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HomeMy WebLinkAbout2417 VENIER WAY - Building Permits 11100 CITY OF COSTA MESA 05ut ,a BUILDING DIVISION t:). � p 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714)754-5626PERMIT NUMBER: M10-00143 PERMIT TYPE MECH STATUS: ISSUED APN: 43914330 DATE ISSUED: 11/30/2010 ISSUED BY: CAC JOB ADDRESS: 2417 VENIER WY CM Suite/Unit: Vicinity: SO. FT: 0 SCOPE OF WORK: HVAC CHANGE OUT SAME LOCATION. 36K BTU OWNER: GARDNER,CAROL TOUGH Address: 2417 VENIER WAY Unit: PHONE: 949-645-2597 City/State/Zip: COSTA MESA,CA APPLICANT: KALEB JUNGERS Address: 1121 WOODCREST AV Unit: PHONE: 562-697-2070 City/State/zZip: LA HABRA,CA CONTRACTOR: COMPLETE PLUMBING HEATING AND AIR INC License No. 952104 - Address: 1121 WOODCRESTAVUnit: PHONE: 562-697-2070 City/State: LA HABRA,CA ZipCode: 90631 CELL: MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $38.30 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $38.30 • • • 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODES. INSPECTION TYPE DATE INTITIALS CODES INSPECTION TYPE DATE INTITIA 1616 Fixed System Final Fire Prevention 206 Final Mechanical X )--12---11 1 P 6Y 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 • I - , WORKERS'COMPENSATION DECLARATION: Owner ID verified by ,cense. 0 Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: O I have and will maintain a certificate of consent to self-Insure for workers' - Verification of Ownership by(type of document.i.e.-property tax bill or deed): 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 tion 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: pe mit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a Ap• be are: person is required to descend,will be made in connection with work authorized / S'a'fe. Coli)(2/15412/10 Lr ZRSa ra ice Ft 7t el by this permit,and that no building structure,scaffolding,falsework,a demolition Car'- : or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Gm (This section need not be completed a'the permit is valued al one hundred dollars($100)w-less.) 2,Arta 5cc 341,Title 8,California Administrative Code). Po, •er: 1/ y 733 7— 20/0 t 0 As owner-builder, I will not employ anyone to do work which would O certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code, I shall forthwith comply with these provisions. —5,j ICI! �/� 7 Q ' Division of Industrial Safety Permit Number: /� q.+ m's Si. ore >' to HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAIL RE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file ///rrrrrrtt1yyy"""444tense is in full force and effect, / a registration form for acutely hazardous materials? 0 Yes 0 No • /SZ /0 V S 6" �CO�# (.. 1 (Section 25533 of the California Health and Safety Code, with some -5a4.0.,..../... ./ exceptions, requires registration with the Costa Mesa Fire Department by � ' 'F�� / /�� each business which at any one time has on hand a quantity of acutely Canary Da 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No 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 (Section 65850.2 of the California Government Code requires that the requested License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications for non-residential building permits). Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK. and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of properly who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No (hereon,and who does such work himself or herself or through his or her own 8 (If"yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and • ❑ I. as owner of the property,am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction. and authorize representatives of Business and Professions Code for this reason: 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. �Signatureo Legal Owner(s) 1Date •/ Signature Dale %/¢/f// � 7l trate O 3057-46(3/07) / e'_And/or Autnonz ppliwnt `T to L Page 1 of 1 h • t l` . yyI�i--/-‘44-,;(;k4 13 (TT %ççk s-,, +,�4 . �l lrcr(y�s JffQ eçc34g4?3{-. 1/ ' rc "'' ?/.4 .-, � Tttt l �. i h r t :119Z4: i ir,. a r �, ytryr. • J ti iittli ',Jr I "t r• ---,p, .ry • An :. P til_ . . to ti _, a 'r r' tri 14112 4 t�µ14, 11rti -1, . �' i 'tj�at el �i�•y.� �r 4t��. .r 2 � x « ..!•i•LF� ._'t lr��r — t . • t, 1,.. f4' A f r a i y'I ... ,� J ::::::,,,:c:::.)..,ei.:111 r rKt\ .4 t .- F, ' I..r / .. z✓' fir,. l v Yh A 5 * F.t'�. .1 L 11i1- '`t p c 7' Y r .'� p. ,( I)4 _ X17 j .e� .� 1 til‘ I , Address N Freeway /Z Frmvay Pommy Street Large /� Names Roads A/ PLANNING, Street . Address H Collector N �'�rPROv.A Crology • Centerlines Points (�[1r $f`/1 nils • Centerlines (cont( City of Costa Mesa Planning Div. Subject to Building Division Regs. Revision must be approved. 1 ����/ """ 'tequired Pr to Building Final: aq 17 Ven iy V t" YES E1j Zoning Inspection IYES 17N0 TraifiG Park Fees By. / y Date:_i30//C7 /{/ http://srv16/parcelview/Print/printview.aspx cCiahcv Vbcf-° 11/30/2010 CITY OF COSTA MESA 4p BUILDING DIVISION fµ, g 177 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us i_".�# FOR INSPECTIONS CALL:(714)754-5626 i c.. " PERMIT NUMBER: E10-00285 PERMIT TYPE ELEC STATUS: ISSUED APN: 43914330 DATE ISSUED: 11/30/2010 • ISSUED BY: CAC JOB ADDRESS: 2417 VENIER WY CM Suite/Unit: Vicinity: SCOPE OF WORK: CHANGEOUT OF HVAC 36K BTU SAME LOCATION 1 RESD PACKAGE OWNER: GARDNER,CAROL TOUGH Address: 2417 VENTER WAY Unit: PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: JUNGERS, KALEB Address: 1121 WOODCREST AV Unit: V PHONE: 562-697-2070 City/State/zZip: LA HABRA,CA :! _ ;ti CONTRACTOR: COMPLETE PLUMBING HEATING AND AIR INC License No. 952104 Address: 1121 WOODCREST AVUnit: PHONE: 562-697-2070 City/State: LA HABRA,CA ZipCode: 90631 CELL: • ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $78.00 Reinspection Fee $0.00 TOTAL FEES $78.00 . 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. '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. CODE O. INSPECTION TYPE DATE INTIALS CODE INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical /fin 200126 Spa 6 Final Re-Roof) 210Final Electrical Plumbing ical X j 2--)4—ID imp .0 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION: Owner ID verified by driv,. .cense. El Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' •Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. rycyC I have and will maintain workers'compensation insurance, as required by (dr?ction 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a t are: . person is required to descend,will be made in connection with work authorized ,r Cd 7M jr C�MS-eC 1 I d f4 -�„Srt lit KOC �U.h by this permit,and that no building structure,scaffolding,falsework,or demolition Q or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section need not bewmpltedd the perm:is valued at one hundred dollars(S100)orless) 2,Art 2Sec.341,Title 8,California Administrative Code). Policy Number: 0 As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date the IAbor Code, I shall forthwith comply with these provisio s. / 30 0 Division of Industrial Safety Permit Number: .•••••••447 qp. .Signato, 40 Dale HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). wi •Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file m e is in full force and effect. 7 a registration form for acutely hazardous materials? 0 Yes 01No wq .# 5.27}0--g_ 12/6" (Section 25533 of the California Health and Safety Code, with some .l/ exceptions, requires registration with the Costa Mesa Fire Department by � rc !/! 3 /.l each business which at any one time has on hand a quantity of acutely c6l�ignalure t 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 10Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safely Code been fully complied with? ❑Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑ No 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 (Sectionfrmt n befu850.2 i the onCnliappiic Government Code requiresbuilding thnt the requested etl License Law(Chapter 9 (commencing with Section 7000)of Division 3 of the information furnished applications for non-residential permits). Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑ No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK. and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application. have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No •thereon,and who does such work himself or herself or through his or her own 8 (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code:The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that • ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 o -gal Owner(s) Pate Signature Date - 4-C/7O 3057-46(3/07) - ..YYIf�tiYY'Y�+'i'�y"rant to N0. 2204 P. 1 I FEB. 27. 2007 6: 36PM �JLAGONA BCH BLDG DIV Raik Eu.. I, ftv it j . CITY OF COSTA MESA ,- ;. P.O.90k 1500 • 77 FAIR DANE • CALICORNIA 0202E-1Z00 a-1. . DEVELOPMENT SERVICER DEPARTMENT CERTIFED MALL RETURN MCEIPT ()VESTED Date 02-I 2_10 jQ f - tilthii, Clu5r4*Thc_Q % , REQUEST FOR PERMISSION TO DUltic 'E OFFICIAL PLAN-SIGNER OF ORIGINaldlOCUMENTS a To Whom ft May Concern: The Building Division of the City of Costa Mesa has received a request to duplicate a co y of the official plans for thebuilding(s)/strueture(s)located at, awl UEnt 6g._ Y , Costa Mesa, California. The party who has requested the duplication of the official plans is: Name: 4.AQ-Q'L Le tC4 \C Address: —7Q1 E. ~ *t&) t }�l_e`D c c Q . r — r� Chi- Clea-Ve I Phone: C-7/e/ 1 '7 $Z— 762 a The requirements and authority for the duplication of plans maybe found in Section 198 1 of the Health and Safety Code(amended by Stats. 1988,c.767,Section 2.) Essentially,this section says that the permission of the owner is required prior to the duplication of plans by the City. An owner is also defined as the board of directors or other governing body of the association, established to manage a common interest development. Consent is not compulsory and may be denied by the owner without . I cause, A blank Authorization to Duplicate Official Plans form, and a self-addressed,stamped envelope are enclosed. Please complete this form and return it to the City within 30 days of the mailing date. If you have questions regarding this request please call me at the number below. Sincerely, (7/ -75- t-1 __ Li<ics-l-Th . 14) Dawn Nichola Office Coordinator` 70 714754-5273 pQ 1 eLV' iJt / V /1� pry C'r, E merry Dh.Yon 47714)1442199-- aCadaaQEQMmtemero(H/)762-5625 •Pbmin;(*Won(714)75445M teR1 IFI b MML."'Yr k a illn1yt5'-L34t - nimicmre+rese.w.mt NO. 2204 P. 2 FEB. 27. 2007' 6:37Pli 71LAGUNA BCH BLDG DIV PAGE 02 AUTHORI TON 0 U LICATE OFFICIAL ' LANS 1, rD JJ LCs i sSiri J , hereby declare 1,at I em the (Certlfled)/(4teensed)f(Itegistered) professional, or his or her successor, ho signed t e original documents which constitute the plain for the building(s)or structu - s)located aII 2-4 17 y/5W 1 C€ — (.t)`f ,Costa Mesa,California. I hereby authorize the Building Official of the City of Costa Mesa, to opy,or cause to be copied, the Official Plan(s) for the building(s) or structure(s) herein on describe¢ subject to the following conditions; (1) That the copy of the plans shall only be used for the melatena•ce, operadoo• and use of the building; (2) That the drawings are instruments of professional service and a e incomplete without the interpretation of the certified,licensed, or regtste professional of record; and, (3) That subdivision (2) of Section 5536.25 of the Business and Pro - cions Code states that a licensed architect who signs pins, specification reports, or documents shall not be responsible for damage caused b subsequentI changes to, or use of, those plans,specifications, reports, or doe went where the subsequent changes or use, including changes ore uses mad by state or I local governmental agencies, are not authorized or approved by the licensed architect who originally signed the plans, specifications, reports, or j documents, provided that the architectural unite rendered by 'e architect who signed the plans, specifications, reports, or documents w not also a proximate cause of the damage. NOTARY (Seetfoa 19851,Health &Safety Code as Amended by Stats, 1981,c.767, •ection 2.) • I certify under the laws of the State of California, that the foregoing d cannon is I true, accurate,and complete to the best of my knowledge and belief. State of California County of Orange r On, a "o( / . bOri , before me, M IVja 1101 P�rlf2%j , oaday.j ta c 'S� appeared, known to me ( to be the person $. hose naso isfi\e; subscribed to the within Instrument and ackno !edged to meat he/sbe/t�ey executed the same in his/h r t�ir authorized capacity(ie), a d that by his/fi�rlth r sign Lure on the instrument, the persouts}�or the entity upon behalf of which the person®acted, executed the instrument. �,r,.:. MNDY LA NORE533 WITNESS my hand and official seal Awn", Commt,sbn 15173as z c , Nolo ry Public California s I Signature s) ' v)n( 4a1-r—(Sean Mr commOrang :.Exalt Oct 2z•oc, ,2002 Pritc4411-a--1" PrantDliz c 1D DU PE . . Sc 4f CITY OF COSTA MESA 4�a BUILDING DIVISION F yPt r71—ffle• , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER rria . PERMIT B04-01327 ' .0=70 44.' DUILDIN6 PERMIT ' (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ua.ub 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2417 VENIER WY Status: FINALED Suite: Applied: 07/26/2004 Vicinity: Issued: 07/26/2004 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 43914330 Zoning: Applicant: LAWRENCE LEBLANC Address: Phone: 949-350-3100 Zip: ISSUED BY:�pm CC 01 Owner GARDNER, CAROL TOUGH Address 2417 VENIER WAY - Phone: COSTA MESA,CA Zip: 92627 N. N Contractor: BALBOA KITCHEN AND BATH - Address: 701 E BALBOA BL Phone: NEWPORT BEACH,CA Zip: 92740 License: 489594 • Arch : Eng: Address: • Address: Phone: Phone: Zip: • License: License: SCOPE OF PERMIT • KREMOVE BEARING WALL IN KITCHEN,REMOVE POCKET DOOR IN THE KITCHEN(OPENING INCREASED BY 3")AND REPLACED WITH A PASS-THRU,ADDITION OF A 6'BOW WINDOW AND ONE 48"X48"WINDOW IN THE KITCHEN. , rFEE SUMMARY ',- Plan Check: $35.10 Calc Valuation: $1,500.00 Permit: $54.00 Claim Valuation: $1,500.00 SMIP Res: $0.50 SMIP Com: $0.00 -, ' . N • - Other: $0.00 Inspection: $0.00 Total: $89.60 • - -:,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 �c—o9E ralE k).) i\ egeD To 'fir CECT ?uPns P4tvtoQSLy ee2PROVc1? . 5c& Ce4Glf'AL Pe(Z'MIT F9e- §UGin WUu ES , ol2(p (© • 7 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-48(8/00) 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 rmit 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 =•ify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to becomes eject to the workers' come-nsation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of th.Labor Code,I shall forthwith comp) ith these provisions. Applicant Sign-ure: Date: WARNING:FAILUR• TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE'AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLA- ($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COD-,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRA 'ORS DECLARATION: I hereby affirm that I am I ensed 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.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AG •CV: ❑ I hereby affirm that there is a • struction lending agency for the performance of the work for which this permit is' ued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that .m EXEMPT FROM THE CONTRACTORS LICENSE LA- for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit t•construct,alter,improve,demolish,or repair any struc •re,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed • rsuant to the provisions of the Contractors License :w(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is - empt therefrom and the basis for the alleged e :mption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than 'ye hundred dollars($500).): ❑ I,as owner of the property,or my employees with w:•es as their sole compensation,WILL DO HE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contracto License Law does not apply to an o er of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,• ovided that such improvements er-.not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will'-ve the burden of proving that h.or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,em EXCLUSIVELY CONTRAC G WITH LICENSED CO •RACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an own: of property who builds .r Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Busine and Profession.Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No !river.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 w h a perso is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or dem. tion or disma ling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which w•.uld require a permit fr.. 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 CERTIFICA•ON: 1 Will the applicant or present or future building Occup: t need to file and certify a Business Plan for em•rgency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safe Code requires,with some exceptions,that a Busines Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a re•',rted year a quantity of hazardous materials equal to or g -War than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standa . emperature and pressure). 2 Does or will the applicant or present or future• ilding occupant need to file a registration form for acutely haze sous materials? 0 Yes 0 No (Section 25533 of the Califomla Health and -.fety Code,with some exceptions,requires registration with the Co to Mesa Fire Department by each business which at any one time has on hand a quantity of acut: hazardous materials equal to or greater than a weight of 500 •• nds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature• d pressure). 3 Does or will the applicant or present or f ure building occupant need to prepare an RMPP(Risk Management and P :venter'Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Heal and Safety Code provides that the Costa Mesa Fire Department may require t : preparation,certification and filing with the Fire Department of an RMPP by busine :s which are required to register acutely hazardous materials with the Fire Departm- t. 4 If an RMPP is presently required,h.•Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or pros: t or future building occupant require for the work which is the subject of this a plication . •ermit for such construction or modification from the South Coast Air Quality anagement District or from any other air pollution control district or agency? Di Yes 31 No (Section 65850.2 of the Califo a Government Code requires that the requested information be furnished on applications for no -residential building permits). 6 Will any part of the facility to b:constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Ye- 0 No (If"yes',the facility must me, 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 •e work which is the subject of this application,have all of the•isclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑ .o 8 (If"yes",attach certificat:of compliance from the appropriate air pollution control officer). CERTIFICATE OF CO •LIANCE:I certify that under penalty of perjury the information given above is:correct.I agree to comply with .I state laws and city ordinances regarding Hazardous =terials and Emissions. Signature: ' . ' - Date: ' CERTIFICATE OF CO 'LIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state th:t the Information given is correct. I agree to co •ly with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Cost. Mesa to enter upon the above-described prop'ny for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspecti• . Signature Of Legal Owner(s) • Date • And/Or Authorized Applicant Date CODE! • ' •115. 1'_ PATE INTITIAL$ CO2E1 INSPECTION TYPE PASS EMU 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 BIocldRetaining 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 \ jl�.� • "CITY OF COSTA MESA “4011111** BUILDING DIVISION >it ___ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. I jis I PERMIT dittWooRrnso' B04-01327 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2417 VENTER WY Status: ISSUED Suite: Applied: 07/26/2004 Vicinity: Issued: 07/26/2004 Parcel Number: 43914330 Zoning: Applicant: LAWRENCELEBLANC ISSUED BY: Address: Phone: 949-350-3100 Zip: Owner: GARDNER, CAROL TOUGH Address . 2417 VENIER WAY Phone: COSTA MESA,CA Zip: 92627 Contractor: BALBOA KITCHEN AND BATH Address: 701 E BALBOA BL Phone: NEWPORT BEACH,CA Zip: 92740 License: 489594 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REMOVE BEARING WALL IN KITCHEN FEE SUMMARY Plan Check: $35.10 Calc Valuation: $1,500.00 Permit: $54.00 Claim Valuation: $1,500.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $89.60 • 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 . 2446-46(6/00) 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.) N. 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' lcompensation laws of Canto =,and afire=that if I should become subject'to the workers'compensation provisions of Section 370 of the Labor Code,I shall forthwith comply these provisions Sig / Date: d\ (/'2_ n ^ �q Applicant Signature: � �4 l F/moi —+1 WARNING:FAILURE TO SECURE WOR ,f S'•• •ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL NES UP TO ONE HUNDRED / T ONRAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lice sed n.'r.rovisi•n of Chapter 9(commencing with Section 7000Ydf Division 3 of the Businerg and Professions Code,and my license is in full force and effect.Lie.4 .L Class 4 (/-, Contractors Signature: Fir Date: " �- ',�, L 71 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of industrial 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 ❑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 IT an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application 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 U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits), 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? (i Yes ❑No (if'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (if-yes'',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given Is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described p .pe for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signatur: Of :ger(s) _ .0 Fate �J And/or"...' Applicant Date CODE 1 INSPECTION TYPE 12611 1NfnIAL$ CODE INSPECTION TYPE PATE MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site / /\ 204 Final Demolition 250 Final Building/Occupancy "—![FO 5 S.T� ` `\ J 4 Trus Joist •Microdams LVL Specifiers Guide 2020 •August 2003 General Notes " • Table is based on: t" ' yt A1�A i t "•a'•�as 1 a 111 ® - Uniform loads(beam weight considered)and the more restrictive of simple - , r ) Al ' ITS •1 or continuous span. •• 1 y w �•. 4 ' � ` ' s' a F7 .v: • "-pi. - Deflection criteria of L/240 total load and L/360 live load. cs Cil : i; '7, 's�. 7.•,::: 1 ���q yI 'Q • � 1:-.'ss ; • For deflection limits of L/240 and L/480,multiply live load values by 1.5 and "S' T' 'b'$ •T. �' 0.75, respectively.The resulting load shall not exceed the total load shown. f 2 nn ', - Also see General Assumptions on page 3. N -6i1 1 :, • 31/2"Widthidth - Span Condition 14' 16' 18' 20" 51/27 .71/4" 91/." 91/2• 111/4' 112/e" 14' 16' 48' . 20" Total Load 3,589 3,917 3,917 3,917 . 1,297 2,287 3,082 3,188 3,972 4,272 5,384 5,875 5,875 5,875 - 6' Live Load L/360 870 1879 ' ' Min.End/Int Bearing(in.) 4.1/10.3 4.5/11.3 4.5/11.3 4.5/11.3 1.5/3.5 1.8/4.4 2.4/5.9 2.4/6.1 3.0/7.6 3.3/8.2 4.1/10.3 4.5/11.3 4.5/11.3 4.5/11.3 • ' Total Load - . ' 2,414 2,885 2,932 2,932 438 978 2,086 2,193 2,745 2,935 3,621 4,328 4,399 4,399 8' . Live Load L/360 380 842 1,666 1,792 ' , Min.End/Int Bearing(in.) 3.7/9.3 94/11.1 4.5/11.3 4.5/11.3 1.5/3.5 1.5/3.5 2.1/5.3 2.2/5.6 2.8/7.0 3.0/7.5 3.7/9.3 4.4/11.1 4.5/11.3 4.5/11.3 . Total Load• , .' - 1,937 2,294 2,466 2,466 219 498 1,475 1,551 2,128 2,354 2,905 3,441 3,699 3,699 .4 9'=6" Live Load 1360 _• 1,032 1,112 1,778 2,061 Min..End/Int Bearing(in.)'. 3.5/8.8 9.2/10.5 4.5/11.3 4.5/11.3 1.5/3.5 1.5/3.5 1.8/4.5 1.9/4.7 2.6/6.5 2.9/7.2 3.5/8.8 4.2/10.5 4.5/11.3 4.5/11.3 • Total Load' - 7,817 2,147 2,342 2,342 177 406 1,325 1,398 1,919 2,123 2,725 3,221 3,513 3,513 10' Live Load U360 • 893 963 1,544 1,792 ' • Min.End/Int Bearing(in.) 3.5/8.7 4.1/70.3 4.5/11.3 4.5/11.3 1.5/3.5 1.5/3.5 1.7/4.3 1.8/4.5 2.5/6.1 2.7/6.8 3.5/8.7 4.1/10.3 4.5/11.2 4.5/11.2 Total Load 1,333 1,709 1,948 7,948 82 193 781 844 1,327 1,469 2,000 2,563 2,922 2,922 ' .'.12'': Live Load L1360 - 1,138 1,635 ' • 530 572 927 1,080 1,707 2,453 • Min.End/Int Bearing(in.) 3.1/7.7 3.9/9.9 4.5/11.3 4.5/11.3 1.5/3.5 1.5/3.5 1 1.5/3.5 2.0/5.1 2.3/5.7 3.7/7.7 3.9/9.9 4.5/11.2 4.5/11.2 Total Load . • _ 975 1,253 1,563 1,667 100 C 494.1 535 879 1,028 1,463 1,880 2,345 2,500 14' Live Load L/360, 791 1,075 1,483 339+ 366 597 697 1,112 1,613 2,225 ' . Min.'End/Int Bearing(in:) 2.6/6.6 3.4/8.5 4.2/10.5 4.5/11.3 1.5/3.5 1.5/3.5 1.5/3.5 1.6/4.0 1.9/4.7 2.6/6.6 3.4/8.5 4.2/10.5 4.5/11.2 Total Load ` S 684 897 1,120 1,365 300 326 540 634 7,026 1,346 1,680 2,048 16'4"' Live Load L/360 465 680 945 1,263 209 227 371 435 698 1,020 1,418 1,895 I . Min:End/Int'Bearing(in.) 2.215.5 2.917.2 3.6/8.9 4.9/10.9 1.5/3.5 1.5/3.5 7.5/3.5 1.5/3.5 2.2/5.5 2.9/7.2 3.6/8.9 4.4/10.9 Total Load 488 710 887 1,082 210 228 382 449 733 1,066 1,331 1,623 18'767. Live Load U360 335 491 686 922 149 162 266 311 502 737 1,030 1,383 Min.'EndilnLBearing(in.) 1.8/4.4 2.6/6.4 32/8.0 3.9/9.7 1.5/3.5 ,1.5/3.5 1.5/3.5 1.5/3.5 1.8/4.4 2.6/6.4 3.2/8.0 3.9/9.7 - Total Load;.;--r- 387 573 756 922 164 . 178 300 354 580 860 1,134 1,384 L '201': Live Load360• --', 267 393 550 741 119 128 212 248 901 590 826 1,112 Min.End/Int Bearing(iri.)' 1.5/3.8 2.2/5.6 3.0/7.4 3.6/9.0 '1.5/3.5 1.513.5 1.5/3.5 1,5/3.5 1.5/3.8 2.215.6 3.0/7.4 3.6/9.0 ' - Total Load, •.24' • • " 221 332 471 634 89 98, 168 199 332 498 707 951 • Live Load L/360; „157.., . 232 326 442 69 75 123 145 235 348 490 663 . Min:End/In i. t Bearing,(in7).,}1:5/3.5" ,11;6/4.0 2.2/5.6 3.0/7.5 1.5/3.5 1.5/3.5 1.5/3.5 1.5/3.5 1.5/3.5 1.6/4.0 2.2/5.6 3.0/7.5 51 56 100 120 203 308 44Z 607 28' " Live Load 1/360` •0 99_ 148 ry208 283 43 47 78 92 149 222 313 425 r.Mid.End/Int Bearing(in:)- 1.5/3.5 1.5/3.5'•• 1.7/412 2.3/5.7 1.5/3.5 1.5/3.5 1.5/3.5 1.5/3.5 1.5/3.5 1.5/3.5 1.7/4.2 2.3/5.7 Indicates TOTAL LOAD value controls \ � JOHN n. GUSrAFSO:�\ ,� neo.�z�.7z3 ® • A ' /114)'1 -46 '3.51 X l .5= 49 8 1l Irl ' . �P 1'2-73 (/05 . 1 6-.. •‘-„.: - di A. trienunall . ., 1111116 Feet U DP i1.4`lei ?--S- -,..,:.:--it. ,.. - ..-. :.,,•,i pacinqi .9L'Idl: Inches Spat - , : - . , • . , ,. , , • . , 7-7" --.7 " ' • ' 11i_.:H.,:,.. •Psi 4,, r•LI 4..DE:Deflection L/ (4 "I' : . I' , '. 'j... : I''' leadload .-., } PI ' • Loadlbefiection Li:,f360 :••• .-- ., -- -‘.:. ;,-, ' 'Print -4. . . --',„ •• ---,-- .cf- .t,':: e -h- .iveidadtV-1 __ .,_••• -;: '.: r CiY..er, -,,:.z. ,......, ,. , •. ..; ...... , .,4-. -.: i k -. -;,•,t,;;,...". : --., „L. ; - • .1.2...;--f:C.1:. ..-: - --•:;'' giViiiaSeasociecntal)le.16-E1 A.44 .t.fr •-:.:-..,--.1-*eft;' t.i; '''''',--,----=--::--; " "''7; ,1 :: • {, :,::- t:' V Ciaa:DUratioll 1 "r -, te:.,•.1.7- :. -...=:. -.. , "-T. 'e ' f,• ' f' C., . t',aii.:;a: - ''' '• ; ij' t- i iitcli -e.-11 ---" - " . I .thade.114^ 1 ple*Ccielli.lb..11..1 AS 7 i_ -I ARCH Dinah' + ;‘, ,, . ,2. . . ,.., . _ ‘ . i., .........4, ...... (6:4:Eack ...,..7y:m:.7..4, ,.‘,.;. ,,.- -:".•ri-s-i'Ilm,.::Cry 4-'2v-Tc: '.di; Fe,lovIll E --,- - c_jrc..;: Eb " -7,F. • • c i ,825 111900 i:. 11600000 i• . -- -73-- .4 . •t... ,....: _ - . .-;,..-- , •,. .._ -1 •F4'..--:„ -- -..-`..:„-c-na. 4Th... 1875 1.115130 t'.I9u 625 j925 1 (1600000 umber "-Table 23I Ki -.: t - . -..•„;„,-, .` ,----•' • ', : : ,11303 11675 HOS 1 Timbeii'Table 23-1-A:4:41 Exit ' 4---..‘1 .--,; - --...r:ci-43.,•-,-,;:, . -'; , ' ''.;.' .:• .- . • ' : — , : I- - :3 .'" • ... - .. stc-4' r* - - • ' ' '. l't;'- Till ' ' - • . .* — .A= 32.38 in? • DelcifilinPf:.-k1-4. 1 ,-4 • 1- • 6:1 ;, 8 : :."; ', . i . .. • ipan.batqchor:14e:,,,.., ., —.L. . I ; 230.84 in4 i ' t 2' 2" " 1.; ::'• - " . . ThjckfleSS DefithTaind.;;;;., ‘ 2'2! 0'-r 11*-4" .1'.11", __2_,- - . , , . • ' M =4253.47 RAI 4,444 , - .• 2041678 .: '!' ,,.. s: - •:!6'; 2 1 - 611 710 L., ..i. 4- 4vAllielithl 18, 2_9- 1-61-6“ 13u-6" __ • .4 9459psi, . 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', :.., :•_, 1.,, "!,. . : .,, .:. . ;.,;::,- -i- ,:;.-'4-:: )-','. t","'.;!.: ,--if, ' _ : t,:: 1 -.L.'',Lt,1";z- ::::/:),":":".,14.11:-;L'',"?.;41-;:•‘:: '• :'"; :;e:;12-:-2' ::i.,, :. ..',..,'*: :r'.2 ' 7!': - :a: ' - .: ': ' r.,,., - ,,:-.. : :t 4.1.:-;:!tf: 1:: .4-7, -:', - L '. 1 ', ...i 7 4., :744•17•/I.7,;7... 4-it,.72 .,k, • •• . , opt R i /1 /4. ,. -. •LL :7 4. . . . .- .. - 1 , . • _. --• .,... 5 .. I '''''''-----.--"-----•-•••••• I • C::y t's t CSI S7-4 /4 4§-5.4) -,4 . c.„ /JOHN it GLISTAFSOX it NO. 24736 I v.4h. 4. ig 4,11,4174.r._ r--) Mil ,/,,-•1 Oh - ,..,- • 1. • ''....••„.,6,L..f2H: r„c\ •,...." /ate fl-/S If 03 A13 , 2ooc# ca,/ ay. S-�� mQs� raSt� s<< RX 114 g C)44 01327 -army gial/c u11)cx1 14ck--cfn C ? ScL�wf3 t�'c[( be . ivi °ver- i e rol . J ' F. • CITY OF COSTA MESA 4 ► BUILDING DIVISION F .,41 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER o N PERMIT *ta4,b , 140/B04-01437 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2417 VENIER WY Status: ISSUED Suite: Applied: 08/13/2004 Vicinity: Issued: 08/13/2004 Parcel Number: 43914330 Zoning: Applicant: SCHWARTZ, DAVID ISSUED BY: Address: 940 IRVINE AV APT A202 l . Phone: 949-677-3983 CELL NEWPORT BEACH,CA Zip: 92663 Owner: GARDNER, CAROL TOUGH Address 2417 VENIER WAY Phone: COSTA MESA,CA Zip: 92627 Contractor: DAVID SCHWARTZ GENERAL CONTRACTOR Address: 940 IRVINE AV APT A202 Phone: 949-677-3983 CELL NEWPORT BEACH,CA Zip: 92663 License: 818139 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT BLDG PERMIT REISSUED TO NEW CONTRACTOR IN CONJUNCTION WITH THE REMOVAL BEARING WALL IN KITCHEN. ADDITIONAL WORK TO INCLUDE REMOVAL OF A POCKET DOOR IN THE KITCHEN(OPENING INCREASED BY 3")AND REPLACED WITH A PASS-THRU,ADDITION OF A 6'BOW WINDOW AND ONE 48"X 48"WINDOW IN THE KITCHEN. REF:B04-01327 FEE SUMMARY Plan Check: $72.31 Calc Valuation: $4,250.00 Permit: $111.25 Claim Valuation: $4,250.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 . _ Inspection: $0.00 . Total: $184.06• ` 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(6/00) DEC-ARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 171 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 �C. 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 end policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued et one hundred dollars($1 0)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, gree t..t If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with ihvisions. t + J/ -1 Applicant Slgnatur z *� Date: WARNING:FAILURE TO SECURE WORKERS'•• •-• ION es ••GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under.rovislons of C apter 9(commencing with Sectigy700O)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# a Class# . • Contractor's Signature: .f � Date: 8 �/ 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 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.). O 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. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O 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 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aaemtit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed ender this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer), CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct, I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. gnatur: •f Leal Owners) / g I/� Die C. ! .// U ( ///DDDJ ate • prized Applicant CODE 0 INSPECTION TYPE I?DI€ INTRIAL$ CQDE1 INSPECTION TYPE PAIS INTRIALS 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 20_3 _Final Sign_,,... 222 Final Site 204 Final Demolition �. 4 250 Final Building/Occupancy •1'S 1'05 • : .)O d.'d Ce:-' 0G.. �:rt-Z ec,,-4,lr,e-I( c r•...ifvf a l-n.` `,IS r .J ( 7 ,3: C".._____, r.J, \ ) r y G3 6: ' \. � / . I i `Ix149Fh64./- NAt: Lii..,..i I 1 � • e —I ulw Wu`es 41 --, — -- — — uuenss 1°sAep OBI u!UUM I°)EOE 09ue Wal Fq�l x PO esu y411° 1io8I g9a41a4^ug Ill etuo°agP E1S00130 43 Aue10 ae,na1' uglel 1 °aid II. P I I i nel etelS/010118 OqoI aweuF • etre AUO Aue seew o q�111U10N; i I , lenoddeuee id,10 h9 Ip 0 1 fiuyriB1°p N p t Q N S '�. x� d 8 i 84 y1dr i j t--.It QayO11dd • 1t9o0 dd 13 xi S roN h1llfl:Jo NOIS1 IQI , , I1, h _ ill I i 1 or ni-T5 'f" 1LYi Cr,2.GChJ ,ELi- MK.r^- rr ', 14C-0" X — -'--`---.— l,'-G' - 1 x ~' Nr. ;n.•Itd? A.vL.J 'c : — � �'� �3,•.•- _..<.lo� - �....u> �I ---X.o- IIA 7 “ (ba...17-.1 ,>iLJ- • II if. v a3uenssl to sleep 09l WAWA(P)EOE§09Ue a U Aq dxauPut il plod pu o�� UJ e sueld seta 1 ,0 5agmg 941111:49h PUe lint' am3:m P o Pop*94110 Lowe mew)esaW elso0 to_-7 due,o ped spug due 1 0 soots o41 •Mere �o1mC lltlFSsuateou4ads �soolu _ _ _ enordde KI 01 Pial 1011 eseW e1so0 to dD.O'd1a1eS Pua �y, ` -. I due a I • — — { . uaWIM Ino4W awes uo ua ialie 10` Id Io las aw { fiwtpMuaswwW uas nu WI aq 1SnW suo leoypads P� d9 3 c., ti 10 I 1 Q3A02Iddt' -` I VS3WV1S00d0A110 1 te , I . u AZi3dS ONLn�In9 30 NOiSIN z I ^ y Y I ii,11it'ROVED � L 3 CITY 01' COSTA MESA ' PLANNING DIVISIQN SUBJECT TD,BLDG. D 17 .REG. I ' I .�:.I i ! II ra 1. F(= '.r ly-.T varR_ 1 NOTE: ADDITIONS, DELETIONS, I 8{2 GOR r I I V �I APPROVEDBY-THE PLANNING DIV. ✓— 3770'' r rtrI\L-te /y — — — lam;, r r im %r_ it 9 lief 9=— DATE: —�( ;i' 1 w ,,..•-1I Co:.,/mc ic-2. Corel 6Rr r/ii.r; 7._."II 1 Yed rC:R- 1:•,,AI Cc'Sj4.g-.a: 5l4- cIZc, `, 7 r...arD ' N — ? • «' —— — -----— • 4..-, Y i v L 71-\ • DIVISION OFC AEDA Oale��--^ on a�1°Date__Tunes-Den on�---._g to 6Y andspeaca s nS4� ° onPenn�to il hrnnlhe mak set o1 Pers ilorto be an°PPfOMal any dry or alterM�a°same ��la P°m' andlor Stale law. Safery,0motCosta tionsSNALL1YOTbe and mesiamPl^0 of lhis p�rovlaons of anY C'riV of Costa Mesa Ord'man°° arae — ds a NCllaliof and Costabecoffeesa ftland, obtu yck. — the vinl of anY p _ . ire°Y §.303-0- Ahm - "00005 er a Penne shanSal lamed atwepar4 tsrnlcarrua • 5.Ak -t 5; — • 1. CITY OF COSTA MESA 49 BUILDING DIVISI41N 4 DEVELOPMENT SERVICES DEP tTMENT PERMIT NUMBER 1. 1 PERMIT l -"r>oun'o 446 PO4-00566 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2417 VENTER WY Status: ISSUED Suite No Applied: 08/13/2004 Issued: 08/13/2004 Vicinity: KITCHEN ISSUED BY: Parcel Nunmber: 43914330 Applicant: GARDNER, CAROL TOUGH Address: 2417 VENIER WAY Phone: 949-645-2597 COSTA MESA,CA Zip: 92627 Owner: GARDNER, CAROL TOUGH Address 2417 VENIER WAY Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch / Eng: - Address: Phone: Zip: License: • SCOPE OF PERMIT ELECTRICAL AND PLUMBING FOR KITCHEN REMODEL. REF:904-01437 - , PLUMBING TO INCLUDE: 1 DISHWASHER, 1 GAS(1-4 OUTLETS),2 LAUNDRY TUB/WASHER,AND 1 KITCHEN SINK. • 08/13/04 REVISED:ADD 1 P-TRAP FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $19.60 2 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 $9.80 1 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 $0.00 0 Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 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 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 2446-46(WOO) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declaratl s: ❑ I have and will maintain a certificate of consent to self-Insure f r workerslcompensation,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 U the permit is valued at one hundred dollars($100)or less.) jsscertify 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 agre that if I should become subject to the workers'compensation provisions of S ellen 3700 of the Labor Code,I shall forthwith comply with these pr y , 5 Applicant Signature: • Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOIJ.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.Lie.# 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 permit subjects the applicant toe civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is els, 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.). L7 I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt sec. Business and Professions Code for this reason: . Signature: ., xpires: — 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 B,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 Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater then 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). . ..t..r. 3 Does or will theeapplicant 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 aermil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes In 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? ❑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:1 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 tori tion p s . gree not t o occupy or allow occupancy of any building authorized by thia.�Te]\rmit u inspection. Signature Of Legal Owner(s) ,�, Date And/Or Authorized Applicant Date LODE I 11ISPECTION TYPE gdIE INTRIAI5 CODE INSPECTION TYPE PAM INTITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing .•�/f'-fc 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 01� CITY OF COSTA MESA • BUILDING DIVISION f• „'l �I DEVELOPMENT SERVICES DEPAd TMENT PERMIT NUMBER pritur PERMIT A 1 4%4PoRarso as* PO4-00566 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2417 VENIER WY Status: ISSUED Suite No Applied: 08/13/2004 Issued: 08/13/2004 Vicinity: KITCHEN ISSUED BY: Parcel Nunmber: 43914330 Applicant: GARDNER, CAROL TOUGH Address: 2417 VENIER WAY Phone: 949-645-2597 COSTA MESA,CA Zip: 92627 Owner: GARDNER, CAROL TOUGH Address 2417 VENIER WAY Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT ELECTRICAL AND PLUMBING FOR KITCHEN REMODEL. REF:B04-01437 PLUMBING TO INCLUDE: 1 DISHWASHER, 1 GAS(1-4 OUTLETS),2 LAUNDRY TUB/WASHER,AND 1 KITCHEN SINK. FEE SUMMARY AMT QTY - AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $19.60 2 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Inigatlon $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 $0.00 0 Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 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) '1 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 fl s°ipermit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(NW) DECLARATIONS 1 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declaratiins: ❑ I have and will maintain a certificate of consent to self-Insure A worker)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 wit 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: (Thais section need not be completed i/the permit is valued of one hundred dollars($100)or less.) 2 I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shell forthwith comply with these provision _ /� C� 'N 1 Applicant Signature: 1l.r'C Date: Z] -IQ,- �-+�-f 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 DOL ARE(S100.000),IN ADDmON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I 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.4 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 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 Id 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.). ( 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: • a tSC a. a Date: A— SR-- 04 Owner ID verified by•river's license. 0 Yes 0 No Driver's License No. Expires: 2- 1 -46 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: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑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 agermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ID Yes LNo (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.1 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 for ins tionurposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.45 Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date ODE I INSPECTIONTYPE PATE fall POE INSPECTION TYPE MI MALI 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 2D1 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 • yr CITY OF COSTA MESA • 4 @ BUILDING DIVISION F `. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER e PERMIT dP W101 00126 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2417 VENIER WY Status: ISSUED • Suite No Applied: 08/13/2004 Issued: 08/13/2004 Vicinity: KITCHEN • ISSUED BY: Parcel Number: 43914330 Applicant: GARDNER, CAROL TOUGH Address: 2417 VENIER WAY Phone: 949-645-2597 COSTA MESA,CA Zip: 92627 Owner: GARDNER, CAROL TOUGH Address: 2417 VENIER WAY Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License:000000 SCOPE OF PERMIT ELECTRICAL AND PLUMBING FOR KITCHEN REMODEL. REF: 804-01437 MECHANICAL TO INCLUDE: 1 HOOD W/MECH EXHAUST FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $0.00 0 Repair/All Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 - Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 -0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust 510.65 1 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 '0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 - Up to 3 hp , $0.00 0 Smoke Dampers $0.00- 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee- Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 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 odes,"an required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiratio th s.permit. FOR INSPECTIONS CALL: (714)754-5626 244G48 WW) • DECLARATIONS I C .\ WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers compensation Insurance carrier and policy number are: Cartier: Policy Number: (miirecflon need not be completed if the permit Is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is Issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,end agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisl JA/Ll� l Applicant Signature: Date: v ` 7- Vim-(' WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MID CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lie.II Cfass x 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).): 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 .-fold 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.). 1:47,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 and Business and Professions Code for this reason: Signature: �p Date: �{- Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,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 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 implication 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 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 pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (1f 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 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 pr for i pec(t'wy_ rposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. VQ-v.eYn-y•D, 12" -� Signature OI Legal Owner(s) Date And/Or Authorized Applicant Date OODE r INNSPECTIONTYPE PEI lKUtM 5 SODE• INSPECTION TYPE PAff. 1616 Fixed System Final Fire Prevention 206 Final Mechanical —fit}-0.3 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA - o,f4 BUILDING DIVISION f •.�. � i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT S '�# /E04-00903 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2417 VENTER WY Status: ISSUED Suite No Applied: 08/13/2004 Vicinity: Issued: 08/13/2004 Parcel Nunmber: 43914330 r Applicant: GARDNER, CAROL TOUGH ISSUED BY: /a Address: 2417 VENIER WAY Phone: 949-645-2597 - COSTA MESA,CA Zip: 92627 Owner: GARDNER, CAROL TOUGH Address 2417 VENIER WAY Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT ELECTRICAL AND PLUMBING FOR KITCHEN REMODEL. REF:B04-01437 • ELECTRICAL TO INCLUDE:8 LIGHT FIXTURES,8 OUTLETS,8 SWITCHES AND 5 RES. APPLIANCES. 08/13/04 REVISED:ADD 1 FIXTURE(SMOKE DETECTOR) 8/17/04:SUPPLEMENTAL PERMIT TO ADD 1 SUB PANEL FOR THE GARAGE FEESUMMARY 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(34-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 $9.90 9 up to 50 kva/kw $0.00 0 ' Recept Outlets $8.80 8 up to 100 kva/kw $0.00 0 / Switches $8.80 8 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $23.75 5 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 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(8/00) 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.) Vitality cenity 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 pr7japs. ��-� Applicant Signature: . � 1V�N� Date: TJ' ( — Oil— WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lie.4 Class 0 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property.or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). [VI,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 exemp r sec Business and Professions Code for this reason: Signature: - -Q �� .1k iv..)1q Date: -( -1—OL' Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: _Z—-7 wp 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,Califomla Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health end 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 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 RMPA 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 akEermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes u No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 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 end 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 p y for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signatur •f Lera•wner(s) Date And/Or Authorized Applicant Date SODS t j$SPECTION TYPE LAIE INI SOK SODS I INSPECRON TYPE RAIL BMW 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ,,L A 200 Final Re-Roof 210 Final Electrical I-31- 051 �ry") 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • • , CITY OF COSTA MESA 1 , • BUILDING DIVISION •L ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t s.•_ . t PERMIT -`°Maw E04-00903 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2417 VENIER WY Status: ISSUED Suite No Applied: 08/13/2004 Vicinity: Issued: 08/13/2004 • Parcel Nunmber: 43914330 • Applicant: GARDNER, CAROL TOUGH ISSUED BY: Address: 2417 VENIER WAY ' Phone: 949-645-2597 COSTA MESA,CA Zip: 92627 Owner: GARDNER, CAROL TOUGH Address 2417 VENIER WAY Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 • SCOPE OF PERMIT • ELECTRICAL AND PLUMBING FOR KITCHEN REMODEL. REF:B04-01437 • ELECTRICAL TO INCLUDE:8 LIGHT FIXTURES,8 OUTLETS,8 SWITCHES AND 5 RES. APPLIANCES. . 08/13/04 REVISED:ADD 1 FIXTURE(SMOKE DETECTOR) 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 $9.90 - 9up to 50 kva/kw $0.00 0 , ' Recept Outlets $8.80 8 up to 100 kva/kw $0.00 0 , Switches $8.80 8 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 '07 Res Appl $23.75 5 . Low Volt Wiring System/Ckt $0.00 , 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor .$0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 • 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 244648(8/00) DECLARATIONS (I) I 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 et one hundred dollars($100)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 provision \� Applicant Signature: �f' GC/V� Date: "' ! I^ ' m WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CO E,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.I 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 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 old 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.). • 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 ec. . {� Business and Professions Code for this reason: ? ,..y Signature: $ - " �'�-Y/1'V-n Date: 1 7. L 08 Verification Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: 7 Z-0C) 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,wilt be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 6,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materiels with the Fire Department. .l..e..ir d, Section 23 o........lf.r.i..Health a...Safety C. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? JI 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 ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No B (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for i tion p ses.I agree n to occupy or allow occupancy of any building authorized by this p it until final inspectioon. C'D u I7 - LOBI --Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date BODE* INSPFCTION TYPE p_ac INTRIALS CODE* INSPECTION TYPE PAIL IIaBELS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing I 200 Final Re-Roof 210 Final ictrical 201 Final BIocWRetaining Well12 F j '�=v- io v y 202 Final Factory Fire Place 2 f Final Planning Approvaljerrar 'sr 203 Final Sign 2 2 Final Site _ 204 Final Demolition 250 Final Building/Occupancy • ' CITY OF COSTA MESA jil I ;r �•.• ' ' BUILDING DIVISION ' J • % DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER H t w.wo. 1 _ / i PERMIT Jitberrokrukt � E04-00903 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2417 VENIER WY Status: ISSUED Suite No Applied: 08/13/2004 Vicinity: Issued: 08/13/2004 Parcel Nunmber: 43914330 Applicant GARDNER, • CAROL TOUGH ISSUED BY: Address: 2417 VENIER WAY Phone: 949-645-2597 COSTA MESA,CA Zip: 92627 Owner: GARDNER, CAROL TOUGH Address 2417 VENIER WAY Phone: COSTA MESA,CA Zip: 92627 Contractor OWNER-BUILDER Address: ' Phone: Zip: License: 000000 SCOPE OF PERMIT ELECTRICAL AND PLUMBING FOR KITCHEN REMODEL. REF:B04-01437 ELECTRICAL TO INCLUDE:8 LIGHT FIXTURES,8 OUTLETS,8 SWITCHES AND 5 RES.APPLIANCES. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft 50.00 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 $8.80 8 up to 50 kva/kw $0.00 0 Recept Outlets $8.80 8 up to 100 kva/kw $0.00 0 Switches $8.80 8 over 100 kva/kw $0.00 0 • Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl \ - , $23.75 5 Low Volt Wiring System/Ckt $0.00 0 Service to 200a - $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand - - • $0.00 0 Motors to 100hp $0.00 0 - - Other Electrical Fee $0.00 Motors over 100hp $0.00 0 - Communication drops $0.00 0 Investigation Fee $0.00 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 abadrf oned 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:code all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration4 t!Ls permit. FOR INSPECTIONS CALL: (714)754-5626 J 2446-4a(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'compensapon,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.) [7I 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 provisi � nn rY� Applicant Signature: ( C�l. ' Date: T'T- -04- WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES up TOONE HUNDRED THOUSAND DOLLARE(5100,000),IN AbDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37050F 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.0 Class 0 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant 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 old 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.). as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under s c. Business and Professions Code for this reason: Signature: r Date: CP. - OL-1- Owner ID verified by d vets license. ❑Yes ❑No Drivers License No. Expires: 2 - 7- CB Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous materiel? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires.with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑ o ❑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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? L-I Yes LU No (Section 65850.2 of the Catifomia 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? ❑Yes 0 No (If"yes",the facility must meat the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property f ' cti ;poses.I agree not to a'ri ipy or allow occupancy of any building authorized b this permit until final inspection. ' _ivl (1 �C UJ 3 I 7 c7 Signature 01 Legal Owner(s) Date And/Or Authorized Applicant Date BODE 0 INSPECTIONTYPF PAH INTRUL$ CODE It INSPECTION TYPE PAIL WEALS 1616 Fixed System Final Fire Prevention 206 Final Mechanica 1266 Pool Spa Final 208 ' : ' . 200 Final REEt:t:t 0a201 Final B 2 Fina202 Final F 220 Final Planning App al 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy A13 , 20c), GTI aL cosr i rnesQ Ce �4f` Vet,,erwc. costo meso Perm4 Ar7 gams- - 0132-7 Loony Le. (Slc_ilc ) c4 b4 .Gtb Kik-cfne,‘ cuncl�A� .den ll�� ff�} (�} ' Yt�:nAfCe L/O.iVLei Scin_u-iitrA3 tN4( be '- kCn5 e.,.ter ‘r-k4 ero . OWNER DOYLE & SHTFLDS Development Co. ,Inc. DATE 6-3-63 JOB ADDRESS 2417 Venier BUILDING PERMIT NO. 19720 GENERAL CONTRACTOR Doyle & Shields Dev.Co. ,Inc. VALUE $ 19,417.00 AP No. LOT 136 TRACT 3433 FIRE ZONE DESCRIPTION OF WORK Reg.wjatt.gar. INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE R-2 Sim L, he 6-/e-1PERMITS ISSUED Ga >'s� 3- SUBCONTRAC'1'UR DATE NUMBER Water Rough Corn. Refrig. 0 Air Cond. 0 Rough Heating ,C� iu „ � IIID_2-19. 0 6 Rough Plumbing MI5' �O-y"7i3 ra1 �jj _as -3-/0,/ ' . 3. Miscellaneous ° Prop. Swr. Line IJ House Con. VJ-St. Swr. 0 -rj ft-V-4,t e-�._� e _ect _./4_,15__./4_,15_00 ..5/.4.2_ _Q.2- ' Sprinkling System 1rfe Construction Pole Underground 0 Power 0 Rough Wiring 'f, Its/0.6 6 k4 --P_.QCec. c -30-6s a. 7 S Trenches ( Forms Ur Steel Reinf. 0 G"<y717s Floor System r'41, Li-Ette nn��rr��..� Bond Beam 0 Steel Reinforce ❑ Sheathing n- 7 a— 34 - 63 Frame and Flashing Lathing -In,p. Out 0- ll` , 61_,Y-7,A__ Plaster, brown coat - - :� 1 V Rpitig. 0 Air Con. 0 Final /' 1� Heating, Final ice/-30-L.' U r1__ Plumbing Fixtures, Final y ,- ' `a Final Gas xtures, - '_Z `L */ Electric Fixtures, Final --sr.,-�� 7 _ Building, Final As - 7-if-- � OCCUPANCY {.ifrr mn cm n... n*-nr " rrnnr a — """ "wr�` 9-720 F E RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT kIN a 1883 P.O.BOX 917 COSTA MESA,CALIFORNIA • FINAAFNCr(EnnSSDEPT. • For Applicant to Fill In Completely APPL6I 1&!I F PERMEITa TYPE OR PRINT BUILDING . 7 17 ^ ^ For Office Use Only AD BUILDRDEING SS rif-"n M. `^-X' t RECEIPT NO. PERMIT NO. COSTA MESA, CALIFORNIA _ _ ! 07201 R a.IVED BY DATE RECEI Vj D DATE IASUEO' OWNER Doyle & Shields Dev.Co„Inc 'I / ////,,,, S 7f-G 2 JUN 3 ®119983y MAIL B is DING - ,l/�jJ Li(/Z✓r ADDRESS 831 So. Manchester A,•RES$ )”' / FIRE NO. CITY Anaheim 2-8020 ZONE TYPE GROU ARCHITECT TEL. 871- B1P,PROVED DATE OR ENGINEER Hai C- Tan NO. 2 1 O CC0 onwealth, ZONING ADDRESS 4100 W. Rw sr Fullerton7 e -OOI Nu.OgOEFQ I BUwUEI VAU `eI_ CONTRACTOR Sane ` LEGAL ADDRESS Same DESCRIPTION Lot- 11.336, Tract 3433 CITY Same A.P.NO. `�} NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE LIC..NO. 151-250-B--1 rNio' PR 2-8020 90"TO HIDE Et REAR P.L. EAVES SI ZE LOT 33 x 53 .50 NO.OF BLDGS. ALLOWED (U.B.C.REQUIREMENT) NOW ON LOT YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. -- (FROM C/L/ FT.SETBACK LINE FROM FT. CENTER OF STREET 20.501 REAR YARD -- FRONT LJ 0 - - - SIDE YARD LEFT -- I RIGHT R.SIDE FT. FT. DESCRIPTION OF WORK L.SIDE 0 FT. Fr. NEW X ALTERATION ADDITION r REAR 10 FT. DISTANCE BET. BET.MAIN @ • REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS. BUILDING NO.OF VAR. DATE SIZE 33353-SO ROOMS 7 STORIES 2 C.U.P A APPROVED EXTERIOR WA ROOF APPR1k` 1 , ,� COVERING CO I COVERING COm.O. +Y F�\ „AAI DATE IP USE OF BUILDING AND WORK TO BE PERFORMED V Residence w/attached garage Model 42 1824 se.Fr. 711 Q ` p 7.7 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHO UNDER VALUATION IS FOR THE F' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ES LISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING -- - 7 -VALUATION / co BUILDING CONST CTION. p,ogtu•1 Aii 40 PERMIT FEE $ l/J_V( PERMITTEE SIGNATURE O� 1 ( (p 2 CV D $f// yo 00 A C EC ✓ in 0 1 (� A ��)�� """" 9 `� LL AUTHORIZED AGENT 'I'-y TOTAL FEE $ /