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Home My WebLink About3078 YELLOWSTONE DR - Building Permits - a S. CITY OF COSTA MESA ;wMs BUILDING DIVISION tl" �I77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 1 FOR INSPECTIONS CALL: (714)754-5626 4.`4"'OlaT. PERMIT NUMBER: P09-00149 PERMIT TYPE PLUM STATUS: ISSUED APN: 14107217 DATE ISSUED: 11/17/2009 ISSUED BY: RMD JOB ADDRESS: 3078 YELLOWSTONE DR CM Suite/Unit: Vicinity: THROUGH OUT HOUSE SCOPE OF WORK: PLUMBING PERMIT FOR COPPER REPIPE THOUGH OUT HOUSE. NO FIXTURES TO BE CHANGED OUT. OWNER: DEVLIN,THOMAS HUGH Address: 3078 YELLOWSTONE DR PHONE: 714-546-1461 City/State/Zip: COSTA MESA,CA APPLICANT: PEPANYAN,ARA Address: PHONE: 818-566-1390 City/State/zZip: CONTRACTOR: NUMBER ONE STATE PLUMBING INC License No. 818637 Address: 400 N GLENOAKS BLVD PHONE: 818-566-1390 City/State: BURBANK,CA ZipCode: 91502 CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $33.30 TOTAL FEES: $33.30 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. CODE#. INSPECTION TYPE DATE INTITIALS CODE It INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical �\ /A�. 1266 Pool Spa Final 208 Final Plumbing If/y-pr� 4 00 aye) 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 WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. ❑Yes ❑No I 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 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 D I hereby certify that no excavation five(5)or more feet in depth into which a number ar -. n person is required to descend,will be made in connection with work authorized I t i by this permit,and that no building structure,scaffolding,falsework, demolition (,Carrier: �(.t(K 1!ns,) -k/' (t1,In�S a or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section need nal be completed Tithe permit is valued one hundred dollars(5/00)or less.) 2,Art2 Sec.341,Title B,California Administrative Code). PotiPoli Nurhber: 19 y 9 �/7 ! Ci 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 Dale the Labor Code,I shall forthwith c... ly.a..ith these provisions. /1"17 DP Division of Industrial Safety Permit Number: .gicanl Signature ! Date 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 ❑ 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 are 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 my license is in full force/ and effect. a registration form for acutely hazardous materials? 0 Yes 0 No L'i 8/ 8n 37• "—Class.# (Section 25533 of the California Health and Safety Code, with some ,5 / exceptions, requires registration with the Costa Mesa Fire Department by 6 _ sB;gnature Y - 3o '// each business which at any one time has on hand a quantity of acutely �d>nconacmr' Date hazardous materials equal to or greater than a weight of 500 pounds, or a �"""44Z-- 'K'`' • volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). O 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)? 0 Yes 0 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 ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits). 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 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($S00).): of the California Health and Safety Code). O 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 0 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 O 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 Dale 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 0 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 of Legal Owner Date Signature Date 3057-4613/07) _40dtoLAulhorized 'ppllcanl CITY OF COSTA MESA 4 ati. , BUILDING DIVISION > %l; ,r1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. k ;� PERMIT -`b B06-01124 ro (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.lRtnLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 3078 YELLOWSTONE DR Status: ISSUED Suite: Applied: 07/07/2006 Vicinity: Issued: 07/07/2006 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 14107217 Zoning: R1 Applicant: JANOSIK, STEVE Address: 1621 EST ANDREW PL Phone: 714-259-5120 ISSUED BY: SANTA ANA,CA — -•----Zip:_. 92705 --- Owner: DEVLIN, THOMAS HUGH i' >-\ r � Address 3078 YELLOWSTONE DR c ,t 1 1 I �' 7 y" h, `' Phone. , i �`; COSTA MESA;CA, . Zip:, 92626-3028 7�i Contractor DIAL ONE WINDOW-REPLACEMENT SPECIALISTS (�. Address 71621ESTANDREWPL - --'_;� - _ - �; A 7 �- // _ 1 '� / �/ Phone: 714-259-5120: -' i V"� �� 'A / A' 7> Vim, /7�. L,SANTAANA,-CA2 '> 2, �, v/ � AA� 1 2 '92795/ 7/1,// License: 523043 N - , \\ Arch. ,/,i// Eng: 'y oA - '.A Address: - 7,7', 7 Address: A .` - • \ 'i-„ Phone: , A 'Phone: 'l ��i� - A �o - .„ ' v e ' ' License: ! License: \\ 7 . - 1' SCOPE OF'PERMIT__ ` , 4,A - 'CHANGE OUT 4 BEDROOM WINDOWS-THROUGHOUT S.F.D.TO MEET 1997 U.B.C. EGRESS-REQUIREMENTS..HEADERS WILL-REMAIN THE SAME. L /, �, `. • -FEE SUMMARY , -, , r Plan Check: • $0.00 % /Pm "`1 i-r -'— 7,17.171.7 ! - 9,7). C Calc Valuation. _ -$2 500 oo ,.c 41i-! J c!_.0 .f-.. � $2,50090 Permit $83.25 _ w Claim Valuation: �SMIP Res: $0.50 ,-t, SMIP Com $0.00 v'. Other:; $0.00 -_ % •` r�V - [ ✓ 4 -`.j \' Inspection: $0.00 f/ Total: $83.75 ,'�.. - V' ,/;. �" ` y� PLANNING &ZONING / - SETBACKS' ._t , - MAIN STRUCTURE Front v 0-0 Rear 0 0 , - Left„ ' 0`0;*„Right 0•07/ ' ACCESSORY '' Front_ 0; ' ("'' Rear 0-0 '` `"_Left 0 0 Right 0,0 � j \ , ' iv \\ q V � . / /A PARKING c,'- Existing " - 0Required: 0 ', Proposed: 0 - -j _ _ (/. V,j ?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 • 244646(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. Shave 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. r —My wbrkers'Lcompensation Insurance carder and policy number are: J �j / Cartier:„” SE)g 2)CZ/-1 1 (-`PoylicNumber: e O I O 1_9 o c9 c G C -(Th/s sedt/on need not be completed I!the permit Is valued et one hundred dollars($100)or less.) L� ❑ 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 shoul. .:come subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro Asi ins. -Applicant Signature:. ( `--- Date: f •"(3 ,WARNING:FAILURE TO SECURE WORKERS's NSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S1 W,OgD),IN ADDITION E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under pro ions of Chapter 9(commencing with Section 7000)of Division 3,of-the'Businesioand Professions Code,and my license Is In full .force andeffeoCLlc:ft" -5 r' .- LClass.4- Contractors'Sidiiaiure:"' ' Date: " "^ 7 0 CO 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.). ' ❑ 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 contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial 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 Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the 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 metedals 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 ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application aEEermit 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 65650.2 of the Califomia 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? ❑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 ❑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. g . : • Lego-•' ner(s) to �D L •nd/Or Authoriz:.. App cant �Oete' CODE I IfISPECT10N TYPE DAIE VIALS CODE! INSPECTION TYPE PAIS RITIDALS 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 Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Dem 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ••/,�; CITY OF COSTA MESA �'� BUILDING DIVISION F „,g,DEVELOPOIENT SERVICES DEPARTMENT PERMIT NUMBER 1.111 1k • PERMIT itbefttrop 801205 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3078 YELLOWSTONE DR Status: ISSUED Suite: Applied: 07/20/2005 Vicinity: ROOF Issued: 07/20/2005 Primary Occ: R3 Type of Construction: V-N Parcel Number: 14107217 Zoning: R1 Applicant: DEVLIN, THOMAS HUGH ISSUED BY: 0 420 Address: 3078 YELLOWSTONE DR Phone: COSTA MESA,CA Zip: 92626-3028 Owner: DEVLIN, THOMAS HUGH Address " 3078 YELLOWSTONE DR Phone: COSTA MESA,CA Zip: 92626-3028 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: Address: • Address: Phone: Phone: Zip: - License: License: SCOPE OF PERMIT TEAR OFF EXISTING ASPHALT SHINGLES AND INSTALL NEW SHEATHING:HOT MOP AND ASPHALT SHINGLES ON ATTACHED HOUSE AND GARAGE,APPROX 1400. • FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,500.00 Permit: $83.25 Claim Valuation: $3,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 ,• Total: $83.75 - PLANNING &ZONING SETBACKS •_ MAIN STRUCTURE,Front 0-0- Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646 WOO) DECLARATIONS • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This ce�tlsection need not be completed it the pemut is valued et one hundred dollars($100)or less.) _fLthat 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 ApalicatitSignatoret--1 r' ei--1 - U WARM J<�G:FAILURE TO SECURE WORKERS'COMPENSATIppp COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDr11ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lie.N Class 4 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agony 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).): :GAs 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: ,, Expirres:.I`—t 3 a 6 Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safely 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. ..r presently qod,......e to....5 4 o........lf.r.i.. e lh.. 4 If 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? IJ Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 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 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 penally 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-dnbed property for inspection pu es.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SSI n turadf LagatOwner(s)— And/Or Authorized Applicant Date CODE I INSPECTIONTYPE PATE MALE CODE! INSPECTION TYPE QAIE E{IMDALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final -y,�� 208 Final Plumbing �J� 200 Final Re-Roof ! G(T UU 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 4Lo Mac 9 CITY OF COSTA MESA akik ��@@@ BUILDING DIVISION o Wait". DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F ( i I TA. MIPPV4 PERMIT E03-00402 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 3078 YELLOWSTONE DR Status: ISSUED Suite No Applied: 05/29/2003 Vicinity: FAMILY ROOM AT REAR OF SFD Issued: 05/29/2003 Parcel Nunmber: 14107217 Applicant: DEVLIN, THOMAS HUGH ISSUED BY: _"#t Address: 3078 YELLOWSTONE DR. • ' Phone: 714-546-1461 COSTA MESA,CA Zip: 92626-3028 Owner: • DEVLIN, THOMAS HUGH Address 3078 YELLOWSTONE DR Phone: COSTA MESA,CA Zip: 92626-3028 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT 160 SF FAMILY ROOM AT THE REAR OF AN EXISTING-SINGLE-STORY SFD.9 LIGHT FIXTURES (INCLUDING FAN),6 OUTLETS,3 SWITCHES, 1 SERVICE TO 200A. REF:B03-00402 • 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 - 9 - up to 50 kva/kw $0.00 0 Recept Outlets $6.60 6 up to 100 kva/kw $0.00 0 Switches $3.30 3 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $30.50 - 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp • $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00' 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 • 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 - Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 I 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) 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 Cale,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.) isc.&certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. �- Applicant Signature: Date: S - 2 -7 - cs WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE f$100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# 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 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: ?--�- 2--�= Date:' '-Z 9 - o Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: - \ -Z 3-o G 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,telsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled 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 hes on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes u No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 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. --- e - 2 %-0 ature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE 0 INSPECTION TYPE PAIS 1NTI11ALS CODF( INSPECTION TYPE PALE Ea: MSLS 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 it , r 69 CITY OF COSTA MESA 4 BUILDING DIVISION e ' rj '.4 DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER 01.14 • PERMIT '41� a li4° B03-00402 ng (714)7�5R4--5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3078 YELLOWSTONE DR Status: ISSUED Suite: Applied: 03/11/2003 Vicinity: FAMILY ROOM AT REAR OF SFD Issued: 05/29/2003 Parcel Number: 14107217 Zoning: R1 R1 a Applicant: DEVLIN, THOMAS HUGH ISSUED BY: /:A Address: 3078 YELLOWSTONE DR _ Phone: 714-546-1461 COSTA MESA,CA Zip: 92626-3028 Owner: DEVLIN, THOMAS HUGH Address ,/3078 YELLOWSTONE DR Phone: COSTA MESA,CA - Zip: 92626-3028 , Contractor: OWN ER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: Address: Address: Phone: Phone: Zip: • License: License: SCOPE OF PERMIT 160 SF FAMILY ROOM AT THE REAR OF AN EXISTING SINGLE-STORY SFD. , FEE SUMMARY Plan Check: $163.31 Calc Valuation: $14,784.00 • Permit: $251.25 .Claim Valuation: So.00 SMIP Res: $1.48 , SMIP Com: $0.00 Other: $0.00 . Inspection:• $0.00 Total: $416.04 PLANNING &ZONING SETBACKS - MAIN STRUCTURE Front 10-0 Rear 30-0 Left 5-0 Right 5-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 2 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 2446-4a WOO) • 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: i Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' -4 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 provision Applicant Signature: ' cf^— /��// Date:\ 5- 2 l - o 3 WARNING:FAILURE TO SECURE WORKERS'COIOPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): 0" 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.). ❑ l am exempt under sec. Business and Professions Code for this reason: _ Signature: Date: n 5= 2 L-o -5 Owner ID verified by driver's license. Yes ❑No Drivers License No. Expires: ht.- 5-06 Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled 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 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_pgermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ❑No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes 0 No e (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 properly for ins ecction purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 2-7- 63 Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE f INSPECTION TYP( PATE JNTITIALS COPE f INSPECTION TYPE pATE 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/Retainirtg Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site b-ul�� 204 Final Demolition 250 Final Building/Occupancy 0..024,-00..024,-0 • 5111 We CITY OF COSTA MESA 4 BUILDING DIVISION I. • rr,xr .4I DEVELOPMENT SERVICES DEPARTMENT - PERMIT NUMBER i. 1 w...�a 1 k • PERMIT �� .arm ► M02-00053 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 3078 YELLOWSTONE DR Status: ISSUED Suite No Applied: 02/01/2002 Issued: 02/01/2002 Vicinity: Parcel Number: 14107217 ISSUED BY: 4/, Applicant: COOTER, LYLE Address: 23725 ROSCOE.BLVD _ - Phone: 818-988-8110 - - . WEST HILLS,CA' • ' Zip: 91304 '- . Owner: - DEVLI N, THOMAS HUGH - Address: 3078 YELLOWSTONE DR _ - • - - - Phone: - - COSTA MESA;CA Zip: 92626-3028 Contractor: E L PAYNE COMPANY - • Address: 23725 ROSCOE BLVD ' Phone: 818-988-8110 WEST HILLS,CA.. ' ' Zip: 91304 , •License:120228 - , SCOPE OF PERMIT ' MECH PERMIT TO CHANGE-OUT A FAU IN AN EXISTING SFD. 1 INST FAU< 100K BTU. NO OTHER WORK WITH.THIS PERMIT. -: - -- - . -, , • FEE SUMMARY Quantity - Quantity ISSUE FEE $23.50 _ • ' - -Repair/Alt Absorbtion Unit ' $0.00 0- Inst FAU<100 k BTU $14.807`1- , - ` Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 -'0 - Ventillation System , ' $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 - Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Rettig Sys>100 k BTU $0.00 0 _ Compressors/Absorption Systems Gas Piping $0.00 0 ' ' - Up to 3 hp/100 k BTU $0.00 0 Factory.Fireplace $0.00 0 • . 3 To-15 hp/500 k BTU •$0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp 0,000 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 v $0.00 0 Over 50 hp/Over 1,750 BTU $0.00/ 0 Appliance x$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 TOTAL CALCULATED FEES $38.30 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have end 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' ompensatlon Insurance carrier and policy number ere: G C /U (o c2-9Carrier: f—/- CI-6 ( I r Policy Number: 44-1 (This section need not be completed it a permit is valued at one hundred dollars($100)or less) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. _ 25:)°° Applicant Signature: • Date: �/ WARNING:FAILURE TO SECURE WOPENSATION 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.Lic.# 5 Class N ,'�gZ o /4 r < t Contractor's Signature: Date: ��" 5. CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: _ _ Signature: _ _ Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ 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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers 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 Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and 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 a plication 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 ❑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? ❑Yes ❑No 8 (If"yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature f Legal Owner(s) Date / —� nd/ 'zed Applicant ✓ Date BODE I INSPECTION TYPE PAIS 1NTIi1ALS p,ODF( INSPECTION TYPE �L PAIE /� 1616 Fixed System Final Fire Prevention - _ 206 Final Mechanical -ao-O a A/ 1268 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 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION P=RMIT P,ERMITklO. 4 TRACT NO. LOT NO, UNIT NO. A P # Zone Project Address 3o yEL[..`�WSj'GlU '�j Q+r- _/J1.. ' �.w - rI � t S Main Building: Accessory Building: Applicant's Mailing Ad ss # /OGS �•� ✓in- C./.'t• TYPE OF CONSTRUCTION D NEW U ADD LJ ALTERATION HitEPAIR E • Z r Y ❑ CONVERSION ❑ DEMOLISH ❑ OTFR ' T Front 0 Owner's Name 101.1 �EI/L�.J Phone•� ��y6� 8ESCRI TION 0 ORK/USE OF BLDG. rea-ccry- - - B Rear N Address 'a on ye 0 0'�/� c,1'i- -__ _ A_ V)A - :., •J. ✓ o+'-- a e - ' - I TYPE OF PERMIT II GRADING it DUNDATION II STRVCT RAL C Right N Arch/Eng. License No. K G Address / p� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left R Contractor's Name L f•-''s/ er ,6. /N�- Phone 6,7 -. ❑ OTHER vI^/''�JS Ping. Ref.# Parking Req./Provided Q Address(mailing) ! Nt ✓7� a� PROJECT DESCRIPTION SQ. FT. OCCUPANCY - M //ms�ss,.,�j VN VALUATION$ ��{{{`"""'�III o-i PlanningNotes: 33 TS CONST RUCTION TYPE T City LLICENSED CONTRACTOR ZONE GRADING CU.YDS ACRES S. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: i • with section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and fect. /�-j''rt ELECTRICAL FEES License ss C.3 License No. '7'� .0 - Date "—i2-89 Signature Ir- - PLUMBING FEES Automatic Washer Transformer 0 15.50 KW -' '+R KERS'COMPENSATION DECLARATION `� Construction Pole Sub. 0 50+KW reby affirm that I have a certificate of consent to self-insure Or a certificate Bar Sink Show¢fs Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps 3800, Lab. C.)' 0962 Dishwasher Meter Clover 100 amps Policy No. Company Backflow Irrigation Sewer Cap _ Saarrttified copy is hereby furnished. Dryers ❑Gas DElectric Sub Panel Date re--Certified copy it Uled with the city Building Divlsiorp Bathtubs Sewer Connection Date e/-/Z' -)`� Applicant L/,.+d 6+�T 4-stP1N G Fan Motors ❑0-1HP 011/2-8 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors (This section need not be completed if the permit is for one hundred ($100)or Dishwasher Solar Piping F.A.U. Inc.Solar 09-15 HP-❑16-15+ less). I certify that in the performance of the work for which this permit is Issued, I Fixtures shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave Workers' Compensation Laws of California. Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light ONOTICE:If,after making this declaration, you should become subject to the - Outlets Range Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal /�+ comply with such provisions or this permit shall be deemed revoked. G.... CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign 1 I hereby affirm that there is a construction lending agency for the performance 1 of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections Lender's Name 1 Lender's Address Kitchen Sink Water Service _ Generator 00-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION IV/tl I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains a Contractor's License Law (Chapter 9(commencing with Section 7000)of fision 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee ! $15 Issue Fee $ 3 .erefrom 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). DEVELOPMENT SERVICES REQUIREMENTS: ❑ I, as owner'lbthe property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 Zoning Approved By Date compensation, will do the work,and the structure is not intended or offered - for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By License Law darts not apply to an owner of a property who builds or Improves __ __ _ Data, thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I ❑ Application Issued By / Dat — -� employees, prodded that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 SUMMARY OF FEES platten, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground prove for the purpose of sale). BUILDING PERMIT $ ,2 SMIP $ _O— O I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $ builds or improves thereon. and who contracts for such nroiects with a con- _ tractor(s) license pursuant to the Contractor's License Law). I am aware'that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $ O I am exempt under Section B. & P. C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers— PLAN CHECK 50% $ MICROFILM $ Date Owner Heating System& Ducting Registers _ MECHANICAL $ TOTAL FEE $ Z Y I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BTI. PLAN CHECK 25% information is correct. I agree to comply with all city andcounty ordinances $ and state laws relating building construction, and hereby authorize repre- sentatives of this i to enter upon the above-mentioned property for _tr.spection purpos �,1-s p� _ Signature - Date L U• Reins ection Fee $15 Issue Fee $ 3Illir kik, n• - Drivers' License or SS "` P �? IQs v2._uJ'��7(]f'�7b.: -f-p�g T, 0865.46,rev. 5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor Ortlt: 09/12:8; TLE: C/7'i. CONSTRUCTION AND PLANNING • PO a SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical.Conduit'Utility-Undrgrnd' 54. Forms 4: Electrical Conduit-Undrgrnd. • - 55. Electrical Bonding 5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Gr-nd 57. APPROVAL TO COVER-GUNITE 7..Footi ngs - 58. Electrical Conduit-Undrgrnd. 8.-"Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10..Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing-. 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank D Gas D Oil 25. Roof,Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation . 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat! 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning l 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING Y h J1 It31 pitez 48. Special Requirements Completed 1111 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co - • 51. CERTIFICATE OF OCCUPANCY No. Date • PROJECT ADDRESS: 3078 YELLOWSTONE DR UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 052099 OWNER'S NAME: DEVLIN JOSEPH T ADDRESS: 3078 YELLOWSTONE DR PERMIT NO: B 052099 PLAN CHECK NO: 01719-91 S GOVT: N SUPP: N COSTA MESA,CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH 546-1461 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : 208LF-6FT HIGH WOOD FENCE W/BLOCK PILAST SQ FT: 208 r ADDRESS: UNIT: CLAIM VALUE: 2, 100 . 00 CALC-VALUE: 2, 080 . 00 GROUP OCC: R-3 / PERMITTEE: JOSEF DEVLIN ( 714 ) 546-1461 ADDRESS: 3078 YELLOWSTONE COMMENTS: X C.M. CA 92626 *******>t+P**fEx*******************************aE** *******+tiE********************** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code, and my license is in full force and effect, SETH ACK S CITY LIC.: STATE LIC.: CLASS: Date, Signature. MAIN BUILDING . ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation insurance.or a certified copy thereof,(Section 3300,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: ' ` COMPANY: PARKING REQ• PROV: PARCEL: 14107217 ZNE• R1 REF NO: ❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> 208 LINEAL FOOT BLOCK AND WOOD FENCE ALONG REAR AND > SIDE PROP, LINES, Date: Applicant: *************************** *****************************************_********** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D E V E L O P M E N T SERVICES R EQUIR EMEN TS I certify That in the performance of the work for which this permit is issued.I shalt not employ any person in any manner so as to become . subject to the Workers'Compensation Laws of California. ZONING APPROVED BY Sr c DATE: j I C, (moi �. Date: Signature' BUILDING APPROVED BY : DATE: NOTICE:de, If. making this ywideclaration.youh should become this pert the Workers'merempensation provisions of the Labor r - Cotle.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPL I CAT ION ISSUED BY: DATE: - . J I which this permit is issued(Section 3097.Civ.C). *********************************************** * ******ie************* * 4:4** LENDER: ******************************************************************************* ADDRESS: . LEGALIZATION:N F E E SUMMARY - STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm mat I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 54 . 00 ,50 repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 35 . 10 and Professions Code)or that he/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 penally of not more than five hundred dollars($500). ISSUE FEE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE AA PJ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 54 , 50 0,00 3 5. 10 89 . 60 8 9 , 6 0 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 89 . 60 OVER/SHORT• 00 for theepurpose sold le) one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK for the ipumprovement is dale) I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 . 00 50 35. 10 ❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of property who builds or improves(hereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ************'******************************************************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.A P. for this reason: N. - / YPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date:M.dKy Ica, IoiciI ow .. ..we_ a •,� -• • - - SFR 208 RES-PILASTER WITH WOOD ETC BET/ FT. 10. 00 2, 080. 00 I do hereby certify that I am aware of and understand the requireme of Cali rrnia Heal e d Safety Code Sections 25505,25533,and END OF FEES 5534 and that I or any future building occupant will/will not(circle ne)need t comply said state codes and the requirements for a permit for construction or modification from the Air Ouality Maned ment Distr;t.Residential construction applications are exempt from (hese provisions. Dale: Applicant: I hereby certify that I have read this application and state that the above information is correct,I agree to comply with all city and county p ri7 r .m — — ordinancesandstatelawsrelating to building cow L, ion and hereby authorize representatives of this city to enter upon the above-menboppped 01 0002719—'—OOiJ1.�•`)r a C: , 1,/... property for inspection purposes. i • �_,r _ r r� • 14:3'. t / //�� ` DATE: 05/16/91 TIN- 1)// Date: IT. I LD, '"it i— Signet ti •\ _ _ Driver's License or Social Security#: 1641-46 White—Building.Green—Code Enfor vent:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor • CONSTRUCTION AND PLANNING FOUL & SPA APPROVALS Permit# Date Inspector APPROVALS Permit • Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3: Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test -- 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. '10. Structural Floor System 61. APPROVAL TO DECK • -,11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final • 13. Roof Drains 64. Plumbing System - Final 1 14. Rough Plumbing - 65. Electrical-Final , 15. Rough Electrical-Conduit 66. Solar System-Final , 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING - 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace - + APPROVALS' ' Permit# " 21. Ducts, in Structure • - .70. Underground Hydro 22. Ducts, Ventilating. • - - : 71. Product,Piping 0 Gas 0-Oil 23. Gas Pipe-Rough &Test i . 72. Underground Flush 24. Roof Framing ° -73.: Undergrnd.Storage Tank 0 Gas 0 Oil • 25. Roof Sheathing - ; ' - , 74,,Overhead f-lydro 26. T-Bar Ceiling (Structural) &•Monocoat - ' _ ' 75. Dry Chemical . 27.;Frame and Flashing 76. Dry Standpipe .• 287 Lathing& Siding - . L -. . >' 77. FIXED SYSTEM FINAL 29. Insulation ' . - , .. - f . 78: FIRE PREY. FINAL - . . 30. Drywall7Nailing I HEALTH:DEPT. REQUIREMENT 31. Plaster Brown Coat I. ,79:-FINAL INSPECTION v - 32. Electrical Power Meter-Final j .80..FOOD CERTIFICATE ISSUED 33.;Final Electric - - ! I I. ; ' Notes: -34. Final Heating & Air.Conditioning, ,mi i . - - - - 35.'Final Gas Pipe-Test '3' • - i I I^ ; '. -• 36.'Hood or Canopy - - - . - 37. Final Factory Fireplace - '."' 38. Final Plumbing . .. .,,. 39: Water Service-Finale ' ,40.'Gas Service-Final I 41. Solar Domestic-Final •- • 'r 42. Backflow Preventer. - I , 43. Backflow Irrigation 3 . e ; - - - 44. Landscape Irrigation System : , , 45._Sound Attenuation - - ' 46. Handicap Regulations - ' 47. FINAL STRUCTURE & BUILDING &f 4141 r-' ) . 48:'FINAL PLANNINGI ., - 49. Electric Release to Edison i , .1 50. Gas Relise to Southern California Gas Co , . '51. CERTIFICATE OF,000UPANCY - No. Date . 1.35991 it RECEIVED JAN 1019611 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P.O.BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA N fOR APPLICANT TO flit IN COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING ADDRESS 3078 YELLOWSTONE DRIVE COSTA MESA, CALIFORNIA FOR OFF/CE USE ONLY RECEIPT NO. 11 Anil?)OWNER KWK CONSTRUCT I ON CO INC [-I,I t v MAIL RECEIy Ey BT DATER CEIV D DATE ISSUED ADDRESS 1555 PLACENT I A AVENUE r11 5, /— e—e� I ..:II¢ 1 1 1961 CITY NEWPORT BEACH C. BUILDING L IF . T No -3227 ADDRESS ARCHITECT LIC. COSTA MESA. CALIFORNIA 'f OR ENGINEER NO. FIRE -VL(� L ADDRESS ZONE TYPE GROUP ._. / \x STATE APPROVED /fin CONTRACTOR K. W. KoLL LIC.NO61195 BY DATE ADDRESS 1555 PLA CENT IA AVE N. IjpJ� ZONING p I4o I ZONE I NO. I USE OF NEW b14& fart LEGAL ILO. 26 • DESCRIPTION NO. BLOCK TRACT R-1 PLANS 2 BUILDING w att APPROVED NY none BY W.L.D. /,x/1/6 DATE 1-6-61 SIZE 60x 1 00 I NO.OF BLDOS. YARDS �//EKES OF LOT NOW ON LOT 0 REQUIRED ALLOWED " USE OF (CENTER LINE ST.) q�, n EXISTING BLDG. FRONT LL0 FT. C a . ?'j AN. SETBACK LINE FROM 1 CENTER OF STREET ko I REAR YARD 'J 0 :, R.SIDE '" FT. IN. • SIDE YARD I LEFT 51 RIGHT 5' : L.SIDE C FT. IN. DESCRIPTION OF WORK REAR V(J FT. IN. NEW I X II ALTERATION I II ADDITION I . REPAIR I II MOVING I II DEMOLISH I BUIL' SIZE ROOMS 1485sF NO.OF ROOMS 7 STORIES 1 _ EXTERIOR WALL G C O I ROOOF NG OMPPCO'fSIIII.}(T;ION USE OF BUILDING AND WORK TO BE PERKO�MEb EG SINGLE F. • • I. e . $ is. )..i ATTACHED GARAGE PLAN No. 4-C `/ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT A AGREE TO COM- OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORD NANCES AND STAT AWS R ATI NG BUILDING CONSTRUCTIO VALUATION ..SIGNATURE OF / M'� /�/ PERMIT FEE $ a 5--.---- PERMITTEE �/w L / $ /,5/ Y// PLAN CHECK $ / 7 - AUTHORIZED AGENT t ��'�1 TOTAL FEE 8 (/ JOB SITE 3018 •/e L.LCOW 'SSTC) 1%,1E • ZIP CODE C211.211.CO 2.421 O 1 P/L---________Er. P/L 18' P/L 3 f MBED BED3 II 4 2 BED2 MBATH 1 BED1 " - BATH P L nilril -. Pt 1 - STORY SFD 22' YELLOWSTONE . IS a• !c- .r �y'" ..,--0,, , ,eT1.) ,,, X16 ,,,..2---.,=.4.2 -,-;,:,,,` * - s .-..�-4-.'.,:�—..1:1-4-4- 4,:------- v � - _ Window&Door Replacement A. In the space provided, sketch a goon plan indicating all adient NO. ROOM EXISTING WINDOW / DOOR NEW WINDOW / DOOR rooms and their square Wages, esthg windows and doors, SIZE / TYPE SIZE / TYPE tocationsofwindow and door replacements. 1 BED1 69 X 33 ALUM XO WINDOW 69 X 33 RBA XO WINDOW 8 Atl windows must meet UBC Sed. 2406 for Safety Glazing. The 2 BED2 69 X 33 ALUM XO WINDOW 69 X 33 RBA XO WINDOW following locations require safely gig(temper or laminated)b 3 BED3 69 X 33 ALUM XO WINDOW 69 X 33 RBA XO WINDOW beetch n ed' 4 MBED 69 X 45 ALUM XO WINDOW 69 X 45 RBA XO WINDOW 1. Glass in doors 2. Glass in windows within 24'from doors and less than 60'high 3. GSaang within 5feet from pod or spa 4. Glaring in windows at shower or bathtub and stair landings less Owner TOM DEVLIN Contractor Address than 60'above surface Address 3078 YELLOWSTONE 1621 E. St. Andrew Place C. Ad construction shall comply with tut 2001CafdomiaBuilding Code City,Zip COSTA MESA, 92626 Santa Ana, 92705 M windows aro rated with 201bslsf of wind bad All windows must meet UBC Sec 1203 for tight and Ventilation Phone 714-546-1461 714-259-5120 Ail replacement windows and glass doors must comply with the Prepared By: Steve Janosik California Energy Code,with a U factor 0.67 and SHGC 0.40 D. Rooms that can be used for sleeping purposes: All New Windows and Doors Have Dual Glaze, Low- E Glass • Smoke alarms per UBC 310.9 Unless Otherwise Stated • Al least one window or door opening directly to the exterior and the window must meet the following criteria: LEGEND Mm.net dear area: 5.7 sq.R Mm net dear height 24' XX Slider-.Slider AWN Awning Window Max.sill height 44' Min.net dear width: 20' XO Slider- Fixed DH Double Hung Window E. Replacement windows that alter the existing moisture barrier must GW Garden Window SH Single Hung Window - provide the following: CST Casement RBA Renewal By Andersen moist-stop gashing around windows and doors. &tdmUtane at PIX Picture Window AND Andersen Vinyl Clad Patio Door vertical to horizontal fnterseclbns.Exterior stucco per UBC Chap.25 with 60 mit building paper. Separate Inspections for each phase of stucco construction:scratch,brown and color.Two layers of Grade D O B: 17 9 5 0 m b paper at all exterior wags with wood base sheathing end stucco coveting per UBC 2506.4. Provide 4'and 2'dearance horn weep screed to grade and paved surface respectively per UBC 2506.5. F. Doors that swing outward must open over a landing that is not mom than 1'tower than the interior finished floor level.The landing must SCOPE OF WORK: he as wide as the door(s)and extend out a minimum of 3 feet. RETROFIT 4 WINDOWS WITH ANDERSEN RENEWAL WINDOWS INTO t EXISTING OPENINGS _ NO OPENING MODIFICATIONS _-- — — NO HEADER CHANGES Di al -- al - - - �' o Donkp�Spectrum renew . 1 „inc. :: oil u.1 Windows &Doors • Window Replacement Specialises Energy Efficient Windows&Doors ,a.-- -.- '