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Home My WebLink About3352 VIA TIVOLI - Building PermitsMay 12, 2003 G!�'Y 4F COSTA MES� P.O. BOX 1200 • 77 FAIR ORIVE • CALIFORNIA 9262B-1200 DEVELOPMEN75ERVICES DEPARTMENT To: auiiding Saiety uivision Code Enforcement Communications County Clerk County Planning and Dev. Services County Registrar of Voters County Tax Assessor Engineering Division (2) ESRI Fire Admin. - Training Officer Fire Admin. - Mark Brown (Station 6) Fire Prevention Irvine Ranch Water District Mesa Consolidated V�,'ater District OLD ADDRESS 1325 Sunflower Avenue AT&T Broadband Newport-Mesa Unified School. Dist.12) Pacific Bell Police Dept. - Planning & Research Sanitary District Engineec. Sanitation Division Office So California Edison Company Southern California Gas State Board of Equalization U. S. Post Office - AIS U. S. Post Office, Adams Thomas Brothers File (2) NEW ADDRESS 3351 Via Merano 3353 Via Merano 3355 Via Merano 3357 Via Merano 3359 Via Merano 3361 Via Merai�o 3363 Via Merano 3350 Via Trentino 3351 Via Trentino 3352 Via Trentino 3353 Via Trentino 3354 Via Trentino 3355 Via Trentino 3356 Via Trentino 3357 Via Trentino 3358 Via Trentino 3359 Via Trentino 3360 Via Trentino 3361 Via Trentino A. P. NO. 140-041-60 Buildinq Division (714) 754-5273 • Code eNorcemeN p14) 754-5623 • Planning Division (714) 754�52a5 FAX (714) 754-4856 • TDO pt4) 75<.524a • www.ci.costa-mesa.ca.us OLD ADDRESS 1325 Sunflower Avenue NEW ADDRESS 3350 Via Parma 3352 Via Parma 3354 Via Parma 3356 Via Parma 3358 Via Parma s�tiU Via Parma 3351 Via Siena 3353 Via Siena 3355 Via Siena 3357 Via Siena 3359 Via Siena 3361 Via Siena 3350 Via Siena 3352 Via Siena 3354 Via Siena 3356 Via Siena 3358 Via Siena 3360 Via Siena 3351 Via Tivoli 3353 Via Tivoli 3355 Via Tivoli 3357 Via Tivoli 3359 Via Tivoli 3361 Via Tivoli 3352 Via Tivoli� 3354 Via Tivoli 3356 Via Tivoli 3358 Via Tivoli 3360 Via Tivoli 3362 Via Tivoli 3364 Via Tivoli 3366 Corte Cassi$ 3368 Corte Cassis 3370 Corte Cassis 3372 Corte Cassis 3374 Corte Cassis 3376 Corte Cassis 3378 Corte Cassis 3380 Corte Cassis 3382 Corte Cassis 3384 Corte Cassis 3386 Corte Cassis 3388 Corte Cassis 3364 Corte Cassis A. P. NO 140-041-60 OLD ADDRESS 1325 Sunflower Avenue NEW ADDRESS 3367 Corte Levanto 3369 Corte Levanto 3371 Corte Levanto 3373 Corte Levanto_ 3375 Corte Levanto 33i7 Corte Levanto 3379 Corte Levanto 3365 Corte Levanto 3366 Corte Levanto 3368 Corte Levanto 3370 Corte Levanto 3362 Corte Levanto 1336 Corte Venosa 1334 Corte Venosa 1332 Corte Venosa 1330 Corte Venosa 1328 Corte Venosa 1326 Corte Venosa 1328 Corte Maltera 1326 Corte Maltera 1324 Corte Maltera 1322 Corte Maitera 1320 Corte Maltera 1318 Corte Maltera 1316 Corte Maltera 1314 Corte Maltera 1312 Corte Maltera 1310 CortP Maltera 1308 Corte Maltera 1306 Corte Maltera 1304 Corte Maltera 1302 Corte Maltera 1300 Corte Matlera 1323 Corte Maltera 1321 Corte Maltera 1319 Corte Maltera 1317 Corte Maltera A. P. NO 140-041-60 OLD ADDRESS 1325 Sunfiower Avenue NEW ADDRESS 1315 Corte Maltera 1313 Corte Maltera 1311 Corte Maitera 1309 Corte Maltera 1307 Corte Maltera 1305 Corte Maltera 3383 Corte Cassis 3381 Corte Cassis 3379 Corte Cassis 1324 Corte Alemano 1 322 Corte Alemano 1320 Corte Alemano 1318 Corte Alemano 1316 Corte Alemano 1314 Corte Alemano 131 2 Corte Alemano 1 310 Corte Alemano 1 308 Corte Alemano 1 306 Corte Alemano 1327 Corte Alemano 1325 Corte Alemano 1323 Corte Alemano 1321 Corte Alemano 1319 Corte Alemano 1317 Corte Alemano 1315 Corte Alemano 131 3 Corie Alemano 1311 Curte Alemano 1 309 Corte Alemano 1 307 Corte Alemano 1 305 Corte Alemano 1 303 Corte Alemano 1 301 Corte Alemano A. P. NO 140-041-60 Your cooperation in this matter is appreciated. — �' � �� ULx-�e[1 Sincerely, /3o s� �3a6 Willa Bou - illeen ��8 S r Planner (3�� /3 �� c: Kimberly Brandt �3 �c� I 3 i,l Dana Bieber �3�Cd Standard Pacific �,�a0 15326 Alton Parkway i3aa Irvine, California 92618-2388 ��a� � ��J - w ,, V� ��MLqND � SUSAN S7AE�f -,: :.— . y �_ - - ��'t�` Yt•, ve� wr Y � . 1M] - � w� �a�� ' " rn . ��—' ewa "'_' • D ' �• .i � � ,,,, p [O "• -- Y � ` \ Via iremino � '' . . , � „ „d o o,o , _ � �w � an o c a' • « ��€ . _. u--� _ ._ _ �� ;,. — ;4 a�a o � rn �>>C]pp �' � ---- ------' °t . � � �NILd�G 9 ❑� / I � �. II . � r.. . . � (' [ S ' I �'y � vY �X� �m g€ —'�- - '— -...: � o Y" � i _ G ' DOO�L�.prn, i,> � . . eompr e '}i :��. __ -__..._.._-� . �:i! . Botpvt r°l•.i• ��I'"II e. ' •I i� �� oo �no.., rn!�i � � . `�_'____.__ ; 1 I� �I� �rn , � � �'r 9 � I' �! �� ' I f i � :. I � � ... C _.:f:-. I 6� I I - "' —. __ ,. . 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K r. ` � i.�' '-i•.,. �./ I I'. �laa�l '� ]WV • �_�i F _i.µ._ ..,,.. ,,. . � .. _.. ___F � - _ ' .. _ __ .'__�-_.. —�--�u.�=- - _ � ~ p ��_ _`-_�� _ _ ' -- (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.�{�LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Sufte: Vicinity: 3352 VIA TIVOLI 3352, 335d, 33 56, 3358, 3362, 3364 Parcel Number: TPN003051 Applicant LONG, JENNIFER Address: J.L. HARE AND ASSOCIATES ,,. SANTA ANA, CA . � - 505 N TUSTIN AVENUE SUITE 212 ' � � Owner. STANDARD PACIFIC Address 15326 ALTON PARKWAY IRVINE, CA Contractor: Address: Zaning: Phone: 714-245-9760 Zip: 92705 Phone: 949-789-1716� Zip: 92618 Phone: Status: ISSUED Applied: 10/30/2003 Issued: 11/10/2003 ISSUED BY: � �A �� Zip: • License: ' � Arch : BASSENIAN/LAGONI Eng: RICHARD MOORE/MCE CONSULTANTS Address: 2031.ORCHARp DR Address: 1100 S COAST HWY, 318 , � SUITE 100 Phone: 714-553-9100 Phone: 949-376-6407. NEWPORT BEqCH, CA LAGUNA BEACH, CA . -� Zip: 92660-0753 License: C8395 92651 . License: C23971 aa.vr� a�r rcrtmi i _ CONSTRUCT NEW 10,953 S,F. 7-PLEX WITH 3,090 S.F. GARAGE�AND 135 S:F. PORCH/DECK�. "BUIIDING TYPE • C". BLDG 6. ADDRESSES INCLUDE: 3352.3354.3356.3358.3360.3362,3364 VIA TIVOLI. SEE PA-02-41(f-16416 � - � ��3352/UNIT 40 - 684 SQ FT 1ST FLR, 1023 SQ FT 2ND FLR, 455 SQ FT GARAGE, 16 SQ FT PORCH. TOTAL LIVING 1707 SQ FT .(38) 3354/UNIT 39 - 560 SQ FT 1ST FIR, 917 SQ FT 2ND FLR, 436 SQ�FS GARAGE, 4 S� FT-PORCH. TOTAL LIV WG 1477 SQ FT. (1B) ; 3356/UNIT 38 - 589 SQ FT 1ST FLR, 965 SQ FT 2ND-FLR, 436 SQ FT GARAGE, '17 SQ FT PORCH. TOTAL LIVING 1554 S� FT. (2E) 3358/UNIT 37 - 560 SQ FT 1ST FIR, 917 SQ FT 2ND FLR, 436 S� FT GARAGE, 4 SQ FT-PORCH. TOTAL LIVING 1477-SQ FT. (iD) , 3360/UNIT 36,- 589 SQ FT 1ST FLR, 965 SQ FT 2ND FLR, 436 SQ FT GARAGE, 20 SQ FT PORCH. TOTAL LIVING 1554 SQ Fi. (2F) 3362/UNIT 35 - 560 SQ FT 1ST FLR, 917 SQ FT 2ND FLR, 436 SQ FT GARAGE, 4 S� FT PORCH. TOTAL LIVING 1477, S� FT. (1A) 3364/UNIT 34 - 684 SQ FT 1ST FLR, 1023 SQ PT 2ND FLR, 455 S� FT GARAGE, 11 SQ FT PORCH. TOTAL LIVING 1707 SQ Ff. (3A)' ,� � � �: EEE SUMMARY , � Plan Check: $964.80 -' � ` " - . - Calc Valuation: gi,oes,ass.ao � Permit: $5,937,25 ; Claim Valuation: , go.00 SMIP Res: $108.95 � SMIP Com: $0.00 Other: $0.00 Inspectioni $0.00 Total: $7,011,00 PLANNING & ZONING � 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 780 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 flnal approval must be obtained. Failura to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2aae-0e (s�ool WORKERS'COMPENSAnON DECLARAnON: — � 1 hereby atFirtn untler penalry of perjury one of the following declarations , ❑ I �eve antl will meintain a certificete of consent to selbinsure lor workers' compensation, es pmvidetl tor by section 3700 of the Labor Code, tor tha pertormance of the wark tar which lhis permit is issued. I have and wlll maintain workers' compensation insurance, as required by sectlon 3700 of ihe Labor Code, lor the peAortnance of the work for which this pertnit Is issuetl. My workers' compensation Insurance carrier and policy number ere: -. � rtier: Policy Number: (This section need not be complered it (he p if i ed at one hundred dollars ($100) or less.) ❑ I certity Ihat in ihe pedormapce rk for wfiich his permit is issued, I shall not employ any person in any manner so es to becoma sublect to Ihe workers' compensation laws of Calif r e t et if I sh IA-become subject to the workers' compensation provislons oi Secllon 3700 ot Ihe Lebor Cotle, I shell fotlhwith comply with lhese provisio . ^ f� Applicant Signature: Date: � ��O ' Cl \ WARNING FAILURE TO SECURE ORKE COM NSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECi AN EMPLOVER TO CRIMINAL PENPLTIES AND CIVIL FlNES UP TO IXJE HUNDRED THOUSAN�DOLLARE(5100,000),I I T HECOSTOFCOMPENSATION,DNMGESASPROVI�EDFORINSECTION37060FTHEUBOFCODE,INfEREST,ANDATTORNEI"SFEES. LICENSED CON7RACTORS DECLARATION: I hereby affirm that I am licensetl untler provisions of Chapter 9(commencing with Section 7000) oF Division 3 of the Business antl Professions Code, and my license is in full force end ettect. Lic. M Cless # Contrec�or'S Signawre: Date: CONSTRUCTION LENDING AGENCV: ❑ I �ereby aHirm Ihat Ihere is e consiruction lending agency For Ihe pedormanca of Ihe work for which this pertnit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lender's Atltlress: Signa�ure: Da�e: OWNER-BUILDER DECLARATIONS: I hareby ettirtn that under penelry ot perjury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business entl Professlons Cotle: Any ciry or counry which requires a permit to constmct, alter, improve, tlemolish, or repair eny structure, pnor to its issuance, also requires the epplicant tor such permit to file a signed statement Ihet he or she is licensed pursuant b the provisions ot the Comractors License Law (Chapter 9(commencing with Sectlon 7000) of Division 3 oi the Business and Professions Code) or t�ai he or she is exempi thereirom and the hesis for the ellegetl exemption. Any violation o� Section 7031.5 by any epplicant for e permit sublects the applicant to a civil penelry of not more than five hundred dollars (5500).): ❑ I, as owner ot iha properry, or my employees with wages es Iheir sole compensation, WILL DO T}1E WORK, and the structure is not intentlatl or oRered for sale (Sec. 7044, Businass end Professions Cotle: The Contrectors License Law tloes not apply to an owner oi property who builGs or improves thereon, and who tloes such work himself or harself or Ihmugh his or her own employees, provitled that such improvements are not intendetl or oNeretl br sele. Ii, however, the builtling or improvement is nsold within one year of completion, the owner-builder will heve ihe burden of proving ihat he or she did not build or improve for purpose of sale.). �I 11, as owner of Ihe property, a XCLUSIVELV CONTflACTING WIT}i LICENSED CONTRACTORS to ton5�ruct Ihe projeci (Sec. 7044, Bu5in855 end Professions �/ Cotle: The cnn n5e La does nol epply to an owner ot pmperty who builtls or Improves thereon, and who contracls for such project with e contrector(s) �� license pu nt oniractors 'cense Lews.). ❑ I em exe t Signature: Owner ID u Venlication �_ Business and Professions Code for �his reason: Date: ie. ❑ Ves ❑ No Driver'S LicenSe No. Expires: • I of document, i.e. - property taa bill or tleed): OIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more teet in depih into which e person is required to descend, will be made in connection with work aulhorizetl by ihis permil, and ihat no buildinq 5irucWre, scattolding, falsework, or demolition or tlismantling thereof, will he more than thirty-siz (36) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, 7tle B, Celltomia Adminisirative Code). ❑ As awner-builder, I will not employ anyone to do work which would require e permit from Ihe Division of Indusiriel Sefery, es notetl ebove, unless such pereon has e permii to tlo such work tram the tlivision. Signawre: Date: Division of Indusirial Satary Permit Number: CERTIFlCATE OF COMPLIANCE AND AUiHORIZATION OF ENTAV: I certity under penalry ot perjury that I �ave read this epplication and stale Ihat the infortnalion given is correct. I agree to wmply with ell stata la d city ordinances relating to 6uiltling consiruclion, and authorize represen�atives ot ihe Ciry ot Costa Mesa to enter upon Ihe ebove-tlescnbetl property for ins e' purposes. ree not to occupy or allow occupancy of any building authonzed by Ihis permit until final inspection. COUE I' INSPECTIONTViP� " 1616 Fi:etl System Final Fire Prevention 1268 Pool Spe Final 200 Final Re-Rooi 201 Final BIocWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demoliiion FAIE " IMRIALS /r�/n� ��e'� Date COUE� INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Si�e 250 Final Building/Occupency ceie u�s ''Lj'-0-1 � To NEWPOR'%MESA UNIFIED SCHOOL DISTRICT CERTIFICATE OF COMPLIANC,E OF DEVELOPMENT FEES PURSUANT'�O'A9�1600 AND AB 781 N° 4918 ('' ) Ciry of Costa Mesa DisUict Receipt No.l ��C,� ( ) City of Newport Beach ( ) Counly of Orange Plan Check No�� Applicant: Address: Telephone TracVParc Location of Project: �✓✓ ��_ \/ I&- I I U � I 1 Number of Square Feet of.✓ �`�' � v ' � � ` `� " I � Residential Space ��x 51.84 Commercial and Industrial Space CommerciaUlndustrial Project is: (Check One) _ Warehouse R&D _ Movie Theater _ Mini-storage _ Heavy Industrial _ Regional Shops _ Light Industrial _ This project is exempt because z $ .30 _ Motel 8ank _ Neighborhood Shops _ RacqueVHeallh _ Hotel Medical Office Office Park To�� (�, /�3. ��-. Total _ Preschool _ Auto Repair _ Hospital _ Large Office _ O(fice Bldg. _ Resiaurant _ Fast Food This certifies that the above-named Developer/Applicant has paid school faatity fees in compfiance with Government Code sections 53080 and 65995. The Building Permi� tor this square footage in this proposed development may now be issued by your jurisdic6on. Checks are to be made payable to Newport-Mesa Uni The above representatlon as W square tootage is We. AppNcant agrees that if k is later detemiined that such representations are not true, then this certificate shall automatically terminate and the appropriate City/Co � �Q�6� �883/3:11 PN/f 37589.36 RCPT�:01-0123372 p � O 120887 Date: I Amlir� t � (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 3352 VIA TIVOLI Suite No Vicinity: TR 16416 BLDG�f(p Parcel Nunmber: TPN003051 Applicant: LONG, JEN Address: Owner: STANDARD.PACIFIC Address ,�5326ALTONPARKWAY IRVINE, CA Contractor. Address: � . Arch / Eng : � Address: � - ISSUE FEE BackFlow irrigation BackFlow Preventer BathWb Clarifer System Connect Qce,Soda,etc) Dental Units Dishwasher , ISSUED BY: Phane: 714-245-9760 Zip: Phone: 949-789-1716 Zip: 92618 Phone: Zip: License: Phone: Zip: �- - ticense: Status: ISSUED Applied: 10/31/2003 Issued: 11/10/2003 SCOPE OF PERMIT �REF:B03-OOW1. NEW 7 UNIT MULT-IFAMILY BUILDING..INCLUDES ADDRESSES: 1301, 1303, '� �. 1305, 1307, 1309, 1311, AND 1313 CORTE ALEMANO. BUILDING 4, TR 16416. ', ; PLUMBING TO INCLUDE: 9 BATHTUBS,-7 CONNECT�QCE, SODA), 7 DISHWASHERS, 7 GAS OUTLETS , � (1-4),7 GAS (OVER 4 OUTLETS). 7 GAS SERVICES, 7 LAUNDRY TU8/WASHER, 7 PRESSURE - REGULATORS, 7 SEWER CONNECTIONS, 7 SHOWERS, 30 WASH BASWS,-7 KITCHEN SINKS, 21 " , WATER CLOSETS; 7� WATER HEATERNENT, 7 WATER SERVICES: � �� - � - - � - AMT QTY ., $23.50 . . $0.00 0 �$0.00 0 $88.20 9 $0.00 0 $68.60 7 $0.00 0 $68.60 7 FEESUMMARY AMT laundry Tub / Washer $68.60 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $68.60 Process Piping (per 10 ft) $0.00 Recep[ors � $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 QTY 7 0 0 7 0 0 0 0 AMT Sump Purnp ' , � $0.00 Swimming Pool ' $0.00� Trap Primer � $0.00 Urinal $0.00 Vacuum Brkr Bkflow(1-4) $0.00 Vacuum Brkr Bkflow(5+) $0.00 Wash Basin $294.00 Wash Basin Set $0.00 QTY 0 0 0 0 0 0 30 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 it work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of this permi�. FOR INSPECTIONS CALL: (714) 7545826 244Bd8 (NW) WORKERS'COMPENSAnON DECLARAnON: '" � I hereby aflirtn under penalry of perjury one ot the tollowing tleclarations: ❑ I heve and will meintein e certiticate ol consent to selt-Insure tor workers' compensetion, as pmvitled for by section 3700 of the Labor Code, for Ihe peAortnance of Ihe work for which this permit is issuetl. I heve and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cotle, tor ihe peRortnance of ihe work for which this pertnit is Issuetl. My workers' compensation InsurenCe carrier and policy number ere: ' Carrier. Policy Number. (This secf/on need not be canp/eted it the permit is va/ued af one hundred dollars ($100) or /ess.) ❑ I cenity that in the pertorma o t tor which 1's permit is issued, I shall not employ any person in any manner so as to bacome su6jact to ihe workers' � compensatlon laws oi Ca' mia, e ihat It I sho Id bacome subject to the workers' compensetion provislons oi Section 3700 of the Labor Cotla, I shell forthwith comply wilh Ihese Or ' ons. J` /Q D� Applicant SignaNre: Date: � � WARNING: FAILURE TO SECU WO ENSNTION COVERAGE IS UNUWNL AND SHALL SUflIEGT AN EMPLOYER TO CRIMINAL PENPLTIES AND CML FlNES UP TOONE HUNDRED THOUSANDDOLLARE(E100.000), OIT THECOSTOFCAMPENSATION,DAMAGESASPROVIDEDFORINSECTION3]O60FTHELABOiiWDE,IMEREST,AN�ATTORNEY'SFEES. LICENSED CONTRAC70R5 DECLARATION: I hereby attirm that I am Iicensetl untler pmvisions of Chapter 9(commencing with Section 7000) of Division 3 of ihe Business antl Professions Cotle, entl my license is in full force end ettect. Lic. M Class M CONractor's Signature: Dete: CONSTRUCTION LENDING AGENCY: ❑ I hereby a%irtn that there is a conslruction lending agency for the performance ot tha work for which ihis permit is issued. (Sec. 3097, Civil Code). Lender's Neme: ' Lentler's Atltlress: Signaiure: Da�e: OWNER-BUILDER DECLARA710N5: I hereby ettirm Ihat under Denalry of Derjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which requires e permit to constmct, alter, improve, demolish, or repair any strucWre, pnor Io its issuance, elso requires the epplicant for such permit b tile a signed statement Ihet he or she I5 Iicensed pursuent to the provisions ot the Contractors License Lew (Chflpter 9(commencing with Sectlon 7000) of Divislon 3 ot ihe Business anC Professions Code) or Net he or she is ezempt thereirom end the hesis for the alleged exemption. Any violetion of Section 7031.5 6y any epplicant tor e parmit subjects the applicant to a civil penalry of not more Ihan five hundred dollers ($500).): ❑ I, as owner of Ihe property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, end Ihe structure Is not intended or aHeretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Lew dces not apply to an owner oi property who builds or improves ihereon, end who does such work p'�nsetl or herself or through his or her own employees, pmvided ihat such imp�ovements are not Intended or offered for sale. If, however, the building ar improvement is / cjd within one year of completion, the owner-builtler will have Ihe burden of proving that he or she did not build or improve Por purpose of sale.). ' �� as owner ot the property, a USIVELV CONTRACTING WITM LICENSED CONTRACTORS to wnsiruct the project (Sec. 7644, Business and Protessions �— Code: The contrectors se Lew d not apply to en awner of pmperty who builtls or improves Ihereon, and who wniracts lor such pmject wiih a contraclor(s) ❑ I em exi Signature: _ Owner ID ven Verification ot � Business and Protassions Code for this reason: Yes ❑ No Drivers License No. �� Exoires ot tlocument, i.e. - properry tax 6111 or deetl): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICA710N: ❑ I hereby certity thet no excavation five (5) or more feet in depth into which a person Is required to descend, will be matle in conneciion with work authonzetl by this permit, and that no builtling siruqure, scaRoltling, falsework, or demolition or tlismanUing t�ereoi, will be more Ihan thirry-six (36) feet high. (Chap. 32, Grp 2, Atl 2, Sec. 341, 7tle B, Califomia Atlminisiretive Cotle). ❑ As owner-builder, I will not employ enyone to tlo work which would require a permit irom ihe Division ot Indusirial Safety, as noted above, unless such person hfls e permit to do such work from the division. Signature: Date: Division of Industnal Salery Pertnit Number. CERTiFlCATE OF COMPLIANCE AND AUTMORIZATON OF EMAV: I certify under penalry ot perjury that I have read this application and stata that the information givan is wrrect. I agree to comply with all state laws and ciry ordinances relating to builtling consiruc�ion, and authodze represenlatives ot the Ciry of Cwia Mesa to enter upon Ihe above-descnbed propejly for inspection . not to occupy or allow wcupancy of any building authorizetl by �his permit until final inspection. cooe �. isis 1268 Fixed System Final Fire Pool Spa Final 200 Final Re-Roof 201 Final BIocWReteining Wall 202 Final Factory Fira Place 203 Final Sign 260 Final Demolition P� I[�J�64 � / /�ate �� Date �� iNsaecnoxTrve 206 Final Mechanical 208 Final Plumbing 210 Final EIetMWI 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy eeg u�eLs S—�'C��{ �K.f V (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Jobnddress: 3352 VIA TIVOLI Suite No Vicinity: BL 6, 3352,3354,3356,3358,3360,3362,3364 Parcel Number: TPN003051 Applicant: LONG, JEN Address: Owner.' ' STANDARD PACIFIC Address: 15326 ALTON PqRKWAY IRVINE,.CA Contrector: Address: Phone: 714-2459760 Zip: Phone: 949-789-1716 Zip: 92618 Phone: Zip: � . . License: Status: ISSUED Applied: 11/06/2003 Issued: 7 7/70/2003 ISSUED 8Y: � � � SCOPE OF PERMIT � "- REF:B03-07892. NEW 7 UNIT MULTIFAMILY BUILDING. INCLUDES ADDRESSES: � 3352,3354,3356,3358,3360,3362 AND 3364 VIA,TIVO�I. TR 16416, BUILDING 6. MECHANICAL TQ INCLUDE: 7 COMPRESSORS UP TO 3 HP. 7 FAU'S LESS THAN 100 K BTU, 7 , FACTORY FIREPLACES, 26 VENT FANS, AND 7 APPLIANCE VENTS. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100, k 8TU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping, � � Factory Fireplace , Hood w/Mech Exhaust VAV Box Venl Fan / Single Ducl Appliance Fire Dampers � Smoke Dampers ' Inst or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> 10000cfm Floor Furnace Floor or Suspentl Healer _ FEE SUMMARY Quantity $23.50 $103.60 7 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 . �$0.00�� .0 $74.55 7 so.00 0 $0.00 0 $203.00 28 80.00 0 $0.00 ' 0 $0.00 0 $74.55 7 $0.p0 0 So.00 0 $O.DO 0 $0.00 0 Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit . . Ventillation System ,' Evaporative Cooler - -. . ' � �-Commerciallncinerator , - . . - Domestic Incinerator � Compressors / Absarption Systems ; Uplo3hp/t00kBTU��- - � 3To15hp/500kBTU . " " 15To30hp/1,OOOkBTU 30 To 50 hp / 1,750 k BTU ' Over 50 hp / Over 1,750 BTU Bailers Upto3hp _ ,,,. , , 3To15hp � 15 to 30 hp . � , 30 l0 50 hp . � Over 50 hp , Other Mechanical Fee. ' � - Investlgatlon Fee Plan Check Fee $0:00- $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $102.90 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 Quantity 0 0 0 - 0 , 0 0 0 0 0 0 0 7 . 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under tbis permit to be considered legal, such work must comply with all applicable codes, antl all � requlred Inspectiona and final epproval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2aaceelaroal WORKEHS'COMPENSATON DECLARATION: � ' � I hereby affirtn untler penalty ot perjury one oi the followinq declarations: . � I heve entl will maintain a certificate of consent to self-Insure for workere' compensation, as provided for by section 3700 of the Labor Coda, for the pertormence ot ihe work for which this pertnit is issuetl. I have antl will maintain workers' compensation insurance, as required by section 3700 of the Lebor Cotle, for the peAortnance of the work for which this pertnit is issuetl. My workers' compensation Insurance carrier and policy number are: Cerrier: PoliCy Number: �(Th/s sec(ion need nof be comp/eted il the pe ' is valued at one huntlred dollars ($100) or less.) ❑ 1 certiry Ihat in the pe m+e the work for hich thisp ertnit is issueQ I shall not employ eny person in eny manner so es to become subject to tha workere' • compensetion lews Cal�' a ree � iH-sii6uTd hecome subject to the workers' compensation proNslons of Sec[ion 3700 of the Labor Code, I shall fort�with wmply with ihes ro 'efo . /� Applicant SlgnaWre: Date: ' / ' _�{ / � �� WARNINO: FAILUFE TO ECUR E 5' COMPENSATION COVERAGE IS IINLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED TYKKISAND DOLLARE ( 100,000), D IIXJ TO THE COST OF COMPENSATION, DAMAGES AS PfiOVI�ED WF IN SECTION 3)OB OF THE LABOR CODE, IMEREST, AN� ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eMirtn that I am licensed under provisions of GhaDter 9(commencing with Section 7000) of Oivision 3 oi �he Business and Professions Code, and my license Is in full force end effect. Lia k Cless k IConlrectofsSignaWre: Date: ' CONSTRUCTION LENDING AGENCV: � � I hereby aMirtn Ihat Ihere is e consiruction lending agency for the peAormance of ihe work for which Ihis permit is issuetl. (Sec. 3097, Civil Code). Lentler's Name: Lenders Address: Signe�ure: Date: OWNER-BUILDEH DECLARATIONS: I hereby ettirm ihet untler penalty of perjury that I am E%EMP7 FROM THE CONTRACTORS LICENSE LAW for the following raason (Sec. 7031.5, Business antl Protesslons Cotle: Any ciry or counry which requires a pertnit to consiruct, altar, improve, tlemolish, or repeir any stmctura, prior to its issuance, also requires the applicaN tor such permit to file a signetl slatement that he or she is licensetl pursuant ro Ihe provislons oi the Conlrectors License Lew (Chepter 9(commencing with Seclion 7000) of Division 3 of t�a Business entl Protessions Code) or that he or s�e is exempt iherefrom and ihe basis tor the elleged ezemption. Any violation of Saction 7031.5 Dy any epplicent for a permit subJects the epplicant to e civil penalty of not more Ihan five huntlred doliars ($500).): ❑ I, es owner ot Iha pmperty, or my employees with wages as their sole compensation, WILL DO TME WORK, and Ihe sirucWre is not intended or o%eretl tor sale (Sec. 7044, eusinass antl Professions Cotle: The Contractors License Law does not epply to en owner of propery who builds or improves thereon, antl who does such work imsetl or herself or through his or her own employees, provitled that such improvemenis are not intended or ottered tor sale. It, however, the builtling or improvement Is old within one year oi completion, the owner-builder will have the burden of proving ihat he or she did not build or improve for purpose ot sale.). � , as owner of the Drop CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to wnstruct the project (Sec. 7044, Business antl Pmfessions otle: The conire License La oes not apply to an owner of proparty who builtls or Improves t�ereon, and who contrects tor such prolect with a coniractor(s) license Ours thflCamractors cense LawSJ. ❑ lame SignaNre: Owner ID v Verification s � Business antl Pmfessions Cotle for ihis reason: /�, � � Exoires: ' I7• PY/ by (rype ot documenL i.e. - property taz bill ar deetl): DIVISION OF INOUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certlty thet no exwvetion tive (5) or more Feet in dep[h imo which a person is required to descend, will be made in connection with work euthorized by this pertnit, end that no building slrucWre, scattolding, falsework, or tlemolition or dismamling ihereof, will 6e more Ihen ihirty-six (36) teet high. (Chap. 32, Grp 2, Ah 2, Sec. 347, Title B, Califomia Atlministrative Code). ❑ As owneo-Duiltler, I will not employ anyone to do work which would require a permit from the Division of IndusMal Sefery, as noted ebove, uniess such person hes a permit lo do such work irom ihe division. Signature: Dale: Division oi Intlustrial Safery Permi� Number. CERTIFlCATE OF COMPLIANCE AND AIJT}fORVATION OF ENTFiY: I certify untler penalry oF perjury ihat I have reaG this epplication end state �hat Ihe information given is wrrect. I egree to comply with all stete laws antl ciry ortlinances relating to building constructioq entl euthodze representatives of Ihe Ciry of Costa Mesa to enter upon ihe above-descnbed prop�qy for ins�gC`on os e not to occupy or allow occupency ot eny building euthorized by this parmit until final inspection. GODE �. INSiECTONTYPE 1616 Fixed System Final Fire i 1266 Paol Spe Finel 200 Final Re-Roof 201 Final Block/Retaining Well 202 203 Final Factory Fire Place Final Sign 204 Final Demolition PdIE Uffi�Lff ��'�( J'�aV � Date COOE I INSPECTION TYPE 20fi Final Mechanical 208 Final Plumbing 210 Finel Electncal 212 Final Flra Preventian 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency / (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa,G��sCTRICAL PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 t Job Address: Suite No Vicinity: Parcel Nunmbpr: ApplicanC Address: 3352 VIA TIVOLI TR 16416 BLDG 6 TPN003051 LONG. JEN owner: STANDARD PACIFIC Address 15326 ALTON PARKWAY IRVINE, CA ConVactor. Address: ISSUE FEE Temp servicE test Res. a/c package New Res (1-2 units) New Res (3+uriits) Pool / Spa � � Lighting Fixls � Recept Outlets � Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to SOhp Phane: 714-245-9760 Zip: Phone: 949-789-1716 Zip: 92678 Phone: Zip: License: ISSUED BY: .�� . �\ ' Status: Applied: Issued: ISSUED 11 /05/2003 11/10/2003 SCOPE OF PERMIT , REF:B03-001892. TR 16416 - BLOG 6. CONSTRUCT.NEW-7 UNIT MUtTIFAMILY BUILDING. INCLUDES ADDRESSES: 3352, 3354, 3356, 3358, 3360, 3362; AND 3364 VIA TIVOLI. ELECTRICAL TO INCLUDE: 7 LIGHT FIXTURES, 14 OUTLETS, 7 SWITCHES, 1000 AMP SERVICE, AND 8- 200 AMP SUB PANELS. RES S�UARE FOOTAGE IS 10,953 SQ. FT. INCLUDES SUB PANEL FOR HOUSE METER. HOUSE METER IS ADDRESSED AS 3352 "A" VIA TIVOLI. � $23.50 $0.00 $0.00 $0.00 $553.20 $0.00 $7.70 $15.40 $7.70 $0.00 $0.00 $0.00 $62.15 $0.00 $0.00 $0.00 $0.00 Quantity 0 11064 0 7 14 7 0 0 0 � 0 0 0 0 FEE SUMMARY Quantity, ,� �d'�Temp Dist System / Lighting $0.00 . 0 , • � Busway-/100ft $0.00 . 0� �- � � Standing Section- $0.00 " 0 Misc Electrical EquipmenL � $0.00 - � 0 Transformers up to �1 kva/kw �. $0.00 0 ................up to 10 kva/kw $0.00 0 .................up to 50 kva/kw $0.00 0 � .................up to 100 kva/kw . $0.00 0 ..................over 100 kva/kw $0.00 0 . Low Voltage Equipment $0.00 � 0' "� Low Volt Wiring System / Ckt . $0.00"; 0� � Misa Canduit $0.00 �0 - Misc. Canductor $0:00� - " 0 Circus ( gen or ride) $0.00 0 Circus (mech ride or lights) $0.00 0 Christmas Tree Stand ` $0.00 0 Fireworks Stand $0.00 0 NOTICE: The work authorized by ihis permit shall compty with afl applicable handicap access requirements under California statufes and relafed regulations. (Ord. No. 92-28, § 1, 12-21-92) � EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor the work au�horized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepections and final approval must be obtained. Failure to obtain inspec�ions and final approval will result in lhe expiration of this parmit. FOR INSPECTIONS CALL: (714) 7545626 244648 (&00) WORKERS'COMPENSAnON DECLARAnON: � '� I hereby aNirm untler panalty of perjury one of the following tleclarations: � ❑ I heve anC will meintein e certificete of consent ro self-Insure tor workers' compensation, es provided tor by section 3700 of tha Labor Cotle, tor the pertormenca of the work tor whlch this permit Is issued. �I �ave and will maintain workers' compensation insurence, as required by section 3700 of the Labor Cotle, for the perfortnance ot [he work tor which Ihls pertnit is issuetl. My workers' compensatlon Insurance carner and policy number are: Carrier: Policy Number: (TAis secfion need nof be comp/eled i/ the permit is valued at one hunOretl tlollars ($100J oi less.) ❑ 1 certify thal in Ihe perto g� he work for whi h Ihis permit is Issued, I shall not employ any person in any manner so as to berqme Subleci to Ihe workets' compensation laws ot I(omi , gr e tha ' ulA-mecome sub�ect to the workers' compensation provisions oi Sectlon 3700 ot the Lebor Cotle, I shell fonhwi[h comply with Ihese Isions, I I /� ,� � ApplicantSignaWre: Date: ��`��f, WAiiNING: iAILURE TO ECURE WO ERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO IXJE HUNDRED TFKK/SANDOqlAFE(SOO,OW�,INJm TOTHECOSTOfCOMPENSATION,OAMAGESASPtiOVIDEDFORINSEGTIqJ3�O60FTHEUBORCODE,IMEREST,ANDATTORNEVSFEES. LICENSED CONTRACTORS DECLARA710N: I hereby affirm that 1 am licensetl untler provisions ot Chapter 9(commencing with Section 7000) of Division 3 ot ihe Business and Professions Code, entl my license is in full force antl e%ect. Lic. N Class % Contrectols SigneWre: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn chat Ihere is e consiruction lending agency lor the pedormance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenaefs Adtlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I here6y aMirtn thet under penalry ot perjury that I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Busineu end Professions Code: My city or counry which reQuires a permit to construct, alter, improve, tlemolish, or repair any struciure, prior to its issuance, elso requires lhe epplicant for such pertnit to tile a signetl statement thet he or she Is Iicensetl pursuant to ihe prodslons of lhe Contractors License Law (Chapter 9(commencing with SecNon 7000) ot Division 3 oi the eusiness and Profeuions Code) or that he or she is exempt therefrom antl the basis for tha alle9ed e:emption. Any violation of Saction 7037.5 by any epplicant for e pertnit subjecis ihe applicant to a civil penalry of not more ihan five hundred dollars ($500).): ❑ I, es owner oi ihe property, or my employees with wages as their sole compensation, WILL DO 7HE WORK, antl ihe slructure Is not intentletl or ottered ior sale (Sec. 7044, Business end Professions Code: The Contractors License Ww does not apply to an owner oi properry who builds or improves ihereon, end who does such work imself or herself or ihrough his or har own employeas, providea t�at such improvemenis ere not intended or ottered for sale. tl, however, the builtling or imp�ovement is old within one year ol comple�ion, ihe owner-builder will have tha burden of proving that he or she did not build or improve for puryose of sale.). � es owner oi lhe prop rty, US V CONTRACTING WITH LICENSED CONTRACTORS lo constmct ihe project (Sac. 7044, Businass entl Profe55ions Code: The contrector nse Law tloes no appty to an ownar of property who builds or improves ihareon, antl who contracts for such project wlth e contractor(s) license pursu oniractors License w5.). ❑ I am ex m und — Business and Protessions Code for Ihis reason: Signature: ` e:oi�as� Venfication of b(type of document, i.e. - pmperty tau bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cenify thet no excavetion five (5) or more feet in tlepth into which e person is requiretl to tlescentl, will be made in connection with work authonzetl by this permit, antl ihat no builtling siructure, scattolding, falsework, or demolition or dismantling Ihereof, will be more ihan thirty-six (36) lee� high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Ttle B, Celitomia Adminisirative Code). ❑ As owner-builder, I will nol employ anyone to do work which woultl require a permit trom tha Division of Industrial Safery, es notetl ebove, unleu suc� person has a pertnit �o do such work irom t�e division. Signature: Date: Divisian of Indusirial Safety Pertnit Number. CEHTIFlCATE OF COMPLIANCE AND AIJTH R�ZATION OF ENTFiY: I certiy untler penalry oF perjury that I have read this application entl s�ate Ihat Ihe infortnation given is correct. I agree to comply with end ci ordinances relating to building construction, and authorize represeniatives of Iha Ciry oi Costa Mesa to entar upon the above-describetl property fo ' spection p . agree to occupy or allow acupency of eny building authonzed by this pertnil un�il finel inspection. CQOE I, 1616 1266 200 201 202 203 Fixad System Final Fire Pi Pool Spe Finel Finel Re-Roof Flnal Block/Reteining Wall Final Fecfory Fire Place Final Sign 204 Final Demolition PdI€ 1tlIlDelS � %- %�� '(°i� oate COOE 1 INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 270 Final Electrical 212 Final Fire PreveNion 220 Final Planning Approval 222 Final Site 250 Final Builtlinq/Occupency �i_r —_- t— � (714) 754-5273 • Fen (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 FIRE SUPRESSION PERMIT Job Address: 335P VIA TIVOLI Status: ISSUED Suite: Applied: 05/24/2004 Vicinity: MULTI FAMI4Y BLDG. Issued: OS/28/2004 Parcel Number. TPN003051 ZOning: ISSUED BY: � Applicane FIRE SPRINKLER SYSTEMS INC Address: 705 E HARRISON ST" �� - ' , SUITE 200 - - - - - . Phone: (800) 915-3473 � . , � CORONA, CA ' Zip: 92879 , - . - � i,.:.,-' - '� -` � _ . � � _� �� Ownec��STANDARb'PACIFIC.- � _ � � � ,�'��,�,� Address: '-15326ALTONPARKWAY " - � � � � � --,`� . . , � , - �- . Phone: 949-789-1716 . . . . ". , " JRVINE, CA' - , - Zip: 92618 � ; � , _ � �� `. Contrecror. FIRE SPRINKLER SYSTEMS INC � �� ," Addressi ,' 705 E HARRI&ON ST , ' � � � . � � �� ; SUITE 200 Phone: . (800) 915-3473 , � - -' ` � . CORONA, CA . " �,�Zip: 92879 , - . ' : \ � � � � License: 684600 , - • � . � � � � � " ' � � SCOPE OF PERMIT � � � OVERFiEAD'FIRE SPRINKLERS FOR NEW 10,953 S.F. 7-PLEX WITH 3,090 S.F. GARAGE AND 135 S.F. PORCH/DECK. "BUILDING TYPE - C". BLDG 6. , � � ` � _ _.,., _,. . ADDRESSES INCLUDE: 3352,3354,3356 3358 3360 3362 3364 VIA TIVOLI �REF: 803-01892 ' ' � FEE SUMMARY. ;� „ Plan Check: � $117.81 — - - — - - �' _ - 'Calc Valuation: $s;a2o.00' , Permit:' `. $181.25 ' " Claimed Valuation: Ss,azo.00 �_ ,.Other: ', $0.00 ' .,' � � � �' , �, , � • - . . - , �' ; , , , Total � � 5299.06 ,�, � - � �t , , � � ..,.'., �= . ' . , - - . . , ,t � . , �' , .� . . - : � ' n .. .' - 2 , '� i/ i„ ., . , . � , _. . � , .. � � -, , " , °!� .� / � . ' " _ _ � ' ' . �/i � � . , � . . , � i = ' � ' , � , � .� ' , . ' I� 'V . - . . � , ` -.. - - ., . i<'i,� i':.ii' , '� / NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRA710N: This permit shall automatically expire and become voitl if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPEC710NS: In order for the work authorized under this permit to ba considered legal, such work must comply with all applicabla codes, and all required inspections and tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 754-5626 !eas-ae Ia'oo) WORKERS' COMPENSATION DECLARA710N: ' I hereby aHirm undar penalty of perjury one of the tollowing tleclarations: � ❑ I have and will meintain a certificate of consent to seli-Insure tor workers' compensation, as provided for by sedion 3700 of iha Labor Code, for the pertormence of tha wi rk for which ihis pertni� is issuetl. �9�have antl will maintain workers' compensation insurance, as requiretl hy section 3700 of Ihe Labor Code, for the pertortnance of the work for which ihis pertnit is issued. ..F�jMy workers' compensation Insurance carder antl policy number are: p �arrier. ��i'� �U-�U i� /Pplicy Number. I� y� 9 D�/ —� 00 3 (This sectlon need nof be completed il the permit is valued at one hundred dollars ($100) or less.) �' � ❑ I certity that in Ihe pertortnance ot ihe work for which this pertnit is issued, I shell not employ any pereon in any manner so as to become sublect to the workers' compensation laws ot Califomla, antl egree thet if I should b a e sub�ect to the workers' compensation provisions oi Saction 3700 of the Labor Code, I shall forthwith comply with Ihese provi ie . � cp ant Signeture: �% -� �. +D e 5 a� �� WAFNING: FAILURE TO S URE RKERS' C(kAPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CFIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED TFIOUSANDDOLLARE($1 . AODRIONTOTHECOSTOFCqMPENSATION,DAM4GESASPiiOVIDEDWRINSECTION3]O60FTHELA90RCODE,INIEREST,ANDATTORNEY'SFEES. LICENSED CONTRACTORS DECLARATION: I herehy attirtn that I am Ilcen�� tl��}}ff��JJ provi ions of Chapter 9(commencing with Section 7000) of Division 3 of ihe Busine and ryfessions Cotle, anA my license is in tull force nd eHect. Lia N � � � - /1 �9s # � � � <P Gl IrectoYs Signature: /% W . ate: � Si � 6 r T CONS7RUC710N LENDING AGENCY: � I hereby aHirm �hat ihere is a constmction lentling agency tor the peAortnance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Code). Lentlefs Name: Lender'S Atldress: Signawre: OWNER-BUILDER DECLARA710NS: Date: I hereby attirtn that under penalry of perjury thai I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business and Protessions COCa: Any ciry or counry w�ich requires e permit to construct, alter, improve, demolish, or repair any structure, pnor to its issuance, also requires Ihe applicant for such pertnit to tile e signed statemem that he or she is licensed pureuant to the pmvisions of the Coniracmrs License Lew (Chapier 9(commencing with Sedion 7000) of Division 3 of the Business end Prolessions Cotle) or that ha or she is exempt Iherefrom and the 6asis for the alleged e:emption. Any Nolation of Section 7031.5 by eny applicant for e pertnit subjects Ihe epplicant ro a civil penelry of not more ihan five �untlretl tlollars ($500).): ❑ I, as owner ot ihe property, or my employees wlth wages as their sole compensatlon, WILL DO THE WORK, antl the strucNre is not intentled or oRered for sala (Sec. 7044, Business and Professions Code: The Conirectors License Law tices not apply to an owner of properry who builds or improves [hereon, antl who does such work himsetl or herself or ihrough his or her own employees, pmvided ihat such impmvements are not intended or oHerad tor sale. If, however, ihe huilding or improvement is sold wit�in one year of completion, the owner-builder will have the 6urden ot proving that he or she tlitl not build or improve tor purpose of sale.). � ❑ I, as owner ol the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Proteuions Code: The contractors License Law tloes noi apply to an owner ot property who builtls or improves ihereon, and who contracts tor such project with a coniractor(s) license pursuant to ihe ConireIXors Licensa Lews.). ❑ I am exempt undar sec. Business antl Professions Code for this reason: Signature: Date: Owner ID verilied by tlrivers license. ❑ Yes ❑ No Dnvefs License No. Venficetion ot Ownership by (rype of document, i.e. - property tae hill or dead): Expires: DIVISION OF INDUSTRIAL SAFE7Y PEPMI7 CER7IFICATION: ❑ 1 hereby certity that no exwvation tive (5) or more feet in depih into which a person is required to tlescend, will be made in cnnnedion with work authonzed by t�is pertnit, and ihat no builtling siructure, scattolding, falsework, or demolition or dismantling t�ereof, will be more Ihan ihirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle e, Calitomia Adminisirative Code). ❑ As owner-builder, 1 will not employ anyone to tlo work which woultl require a pertnit irom the Division of Industrial Safery, as noted above, unless such person has a permit to tlo such work irom the division. Signature: Date: DiviSion ot Indus�rial Se�ety Permit Number: CERTIFlCATE OF LOMPLIANCE AND AIfT}iORVATON OF ENTRV: I cenify under penalry of perjury that I have read this application and state Ihat the infortnation given is wrrect. I egree to comply wlth all stale laws and ciry ordinances relating to building construction, and authonze representatives of the Ciry of Costa Mesa to enier upon Ihe above-descnbed property for inspection purposes. I agree not to occuOY or allow occupancy of any building authonzed by ihis pertnit until final inspection. GOOE I, INSPECTIONTYPE 1616 Fixed Syslem Flnal Fire Preveniion 1288 Pool Spe Final 200 Finel Re-Rooi 201 Final BIocWRetaining Well 202 Final Factory Fire Place 203 Finel Sign 204 Finel Demolilion Pdg 1t�ALe^ � aP�d � � Date CQOEt MSPEC710NTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 272 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy PAIF. I[�AL9 y•ab•�t �