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Home My WebLink About1629 SANDALWOOD ST - Building Permits 1 . CITY OF COSTA MESA 4 . ►9@ - BUILDING DIVISION - :J "11 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER • I. I �^i- I PERMIT' ` � i E01-00973 • .a m (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1629 SANDALWOOD ST Status: ISSUED Suite No Applied: 11/19/2001 Vicinity: Issued: 11/19/2001 Parcel Nunmber: 13921301 Applicant: PERKINS, ROBERT L ISSUED BY: . Address: 1629 SANDALWOOD ST Phone: 714-546-1116 COSTA MESA,CA Zip: 92626 , Owner: 'PERKINS, ROBERT L Address 1629 SANDALWOOD ST Phone: COSTA MESA,CA Zip: 92626 Contractor: Address: Phone: Zip: License: SCOPE OF PERMIT CONSTRUCT 120SF LAUNDRY ROOM. REF B01-01839. 7 LIGHTS,4 OUTLETS,4 SWITCHES. l//off REVISED: UNDERGROUND CONDUIT,3.-;110-OUTLETS AND 1.-220 AMP OUTLET FOR ABOVE GROUND SPA. SUPPLEMENTAL ISSUE FEE. 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 $0.00 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 $7.70 . 7 up to 50 kva/kw $0.00 0 Recept Outlets $3.30 3 up to 100 kva/kw $0.00 0 Switches $4.40 4 over 100 kva/kw $0.00 0 Non Res Appl $0.00 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 $18.20 1 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 lhp $4.75 1 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 $7.50 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 $69.35 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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 , 2448-48(Mm) 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 shell 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 CML FINES UP TO ONE HUNDRED THOUSAND DOLLA RE(5108000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F 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.Llc.# 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,CMI Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 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 Lew(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 pemr4' 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 properly,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 drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-properly 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,An 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 DMsion 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? ❑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 o1 compressed gas at standard temperature end 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 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 ermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? Ur Yes pi No (Section 65850.2 of the California Govemment 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 ❑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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE I INSPECTION TYPE PTE lNImALX ;OK Q INSPECTION TYPE RATE MALI 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing nn ��,z,�� 200 Final Re-Roof 210 Final Electrical 5/3%c2 £ U 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 4W CITY OF COSTA MESA t BUILDING DIVISION >1. 1 r.„ ..► DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �� PERMIT' • ° ; E01-00973 Sakettmt•IP (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1629 SANDALWOOD ST Status: ISSUED iSuite No Applied: 11/19/2001 Vicinity: Issued: 11/19/2001 Parcel Nunmber: 13921301 ISSUED BY: Applicant: PERKINS, ROBERT L Address: 1629 SANDALWOOD ST Phone: 714-546-1116 • COSTA MESA,CA Zip: 92626 ` , Owner: PERKINS, ROBERT L l/ 1�\ Address 1629 SANDALWOOD ST �1Y Phone: \ COSTA MESA,CA Zip: 92626 Contractor: L 573-*/O Address: ` *- '•� `b' P: Phone: * T • Zip: • License: SCOPE • PERMIT CONSTRUCT 120SF LAUNDRY ROOM. REF ;.1-01839. 7 LIGHTS,4 OUTLETS,4 SWITCHES. EE 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 $0.00 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 $7.70 7 up to 50 kva/kw $0.00 0 Recept Outlets $4.40 up to 100 kva/kw $0.00 0 Switches $4.40 • 4 over 100 kva/kw $0.00 0 Non Res Appl $0.00 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 $0.0, 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.'•0 0 Christmas Tree Stand $0.00 0 Motors to 50hp $r.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 $40.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTIC The work authorized by this permit shall comply with all applicable handicap access requirements under California stat_it=s 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,•'nded 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_d applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in or: expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446443(WOO) • 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 lass.) ❑ 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 1 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 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.Lie.p Class N Contractors Signature: Date: r e. 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 for a perme1 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}Inder ec. Business and Professions Code for this reason: gnature: Date: Owner ID verified by driver's license. v'es 0 No triver's License No. • Expires: 1-2-3'C'f Verification of Ownership by(type of docJfnent,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 e 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 ❑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 ❑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? U Yes 2 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 abwe-describedproperty for inspection urpo s.I a ree not to occupy or allow occupancy of any building authorized by this permit until final inspection. gv matt. 11 - 19- 1 Signature Of Legal Owner(s) Date a And/Or Authorized Applicant Date CODE I INSPECTONTYPE QATE •• -. CODEI INSPECTION TYPE kat 11:08DAL5 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 W: _ 212 Final Fire Prevention 202 Final Factory Fir: •ace - 220 Final PI:.' a Approval 203 'nal Si.• 'nal Site / ' 204 Final Demolition _ 250 Final Building/Occupan G tai P CITY OF COSTA MESA t BUILDING DIVISION N, SINIIMIrr%, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER -1""7" PERMIT +roF • P01-00679 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1629 SANDALWOOD ST Status: ISSUED Suite No Applied: 11/19/2001 Issued: 11/19/2001 Vicinity: Parcel Nunmber: 13921301 ISSUED BY: /�ylt Applicant: PERKINS, ROBERT L U Address: 1629 SANDALWOOD ST Phone: 714-546-1116 COSTA MESA, CA Zip: 92626 Owner: PERKINS, ROBERT L • Address 1629 SANDALWOOD ST Phone: COSTA MESA,CA Zip: 92626 Contractor: • Address: Phone: Zip: License: Arch / Eng: • Address: Phone: Zip: , License:• - SCOPE OF PERMIT CONSTRUCT 120SF LAUNDRY ROOM. 1 LAUNDRY. REF B01-01839. REVISED: 11/26/01 ADD ONE GAS LINE WITH 3 OUTLETS.SUPPLEMENTAL ISSUANCE FEE. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 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 50.00 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 $0.00 0 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) $0.00 0 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 $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $7.50 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: $46.95 L.UMMCN I S I SYLL.IAL L.UNUI I IUNS 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 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(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 Ni EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100000),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.N 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), 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 perms' 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. ❑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 Safely 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 ❑No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a 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 Safely 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 akermit 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 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 California Health and Safely 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 e (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 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, Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date ;ODE U INSPECTION TYPE PAIS lft$19L$ ;ODE* INSPECTION TYPE 2a3 JNTTT1A11 1616 Fixed System Final Fire Prevention 206 Final Mechanical • 1266 Pool Spa Final 208 Final Plumbing .J/ OZ aF./.x-y�.� 200 Final Re-Roof 210 Final Electrical 0 201 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 ar% ►� BUILDING DIVISION >'' .`r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t f r PERMIT 4. comm le P01-00679 (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1629 SANDALWOOD ST Status: SSUED Suite No Applie . 11/19/2001 Iss ed: 11/19/2001 Vicinity: / Ohl Parcel Nunmber: 13921301 ISSUED BY: C Applicant: PERKINS, ROBERT L Address: 1629 SANDALWOOD ST Phone: 714-546-1116 COSTA MESA,CA Zip: 92626 \ Owner: PERKINS, ROBERT L \119 OAddress 1629 SANDALWOOD ST Phone: COSTA MESA,CA w Zip: 92626 .a' Contractor: f!, Address: Phone Li : se: 1 Arch/ Eng: Address: % Phone: Zip: License: SCOPE OF PERMIT CONSTRUCT 120SF • NDRY ROOM. 1 LAUNDRY.REF B01-01839. FEE SUMMARY AMT Q AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation $0.00 r 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) $0.0r 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.,' 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $r.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor -1.00 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) $0.00 0 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 Va e $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) 50.00 0 Sink,kitchen $0.00 0 Water Softener $ .00 0 Gas(Over 4 ou -ts) $0.00 0 Sink,service/mop $0.00 0 OTHER .00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION 0.00 Gas Servi : $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Intercep : s(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED F S: $33.30 :rano COMMENTS /SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements undo alifornia 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 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 c r 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 Canner and policy number are: • - • , Cartier: Policy Number: (This sect/on need not be completed li 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 Ni EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TOME COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE.INTEREST,AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Lie.it Class e 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: 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 end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,of 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.II,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 properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). sic1 am exem�and r sec. Business and Professions Code for this reason: Signature: /'( Date: II' I9-0 1 Owner ID verified by driver's license. glitas 0 No WDrivers License No. atxpires: ( '3-3'0 5. Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feel 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 then 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 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 et 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 end 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 ..._ ._ __.._ __._. _...____.i.._ 5 Does or coo the applicant or QualityiManagement art n b isding or at any other air the work onich districtIs the oof this application eggermit for such construction or modification from the South Coast Air District or from other pollution control or agency? Ll 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). 7 -11-a permit from the South Coast Air Ouality Management District or other air pollution control district or agency is required fo7 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 El 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 slate laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-dpribed ape" for inspvgcti rpo s.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Cl Legal Owner(s) Date a And/Or Authorized Applicant Dale coop INSPECTION TYPE PAIL IMMO POOP( INSPECTION TYPE prig IlU 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof .10 Final Electrical 201 Finer aock/Retelning a '- — 21 t Final Fire Preventlo (f 202 Final Se Place 20 -4"-Wer c a:•e 203 Final Sign 222 Final Site ql�/yQ- 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA 4 9 BUILDING DIVISION >: ,,,,.' r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER Isst ..._11 PERMIT Mn1_n05R9 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1629 SANDALWOOD ST Status: ISSUED Suite No Applied: 11/19/2001 Issued: 11/19/2001 Vicinity: • Parcel Number: 13921301 •ISSUED BY: 01411. Applicant: PERKINS, ROBERT L Address: 1629 SANDALWOOD ST Phone: 714-546-1116 COSTA MESA, CA Zip: 92626 Owner: PERKINS, ROBERT L Address: 1629 SANDALWOOD ST Phone: COSTA MESA,CA Zip: 92626 Contractor: Address: Phone: ,k ,4_, Zip: License: SCOPE OF PERMIT CONSTRUCT 120SF LAUNDRY ROOM. 1 APPLIANCE(WASHER AND DRYER)REF B01-01839. S FEE SUMMARY ' Quantity Quantity • ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 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 $0.00 0 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 $10.65 1 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< 10000cfm $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 $34.15 COMMENTS I SPECIAL CONDITIONS .:s NOTICE: The work authorized by this permit shall comply with ail applicable handicap access requirements under California s tes 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 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 wit II applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in, e expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(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 OWL FINES UP TO ONE HUNDRED THOUSAND DOU.ARE($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.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). 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 perm+' 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.wBusiness and Professions Code for this reason: Signature: Ro—e v7 Date: L l—i q-o Owner ID verified by driver's license. AYes ❑No drivers License No. / •Expires: I— "O S 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,talsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). owner-builder of employ anyone to do wool al-Safety,as noted above,unless such person has a permit to do work om the division. nater • 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? ❑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? 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 we 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 ❑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_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 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 end 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 end Safety Code Section 42303 been made? 0 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,end authorize representatives of the City of Costa Mesa to enter upon the above-described pr 'oyparty foron'on pu oses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /k'yY // ly —o / Signature Of Legal Owner(s) Date S And/Or Authorized Applicant Date COPE I INSPECTION WPC PATh MAO CODE INSPECTION TYPE .YDI_E • 1616 Fixed System Final Fire Prevention 206 Final Mechanical .�/3d,/0 Ze'r 1266 Pool Spa Final 208 Final Plumbing G 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 �"ri CITY OF COSTA MESA • r 4 BUILDING DIVISION a> I , DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER Ft PERMIT . M4 B01-01839 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1629 SANDALWOOD ST Status: ISSUED FSuite: Applied: 11/19/2001 Vicinity: Issued: 11/19/2001 Parcel Number: 13921301 Zoning: R1 R1 Applicant: PERKINS, ROBERT L ISSUED BY: Address: 1629 SANDALWOOD ST 6014s Phone: 714-546-1116 COSTA MESA,CA Zip: 92626 Owner: PERKINS, ROBERT L Address 1629 SANDALWOOD ST Phone: COSTA MESA,CA Zip: 92626 Contractor: Address: Phone: Zip: License: :y Arch fr. ex, Eng: Agfir Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 120SF LAUNDRY ROOM. FEE SUMMARY Plan Check: $126.91 Calc Valuation: 510,260.00 Permit: $195.25 Claim Valuation: so.00 SMIP Res: $1.03 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $323.19 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 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 lutes 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 spended 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 expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(MO) DECLARATIONS Y 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,end 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 DOLLARE(5100.000),IN ADDmON 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 end effect.Lic.a Class ft Contractor's Signature: Date: w 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 DhAslon 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 perik. 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.). !/cp! I em exemg under ec. i - Business and Professions Code for this reason: Signature: �� '� Date: /(- 19- O Owner ID verified by driver's license. jaw ❑No driver's License No. Expires: (-1-3-D S 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? ❑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? ❑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 materiels equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65650.2 of the California Govemment 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 ❑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 ❑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 property for ins ectioppurposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. It - /(1-0 SignatuOrg f Legal Owner(s) a=te And/Or AuthorizediApplicant Date goDE 0 INSPECTION TYPE PATE INTmALS CODE! INSPECTIONTYPE gag, MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 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 /L�,�x 204 Final Demolition 250 Final Building/Occupancy ti 3V V(, er APPROVED 1 r City of Costa Mesa Building Dept. 11 • 1 p, • SA. DATE212k 198_25_ 1 AIPPROVED '-ESE PLANS[AUT PE ON JOB AT ALL TIMES MAKE CD ICITY'l COSTA MESA Nu CHANGES WiTHCJE PRIOR APPROVAL OT DEPT . , i PLANNING DEPT. . , SUBJECT TO BLDG. DEPT. REG. ' - '-:41SSijk,`,:U ::::': i t;'A'‘'7,'-':- C.' 6, ,"''... ' ^' 2;;..-r•,-. — 1 i I BY—C1(;&-DATF • DIR OP PLANNING ) :a1-1.CH IT . ,,. . THE ISSUANCE OF A i'fR;.%!: '.. :-.,^ . ',rg ,...S:.'5. P.,.-.D 5PEI:a:IC.1110MS SNAIL NO( PRE%E. I IRC.A THEREAFTER REOUFIFiNG IriF COI(RECE,Go OF EFI.DR: IN ' .AffERDLRION0Sv,EDDELBEyTITOHN:3pLOF,:.if.,C,CORRECTIONS SHALL ' :At PLANS AND SPECIFICATIONS OR FROM PREVENTING NING DEPARTMENT IJE_HING OPERATIONS BEING CARRIED ON THEREUNDER WHEN OLATION OF THIS COD2 OR OF ANY OTHER ORDINANCE OF g ••-4/it ., HE CITY. ‘... -fl.suie.=.00csaa. . _ .. 1 . ‘... I 'V) ID . lb — RESIDENCE RESIDENCE RESIDENCE RESIDENCE I.. I.. IQ III 4/ 141 et 14 1... en VI I . 1 t OXInCAcj tjjetd STREET 4 IR all•1111 TYPICAL 611 CONCRETE BLOCK FENCE a Cement Coping Optional ;1qj • • GENERAL- NOTES Channel Block With 1-3/80 ft il ., - _ Fences Horizontal op of all • � MORTAR: One Part Plastic Cement, and Three Parts Sand FortBars 3 8•' -0" ill Three riii " GROUT; One Part Cement Three and For Fences5'or Less One Half Parts Stand / ¢at 4' D.C. o _ — COPING: One Port Cement, Three LL ° I. ' Parts Sand For Fences Higher Than 5' dYa `� CONCRETE: Well Mixed 1:2-1/2: 3-1/2 Vert.Bars 3/8.4 at 32" O.C. > w a I Max. of 7- 1/2 Gallons of Fill Cells Solid With Grout �� > z I" r.' Water Per Sack of Cement Where Steel Occurs 11 a -- - - Reinforcing Steel Shall f __ _ I -, I� OF GRTHE UT FENCEY EIN CELLS WHERE STEEURED FROM THE L P Conform to Sec.A-15-39 w o _- OCCURS. A.S.T.M. Ill 1- z INI 1 II' I �� CELLS AND AREAS OF HORIZONTAL REIN- w n ■ FORCEMENT SHALL BE CLEAR,CLEAN& All Steel to be lapped10 IL -.-- FREE OF ALL MORTAR DEBRIS.ETC. 24"or to Code NATURAL GRADE 1 MI 0 1 TWO 3/8"'BARS —a e • ♦ ♦ . CONTINUOUS TOP I -- . . &BOTTOM 0WIDTH TO 16' 0.C. MAX. SEE CHART ♦ -♦ �. HOR7=-STEEL MUST BE TIED IN BELOWa DEPTH OF EARTHTCOTH PLACE AT TIME OF TRENCH r I 1/3 THE HEIGTH OF FENCE INSPECTION. ♦ • j 1 L SOW •BOTTOM OF FOOTING. '-1 io' 2,.Ab . � SCALE: I/2° = I' • FOOTING REQUIREMENTS CHART WALL HEIGHT 6' 5 � � ! 4 3' I . WIDTH 14" 14" i 12 . 12" r THICKNESS 10" 10" 8 ". . 8 " DEPTH OF EARTHTOOTH . . . 24" 20" 16" . . 1 12" SPACING OF EARTHTOOTH. . 12' 14' 16' 16' • OWNERS NAME: City of Costa Mesa, California JOB PEERMITADDRESS: NUMBER _ _ Building Department SIGNATURE: • • EEVISED Nov.B2. CO - f+ /, Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. • 5796 2/26/8045,05 TL CITY OF COSTA MESA CONSTRUCTION PERMIT — PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address 1(or,.�( St Aa\tc"orar4 c f 133t33Z �.z. � � • Applicant's Mailing Address Srus,x P-• = TYPE OF CONSTRUCTION NEW U ADD ALTERATION LJREPAIR ❑ CONVERSION El DEMOLISH LI OTHER A.P.# Zone O Owner's Name - - . hone rjz(L- n � o��b ` • j_\itDESCRIPTION OF WORK/USE OF BLDG. � l^ \ IJ_I _�I� —d ~ I Address - . - - Ai � - . - S Main Building: Accessory Building: 1'� E Z Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION�`TRUCTURAL T Front 40 S Q ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear Uf N Address CC Contractor's Name Phone ❑ OTHER r' C Right QfN Address(mailin 1 PROJECT DESCRIPTION -Carr'? (-.F OCCUPANCY �7 &i K / G 9 • CONSTRUCTION TYPE VALUATION$ IC7C-0 S Let "7n, 32sf R City License No. - ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req,/Provided E LICENSED CONTRACTOR DECLARATION /- �y Q I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: g' L.gr/ _)j j - '-Lua� m(,—M with section 7000) of Division 3 of the Business and Professions Code,and / . .� . 1 ,�z�, sn�6LF.-'Jp• my license is in full force and effect. - + Aftadi�cLL V Y'P I T License Class License No. S Date Signature PLUMBING• .. • FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES lereby affirm that I have a certificate of consent to self-insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink ,00, Lab. C.) Automatic Washer Transformer 0 15-50 KW Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW Certified copy is hereby furnished. - Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Applicant - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION - Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100)or Dishwasher Solar Piping Dryers ❑Gas ❑Electric less). P 9 V Sub Panel I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner sosoas to become sub'ect to the Drinking Fountains Solar Tank Fan Motors 00-1 HP D1%-8 Workers' Compens tion La of Califor+Wlal. (\-1(�-1'\'F\' \ —� _ Date ignat ure \ a . Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+ NOTICE:If,after mak ng this declaration, you should become subject to the - Workers' Compensation-provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light I 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.) Interceptors Water Heater Outlets Range Lender's Name Lender's Address Kitchen Sink - Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that ram 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 00-5 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 the Contractor's License Law(Chapter 9(commencing with-Section 7000) of nivision 3 of the Business and Professions Code) or that he/she is exempt erefrom and the basis for the alleged exemption. Any violation of Section ,31.5 by any applicant for a permit subjects the applicant to a civil ,.malty of not more than five hundred dollars($500). $ 3 tQoQ_mI, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee pensation, 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 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 / Hood or T DEVELOPMENT SERVICES REQUIREMENT Qqx employees, provided that such improvements are not intended or offered for Boiler ype I ❑ a•a5•W sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By / Date elation, 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). C ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By c,h Damn 2-12.20/1S8 tractors to construct the project (Section 7044,Business and ProfessionsCode: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU ❑100,000 BTU SUMMAR63'OF FEESte builds or improves thereon,and who contracts for such projects with a con- _ $ O tractor(s) license pursuant to the Contractor's License'Law).-1 am aware that BUILDING PERMIT $ Z SMTP Exhaust System ❑ Multiple❑ System Repair/Alteration Z proof o their Worker's Compensation insurance should be provided to me. PLAN CHECK $ r `' PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $ • Date Owner Sb-e \\ ?--' s Heating System& Ducting r— Registers PLAN CHECK 25% $ ENERGY P.C. $ -- • r I hereby certify that I have read this application and state that the above ❑0-100,000 BTU 0100,000 BTL. _ ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives of this city•to enter r\,.y4I\pon the above-mentioned property for inspection pur sets C--� - MECHANICAL $ Signature �.\. � 1.:__.! a. �( TOTAL FEE $ Drivers' License or SS IF Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 White'- Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor • CONSThUCTION AND PLANNING POOL&SPA APPROVALS Permit# Date Inspector •APPROVALS Permit# Date Inspector 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 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 2>/I/Sb oe 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 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 r?� 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# 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 O Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro ' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. 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: 3/7/ 5' K -- 34. Final Heating & Air Conditioning 311618€ WR-LL OAC ro C 35. Final Gas Pipe-Test A)*eos Sn'70Kb Disal, nt. .L '�1v 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing • 39. Water Service-Final • 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer - ' ' 43. Backflow Irrigation -.� 44. Landscape Irrigation System • • 45. Sound Attenuation 46. Handicap Regulations / - • 47. FINAL STRUCTURE & BUILDING 3/ 48. Special Requirements Completed _(/yva 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. s Date _ • OWNER WILLIAMS, ROBERT L. DATE 7/5/63 JOB ADDRESS 1629 Sandalwood St. BUILDING PERMIT NO. 20117 GENERAL CONTRACTOR Aluma Kool VALUE $ 1,000.00 AP No. 139-213-1 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK Mt.Patio to e r ], INSPECTIONS Signature DATE GROUP J TYPE IV ZONE R Soil SUBCONTRACTORPERMITS ISSUED Gas _ DATE NUMBER Water Rough Com. Refrig. 0 Air Cond. ❑ Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line C] House'Con. ❑ St. Swr. ❑ Sprinkling System Construction Pole Underground ❑ Power Rough Wiring Trenches ❑ Forms 0 Steel Reinf. ❑ Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing— In Out 0 Plaster, brown coat Refrig. 'O Air Con. 0 Final Heating, Final , Plumbing Fixtures, Final Final Gas Test Electric Fixtures. Final Building, Finale. Ee> ti F/d /--e 9–69 OCCUPANCY Form BU4-5M 3-»–„_B p el/1/7 - C_ .`-Y 2 Olir . •• . , COSI°MESA BUILDING-SAFETY DEPARTMENT FEE RECEIVED P.O.BOX 317 COSTA MESA,CALIFORNIA 5 1963 For Applicant to Fill In Completely EU�,PIINAZ aP.ERMIT TYPE OR PRINT Y 1ry}R� aSlicENICERy �LD+1 f' BUILDING (� C r " f ADDRESS /fr O - ' 3G1.'n di weed RECEIPT NO. P�'M�1N�7 COSTA MESA. CALIFORNIA ��-'1111 l` 'JJ, / �/j� RECE ED EY OAT RECEIV ATE IED OWNER �OJP1Y✓ L i Y✓I'LLia,.ri,c 7 �-s-03 j", 'G3 BUILDING At/DRESS AI ) //�� q V ,// �e ADDRESS ADDRE98 /� P� / ,/levGA/-1'L`E- ✓1/OLB T CITY Ca SILL / ,aa NO 7A Z/-�oJ ZONE �TYPF GROW /1i ARCHITECT L�s't�7.��Lp.VTEL BY DATE l /� 3 OR ENGINEER / NO. �} y ZONING ADDRESS 3J�' ,2 %1/' Uernt,on • GR-, ZONp7/�/ NO.OF USE OP NEW Q A Liu Acct. JOB / 7Q 1 I PLANS EUILDINQ 0�I /� CONTRACTOR K F/+ 1 ` ,0--1..-.19---- , / ` ^/ ^- r LEDAL 2.D ) �O 1 1-R .2,S" / +— ^ �1 O re'sucroA• DEscRlmon �/� 1.----- ADDRESS 0.�� ` /_/. CITY L O S A 'yL, Q`Q�SI`�•r A.P.NO. 1I� l� / _ NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE t �+ i/./ NEOL•.C.Pr.q' 9,cC 30"TO SIDE @ REAR P.L. LIC.NO. / / at / EAVES SIZE I NO.OF BLDGS. I ALLOWED (U.B.C.REQUIREMENT) OF LOT NOW ON LOT YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. , (FROM C/L rp SETBACK LINE FROM FRONT , i. • PT. CENTER OF STREET REAR YARD !• SIDE YARD LEFT I RIGHT R.SIDE CJS FT. L� FT. DESCRIPTION OF WORK ie".." S 36 ---'__ FT. er NEW ALTERATION _ ADDITION REAR FT. FT. '�, • DISTANCE BET. BET.MAIN @ REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLOGB. DATE BUILDING l TiROOMS STORIES CSU.P. - APPROVED SIZE fr EXTERIOR WALL 1 ROOF APPR• TI i^,AAw f COVERING COVERING BY •� V5 COVERING DATE 7U USE OF BUILDING AND WORK TO BE PERFORMED I I 2 /') /� /pp1 ' 2.34:6;0 CoV r ("Aea/97 / ✓m \ id 4cy'r .. . SQ.FT. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE X' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AND STATE LAWS EGULATING VALUATION q BUILDING CONSTRUCTION. 7 PERMIT FEE 5 SIGNATURE OF PERMITTEE �,/{ G /�r/A $ I DOV �- PLAN CHECK $ �i o AUTHORIZED AGENT v / "✓ / ...� I. (P TOTAL FEE 5 / OWNER ROSSLANE LAND COMPANY ' DATE 7-31-59 JOB ADDRESS 1629 Sandalwood St. BUILDING PERMIT NO. 10000 GENERAL CONTRACTOR Dike and Colegrove, Inc. VALUE $ 13,715.00 AP. No. LOT201 TRACT 2822 FIRE ZONE DESCRIPTION OF WORK res.Watt.gar. INSPECTIONS g4,.g9 DATE I GROUP TYPE ZONE R1 Underground Soil /1.1,/- U.G. Water,9J- c-7-s9 SUBCONTRACTOR PERMITS ISSUED Underground Gas DATE NUMBER - Overhead Water and Gas Rough Heating i f/�,Rien -d -8-a/ -S`j_ die)t ✓ ti Rough Plumbing / l - -t5/ ,deb_A- (i?, 4-, 1)-s-1 ,-2b/4/,7 J !r Miscellaneous �/ p Prop. Swr. LS•ne�Houkgt n. St. Swr. 57.Wrq ..e„..,_. ---- 7/?d/S , Sprinkling System ��f� i Heatibxt � ./�/��-4 A/° V Plumbing Fixtures / - 0 � Y,f Final Gas Test Pi ii-.u/ l, /n 46d Construction Pole Underground Power Rough Wiring 11C7 /&'fr e rWt; 51n,O.U.arll.A , 9-Id/-T9 /at IA-1(7 Trenches it Forms,( Steel flieit j_q-SY _ _ - Floor System Steel Reinforce Chimney Re-Rod - I Bond Beam Sheathing get 59 (0- 2 - Frame and Flashing ,(j/} (0 -14-5-4 Lathing, In ,/ Out /,7441. /0^1$ — Plaster, brown coat % j# h-1¢- Plumbing Fixtures, FinalAElectric Fixtures, Finl _ Building, Final OCCUPANCY I Form 210-3M-4-59 - - 10000 10000 ..4- CLE RECEIVED JUL 31 1959 COSTA n'ESA BUILDING-SAFETY DEPARTMENT P.0:30X 317 COSTA MESA, CALIFORNIA FINANCE DEPT. TY FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FORA �ESA PERMIT TYPE OR PRINT BUILDING t. BUILDING ADDRESS 1629 Sandalwood St. COSTA MESA. CALIFORNIA FOR OFF/CE USE ONLY OWNER Rosslane' Land Co. RECEIPT NO, I APtSf3 QO E. 1V-l/lJ(� AMAILDDRESS •• 1 th St. E ED BY 7'.11 RECEIV I DATE ISSUED 7 Y 7— 3i---57 : arY Costa Mesa No;L181159ADI RESS we ADD 7 ARCHITECT Carlson & LIC. COSTA MESA. CALIFORNIA OR ENGINEER 1•iiudlebrouk NO.. 1. ADDRESS Garden Grove . FIRE -- ZONE Dike & Colegrove, Inc. STATE 167293 APPROVED CONTRACTOR LIC.NO. BY DATE . ADDRESS 419 E. 17th St., Costa Mesa, • ZONING LEGAL I LOT 201 I 2822 .' ZONE NO.OF 1......... USE OF HEW 8. '-/ DESCRIPTION NO. BLOCK TRACT - IIfi (PLANS IBVILDINGv] A.P.NO. BYPROVED� / 0 (a/9 ATE (+j Is J SIZE NO.OF CLOGS �/�//�,(� V�EVES 3. OF LOT 64 X 101 NOW ON LOT none . REQUIRED ALLOWED USE OF • i (CENTER LINE ST.) TT EXISTING BLDG. FRONT 5 FT. IN. SETBACK LINE FROM C I • CENTER OF STREET 54 REAR YARD 271 i R.SIDE FT. IN. SIDE YARD I LEFT 61 • I RIGHT 141 F DESCRIPTION OF' WORK _ EAR IN. NEW I y I ALTERATION I II ADDITION REPAIR I II MOVING I I DEMOLISH I O.OF SIZE 1365 1365 ROOMS 6 STORIES 1 EXTERIOR WALLL, ROOF COVERING SLUCCO COVERING Rock USE QC BU LDING AWORK TO BE PERFO{2 D Single fNamily residence with • , attached garage. . Plan 1100 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 PERMIT PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. 1 VALUATION SIGNATURE Ol= `C , ��a.�I PERMIT OD PERM ITTEE JT// PLAN CHECK $ 16.00 ° AUTHORIZED AGENT Ili kP R. (In]Parnire Tnr_ , TOTAL FEE 15 48.00