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Home My WebLink About3166 YELLOWSTONE DR - Building Permits M6 CITY OF COSTA MESA 4 a BUILDING DIVISION �y�,4 F i r,_,� � I DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER 4 � PERMIT E06-01490 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaELECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 3166 YELLOWSTONE DR Status: ISSUED Suite No Applied: 12/15/2006 Vicinity: Issued: +006 Parcel Nunmber: 14153128 r fa Applicant: IBANEZ, ADOLFO B Address: Phone: 'r '¶ ' cls OED BIS• ei Zip dd, r Owner: ESPARZA, SEGUNDO GUSTAVO ' Address 3166 YELLOWSTONE DR Phone: 714-546-4213 COSTA MESA,CA- - Zip: 92626-3044 Contractor: ECONO AIR. - _ Address'. 3101 ENTERPISE STREET , Phone: 800-503-2666 BREA,CA Zip: 92821 License:445220 SCOPE OF PERMIT , . UPGRADE SERVICE PANEL TO 200A FOR A SFD. 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 $0.00 "0 - up to 50 kva/kw - $0.00 0 Recept Outlets ' $0.00 ' '_0 up'to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 - 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 . 0 Low Volt Wiring.System/Ckt $0.00 -0 Service to 200a $30.50 1 Misc.Conduit $0.00 - 0 • Service to 1000a $0.00 0 '- -Misc.Conductor $0.00 0 Service over 1000a $0.00 0 • Circus(gen or ride) $0.00 0 Motors to 1hp ' $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to tohp $0.00 . 0,-.r, Christmas Tree Stand . $0.00,' 0, Motors to 50hp. ,, $0.00,.' S-"-of '. -Fireworks Stand ,‘ $0.00 0 Motors to 100hp' ./ '. $0.00. ' 0 Other Electrical Fe $0.00 Motors over 100hp , ' $0.00 -+_, c, 0 ' - Communication drops, ' '$0.00 0,0- ,, Investigation Fee - $0.00 Sub panel to 200a , -$0.00`. , ' 0 Plan Check Fee $0.00 ' Pole Light Pkg , ," .$0.001 - ` 0 ' - ' 'Reinspection Fee - $0.00 Sign Circuits $0.00 ' ' 0- , , Temp Pwr Pole $0.00 ' 0 TOTAL CALCULATED FEES ' $54.00 Intermed Pole $0.00.. 0 " - -COMMENTS 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) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O 1 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. j ._,.,aMy 4ork rs'compensatio nsurance carrier and policy number are: ! -` Policy Number: �S£6(G I cry ra (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these,prowsl s. 12 /�no c `WA`WARNING: FAILu E T:'� t Date: `THOU AN FAILURE TE( SECURE W ERS'C ThE ASI EPENS IS UNLAWFUL AND SHALL SUEUECT N TOV376O THE AL PENALTIES I AND CIVIL FINES TP N ONE'SHUNDRED THOUSAND DOLLARS(Sta0,a)0),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION OF3706THE 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 a Contractors Signature. ,Date:- ' CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). 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(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.). D I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑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? ❑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? ❑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? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 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 stale 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. Sign a ne� to 0 _ z —/�� e C ' OrAuthoriieWAp cant Fr—Date-0 coos r INSPECTION TYPE RAil INTRIALS CODE• INSPECTION TYPE PATE JNTf11ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ger Final Re-Roof 210 Final Electrical /®6 201 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 _ 1 r CITY OF COSTA MESA , r BUILDING DIVISION Y ! " ; DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER ' 4. Ira • PERMIT M06-00688 wry (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 3166 YELLOWSTONE DR Status: ISSUED Suite No Applied: 11/01/2006 Issued: 11/01/2006 Vicinity: Parcel Number 14153128 ISSUED BY: Applicant: JOHN PENSO Address: 3101 ENTERPISE STREET Phone: 800-503-2666 BREA,CA Zip: 92821 Owner: ESPARZA, SEGUNDO GUSTAVO Address: 3166 YELLOWSTONE DR " Phone: '+st v.., yak 'i 'w"T - - COSTA MESA,CA Zip: 92626-304 'T I ° ru Contractor: ECONO AIR ' _ Address: 3101 ENTERPISE STREET " Phone: 800-503-2666 , BREA,CA Zip: 92821 License:445220 SCOPE OF PERMIT CHANGE OUT OF AC AND FAU FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 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 $14.80 1 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 • Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0,00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers . Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 . 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp .,- $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp '4 - $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 $53.10 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1,12.21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754.5626 2446-46(6x0) - 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. ve and will maintain workers'compensation insurance,as required by section 3700 of the Labor C••: • .. ... ermance of the work for which this permit is issued. My w ere'compensati�on InsuranceIcarrier and policy number are: / Carrier: 4 e��o�--••L) Pot W 1/4\-.1) /T4 `f'6r3 ection need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance the for w • his permit is issued,I shall not employ any person in any manner so as to become subject to the workers' co tion laws of Califs an ee that - ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith th Se provislo /— 6 5 hcant SI nate / 2 /X" e: l�_ URE TO SE RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECTANadapySAT TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND OOLLARE($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 C.• :,CTORS DECLARATION: I h:�-,•• • am licensed under rovisions of Chapte (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full �— IIL# 44o aa° i ,� Cleaaa �o �G2 ' ,or ntractor r.".nature: Br / - /- CONSTRUCTION LENDING AGENCY: 9 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Cade:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No 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 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the 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 feel 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 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (if yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANC - D 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 co •ly wit. state laws an, ity ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pr.•.rty f• .pection pu •o I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Ai ..3 • �Jy (s'• I . Ac5 And/Or Auth• ' _• plica CODE# INSPECTION TYPE BRIE INTRIALS CODE INSPECTION TYPE 1616 Fixed System Final Fire Prevention 206 Final Mechanical r /7 7 ./g, 1266 'Pool Spa Final 206 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 40. 411 Q c___- 1)„ APPROVED CITY OF COSTA MESA PLANNING DIVISION P� SUBJECT TO BLDG. DEPT. REG. NOTE:ADDITIONS, DELETIONS, S/, OR CORRECTIONS SHALL BE APPROVED BY THE PLANNING DIV. \b eS?-- BY: DATE: k. �. 11 i Era �\ 44a- CITY OF COSTA MESA• BUILDING hiVISION t.nraa,ani.t �r DEVELOPMENT SERVICES DEPARTMENT PER NUMBER 01011411 • PERMIT 04-01624 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3166 YELLOWSTONE DR Status: ISSUED Suite: Applied: 09/16/2004 Vicinity: ROOF Issued: 09/16/2004 Parcel Number: 14153128 Zoning: R1 R1 Applicant: FIRST QUALITY ROOFING ISSUED BY: Address: 405 S BENGAL ST Phone: (714)571-0120 SANTA ANA,CA Zip: 92704 Owner: ESPARZA, SEGUNDO GUSTAVO • Address 3166 YELLOWSTONE DR Phone: COSTA MESA,CA Zip: 92626-3044 Contractor FIRST QUALITY ROOFING Address: 405 S BENGAL ST Phone: (714)571-0120 SANTA ANA,CA Zip: 92704 License: 776969 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 30#FELT,40 YEAR COMPOSITION SHINGLES,AND REPAIR/REPLACE SHEATHING AS NEEDED.29 SQUARES INCLUDES ATTACHED GARAGE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $5,400.00 Permit: $125.25 Claim Valuation: $5,400.00 SMIP Res: $0.54 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.79 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right .0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) 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. 1 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 workersyorppense on Inure ccee carrier and olicy number are: CACamer" -V I" '- t tents. - (This section need not be completed Wil a peA/it_Is valued et 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 Callforni:,an. :. ee that II I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi ' (� ri WARNING:FAILURE TO SECUR•• •R S'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,...,IN ADD f ION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR COOE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereb affirm that Imam licensed under provisions of Chapter 9(commencing with Section 7000)of Divisio theSusiness and Professions Code,and my license Is In full Com ,."4lio"•fY'.' •f o '_ / • 9a.k ContracjcaSignBture:--"— Date- '.-. 0 67 CONSTRUCTION LENDING AGE CY ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 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 California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous 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 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? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penally 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 Of Legal Owner(s) Date And a�Am oozed Aepltc`m— F * to .p_ A / CODE I INSPECTION TYPE PATE 'MALS CODE If INSPECTION'Mg MALI MALI 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final •1� 208 Final Plumbing n 200 Final Re-Roof -1— L3 OM. ►i`#‘ 210 Final Electrical 201 Final Block/Retaining Well 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