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Home My WebLink About3118 YUKON AVE - Building Permits 44 �y ' Lit CITY OF COSTA MESA BUILDING DIVISION F • .,. ,4 'IMGMI-ALIA . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT / f� �ORPopaflO a Mna_nn1nc (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 3118 YUKON AV Status: ISSUED Suite No Applied: 03/04/2004 Issued: 04/09/2004 Vicinity: �I Parcel Number: 41805244 ISSUED BY: Applicant: MADDUX, JIM Address: 14736 BEACH BL Phone: (714)897-4595 WESTMINSTER,CA Zip: 92683 Owner: MELDRUM, NORMAN M JR Address: 3118 YUKON AVE Phone: COSTA MESA,CA Zip: 92626 Contractor: JAMES ROSS MADDUX Address: 14736 BEACH BL Phone: (714)8974595 WESTMINSTER,CA Zip: 92683 License:224975 SCOPE OF PERMIT 454 SINGLE STORY ADDITION.SCOPE OF WORK TO INCLUDE:ADD 2 BEDROOMS, 1GAS PIPING FOR POOL,3VENT FANSL.REF:B04-00487. • 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 $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $6.15 1 - 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 $21.75 3 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp - $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation-Fee $0.00 Plan Check Fee $0.00 Reinspection,Fee $0.00 TOTAL CALCULATED FEES $51.40 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28, §1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS • • • WORKERS'COMPENSATION DECLARATION: , I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. O 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: -Stick Tt,---• U^uO ' Policy Number: ?Z't— biz 3 f (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) Ca" 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 provi ' Applicant Signature: ... /i� j�.�Y"L / 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 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section)of Division 3 of the Business and Professions Code,and my license is in ful force and effect.Lic.# e{ Class# 'S ----Si Contractor's Signature' j��c1 / Date: tp—Q-eel CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a Construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: _. Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: _ Date: Owner ID verified by driver's license. 0 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 California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Are 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 ❑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 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 LI 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 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 .........y.... t.. 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signatur Of egal Ow er(s) Date Are Li-7 And r •ut or:d Applicant Date CODE N. INSPECTION TYPE DATE INTmALS COPE# INSPECTION TYPE PATE INTRIRL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 8'y — r L{ 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 4�0601 bF CITY OF COSTA MESA • fi BUILDING DIVISION F v . I .. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT PO -00157 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 3118 YUKON AV Status: ISSUED Suite No Applied: 03/04/2004 Issued: 04/09/2004 Vicinity: Parcel Nunmber: 41805244 ISSUED BY: ,A Applicant: MADDUX, JIM O� Address: 14736 BEACH BL Phone: (714)897-4595 WESTMINSTER,CA Zip: 92683 Owner: MELDRUM, NORMAN M JR Address 3118 YUKON AVE Phone: COSTA MESA,CA Zip: 92626 Contractor: JAMES ROSS MADDUX Address: 14736 BEACH BL Phone: (714)897-4595 WESTMINSTER,CA Zip: 92683 License: 224975 • Arch / Eng : Address: Phone: Zip: License: SCOPE OF PERMIT 454 SINGLE STORY ADDITION. SCOPE OF WORK TO INCLUDE:ADD 2 BEDROOMS, 1SHOWER, 1SINK, 1KITCHEN SINK,1REOLCATE SWIMMING POOL EQUIP., 1WASH BASIN, 1WATER CLOSET.REF: 804-00487. - FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $60.75 1 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 $0.00 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 1 Drinking Fountain $0.00 0 Sink,bar $9.80 1 Water Piping(Inst or Rep.) $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)7545626 2446-46(6/00) rmir WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Ci GIJ,J9 Policy Number: ZZ p ..O0??�-� (This section need not be completed if the permit is valued at one hundred dollars($1 J or less.) / ❑ 1 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.r. Applicant Signet `. , l#‘7•1111- Date: !i j-oy WARNING:FAILURE T•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 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing with Section 7D60)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.# 2-2-k-cf.75 Class It 13 . Contractors Signature� 2 Date: L/-9-0'1f -✓ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). • Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation.WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply loan 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,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions.requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end 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 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication appermit for such construction or modification from the South Coast Air Quality 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 Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No ..f"yes", yeCattach certificate o.. 8 (II yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. "net net e e Owner(s) ( ?pae ` ( tttyyy 7 r AtadzUtl-Applicant Date coos I INSPECTION TYPE DATE INT1TIALS CODE INSPECTION TYPE ELTE INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical p ^, 1266 Pool Spa Final 208 Final Plumbing R-H -C)4 L71y 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 4`OW M6s9 CITY OF COSTA MESA . Imo, BUILDING DIVISION F � �w�� ; DEVELOPMENT SERVICES DEPARTMENT PERMI UMBER C PERMIT I 04-00215 OR^ut m o Ary' (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • ELECTRICAL PERMIT Job Address: 3118 YUKON AV Status: ISSUED Suite No Applied: 03/04/2004 Vicinity: Issued: 04/09/2004 Parcel Nunmber: 41805244 p /� Applicant: MADDUX, JIM ISSUED BY: lh/ d' Address: 14736 BEACH BL Phone: (714)897-4595 WESTMINSTER,CA Zip: 92683 Owner: MELDRUM, NORMAN M JR Address 3118 YUKON AVE Phone: COSTA MESA,CA Zip: 92626 Contractor: JAMES ROSS MADDUX Address: 14736 BEACH BL Phone: (714)897-4595 WESTMINSTER,CA Zip: 92683 License: 224975 SCOPE OF PERMIT 454 SINGLE STORY ADDITION.SCOPE OF WORK TO INCLUDE:ADD 2 BEDROOMS,RELOCATE 1POOIJSPA.24FIXTURES,2000TLETS, 12SWITCHES, 1SERVICE.REF: B04-00487. 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 $49.50 1 up to 10 kva/kw $0.00 0 Lighting Fixts $24.92 24 up to 50 kva/kw $0.00 0 Recept Outlets $22.00 . 20 up to 100 kva/kw $0.00 0 Switches $13.20 12 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $30.50 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 r Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Cede,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: %FT'I—S- Fz�/ � Policy Number:?D7—'c z33 l^ (This section need not be completed if the permit is valued at one hundred dollars($1065.;;.) / Ell 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 Califorri and agree that if',should become subject to the workers',compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the= scans. / 47. Applicant Sign e: — - /CV. - Date: 411' S WARNING:FAILURE TO SECURE WORKERS'••MPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND 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 It S I i Contractor's Signature: - Date: G/—"7"-‘541 (Z/ 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 tile a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 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 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has an 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 a plication apgermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes 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 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 B (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig -:tur: •f eg. swner(s) Date An 'uiorized Applicant Date CODE r INSPECTION TYPE DATE INTITIALS CODE INSPECTION TYPE D&I€ INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing a 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 41 4,5•01 Mss, CITY OF COSTA MESA pg BUILDING DIVISION F •c„, ,.S DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER �• IraffL° PERMIT ”`0+.0 049 B04-00487 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3118 YUKON AV Status: ISSUED Suite: Applied: 03/04/2004 Vicinity: Issued: 04/09/2004 Parcel Number: 41805244 Zoning: R1 R1 - A Applicant: MADDUX. JIM ISSUED BY: Address: 14736 BEACH BL Phone: 714-8974595 WESTMINSTER,CA Zip: 92863 Owner MELDRUM, NORMAN M JR Address 3118 YUKON AVE Phone: COSTA MESA,CA Zip: 92626 Contractor: JAMES ROSS MADDUX Address: 14736 BEACH BL Phone: (714)897-4595 WESTMINSTER,CA Zip: 92683 License: 224975 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT 454 SINGLE STORY ADDITION.SCOPE OF WORK TO INCLUDE:ADD 2 BEDROOMS, 1 BATH,RELOCATE LAUNDRY, REMODEL EXISTING KITCHEN,RELOCATE POOL EQUIPMENT AND NC.MISC. PLBG, ELEC AND MECHANICAL. • FEE SUMMARY Plan Check: $422.99 Calc Valuation: $50,949.60 Permit: $650.75 • • Claim Valuation: $0.00 SMIP Res: $5.10 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • Total: $1,078.84 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 13-4 Left 5-0 Right 35-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 4 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(6100) 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: TATC FUND / Policy Number: "ZZl- PAZ 3 (This section need not be completed if the permit is valued at one hundred dollars($100or less.) C- 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 prowsi syr Applicant Signal ue�� ^� Date: G-9'c>41 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 3106 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 70 of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# 4- R-IS / Class# 5-/ Contractor's Signature: 7/S� Date: y-'7-c yJ CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 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: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, 1 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 permit 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 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 agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig -tura . .a ner(s) Date 04/ •nd/•r Aut'rized Applicant Date CODE t INSPECTIONTYPE QAC INTITIALS CODES INSPECTION TYPE PAM INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall _ 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign _ 222 Final Site 204 Final Demolition _ 250 Final Building/Occupancy Y- $21/ {�_ - $21// (y"i a ? CITY OF COSTA MESA F a �) BUILDING DIVISION PER NUMBER DEVELOPMENT SERVICES DEPARTMENT, trigt PERMIT '`AJoNm ;4. BOO-00552 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3118 YUKON AV Status: ISSUED Suite: Applied: 04/25/2000 Vicinity: Issued: 04/25/2000 Parcel Number: 41805244 Zoning: R1 R1 c�A. ISSUED BY: v Y" Applicant: AMY WIRTJES Address: Phone: 949-481-0213 Zip: Owner: MELDRUM, NORMAN M JR Address 3118 YUKON AVE Phone: COSTA MESA,CA - Zip: 92626 Contractor: SPLASH POOLS AND SPAS Address: 116 PARK CREST DR Phone: 949-632- NEWPORT BEACH,CA Zip: 92714 License: 737291 '. Arch : Eng: Address: Address:. Phone: Phone: Zip: License: License: SCOPE OF PERMIT REMOVE AND REPLACE 210LF BLOCK WALL,CITY STANDARD. FEE SUMMARY Plan Check: $0.00 • Calc Valuation: $4,200.00 Permit: $111.25 Claim Valuation: $0.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $111.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 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 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'comp/r�jJ[aj'�+rrInsurance carrier and policy number are: Carrier: '7 ' ! Policy Number: (This section need11 a completed if the permit is valued of one hundred dollars($100)or less.) yI certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so a to become subject to the workers' compensation laws o California,and agr.= that if - •uld become subject to the workers'compensation provisio s of Section 7 0 of the Labor Code,I shall forthwith comply with these pr,' ision•:�/; Applicant Signature: .'O E - Date: WARNING:FAILURE TO - O' E- COMPENSATION COVERAGE IS UNLAWFUL AN HALL SUBJECT AN EMPLOYER TO CRI If�AL PEnA TI S D IL FINES UP TO ONE HUN ED THOUSAND DOLLARE($100000),IN A•DIT• TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OFT E LABOR CAD ,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licens=d un• r4so 'sions of Chapter 9(commencing with SeclietT7000)of Division 3 of the Business Professions Code,and my license is in full force and effect.Lic.# 41.01 Class# Contractor's Signature: 41!irlerair li— Date: s1 CONSTRUCTION LENDING A . ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: _ Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, em 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. ❑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? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the 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 present f_future for the t ..__w-____— rm.______ const modification 5 Does or will the applicant or M a or emen building occupant at y other work which isi the subject this a estion apermii for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? �Yes ❑No (Section 65850.2 of the California Government Code requires that the requested information be fumished 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 Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct, I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si.•. ur:Of Legal : (( l All ( z A r •r Authorized App let Dat CODE I INP NTYP ':I. INTrI'IALS CODE INSPECTION TYPE gag 1NTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy .tJ7�I r / 2446-46 a CITY OF COSTA MESA c t 4 . BUILDING DIVISION PE IT NUMBER 1- t "'�" ' DEVELOPMENT SERVICES DEPARTMENT PERMIT apa ,A E00-00392 (714)754-5273 • Fax(714)754-4856 - 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 3118 YUKON AV Status: ISSUED Suite No Applied: 05/01/2000 Vicinity: REAR YARD Issued: 05/01/2000 • Parcel Nunmber: 41805244 .),Py� Applicant: MELDRUM, NORMAN M JR ISSUED BY: Address: 3118 YUKON AVE - . Phone: (714)435-9336 COSTA MESA,CA - Zip: 92626 Owner: MELDRUM, NORMAN M JR - Address 3118 YUKON AVE Phone: COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: • Phone: Zip: License: 0 SCOPE OF PERMIT INSTALL 3 OUTLETS IN•BACK YARD FOR FUTURE WORK TO BE DONE.SUBJECT TO FIELD INSPECTION. 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 $3.30 3 - 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 $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 $26.80 Intermed Pole $0.00 0 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 • DECLARATIONS WbRKERS'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 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# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors 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. 704 ;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 self 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, .. IVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors Li aw d•-s not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant tot oniractor` aws.). ❑ I am exemp .i.. : _ Business end Professions Code for this reason: Signature: /�„� �•- Date: Owner ID or:r s license. ❑Yes ❑No Driver's License No. < Expires: Verification of z ership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires.with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater then a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑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). .......-.-..Doeso-__.__....._appcanopeenor..uebuildngoccupant need 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. ......... is quict Safety C ..fully.. with? ... ............ ... ......... ... ............... ............... 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied wh ❑Yes 0 No 5.......... ll.the o.r"- ” or Tutu which subject application ermi._forsuc_ . 5 Does or willthe applicantsAiru present or emen building occupant at any other for the work ontch districtis the sor agency?this a estion aggermit for such construction or modification from the South Coast Air Quality Management District or from other air pollution control or �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..._.. part of ylob .t.r c h.-. "e'--.-..... any 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 Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE TON 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 . • city•n'-• : relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described propej_-:. pec • yam-: . agree not to occupy or allow occupancy of any building authorized by thispe)Luatil final inspection. �I. -lure Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE 4. INSPECTION TYPE DATE JNTIT1ALS CODES INSPECTION TYPE PAIS INIIDALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical ; 1266 Pool Spa Final 208 Final Plumbing / 200 Final Re-Roof 210 Final Electrical 21/If q 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 244646 rCITY OF COSTA MESA ,4y' �t BUILDING DIVISION PERMIT UMBER b.f' "•"'w ' DEVELOPMENT SERVICES DEPARTMENT, . PERMIT 44.4boinTrie 4" • P00-00196 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • ° PLUMBING PERMIT Job Address: 3118 YUKON AV Status: ISSUED Suite No Applied: 04/25/2000 Issued: 04/25/2000 Vicinity: ISSUED BY: S'A. Parcel Nunmber: 41805244 Applicant: AMY WIRTJES Address: Phone: 949-481-0213 Zip: Owner: MELDRUM, NORMAN M JR Address 3118 YUKON AVE Phone: • COSTA MESA,CA Zip: 92626 Contractor: SPLASH POOLS AND SPAS Address: 116 PARK CREST DR Phone: 949-632- NEWPORT BEACH,CA Zip: 92714 License: 737291 Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT • POOL AND SPA. PLUMBING WORK, RE:B00-00553. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/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 $0.00 0 Dishwasher $0.00 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) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 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) $30.25 1 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: $53.75 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 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: is hon 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 b oma subj t to the workers' compensation laws of Cali•mia,and agree that i should become subject to the workers'compensation provisions of Section 3700t Labor C e,Irthwith comply with these provisi• � •� Applicant Signature: iI!L'I' �t Date: WARNING:FAILURE TO SECUR ORKERSL'•L•• NSAT illWir • COVERAGE IS UN • J AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN CIVIL FIN UP TO ONE HUNDRED THOUSAND DOLLARE($106,000),IN ADDRI •THE••- 0 COMPENSATION,r• •`•-ES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INT EST,AND TTORNEYS FEES. -4LICENSED CONTRACTORS DECL•- •TION: I hereby affirm that I am licensed u •er•ro 'si• s.f Chapter 9(commencing with Section 7000)of Division 3 of the Business P ofesslons Code,and my license is in full force and effect.Lic. a .� • t Class k l 1 Contractor's Signature: a I t-- .lar Date: ZJt,I ^ et �___ TRUCTION LENDING AGENCY: ill I hereby affirm that there is a construe n lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). r ame: _ Lender's Address: Signatu ' Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534(lithe Califomia Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 8 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 froom 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 Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. i ale Signature Of Legal O•wner ' 'a vir i7 G AIWA mit Om 7 And/Or uthorized App cant . D: a CODE 0 . ' I.., EP \ PATE )MITIAL$ CODE(f INSPECTION TYPE PM I LS 1616 Fixed System Final Fir: Preven• 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 2_/r?(Y 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 2446-46 CITY OF COSTA MESA • F`K ►I BUILDING DIVISION PER IT NUMBER DEVELOPMENT SERVICES DEPARTMENT. ° ' ' ; PERMIT go (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE, OQ0S1&892626 MECHANICAL PERMIT Job Address: 3118 YUKON AV Status: ISSUED Suite No Applied: 04/25/2000 Issued: 04/25/2000 Vicinity: ISSUED BY: S 4 Parcel Number: 41805244 Applicant: AMY WIRTJES Address: Phone: 949-481-0213 Zip: owner: MELDRUM, NORMAN M JR Address: 3118 YUKON AVE Phone: COSTA MESA, CA Zip: 92626 Contractor SPLASH POOLS AND SPAS • Address: 116 PARK CREST DR Phone: 949-632- NEWPORT BEACH,CA Zip: 92714 License: 737291 Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT POOL AND SPA. HEATING SYSTEM, RE:B00-00553. 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 $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $6.15 1 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 11,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp . $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent • $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 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.cornmenced 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 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. O I have and will maintain w ompensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'comp do ance carrier and policy number are: . Carrier: / Policy Number: his-• lion need not be completed If the permit is valued at one hundred dollars($100)or less.) • 'ertify 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 hould becomes bject to the workers'compensation provisions of et' n 3700 of the Labor Code,I shall forthwith complyg with these pro 'sions peCi /A••licant Si nature: iiiref �� lea _.► . Date: //�WARNING:FAILURE TO SE iRE •RK=-S'CAMP' ION COVE-4 E IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMIN L ENALTIESIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100.000}. ADDI ION TO ' ••- OF CO T'SATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, T AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensedyq pr inions of Chapter 9(commencing with Sectione7060)of Division 3 of the Business .Professions Code,and my license is in j force and effect.Lic.# I t Class# Contractors Signature: A2z.l.a•ar - ,11.7%37-, / Date: j CONSTRUCTION LENDING AG- ' It ❑ 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 property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). O I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). • 0 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). O As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure)__ _ ..r . . —__ ___ .-.___ ..._..... ......_. 2 Does or will the applicant or present or future building occupant need to file a registration formmfor acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? 0 Yes 0 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 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (It"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 Calif omia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / 4. �tr�'' re Of Leg:Ay mer(. Date / �G�``� t�/L�l _ _ / / A�fd/Or,, uthori -d Ap•� Date CODE I . P (,•, I' �/ IATg UMW CODE0 INSPECTION TYPE DATE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 2 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 2446.46 CITY OF COSTA MESA \. a' �� BUILDING DIVISION F(" "^' ' DEVELOPMENT SERVICES DEPARTMENT. PERM UMBER ;# PERMIT E00-00376 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT - Job Address: 3118 YUKON AV Status: ISSUED Suite No Applied: 04/25/2000 Vicinity: Issued: 04/25/2000 Parcel Nunmberc. 41805244 _ ISSUED BY: ClOr Applicant: AMY WIRTJES Address: Phone: 949-481-0213 Zip: Owner: MELDRUM, NORMAN M JR Address 3118 YUKON AVE Phone: COSTA MESA,CA Zip: .92626 Contractor: SPLASH POOLS AND SPAS Address: 116 PARK CREST DR Phone: 949-632- NEWPORT BEACH,CA Zip: 92714 License: 737291 SCOPE OF PERMIT POOL AND SPA. ELECTRICAL WORK,RE:B00-00553. 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 $49.50 1 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 $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 $73.00 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 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 wit maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'comps • surance carrier and policy number are: / Carrier: y\ L Policy Number: (This section need not 6•e o I ted if the permit 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 California,and agree a should become subject to e worker 'compensation provisions of Section 3700 f the Labor Code,I shall fonh'4.a comply with these p vision' Applicant Signature: _Sara sa*" Air Date: /f L•r WARNING:FAILURE TO SECO-E WORK?��is,au ON COVERAGE IS • -WAS.AND SHALL SUBJECT AN EMPLOYER TO GRIM PENALTIE AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1W,000).IN ADD. • r4• • •ENSATB•.•,DAMAGESASPROVIDEDFOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS OECLAR• I hereby affirm that I am lice.s=d neer Jr• 'sions of Chapter 9(commencing with Section 000)of Division 3 of the Busines an• Professions Code,and my license is in full force and effect.Lic.k ;Sr _ Class a a _ / Contractors Signature: �7� sar�� Date: '�if/Lig r CONSTRUCTION LENDING AGENCY: Wilir ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend, will be made in connection with work authorized by this permit,and that no building structure,scaffolding,fatsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has 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 end 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 end Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 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 et 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California 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 California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (if yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. �/x� Signatur: • Leal• ne • w /GrOr Authorize. •,40 sate CODE 0 , -.,1•. it. ME EMMA RODE! JNSPECTION TYPE 12IE PrRMLa 1616 Fixed System Final Fire Prevention 206 Final Mechanical a 1266 Pool Spa Final 208 Final Plumbing �_/�_51 ,/ 200 Final Re-Roof 210 Final Electrical re 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 2440.46 Twining Laboratories of rSoutiztn eal2fotnia, Lam. ,� 3310 Airport Way (562)426-3355 4,2� 426-6424 .1op�''' AI��6i Mail: P.O.Long ox Be47,hE 0801CA0806 www.twiFAX n ng abs.com TESTING Compression Test on Gunite • CUSTOMER: LUIZ RICHARD EXAM NO: 90-1-249755 5071 LOYOLA AVE DATE: 06/07/20 WESTMINSTER, CA 92683 JOB NO: 91109001 PERMIT NO: JOB NAME: RICHARD LUIZ : VARIOUS SITES OSH PD: (SEE BELOW "SAMPLED FROM" OSA AP #: ADDRESS : FOR JOB NAME & ADDRESS) FILE #: PAGE #: 1 • ARCHITECT: CONTRACTOR: SPLASH POOLS ENGINEER: SUBCONTRACTOR: LACHER • TRI FORCE GUNITE INC. SAMPLE FROM: FLOOR OF SWIMMING POOL. PERMIT #00-00553 MELDRUM- 3118 YUKON AVE. , COSTA MESA MIX: 4 1/2 TO 1 - SPEC. STR. (PSI) : 2000 SLUMP: N/A CAST: 05/15/20 DATE TESTED 05/30/20 - . SPECIMEN NO 01 AGE (DAYS) 15 TOTAL LOAD (LBS) 87750 LBS PER SQ IN 2970 SPECIMEN SHAPE: Cylinder SIZE: 6 . 130 x 12 . 270 AREA/SQ IN: 29 . 51 LAB #5895/TEST METHOD: ASTM C39 SPECIMENS BY: CARLOS DELIVERED BY: R. LUIZ RECEIVED ON: 05/23/20 DISTRIBUTIONS : LUIZ RICHARD, 1 CL'ENT•,t;R^CSHED S.,:+, -ES This test hes }tern porter/rod end report e rprred based upon the s:eci tic scr.nle 1 sI ores i.ed no uc by above client. We assume no responsibility ter • variations in Quclity I ccroraiticn, appeproroy, Cer- fermcnce, etc.i or any other footsu; el simitcr iubl^G m.crrer produced Im;:nci-..ctu,ed, icbriccred, erc.I by persons or under conditions a which .._ ise.e no central. / lax)hip:in/nit/Jai 4-2000 ALL REPORTS REMAIN THE PROPERTY OF TWINING LABORATORIES OF SOUTHERN CALIFORNIA,INC.AUTHORIZATION FOR PUBLICATION OF OUR REPORTS.CONCLUSIONS.OR EXTRACTS FROM OR REGARDING THEM IS RESERVED PENDING OUR WRITTEN APPROVAL AS A MUTUAL PROTECTION TO CLIENTS.THE PUBLIC AND OURSELVES. 15E J CITY OF COSTA MESA ` �� BUILDING DIVISION PERMIT NUMBER 1. 1 """: ' DEVELOPMENT SERVICES DEPARTMENT. v PERMIT SCWPOIWO;4* BOO-00553 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3118 YUKON AV Status: ISSUED Suite: Applied: 04/25/2000 Vicinity: Issued: 04/25/2000 Parcel Number 41805244 Zoning: R1 R1 ISSUED BY: Applicant: AMY WIRTJES Address: Phone: 949-481-0213 Zip: Owner: MELDRUM, NORMAN M JR Address 3118 YUKON AVE Phone: COSTA MESA,CA Zip: 92626 Contractor SPLASH POOLS AND SPAS Address: 116 PARK CREST DR Phone: 949-632- NEWPORT BEACH,CA Zip: 92714 License: 737291 Arch : Eng: • Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT POOL AND SPA. FEE SUMMARY Plan Check: $217.91 • Calc Valuation: $21,000.00 Permit: $335.25 Claim Valuation: $21,000.00 SMIP Res: $2.10 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $555.26 • PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not.commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 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'com cation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compenn tion a, carder and policy number are: . Carrier: Y V Policy Number: (T section need not be comple d' 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•lCalifornia,and agree -t if I sh••d bec• e subject to the work= -'compensation provisions of action 0 of the Labor Code,I shall forthwith comply with these pr. ision a / Applicant Signature: i%' 4 a /,t r 4 . Date: L WARNING:FAILURE TO SE• R I,••KER"MP-ATION *V •.GE I UNLA if L AND SHALL SUBJECT AN EMPLOYER TO CRIMN L PENALTI S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION •THE COST 0 CO PENSATION,0'. 'GES AS PROVIDED FOR IN SECTION 3706 OF THE BOR COD 'INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECL'- • ION: I hereby affirm that I am lice. :• u•.: pr• is•ns of Chapter 9(commencing with Section 7000)of Division 3 of the Busines - • Professions Code,and my license is in full force and effect.Lic.# A -.A 4 Class# .I Ai Contractors Signature: rI��ltY�SEtAT 4a Date: i Tag "alb r INF CONSTRUCTION LENDING AGENCY illr ❑ I hereby affirm that there is a cons • on lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant toe civil penalty of not more than five hundred dollars($500).): 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 property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑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 et 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? CI Yes ❑No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and tiling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Section a Health Safety c 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Ves ❑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? LJ Yes LJ No (Section 65850.2 of the Califomia Government Code requires that the requested information be fumished 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). a from the South Coastst--Auat..Ds__—__r-..__pollution control 7 application,If a permit from tae South Quality Management is Healthat or otherd fir p on cn42303 district been agency is required for the work which is the subject of this have all of the disclosures prescribed by California and Safety Code Section made? ❑Ves 0 No B (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. O :sal Owns(s) • Dill • _ "/rt //L / 4 ` •(• Ors r Authorized Ap•licantl DateitO CODE N. SPE TYP DAL CODEC INSPECTION TYPE P� INTITIALS 1616 Fixed System Final Fire -revention 206 Final Mechanical 1266 Pool Spa Final O(ten 208 Final Plumbing 200 Final Re-Roof I 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 2446-46 • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . ,C)2Y.8F COSTA MESA G CONSTRUCTION PERMIT a PERMIT NOTRACT NO. LOT NO. UNIT NO. A.P.# I Zone Project Address illD yvke- ems"t— 13 act 7 " - S Main Building: Accessory Building: Applicant's Mailing�A,�dr ss • -Q TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION REPAIR E Z �/�p�/9. ❑ CONVERSION ❑ DEMOLISH El OTHER T Front • 0 Owners Name Soon 'j r / la eie d rt Phone CC,.DESCRIPTION IF WORK/USE OF B a G. -1 -• ' `4 ward ' Au'/ � B Rear N Address' J/ ---2 .JN " '� J i . �C i. 'L'd✓3i-� A I Arch/Eng. License No. TYPE OF PERMIT 111 GRADING . FO NDATION III STRUCTURAL I C Right G Address ❑ TENANT ❑ ELECTRICAL��, ❑ PLUMBING ❑ MECHANICAL S• Left R Ac' f iy)2El OTHER /�eIL.z.KJ/ E Contractor's Nam¢i/i/'P J irenA "� hone '` �Ping. Ref.# Parking Req./Provided PROJECT DESCRIPTION SQ. FT. �S --. OCCUPANCY Address(mailing) 23d� ;2—, Jr�f � ' �G Planning Notes: • M �� CONSTRUCTION TYPE �� A VALUATION$ S T City License No. ZONE GRADING CU.YDS. ACRES M LICENSED CONTRAC OR DECLARATION S. I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: / {k r • with Section 7000) of Division 3 of the Business and Professions Code, and �� 0 -Ir-rj0 ELECTRICAL -FEES my license is In full for ,d effect. G /� J License Class._( `t/C2 No '�� J��fr^��1� � usr•!!� eV� a�.�a�seh(_`5� l �Q Jatey�ignature lam_\--f��S// PL MBING EES Automatic Washer Transformer 0 1550 KW • WORKERS' COMPENSATION DECLARATI N DOn$trllCtlOn POIe$Ub. 0 50+ KW I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers of Workers' Compensation insurance, or a certified copy thereof (Section Cooking Unit Meter Cup to 100 amps 3800, Lab. �•y� Backflow Preventer Service Sink Policy No. p/-1��a 7 Company L 'V� - - Dishwasher Meter ❑Over 1008m 5 \ / I v Backflow Irrigation Sewer Cap f..-' , \ Certified copy is hereby Turn fished. .. Dryers OGas ❑Electric _Sub Panel -, Certs/ietl cois filed with the city Bu' ' g D si..%., Bathtubs $ewef Connection VDate /a -/-1-?� Applicant L� ATI SEC Clarifiers Solar•Collectors Fan Motors❑0.1 HP 01'A-8 EXEMPTION FROM WORKERS'COM E SATION DECLARA ION (This section need not be completed if the permit is for one hundred ($100)or - - F.A.U. (n0.SO B-15 HP ❑lfi-1$+ less). � Dishwasher Solar.Piping I certify that in the performance of the work for which this permit is issued,I • Fixtures shall not employ any person in any manner so as to become subject to the Drinking Fountains ar Tank _� icrowave - Workers' Compensation Laws of California. I - Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light NOTICE:If,after making this declaration, you should become subject to the . ' / Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal - _ Outlets Range - .. _, comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign • I hereby'affirm that there is a construction lending agency for the performance • of the work for which this permit Is Issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections Lender's Name Lender's Address • Kitchen Sink Water Service Generator 00.5 KW ❑5-15 KW Trash Compactor OWNER BUILDER DECLARATION — - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash , a#011owing reason (Section 7031.5 Business and Professional Code: Any city or . Y,rpunty which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays S; f,�•"sy structure, prior to its issuance, also requires the applicant for such permit "-ko 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 Fee therefrom and the basis for the alleged exemption. Any violation of Section • _• Reinspection $15 Issue Fee $ 3 • 7031.5 by any applicant for a permit sublectf the applicant to a civil penalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: ❑ 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 Zoning Approved By Date for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By als / Date O 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 Application Issued By D ,G, /�� Dat employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I C. Sr sale- If, however, the building or improvement is sold within one year of com- Canopy Type II 0 MMARY •F '� S 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 PERMIT $ 72 .aa SMIP $ . 5-0 13 las owner of the property, am exclusively contracting with licensed con- Duct-Structural Ref eration System PLAN CHECK tractors to construct the project (Section 7044,Business and Professions Code: $ PERMIT The Contractor's-.License Law does not apply to an owner of property who Duct-Ventilating0-100,000 BTU 0100,000 BTU ISSUANCE builds or improves thereon.and who contracts for such oroiects with a con- - PLUMBING $ $ tractors license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's Compensation Insurance should be provided to me. ELECTRICAL $ .GRADING $ al am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers MICROFILM $ — PLAN CHECK 50% $ Date Owner Heating System& Ducting Registers TOTAL FEE $MECHANICAL $ 7y • SDI hereby certify that I have read this application and state that the above ❑O-100,000 BTU ❑100,000BTL— information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ ' • and state laws relating to •.ilding construe on,and hereby authorize repre- sentatives Of th' 'ty t/•nl• upon-i; above-mentioned property for inspection pure.- /r� j9 /J Signature A - lei Date/A/-/iT Reinspection Fee I $15 Issue Fee $ 3 01 00016918-00016919 TOT 72,50 Drivers' License or SS# ,�,,,, . _ DATE: 10/12/82 TINE: 13e30. 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor I' CONSTRUCTION AND PLANNING N DOL& SPA i APPROVALS Permit# Date Inspector APPROVALS .Permit# Date Inspector f 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. .,. 1 53. Steel Reinforcement - 3.1ElectricalConduitUtility-Undrgrnd. 54. Forms -4. Electrical Conduit-Und?grnd. t - 55. Electrical Bonding . 5. Steel Reinforcement . ;j' 56. Rough Plumbing & Pressure Test 6., EI'ectrical UFER Grnd• .I 57. APPROVAL TO COVER-GUNITE • i' 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation ' ' .1- 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. - 1 _ 60. Backwash Lines, P-Trap, 0 Undrgrnd. I 10. Structural FIopr.Sysiem 61. APPROVAL TO DECK , 11. Property Sewer Line:& House Connection I 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 'r ' ' 64. Plumbing System - Final ' i 1 Rough Plumhin9 ,• ' 65. Electrical-Final 1: .. Rough Electrical-Conduit 66. Solar System-Final 16! Rough Electric Wiring i' ii 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling .1 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating $i Air Conditioning FIRE DEPT. REQUIREMENT ?0. Rough Factory'Fireplace i 1 : . APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating H I _ 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Tent . , 72. Underground Flush 24. Roof Framing . d "I` ' 73. Undergrnd.Storage Tank 0 Gas 0Oil' 25. Roof Sheathing �� '7./ 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Montocoat 75. Dry Chemical 27. Frame a'nd Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. DrywalliNailing . , HEALTH DEPT. REQUIREMENT 31.•Plasteg Brown Coat - 79. FINAL INSPECTION 32. Electrical Power Meter-Final 1. 80. FOOD CERTIFICATE ISSUED . 33. Final Electric '., - Notes: /0,4_- cHA { �cr� ie 34. Final Heating & Air Conditioning /'� 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer - • . I 43. Backflow Irrigation / I ,/ 44. Landscape Irrigation System ' 45. Sound Attenuation 46. Handicap Regulations // 47. FINAL STRUCTURE & BUILDING ze /LO/Gr c 48. Special Requirements Completed f 6 (� 49. Electric Release to Edison ,- 50. Gas Release to Southern California Gas Co - . 1 - •I 51. CERTIFICATE OF OCCUPANCY No. Date -• Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - C F COSTA MESA CO NSTRUCT ON PERMIT RM T NO. TRACT NO. LOT NO. UNIT NO. 3Btl55 9/25/86 Project Address _ gr 4 U.e. � c � �(� - 12.00 TL 111117 ■ �� TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION LI REPAIR ' Applicant's Mail'ng A ores • n as ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Owner's me�E �"I a A'••A - 'hone �Z --- - A.P.# I2one Mag (,. • r DESCRIPTION OF WORK/USE OF BLDG. Address 8 "4S(! 1- �' UQ ^ �� ES Main Building: Accessory Building: Z Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING U FOUNDATION U STRUCTURAL T Front O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B N Address - /) -/. Rear A I a I�OWi.,l.-.iP ❑ OTHER C Right N Contractor's Nam hone PROJECT DESCRIPTION SQ. FT. OCCUPANCY Address(moiling) CONSTRUCTION TYPE VALUATIONS $ I Left R City License No. ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: Q with section 7000) of Division 3 of.the Business and Professions Code, and M • 1y license is in full force and effect. • T Jcense Class License No. • - S Date' • ' Signature PLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers ' I hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL .FEES .of Workers' Compensation Insurance, or a certified. copy thereof (Section • Backflow Preventer - Service Sink 3800, Lab. C.) - __. Automatic Washer Transformer 0 15-50 KW ' ' Policy No. Company • • Backflow Irrigation Sewer Ca 0 50+KW ACertified copy is hereby furnished. p Construction Pole Sub. •• Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit • Meter ❑up to 100 amps Date Applicant ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps (This section need not be completed if.the permit is for one hundred ($1001or less). ' Dishwasher ' Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued I shall employ��y�persws in any man er sP as ret bee mp a subject t0 the • Drinking Fountains Solar Tank Fan Motors ❑0.1 HP ❑1'h-6 Work FOLD ty6/n Laws of Calif. i [.er sg (//j/-fin KJJvv,subject t • • - Date Signature Floor Drains Swimming Pool w/Spa F.A.U. NOTIC :if,afte •making this declaration,you should become subject to the Inc.Solar ❑9-15 HP ❑16-1$+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. MicrOwav¢ 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 Civ. C.) ' Interceptors Water Heater • qq Outlets , Lender's .Name lY. Range • Lender's Address Kitchen Sink Water Service ' OWNER BUILDER DECLARATION Switches Sign ' hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash - Allowing reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal • Standing Sections .ounty which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays . Generator ❑0-5 KW ❑5-15 KW Trash any structure, prior to its issuance, also requires the applicant for such permit Compactor 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 •- -Ity of not more than five hundred.dollar:($500). - \1V1 i I, as owner of the property Reinspection Fee $15 Issue Fee $ 3 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'sMECHANICAL 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 BuildingApproved y prove for the purpose of sale). PP OVed B C+ Date q �.ry� U I; as owner of the property, am exclusively contracting with licensed con. Duct-Structural Refrigeration System Application Issued By J ur, Date f.Arit Cl tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0.100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or Improves thereon,and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that BUILDING PERMIT $ SMIP $ • .of of their Worker's Compensation insurance should be provided to me. Exhaust System ❑ Multiple ❑ System Repair/Alteration A.Ar I am exempt u der Section B.& P.C.for this reason Firepl/Fact.BIL ICBG# Fire Dampers PLAN CHECK $ QV PERMIT $ (V! PLUMBING $ sr' Date �T owner -,�LJt/ITL�— Heating System&Ducting ` Registers PLAN CHECK 25% $ _ ENERGY P.C. $ I hereby certify that I have read this-application and.state that the above I �-100,000 STU ❑100,000 BTL // Information is correct. I agree to comply with all city and county ordinances 7. -O ELECTRICAL $ GRADING $ and state laws relating to building construction,and hereby authorize repre- sentatives of t is city to an up n the above-mentioned pW petty for D Lr C inspection pySDrypses. a (i)/�/8/ MECHANICAL $ Signature le or SSl✓( Date !I lD Reinspection Fee I $15 Issue Fee $ 3. PLAN CHECK 25% $ TOTAL FEE $ �� Drivers' License or _ - CMF 0865.46,rev. 10/84 white - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor 1/1 CONSTRUCTION AND PLAN',,..G ,POOL &SPA APPROVALS Permit# _ _ Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation • 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS 'Permit# _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72., Underground Flush 24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL' 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION . 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final.Heating & Air Conditioning 1-cf-e7 L09 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing I R9e.7 L2'' 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation • 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY _ No. Date 25435 ' CITY OF ^'TSTA.MESA COSTA MESA BUILDING-SAFETY DEPARTMENT MAR 23 966 P.O. BOX 1209 COSTA MESA, CALIFORNIA 92625 • For Applicant to Fill In Completely APPLICA IgE TYPE OR PRINT BUILD INQ oF�ffice Use Only ADDRESS 3118 Yukon Avenue RECEIPT NO. PERMIT NO. COSTA MESA. CALIFORNIA 2443355 11ECEIVp RY RECEIVED DATEIB80[D OWNER U.S. Financial fT 9-/7-LG riMR 2 p IOW BU ILDING MAADDRESS 1355 Front Street ADDRESSFIRE // ///� T ZONE TYPE Y GROUPN �d CITY San Diego. Calif. No BE-980111 ARCHITECT TE AePFROV[D DATE OR ENGINEER A. S. Henryck NO i-331914 / ANS ZONING / ADDRESS 12061 Santa Rosalia, Stanton O.of &.. IBUILODPNHGEW ;!mo .•,., CONTRACTOR LEI i s R. Schmi d LEGAL ADDRESS 29110-A Randolph _ DESCRImON O �.]' CITY Costa Mesa, Calif. A.P.NO. - ..,6—NOTE: NO NAVE OVERHANG SHALL BE LESS THAN ESATE TEL.LLIC.NO. 2311399 NQ, 5l,.ae96oVES DO'TO SID[a REAR P.L SIZE NO.OF ELDS. ALLOWED .W.B.C.REQUIREMENT/ OF LOT 6o x 300 I G NOW ON LOT G I U YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING _ ACCESSORY BUILDING EXISTING BLDG. [PROM C/L YTRIf['U-/6 SETBACKENTELINE FROM C• C,fp l CENTER OF STREET 501 .. REAR YARD 371 ...• FRONT .i y PT' SID[YARD I LEFT 61 RIGKT 5.671 R.SIDE C:. FT. \ FT. DESCRIPTION OF WORK L.SIDE Sr.Prr. NEW X ALTERATION ADDITION .... REAR ..4?7 Fr. Fr. NCE M MAIN BLDBET. BET. S.Be REPAIR -MOVING DEMOLISH MAIN BLDG;. ACCESS.BLOCS. BUILDING-02.n NO OF J VAR.# DATE SIZE 1'119 $(I. ROOMS 6 STORIES 1 C.U.P.#��////�,��\' APPROVED CEXTERIOR OVER NOWwII, ','food- I ROOF Shake and APPROI{ELCiOt t V.�/f-6 Y]as ter COVERING Shingles BY 1y. / DAT[..! USE OF BUILDING AND WORK TO BE PERFORMED P. Sirig]a Fp mi 1y Dwelling vrith Attached 1° Garage P- j 1 //I /' / I l �4/1 I. SQ.FT. . (O/ / lI 11 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 CON• PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. 113 PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULA INS BUILDING CONSTRUCTION. /VALUATION tO /3 em E SIGNATURE OF PERMIT FEE $ C// PERMITTEE 1 •� _ / X9, 535 �� / s PLAN CHECK S �r AUTHORIZE AGENT �4 56 '1 _ 3 TOTAL FEE 5