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HomeMy WebLinkAbout3089 YUKON AVE - Building Permits F 9 CITY OF COSTA MESA _- • pC BUILDING DIVISION r F°0-rrilINIENn- Il•8 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ;• PERMIT 4144b em,o'49 02-00026 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT . Job Address: 3089 YUKON AV Status: ISSUED Suite No Applied: 01/09/2002 Issued: 01/09/2002 . Vicinity: BATHROOM Parcel Nunmber: 41806205 ISSUED BY: Applicant: MORAN, JAVIER Address: 3089 YUKON AVE Phone: (714)708-2826 COSTA MESA,CA Zip: 92626 Owner: MORAN, JAVIER Address 3089 YUKON AVE Phone: (714)708-2826 ' COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT ' PLUMBING PERMIT FOR ADDITION&REMODEL OF EXISTING SINGLE FAMILY RESIDENCE. INSTALL 1 SHOWER, 1 WASH BASIN,& 1 WATER CLOSET. REF:801.01801 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub I Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units - $0.00 0 Septic Tank $0.00 0 Wash Basin $9.80 1 Dishwasher 50.00 0 Sewer Cap for Demo $0.00 0 / Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line - $0.00 0 Water Closet(Toilet) $9.80 1 Drain, Roof $0.00 0 Shower $9.80 1 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $52.90 NOTICE: The work authorized by this permit etSIONINLEA i6 dl6da6&AkIG01d611E1113fdarequirements 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 fora 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 l ' 2446-413(WOO) 4/ DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND COLLARS($10,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTiON 3700 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.a Class It_ Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: - Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): r^_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: grwture 4./2///P2ti&n/. it= //DV s. Owner ID verified by drivers license. 0 Yes 0 Na DrivLicense No. / l�bipires-0.V-7,7c 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 bo 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 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 then 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 Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application 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 Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 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 Safely 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.Igree 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-d cribed pro r for ins tion purposes.I agree not to occupy or allow occupancy of any building authorized by is permit until final inspection. �ll�eo �plG+ //) ©/ 07/9Z— g ure Of Legal Owner(s) a—_ And/Or Authorized Applicant Date CODE I INSPECTION TYPE PAIL DfAL3 - ODE! INSPECTION TYPE UM ILLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical ^ �} 1266 Pool Spa Final 208 Final Plumbing J�C-3-0a 10r.' 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 Sin 4I CITY OF COSTA MESA 6 BUILDING DIVISION )ii . i �( DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER V• P • PERMIT • E02-00019 moo (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 3089 YUKON AV Status: ISSUED Suite No Applied: 01/09/2002 Vicinity: ADDITION&REMODEL Issued: 01/09/2002 Parcel Nunmber: 41806205 Applicant: MORAN, JAVIER ISSUED BY: Address: 3089 YUKON AVE . Phone: (714)708-2826 COSTA MESA,CA Zip: 92626 Owner: MORAN, JAVIER Address 3089 YUKON AVE Phone: (714)708-2826 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip . License: 0 SCOPE OF PERMIT ELECTRICAL PERMIT FOR ADDITION&REMODEL OF EXISTING SINGLE FAMILY RESIDENCE. INSTALL 9 LIGHTING FIXTURES,9 RECEPTACLE OUTLETS,&7 SWITCHES. REF:B01-01801 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 $9.90 9 up to 100 kva/kw $0.00 0 Switches $7.70 7 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 ' Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee • $0.00 Motors over 100hp $0.00 0 - Communication drops $0.00 0 Investigation Fee $0.00 • Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $51.00 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 i" 244640(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued, My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not bo completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THO JSAND DOLLARE(S400.000).IN AODRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 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.0 Class 0 Contractor's Signature: Date: CONSTRUCTION LE\4DING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): 1;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. T`-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 properly 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 s_ec./ L Business and Professions Code for this reason: lgnature:-TL// 4//GO T/ cal xpires:n.C` 304 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(38)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? ❑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 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�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). _ .__.._.._ .__ 0fee—_........__.._boon __D _....__.—__ 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). the South en_.ty IfpermitQualitydistrict the work which is the subject of this application,have all of the disclosures prescribed by Californiaia Health and Safety Coda Section 42303 been made? ❑Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I ren not to occupy or allow occupancy of any building authorized by t permit until final inspection. oel Sign&D7ie.Ol.Legal ner(s) / 'Bete—_ And/Or Authorized Applicant Date CODE• INSPECTION TYPE PATE INTITIAL5 SODS! INSPECRONTYPE MI EOM 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing — n J 200 Final Re-Roof 210 Final Electrical ale 201 Final Block/Retaining Well 212 Final Flre Prevention • 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - -. 250, Final Building/Occupancy l -i M ,\ti r 5111 CITY OF COSTA MESA BUILDING DIVISION >• ( ,)170n; �r g DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F1 /� t!P PERMIT J' RyNPAcourist 601-01801 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3089 YUKON AV Status: ISSUED Suite: Applied: 11/13/2001 Vicinity: REAR OF DWELLING Issued: 01/09/2002 Parcel Number: 41806205 Zoning: R1 R1 Applicant: MORAN, JAVIER ISSUED BY: Address: 3089 YUKON AVE Phone: (714)708-2826 COSTA MESA,CA ' • Zip: 92626 Owner: MORAN, JAVIER Address 3089 YUKON AVE Phone: (714)708-2826 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 Arch : Eng: - • Address: Address: Phone: Phone: Zip: License: • • License: SCOPE OF PERMIT 474 SQ. FT.ADDITION TO A SFR.ADDITION TO INCLUDE A MASTER BEDROOM EXTENSION AND WALK-IN CLOSET FOR MASTER.ADDITION ALSO TO INCLUDE A NEW BEDROOM AND A NEW BATHROOM. REVISED FROM 600 SQ.FT.ADDITION PER PLANNING REQUIREMENTS. FEE SUMMARY - Plan Check: $427.54 Calc Valuation: $51,300.00 Permit: $657.75 Claim Valuation: Sono SMIP Res: $5.13 SMIP Corn: $0.00 Other $0.00 Inspection: $0.00 • • Total: $1,090.42 PLANNING &ZONING • SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: COLLI KJ 01/08/2002 REVISE PERMIT FEE. FEE WAS BASED UPON 600SF ADDITION; APPR PLANS NOW SHOW 474SF ADDITION. DO NOT REDUCE ORIGINAL PLAN CHECK FEE. COLLI KJ 01/08/2002 FEES REVISED TO REFLECT SQUARE FOOTAGE REDUCTION PER MARTHA FORD'S COMMENTS. NO FURTHER ADJUSTMENT REQUIRED FOR PERMIT. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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) 't • -1/4 • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued: ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,end agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: _ _ Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),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 4 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm Fiat there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Cade). 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 end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): _I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. Yom.-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 exert/under sec. Business and Professions Code for this reason: ' attire:`'L,, in 1 ,�Explres: OZ z.3'OG 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? ❑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 Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and tiling 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 a plication aggermit for such construction or modification from the South Coast Air Ouallty Management District or from any other air pollution control district or agency? Li 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 ❑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 Duality Management District or other air pollution control district or agony is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No B (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agre 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-descn dd�p�ropperty for inspecctiourposes.I agree not to occupy or allow occupancy of any building authorized by this perm) until final inspection. lw4e /t of 0''1 01 07 002 Signature Of Legal Owner(s) And/Or Authorized Applicant Date CODE 1 INSPECTION TYPE RAIL INTTTULS CODE INSPECTION TYPF PAIS 1ffImALS 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 1 204 Final Demolition - -. 250 Final Building/Occupancy 7 / -C z— off 0 CITY OF COSTA MESA q 4 ) BUILDING DIVISION F -►I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT J�y -`<pPara le Ra 02-00007 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 3089 YUKON AV Status: ISSUED Suite NO Applied: 01/09/2002 Issued: 01/09/2002 Vicinity. ADDITION&REMODEL Parcel Number: 41806205 ISSUED BY: Applicant: MORAN, JAVIER Address: 3089 YUKON AVE Phone: (714)708-2826 COSTA MESA,CA Zip: 92626 owner: MORAN, JAVIER Address: 3089 YUKON AVE Phone: (714)708-2826 COSTA MESA, CA Zip: 92626 Contractor: OWNER-BUILDER Address: -Phone: Zip: License:0 SCOPE OF PERMIT MECHANICAL PERMIT FOR ADDITION&REMODEL OF EXISTING SINGLE FAMILY RESIDENCE. INSTALL NEW VENT'FAN&AIR REGISTER&DUCTWORK FOR NEW BEDROOM. REF:B01-01801 • FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 • Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $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 $7.25 1 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 SO 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 $44.45 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 2466-18(aroo) DECLARATIONS ' WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. . ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: ' (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML 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.x Class a Contractor's Signature: Date: CONSTRUCTION,IIENDING 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 end 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).): jI„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.). 0 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 0 I am examg�under sec. Business and Professions Code for this reason: 6ignalure: N(L(//er ', l.7 _trizibg/D Z l Owner ID verified by driver's license. 0 Yes 0 No D_ripeY4 Cfcense No. _„•, &pirgs:.f�/Qat c Verification of Ownership by(type of document,i.e.-property tax bill or deed): kr 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 e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 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 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apemit 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 LU 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). ....Management g mn...i..i.t. other e e r. o lti n. o... 7 a permit fromv the South Coast res prescribed by gement Di Heal or Sr et pollution coon 4l district3 agency is required for the work which is the subject of this application,have all of the disclosures by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-des ribed property for inspectio urposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. above-des 0/A77/2.9-- Signe re Of:Legal ner(s) Date eft-- - And/Or Authorized Applicant Date ;ODE I INSPECTION TYPE gall INTTALS CODES INSPECTION TYPE rr �f2AIE 1618 Fixed System Final Fire Prevention _ 206 Final Mechanical 5' S-Ca 1266 Pool Spa Final 208 Final Plumbing -. _ 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place - 220 Final Planning Approval , - 203 Final Sign 222 Final Site 204 Final Demolition . 250 Final Building/Occupancy CITY OF COSTA MESA 4 49@@ BUILDING DIVISION >:� ,• DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t Ira . PERMIT /B01-01634 J' , (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3089 YUKON AV Status: ISSUED Suite: Applied: 10/15/2001 Vicinity: BLOCKWALL @ RIGHT SIDE PROPERTY LINE Issued: 10/15/2001 Parcel Number: 41806205 Zoning: R1 R1 Applicant: MORAN, JAVIER ISSUED BY: Address: 3089 YUKON AVE -Phone: (714)708-2826 COSTA MESA,CA Zip: 92626 Owner: MORAN, JAVIER Address 3089 YUKON AVE Phone: (714)708-2826 COSTA MESA,CA . Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 71 LINEAL FT OF 6'HIGH BLOCKWALL,ALONG RIGHT SIDE PROPERTY LINE. FEE SUMMARY Plan Check: $35.10 Calc Valuation: $1,420.00 Permit: $54.00 Claim Valuation: $0.00 SMIP Res: $0.00 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $89.10 • PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 - Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 29-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-48(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 Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: • Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a per+' rsubjects.the applicant t0 a civil penalty of not more than five hundred dollars($500).): -❑—Icas caner 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 pursu nt to the Contractors License Laws.). ❑ I I am exemp under sec. Business and Professions Code for this reason: �igniture:_ LDat if n‘,Owner ID vert ied by drivers license. 0 Yes 0 No Drivers License 'No. _ (�J xpires: 110 '2 3-0C Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof.will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). __ _ _ _ _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a permit 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 IJ No (Section 65850.2 of the California Government Cade 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 Duality 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 ree to comply with all stet laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-de ribed property for ins ec'�/Ypurposes.I agree not to occupy or allow occupancy of any building authorized by this ermit until final inspection. ii� Pry - era d l /0 (S�01 Sign to OfLegal ner(s) (Date And/Or Authorized Applicant - Date ;ODE I INSPECTIONTYPt MI I8151:1ALS ;ODEf INSPECTIONTYP[ PATE JNTRIALq 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 I0/2-�Dy 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 •THIS SKETCH IS FOR INFORMATIONAL PURPOSES •SOW WALLS/FENCESBETWE '&6'NO F�•]GHT SHALL ONLY. APPLICANT IS RESPONSIBLE FOR PROVIDING BE StTBAIX AT LEAST](Y FROM FRO 2 4FRONT PROPERTY LINE AN ACCURATE REPRESENTATION OF THER PROPERTY N CASE THE SHAPE AND SIZE DO NOT CORRESPOND • OLID WAINOi EX®7 6'N F�7CHT WITH THE INFORMATION PROVIDED ON THIS SLAT. WTIT�ISId LL THES/FFNC65 FRONTSHALL PROPERTY UNE�IOf CURB l NEE). •VERIFY DISTANCE FROM CURB TO PROPERTY LAZE APP 11I ®�J�j AND SHOW ON PIAN. VE1UFTCATIONFROM THECI YS VE ENGINEERING DIVEION IS REQUIRED. CALL(714)754,5143 CITY OF COSTA MESA f01-0/(0544 POR INFORMATION. f01-0/(054 PLANNING DIV. SUBJECT TO BLDG. DEPT. REG. BYi/,/ .1, Of 10/7 /0/ NOTE ADDITIONS, DELETIONS, OR CORRECTIONS SHALL "PEWIT',"PRO10 nl lri\ :I II\C uivioiUllr • •K I ig C90EMQ tIQ Wm. :a WI 44 �.v;�poi • at‘ SII 0]; OF EU L^uLi1'G SAFET j4 -c CITY OF CC TA MESA 1� I I APPR VED Ii ' Th:s' -- - r-t-'--` - :.__Dae \O'( r;.a �, plansspecificUDC /J i'L h Jt0^fr•;^F e Est at 21 tmm Ili;Brunk:,ur t and '/ C lr.,:: 1,r at .7 c same: r.} I'tn,c•+ltissY,nifromih,Dr `i:.iMing Z C m }a The staind 1plalard secc:.,C D, °. 4l' IVO I a of!!!a 4, I lg n, I. -`,ab to inancc rido { d, .9c"I a / ei an - I n 4 Mew Or ancr and ii I.to ,lav//'� ' RE90ENCE RSOE;•CE RESIDENCE I .. Th esc p 'N..., RC90EN¢ r xmel: l, ntitrait!�bnl ng won;is nal-amp::noes: ? ecr . - 'lR 3;rn>;p>d ar. �'ti!' r- 3'JJ I�iI'fiililfl lv, day. JS ' Ce. ' v F•i r • 30Sq 07 S. W pLD - T DADAM . \ , NO( rr yoof�O/'J Ay'e _ ___---> yulcO'1 /9ve_-0 F STREET no co/lel -2 BLOCK WALL LAYOUT FOR BUILDING PERMIT PLANNING DIVISION _ __ s._••••- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ..� CITY OF COSTA MESA CONSTRUCTION PERMIT - PER Iyi) IVO./��� TRACT NO. LOT NO. UNIT NO. �,(') YL/Jl 1401 12/11 /87 5.00 TL Project Address 3O&7 \ u COO 15'33 lx) kJ(0 OCLO TYPE OF CONSTRUCTION Li NEW U ADD U ALTERATION L I REPAIR Applicant's Marlin Address / -- 54���p� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Owner's Name Phone 6 A.P. # I Zone N� ��-L-L �u M DESCRIPTION OF WORK/USE OF BLDG. Address S Main Building: Accessory Building: Z Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING U FOUNDATION El STRUCTURAL E Front O Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N •Th I 11/1r� ❑ OTHER A I Contractor's Namei /lL' ORIS�L1)IY�d/U�, Phone 97�-�y/f� C Right - N q PROJECT DESCRIPTION SQ. FT. OCCUPANCY_ G Address(mailing) 1533 A 1, fL��7LIl� K City License No. tel% 1S ��' 7 CONSTRUCTION TYPE VALUATION $ S Left R ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Req./Provided e} E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: R EC EI VEU NUV J U 1.98? NI Q with section 7000) of Division 3 of the Business and Professions Code, and my license is in full for a and effect. ^In n T License class �jlc n e No 'J 7 S Date 1- - Signature L//� PLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES • .f Workers' Compensation Insurance, or a cert led copy thereof (Section Backflow Preventer Service Sink 3800, Lab. C.)©I lc,I nl' Automatic Washer Transformer 0 15-50 KW O3 Policy No. -/ O C Company ////✓✓✓✓ /40`� )��- Backf low Irrigation Sewer Cap Construction Pole Sub. 050+KW Certified copy is hereby furnished. Certi i • c` is III with the city Bwl ry sic Bathtubs Sewer Connection ,� Ang fJ ) /l- I Cooking Unit Meter ❑up to 100 amps . - - Appilcant re G/// l Clarifiers I XEMPTIO.` .. WORKERS'COMPENSATION DECLARATION Solar Collectors Dishwasher Meter Dover 100 amps scs - ion need not be completed if the permit is for one hundred($100) or less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel 1 c• - .• • . • which this permit is issued, I 5-.Il not employ any person In any manner so a • • - .••• - he Drinking Fountains Solar Tank .rkers' .•-,s. it. . s of Callfornl-g _ Fan Motors 00-1 HP ❑1X-8 Da e "a'�%c•� wil '•nature � r-rte -• Floor Drains Swimming Pool w/Spa `— F.A.U. NOTICE:If,after making this dec ara ion, you s ou • •e . - • • o the _ Inc.Solar 09-15 HP 016-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal comply with such provisions or this permit shall be deemed revoked. Fixtures Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance ^ Pole Light of the work for which this permit is issued (Section 3097 Clv. C.) Interceptors I Water Heater Cx Outlets Ran e Lender's Name 9 Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or 9 p ;Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW❑5.15 KW Trash Compactor any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she is exempt -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). LI I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered - Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves .. __. thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I 0 sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date pletion, 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 Approved ByDate LJ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat tractors to construct the project (Section 7044,Business and Professions Code: - (4/ The contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon,and _who contracts for such projects with a con- tractor(s) license pursuaritto the Contractor's License Law). I am aware that Exhaust System 0 Multiple❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ _ PERMIT 0 I am exempt under Section B.& P.C.forthis reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ✓, l J ISSUANCE $ Date Owner Heating System& Ducting Registers i PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BT ICAL GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTR $ and state laws relating to building construction, and hereby authorl • epre- PLAN CHECK 50% $ MICROFILM $ sentatives of this city to enter upon the abve-mentioned pr for ,�tt--^���--ta Inspection purpo • .- y MECHANICAL $ TOTAL FEE $`--�•w Signature . a. . /LL/A Date .�i•I Drivers' License or 55# - % -7 Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ a. CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor II V • ,A) • Y' . 3JECT PROPERTY INFORMATIOI 1) Property: 3089 YUKON AV, COSTA MESA CA 92626-2919 CO20 APN: 4184)62-05 Use: SFR County: ORANGE, CA Tax Rate Area: 15013 Total Value: $46,378 Census: 639.08 Prop Tax: $627.84 Land Value: $17,797 Map Pg: 27-F3 Delinq Tax Yr: Impry Value: $28,581 New Pg: 859-05 Exemptions: Assd Yr: 1997 Phone: % Improved: 61% Owner: MORAN JAVIER & DORA Mail: 3089 YUKON AVE; COSTA MESA CA 92626-2919 SALES INFORMATION IMPROVEMENTS LAST SALE PRIOR SALE Bldg/Liv Area: 1,369 Transfer Date: 11/26/97 08/12/66 #Units: Sale Price/Type: $184,000 FULL $23,000 FULL #Bldgs: Document#: 612803 805000183 #Stories: 1 Document Type: GRANT DEED 6/SF: $134.40 1st TD/Type: $147,200 Yrblt/Eff: 66 Finance: Total Rms: 6 Junior TD's: $18,400 Bedrms: 3 Lender: SUNBELT NAIL MTG Baths(F/H): 2 • Seller: ELLSWORTH MARY F Fireplace: Pool: Title Company: GUARDIAN TITLE CO. Bsmt Area: Transfer Info: Construct: SITE INFORMATION Flooring: Air Cond: Improve Type: Lot Size: 60 X 100 Heat Type: HEATED Zoning: Lot Area: 6,000 Quality: County Use: 1 Parking: ATTACHED Condition: Bldg Class: Park Spaces: 2 Style: Flood Panel: 06059C-0047E Site Influence: Other Rooms: • Phys Chars: Legal: L7 TR4674/N Comments: Copyright© 1996-97 Experian Page: 1 of 1 254 17 CITY OF COSTA MESA I COSTA MESA BUILDING-SAFETY DEPARTMENT q P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 MAR 3 1�+Q 66 For Applicant to Fill In Completely APPLICATION FOR PERM TYPE OR PRINT B 'p.1.- BUILDING D 4., 7 Fe E„ . • . ADDRESS 3089 Yukon Avenue ADDRESS RECEIPT NO. '2541 I COSTA MESA. CALIFORNIA } RECO DRYR EIVED DATE ISSUED OWNER U. S. Financial 5./?— MAR 2 2 19bn MAIL BUILDING ADDRESS 1355 Front Street ADDRESS / FIRE ,,[9'" an San Diego, Calif . TPIo'BE-96C1 1APZONE TYPE GRou V /f- AF TELT T!L BY DATE DATE (/ O. IINEER 'A.S. ilenryck No. TIN-331914 ADDRESS 12061 Santa Rosalie. Stanton ZONING �11 n � SOH NO.OF Yat or HLW' / I FIAN'oZ I BUILDINSa �/ CONTRACTOR Lewis R. Schmid / /�/�JJ r ' LEGAL 7--IAT . . 7/'/ �J ADDRESS 2940-A Randolph DEKRIT�N _ ///Z (O / CITY Costa Mesa, Calif. A.P.NO. NOTE: NO RAVE OVERHANG SHALL BE LESS THAN ATE LIC..NO. 236399 , 540-o960 30"TO SIDE 61 REAR P.L. NO EAVES SIZE I NOW OF ON LOT Q ALLOWED (U.B.C.REQUIREMENT) OF LOT 6Q x 300 USE OF YARDS APPROVED YARDS APPROVED EXISTING BLDG. MAIN BUILDING ACCESSORY BUILDING (FROM C/LrTS�TREET SETBACK LINE IRON r V�FRONT $ FT. \�/ FT. CENTER OF STREET 7r0 1 r REAR YARD [24 1 (, E 7 SIDYARD I LEFF 5.5 1 RIGHT 5.5 I R.SIDE .>✓FT. . FT. DESCRIPTION OF WORK L.SUMO— S Pr. FT. NI. X TIFRATI N ADDITION Fir REAR .2--Lit PT. Fr. DISTANCE BET. BET.MAIN S MAIN BLD• - ACCESS.BLDGS. REPAIR MOVING DEMOLISH G, r DATE S ZELLINGi343.253q• I ROOM; 5 ST9RIBS 1 APPROVED EXTERIOR WALL Wood- ROOF Snake APPR ane �_/ 7 / /( COVERING Plante7COVERING Shin&P, � DATE C� (7 USE OF BUILDING AND WORK TO BE PERFORMED 1 Gall W Single Fami y Dwelling with attached c Garage P - at 1 -7 / / / 3.4 ;O.PT. fC &IC2 C I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. IDyS PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION ect /O by O / PERMIT FEE $ (/!7 F 7 Oe E PERMIERMI TTEE" /".. �., _ _..:...., .....- 571102/ /fI O( /4 PLAN CHECK S ] a 6' AU IZ AGENT ^DmO TOTAL FEE S