forthwith comply with the a prow ons. ) _ Applk:mrrSlgnature:�p- / Date:= qc 1 1 fl S -I:a WA THOUSAND FARURE To.SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAB.PENALTIES AND CIVIL AWES UP TO ONE HUNDRED THOUSAND DOLLARS(mom,IN AMMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is in full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: _ Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business end Professions Code:Any city or county which requires a permit to constwct,;alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that•lieor she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): 1 as owggh&s property, iomy employees with wages is their sole compensation,WILL DO THE WORK,and the structure is not Intended or offeredho for sale(Sec. 07044,Blftlness and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or•herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) .S liter rsuant to Contractors License Laws.). piexfLundeq sQc. d Business and Professions Code for this reason: awnerI Date: /i'f) '71 OS Owner ID verified by drivers license. Yes 0 No cDiivels Iucense:No.;� Ri estO 6 p///I Verification of Ownership by(type ofd umen,I.e.-property tax bill or deed):'" ' �� a'�'''�" DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Wit the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apEermit for such construction or modification from the South Coast Air Qualify Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (if yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CE ATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application end state that the information given is I rect. I agree to ply with all stat w nd city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the a ve-d scribed Try for insp ti pu ses.I agree not to occupy or allow occupancy of any building authorized by this perm' until f al inspection. i/��7�Q +'SlgnatureOf:Eegal.Owner(s)-4.,;- Date 't' t_ mea 2r�i ,F2: ,�t;r:t T3_ — --a, And/Or Authorized Applicant Date I 800E I INSPECTION TYPE MI INITIAL$ CODEI IISPECRON TYPE gall INRRALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing • 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 7_25`Sb �,-3-iLL! y, ' CITY OF COSTA MESA 4 BUILDING DIVISION • f • .-� DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER J1.1511k PERMIT q� "•qro ,,et" E05-01406 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2873 REGIS LN Status: ISSUED Suite No Applied: 12/29/2005 Vicinity: . Issued: 12/29/2005 Parcel Nunmber: 14156317 Applicant: HOBBS, DANIEL Address: 2873 REGIS LN ISSUED BY: Phone: 714-540-3440 COSTA MESA,CA Zip 92626-4210 • Owner HOBBS, DANIEL Address 2873 REGIS LN � fi Phone: r�.t.:, ,\C. +7"�•8,Y COSTA MESA,CA Zip: 92626-4210 •" ,�,. -, F+ '4 :.;. Contractor OWNER-BUILDER Address: Phone: Zip: License:000000 SCOPE OF PERMIT ELECTRICAL PERMIT TO CONSTRUCT A 243 SF ADDITION TO AN EXISTING SINGLE-STORY SFD WITH A 200 SF REMODEL OF THE EXISTING RESIDENCE. REF#:B05-01647 WORK TO INCLUDE:1 RES NC PACKAGE,20 LIGHTING FIXTS,20 RECEPT OUTLETS AND 15 SWITCHES. FEE SUMMARY Quantity . Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 , Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $54.50 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $22.00 20 up to 50 kva/kw $0.00 0 Recept Outlets $22.00 20 up to 100 kva/kw $0.00 0 Switches $19.80 18 over 100 kva/kw $0.00 0 Non Res Appl $0.00 i 0 - Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 .0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 • Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $141.80 Intermed Pole $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes andxrelated 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 pended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS n (Th WORKERS'COMPENSATION DECLARATION: . I hereby affirm under penally of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier end policy number are: _ Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) - 'I certify that in the performance of the work for whi h this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' ,compensation lawslifomie,aOd agree that if should ecome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these ovi ons..ff//////// • q Applicant'Signature:--1 r Date:'ti A2-— / — 0_3-- WARNQILBFALURE•TOSECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FiNES UP TO ONE HUNDRED THOUSAND DOLLARE(4100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.if Class It Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant t0 a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • �" [�siTas owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pur nt to thA Contractors Lic a Laws O I am exe t u der�a} Business and Professions Code for this reason: (Signatuie: '.• ' 5 date:/7-- Zg -.0-5- Owner'IDv vert led by driver's license. Yes 0 No tDriver's beanie No. / Ezpira. O%= or-/0 Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous materiel? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomla Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (II yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I a ree to com ly with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-d Cr ed pro for inspection sgs.,iagree not to occupy or allow occupancy of any building authorized by this permit until final inspection. � �\\>> L//�J(L� /2 ' 29 - oS _ I-9t(jnature' L`9gai'Owner(sr,77 - E. Date "/ ll -t L / And/Or Authorized Applicant Date LOPE f INSPECTION TYPE. PATE INTMALS - CODE# INSPECTION TYPE D.A.Ti - m'rm*ii 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical ' , S.- 4 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final Planning Approval. 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • • • • CITY OF COSTA MESA 4 BUILDING DIVISION •, :J r,,' ; �I DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER J. as PERMIT 05-00796 % (714)77541-'527733 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • MECHANICAL PERMIT Job Address: 2873 REGIS LN Status: ISSUED Suite No Applied: 12/29/2005 Issued: 12/29/2005 Vicinity: Parcel Number: 14156317 ISSUED BY: Applicant: HOBBS, DANIEL Address: 2873 REGIS LN Phone: 714-540-3440 • COSTA MESA,CA Zip: 92626-4210 • .,i• Owner: HOBBS, DANIEL Address: 2873 REGIS LN Phone: 4;,,•,.,> COSTA MESA,CA Zip: 92626-4210 artnik„ .•4 Contractor: OWNER-BUILDER Address: Phone: Zip: License:000000 SCOPE OF PERMIT MECHANICAL PERMIT TO CONSTRUCT A 243 SF ADDITION TO AN EXISTING SINGLE-STORY SFD WITH A 200 SF REMODEL OF THE EXISTING RESIDENCE. REF#:B05-01847 WORK TO INCLUDE:1 INST FAU LESS THAN K BTU AND REPAIR/ALT COOLING/HEAT AND 1 COMPRESSOR:3 TO 15 HP/500 K BTU FEE SUMMARY Quantity Quantity ISSUE FEE , $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU - $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $27.15 1 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 • 30 To 50 hp/1,750 k BTU . $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000dm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 . 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $79.15 • • 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 suspend or abandoned fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and fInal approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46 t6/ool DECLARATIONS n (Tl WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued of one hundred dollars($100)or less.) I.certify;that n the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' campe_psation'ta s oflifomie, agree th I if I shout become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith y w complith ese`p w _ si s. C AppItcant'Signature: `( ), I Oates"/ Z C) - d.f WARNINGrFATCURE O SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37x6 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit , -he applicant to a civil penalty of not more than five hundred dollars($500).): as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work k himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is stg.within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • I owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions \-------Code:The contractors License Law does not.•ply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License -ws.). ❑ I am ext under Business and Professions Code for this reason: Signature:79-1)e)e ' _ 7, / [Daiiirrt2—Z9 rp-fie_- OwxnerlD'verified by driver's license. T. Yes 0 No Drivel` rise No. tExplres(jO�'O i-/O Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder', I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Ye5 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑NO (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 II an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a.aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L-I No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If`yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have ell of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state aw city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the abov -de ribed p rty for i ectio pu os s.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si( re•Of LegalOwnar(s) F Date And/Or Authorized Applicant Date '',�j''' 1ODE 6 IFSPFCSON TYPE DAE INTRIALS CODE* Final TION TYPE 7/T yayoaLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical C//moi 1266 Pool Spa Final 208 Final Plumbing • 200 Final Re-Roof 210 Final Electrical ' 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place - 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy , CITY OF COSTA MESA BUILDING DIVISION . r�044: � DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER fi rr a I J nil PERMIT 'els P05-01017 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa..ccLUMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2873 REGIS LN Status: ISSUED Suite No Applied: 12/29/2005 Issued: 12/29/2005 Vicinity: Parcel Nunmber: 14156317 Applicant: HOBBS, DANIEL ISSUED BY: Address: 2873 REGIS LN Phone: 714-540-3440 COSTA MESA,CA Zip: 92626-4210 Owner: HOBBS, DANIEL • .,- Address 2873 REGIS LN -: Phone: ',. " pyo • COSTA MESA,CA Zip: 92626-4210 �cw- w,' ':'# • Contractor: OWNER-BUILDER Address: Phone: Zip: • License: 000000 SCOPE OF PERMIT . PLUMBING PERMIT PERMIT TO CONSTRUCT A 243 SF ADDITION TO AN EXISTING SINGLE-STORY SFD WITH A 200 SF REMODEL OF THE EXISTING RESIDENCE. REF#:B05-01847 WORK TO INCLUDE: 1 GAS(1-4 OUTLETS),1 KITCHEN SINK, 1 WASH BASIN AND 1 WATER CLOSET. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator • $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $9.80 1 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0' ' Sewer Private Line $0.00 0 Water Closet(Toilet) • $9.80 1 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $6.15 1 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 ' Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 .0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $59.05 COMMENTS/SPECIAL CONDITIONS • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and rel ted- regulations. edregulations. (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 o e bandoned 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 applicabl odes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 . 2466-46(6/001 DECLARATIONS r-h WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ..✓__— _,t{. Lr I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' ,-----rompensation laws of California,and agree that if sh u�came subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with thgse?svisions. _Vllt -Ap cant S�ignatu 7A 14 Y 6--- r oats /..L- 2. 9- o/— LWA IRN NG:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Mc.N Class 8 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of.the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • r I:I:RUA owner of the property,am EXCLUSIVELY CO ACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions —""Code:The contractors License Law does not ap to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License s.). ❑ I am exempt under sec. Business and Professions Code for this reason: _ Signature; . LData:- -- Z - 2 9-or c O�IDwerified by driver's license. es 0 No DriderVLi_e`n'se`No. Expires:"-nO/-<8-/D Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gly 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aoPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _. h .s the subj.._....-.....this" 7 If a permit athe South Coast res Quality cri ed Management DistrictHor other airpollution ioncontrol district3 agency is required for the work which is the subject of this application,have all of Ire disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the abov` s ribed pe rin p cti p poses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. (L -- Z4-or' Slgnatufe.Of.Legal'Owuer(s) Date And/Or Authorized Applicant Date ODE L INSPECTION TYPE DATE MALI BODE A INSPECTION TYPE P_AIE INTTIT1AL5 1618 Fixed System Final Fire Prevention 206 Final Mechanical / / 1266 Pool Spa Final _ 208 Final Plumbing 1//.PbJ 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall _ _ _ 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy i �..y, lrtiBr1t+.oWryywSwyan7q,v-n• "'' ,."'"'",,"hia°wwfuy.wy g ' Y",w`�Q" ' 'f`'0,'v i;nd';.; M.,.,v,lk�,.4%;; • k7COr. ir. , BAL ) I .... rs Deputy Inspector Cell: 714.658.2454 •Fax: 714.536.6752 Epoxy Bolts•Proto II •Reinforced Concrete•ICC/ICBO•Stuctural Steel Welding Structural Masonry•ACI Technician•Pre-Stressed Concrete• Batch Plant Inspection•Fireproofing DAILY OBSERVATION REPORT Job Address per, n • o ..Issued9 (4 Job Name/*Lbs T�/�T���/� Archilee (dot, /iC' ° _ Material DcscriptiunJ��' vv/ Engineer 4 ,, , ..,/ �j. Observer's Name /! /y/ Contract-/ Ii4er /./.../7.:Sam les 2474uantit Subcontr / DESCRIPTION OF WORK OBSERVED 1,� (I DATE (DAY) /— /3_ na „c,g/. V / //bi- t/.c' ' /0/o/'e/ '/-t-15.7)::17Z. aTioy c,f t it /-/ 8,21 __ v "2 " 4v/Afkry,,,//,�-f r'" /-(4e /,75c;o71 4S .312 . ),zv�.47"/o---v P/4,-/ ,.dvticdT ri7_ z //4 AZL- 1z<z t /R/&�.v/t-2 -ri - A//./517 fr 59r7 ,-- T fh��� ir- )ti 779 S/-1 ��762 42 g /..E . ap �f�Ti-4' 70 £ R?744 //-e_. _ ;y2iT�� 4'( 4T A �f,�o,-r 2 j ,U u9 74? E>/ 77, li c (e9/l,%Tie2,v &4// //- r/G .hel�/1/e.e • G /9c.. -- rY/ilg i v /4-C(� /, k.f G G(1/7 -10-12 . e //�_'//9 rZ4-c's 4.-o / 4GC_ t _ A,`e,2/ / , a,A/7- y /.(_2 7- ziAzLIJ-7-4;.-v, _ • in7,3 7/4 //>/l/c ,0r "_ ?/7 . <% / 7) v./ 1 / \ \At_ , ( , / \ `' (-7�`-(-- / ATTORNEY'S FEES—If any action at law or in equity is brought to enforce or interpret the terms of this contract,the prevailing party shall be entitled to reasonable attorney's fees,costs,and necessary disbursements in addition to any other relief to which such party maybe entitled. '.-------------:--------- TIME IN TIME OUT _MIN.FEE DAILY,FEE O.T.HOURS,11.T.HO4IRS.---I hereby certify,that at the time of this report,I have observed all of the above reported / -*Zi.: e y / iwork,unless otherwise noted.To the best of my knowledge and belief,I have found this 7 _J/ kV. /" • ,worlrtotomply ilh the approved plans,specifications,and applicable.ection(s)of the All observations based on a minimum fee for up to 4 hours or a daily fee for 4 to 8 hours../ building code asrapplicable to the jurisdiction where the oroje lnca d.This report cannot be con d to he a recomnendaoon work ny nature to be performed The Any observations extending past noon will be based on a daily fee.Over 8 hours•and Saturdayi ' Owner or uccessor'n mteresVASA-hnid h l• Scott Bald from any and all legal is time and a half.Over I I hours and Sunday is double time. N"•-. i p_ rocccdings of any nature who sdever_that- `at>I to the ob alio%services provided. rSSignator f Ohscry S 4 �// Approved By: a I rY Project Superintendent Specialty Registered No. Agency WHITE—OFFICE COPY,CANARY—ACCOUNTING COPY,PINK—OBSERVER'S COPY,GOLDENROD—JOB SITE COPY - V'ro Q�'ry y5 - \ y --__ --------- 7 i ‘1J//1 Rao < 0Ott L w ,1 1_9 IA N ���J� r SdF _ _ Sq) ( H ccos�.f - Sc'ef\fic ,uY 0 \ \ rC65EI N is LA o 8 73 ReCS _ / SSR,% I E 0 � —Ot �(06 { Vii-` ---Ca I MS7 (3r0 ris* ion+10 MA t^i / /5.11MP t1/4.c.,741 HALF i (No/ANtt. /5 AMI Lf5 SootW HALF %I L f 5 -- 3 2 J AMp pLu9S gee y o 'PAP Lu S L�uIH 2 P P ,7 f , jy/rrrw) , aQrN z Amp pt.9s LAum Ory b Zo (imp Pool Fitter 7 to Amp 4ArR9e SaaMP s p 9 Is AMp SM clew- AtArwy /v —- M AS lee I3e0yL r 15" Fl MSP HALL ray L rl/1tS / Z M 5 t I 3 i5-AMe tanoe ov?(tTJ aArN I t/ Sea*e_ !S 20 Amp pe-95 pgtrot nit°RA, 16 20 ---_ _ Flap 1 7 _ .._. F/tYtr pump ! aoAnp 0/5-pant 204Mp rur Jug)CC. ,_ .. ......._ t A Nt Atter r .(�'q Yfl rOON PCryJ pp.✓[iL = °Lo etas'tA'3 c /rc uYl per, = New cheat. 2B73 cRe ( s EO $ - o ' LOS SA Sete t ALArss G 767134- New /S ,gkio erreut Ta pvotc LiSHrf Oto tDOM or exat,Nj c,,,,ur .(,✓utoocXea) MASrsr OutSiOC 641 C7eX.tt141 [3en roots crrcu� C.�yvµ MSt S, Sec Z t7 yq« °� es," ���) ^� SYfjety Cr • LNt,S NSW /Sgktpclecut rpt�lL f °"' exisf�y tigHt c,rcuf (luew � Q Ling y1 0 at ru R//ic, �T ©Uy L¢�'s Geo Roo" aPN E%,:t,Ny c/rcvt', Glen roan L MS * Bea New 1. An csecu7r oQrs'o2 B9tN 7b7x3C /a oo�`Lars 115T BelW oa exis fA, csfCur (uei& J 3a su ANrc ) 2873 tee% 1 S L nJ OW! CITY OF COSTA MESA i 4 66 BUILDING DIVISION F del DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 PERMIT 4%0RaTto 44* 1602-00147 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2873 REGIS LN h-' • Status: ISSUED Suite: Applied: 01/30/2002 Vicinity: FRONT RIGHT PROP LINE Issued: 01/30/2002 Parcel Number: 14156317 Zoning: Applicant: TUCKER, MIKE . ISSUED BY: 41___ Address: , . _ _ • Phone: 714-593-3135 , ' i - Zip: , /: �\ Owner: BIBELNEIMER MILD , Address 2873 REGIS LN - - Phone: -COSTA MESA,CA - Zip: 92626-4210 Contractor: -A J M CONSTRUCTION SERVICES Address: 9414 EL CAMINO AV Phone: (714)593-3135 '�` �\ FOUNTAIN VALLEY, CA Zip: 92708 License:- 562156 - : - Arch : - Eng: : 1 - � � Address: • Address: Phone:• Phone: Zip: License: . " ��-:License: SCOPE OF PERMIT CONSTRUCT 4 LINEAR FEET OF 6-FT HIGH BLOCK WAPER CITY STANDARD'LLRDS.'` ' - • FEE SUMMARY Plan Check: $15.28 � - Calc Valuation: , ,$80.00 Permit: ' $23.50 - - - - - - /•--- = Claim Valuation: ,t-. ' : $o'oo SMIP Res: . $0.50 'SMIP Com: $0.00 Other:: $0.00 - Inspection: $0.00 Total: $39:28 _ 2 PLANNING & ZONING ' ' SETBACKS _i' MAIN STRUCTURE Front 0-0 Rear 0-0 - Left 0-0 . 'Right y 0-00 'N , � ` ACCESSORY -'Front 20-0 Rear 0-0 Left 0-0 Right .% ,0-0,. ' PARKING Existing:_ 0 Required:. 0 Proposed: - 0 NOTES: ���� • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all 1 required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. I FOR INSPECTIONS CALL: (714)754-5626 1 2446-46(6/00) DECLA • TIONS fl f'11 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ . I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the l� work for which tis permit is issued. )"' I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My work ./�p/ml pe tion Insurance' carrier and policy number are: /3)760-01 Carder: /!r_ FIA)D Policy Number: (This section need not be co plated if the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of a rk for w this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo a, n a roe tha I should become subject to the workers'compensation provisions of Se ion 370 of the Labor Code,I shall forthwith comply with these provision / 7(] OD Applicant Signature: Date: WARNING:FAILURE TO SECURE WORK RS'COMPENSATION COVERAGE IS UNLAWFUL AND,SHALL SUBJECT AN EMPLOYER TO CRIM PE TIES AND OVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN AD TION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLA- 'ION: I hereby affirm that I am license un,: o " of -pter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.If / 'a AA Class k —.Pr Contractor's Signature: �' 'SP Date: CONSTRUCTION LENDING AG NCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): • DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described props nspect• purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. „ -nature Of Legal Owner(s) ate L / /���• r • Authorized Applicant D e ;ODE t L', E' PAIS lNTt1ALS LODE. INSPECTION TYPE DATE 1(M& 1616 Fixed ystem Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Wall 1.,1 -tt 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy � % . . •MIS SKETCH IS FOR INFORMATIONAL PURPOSES •SOLID WALLS/FENCES BETWEEN 2'.6'&6'IN HECHT SHALL ONLY. APPLICANT IS RESPONSIBLE FOR PROVIDING BE SETBACK AT LEAST10' FROM FRONT PROPERTY LINE. AN ACCURATE REPRESENTATION OF TTER PROPERTY IN CASE THE SHAPE AND SIZE DO NOT CORRESPOND •90LID WALLS/FENCES SHALL NOT EXCEED 2'6•IN HEIGHT WITH THE INFORMATION PROVIDED ON THE SHEET. WITHIN Id OF THE FRONT PROPERTY UNE(NOT CURB LINE). •VERIFY DISTANCE FROM CURB TO PROPERTY UNE AND SHOW ON PLAN. VERIFICATION FROM THE CIfYS 2..-C/9 141 ENGAIEERING'DIVISTONEREQUIRED7CALL171475415343 . - -. . . FDR INFOItMATn PP ® ID. NOTE CITY OF COSTA MESA ADDITIONS, 9_,LI. OR CORRECTIONS SHALL PLANNING DIV. 6'e f'.PPR o io THE PLANNING DiViSION SUBJECT TO BLDG. DF REG. DATEI 1/3(/° ypRpy� A I I RESIDENCE RESIDENCE C1E n .��y 0 T DI VIS O�u�OF BUILDING SAFETY • cn'vorcos -- -- APPR ! VE1/ 4 _4?- / .. Date / .3d D This ect at puna and*ant'nation MUSTS leapt on Ha I,at Mho and lila unlawi I to mak°an.them at ahata'MI nn aalna wtii ofhton pu intohorn tha DlYhbn of:. I rigIN L )i o,+1 1 11`a ,e 2 O� 1 Ms afan MN Of t la k Ian of flapeslFs"suena€htia I.hh Fa H nalg t. L'I!ID YI -,lean Of illy Ito ir a t i my Cite 6f r !.,I'?6a L'd:nadde andlnf&aIa awl a L L 'nine tl. 14 rind ¢I!.&9r }/Irll.l: n A c-:"' {II I i.' ':.+r1C°� -�"r -:«_: g - °navaldlfifiabfldNi�pf a 3 Ig t4ie I.{Ie, pi d I,if 11N iyb' II of I aim s. 3 RESIDENCE RC90ENCE RESIDENCE RESIDENCE I n Xn^ N > ' / W �I W 1 - 4• MDN woo( . SI'T BRCS . :I)i • • C /81 TREET _ BLOCK WALL LAYOUT FOR BUILDING PERMIT r J PLANNING DIVISION TYPICAL 611 CONCRETE BLOCK FENCE Cement Coping Optional i •• GENERAL- NOTES Channel Block With 1.3/80 .ill Si • - Horizontal Top of all e! Fences H ' I MORTAR; One Part Plastic Cement, and !' Three Parts Sond For . rs 3/ or5 Less Ia a� I GROUT: One Pmt Cement Three and One Half Parts and Vert. Bars 3/8"¢at 4' .0"O.C. - id o Trill I COPING: One Part Cement, Three • az: For Fences Higher Than 5' ' 4Ls '; Ports Sand Vert. Ban 3/8"0 at 32" O.C. rYJY a w CONCRETE: Well Mired 1:2-I/2: 3-I/2 ��I a cc - , -" Mar of 7- 1/2 Gallons o1 Fill Cells Solid With Grout > - wnereSteelOcwrs , -- , Water Per Sack of Cement Reinforcing Steel Shall +!ae{F�' 4 t 'o 1 .+ GROUT MAY BE POURED FROM THE TOP ill -, OF THE FENCE IN CELLS WHERE STEEL Conform to Sec.A.15.39 ' w o - • OCCURS. A.S.T.M. III Z ~ - - '�,� I CELLS AND AREAS OF HORIZONTAL REIN All Steel to be Lapped I 4 ---_ --- FORCEMENT SHALL BE CLEAR.CLEAN 6 24"or to Code 111I . FREE OF ALL MORTAR DEBRIS.ETC. - ' NATURAL GRADE I . tLihir Vr U110 I &BOTTOM FIli 1 --ar--WIDTH TO 16. 0 C MAX it SEE CHART H o MUST BE TIED IN DEPTH CF CARTHTCOTH ' PLACE ATT BELOW TIME OF TRENCH PLACE t I , �IR/�' THE HEIGTH OF FENCE INSPECTION. L OC LOW BOTTOM OF FOOTING 1_,,,i11;_i io" T2•• __ SCALE: I/2" t I' • FOOTING REQUIREMENTS CHART - I WALL HEIGHT 6' 5 4' 3' WIDTH . . . 14 . . . . . 14" . 12" . . 12" THICKNESS10" . . 10" 8 " 8 " DEPTH OF EARTHTOOTH 24" 20" . . . 16" 12" SPACING OF EARTHTOOTH 12' 14' . 16' 16' BUILDING DIVISION iiil • IADDRESS OF BUILDING: 2873 REGIS LN UNIT: CITY OF COSTA MESA - BUILDING PERMIT mmum WEIFl c*f MACALUSO, DON ADS 2873 REGIS LN SPERM NO: B 079420 COSTA MESA,CA 92626 PERMIT NO: B 079420 PLAN CHECK NO: N < GOVT: N SUPP: N 556-6547 APDL.MMLIND ADDRESS: CONSTRUCTION TYPE: V-N • PERMIT TYPE: STR PURPOSE: 0TH 'ARCHITECT OR ENGNB:R: • UC.No.: JOB DESCRIPTION T/OFF SHEATH & REROOF W/COMP SHINGLES SQ FT: 4, 500 yhCH.OR ENDS ADDRESS: Uxr: CLAIM VALUE: 4 , 500 . 00 CALC VALUE: • 4, 500 . 00 GROUP OCC: R-3 / cowwAOToxsgeE LEWIS & SONS CONSTRUCTION ( 714 ) 533-4900 CONTRACTORS IMMO 424 N JANSSAV COMMENTS: SMOKE DETECTORS REQUIRED BY 94UBC, REROOF 2400SF RESIDENCE W/COMP ADDRESS: ANAHEIM CA uc.ND.: 416525 **********+1'+E**********IEIc****4*****SEN"****It*******+E -*RF**+E*********SE**N"x"********x"+c 92805 UNIT: Z ON ING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affrm under penalty of perjury that I am licensed under provision d Chapter 9 SETBACK S (uprmmendag with Section 7000)d Division 3 d the Business and Professions Code,and my Doane S in lull lou and died. CITY uc.No.: 062407 LIC.CLASS: C-39 LIC.NO.: 416525 EXP : 00/00 MAIN BUILDING ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Date: — l��Y�� contractor: LA2Ly,, Svw� LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason(Section 7031.5 aeewss end Professions Code:Any cry or county which requires a pennn to oanmx:L altar,improve, PARKING REQ: PROV: PARCEL: 14156317 Z NE: REF NO: demolish.Cr repair any structure.prior to its issuance.also requires the applicant for such permit to Ale a signed statement that he or she e licensed pursuant to the provision of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES> Business end Professions Codej Of that he or she is eaenipt therefrom and the basis for the alleged exemption.Any violation of Section . > p . 7031.5 by any applicant for a permit subjects the applicant to a civil penally of nal more than bee hundred dollars 15500]1. iflfiE3F1EIf1Eif1E)ElE1EiElEiEIE)E1E1E1E1EiflEiFlE1EIF3EIEIElE1EjEIFIEIE1FiElFifikf(jkjFififlflEiElEif1(fE1fiEIEIEIEifdFlEifiEdEifi("fFfflklk*iElflf"i(1E1E1E)E ❑ I.a owner tithe properly or my employees with warm d the:sae compensation.will do Ow work.and the structure is nal intended D E V E L OPMENT SERVICES R E v� U I R E M E N' T S or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply to an owns d property M who Weds or improves thereon,and who does such work himself or herself or through he or her own employees,provided that such improvements are net intended or offered for sale,i.however,the builoing or improvement is add within one year of completion,the ZONING APPROVED BY DATE: ownenbuilder will have the burden of proving he or she did not build or Improve for the purpose of sale). ❑ I,as owns of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and • Profession cede:The Contractors License Law does not appy to en owner of papett).who builds or improve thereon and who BUILDING APPROVED BY : DATE: contracts for suchprojects a contractor(s)Ikensed pursuant to the Contractors License Law). ❑ lamesemqunderSection: B.AP.C..for this reason: APPLICATION ISSUED BY: DATE: ********************************************* ******************** * * T. Date: Owner: LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y I do hereby certify that I am aware of and understand the requirements of California Neem and Safety Code Sections 25505,Pac49.and 25590,and lh t I or any future building occupant will/wit not(circle ow)need to comply with said date codes e d the requirements b a permit laowmroctona mdihwtianfrom the A'r °sty aropenwnl District Rssidentd construction applications°nexempt these esa BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE $MIP/RES GRADING provisions. PERMIT 99 . 75 . 50 • Date: Applicant - SMIP/NON-RES PLAN WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one d the following dedarmiws: ISSUE FEE ❑ lh°veend wumalmainacertificate dconsent toself-insure for workers'compensation,es provided for bySethon37Wathe Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE cndat«the pedomnanceduw work for wNm mita permit is issued. TOTALS----> 100 . 25 0 . 00 0 . 00 100 . 25 100 . 25 -- --- -----..00 ElI have end wit maintain workers'compensation insurance.as required by Section 3700 d the Labor Code,ler the performance d the -- work for which this permit is Sued,My workers compensation insurance carrier and policy number are: • canner STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 100 . 25 OVER/SHORT: .00 Perky Number. 1317548-95 10/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (This section need not be completed If the genre is for one hundred dollen 1510010 lest.) 99 . 75 . 50 ❑ I certify that in the performance of the work tor which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'compensation lays of California,and agree that R 1 should become subject to the wakens' ******************************************************************************* comps" ,ion provisions d Section 3703 d the Labor Code,I shall forthwith*amply with those provision.. IND I VIDUAL F E E BR E AKD OWN Date: /.-.9-1-54 Apgioant: �[ '�� • . Warning:Failure to secure aureate'compensation coverage la unlawful,and atoll aub)act an employer to criminal penalties and TYPE QTY D' E S C R I P T I O N UNIT COST TOTAL COST civil fines up to one hundred thousand dollars($100,000),In addition to the coat of conpensat/an,damages as provided for in ' Section 3706 of the Labor Cods,Intelsat,and attorneys yaes. SFR 4500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4 , 500 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under Penally of Perjury that there is a construction lenang agency for the END OF FEES performance of the work for whim the perrni a issued(Secs 3097,Cir.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state that the above information is conect l agree to comply with all ay and county ordinances and state Laws relating to building construction and hereby authorize representatives of the city to enter upon the above-mentioned papery for °"purposes. 01 00214587-00214588 TOT 100.25 ,Y.o•/.' - (e 4-/S ^' :DATE: 04/09/95- TIME: 09:45 /�C/.sQ • Print N°�me C �v }�, • /� puimnI/Contrada• Data: ��/-7 r Signature d Owner/Aoen&A -L.1 (5151d6.WP) WhnsBuildig&Safety;Green-File;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor PO( SPA ' CONSTTRUC-'ION AND PLANNING - _ - '`Date Inspe`etor - Date Inspector APPROVALS Permit# •APPROVALS- Permit # - 1. Temporary Electrical Service or Pole ' 52' Pool & Equipment Location • _ ' . 2. Soil Pipe•Undrgrnd.. 51 Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrnd._ 54: Forms } . • 4: Electrical Conduit.Undrgrnd. . . 55. Electrical Bonding - - • . . .5'. Steel Reinforcement 56, Rough Plumbing & Pressure Test I - E:tEiectrical UFER,Grnd. 57. APPROVAL TO COVER•GUNITE "7. Footings - - - 58. Electrical Conduit•Undrgrnd. 8'. `Foundation 59. Gas Pipe, 0 Undrgrnd., Test • 9. Water Pipe-Undrgrnd.= - 60. Backwash Lines,R.-Trap, 0 Undrgrnd, 10. Structural Floor,System - 61. APPROVAL TO DECK 1 . 11. Property SewerLine & House Connection 62. Backwash & Receptor-Final ' • 12. Sewer Cap - 3' - 63. Heater& Vent-Final 13. Roof Drains64. Plumbing System - Final 14. Rough Plumbing65. Electrical-Final 15. Rough Electrical-Conduit - ' = 66: Solar System-Final 16. Rough ElectricWiring ' 67. Fencing Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling -69. POOL/SPA SYSTEMS FINAL 19:- Rough Heating & Air Conditioning • - FIRE DEPT. REQUIREMENT 20. ;Rough Factory Fireplace - « - APPROVALS: Permit# •- '- 21- Ducis,in.Structure ' - . 70.:Underground nderground Hydro _ 22. Ducts, Ventilating=> . _ ' r 71. Product Piping.0_Gas 0 Oil 23. GasPipe-Rough& Test i- 4 ' 72. Underground Flush - 24.,Roof.Framing. , - .- ) G_ 73. Undergrnd.Storage Tank 0 Gas ❑Oil 25. Roof Sheathing • • /�Q - 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat _ -• - 75'. Dry Chemical - - • 3 27. Frame and Flashing- - Ji;:` 76. Dry Standpipe: 28. •Lathing& Siding-- .. . 77', FIXED SYSTEM FINAL 29. Insulation a _ ' - • ' 78, FIRE PREV. FINAL y - 30. Drywall Nailing - r HEALTH DEPT -REQUIREMENT - 31. Plaster Brown Coar,: r ` 79: FINAL INSPECTION . - '. 32. Electrical Power Meter-Final ;i+ r 80. FOOD CERTIFICATE ISSUED . . . 33. Final-Electric ' ` 1 Notes: _ - 34. Final Heating:& Air,Conditioning>- - ; "' - - _ t. ' ' 35. Final Gas Pipe Test " - - - " - - . - - 36. , . - _ - - • �•r . . 37. .Final:Factory Fireplace,- = I. - ry - , 38. Final Plumbing • _ -, ! • _ -- I • _ 39. Water Service-Final� r r - . . -- - 40. Gas Service-Finalt-n-` ._ _ . ! K I/ : 41. Solar Domestic-Final _- If+ - _ - 42.-Backflow'PreventE, - , -- +; - 1 :7- - 43. Backflow Irrigation- 44. Landscape Ir5iation-S stem'co, - A • , - - - t _ -45. Sound Attenuation` - - - "- - ..• - - 46. Handicap•Regulations _ ,_ _ _ 47. :FINL STRUCTURE & BUILDING r/;• _/6' / P 48. FINAL PLANNING; • + - 49. Eleetiic Release to-Edison , 50. Gas Release to Southern California,Gas Co _ _ - '. 51;. CERTIFICATE OF OCCUPANCY- - • - _ - No' Date • CITY OF COSTA MESA CALIFORNIA, P.O. BOX 317 From the Office of the Planning Department Regarding building Permit No: 20418. Date: ,October 29, 1963 Location: 2873 Regie Lane Dear Pool Owner: The Costa Mesa Planning Department called at your property to inspect the Swimming Pool: Our interest in pools is for the purpose of safety and to be sure all provisions of Section 9298.9 of the Municipal Code have been met. Section 9298.9: 1. No swimming pool shall be constructed closer than five (5) feet to any property line, measured from water line of pool. ,2. No swimming pool shall be constructed under any electric power lines or on any electric power easement. 3. No swimming pool shall be constructed unless the yard surrounding such pool is completely enclosed by a six (6) foot fence or the pool itself is enclosed with a fence six (6) feet in height and hav-. ing a self-locking type gate or gates. Note: (Gate should close and latch on a free swing). Your pool will not receive final approval until the requirements of the aforementioned Section of the Municipal Code have been completed. The following disposition is noted in reference to your pool: Li No one was at home. Xj No springs on gate. O Improper latch or defective hardware. 3 [J Wall surrounding pool not 6'.. high. 1 Other. ' ' t � 1�� � Telephone 646-2411 and ask for the Planning Department so �$ that an appointment may be arranged. Since you have incurred certain liabilities through the`.installation of a pool, it is requested that these matters be taken care- of as soon as possible so that your pool will be a safe one. 0 6.9Sincerely'yours; . I? 3[> C By Planning Technician David Leighton 19��'�01 ' ' ' 1024514./n5s;- • .. ,.Es. , LABOR A T O R I E s, I NC.= cs• 90Tafin9 andirnaibecfion (5n7ineere COMPRESSION TEST REPORT Test made for Sunset Pools 1237 S . Brookhurst, Anaheim Job Identification ROBERT E. KENPSHIELD, 2873 Regis Lane , Costa Mesa. , Location in Structure SWIMMING POOL. LABORATORY DATA ' • Laboratory Number 89489 89490 . Mark .1 2 3 Date-moulded 9-16-63 9--16 9-16 • Datetested . 9-23 10-14 ,Q_ 10 43 gibk Age,days 7 28 IftC E Weight per cu.ft.,lbs. - _ �5 IgF� r C6J'41Ca pts c Dimensions, (inches) 5,90x11.9 6.2x12.2 °19' d Area,sq.in. 27.34 30.19 • -lit ,t' Compressive Strength Total Load lbs. 56,000 112, 500 Lba.persq.in. 2,048 3, 726 Not Reqr' d ' FIELD DATA • MIX: 1 :4-1/2 GUNITE Cement •Colton I Specified Strength @ 28 days 20004 Sand Slump . `No.4 Admixture' No.8 •. • Ready Mix Plant No. 2 Cyls. made by . • Water Date cyls. delivered • L� 2 - Sunset Pools ' ----"---1 - Costa Mesa Bldg. Dept. �- • 1 - Wm. S . Miller • 901 E. 68th St. , Inglewood 3 ' Respectfully submitted, m/4 RAYMOND G.O, OSBORNE LABORttSTORIES, Inc. • By /�-'- /4 235 WEST TWENTY•SEVENTH STREET • LOS ANGELES 7. CALIFORNIA • RICHMOND 9- 3111 OWNER KNEPSHIELD, ROBERT- E. DATE AUG 1 ii 1963 JOB ADDRESS 2873 Regis Lane BUILDING PERMIT NO. 20418 .. . . GENERAL CONTRACTOR Sunset Pools VALUE $ 2,200.00 AP No,141-563-17 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK Pvt. Swim Pool INSPECTIONS Signature DATE GROUP J TYPE III ZONE R1 Soil PERMITS ISSUED Gas M-9 S -1-2-6-Ci SUBCONTRACTOR _ DATE NUMBE. I Water Rough Com. Refrig. 0 Air Cond. 0 Rough Heating Rough Plumbing --4:17.&,,, It Q,-2/.-de -fl_. • Jam-/4,-‘3 39/6.P Miscellaneous tear. 4 - -r..•r C . 9_. 7-6.? 3 ,s40 3 Prop. Swr. Line 0 House Con.'u St. Swr. 0 Sprinkling System Construction Pole Underground 0 Power ❑ . - .. ea.,. • >_ /9_ ..Z 3-63 _2, 000 �1' a.-`L , - ..e-t O v 7��'/- 9'-//G 3 Z-,/,/ Rough Wiring O� Trenches Pd' Forms 0 Steel Reinf.a- tir !T q- //..-7 Floor System - Bond Beam mi Steel Reinforce,EV----- --4% 9r-,/,/-4,11 Sheathing N( Frame and Flashing L Lathinng— In 0 Out 0 „ / ifri Plaster, brown coat J.�U lRt • Refrig. 0 Air Con. 0 Final Heating, Final , I ,// Plumbing Fixtures, Final �. JD/{/`✓.� �l Final Gas TesVCr i2 fYS 9L4'GS Electric Fixtures, Final /9//;, — _ Building, Final OCCUPANCY • Form 13U4-5M-3-63-5-B P HOLD FOR SPECIAL, RFOIITRF.MENTS onh i A e.,..: •�L� • . 20418 ` 144 , 4 COSTA MESA BUILDING-SAFETY DEPARTMENT E COSTAMESA. P.O.BOX 317 LCALIFORNIA / For Applicant to Fill In Completely APPLICATION FOR PERMIT !)I'fLTYPE OR PRINT FINA LT! ADESS .(r t23 /PEG � DRivIt,ve (( CIT4°O ( E' IY ' _ RECEIPT NO. PERMIT NO. COSTA MESA, CALIFORNIA I' .20 rf? pECE1V O BY 8 RSC E DATE ISSrUED Rn6F.4r P (1.vb--p.s/4i- o'Ltl c -/ Ls - a- -Ga OWNER BU g-RT2 , (J 75 r co �G • ADDR (� a C" ADDRESS O ADDRESS J/� (/ ' X4 TE017/e,l//g ZONE //JJ GROUP FIRE CITY �S � FS/`( NGr+'/L' rJ /////////////JJJ �J /' / / ARCHITECT /, / rc C TEL, BYPROV[Dy� DATE O % % p•`9 ORENGINEEPLG a- ri/`/rt�4 NCCJI�' 2 ��//11 `` �J7�5� 14,6,14,41-A., [ !+ ZONING , ADDRESS,7 ? LCi G/7 �-'J ff ZONE _, NO.OF I USE OF NEW FJ_ /i (�/' /, `y-/� -'/T`� Pun: E.. BUILDING •l/� CONTRACTOR JL////s /1�8h5 /Jii a �, ADDRESS 173///11/8A2 C 7 Ar/V CIL y([L DESCRIPTION -/� / {( CITY 4&. //©LJ/J r`v OCL J A.P.NO. /41 "" .j-LP5 — i 7 STATE 1 - /may., THLQ /!y- NONOTE: NO SI E VE REAR OVERHANG SHALL BE LESS THAN LIC.NO. I`/ ci`�3/I C/ NO•/ I!T�./ EAVES SIZE - I NO.or SLOGS. ALLOWED (U.B.C.REQUIREMENT) OF LOT NOW ON LOT YARDS APPROVED YARDS APPROVED USE OF • MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG: ( C/L STREET) .Sr F> p SETBACK LINE FROM FRONT FT. ' CENTER OF STREET REAR YARD SIDE YARD I LEFT I RIGHT R.SIDE FT. 2•V FT. DESCRIPTION OF WORK L.SIDE FT. /0 FT. -- • NEW . ALTERATION _ ADDITION REAR - FT. /V FT. DISTANCE BET. BET.MAIN& /-5--- MAIN sMAIN BLDGS. ACCESS.BLDGS. REPAIR _MOVING _DEMOLISH BUILDING �7 !J NO.OF SIZE /b ROOMS STORIES CAU:P.7t J� APPROVED,�VEG[/ EXTERIOR WALL I ROOF BY PROVED� j/� DATE♦/7W/" C COVERING �G� USE p�BUILDING AND WORK TO BE PERFORMED lt///M/1/I/4/6- C`9&0 N SQ.FT. O I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE F \ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINA A T�7 LA R[GU}� NS VALUATION ci- BUILDING CONSTRUCTION. ors- -� O/.r- PERMIT FEE $ /2 — SIGNATUREOF�/(� /O O PERMITTEF /f/I / . IP-L_!'1 m0 B S 2., C,® PLAN CHECK $ o AUTHORIZED AGENT, . ) / ( -/ L TOTAL FEE $ e OWNER KNEPSHEILD, Robert DATE 8-2-67 ).'--JOB ADDRESS 287:3 Regis Lane BUILDING PERMIT NO. 27378 - GENERAL CONTRACTOR Kool Metal DESCRIPTION OF WORK Patio Cover AP No. 141-563-18 LOT TRACT FIRE ZONE VALUE $ 283.00 INSPECTIONS Signature Date GROUP J TYPE IV ZONE R-1 Soil PERMITS ISSUED %- Gas SUBCONTRACTOR Date Number I Signature Water Plumbing Rough Plumbing I Prop. Swr. Line 0 House Con. Sprinkling System Miscellaneous _ Rough Heating and Air Conditioning Temporary Service or Pole Underground 0 Power ❑ Rough Wiring Heating and Vent. Trenches p Forms O Steel Reinf. ❑ I Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing— In 0 Out p Plaster, Brown Coat Structural, Final Electric _ Heating, Vent., Refrig. and A.C., Final Plumbing, Final and Gas Test 0 Electric, Final �,�,I� Building, Final S- 1-4.f-0/ � , _� : � 27378AID AUGnuc -z-67-67400 2511 �,:._,,. ,; 3.uo COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92526 For Applicant to Fill In Complotaly APPLICATION FOR PERMIT TYPE OR PRINT BUILDING k. muILDINa ,�Lj7J �_E /,'} For OHS Use Only ,i� ADDRESS /���( $ ��h RECEIPT NO. 127378 COSTA MESA. CALIFORNIA // R[CEI • [� D RE lIVE Bdpo...JCS LLS ISSUBp ps OWNER her K 15/ / • _ at_ d �r V/V/.• / tt p '7 y D BUILDING - 2- ADDRESS 2. I`�y I's %7. s.Fs ADDRESS /` /f�� SQ- O.TNEL ZONE TYP GROUP FIRE CITY CO S�Z /� /y i ARCHITECT TEL BYPROVED /'' c, ARCHITECT d" 2 C `7 • OR ENGINEER NO. ZONING ADDRESS • ,J�/� ZON,rE2 I NO.OI US[OFNEW . CONTRACTOR koc / A C/e�/ ![ / PLANS BUILDING �/�����T/n"````fff��// A . ✓: LEGAL ADDRESS 3,20 4E. 7o a DESCRIPTION i �O'�U lI(�'' /�O� I� CITY �79 L , cOe A.P.NO. /1/- 5b3 -/.7 ' STATE /1- ,T.2/9• C NO fie /art,/ 80^NOTE: O SIDE 8 REAR OVERHANG NO EAVE SHALL BE LESS THAN LIC.N O II EAVES SIZE I NO.OLOGE. ALLOWED (U.B.C.REQUIREMENT) i' OF LOT NOW ON LOT YARDS APPROVED YARDS APPROVED UHE OF Q MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. AR- ,,ROM ;kyr. ) / SETBACK LINE FROM FROM. tZ O, PT. CENTER OP STREET REAR YARD - QQ SIDS YARD! LEFT RIGHT R.SIDR��"(`PT. FT. DESCRIPTION OF WORK L.SIDE -5O PT. �L// I (j rr NEW /" ALTERATION_ ADDITION RBA FT. FT. DISTANCE BET. BET.MAIN R } MAIN ELDGS. ACCESS.BUDGE. REPAIR MOVING DEMOLISH BUILDING NO.OF VAR•# DATE SIZE ROOMS STORIES C.U.P.#I APPROVED '' EXTERIOR WALL ROOF "PRIY.q aL' . COVERING .! COVERING 4Y LLJ. / Mk-GLtNDATQ ���� USE OF BU I LOINS AND WORK TO BK P FORMES 0. 31 9'4f'/ 1 f. -F , a 6 19 1>Dir- iti' /fir' SO.PT. I I HEREBY ACKNOWLEDGE THAT.I NAV, IAD THIS APPLICATION TN[ AMOUNT SHOWN UNDER VALUATION IS POR THE O AND STATE THAT THE ABOVE at AND AGREE TO cos. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDI 'A c STATE LAWS REGULATING _' BUILDING CONSTRUCTION ,i /'� VALUATION -- PERMITTE111 E OF , .4%jj9V d/ / PERMIT FEE $ Lam' E S.✓ PLAN CHECK S w AUTHORIZED AGENT 1✓✓/��� TOTAL PEE $ 3 ----- � cg.VVD ,_ . 15391 Lot 800 Tr c 0 , n SEP 11136 COSTA MESA BUILDING-SAFETY DEPARTMENT I I FINANCE DEPT. P. O. BOX 917 COSTA MESA. CALIFORNIA CII OF COSTA MESA For Applicant to Fill In Completely APPLICA ION FOR PERMIT TYPE OR PRINT BUILDING BUILDING ADDRESS 2871 Regis "lane COSTA MESA. CALIFORNIA For Office Use Only I RECEIPT ND. I `II ''MIITiNOi, OWNER Mesa Del Mar Development Co. t�j MAIL RECE sY DATE ISSUED ADDRESS 3800 E. Coast'Highway f- / /' / IC}P G 'a city Corona del gar, Calif. TEL 34220 BUI ess ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER Mannn nnrnnrat.inn NO.fP 3)220 ADDRESS 3800 E. Coast Highway ZONE TYPE !/ GROUP tiOVL$- CONTRACTOR Macco'Corporation BYPROVED DATE ADDRESS 3800 E. Coast Highway ZONING ""_�_� ZO"� NO.OP USE OF NEw I • L *an CITY Corona del `lar, Calif. - VZ—j I PLANS �jI-BUILDING/,17 aJ:L r c HD.-98808-SH-1 No. OR 34220 LEGAL h 11 DESCRIPTION ( -k/ `(�T • OF LOT 9397 S F I NO. OF NOW ON BLOCS T hone A.P.NO. USE OF none YARDS EVES EXISTING BLDG. ' _ APPROVED ALLOWED SETBACK LINE FROMII�� 'i• (CENTER LINE ST.) // CENTER OP STREET 3811" T REAR YARD 261 —. FRONT -`0 FT. / • IN. 61_ 61 SIDE YARD I LEFT RIGHT R.SIDE CET. �— IN. DESCRIPTION OF WORK L.SIDE 9 FT. N. NEW In II ALTERATION I II ADDITION 1 REAR Z ' i FT. IN. REPAIR I MOVING 1 V DEMOLISH I APED BY .PR. MOkl /C2 DATE t;<%/4%( SIZDN94491X5 0161RROOF 6 STORIES1 ilr 10e EXTERIOR WALL Stucco ROOF CO COVERING COVERINGP Living Area 1281 S F USE OF BUILDING AND WORK TO BE PERFORMED Single family residence Garage Area 445 S F w/attached garage Covered Porch Area 77S F I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF. ESTABLISHING A PERMIT PEE ONLY. FLY WITH ALL ORDINANCES AND STATE LAWS REGULATING CONSTRUCTION.CONSTRUU CTION. VALUATION '/ SIGNATURE OF PERMIT FEE $ 3.7 PERMITTEE M nPl Ma Del/elDevelopment CO 246.00 �/ R BY /,�J $ l4, PLAN CHECK 5 / AUTHORIZED AGEN illi, did ce a OSA® - TOTAL FEE 5 51 nn 2