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Home My WebLink About2203 REPUBLIC AVE - Building Permits ' ' rFr CITY OF COSTA MESA BUILDING DIVISION e DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER /.� .; PE^ni 71T V II � %erogeni, E05-00748 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT • Job Address: 2203 REPUBLIC AV Status: ISSUED Suite No Applied: 07/14/2005 Vicinity: REAR OF HOUSE Issued: 07/14/2005 Parcel Nunmber: 42238309 �. !� Applicant: HERNANDEZ, RAMIRO - ISSUED BY: r Address: 2203 REPUBLIC AVE•, _ - -- - , Phone:, COSTA MESA_CA" -, 'i r Zip r --92627 '- r, _ /-,_ - Owner:';1HERNANDEZ' RAMIRO Address%72203 REPUBLIC AVE-,- \- , <-7":7;:/// Phone: - `� COSTAMESA;CA Zip: 92627 \'.�.\ i/c' \, �� / ,, ,'` ,' / (�� 1 if, • - . Contractor: OWNER-BUILDER . - 'i t yr Address` - - .. ; 9 Zip: /_ � License:000000 _ % ,` x - `� ,,, \ v: , / y SCOPE OF PERMIT "'' I 'SERVICE PANEL UPGRADE TQ 200A',SAME LOCATION.' -• '- - -- - ' "1, - - - s.' ' - ;h-,5'1 SERVICE TO 200A. - - - .:","/ L- " FEE SUMMARY ;i • \, - Quantity - , Quantity ISSUE�FEE $23.50 • ' --- ` ) Temp Dist System/Lighting $0.00 0 �� '- Temp service test ,�k $0.00 ' Busway/100 ft ,,.' $0.00 07/',/ , Res.a/c package, `�yV,- $0.00 , Standing Section — $0.00 0 / - • New Re`s'(1-2 units) ' $0.00 . 0 "Misc Electrical Equipment $0.00 (/07 / ' New Res'(3+units) " \•x',$0.00 - 0 -7' . Transformers up to 1 kva/kw $0.00 7i0 / . r x Pool/Spa‘1A \$0.00 0 ,r u`p'1o40 kva/kw $0 o0j\/0 Lighting Fixts-�. '' 1 \$0.00 0 ' up to'50 kva/kw ` $0.00/7 0 - ', Recept Outlets ''' $0.002 3!-,c,-7.0:7;,,-,c -_ - -up to 100.kva/kw"^x $0.00/ 0 r, Switches �., ' $0 00/ 7 0 r ' '. over 100 kva/kw $0 00 , 0 Res ApplNon Res Appl N\-\(SCA $0.00\ ti�,,,,-„„,..s 0 r Low Volt Wiring System/Ckt---',;<2"40.001-'4.0; "$0 00-\0 /j%,:'r 0� J Service to 200a V'c v $30:50'-�-, 1-=-A_1‘. y,. �Misc Conduit- ,:--_-_,,..-:>/, x-•'$0.00/ 0//� �/ Service to 1000a \ ; $0 00 x, 0_ -- Misc`..Conductor - ` _ -$0.00, 0 Service over 1000a NS x'-$0.00 i , ,/.�/0<- , Circus(gen or ride). - -,,$0.00 A0 Motors to 1hp " `"$0;00 ii .0- `,` - l � r Circus(mech-ride orlights) '$0.00.172 0 Motors to 10hp '$0.00 "'0, ` r - ;I f i . 'Christmas Tree-Stand- ) _$0.00,-' 0 Motors to 50hp $0.00:> 0 .Fireworks,Stand : - ,(;$0.00 0 Motors to 100hp $0.00 ` -` ' ' \ 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 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 it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS ( ) n 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: Cartier: Policy Number: (This section need not be completed it the permit Is valued at one hundred dollars($100)or less.) 770"'I.291r ify 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' {�compensatlon laws of California,and agree that H I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro ApPrcaLit;Slgneltire� Y w.,,_ c----1.----' 'Date:2-- •-r —67 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO-CRIMIAL PENALTIES AND CIVIL TINES UP TO ONE HUNDRED THOUSAND DOLLAAE($1X,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Uc.4 Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation 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).): [le--t .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.). ❑"h m pt under sec. Business and Professions Code for this reason: Signature �w b �1 Date: 0 7--! led.tiy_driver's been es 0 No Diive/tUcense.No cF•plras. --R,01 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,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I 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 ❑No (Section 25534 of the Califomia 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 a plication aapermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes jJ 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 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 above-described proarty for inspection purposes. agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / se, Signr9'Of�Lagal Owner(s1—__--,- D'afe------a And/Or Authorized Applicant Date CODE r INSPECTIONTYPE PAIE INTITIALS CODE INSPECTION TYPE DATE EMU 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -/ p 200 Final Re-Roof 210 Final Electrical /j///71O' 4 /An..,a .) 201 Final Block/Retaining Wall 212 Final Fire Prevention P l//l 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition _ 250 Final Building/Occupency pSTp 9 CITY OF COSTA MESA BUILDING DIVISION 141 t• a, , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F 1 pk:..fi i PERMIT 4t- •,0 4E101-01909 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2203 REPUBLIC AV Status: ISSUED Suite: Applied: 12/04/2001 Vicinity: Issued: 12/04/2001 Parcel Number: 42238309 Zoning: Applicant: RAMIRO HERNANDEZ - ISSUED BY: k Address: , Phone: 949-642-0980 ''.�I •Zip: i .'. r" - r . owner: HERNANDEZ,,RAMIRO - Address 2203 REPUBLIC AVE - - - - -,. l ' � Phone: '`�� - - COSTA MESA, CA ' Zip: 92627 Contractor: " ' Address: • , Phone: Zip:- License: • Arch-: - - En• g , (\ Address:" - - Address:; . . :-• Phone: • - _ ,. . - .. Zip: - -, i License: - `License: ,- SCOPE OF PERMIT T/OFF AND REROOF 2100SF RESIDENCE W/LT WT,TILE(5.8PSF MAX Wt)ICBG#ER3523.; - FEE SUMMARY - Plan Check: . $0.00 : Calc Valuation: - ;-_:17,000.00 Permit: • . $139.25 - ,,, • Claim Valuation: -; $7:000:00 SMIP Res: $0.70 , " 'SMIP Com: $0.00 ' Other: ' - $0.00 • - Inspection: $0.00 . I. - . • - ' Total: $139.95 - - i' - PLANNING & ZONING ` SETBACKS y"% </ Al-%� 2. MAIN STRUCTURE-Front,:010 Rear ' 0-0 Left 0-0 •- - Right "00'"• � �; % ' ACCESSORY Front - 0-0 - Rear 0-0 Left 0-0 Right - 0-0 -�- � - C PARKING Existing: 0_ . -Required: 0 Proposed: 0 --. NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ 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.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100.000),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.# Class# 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: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit subjects the applicant toe 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 (cense Laws.). ❑ I am exempt under sec. Business and Professions Code for this reaso Y Z- Signature: r'._ , v� 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 6,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 ❑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? 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 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 Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes ❑No B (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / 2- -v I Signature Of Legal Owner(s) / Date And/Or Authorized Applicant Date EWE I PfSPECnON TYPE PATE INTITIALS CODEI INSPECTION TYPE MEE PBIBAU 1616 Fixed System Final Fire Prevention _ 1 206 Final Mechanical 1266 Pool Spa Final S 208 Final Plumbing -. 200 Final Re-Roof 7 / 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 -_ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF:COSTA MESA CONS UCTIONyyPERMIT PERMIT NO�� , • Ta)a�T � L�T yb UNIT No. • Project Address 2.20" e tih//c. `C `� ��v// `(J f�j f • • TYPE OF CONSTRUCTION ❑ NEW WADD H ALTERATION ❑ REPAIR • • Applicant's Mailing Address . lA 9 LC�• ,..9,'-5-44 c5'�,� A.P.# ((�— '1 n 3 — c0 9 Zone I g CI CONVERSION III DEMOLISH CI OTHER TT ) TI Owner's Name • d Na /'J - Phone DESCRIPTION OF WORK/US OF BLDG. A s •' if Address 0R- O apubG�'� A ; AAi v'�{ = /.eft 1" e. - - i E Main Building: Accessory Building: Z • Arch/Eng. License No. TYPE OF PERMIT CI GRADING S FOUNDATION In STRUCTURAL T Front a; - O Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear 2S • • N ;Contractor's Name e2.4L)F e;2ias.S' LS 77 rs7///%`fj CI OTHER C Riyht •�S - N 4l.[-' /STA •Jf% - PROJECT DESCRIPTION SQ. FT. UPS OCCUPANCY ^ G Address(mailing) 779 e O� CONSTRUCTION TYPE VALUATION$ lb U l .•- s Left Iia •4p kick? R City License No. - t4 . ZONE GRADI NG CU.YDS. ACRESE LICENSED CONTRACTOR DECLARATION f Ping. Ref.# /I/-t Parking Req./Provided Q I hereby:'aff irm that I am licensed under provisions of Charter 9 (commencing Remarks: IC 160* 2q21 Planning Notes: �Q�,‘ ezQ /1 sta ...9--A-- SP� M with section 0000) of Division 3 of the Business and Professions Code, and J Etc �s t�s'Y60"j'T'"•"� T my Iicenie is in fill Pfarce and effect. - I /s 11 _ + S License di..s-• t't; `; - License No, Date a a a-: Signature -- a/ - . ........... - PLUMBING FEES _ • 'ORK I{FIS!,C•MPENSATION DELL• •ATIONBar Sink Showers ELECTRICAL FEES areby affirm that_I_have a certificate of consent to self-insure or a certificate _ Workgrs' com_pegsation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW • PoOQ Lab. C'.17. - C•1 /- I44D "- '❑ 50+ KW Policy No. �' n"1y Company J�Y1T� Backflow Irrigation Sewer Cap Construction Pole Sub. V QII Certified copy:is hereby furnished. " Certifiedcopy'js filed with the city Bu d' Division. /J Bathtubs • Sewer Connection Cooking Unit • Meter El up to 100 amps Q0Date 7 �/ p APplicanf. a-to '( /, -;71 - Y� EXEMP ION FROM WORKERS'CO(((MPEEENSATION DECLARATIO Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps (This section.need not be completed if the permit is for one hundred 0) or - less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel T1 I certify [Fit in the performance of the work for which this permit is issued, I . Nshall'not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank - Fan, Motors❑0-1.HP D%-8 Q Workers' em pensation Laws of California. Date •Signature —Floor Drains Swimming Pool w/Spa , F.A.U. Inc.Solar 09-15 HP 016-15+ NOTICE: If,after making this declaration,you should become subject to the • (/' Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal • - Fixtures Microwave U-) comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Interce tors Water Heater Lender's Name p Outlets Range Lender's Address • Kitchen Sink - - Water Service - . - Switches Sign OWNER BUILDER DECLARATION ' , I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash . Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or , county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry,Trays Generator ❑0-5 KW 05-15 KW Trash Compactor any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains • `,e Contractor's License Law (Chapter 9(commencing with Section 7000) of tsion 3 of the Business and-Professions Code) or that he/she is exempt -- - - - " • .44efrom and the basis for the alleged exemption. Any violation of Section " 7•:11.5 by any applicant for a permit subjects the applicant to'a civil enalty of not more than five hundred dollars($500).I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 - compensation,,will do-the work,and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3 , for, sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES - - - - - License Law does not apply to an owner of a property who builds or improves _,.-. - _ - • thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: ' employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ 90 _ sale, If, however, the building or improvement is sold within one year of com- --- Canopy Type II 0 Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved By Date prove for the purpose of sale). • . - ❑'I, as'owner of the property, am exclusively contracting with licensed con- Duct-Structural • Refrigeration System Application Issued By Date • tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating . ❑0-100,000 BTU 0100,000 BTU SUMMARY OF FEES /'��\{`'7 builds or improves thereon, and who contracts for such projects with a con- - - --• - (o3'1-'4 $MIP $ \ / %� tractor(s) hcense.pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ • ofExhaust System 0 Multiple 0 System Repair/Alteration pp proof their Worker's ti Compensation insurance should be P.C.fr providedhis reason me. J _ PLAN CHECK $ L 3"1c PERMIT • ❑ 1 am exempt under Section B. & .for this Firepl/Fact.Bit. IC80# Fire Dampers PLUMBING $ ISSUANCE $ ;Date Owner - Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ _ ' I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000BT ELECTRICAL $ GRADING $ information is correct: I agree to comply with all city and county ordinances and state laws relatingis totbuilding construction, and- hereby ion dutho for • - MICROFILM S inspection of this city to enter upon the above-mentioned pr perty for - PLAN CHECK 50% $ inspection put e _ • MECHANICAL $ TOTAL FEE $ WTI Signature • < 'Date ReinspectionFee ' $15 Issue Fee $ 3 PLAN CHECK 25% $ Driven' License or SS# CMF 0865-46,rev. 10/84 White - Canary -Applicant; Pink - Accounting; Goldenrod -Assessor U1 UW 1U00}-uuu iubUo I U I lU},}. DATE: 07/27/88 TIME: 15:06 . CONSTRUCTION AND PLANNING POOL & SPA Date Inspector - Date Inspector APPROVALS `Permit# APPROVALS Permit# - - 1..-Temporary Electrical Service or.Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. - 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement • 1 56. Rough Plumbing & Pressure Test . . 6. Electrical 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,P-Trap, ❑ Undrgrrid.- 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final- 12. Sewer Cap 63. Heater & Vent-Final ( - 13. Roof Drains 64. Plumbing System - Final , - - .. 14. Rough Plumbing 65. Electrical-Final . - 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 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# (' i 21. Ducts, in Structure 70. Underground Hydro ' 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough &Test , 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing * 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 'j - 27. Frame and Flashing 76. Dry Standpipe _ •- _ - 28. Lathing & Siding 77. FIXED SYSTEM FINAL •• 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION ; 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy - 37. Final Factory Fireplace '" 1 38. Final Plumbing ° ./ i ' 39. Water Service-Final " - . ; '� I - 40. Gas Service-Final 't , - 41. Solar Domestic-Final - -- ' • ' i 42. Backflow Preventer • . !, 43. Backflow Irrigation , ' • 44. Landscape Irrigation System - - • - -45. Sound Attenuation - I ' 46. Handicap Regulations . ` 47. FINAL STRUCTURE & BUILDING ;' '. EXPIRFn 48., Special Requirements Completed Incomplet Inspectio ns . f19. Electric Release to Edison • trate __( gig P Qir/--- pGas Release to Southern California Gas Co - 0. 51. CERTIFICATE OF OCCUPANCYII _,• No. -_1_ Date 1 . 5213 4 FEE RECEIVED MAY 21 1961 a,Q , COSTA MESA BUILDING DEPARTMENT FINANCE O. BOX 317 DEPT. COSTA MESA. CALIFORNIA CITY OF COSTA MESA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING 4 //�� (� � BUILDING ADDRESS Gi cl�' LWT • COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY l 1 p�. D,,�' ,1 /I RECEIPT NO. PE5221 OWNER _J 2f AL_1_n_�L.� / _4-(1 �"l2V yM1/1 MAIL Qrt /n G nn� //� �� ,, �r1^ I. 1 RECEIVED BY / DATE RECEIVED n Arr 16�+'-UEDtg 7 ADDRESS `ti °L L.fl.€L/ 61-6-- ----7-T-1-$1"E/e/ 1/45--7/--17 'MFAiY J3 11 19V7 (� TEL �-} 1 BUILDING/ CITY L-� NO.(-]_.� ?- S / ADDRESS ARCHITECT LIC. OR ENGINEER NO. COSTA MESA. CALIFORNIA FIRE' ADDRESS ZONE CITY LIC. .1706 ZONE�_� NO_OFTYPE GRO CONTRACTOR NO. / !W/) yDnTEL. APPROVED ADDRESS . -- 0-i------Q--- NO. BY DATE LEGAL LOT L L. 3t$S CORRECTIONS DESCRIPTION NO. BLOCK TRACT 3/6'C NO SIZE P 1 v 1 `� L. NO.OF BLOCS. 46 OF LOT (1 / ^ lNOW ON LOT USE OF EXISTING BLDG. SETBACK LINE FROM 1 . CENTER OF STREET 5D REAR YARD T- I SIDE YARD RIGHT .6 LEFT 5-- DESCRIPTION OF WORK NEW 7 ALTERATION ADDITION REPAIR MOVING DEMOLISH SIZE BUILDING n '/ 1 ROOMS STORIES • EXTERIOR WALL ROOF `_ I COVERING may/-M -U V�/�/[[/COVERING -P�Y�J f�). USE OF N 24,��'/ (I oi,t �_ . BUILDING y 'I�GQ;O ,�/„11�+q'KLSAoy/ ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES ANO STATE LAWS REGULATING BUILDING CONSTRUC. TION. �] VALUATION SIGNATURE OF / /I7 �ad � � PERMIT FEE S �- PERMITTEE //V4 !lull $ /�G/ - PLAN CHECK $ /02" AUTHORIZED AGENT TOTAL-FEE $ J 6 — GBir e, . JOB ADDRESS 22(Y3 Reoublir• Ave_ Nt'&ICAKF{2 Sari( BUILDING PERMIT NO. 52.21 s- 31 GENERAL CONTRACTOR Same VALUE $ 9,876.00 S 7 AP. No. LOT FF TRACT 1180 FIRE ZONE DESCRIPTION OF WORK Ras_ ar/att gar . • GROUP I & ,J TYPE v ZONE RIS PLAN NO. 5713 — INSPECTIONS . DATE SUBCONTRACTOR PERMITS ISSUED I DATE NUMBER Trenches ,Forms - Steel c--/9.-57 Floor System - Steel Reinforce �.hi ney Re-Rod '�/ BD m �� 7 Wain Frame and Flashing t,�7 x/-,- 1I£IC) - Lathing, In Out ��j �i.,/�7 Plaster, brown coat 1/i' b-9d1 e Ta Underground soil Wie-Pip ( 6-/9--t'T Top Out \At..(S ?.,�S7 Furnace 02/4 vkz S 4..”-,.....<-7 4,UteLetaA./. nc— NAY 31 1957 /I,t16 l r Gas Vents / ` Rough Plumbing - eaLtr/ 1Z'C/ /,f Ay q 1 iq S7 /a n/ Cesspool Septic Tank _ Prop. Swr. Line House Con _S *Si.fiS !/�/yytj 2 ' r - at - ,, - I Sprinkling System • U r/ . • Ux zba.a. :9 -to-s-7 /a7 t h Heating Final 441.1-C to .2.!'7 4 / _ Plumbing Fixtures, Final 44 H-C 1-22L-47 „ - 7 �i Final Gas_Test /3_ /N/>tC 16-2_-2.-S-7 t � (l t G7--zi�,_7_� ,/?"-; /�f�.yl 2/l/l/ _ Construction Pole / / Underground Power Rough Wiring 21-1" 9_u -4i /f e 5-P1LP .iT.fw.. ,-.5----4-7 cz9-r Fixtures, Final ��./' /0-"--ill�7I �"` /�C.,, _ /c', -.1 1-cf H . r .nrrT ID AMrV t Ate. .. _ /✓t/ `-i /. rr_ / _ __