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HomeMy WebLinkAbout1865 SWAN CIR - Building Permits �DytN MFsq CITY OF COSTA MESA 4' o BUILDING DIVISION PERMIT NUMBER :r TPor ' DEVELOPMENT SERVICES DEPARTMENT .) x' PERMIT E00-00059 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1865 SWAN CI Status: ISSUED Suite No Applied: 01/27/2000 . Vicinity: KITCHEN AREA Issued: 01/27/2000 Parcel Nunmber: 13952413 pp Applicant: ROSS, JACK W III TR ISSUED BY: d Address: 1865 SWAN CIR l( Phone: (714)556-7446 COSTA MESA,CA Zip: 92626 Owner: ROSS, JACK W III TR Address 1865 SWAN CIR Phone: COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: ' - - Phone: Zip: License: 0 SCOPE OF PERMIT 56 LIGHTS, 13 OUTLETS AND 15 SWITCHES FOR KITCHEN REMODEL. REF:500-00085 • 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- $46.28 56 up to 50 kva/kw $0.00 0 Recept Outlets $14.30 13 up to 100 kva/kw $0.00 0 Switches $16.50 15 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 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$626 DECLARATIONS I • . • WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations:, ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: . Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) • ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOI I ARE($100,000),IN ADDITION TO THE MST 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 If 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: I 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 L. 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 pursu- t to t e C• -tors License Laws.). ❑ I am exemp /der e . Business and Professions Code for this reason: ^ N� Signature: IC ..,4 A IV, _ Date: h `i-)7 ZOI� • Owner ID v: i • sy driver's license. 0 Yes 0 No Driver's License No. Expires: Verificati• of 0 ership by(type of document,i.e.-property tax bill or deed): DIVISIO O-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,end 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? 0 Yes ❑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). .............. .. occupant d-.to...pr s.. l ) .. 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 applicant or psenu._-r__ ccupa_..reuire for w__ which is -f-this_epplicatii___.-__rmitsuchcn_ m-._.i__.___.-. 5 Does or will the applicant Quality present a emen buildingsoccupant at any other the work ontch the district or this a pl iestion e0Permit for such construction or modification from the South Coast Air Management District or from other air pollution control or agency? �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 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). hCo ___.. ot - n- strict e.-_-_ sr th- jet hs 7 Ifa a patron from tae South iscAir p r scri Management is Heat hr nd S air p don control 0district agency is requiredsfor 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 A ORIZATION 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 com•y with . state las nd city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prop- for'n-/-. tion • rp es.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /r eh./ .)-1 ^211,r Si•oa ure•f eget Owner(s) /Date Ai. And/Or Authorized Applicant Date CODE Y. N P DATE )NTRIAL$ COREY INSPECTION TYPE DATE INTITIALni 1616 FiWystem Final Fire Prevention - 206 Final Mechanical 1266 Pool Spa Final 208Final Plumbing �L�� , 200 Final Re-Roof 21010 Final Electrical F i)/z—/�r 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 2446-46 pM (�, ►q CITY OF COSTA MESA it F4c 4BUILDING DIVISION PERMIT NUMBER DEVELOPMENT SERVICES DEPARTMENT 4. SKS • PERMIT B - 0085 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1865 SWAN CI Status: ISSUED Suite: Applied: 01/21/2000 Vicinity: KITCHEN,DINING,&LIVING ROOM Issued: 01/27/2000 Parcel Number 13952413 Zoning: R1 R1 Applicant: ROSS, JACK ISSUED BY: RPS Address: 1865 SWAN CIR. Phone: (714)540-1683 COSTA MESA,CA Zip: 92626 Owner: ROSS, JACK W III TR Address 1865 SWAN CIR. Phone: (714)540-1683 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 Arch : GEORGE HANDY Eng: SCOTT W. ROSS/ESI/FME • Address: - Address: Phone: Phone: Zip: - License: C19024 License: C45309 SCOPE OF PERMIT LEGALIZE 3 POP-OUT WINDOWS, INSTALLATION OF 2 SKYLIGHTS,&CREATION OF VAULTED CEILING. FEE SUMMARY Plan Check: $300.59 Calc Valuation: $32,000.00 Permit: $462.45 Claim Valuation: $32,000.00 SMIP Res: $3.20 SMIP Corn: $0.00 Other: $462.45 Inspection: $0.00 Total: $1,228.69 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 . . IORKERS'COMPENSATION DECLARATION: 1 hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($t00,o00),IN ADDRION 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 l 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 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.). AI, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors Lic,r 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 pur Ark nt to the Cor t ct rs License Laws.). ❑ I am exe 07 di 4c. Business and Professions Code for this reason: jam v 7� !7-010Signature: Pate: W Owner IF verifi:• by drive s license. ❑Yes ❑No Driver's License No., ) ( Expires: Verifi•:tion of•wnership by(type of document,i.e.-property tax bill or deed): DI SI. • OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 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,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 Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 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 . --........ .....i .. equ- ... -"-.... .................. ............... 4 If an RMPP isspresently 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 apermit 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). 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 ❑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 CO -LIANCE UTHORIZATION 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 co-p i w' all t e ws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pro-e to i e T n urposes.I agree not to occupy or allow occupancy of any building authori d by this permit until final inspection. Ors �._ a7, 21/4 Signa f Legal Owner(s) Date And/Or Authorized Applicant Date •• # INSPEC.•N TYPE DATE INTITIALE CODES JNSPFCTION TYPE PATE INTRIALS 1616 F' 'd 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 61 1(7 'PO 4sfrii 2446-46 sTRM CITY OF COSTA MESA • 4w _ �, BUILDING DIVISION PER NUMBER h r """� I DEVELOPMENT SERVICES DEPARTMENT ° raigt 4% re PERMIT E99-00945 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1865 SWAN CI Status: ISSUED Suite No Applied: 10/13/1999 Vicinity: RIGHT SIDE OF HOUSE Issued: 10/13/1999 Parcel Nunmber: 13952413 ISSUED BY: Applicant: DANIELSON, STEVE Address: 12356 PENTAGON CT. CA Phone: (714)539-9413 GARDEN GROVE Zip: 92841 Owner: ROSS, JACK W III TR Address 1865 SWAN CIR Phone: COSTA MESA, CA Zip: 92626 Contractor: DANIELSON ELECTRIC Address: 12356 PENTAGON CT. CA Phone: (714)539-9413 GARDEN GROVE Zip: 92841 License: 375631 SCOPE OF PERMIT UPGRADE EXISTING 100 AMP ELECTRICAL SERVICE TO 200 AMP. FEE SUMMARY Quantity Quantity t 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 $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 $30.50 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00 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 i ' WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 0 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 action 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 th' 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 shout become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these p Ions. n 3 Applicant Signatur / Li 54--` Date: 0— ( — l Si WARNING:FAILURE T6666SECURE WORKERS' COV RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYENIO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,020),IN ADDITION TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECNON 37080F 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 an Professions Code,and my license is in full force and effect.Lic.a & 3 Class a c' / C [.� Contractor's Signature: ri�!i._:� .. I+ C Date: ( Ce)-- / 3 ^ Q 1 CONSTRUCTION LENDING AGENCY; O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Of not more than five hundred dollars($500).): ❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his of 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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 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? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4.......... ...Ps... __.._. has Section f the California Safety been ...wth 4 If an RMPP is presently required, Sect25534 of the California Health and Safety Code been fully complied with? CI Yes 0 No ....--...... iil..th applicant or which subject ermit... ...ntr.. r d.i. ati..__... 5 Does thee will the Coast Air ou Quality Ma or emefuturn building occupant at any other for the work districtis the sor agency?this application appermit for such construction or modification from South Air Management District or from other air pollution control or Yes LJ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No ..-----. . .i.c-er).- ............. ---------. ...... 8 (If"yes",attach certificatee of compliance from rom the appropriatee 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 egal Owner(s) Date i _Y? . cam. ��--�— '70 -/ ¶3 `� 4 nd/Or thorized Applicant Date CODE#. INSPECTION TYPE on INTITIALS CODE# INSPECTION TYPE PATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing i ii 200 Final Re-Roof 210 Final Electrical AWE12. 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 2446-46 REGISTERED CIVIL ENGINEERS JENNINGS • HALDERMAN • HOOD A CORPORATION 1 6 6 6 EAST SEVENTEENTH STREET, SUITE 2 0 0. SANTA ANA. CALIFORNIA • 6 6 T -4 1 6 6 27 OCTOBER 1965 MR, DON SOUTHWORTH CITY OF COSTA MESA 695 WEST 19TH STREET COSTA MESA, CALIFORNIA TRACT NO . 5781 — FINE GRADE CERTIFICATION THIS IS TO CERTIFY THAT LOTS 66 THROUGH 84 OF TRACT No. 5781 HAVE BEEN FINE GRADED IN ACCORDANCE WITH THE APPROVED GRADING PLAN. IT IS OUR CONSIDERED OPINION THAT THESE LOTS ARE READY FOR LANDSCAPING. CLIFFORD C. HOOD CCH: JI CC: PEMBA SUBDIVIDERS ASSOCIATES: JINNIN09 ENGINuwna Co., Ins Angelo • .1ENNINOS-MCDnMo1T ENWNQVNO Co., San Joao Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO- TRACT NO. LOT NO. UNIT NO. CITY OF COSTA MESA CONSTRUCTION PERMIT Q 3t4 33 ) • A.P.# . Zone Project Address 1865 Swan Circle I� S Main Building: Accessory Building: Applicant's Mailing Address TYPE OF CONSTRUCTION .❑ NEW CI ADD LTERATIONc H REPAIR E Z ❑ CONVERSION ❑ DEMOLISH OTHER T Front- • 0 Owner's Name. Jack or Nancy Ross Phone821-2385 DESCRIPTION OF WORK/USE OF BLDG. I B Rear N Address 1865 Swan Circle Costa Mesa c Right N Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ' $. Left G Champion Roofs• 1nC 259-0451 ❑ OTHER Ping. Ref.# Parking Req./Provided E Contractor's Name PPhone p 3257 Verdugo Rd L.A. 90065 PROJECT DESCRIPTION SQ. FT. Z OCCUPANCY ._.S.— Planning Notes: M Address(mailing) g CON ST RUCTION TYPE VALUATION$042725 T City License No. ZONE - GRADING CU-YDS- ACRES - � - S. LICENSED CONTRACTOR DECLARATION • I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: C � � with section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect. 4294$1 ELECTRICAL FEES License Class — • Ak'e,ns�No. - ' gate 6124/Si$nature %�/7 >�x"""""% PLUMBING FEES Automatic Washer Transformer 0 15-50 KW WORKERS'COMPENSATION DECLARATION . ✓✓✓ Bar Sink Showers Construction Pole Sub. ❑ 50+ KW • I hereby affirm that I have a certificate of consent to self-insure or a certificate ' Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps 100, Lab. Cr) Policy No. U}'kDO W7 Company 19-QA is L C,4-)4o Backflow • Irrigation Sewer Cap Dishwasher Meter Dover 100 amps — • Certified copy is hereby furnished. Dryers ❑Gas DElectric Sub Panel Certified co killed led with the city Buil n9 Qivisjon- Bathtubs Sewer Connection Date G -a�- Applicant (/((! T Fan • Motors 00-1 HP ❑1X-8 fffvv, EXEMPTION FROM WORKERS'.COMPENSATION DECLAR TION (This section need not be completed if the permit is for one hundred ($100)or F.A.U. Inc.Solar 09-15 HP 016.15+ less). Dishwasher Solar Collectors Solar Piping I certify that in the performance of the work for which this permit is Issued, I Clarifiers • Fixtures shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave NWorkers' Compensation.Laws of California. Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light - I NOTICE:if,after making this declaration,you should become subject to theOutl¢ts Range Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • Urinal ` ^^`' _comply- with such provisions or this permit shall be deemed revoked. , V CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet . Switches Sign V 1 hereby affirm that there is a construction lending agency for the performance - of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater . Garbage Disposal Standing Sections Lender's. Name- Lender's Address • Kitchen Sink Water Service _ Generator 00-5 KW 05-15 KW Trash Compactor ' 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 county which requires a permit to construct,alter,improve,demolish or repair P—Trap ' Laundry Trays • 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 - - „Division, 3 of the Business and Professions Code) or that he/she is exempt _ Reinspection Fee $15 Issue Fee $ 3 Ftt,;erefrom and the basis for the alleged exemption. Any violation of Section .$w,-131.5 by any. applicant for a permit subjects the applicant to a civil ;?:malty of not more than five hundred dollars ($500). • DEVELOPMENT SERVICES REQUIREMENTS: ❑ I, as`owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 Zoning Approved By - bate compensation, will do the work,and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's • ' , MECHANICAL I FEES Building Approved By • Date 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 Boiler - - -Hood or Type I ❑ Application Issued By Date '[Q ^zr�-- employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- . Canopy Type H 0 . SUJ)(1MAR�OF FEES , ' pletion,,the owner will have the burden,of proving he/she did not build or im- Duct- Under Ground i., `yl�Ql prove.for the purpose of sale). BUILDING PERMIT $ — SMIP , $ U ❑ I,as-owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System + PLAN CHECK $ PERMIT tractors to construct the project (Section 7044,Business and Professions Code: • The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU 0100,000 BTU - - PLUMBING $ ISSUANCE , $ builds-or improves thereon:and who contracts for such oroiects with a con- . - - tractor(s) license pursuant to me Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration ''1 PLAN CHECK 25% $ ENERGY P.C. $ . proof of their Worker's Compensation insurance should be provided to me. - ELECTRICAL $ GRADING $ 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact:Blt. ICBO dk Fire Dampers MICROFILM $ i PLAN CHECK 50% $ - . Date Owner - Heating System& Ducting Registers r - ' MECHANICAL Ul hereby certify that I have read-this application and state that the above - 00.100,000 BTU 0100,000 BTI, . -. -'1- $ TOTAL FEE $ 59_--- information is correct. I agree to comply with all city and county ordinances - PLAN CHECK 25% $ wand state laws relating.to building construction;and hereby authorize repre- - sentatives of this city. to en r1 upon the above-mentioned property for ; ' - y Inspection pur ses. :Drivers'- gner " ' + Date � _ 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POO. 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 COVE R-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. i I 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 0 Gas 0 Oil 23. Gas Pipe-Rough 8t Test r- 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank O Gas. 0 OiI 25: Roof:Sheathing C .. J • " • 74, Overhead Hydrb - r • -•* -- ; e . -1 __ I 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 0 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED / / 33. Final Electric [Notes: S /0_ c - (/1 rsk et, ( !-ri cave&Y Pest 34. Final Heating & Air'Conditioning -fc 6 /„t 35. Final Gas Pipe-Test !1/0 M-€44- - !r 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 46. Special Requirements Completed 49. Electric Release to Edison - ' 50. Gas Release to Southern California Gas Co s 51. CERTIFICATE OF OCCUPANCY No. Date Trt74087 65781 I CRY OF USIA MESA COSTA MESA BUILDING-SAFETY DEPARTMENT MAY 11 1965 '� P.O.BOX 917 COSTA MESA,CALIFORNIA I For Applicant to Fill In Completely O o PERM ill go .'( TYPE OR PRINT " ' ,/� ® For Office Use Only ADDREISS//JQ b� .t eit r J RECEIPT NO. iRCQM1)t!7 COSTA MESA. CALIFORNIA 6/-4`)11}{l I RECEI Y ° RECK ED/ DATE ISSUED OWNER Pemba Subdividers, Inc. ADRqq// 65 _MAY 1 3 1965 MAIL DESS /86 C L )0tr\( CIZ ADDRESS 2850 Mesa Verde Drive \ TEL ZONE 3 TYPE c/� GROUP L+ IRE CITY Costa Mesa NO. ZONE ARCHITECT TEL. APPROVED BY DATE OR ENGINEERE.G.Kaltenbach ND, 5478041 ADDRESS 1823 E. 17th , Santa Ana ttt ♦♦♦ ZONING ]��,yQ(I(, ZOpi / 1 I r.:,.,..2 I USE DI TII�'�"+' IRLw/ I EUILDI N{I (81 j CONTRACTOR Pemba Subdividers, Inc. � �J {1 �/ /V\v�fl{-' LEGAL 4.2.-/— 6 6 / {lt SW ADDRESS 2850 Mesa Verde Drive °E°`"'^'°" I CITY Costa Mesa A.P.NO. NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE ELTE T . 5490395 90"TO SIDE a REAR P.L. EAVES SIZE 70x120 I NO.OP TLOGS. 0 ALLOWED (U.B.C.REQUIREMENT) OF LOT NOW ON LOT YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. IRONT STREET? /A�CENTERF FTSE FROM 22' 65T FRONT �2--FT.-- CENTER CENTBR OP STREET REAR SIDE YARD I LEFT 10' I RIGHT 91 R.SIDE 9 FT. FT. DESCRIPTION OF WORK L.SIDE /fl FT. FT. NEW @ ALTERATION _ ADDITION REAR 0 LI FT. FT. DISTANCE BET. BET.MAIN& • ACCESS.SLOGS. REPAIR _MOVING DEMOLISH MAIN BLDGB. BUILDING NO OF VAR.$r DATE SIZEX ' 50x49 ROOMS 10 STORIES 2 C.U.P.3F��br APPROVED COERIN WAI0LaCCO I ROOF WoodShiri l APPROV +7 /.,C COVERING LDIIL. COVERING g 9Y DATE b USE OF BUILDING AND WORK TO BE PERFORMED Single gamily residence with attached garage. r ,{ �, CC _© - SQ.FT. �1 4 D n' LI I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONTHE AMOUNT SHOWN UNDER VALUATION IS FOR THE F AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. ' ` PLY WITH ALL CITY ORDI NCES AND STATE LAWS REGULATING VALUATION BUILDING CONSTRUCTION COOO O ch H PERMIT FEE $ Q 7 SIGNATURE OF 14„,:e/r., m PERMITTEE /I')'L'.'7 'ter Iy� '7_t g $ , / H 3 / PLAN CHECK $ 42 AUTHORIZED_T ///���"'' J ✓ /2� �' E San TOTAL FEE $