HomeMy WebLinkAbout653 SEAL ST - Building Permits CITY OF CbSTA MESA
4 BUILDING DIVISION -
> • ,.,,,p , $ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
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PERMIT B06-01800
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.SWLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 653 SEAL ST Status: ISSUED
Suite: Applied: 10/23/2006
Vicinity: HOUSE AND GARAGE ROOF Issued: 10/23/2006
Primary Occ: R3 Type of Construction: V-N
Parcel Number: 42223205 Zoning:
Applicant: BOWE, MARK
Address: 653 SEAL ST
Phone: 949-642-2580 ISSUED BY:
Zip:MESA,CA Zip: 92627-3413
Owner BOWE, MARK
Address 653 SEAL ST
Phone: 949-642-2580
COSTA MESA,CA Zip: 92627- 1 I .a�
Contractor OWNER-BUILDER �F
Address:
Phone: Pa:, D t •
Zip: License: 000000 ya j O I
Arch : Eng: DATt .I
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEA OFF(E)ROOF MATERIALS,INSTALL 2 LAYERS OF 15#FELT ON A 2:12 PICHED ROOF AND REROOF W/4 PLY FIBERGLASS BUILT UP
ROOF ON AN ATTACHED HOUSE AND GARAGE,APPROX 15 SQUARES.REPAIR AND REPLACE SHEATHING AS NEEDED.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,500.00
Permit: $97.25 Claim Valuation: $3,500.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75
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
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
2446-46 t 00) •
DECLARATIONS e
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 if the permit is valued at one hundred dollars($100)or less.)
C77.I.certity 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 provisionsQ - Z3- 6.6Appficant'Slgnature:-7 / Y • `L� �- Date:--- +
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYERTOCRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARS($100,000),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.Lic.ff 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: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
mself 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
SSignature�+M/-t.� L�NL�� `--,Dale:_ ` - ,U 6 $- U'b
Owneo-lD verified by driver's license. es 0 No Diiver'I Liberise No. '(;� Expires: 5'ZZ'O`a
Verification of Ownership by(type of document,i.e.-property tax bill or deed): I
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous .
material? 0 Yes 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 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 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 aggermit for such construction or modification
from the South Coast Air(Duality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air(Duality 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 COMPUANCE 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 prop rty for inspection urposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
_ 1 o -275.06
ature 0 egal Owner(s) _ LL Date
And/Or Authorized Applicant Date
CODE 0 INSPECTION TYPE DAIS INTRIAL$ soot. INSPECTIONTYPF, MIL II§
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof - I -2(-0q • 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
M CITY OF COSTA MESA
)ile 4 BUILDING DIVISION
Fi DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
4 PERMIT
+ e "p B01-01170
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 653 SEAL ST S : us: ISSUED
Suite: Applied: 07/27/2001
Vicinity: REAR OF PROP Issued: 07/27/2001
Parcel Number: 42223205 Zoning:
Applicant: BOWE,MARK ISSUED BY:
Address: 653 SEAL ST
Phone: 949.642.2580
COSTA MESA, CA • Zip: 92626
Owner: BOWE,MARK .
Address 653 SEAL ST
Phone: 949-642-2580 .
COSTA MESA,CA Zip: 92627
Contractor: OWNER-BUILDER
Address: .-
-
Phone:
Zip: License: 0
Arch : - Eng: .
Address: Address:
Phone: Phone:
Zip: License: License:
COPE OF PERMIT
57 LF,6'HIGH BLOCK WALL TO BE CONSTRUCTE'4 ON THE REAR PL. PER CITY STANDARDS.
FEE SUMMARY
Plan Check: $29.15 Calc Valuation: $1,140.00
Permit: $44.85 Claim Valuation: so.00
SMIP Res: $0.50
SMIP Corn: $0.00 .
Other: $0.00
Inspection: $0.00
Total: $74.50 - \
. i7
PLANNING &ZONING
SETBACKS 0 I
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
S.
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ` I I • 1
PARKING Existing: 0 Required: 0 Proposed: 0 ` '.
NOTES:
1 f\''‘ S4_
, 1 y.);\ \IA
NOTICE: The work authorized by this permit shall comply with ail 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
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.)
0 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 DOLLARE($100.000),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.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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a pernt
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
2I,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: _41664.411,6,r___ Date: I •ran` 7✓-A
Owner ID verified by driver's 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,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gry 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:
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 end 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 Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 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 apgermit 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 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any pan of the facility to be!constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If"yes",the facility must meet Ne requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described prop y for inspectio pu oses.I agree not to occupy or allow occupancy of any building authorized by this permit until finalinspection.
t
Signature Of Legal Owner(s) Dateate `""\
And/Or Authorized Applicant Date
CODE A INSPECTION TYPE DATE INTRIALS g00Ee INSPECTION TYPE QATF. INTRULS
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
204 Final Demolition 250 Final Building/Occupancy
e
•THIS SKETCH IS FOR INFORMATIONAL PURPOSES •SOLID WALLS/FENCES BETWEEN 214•&6'IN HEIGHT SHALL
ONLY. APPLICANT IS RESPONSIBLE FOR PROVIDING BE SEIBAO(AT LEAST 10' FROM FRONT PROPERTY LINE.
AN ACCURATE REPRESENTATION OF THEIR PROPERTY
IN CASE THE SHAPE AND SIZE DO NOT CORRESPOND •SOLID WALLS/FENDS SHALL NOT EXCEED 2'6•IN H19CHT
WITH THE INFORMATION PROVIDED ON THIS SHEET. WITHIN 10'OF THE FRONT PROPERTY LINE(JOT CURB LINE).
•
M CURB TO PROPERTY LINE
A) -017 70 ANMD SHOWN PLAN.IFY DISTANCE OVERIFICATION FROM THE Cms
ENGINEERING DIVISION IS REQUIRED. CALL(714)754-5313
N_PP i ®�D Apprllpry NOit _
S,
•F C__STA MESA 8E APPROpV �ID^1S, pg COR�F ntall
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APPROVE ;'
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g I Tos :i of plans ands;' ifi ation MUST be kept on this I at; ���1mv�and i is av/ut la
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'g wryciAngescra.ara!: non•3nnw,7ou1wry: tei• ssionr lheDhhion oIBuding
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0:;!, at9n t1 any:ii,ej10r1 ,t any OL"'of(•e Lc'r:S7 Cr Ji ance di roi Pi it Lar;.
d : he! ,n3 real ss oxpi Ly fc;t irar:"a s^xne;:ll ?I,0'rni7 rt ne huik :y rr
,• • work :" : e: na'rF. r"•r• 1'. 'IP 3!' M.: ILLI I'U os
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BLOCK WALL LAYOUT FOR BUILDING Pk RMIT
PLANNING DIVISION
•
- ,
. TYPICAL 611 CONCRETE BLOCK FENCE
Cement Coping Optional a
Channel Block With 1-318 0 +i MI, : - =H --.1- GENERAL— NOTES •
Horizontal Top of all
Fences N 11.1 Ell I • MORTAR: OneeParf Plastic Cement, and
+ I 1 GROUT: OnThe Pare tts Sand
Cement, Three and
For Fences 5'or Less I +II c�
Ven.Bars 3/e"yS at 4' -0" O.C. d� o I One Half Ports Stand .
a i COPING: One Part Cement, Three
For Fences Higher Than 5' Icy t.a �; Parts Sand
Ven. Ban 3/B"0 at 32" O.C. Y?J� ,- w — - _- - _ CONCRETE: well Mixed 1:2-I/2: 3- 1/2 •
1 a �� Max of 7- 1/2 GollCe en
Fill Cells Solid With Grout + >
Where Steel Occurs Ili > z - „ 1 Writer Per Sack of Cement of
..
Reinforcing Steel Shall
!�I 3 'A
I GROUT MAY BE POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
Conform to Sec.A•15.39 ' ta 0 OCCURS.
A.S.T.M. ;B1i U - '—I CELLS AND AREAS OF HORIZONTAL REIN
La n _ _ FORCEMENT SHALL BE CLEAR.CLEAN&
All Steel to be Lapped oe1 L. FREE OF ALL MORTAR DEBRIS,ETC.
24"or to Code III I —Mal SI
NATURAL R\ E i 1'IIFL v SII III
'�
p/ :
0-all
r 4
• •
•
TWO J/&"O BARS -allNM• c . • _ "
CONTINUOUS TOP 11 -•
&BOTTOM ---I ll F►—µ10TH 10 16 0 C MAX
SEE CHART - .•
HOa,ZSTEEL MUST BE TIED IN BELOW '
DC CTII Cr. C ARTHTCOTH
PLACE AT TIME OF TRENCH ,
INSPECTION. t - Jr! THE HEIGTM or FENCE
- e SLOW BOTTOM OF FOOTING
3 s.
:4o" 2.. F SCALE. I/2rr - I'
FOOTING REQUIREMENTS' CHART
WALL HEIGHT 6' = 5. - • q' 3' I
WIDTH . 14" . _ -.-14" • . 12"
THICKNESS10" . =.- 10" 8 " 8
DEPTH OF EARTHTOOTH 24 -20" . . . . .16" 12"
SPACING OF EARTHTOOTH 12' _ '14 16' 16'
- -------- ---------
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Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 3342 10/31/8�
5 5p0(. IL
ITTYOFCOSTA MESA CONSTRUCTION PERMIT• /54 . J P MI2-I( / _ TRACT NO. LOT NO. UNIT NO.
. Project Address vs. -se- t/ SF ` �"I oC `YoC,
Applicant's Mailing Address - ti LL N- /ffE SOEnA,_' 4/y TYPE OF CONSTRUCTION ❑ NEW LJ ADD H ALTERATION H REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
Owner's Name "//.L> K C-14•-•C'e//7 Phone riyJ — r8.07A.P.# Zone
DESCRIPTION OF WORK/USE OF BLDG.
(� Address S3 Se-4/J-j - S Main Building: Accessory Building;
\\I Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front s O
4.V / /I� C .gyp ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL . B' N
Address / �7 / / A �2�-' A Rear
Contractor's Name y4 CI !OTHER 6 � '7L 9'—�/ Phone 5 -,74-3 - - C Right G
\1 3;Z Z � ;• Jnt� PROJECT DESCRIPTION SQ. FT. - OCCUPANCY K .
\ Address(mailing)• qq�� /� / 9�l. y ' CONSTRUCTION TYPE VALUATION S Left R
City License No. ,X77/7 ZONE GRADING CU.YDS. ACRESping. •Ref. # Parking Req./Provided - E
Q
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: - Planning Notes: _ . M
with section 7000) of Division 3 of the Business and Professions Code, and •
my license is in full forcp.and effect -_ T
License Clas G— C.--Zi) 'License No-•may r'0 G' y • - S
Date / 'R�J/MPESATION ID PLUMBING FEES
YORKERS' COMPENSATION b CLA RATIOryBar Sink Showers ELECTRICAL •
.FEES
rereby affirm that I have a cert, icate of consent to self-insure or a certificate
A Workers' Compensation Insurance, or a certified copy thereof (Section BdekflOW Preventer - Service Sink - -
3800, Lab. c��yJ —J�,(. " Automatic Washer Transformer 0 15-50 KW
Policy No. 'S� /.7r�Q7 Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW
Certified copy is hereby turn fished
Certifie copy'1,(,I d with the cit ,Itli g ivision. Bathtubs Sewer Connection Cooking Unit Meter Duo to 100 amps
Date [�J'///sQ Applican •
___
EXEMPTION FROORKERS'CD PENSATION DECLARATION Clarifiers Solar Collectors I Dishwasher Meter Dover 100 amps
(This section need not be completed' the permit is for one hundred ($100) or -
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric 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 so as to become subject to the Drinking Fountains Solar Tank ' Fan Motors 00-1 HP ❑1'A-8
Workers' Compensation 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 - - -
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY .
• Gas Service Outlets . Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors • Water Heater Outlets Range
Lender's Name I
Lender's Address - Kitchen Sink Water ServiceSwitches . Sign
OWNER BUILDER DECLARATION -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal . $Landing Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator 00-5 KW❑5-15,KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains he Contractor's License Law (Chapter 9(commencing with Section 7000) of ,
ivision 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 ,-• ' '
' 1031.5 by any applicant for a permit subjects the applicant to a civil - • . . . ,
enalty of not more than five hundred dollars($500). - '
LJ 1, as owner of the property or my employees with wages asp their sole Reinipeetion-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 r
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 Rollet Hood or Type I ❑
sale. If, however, the building or improvement is sold within ono year of com- - Canopy Type II ❑ Zoning Approved By Date
p , 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). •
10I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural , ' Refrigeration System Application Issued By g/ - - Dat 62
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law dries'not apply to an owner of property who Duct-Ventilating • 00-100,000:BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con- - '
tractor(s) license pursuant to the Contractor's License Law). I am aware thatExhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $, SMIP $
proof of their Worker's Compensation Insurance should be provided to me. PLAN CHECK $. PERMIT
❑ I am exempt under Section B.& P.C.for this reason, Firepl/Fact.Blt. ICBG# Fire Dampers - PLUMBING $ ISSUANCE $
' Date Owner a[Ing System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $,
I hereby certify that I have read this application and state that the above /100000 BTU ❑100,000 BTU— - a 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°.6 $ MICROFILM $
•
sentative5 f this city to' enter u•• the above-mentioned property r
inspection�l\•o e- ' MECHANICAL $ �'' TOTAL FEE 5 S-
r•
Signatu , .11....S.—......11....S.—..... Date/0 2/ �
Drivers' nse or SS / Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $
`CMF 0665-46,rev. 10/84 White - Building; Canary -Applicant; Pink - Accounting: Goldenrod - Assessor —
• , y
PC i SPA
CONSTRUCTION AND PLANNING
ti1.
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 58. Electrical Conduit-Undrgrnd.
8. Foundation - _ 59. Gas Pipe, O 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
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 0Gas 0 Oil •
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing • 73. Undergrnd.Storage Tank O Gas ❑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 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 id/ J .",
35. Final Gas Pipe-Test j -
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
48. Special Requirements Completed •
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY
No. Date '
•
CITY OF COSTA MESA r
1< •
> I BUILDING DIVISION PERMIT NUMBER
i
m ,,•.
• ' DEVELOPMENT SERVICES DEPARTMENT
PERMIT
699-00505
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 653 SEAL ST Status: ISSUED
Suite: Applied: 04/14/1999
Vicinity: Issued: 04/14/1999
Parcel Nunmber: 42223205 Zoning:
ISSUED BY:
Applicant: BOWE,MARK
Address: 14491 SAHARA LANE
Phone: 949-642-2580
HUNTINGTON BEACH,CA Zip: 92647
Owner: BOWE,MARK
Address 14491 SAHARA LANE
Phone:
HUNTINGTON BEACH,CA Zip: 92647
Contractor:
Address:
Phone:
Zip: License:
•
Arch : • Eng:
• Address: • ' Address:
Phone: Phone:
Zip License: Zip: License:
SCOPE OF PERMIT
REPLACE EXIST.2 WINDOWS"IN THE BEDROOM AND LIVING AREA"REPAIR DRY WALL AND REPALCE SLIDING
GLASS DOOR.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $1,200.00
Permit: $40.25 Claim Valuation: $1,200.00
SMIP Res: $0.50
SMIP Com: $0.00
Other $0.00
Inspection: $0.00
Total: $40.75
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 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
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
hereby affirm under penalty of perjury one of the following declarations: t r 1
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carder and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued 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 DOLLARE($100,000).IN ADDITIONTO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business end Professions Code:The Contractors License Law does not appty 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.).
7.4 I js emp unser sec. a Business and Professions Code for this reason:
gnature:
A a �a�+_. he: • I�'�a/-
Owner ID verified by drivers license. • Yes 0 No r _ . Expires":At VZ.!r')
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)Leet 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 fled 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_._. or
. .. present
u.__ occupant
g ...__ __ at )
3 Does or will the applicant or or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutelyhazardous materials 7
❑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 a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? la 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? ❑Yes in No
(If yes-,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cale).
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
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-dpsgdged pr a for ins•= tion purposes.I :. •• o occupy or allow occupancy of any building authorized by this permit until final Inspection.
Nv 4• Li �C9
Sig .ture Of Legal Owner(s) Date
And/Or Authorized Applicant Date
BODE# INSPECTION TYPE PATE 1MTl➢91S CODE* INSPECTION TYPE gdIE INITIALS
1616 Fixed System Final Fire Prevention" 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
•
200 Final Re-Roof 210 Final Electrical
201 FinalBlock/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
2440.48 .
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1.`
CITY OF COSTA MESA
•
F`0-at BUILDING DIVISION PERMIT NUMBER
�rr4, DEVELOPMENT SERVICES DEPARTMENT
J. PERMIT
P99-00226
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
•
PLUMBING PERMIT
Job Address: 653 SEAL ST Status: ISSUED
Suite No Applied: 04/14/1999
Issued: 04/14/1999
Vicinity: (�
Parcel Nunmber: 42223205 ISSUED BY: (''V
Applicant: BOWE,MARK
Address: 653 SEAL ST
Phone: 949-642-2580
C.M. Zip: 92626
Owner: BOWE,MARK
Address 653 SEAL ST
Phone:
C.M. Zip: 92626
Contractor:
Address:
Phone:
Zip:
License:
Arch l Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT� c
7
REPLACE EXIST.2 WASH BASINS AND TOILETS. . - 12;9161 - bOsb 5
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $22.00 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $17.50 2
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) $17.50 2
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) $0.00 0 Sink,kitchen $8.75 1 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00. 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
•
TOTAL CALCULATED FEES: $65.75
COMMENTS/SPECIAL CONDITIONS
•
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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
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 1f the permit is valued at one hundred dollars($100)or less.)
O 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($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 em 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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors Ucense 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).):
O 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 Ucense 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 : ' .-• y under se Business and Professions Cale for this reason: a
• • ter tap.. D: •12C21L
verified by driver's license. c:Otlieai 0 No CI. . 4111res:5_22z.g.
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,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 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 Safely 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 end 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 a_permit 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 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
_,. ...under...__ the outer 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).
..._.— his-t_ . b_ct ..
7 a permit from av tae South CoastlosAir ri Management Californiant or other air pollution controln di0ibt or agency Is requiredsfor the work which is the subject of this
application,have all of the disclosures prescribed by Celiia Health and Safety Code Section 42303 been made? ❑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 o 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-describ pr•perty or Imp: •n purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection.
•
i Li• 1k-t •` 'r
Signatur: • egal Owner - Y Date
And/Or Authorized Applicant Dale
CODE I INSPECTION TYPE UTE INTITIAL$ CODES INSPECRON TYPE (�LL DAM ALS
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 Slte
204 Final Demolition 250 Final Bullding/Occupancy
2446.46
•
,4$11:1!2..,t,„ CITY OF COSTA MESA
-) .
• F ," "'G �. BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT RMIT NUMBER
Sigiterme E99-00227
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 653 SEAL ST Status: ISSUED
Suite No Applied: 03/22/1999
Vicinity: Issued: 03/22/1999
Parcel Nunmber: 42223205
Applicant: BOWE,MARK
Address: 14491 SAHARA LANE
Phone: 949-642-2580
HUNTINGTON BEACH,CA Zip: 92647
Owner: BOWE,MARK
Address 14491 SAHARA LANE
Phone: 949-642-2508
HUNTINGTON BEACH,CA Zip: 92647
Contractor:
Address:
Phone:
. Zip:- . .
License:
SCOPE OF PERMIT
UPGRADE SUBPANEL 8 METER COMBINATION UP TO 200 AMP.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $22.00 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 $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0
Switches $0.00 0 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 10002 $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $27.25 1 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 $49.25
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
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 end 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
DECLARATIONS
WORKERS'COMPENSATION DECLARATION; r
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 Coder 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($700)or less.)
❑ 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 CML RNES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,003),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.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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business end Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.).
❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon,end who contracts for such project with a contractor(s)
license pursuant to the Contractor License Laws.).
ti I am e :m.t un.er s . Fi 1 34 " Business and Professions Code for this reason:
Signature: Ai Aseater Date: ..
Owner ID verified by driver's license. P. es 0 No Driver's License No: - liairs27-
Verification of Ownership by(type o1 document,i.e.-property tax bill or dee.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 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 Flre
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 Califomia Health and Safety Code been fully compiled 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 fumished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(II 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 COMPLJANCE 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 no to occup or al occupancy of any building authorized by this permit un : '•-section.
art a Z-
Signature Of Legal Owner(s)
nd/Or uthodzed Applicant Date
LODE L INVECTION PATE TALI CODE IILSPFCTION TYPE QAIE INImAIS
1616 Fixed System Final Fire Prevention 208 Final Mechanical
1266 Pool Spa Final _ 208 Final Plumbing /
200 Final Re-Roof _ 210 Final Electrical /p-Lt art_
201 Final Block/Retaining Wall _ 212 Final Fire Prevention 7
202 Final Factory Fire Place _ 220 Final Planning Approval
203 Final Sign _ 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-45
03/22/1999 22:09 714-513-8650 MIKE WEBSTER PAGE 01
*
ADVANSTAR
r' rr .,, ., ri n r , .A T 1‘,N ,
Dawn Bowe
Administrative Assistant/Office Manager FACSIMILE COVER SHEET
DATE: .3l Z 3/11 FAX#: -71(-1-7s'' - `t &S(o
TO: .V;4_ CO: c)l-Cosh. p1s* ,
RE: TER-An;4--
NUMBER OF PAGES INCLUDING COVER PAGE: 3
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//771 ADVANSTAR COMMUNICATIONS
201 OINTE
AVE..STE.600,SANTA ANA,CA 92707
714-513-8479*FAX: 714-513-8481
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03/22/1999 22:09 714-513-8650 MIKE WEBSTER PAGE 02
1010269 PAGE: 2,3
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1114)
CARDINAL
PACIFIC ESCROW,
8111 E.NICUn0 crow hilt 6660•L0M0 MACK CA 90101
CCM(3121 OI% •(111)1441C •91.8(66116174117
lasras Po. 1921021-02 01661x/ natal arch 19, 1996
1»fens.., 663 soil Strata foie 1 Pin
costa masa, CA 9302?
CLOSLNGIVITTEMENT
101111.
Mark Sore
Dar* Daae
611 meal Street
Costa Dasa, CA 92627
Consideration;
Total
CCw.!Oastba 169,000.00
Depodi:
Dapman
y, !lark Sow and Darn sera 6,000.00
Deposit
Sf6 ant lose and Darn Done 7,700.00
Essiding and New Encumbrances:
lee Sn6,omta6C. :60.9so.00
Sanwa Sank of California
yroratioLL:
County Property 7414106 947.75
at 1 966.61 par 6 months
from 09/19/99 to 07/01/96
New Loan Char®er
Se, Saes Sana of California
Interest 6 179.69/daY 316.90
9100 03/19/91 To 04/01/99
Credit LSert 00.00
•Apnraieal 7.. 70C 1 360.00
Tax Service aa.00
Mortgage Ina. Premium 104.36
flood C.rtlfloatton 14.00
Padaral Uprose foe 30.00
Sate Lack Poo 432.66
I6yoonda for tato 422.69
3 month. 16140.63 per month
Impound. Pu Msuranaa 06.64
3 month* 6 3211.441 per month
tapeanda rot at; rot. 706.72
2 months 1 1104.36 per Donn
Ron
•ProotlSlnp tam Pon 1 360.00
Dllbuf6emenfa Pall:
fin Inaurano6 341.16
pd tot OM
Molt Me 20.00
pd to. cardinal Pacific astray, Inc.
'pan. lSaaadpat fM 40.00
pd to. Cardinal Paoiflo Isorow, zoo.
notary 766 60.00
pa us Linda S. Point
TYtlt
Letters Title Policy 341.00
Bob Saorw Tom to Title CO. 126.00
eanerd Gnat 0664 6.00
(Continwd on page 21
03/22/1999 22:09 714-513-8650 MIKE WEBSTER PAGE 03
• 09:05 +.W 23. 1999 .10269 PACE' 3r3 . ,
)lass. Na. 9923021-02 Warm Patti nark 19, Mt
S I....aa, 03 Nal 9tisst pops 2 /ail
Cats lass, 0A 92977
CLOSNaliriaNT
mum
Nan Saws
Dawn Er
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Oat. OaN, Cl. 92927
MoorTrot Med 27.00
21,01./10n 7a 12.70
rapping $ Banr11n; 17.90
Escrow Fed:
..alae l... 470.79
Ilan its-in ra 200.00
Work w..ttb 9 224.11
S.4a1. 9 171,290.00 9 279,290.00
YO FOR ISOaM Tsi ICRPOORB
CITY OF COSTA MESA __
v ..4 BUILDING DIVISION
lei •;.,.....,:•:: , - DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
tt• IP
PERMIT
E99-00316
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
• ELECTRICAL PERMIT
Job Address: 653 SEAL ST Status: ISSUED
Suite No Applied: 04/19/1999
Vicinity: KITCHEN REMODEL Issued: 04/19/1999
Parcel Nunmber: 42223205 p
ISSUED BY: '-}'rn
Applicant: BOWE,MARK
Address: 14491 SAHARA LANE
Phone: (949)642-2580
HUNTINGTON BEACH,CA Zip: 92647
Owner: BOWE,MARK
Address 14491 SAHARA LANE
Phone:
HUNTINGTON BEACH,CA Zip: 92647
Contractor:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
1 LIGHT, 10 OUTLETS 8 1 SWITCH FOR KITCHEN REMODEL. B99-00505,P99-00226.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $22.00 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 $1.00 1 up to 50 kva/kw $0.00 0
Recept Outlets $10.00 10 up to 100 kva/kw $0.00 0
Switches $1.00 1 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 1hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $34.00
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
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 tie 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 DOLLARE($100.060).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E 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.x Class It
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a constmction 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 permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exe t n r s Business and Professions Code for this reason:
Signature: Date: L--'I . I 1 - CC1
Owner ID verified by drivers license. ❑Yes ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth into which a person Is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework.or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If 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 ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 01 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 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 a•ree to comply wit all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-d".•'be, •roperty for spection• roses.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection.
i Li ' 19 - (7 "\
Signature Of L=gal Owner(s) Date
And/Or Authorized Applicant Date
CODE t INSPECTION TYPE PALE llf bL3 CODE0 INSPECTION TYPE • PATE =ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing —/--,L— Q'e
200 Final Re-Roof 210 Final Electrical 1ril
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
2406-06
OWNER HARBOR ESTATES DATE 7-12-55
JOB ADDRESS 653 Seal St. BUILDING PERMIT NO. 3512
GENERAL CONTRACTOR Dike & Cole grove VALUE $ 8,500 OO
LOT 91 BLOCK TRACT 1986 Residence & Gar. Plan 270
GROUP 1 TYPE V ZONE Rh FIRE DISTRICT 1532
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
f / DATE NUMBER
Footing Trench 1V6 -3-55
Foundation Forms and Grade to Garage
Rough ng,Frg l� p-$_�'.
Plumbing,Rough to Sla rY, g 3-.5-4-
Plumbing,
3 r
Plumbing, Rough Complete ow.� 8"2G —G . ._. .,;- t -, G -,2g-j'T( )E&'i .'
Temporary Pole pn,e , �/-J�"'�''V j s�
Wiring, Rough AM 9-7'55'01.-Ca k Nr1/ L[ €1,-S6 /.S U 7
Heating, Rough // Q /\
Heating,Final aG-it'lei '� E 'g-� ?lin 9-023_cf ag AP
Sewer, House Sewer,St. pa 4L{/it/ -, /9.--//-5.--S- L-,// 7
Septic Tank or Cesspool
Lathing, In Out t 9°,41--a-
Plastering err /b-/3-.S.'r
Plumbing,Final,Fixtures Co/m/plet• j/e0' //VS Plumbing,Final Gas Testi,9 /1,o-4 _ -_ _a
Wiring,Final ►' �� 4/-/jz L" � //- ,
Occupancy
. jCosta Mesa Building Department G'�AIP�PLICATION FOR PERMIT
/
COST11A EMESAAST 20t` -TREET FORNIA 1532- . •• IA..1) L. N G ._. ... ..�1.. .
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
Receipt No. Permit No.
Building I ' , .
Address reet - ' S yZ!
653 Sea]_gt
Costa Mesa, California PLC
by Date Reed> Date Isgued '
Nearest {✓.Q'C�:/ 'Xyl /1 'J -42;4:r
Cross St. 19th Street Bui ing
Address I .
Owner Harbor Sstates - ' Costa Mesa, California
Mail •
Address 419 East 17th Street Nearest ,
Tel. Cross St. •
city Costa Mesa No. LI 8-1159 zonenNo.of Te . T
/ I Group
,..e••
or Lic. !JI 4 I Type
Plans v I .1."
Engineer r.—...inn R. Mi r9Al rthr (91r Approved ,
by Date
Address Garden Grove - : CORRECTIONS '
City Lic.
Contractor Dike & Colegrove No. 1301 I _ x
Address 419 East 17th Street ID ® t ° "a' .
9a I '-_{..,..-�. -' S.....!
Legal Lot
Description I No. 91 I Block I Tract 1986 L.•-7
(Attach Metes and Bounds) . I' 1' 1 2 ,CSJ
No.of
Size of Lot 56 x 110 I Now on Lotnone - _ .(1_._._n_ _ �t,��C.
Exist ng Bldg. none of I Families I Rooms - ---£` � i���l 1�+sSA —
Setback Line from Rear Yard - - - - - - -- - - --
Center of Street 50t Side Yard -1 I . - _ •• — D
DESCRIPTION OF WORK - - '- = r
New I X I Alteration . I I Addition
Repair I I Moving I Demolish
t, Building No.of
_Size 1151 Sq. ftRooms 6? Stories 1
Exterior Wall I Roof
Covering opera_ Covering comp APPROVALS
Use of New
Building plan. No. 27C Foundation Location Inspector Date
Forms, Materials,
Single family residence with garage Under-Pinning
Frame: Fire Stops,
:1 Bracing,Bolts
. I hereby acknowledge that I have read this Application •
Lath. Int. •
and state that the above is correct and agree to comply Lath. Ext.
with all City Ordinances and State Laws regulating
building construction. -
Signature of Plaster,int.
Permittee 11 . - . • - • 0 -
,r , Plaster, Ext.
. '
Authorized Agt. �l•
Masonry Reinforced
Valuation - Permit Fee $ a.a. • 0
8 5�.� Plan Check $ 3, 0 0 Bond Beam
$ Total
Fee $ �-S: O0 FINAL
Form 204 G-H IM 12-5::
TI>\V'ISIaq 3IO'I wOI'i'A--'I.IqSIA -_ itioutizsgstY nibliufd - sisal iiPo I.
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a J
0.
: .. COSTA - .� .. . •.. t
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UL 12 SSPDgEsn 435a *.***25.00
- .
•
Street , •• - -
PLOT PLAN - .
Show location and distances from
• property line and between buildings.
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