HomeMy WebLinkAbout2048 MANDARIN DR - Building Permits r t
' CITY OF COSTA MESA
BUILDING DIVISION
� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
rica PERMIT B05-01918
y �e
"esoa
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cBjILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2048 MANDARIN DR - Status: ISSUED
Suite: Applied: 10/25/2005
Vicinity: Issued: 10/25/2005
Primary Occ: R-3 Dwellings/Cong Res X10 Type of Construction: V-N
Parcel Number: 13953409 Zoning: R1
Applicant: TIM MCCARL
Address:
Phone: .. 949-548-5569 ISSUED BY: C
Zip
Owner: MC CRARY;LYNN W
Address 2048 MANDARIN DR
Phone:
COSTA MESA,CA Zip: 92626-0771 .��TT
Contractor: G L R ENTERPRISES INC/DBA CRANK BROTHERS ROOFING l•(�Yr,L
Address: 126 COMMERCIAL WY DA.
Phone: 949-548-5569
COSTA MESA,CA
" Zip: 92627 License: 828379
Arch : Eng:
Address: Address:
Phone: . Phone:
Zip: - - License: License:
SCOPE OF PERMIT
T/OFF EXISTING ROCK AND REROOF 1200SF RESIDENCE W/SAME.
•
FEE SUMMARY -
Plan Check: $0.00 Calc Valuation: $3,180.00
Permit: $97.25 • Claim Valuation: $3,180.00
SMIP Res: $0.50
SMIP Corn: $0.00 •
, Other: $0.00
Inspection: ,', $0.00 •
Total: $97.75
• PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-6 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"
•
ft,
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)
4 '
CEZYARATIONS
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 wo a co pensatlon Insurance crrier and policy number are:
Cartier: e Ft w / Policy Number: 1-'26 q'y 2--2 s CSS
(This section need not be completed it the permit is valued at one hundred dollars($1 or less.)
❑ I certify that In the pe ce 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 rniA,nd e hat If I s uld become subject to the workers'compensation provisions of Sectipn 3700 of the Labor Code,I shell forthwith
comply with th ro io I _
), Applicant Signature: Date: I0 Z-I p�M �r
--Y WARNING:FAILURE TO SEC E ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(St ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 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 7 )of Division 3 of the Business and Professions Code,and my license Is in full
force and effect.Lic.A Class
Contractor's Signature: Data: •
CONSTRUCTION LENDING GENCY:
❑ 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 shell licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of,not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
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 ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure),
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No
(Section 25533 of the 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 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 aEEermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 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 c. IUfrbm 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
appin rhave all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No
8 (If yent'ch 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 Flop Emissions.
I. .sr
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-desc'ad property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
- WNW, Of 'tel Owner(s) / Dam_
♦ A i♦ ♦ z t0� 7 / 6ti /
.r r Authorize•Applicant 1 111 Date
CODE I INSPECTIONTYPE PATE IN1MAL$ MODE. INSPECTION TYPF PAM MAL$
1616 Fixed System Final Fire Prevention — 206 Final Mechanical
1268 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof - 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place ' 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy •
29222 Rancho Veio Road,Suite 127
flank Bruen San Juan Capistrano,CA 92675
Office:(949)54-CRANK 1542-72653
�► OfficeFax:(949)542-7634
Web Site:vnwtCrankConstruction.aom
'pada Mpg in bui:dng Dna*, California State License#458773
"Quality that lasts"
aoIl � - •
Fax
rot City of Costa Mesa/Mary Jane W. From: Crank Brothers Roofing
Fax: 714-754-4856 Pages: 3 (including cover page)
Phone: 714-754-5273 Date: 6/24/2007
Re: Permit 805-01918 cc:
❑Urgent 0 For Review 0 Please Comment 0 Please Reply 0 Please Recycle
• Comments:
Mary Jane Weidenkeller:
Please find the attached copy of the final permit signed off on 11/03/06 to satisfy the
letter dated July 27,2007.
Thanking you in advance for your attention to this matter.
Jacki Nielsen
'd t7C9L-Z(79 (646) Rnnitsuo0 sie43o.i9 Muei0 dgg:EO to UZ 6ny
CITY OF COSTA MESO*atzpv SAFETY DIVISION
POST IN CONSPICU tJ ;FACE ON THE JOB •
Schedule inspection one workday in advance.To schedul4iri TI ons,
Call •
(714)754 0626.Provide the following information:
1) Permit number.2)Job address.3) Inspection item number.
•
seeding Address
auoang Parra a: - - Eleeblrsl Permit.: • - Coroactor. . .. ..
Mechanical Pawn A: Plumbing Pemk/: .lob Descripim
NEW ADD ALTER FAIR n0va0 DEMOLISH ISSUE GATE
•
r r
PERMITS EXPIRE 180 DAYS (6 MONTHS) FROM ISSUANCE OR LAST INSPECTION
CO STRUCTI• APP •VALS
Rene a STRUCTURAL Dale Inspector nem a POOL&SPA Dale bupec or
3 Job Site Consult 94 Pool&Equipment Location
4 Footings/Uier Ground 96 Steel Reinforcement
6 Slab 100 Secuical Bonding
6 Structural Floor 102 Rough Plumb&Pressure Test .
11 Pre-Inspect Roof104 Approval to Cover-Gunite
12 Root Sheathing I Building Height 4.1 106 Elec Conduit-Underground
14 T-Bar Ceiling-Structural -
•
108 Gas Pipe/Underground Test
16 Shear Panel 110 Backwash lines,P-Trap.
18 Frame&Flashing Underground
20 Lathing&Siding 112 Approval to Deck
22 Insulation 116 Pool Plumbing System•Final
24 Drywall Nailing 118 Poo;Eedrical-Final
26 Plaster Brown Coat 122 Fencing/Access/Alarms Approval
30 Pre-Grout 124 Approval for Plastering
31 NPDES)BMP 126 Pool)Spa Systems-Final
33 Disabled Access
FRE DEPARTMENT APPROVAL
1610 Overhd Hydro/Overhd Rough
1612 Dry Chemical
ELECTRICAL • 1614 Dry Standpipe
Th6 Ufer Ground .��. ._.__ _.._ ._��. .__.._._...... _'-' ifilfr 1=loaf=Fraetl System--.,— • . .
38 Elec Conduit-Underground
44 RoughElec-Wiring • I FINAL INSPECTIONS
46 Rough Elec.Conduit (Mast be completed prior to rec::esr•^c-...
48 Elec P-Elarowe Ceiling Can 00 Float Re- loathei�o� p.t s~•I!urc
50 Elec Power Final!Meter Release 200 Final Re-AoW -�/,O( fl LYi
51 Temp Power Fmel 201 Final Block/Retailing Wall
203 Final Sign
204 Final Demolition
206 Final Mechanical
PLUMBING&MECHANICAL 208 Final Plumbing
52 Sod Pipe-Underground 210 First Electrical
53 Shower Pan Can(714)327-7400 for the following: Dam Inspector
54 Wafer Pipe-Underground 212! Final Fire Prevention
55 Underground Gas Call(714)7545671 two(2)working days
62 Rough Plumbing prior to final ? yersemer
63 Prewrap 215 . Frail 01.61C '+5 Dew* Agrnei i f.
£'d b£9L-Zt5 (646) gonrlsuop srel{3oie ))caper dGSl£0 LO 4Z 6ny
CIT` = COSTA MESE DI G SAFETY 'VISION
POST IN CONSPICUJ , ACE ON THE JOB`-‘n
Tlx x
Schedule inspection one workday in advance. To scheduliin tions,Call(714) 754-5626:'Provide the following information.
1) Permit number, 2) Job address, 3) Inspection item numb'Ar.
Building Address: - -- Owner. I j;_,,yIW-(
4&
Building Permit I: ;I. - Electrical Permit I: - . Contractor
Mechanical Permit if: Plumbing Permit t Job Description
NEW ADD ALTER REPAST MOVING DEMOLISH ISSUE DATE 5
PERMITS EXPIRE 180 DAYS (6 MONTHS) FROM ISSUANCE OR LAST INSPECTION
CONSTRUCTION APPROVALS •
Item B STRUCTURAL Date Inspector Item I POOL&SPA Date Inspector
3 Job Site Consult 94 Pool&Equipment Location
4 Footings I Ufer Ground 96 Steel Reinforcement
6 Slab 100 Electrical Bonding
8 Structural Floor 102 Rough Plumb&Pressure Test .
11 Pre-Inspect Roof / 104 Approval to Cover-Gunite
12 Roof Sheathing I Building Height ,;c/`e S 6 )4, 106 Elec Conduit-Underground
14 T-Bar Ceiling-Structural J 108 Gas Pipe/Underground Test
16 Shear Panel 110 Backwash Lines,P-Trap,
18 Frame&Flashing Underground
20 Lathing&Siding • 112 Approval to Deck
22 Insulation 116 Pool Plumbing System-Final
24 Drywall Nailing 118 Pool Electrical-Final
26 Plaster Brown Coat 122 Fencing I Access/Alarms Approval
30 Pre-Grout 124 Approval for Plastering
31 NPDESIBMP 126 Pool)Spa Systems-Finai
33 Disabled Access
FIRE DEPARTMENT APPROVAL
1610 Overhd Hydro/Overhd Rough
1612 Dry Chemical
ELECTRICAL 1614 .:Dry Standpipe
_- . .. HIw
Lifer Gib-arid— ------;_"�- -t6i6-=Fnah=Firnd'System `�'P
38 Elec Conduit-Underground
44 Rough Elec-Wiring FINAL INSPECTIONS
46 Rough Elec.Conduit (Must be completed prior to reques?i,n c„sii an y)
48 Elec T-Bar Ceiling Call(7i4)759-5625 ter 114
50 Elec Power Final I Meter Release 200 Fmal Re-Roof `"Puc.l6 t r
51 Temp Power Final 201 Final Block I Retaining Wal
--
203 Final Sign
204 Final Demolition
206 Final Mechanical
PLUMBING&MECHANICAL 208 Final Plumbing
52 Soil Pipe-Underground 210 Final Electrical
•
S9 CIT„OF COSTA MESA
o,� �,
BUILDING DIVISION
F ( � I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT B06-01788
itakftsirrno
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.SUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
acFB JDAE'N Die
Job Address. Status: ISSUED
Suite: Applied: 10/20/2006
Vicinity: HOUSE AND GARAGE ROOFING Issued: 10/20/2006
Primary Occ: R3 Type of Construction: V-N
Parcel Number: 13913215 Zoning: R1
Applicant: NIELSEN, JACK!
Address: 126 COMMERCIAL WY
Phone: 949-548-5569 ISSUED BY:
COSTA MESA,CA Zip: 92627
YNR Mac-
Owner. CO' - ', •MUE . : INDAA
Address 3165 BER i %• �
Olt
._t
Phone: 714-545-5450 'x
OSTA MESA,CA Zip: 92626-2303 t'
Contractor: G L R ENTERPRISES INC-MBA CRANK BROTHERS�ROON
Address: 126 COMMERCIAL WY 'r •
I?
Phone: 1949-5'48569
COSTA MESA,CA \�`\
Zip: 92627 License: 828379
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF(E)ROOF MATERIALS,INSTALL 1 ROSIN, 1 BASE,2 PLY AND A GRAVEL SURFACE ON ATTACHED HOUSE AND GARAGE,APPROX
13 SQUARES.REPAIR AND REPLACE.SHEATHING AS NEEDED.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $6,900.00
Permit: $139.25 Claim Valuation: $6,900.00
SMIP Res: $0.69
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $139.94
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No,92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-4116001
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.
CMywyfk Jt.) mpegsati-- Insurance 92/der a4 policy are: �_be / ` _ 4(oak
Carrier. 1CycA COCA rl' i e 2- 1. P Number lrl7 5
`(This section need not be completed it 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 the :provisl. s.
Applicant Signature. •., • �" Date: j �— (>6
-WARNING:FAILURE TOO RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
...THOUSAND DOLLARS(S ..,UW).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDEDDED FOR FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed upder prVsi�ns.gf8[lapter 9(commencing with Section 7000)of Division 3 of the Business and PLoofess'ons Code,and my license is in full
force and-effect:Llc�a >i �J ' Q Class a� /y' S c'I
ontractor's Sign uie: ( / Ste`�1 'Date:. 3 /0 -13 — at
CONSTRUCTION LEND! AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business end Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ 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 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 B,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under 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.
azure O eget Owner(s) 7 at
tAPP
AndlOr Authorized-Applicant (—Date
•
CODE L INSPECTION TYPE PAIS =ALA CODE, INSPECTION TYPE BM 1NTmAlA
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final /pp (� 208 Final Plumbing
///3/04 '' V
200 Final Re-Roof1. 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
ME CITY OF COSTA MESA
BUILDING DIVISION
F • .. ) DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
_preps, al
PERMIT
bi 1306-01788
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.gthLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2048 MANDARIN DR Status: ISSUED
Suite: Applied: 10/20/2006
Vicinity: HOUSE AND GARAGE ROOFING Issued: 10/20/2006
Primary Occ: R3 Type of Construction: V-N
Parcel Number: 13953409 Zoning: R1
Applicant: NIELSEN, JACKI
Address: 126 COMMERCIAL WY
Phone: 949-548-5569 - ISSUED BY:
COSTA MESA,CA Zip: 92627
Owner: MC CRARY, LYNN W
Address 2048 MANDARIN DR
Phone:
COSTA MESA,CA Zip: 926264771l�
Contractor: G L R ENTERPRISES INC--DBA CRANK BROTHERS.ROOFI
Address: 126 COMMERCIAL WY n
Phone: 949-548-5569,
COSTA MESA,CA
Zip: 92627 License: 828379
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF(E)ROOF MATERIALS,INSTALL 1 ROSIN, 1 BASE,2 PLY AND A GRAVEL SURFACE ON ATTACHED HOUSE AND GARAGE,APPROX
13 SQUARES.REPAIR AND REPLACE SHEATHING AS NEEDED.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $6,900.00
Permit: $139.25 Claim Valuation: $6,900.00
SMIP Res: $0.69
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $139.94
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 xistinq: 0 Required: 0 ' Proposed: 0
I
NOTICE: The work authorized by this permit shall comply with as applicable handicap access requirements under California statutes an 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 suspe a andoned
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 VI ap Iicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the 'ation of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2441346(WOO)
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.
_VI 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.
f My workers'compensation Insurance carrier and p licy number are: r-,----
- _ .
l Carrier: .�.f��10001 R >c (c% SMo' 4 f •
c Number..----
mber:---
�(This section need not be completed it the permit is valued at one hundreft dollars($100)or less.) ,Poli
❑ 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 Califomia,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 thes: •rovisio . Y -----7Th- ^�
Applicenl'Signetuie: .. rDate: 14/'^)-R — VV
r R
iWARNINGr FAIWRE T• URE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE( •'ICO),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 rovisi n of Chapter 9(commencing with Section 7000)of Division 3'of•the.Business'and Prof ions Code,and my license is in full
rceand.effect.-Licra4 )2" IC_ LClass.N lc .-3
Cgntractor•ss afore:" a A V Date:-----1-0 - -'106 _
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,end 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. 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
❑ 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 Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a p2ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes IQ No
(Section 65850.2 Of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the 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 Califomia 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.
naturne O.^(Ty�y�yNy)))/��rLrrregal Owner(s) rS^/D/aVto
PNIl1fIl dApp icant� .J le1�)1 fDate I `se
CODE#, INSPEDTIDN TYPE P9IE INTRIALS- COMA INSPECTION TYPE RIE JNTIALS
1616 Fixed System Final Fire Prevention - - 206 Final Mechanical
• 1266 Pool Spa Final /��//�J 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
:. CITY OF COSTA MESA
4, - BUILDING DIVISION
t'4.
1 ' DEVELOPMENT SERVICES DEPARTMENT
4. PERMIT PERMIT R
E98-00959
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
. ELECTRICAL PERMIT
Job Address: 2048 MANDARIN DR Status: ISSUED
Suite No Applied: 09/10/1998
Vicinity: Issued: 09/10/1998
Parcel Nunmher: 13953409
Applicant: PATRICIA CHOMEAU .
Address:
• Phone: 714-434-4846 - •
Zip: ..
/
- . A
Owner: CHOMEAU, HENRI- -
Address CHOMEAU, PATRICIA ' - ��,
COSTA MESA,CA -' - _ Phone: N \ - - - ,v r
2048 MANDARIN DR Zip: 92626 ,
Contractor: - ,
Address: "
r
Phone:-• "
' "License: ,
SCOPE OF PERMIT
relocate electrical fixtures in kitchen&nook, 11 fixtures,6 outlets,2 switches.
FEE SUMMARY
Quantity - Quantity
ISSUE FEE $22.00 - Temp.Dist System''/Lighting, • ' $0.00 0
Temp service test $0.00 - .Busway/100 fl'" ' - $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.t p to 1 kva/kw $0.00 0 '
Pool/Spa $0.00 0 - up tol0 kva/kw $0.00 0
Lighting Fixts $11.00 11 up to 50 kva/kw $0.00 " .0' '
Recept Outlets $6.00 6 - up to 100 kva/kw $0.00 0
Switches $2.00 2 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.CConductor $0.00 0 '
Service over 1000a $0.00 - 0 ". Circus(gen or ride) • . $0.00 . 0
Motors to 1 hp $0.000" ... -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 l$0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $41.00
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
EXPIRED
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:
Cather: Policy Number:
(This section need not be completed If the permit is valued et one hundred dollars(5100)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 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(3100,000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.MID ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full
force and effect.Lic.p Class N
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Code).
Lender's 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 Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($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 Ucense 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.).
be I. as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
ode: 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• rs•ant to the Contractors Ucense Laws.).
❑ I am:Se • •er sec. . .S Business and Professions Code for this re n: a -
._�. Signatur: / ., dr %/ /a. Date: - _
Owner ID*rifled by drivers license. 0 Yes 0 No Driver's Ucense No. Expires: 7
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,Tide 8,Califomia Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: _ Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
materiel? 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 end Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP Is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application eQermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
6 (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 end Emissions.
Signature: Date:
CERT CATS 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
corn I gree to comply with all state laws end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
a died property for' Don purposes.I agree not to occupy or allow occupancy of any building authorized by this p it until final' pedion.
9 �����ykp sun 9 !
Signature tr Lega Owner(s) D e
And/Or Authorized Applicant Date
CODE I DKAPFCTION TYPE DATE =ALS co z. INSPECTION TYPE gA¢ =AU
1616 Fixed System Final Fire Prevention 206 Final Mechanical •
1268 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final BIOCkIRetaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Anal Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition • 250 Final Building/Occupancy
2446-46