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Home My WebLink About3130 Airway Ave - Building PermitsCITY OF COSTA MESA Development Services, Division of Building and Safety CERTIFICATE OF OCCUPANCY This certificate is issued pursuant to the requirements of the Uniform Building Code, Section 308 adopted by the City of Costa Mesa certifies that at the time of its issuance the 6u ild ing structure &eiein below described was inspected and approved for occupancy as follows- Building Address 3130 Ai w y�Avenue Bldg. -Permit Number B03-00979 �: Use Cormnercial/Office '� �_/!.;f,�� ' 2... Group V-NTy pe of Constructiom_a,..B/S er-. .rnrv,Fire'Zone Use Zone Owner of Building Kevin', C6 emanTenant Address 3140 Airway Avenue�vCosta"Mesa, CA 9�6 BUILDING OFFICIAL -Rick A.,BrOWII;;C B O E �Petros, of of Inspection \,\ .,; .� 2/03/09 "Date,% REQUIRED TO BE POSTED IN A "CONSPICOUS PLACE (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 3130 AIRWAY AV Suite No Vicinity: Parcel Nunmber: 42708306 Applicant: REYES, SALLY Address: 3130 AIRWAY AV' ". Phone: 714-754-4454 AMT COSTA MESA, CA., - Zip: 92626 QTY AMT Owner: GALTON FAMILY LTD $23.50 Address 3130 AIRWAYAVE �. 0 Sump Pump $0.00 Phone: BackOow irrigation $0.00 0 " COSTA MESA, CA Zip: 92626-4610 Contractor: OWNER -BUILDER Address: - Phone: Zip: License: 000000 Arch / Eng 7 -p - .. Address: - - - - Phone: Zip: — - - - .License: ISSUED BY: Status: ISSUED Applied: 07/08/2003 Issued: 10/07/2003 SCOPE OF PERMIT 45,539 SF SHELL TI TO SUBDIVIDE AN EXISTING TILT -UP INDUSTRIAL BUILDING INTO SIX UNITS. 5 BAR SINKS, 5 WASH BASINS, 10 WATERCLOSETS, 5 WATER HEATERIVENT. AMENDED 10/15/03 - 5 SEWER LATERALS TYING INTO EXISTING ON-SITE SEWER LINE. NO OFF SITE WORK AUTHORIZED BY THIS PERMIT. REF: B03-00979 - - (AIRSPACE CONDOMINIUM TO ALLOW SALE OF THE UNITS INDEPENDENT OF ONE ANOTHER WITH INDEPENDENT TENANT IMPROVEMENTS FOR EACH UNIT. ADDRESSES SPAN WHEN COMPLETED: 3130, " 132,'3134, 3136,313_8 AND 3140 -AIRWAY AV.) 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 2"646 (6=) FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 BackOow 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 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 2"646 (6=) 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 salt -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the LaborCode, for the performance of the work far which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need not be completed i/ the permit is valued at one hundred dollars ($100) or lasts.) I ❑ 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. q Class 4 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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 to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ 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? ❑ 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 California Health and Safety Code, with some exce ions, 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 a plication aadmit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency! Yes a 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 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ................................................................... ...................................................................................................................................................................................................................................................................................... 8 (If yes", attach Certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE E. INSPECTION TYPE PAS, INTIMALS CODE I INSPECTION TYPE 2AX 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Rcof 210 Final Electrical 201 Final Bloc /Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ' BU1LU1NLi PLKMI l Job Address: 3130 AIRWAY AV Status: ISSUED Suite: Applied: 09/02/2003 Vicinity: FOUNDATION ONLY PERMIT Issued: 09/02/2003 Parcel Number: 42708306 - Zoning: ' Applicant: NORWOOD, SHERYL ISSUED BY: Address: 3188 AIRWAY AV UNIT F "�� _�" Phone: (714) 7544454 - - COSTA MESA; CA��:� Zip: 92626 - Owner: COLEMAN, KEVIN " Address /3730 AIRWAY"AVE" -" _ �' - - _ -" - .. ��' ,� �•. - Phone: j COSTA MESA; CA - - - Zip: 92626-4610 Contractor:�NET DEVEOFMENT, INC .Address: 3188 AIRWAY"AVEC - UNIT�F . j Phone: (714) 754-4454 - i COSTA MESA, CA / Zip:-, 92626, Licenser 405930 . Arch t _. - = t Eng: ��_ - 1 Address: -, _ - _ - Address:, Phone: _ - _ - _ Phone: - - - j Zip: License: - License: SCOPE OF PERMIT . FOUNDATION ONLY PERMIT FOR THE NEW BLDGAREA OF,37,955 SF IN CONJUNCTION WITH THE SHELL BLDG TI TO SUBDIVIDE AN EXISTING INDUSTRIAL BUILDINGS INTO SIX'UNITS (AIRSPACE CONDOMINIUM) TO ALLOW SALE OF THE UNITS INDEPENDENT OF ONE ANOTHER. ADDRESS SPAN WHEN. - ,COMPLETED: 3130, 3132, 3134, 3136, 3138 AND 3140AIRWAY AV. REF: B03-00979 AND PM-03-06 FEE SUMMARY Plan Check: ; .$115.99 ; ,, Calc Valuation: %. $60,000.00 Permit'., $0.00 Claim. Valuation:. $60,000.00 , SMIP Res: ,1$0.00 SMIP Coin: '�t2:52 Other. $0:00 Inspection: $OAO�` �- Total: $261.26- "� PLANNING & ZONING '- SETBACKS MAIN STRUCTURE Front,0 "Rear 0-0 "Left 0-0 Right 0-0 ACCESSORY Front 0-0V��_-,Rear _ 020 AALeft_ 010` --�Righl�0-0 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 . DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate o1 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. X1 I have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of Ore work for which this pemllt is Issued. My workers' compensation Insurance carver and policy number are: [` e —7 O O - Cartier: �t 'r� �AN40GYlSQ-F70J1 TV, SU (AVIOC FU LSP Policy Number: % LI ^ 20U (This sec�need not be lewd iT fhe permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this pernit is Issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of CatifforrIlIs, and agree that if I should become ject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provislo e: Applicant Signature: r2l/ Data: d 1 ^ 2 WARNING: FAILURE TO SECURE WORKERS' TION COVERAGE IS UNLAWFUL AND SMALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLIARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: ' I hereby affirm that 1 am licensed ndvisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business�d Professions Code, and my license is In full force and effect. Lic. s d S O Class N,� Contractors Slgnature: Date: ,CONSTRUCTION LENDING AGENCY: ❑ 1 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 em 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. XYes ❑ 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: ❑ 1 hereby cer ity 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 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 and canity, a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Solely 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 motorists 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 builOing occupant need to file a registration forth for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Masa 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 D�r will th❑re the 13 or present or future building Occupant need to ppare an RMPP (Risk ent end P Managemrevention Program for acutely hazardous materials)? Sion 25534 ofof the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. �.__....... n RNI ... __..re..................theCallifo............._._........................__..................__.._......................................... ........................ 4 If an RMPP ts presently required, has Section 25534 of the Celifomia Health and Safety Code been fully compiled with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant requlre for the work which Is the subject of thisa plication a emlll for such construction or modification from the South Coast Air Ouallty Management District or from any other air pollution control district or agency? 8 Yes 6 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer bountlades of a school? ❑Yes 0 No (If lies", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If apemrit from the South Coast Air Ouallryry 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 Celitomle 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 penury that I have read this application and state that the information given ts Corect. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mass to enter upon the above-described property, for Inspection purposes. I agree not to ocapy or allow Occupancy of any building authorized by this permit until final inspection. net Legal lOwner(s) 2 to �- -O� And/or Authorized Applicant Data Y CODE I. INSPECTION TYPE RATE INTMA CODES INSPECTIONTYPE RATE Its 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing _ 200 Final RaRcof 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 Z Ti 4 7 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 3130 AIRWAY AV Suite No Vicinity: Parcel Nunmber: 42708306 Applicant: REYES, SALLY Address: 3130 AIRWAY AV Phone: 714-754.4454 COSTA MESA. CA Zip: 92626 Owner: ' COLEMAN, KEVIN A Address 3130 AIRWAY AVE Phone: 714-754-4454 COSTA MESA, CA Zip: 92626-0610 Contractor: OWNER -BUILDER Address: Phone: ZIP: License: 000000 ISSUED BY: SCOPE OF PERMIT 45,539 SF SHELL TI TO SUBDIVIDE AN EXISTING TILT -UP INDUSTRIAL BUILDING INTO SIX UNITS. 45 LIGHT FIXTURES, 50 OUTLETS, 25 SWITCHES, 6 SERVICE TO 100A, 8 COMMUNICATION DROPS, 6 SIGN CIRCUITS, 6 MISC CONDUITS. REF: B03-00979 Status: ISSUED Applied: 07/08/2003 Issued: 10/07/2003 (AIRSPACE CONDOMINIUM TO ALLOW SALE OF THE UNITS INDEPENDENT OF ONE ANOTHER WITH INDEPENDENT TENANT IMPROVEMENTS FOR EACH UNIT. ADDRESS SPAN WHEN COMPLETED: 3130, 3132, 3134, 3136, 3138 AND 3140 AIRWAY AV. REF: PM -03-06)) NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 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 - 2xa646 (6X0) 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 10 ' 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 $40.25 45 .............::..up to 50 kva/kw $0.00 0 Recept Outlets $43.90 50 .................up to 100 kva/kw $0.00 0 Switches $25.65 25 ..................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 $109.20 6 Service to 1000a $372.90 6 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 (meth ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $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. 9248, § 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 - 2xa646 (6X0) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby all inn under penalty of perjury one of the following declarations: ❑ I have antl 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 workescompensation 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 camp, if the permit is valued atone hundred dollars (SIM or less.) I cenity that in the pedo nce of the work for w this p it is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Ifomia, and at Ih If I s become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pr Is 2'1 Applicant Signature: Date: .CIL-7�-,P) WARNING: FAILU TO SECURE WOIRK(q COMPENSATION 6VER411S UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE ($100.000), IN ADDIDON TO THE OOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that 1 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. N Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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 Cade: 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 then five hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. It, however, the building or improvement H 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.). p I, as owner of the arty, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: ThXcontr License Law does not app, o an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pue Contractors l_! La1 am exemBusiness and Professions Code for this reason: Signature: Owner ID verified by driver's I" se. V s o Driver's License No Expires: Verification at Ownership by t ype of docum i.e, - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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, scatfolding, 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 (he division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I 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.... compressed gas at standard temperature end 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 It 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 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? 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 pert of the facility to be constructed Under this permit be within 1000 feel from the outer boundaries of a school? ❑Ves ❑ No (if yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ..............................................................._._.................._......_...._.__—..._....................................._._............................................................................................................................................................................_.__.......subj.............._his 7 a a porton tram 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 e (If yes", attach certificate of compliance from the appropriate air pollution control ..Ricer). 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 props inspection purposes. I agree not to Occupy or allow Occupancy of any building authorized by this permit until final inspection. ignalu t L s) Date c7Dr uthori ed 44)plice& Date CODE,. INSPECTIONTYPE PATE INTRIA CODE r INSPECTION TYPE 2&M INTITALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing � 200 Final Re-Roof 210 Final Electrical ( " 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 3130 AIRWAY AV Suite No Vicinity: Parcel Number: 42708306 Applicant: REYES, SALLY. , Address: 3130 AIRWAY AV .- Phone: 714-754-4454 COSTA MESA, CA Zip: 92626 Owner: GALTON FAMILY LTD Address: 3130AIRWAYAVE 0 Inst FAU <100 k BTU $0.00 Phone: - COSTA MESA; CA Zip: 92626-4610 Contractor: OWNER -BUILDER Address: Phone: 'Zip: License: 000000 ISSUED BY: SCOPE OF PERMIT 45,539 SF SHELL TI TO SUBDIVIDE AN EXISTING TILT -UP INDUSTRIAL BUILDING INTO SIX UNITS - - - 5 VENT FANS/SINGLE DUCT, 51NST FAU > 100K BTU, 5„COMPRESSORS 3-15 HP/500K BTU (A/C PKG UNITS 3-T6N ROOF TOP UNITS). - REF: B03-00979 Status: ISSUED Applied: 07/08/2003 Issued: 10/07/2003 (AIRSPACE CONDOMINIUM TO ALLOW SALE OF THE UNITS INDEPENDENT OF ONE ANOTHER WITH INDEPENDENT TENANTIMPROVEMENTS FOR EACH UNIT. ADDRESSES SPAN WHEN COMPLETED: 3130, 3132, 3134, 3136,3138 AND 3140 AIRWAY AV. REF: PM -03-06) 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 X66+/6(6 ) 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 $91.00 5 - . Ventillation System $0.00 0 Repair / Alt Cooling/Heat ' ' $0.00. 0 Evaporative Cooler :. - $0.00 0 Inst / Rep. Recess Wall HV $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys <100 k BTU$0.00 0 Domestic Incinerator - $0.00 0 Refrig Sys >100 k BTU $0.00 0- Compressors / Absorption Systems Gas Piping $0.00 - 0 Up to 3 hp 1100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp / 500 k BTU $135.75 5 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 $36.25 5 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 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 X66+/6(6 ) 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 salt -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: Carder: 1. Policy Number: This section need not be i)bmpl if the permit /s valued et one hundred dollars IS 100) or less.) I certify that in the De Ica of the work for which permit is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws (( lomia, and agr th 'f I uId become subject to the workers' compensation provisions o1 Section 3700 01 the Labor Code, I shall forthwith comply with these Isis / Applicant Signature. Date:- WARNING: FAILUA O SECURE WORK ' COMPENSATI N Ca GE IS UMAWPUL AND SHALL SUBJECT AN EMPLOYER 7O CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000), W ARD TOTHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3100 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. a Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued. (Sec. 3097, CMI 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 (commenting with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). I, as owner of th r rty, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The con rsLicense Law does not appty to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursu o the Contractors a w5.). ❑ I am exam fficet. Business d Professions Code for this reason: Signature: Dale: Q ` Owner verified Y ❑ No Drivers License No. Expires: Verification of Owtype of docume , 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 then thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Califomia Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number; HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII 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 then a weight of 500 pounds, or a volume of 55 gallons, .or 200, cubic feet of compreSmcl gas m standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code. with some exceptions, requires registration with the Costs Mesa Fire Department by each business which at any one time has On hand a quantify 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 Tplicant or present or future building occupant need to prepare an RMPP (Risk Management end Prevention Program for eatery hazardous materials)? ❑ Yes ❑ rvo ``Section 25534 of the California Health and Safety Code provides that the Costa Mess Fire Department may require the preparation, certification and filing with the Fire 6apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. an RMP ........................._.._...___""._. ___.._...—.._.._........._r...........____.._.......Ye__ 4 It an MPP Is presently requiretl, hes Section 25534 0l the California Health and Safety Gude been fully compli0d with? ❑Ves ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisa plication a�piermit for such construction or modi ?cation from the South Coast Alr Quality Management District or from any other air pollution control district or agency? 8 Yes u No (Section 65850.2 01 the California Government Code requires that the requested information be furnished On applications for non-rwidenual building permits). .........._........................_.__.._................ ^_._.._... _._.___.-_—__..__..._.........._....._................___................................................ ..................._..........__.............�......._._. 6 Will any pert 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 01 the disclosures prescribed by California Health and Safety Code Section 423D3 been made? ❑ Yes ❑ No 8 (If yes', attach comficate 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 cora ly 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 pro for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sign Of eg O er(s) Date Ari Autlii5ri ed p I Data CODE f. INSPECTION TYPE PATE ILLS CODE INSPECTION TYPE gAU J[{111161JI 1616 Fixed System Final Fire Prevention 206 Final Mechanical - 8-0jt 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Relalning 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-m"W9UPRESSION PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3130 AIRWAYAV Suite: Vicinity: OFFICE CONDOS Parcel Number: 42708306 Zoning: Applicant: JASON MATTISON Address: Phone: 714-632-9381 Zip: Owner: COLEMAN, KEVIN A Address 3130 AIRWAY AV Phone: COSTA MESA, CA Zip: 92626 Contractor: LEE FIRE PROTECTION INC Address: 1188 N GROVE ST UNIT B Phone: (714) 632-9381 ANAHEIM, CA Zip: 92806 License: 682771 Status: ISSUED Applied: 10/16/2003 Issued: 10/28/2003 ISSUED BY: SCOPE OF PERMIT RELOCATION/ADDITION OF 82 SPRINKLER HEADS WITH PIPING CHANGE -OUT FOR 5 OFFICE CONDO IN CONJUNCTION WITH THE TI. REF: B03-00979 FEE SUMMARY Plan Check: $274.33 Calc Valuation: $28,000.00 Permit: $422.05 Claimed Valuation: $28,000.00 Other: $0.00 Total: $696.38 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 2"6.46 (8/00) G 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 sell -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 workersoompensaflon Insurance, as required by section 3700 of the labor Code, for the performance of the work for which this permit Is issued. My workbrannumber are: �U 7Cartier. - J /�y-G Policy Number: (This section need not be completed if the permit is valved at one hundred dollars ($100) or less.) - - ❑ 1 certify that In the perto nce of the work for which this permit Is issued, I shall not employ any person In any manner so as to become4ubjact to the workers' compensation laws of Romia, and agr a that I cul a orae subject to the workers' compensatlon provisions of Sectio 3700 of he Labor Code, I shag forthwith comply with these p Ions. Applicant Signature: ''Data: 03 _ WARNING: FAILURE TO R ORNERS' CONPENSATIN COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENAL ES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE W ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 8708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am tic visions of apter 9 (commencing with Section 7000) of Division 3 of the Business d 1P n fe sions Code, and my license is in full force end effect. LIC. p - Class 4 Contractors Signature: IAI Date: A&2 41AJ3 CONSTRUCTION DI G AGENCY: ❑ I hereby affil that there Is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, CMI Code). Lenders Name: Landers 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 Cafe) 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 (S5DO).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the struciure 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. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property lax 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, 1 will not employ anyone to do work which would require a portrait 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 WIII 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 forth for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptlons, 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 600 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..... .__...... ___...__._._.._._......_....................__...__..........._...- 3 Does or will the aeppplicant 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, hes Section 25534 of the California Health and Safety Cafe been fully compiled with? ❑ Yes ❑ No 5 Does or coil the oast Air or present or future building occupant m require for the work which Is the subject 01 ? a plication epermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution contra district or agency? � Ves S No (Section 65650.2 of the Caglomla Government Code requires that the requested Information be furnished on applications for non-residential building permits). ........_ ............................ ................. _.... _................... ___.................... _.._....................... __.............................................. ........ ..............._... 6 Will an rt of the facility to be constructed under thld �.....— y pe ry permit Da within 1000 feet from the outer boundaries ai a schad7 O Ves O 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 Quail ty 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 coN1y 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: Data: CERTIFICATE OF COMPLIANCE AND AUTHORIZAT10N OF ENTRY: I candy under penalty of perjury that I have read this application and state that the information given Is correct. I agrbe to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above -d Embed property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit unfit final inspection. Ign i)L r s �Q a An A hod Icant ate INSPECTION TYPE - I1d1E gliIITIAl9 WM INSPECTION TYPE gA¢ INITTIA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final EleFire trical Pr 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval _ 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy BUILDING PERMIT Job Address: 3130 AIRWAY AV Status: ISSUED Suite: Applied: 04/13/2004 Vicinity: Issued: 05/11/2004 Parcel Number: 42708306 Zoning: Applicant: FABISIAK, MIKE ISSUEDBY: Address: 3130 AIRWAY AVE Phone: 714-754-4454 COSTA MESA, CA Zip: 92626-4610 Owner: COLEMAN, KEVIN A Address 3130 AIRWAY AVE Phone: COSTA MESA, CA Zip: 92626-4610 - Contractor: Address: Phone: Zip: License: , Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT INSTALL 450SF CANOPY AT THE FRONT OF THE BUILDING. Total: $292.80 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left. 0.0 -Right X0-0 ACCESSORY Front 0-0 Rear 0-0 Left- 0='0 Right 0-0 PARKING Exisiinq: 0 Required: , 0 Proposed: 0- NOTES: ABDER SH 04/13/2004 APPLICANT WAS NOTIFIED THAT,24X36 $10,000.00 $10,000.00 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 it 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 !aaaae (t ) FEE SUMMARY Plan Check: $29.45 Calc Valuation: Permit: $181.25 Claim Valuation: SMIP,Res: $0.00 SMIP Com: $2.10 Other: $0.00 Inspection: $0.00 Total: $292.80 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left. 0.0 -Right X0-0 ACCESSORY Front 0-0 Rear 0-0 Left- 0='0 Right 0-0 PARKING Exisiinq: 0 Required: , 0 Proposed: 0- NOTES: ABDER SH 04/13/2004 APPLICANT WAS NOTIFIED THAT,24X36 $10,000.00 $10,000.00 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 it 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 !aaaae (t ) r e WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance o1 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 Innn1eee'uuuraAno1e Mer antl II um re: Cartier: C X /'l� A Pollcy Number: is section need not be can ed if the permit is volu d at one hundred dollars ($100) or less.) '% certify that In the performance of the work for which this porn erty ogd. I shall not employ any person In any manner so as to became subject to the workers' compensation laws ro Celitomia, end egr sho co r�subjoct to the workers' compensation provisions of Section 3700 of the labor Code, I shall forthwith comply with these of Cao I ('^v,1f Applicant Signature: =".! � Date: c I 1 �" 1 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML Fl ES UP TO ONE HUNDRED THOUSAND DOU ARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION Oma 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. Lk. a Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affiml 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: 1 hereby affirm that under penalty of perjury that 1 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 provislorls of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for seta (Sec. 7044, Business and Professions Cade: The Contractors License Law does not apply to an Owner of property who builds or improves thereon, and who does such work himself or herself or through his or her Own employees, provided that such improvements are not Intended or offered for sale. It, however, the building O 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 n p o an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the �ra Cm Li sA. ❑ 1 am exemp der Business and roje Bions Code rltlis reason: Signature: �e � Date: Owner ID verified by drivers license. ❑ Yes ❑ No i3ffivers " nse No. Expires: Verification Of Ownership by (type of document, Le. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) O more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has e Permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII 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 Costs Mese 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? ❑Ves ❑ 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 motorists equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feel of compressed gas at standard temperature and pressure). ........................_.........................._................._—..............._._.__...__,___..._____._..............._......_...................___..........................................................................___.._..__.. 3 Does or will the applicant or present Or future building occupant need to prepare an RMPP (Risk Management and Prevenllon 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? C1 Yes ❑ No 5 Does or will the applicant rt or present or future building occupant require for the work which is the subject c this a plication appermit for such constmdion or modification from the South Coastst Air Quality Management District or from any other air pollution control district or agency? Vas O No (Section 65850.2 of the Celitomia Government Code requires that the requested information be furnished on applications for non-residential building permlts). 6 Will flny pan of the facility 10 be constructed under this permit be within 1000 feat from the outer bounderfes 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 ........__..._................__................._.._.........._........__.._...........___......._.._.__......................._......._........................................................................... __.................. _._......... __..... B (II }jos', 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 Mese 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. slur Of en, AncUOr Authorized Applicant Q DaI CODE a INSPECTION TYPE gag ItffIDELS CODES INSPECTION TYPE PATY JIMA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pod Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final BlocktRelaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 3130 AIRWAY AV Suite: Vicinity: Parcel Number: 42708306 Applicant: COLEMAN, KEVIN A Address: 3130 AIRWAY AVE 4� r� y COSTA MESA; CA- - /j Owner: COLEMAN, KEVIN A ` Address /3130 AIRWAY -AVE, — j-/160STA MESA CA' _ Contractor: OWNER -BUILDER Address: , !, Zip: Status: ISSUED Applied: 12/01/2003 Issued: 12/01/2003 Zoning: ISSUED BY: Phone: 714-754-4454 Zip: 926264610 Phone: Zip: 92626-4610 Phone: License: 000000 , , Arch : - . , r - Eng. - Address: - ' �" - - Address: . Phone: - - Phone: Zip: 'License: License: SCOPE OF PERMIT- . 2 TRASH ENCLOSURES. REF.: B03-00979_ FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,600.00 Permit: $83.25 -- Claim Valuation: $2,600.00 SMIP ReS: $0.00 SMIP Com: $0.59 �'. Other: °� $0.00_ Inspection: v$0.00 ,,Total: $83:84, PLANNING & ZONING SETBACKS, MAIN STRUCTURE Front ,. 0-0 Rear 0-0 _ Left '0- 0 ACCESSORY Front �,0-0 Rear 0-0 Lek 0-0 PARKING Existing: _ 0�1 Required: 0 Proposed: o NOTES: Right 0-,0 Right 0- 0, NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 244646 (SM) 4� r� y Arch : - . , r - Eng. - Address: - ' �" - - Address: . Phone: - - Phone: Zip: 'License: License: SCOPE OF PERMIT- . 2 TRASH ENCLOSURES. REF.: B03-00979_ FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,600.00 Permit: $83.25 -- Claim Valuation: $2,600.00 SMIP ReS: $0.00 SMIP Com: $0.59 �'. Other: °� $0.00_ Inspection: v$0.00 ,,Total: $83:84, PLANNING & ZONING SETBACKS, MAIN STRUCTURE Front ,. 0-0 Rear 0-0 _ Left '0- 0 ACCESSORY Front �,0-0 Rear 0-0 Lek 0-0 PARKING Existing: _ 0�1 Required: 0 Proposed: o NOTES: Right 0-,0 Right 0- 0, NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 244646 (SM) i WORKERS' COMPENSATION DECLARATION: 1 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 carder and policy number are: Carrier: Polity Number: (This section need not be completed if thepermitIs valued at one hund chars ($100) or less.) I certify that in the performanceyf'The work fol 1i rmlt Is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of sill rt a, antl W1 s ould becom aaFb4haW01N6 nsation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pro s. Applicant Signature: Date: -12-1 WARNING:. FAILURE TO SECURE WORKERVCOMPENSATION4515VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,00)), 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: 1 hereby affiml 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. Uc. If Class p Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 11 7Y - r� 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 Coda: Any city or county which'requaes apermit 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 i9 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 Loomis 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 seta. If, however, the building or improvement is sold within one year of completion, the owner-builder will havethe burden of proving that he or she did not build or improve for purpose of sale.). 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 the Contractors Ucense Laws.). ❑ 1 am axe der sec Rusinaas and Professions Code for this reason: -Signature. Date: �L-1 n3 Owner ID vented by ers license. ❑ 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: ❑ 1 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: Data: 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 California Health and Safety Code, with some excedons, 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 equarto or greater then a weight of 500 Pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..................._................................................................... _................................. _.... ........................... ........................................................................... _... .............................................................................. ..................................................... ........... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .......................................................................................................................................................................................................................................................................................................................................................................................... 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the oast Air or present or future building occupant require for the work which is she subject of this a plication appermit for such construction or matlification tram the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes L] 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 pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ 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 emit 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 cored. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CE FICA F COMPLI A TION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is co Ct. roe t y with a aws and city ortllnances relelin to builtling consimction, and authorize representatives of the City of Costa Mesa to enter upon the abo props nspection pu s.+v o Occupy or allow oco y of any building authorized by this permit until final inspection. (z- i -oz t Legal Owners) Date And/Or Authorized Applicant Dale CODE S. INSPECTIONTYPE grljE gKnnA CODE E INSPECTION TYPE LSA¢, RiTITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy / (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 FIRE SUPRESSION PERMIT Job Address: 3130 AIRWAYAV Suite: Vicinity: NET DEVELOPMENT Parcel Number: 42708306 Zoning: Applicant: HUI, LEON Address: 17992 COWAN Phone: 9494740555 IRVINE, CA - Zip: 92614 Owner: COLEMAN, KEVIN A Address 3130 AIRWAY AVE Phone: COSTA MESA, CA Zip: 92626-4610 Contractor: THE GREATER ALARM CO INC Address: '17992 COWAN IRVINE, CA Phone: 9494740555 Zip: 92614 License: 469046 Status: ISSUED Applied: 0 112 712 004 Issued: 02/13 004 ISSUED BY: SCOPE OF PERMIT INSTALLATION OF A NEW FIRE ALARM SYSTEM IN CONJUNCTION WITH THE 8780 SQ. FT. TI FOR "KEVIN COLEMAN." SCOPE OF WORK TO INCLUDE: 3 NEW RESTROOMS, LUNCHROOM OFFICE AND WAREHOUSE AREA. REF: B04-00144 FEE SUMMARY Plan Check: $45.01 Calc Valuation: $2,000.00 Permit: $69.25 Claimed Valuation: $2,000.00 Other: $0.00 Total: $114.26 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) 754.5628 z� (6=) V 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. ar' have and will maintain workers' compensaffon Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worl�e com eensatl"surance der end policy number are: r Carrier. ��'I_ocA Polity Number: (This section need not be corriplotedd BJe permit is valued at one hundred dW/ars (5100) or less.) ❑ 1 certify that in the performance he wor(kc 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 Calijomis, a d agrz that If I should become subject to the workers' compensation provisions of SecIWWWn 37 of the Labor Code, I shall forthwith complywith these provislpns,/ r Applicant Signature: �I rr Date: WARNING: FAILURE TO SECURE"WORKERS' ON' OVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1 DO,000). IN ADDITION T TO, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirn that I am licensed un err provls ons Chapter 9 (commencing with Section 7000) of Division 3 of the Business an rofessions Cade, and my license Is in full force and effect. Lic. q Class s , G Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 1 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 sola 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 Avner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of tl me , i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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 Industnal 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 WIII 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 Ome 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 torn for acutely hezartlous 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 en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ... ......................................................................... ....... ............................................... ................................... ....... ...................... _...................__.._.............................................................................-_..................... ._.............. __................ __..... 5 Daes 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 LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ........................................................................................................................................................................................................................................................................................ ......................................................................................... 8 WIII any pert of the facility, to be constructed under this permit be within 1000 feet from the outer boundaries of a school? �] Yes ❑ Na (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 ..........................................................................................................................................................................................._......................................................................_.._...................._.............. ...................... _....... B (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. ISI eau a Of egal ner(s) Date 'And/or Authodz d Ap CODE Jr. INSPECTION TYPE ISL$ CODE INSPEcfIONTYPIIS 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/Retaming Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BulldingrOocupancy (714) 754.5273 " Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626 PLUMBING PERMIT Job Address: 3130 AIRWAY AV Suite No Vicinity: Parcel Nunmber: 42708306 Applicant: COLEMAN, KEVIN A" Applied: 02/02/2004 Address: 3130 AIRWAY AVE QTY 0 AMT ISSUE FEE Phone: 714-754-4454 ' Laundry Tub / Washer COSTA MESA, CA Zip: 92626-4610 Owner: COLEMAN, KEVIN A $0.00 Backflow Preventer Address 3130 AIRWAY AVE P -Trap - $0.00 Bathtub $0.00 Phone: Pressure Regulator $0.00 COSTA MESA, CA Zip: 92626-4610 Contractor: OWNER BUILDER Connect (Ice,Soda,etc) $0.00 Address: Receptors $0.00 Dental Units $0.00 0 Phone: $0.00 Dishwasher $9.80 Zip: Sewer Cap for Demo $0.00; Drain, Floor License: 000000 Arch / Eng $0.00 Address: Phone: Zip: - License: ISSUED BY: Status: ISSUED Applied: 02/02/2004 Issued: 02/02/2004 SCOPE OF PERMIT 8780 SQ. FT. TI FOR "KEVIN COLEMAN". SCOPE OF WORK TO INCLUDE: 3 NEW RESTROOMS, LUNCHROOM, OFFICE AND WAREHOUSE AREA. RERB04-00144. PLUMBING TO INCLUDE: 1 DISHWASHER, 1 FLOOR DRAIN, 1 GAS (1-4 OUTLETS), 1 SHOWER, 1 KITCHEN SINK, 1 SERVICE SINK, 1 TRAP PRIMER, 3 WASHBASINS, 1 WASTE AND VENT SYSTEM, 3 TOILETS, 1 WATER HEATER, 1 WATER PIPING.> - -. QTY AMT FEESUMMARY 0 AMT QTY 0 AMT ISSUE FEE $23.50 0 Laundry Tub / Washer $0.00^ Backflow irrigation $0.00. 0 Landscape Irrigation $0.00 Backflow Preventer $0.00 0 P -Trap - $0.00 Bathtub $0.00 0 Pressure Regulator $0.00 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 Dental Units $0.00 0 Septic Tank $0.00 Dishwasher $9.80 1 Sewer Cap for Demo $0.00; Drain, Floor $9.80 1 Sewer Connect $0.00 QTY AMT QTY 0 Sump Pump $0.00 0 0 Swimming Pool $0.00 0 0 Trap Primer $9.80 1 0 Urinal $0.00 0 0 Vacuum Brkr Bkflow(1-4) $0.00 0 0 Vacuum Brkr Bkflow(5+) $0.00 0 0 Wash Basin $29.40 3 0 Wash Basin Set $0.00 0 0 Waste and Vent System $9.80 1 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 249648 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ 1 have and will maintain workers' compensation Insur noe, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit Is Issued. My workers' compensatipq Inpurgn e c r er ntl icy nu bar are: Carder: 0 A! Policy Number: Is section need not be p eted if the permit i, slued at one hundred dollars ($100) or less.) 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' [Appil.ritSignature.nZMi ompensation laws of California, and agree that If 1 should become subject to the workers' compensation provisions of Sect�pn 37 off�th(e Labor Code, I shall forthwith omply with thI JC Z �2 l V �7 / Dete: 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 DOLIARE ($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 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. 11 Class M Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby offiml 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: 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 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 fd 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.). 1, 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.). ❑ 1 am exam u er ec. Business and Professions Code for this reason: Signature: 1_I �J Date: Owner ID verified by driver's license. Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, Le. - property lax 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-slx (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Ca111omla 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). ........................._._........................._.......................ao...........................................oc......_...............................................i.r......._..........................._................................................................. _................._......... _............. __.............._.. 2 Does or will the applicant ar present or future building occupant need to lila a registration torte for acutely hazardous materials? ❑Yes ❑ Na (Section 25533 of the California Health and Safety Code, with some excetions, 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 equarto 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 theappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes 11No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..............................................................._............ .............................................................. ............................................................. ............................. ............................ ................. .... ...;.......... _............... .................................... _.................. ... 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Ves ❑ No 5 Does Or will the applicant or present or future building occupant require for the work which is the subject ofthis application e$ermlt for such construction or modification from the South Coast Air Quality Management District or from any Other air pollution control district Or agency? Byes 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 too[ from the outer boundaries of a school? ❑Yes ❑ No (I1 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 Callfomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................ _.... ..... .......... _... ..... 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-describ d op rty for inxSpeIXioQ pury95es. ag occupy or all upancy of any wilding authorized by his per It petit tin inspection. Signature Of Legal Owner(s) V /ll� Date And/Or Authorized Applicant Date CODE P. INSPECTIONTYPE PATE ILIAL$ CODES INSPECTION TYPE PAIS IMMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing - O 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 2154 Final Demolition 250 Final Bullding/Occupancy MECHANICAL PERMIT Job Address: 3130 AIRWAY AV Suite No Vicinity: Parcel Number: 42708306 Applicant: COLEMAN, KEVIN A Quantity Address: 3130 AIRWAY AVE 0 Inst FAU <100 k BTU $29.60 Phone: 714-754-4454 Inst FAU >100 k BTU COSTA MESA, CA Zip: 92626-4610 Owner: COLEMAN, KEVIN A 1 Address: 3130 AIRWAY AVE 0 - Refrig Sys <100 k BTU $0.00 Phone: Refrig Sys >100 k BTU COSTA MESA, CA Zip: 926264610 Contractor: OWNER BUILDER _ . 1 Address: $10.65 - Hood w/Meth Exhaust $0.00 Phone: VAV Box $0.00 Zip: Vent Fan / Single Duct $0.00 License: 000000 ISSUED BY: Status: ISSUED Applied: 02/02/2004 Issued: 02/02/2004 SCOPE OF PERMIT 8780 SQ. FT. TI FOR "KEVIN COLEMAN". SCOPE OF WORK TO INCLUDE: 3 NEW RESTROOMS, LUNCHROOM, OFFICE AND WAREHOUSE -AREA. REF:B04-00144. - MECHANICAL TO INCLUDE: 2 FAU'S < 100K BTU, 3 FAU'S > 100K BTU, 1 GAS PIPING, 1 FIREPLACE, MISC DUCT WORK. FEE SUMMARY " $0.00 Quantity ISSUE FEE $23.50 0 Inst FAU <100 k BTU $29.60 2 Inst FAU >100 k BTU $36.40 2 Repair I Alt Cooling/Heat $13.70 1 Inst / Rep. Recess Wall HV $0.00 0 - Refrig Sys <100 k BTU $0.00 0 - Refrig Sys >100 k BTU $0.00 0 Gas Piping $6.15 _ . 1 Factory Fireplace - $10.65 1 Hood w/Meth Exhaust $0.00 0 VAV Box $0.00 0 Vent Fan / Single Duct $0.00 0 - Appliance $0.00 0 " Fire Dampers $0.00 0 Smoke Dampers $0.00 0 Inst or Relocate Appl Vent $0.00 0 Air Handlers < 10000cfm $0.00 0 Air Handlers > 10000cfm $0.00 0 Floor Furnace $0.00 -" 0 Floor or Suspend Heater $0.00 0 Quantity Repair / All Absorbtion Unit $0.00 0 Repair / All Refrigeration Unit $0.00 0 Ventillation System $0.00 0 Evaporative Cooler $0.00 0 Commercial Incinerator $0.00 0 Domestic Incinerator $0.00 0 Compressors/ Absorption Systems, Up to 3 hp / 100k BTU - $0.00 0 3 To 15 hp / 500 k BTU $0.00 0 15 To 30 hp / 1,000 k BTU $0.00 0 30 To 50 hp 11,750 k BTU $0.00 0 Over 50 hp / Over 1,750 BTU $0.00 0 Boilers ' Up to 3 hp $0.00 0 3 To 15 hp $0.00 0 15 to 30 hp $0.00 0 30 to 50 hp $0.00 0 Over 50 hp $0.00 0 Other Mechanical Fee Investigation Fee $0.00 Plan Check 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 2"646 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: ' ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensat n Insurance�/ rder and policy number are: Carder: Policy Number: (This section need not be completed it t e 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 S��?ccction 300 of the Labor Cade, I shall forthwith comply with these pOvji�Kis.,, Applicant Signature: LJ+tyI'{�� ✓ �"^'�i Date: o7 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 DOLLARS ($100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION W06 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em 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. p Class 8 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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 adIrm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professlons 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 Lew (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole Compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Cade: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owne(-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to Construct the project (Sac. 7044, Business and Professlons 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.). ❑ 1 am exempt utn�r�ec. Business and Professions Code for this reason: Signature: I un f 49 - of 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: ❑ 1 hereby certity 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, California AdminlstratNe 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 feel 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 exceptlons, 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). ................_..........................._.......................... _..........................................-.......................... _......................... _................................................ __................................................................ .................. __............................. ......................... [_1 Yes ❑ Plo 3 Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..........................................._................................................................................_...................................................................................._............................_.._.._...._.._............................_..... ........................................................ _........... 4 If en RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ................_._._.....................__..................................... __"—__.................__..................._.._................_._........................�.�__................. _._................ _... ........... __........ __.._..... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Mplicalion a kermit 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 L1 No (Section 65850.2 01 the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). .................__......................_..—......................___—_—__.................m"'i'__...................000 f.......................___........._...............__.._...._.............._..... ..._............. _._................ _.................__................_....... 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yea', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ...................._._..._..............._......................_._.__..........___..._.._...................___..................__._..........._____..............._____...._....... _ ... _....... __....... __..._..—.. 7 It a ppermit 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 appliCallon, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ...............................___.._.................... ..__................................._._......................................................._........................._._.................. .—_............__..........__._.....—.... e (It yes', attach certificate of Compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: 1 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 bullding construction, and authorize representatives of the City of Costa Mesa to enter upon the above -1 scribed roperty for inspectio pure ses.`I agra-e�n�o occupy or allow occuparjcy of any building authod/byiVhis per/ni{Vt u til inal inspection. Signature Of Legal Owner(s) l/Ay �I! /�Date And/Or Authorized Applicant Date CODE I. INSPECTION TYPE ATF IML$ CODE INSPECTN)NTYPE LIM UiSMALS 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/Retalning 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 3130 AIRWAY AV Suite No Vicinity: Parcel Nunmber: 42708306 Applicant: COLEMAN, KEVIN A Address: 3130 AIRWAY AVE - COSTA MESA, CA Owner: COLEMAN, KEVIN A Address , 3130 AIRWAY AVE COSTA MESA; CA Contractor: OWNER BUILDER Address: Phone: 714-754-4454 Zip: 92626-4610 Phone: Zip: 92626-4610 Phone: Zip: License: 000000 I ISSUED BY: Status: ISSUED Applied: 02/02/2004 Issued: 02/02/2004 SCOPE OF PERMIT 8780 SQ. FT. TI FOR "KEVIN COLEMAN". SCOPE OF WORK TO INCLUDE: 8 NEW RESTROOMS, LUNCHROOM, OFFICE -AND WAREHOUSE AREA. REF:B04-00144. - - - ELECTRICAL TO INCLUDE: 71 LIGHT FIXTURES, 78 OUTLETS, 35 SWITCHES, 5 MOTORS TO 1 HP, 35 COMMUNICATION DROPS, 1 LOW VOLTAGE WIRING SYSTEM. Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00' 0 $0.00 0 $0.00 0 $25.00 1 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $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 244646 (6/00) FEE SUMMARY Quantity _ ISSUE FEE $23.50 Temp Dist System / Lighting Temp service test $0.00 - r Busway /100 ft Res. a/c package- ,' $0.00 Standing Section New Res (1-2 units) " $0.00 0 - - Misc Elecbical Equipment New Res (3+units) $0.00 0 Transformers up to 1 kva/kw' Pool / Spa $0.00 - 0 ................up to 10 kva/kvi Lighting Fixts .$59.23 71 _ .................up to 50 kva/kw Recept Outlets $64.34 78 .................up to 100 kva/kw Switches $32.95 35 ..................over 100 kva/kw Non Res Appl $0.00 - 0 `- Low Voltage Equipment Res Appl $0.00 0 Low Volt Wiring System / Ckt Service to 200a $0.00 0 Misc. Conduit Service to 1000a - $0.00 0 Misc. Conductor Service over 1000a $0.00 0 Circus ( gen or ride) Motors to the $23.75 5 Circus (mech ride or lights) Motors to 10hp $0.00 - 0 Christmas Tree Stand Motors to 50hp $0.00 ' 0 Fireworks Stand " Motors to 100hp $0.00 0 -' Other Electrical Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00' 0 $0.00 0 $0.00 0 $25.00 1 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) ' EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 244646 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: _ - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will m1afinteil certificate of consent to self -Insure for workers'compensation, as provided for by section 3700 of the Labor Code, for the performance of the thiep work for which this'permit I5 issued. ❑ I have and will maintain workerscompensati n Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers'compe tiourance car' and ollcy number are: Cardec Policy Number: (This section need notFe completed it the p&mit is valued at one hundred dollars ($ f00) or less.) ❑ I certify that in the performance of the work for which this Permit Is issued, I shall not employ any person m any manner so as t bac=n subject to the workers' compensation laws of California, and agree that it I should become subject to the workers' compensatlon provisions of Sectio 3700 o the Labor Code, I shall forthwith comply with these provisio' / n !J Applicant Signature: _ 1/RK.a-e_4-Ly Dete: v WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P ALTIES 613 CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 at the Business and Professions Cade, and my license is in full force and effect. Lic. R Class q Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License laws.). ❑ 1 am exempt un( r °�— Business and Professions Code for this reason: Signature: l/R_-P1Zc1V—t42� Date: Owner ID verified by ddvers license. ❑ Yes ❑ No Onve's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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: I Will the applicant or present or future building occupant need to lila 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 reponed 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). ................_..._..__—......................________._....._upant need ........._.. ""._.............. ........_.__----- --_------ 2 Does or will the applicant or present or future building occupant need to lila 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 appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? [I Yes ❑ Pio (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................................................................................................................................................................................................................................................................................................................................................................................... 4 If en RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thispliralion aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 8 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 WIII any pan 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 eppropnete elr 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: 1 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-describetl r perry for,inspecti n pu oses. I agree not to occupy allow oc pancy of a y building authorized b IN permit nt fna Inspection. tip �� - �i � Signature Of Legal Owner(s) Da And/Or Authorized Applicant Date CODE r. INSPECTIONTYPE PASE INTMALS CODEC INSPECTION TYPE DAM INITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing �,lf 200 Final Re-Roof10 Final Electrical 3 —z O 201 Final BlocklRetaining 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 FIRE SUPRESSION PERMIT Job Address: 3130 AIRWAYAV Suite: Vicinity::.jF ORWV .: 46 Parcel Number: 42708306 Applicant: LEE, DONALD Address: 1188 N GROVE ST UNIT B, ANAHEIM, CA owner: i COLEMAN, KEVIN A Address 3130 AIRWAY AVE - COSTA MESA, CA Contractor: LEE FIRE PROTECTION INC Address: 1188 N GROVE ST Zoning: Phbne: (714)632-9381, Zip: 92806 - Phone: Zip: 92626-4610 UNIT B Phone: (714) 632-9381 ANAHEIM, CA Zip: 92806 License: 682771 SCOPE OF PERMIT REF B04-00144 FOR KEVIN COLEMAN. 70 NEW SP HEADS. Status: ISSUED Applied: 01/22/2004 Issued: 02/04/2004 ISSUED BY: FEE SUMMARY Plan Check: $90.51 Calc Valuation: $7,000.00 Permit: $139.25 Claimed Valuation: $7,000.00 Other: $0.00 Total: $229.76 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 244846 (4488) S DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. ❑ Ilhave 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 carder end policy number are: �^ L Carder: 1 ilii//.Q /tai t^n Policy Number: (r (This section need not be completed if the permit /s valued atone hundred dollars ($100) or less.) , . ' ❑ I certity that in the performance of the work to Ich t s permit is issued, I shall not employ any person in any manner so as to become subject to the workers' Compensation laws of CaLV1 v and agree t If I s uld begme subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith campy with these pro ' Ions. u Applicant Signature: Date: — %_ WARNING: FAILURE TO SECURE OWE COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000). IN ADD ONTO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provislo of Ch ter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Uc. 8 4fClass a _ G Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirn 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: 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).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 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 appy 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Data: Owner ID ventied by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII 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 tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of Compressed gas at standard temperature and pressure). ..........._......_ ... ........... _._—___.......______._...................____..............__..............___.._............_—.__._.................... _.._..................... .......... _................. ..._.................. _... __..... 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mese Fire Department by each business which at any one time has on hand a quantity o1 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 It an RMPP is presently required. hes Section 25534 of the California Health and Safety Code been fully corn.._ with? ❑Yes ❑ No 5 Does or will the applicant or present or future building occupant requirethe work which is the subject of this a plication appermit for such construction or modification from the South Coast Air Quality Management Distract or from any other airit pollution control district or agency? Yea 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 WIII 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 Irom 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 Materiels and Emissions. Signature: Date: CERTIFICATE OF COMP CE D AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comp with stele laws antl city ordinances relating to building Construction, and authorize representatives of the City of Costa Mesa t0 enter upon the above- i ed prope aL10 n rposes. I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection. Z Cure Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE E. INSPECTIONTYPE 2AU ItRIDELS CODES Iiffmc IONTYPE 2AU IISTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing _ 200 Final R 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention Z � 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4656 • www.ci.costa-mesa.ca.us 77 FAIH UHIVE, GUS 1 A Mt5A, GA 92526 BUILDING PERMIT Job Address: 3130 AIRWAY AV Status: ISSUED Suite: Applied: 01/12/2004 Vicinity: Issued: 01/30/2004 Parcel Number: 42708306 Zoning: Applicant: SHERI VALAINIS ISSUED BY: SA Address: - - Phone: 714-754-4454 Zip: Owner: COLEMAN, KEVIN A Address .3130AIRWAYAVE '. Phone: COSTA MESA, CA Zip: 92626-4610 Contractor: Address: i Phone: Zip: License: Arch _ Eng: Address: ` Address: Phone: Phone: Zip: License: License: . SCOPE OF PERMIT 8780 SO. FT. Ti FOR "KEVIN COLEMAN". SCOPE OF WORK TO INCLUDE: 3 NEW RESTROOMS, LUNCHROOM, OFFICE AND WAREHOUSE AREA. FEE SUMMARY Plan Check: $141.01 - Calc Valuation: $81,390.00 Permit: $867.75 Claim Valuation: $81,390.00 SMIP Res: $0.00 SMIP Com: $17.09 Other: $0.00 Inspection:. $0.00 Total: $1,025.85 - 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 44548 (aroo) "4 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 main4ilj 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' compensptlon Insurance carrier and policy number are: Carrier: / Policy Number: (This section need not be completed 11 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' CONWENSATION COVERAGE IS UNLAWFUL AND SHALL SUWECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOL ARE ($100,OD0), 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 ) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. 4 Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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 Cade: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec. 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.). ❑ 1 am exempt QndL4r sec. -.— Business and Professions Code for this reasoryy Signature: 4L/!-�sJ Date: Jo 7�5 Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License Expir s: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is requlredlto 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 6, 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 tlumig a reponed year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume o155 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........._......................._......................._.................. ._........................................__...................._...................._.._........_......___—..._......................... _........___........ _........... _............_.._.............__ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................................................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and tiling with the Fire apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ....................................................................................................................................................................................................................................................................................... ............................................................................................. 4 If en RMPP Is presentlyrequired, 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 this ,a,.ppplication eEEernit for such Construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Vas LJ No (Section 65650.2 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 Cade Section 42303 been made? ❑ Yes ❑ No ...8....._(it..............___................__.—_..__..__.....__.........___—__._...._..11utio_._...trol.....__.......... _—....._.__..___—..._—_._...__. 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. S_ IurB Of Legalwner(s) ///vat And/Or Authorized Applicant / to CODE I. INSPECTION TYPINTITIAL$ CODE# INSPECTION TYPRiTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing -. 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupency FA Job Address: 3130 AIRWAYAV Suite: Vicinity: Parcel Number: 42708306 Applicant: SMITH, CHUCK Address: 1188 N GROVE ST - UNIT B ANAHEIM, CAS- , owner: COLEMAN, KEVIN Address," 3130 AIRWAY AVE, j COSTA MESA, CA Contractor: LEE FIRE PROTECTION INC Address: 1188 N GROVE ST Zoning: ISSUED BY: Phone: (714)632-9381 Zip: 92806 ' Phone: Zip: 92626-4610 UNIT B Phone: (714) 632-9381 ANAHEIM, CA Zip: 92806 - License: 682771 SCOPE OF PERMIT INSTALL UNDERGROUND SYSTEM. REF.: B03-00979 FEE SUMMARY Plan Check: $54.11 �•-� - - Permit: $83.25 Other: $0.00 Total: $137.36 - Status: ISSUED Applied: 09/11/2003 Issued: 10/08/2003 Calc Valuation: $2,500.00 Claimed Valuation: $2,500.00 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 244646 (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 kitIor which this permit is issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the pertormance of the work for which this permit is issued. My workers'compgnsallpia Ins nce carrier and policy number are: Carder: .w. ✓l Policy Number: (This section 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 wee t if I should become subject to the workers' compensation provisions of Sect X700 01 a Labor Code, I shall forthwith comply with these pravis'lynsz I /� Applicant Signature: ES 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 310E 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 ai Profess' ns Cotle, and my license is in full force and effect. Lie. a Class a Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). 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 fallowing 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ 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 WIII 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 Cade 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? ❑ Ves ❑ 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 aqua to or greater than a weight of 5DO pounds, or a volume o1 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 appertnit for such construction or motlitication, from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Ves LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ...................................................................................................................................................................................................................................................................................................................................................................................... 8 Will any pert 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 bean made? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ B (If 'yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I 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. 4A= e gal Owners) OS nd/ r Authorized Applicant ate CODE It INSPECTIONTYPE 2M INTRIAL$ CODE# INSPECTION TYPE 2ATE INITTISLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical x 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.c3,LfJILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 .lob Address: 3130 AIRWAY AV Suite: Vicinity: ADDRESSES: 3130-3140AIRWAYAV Parcel Number: 42708306 Zoning: Applicant: REYES, SALLY Applied: Address: 3130 AIRWAY AV 10/07/2003 SMIP Com: $50.40 Phone: 714-7544454 $0.00 COSTA MESA, CA; - Zip: 92626 i Total: , Owner: COLEMAN, KEVIN Address ,3130 AIRWAY•AVE i Phone: -COSTA MESA, CA'i _ - Zip: 92626-4610 Contractor: OWNER -BUILDER Address: i Phone: I Status: ISSUED Applied: 06/10/2003 Issued: 10/07/2003 ISSUED BY: Z//' Zip: License:. 000000 Arch : CORTLAND MORGAN Eng: ANDERSON STRUCTURAL ENGINEERING Address: 6910 WOODLAND DR ' Address: 25401 CABOT ROAD Phone:- 214-368-3687 - SUITE 211 Phone: 949-470-2323 DALLAS,CA LAGUNA HILLS, CA Zip: 95225 - License: C25519 92653 License: SE2609 _ SCOPE OF PERMIT DEMOLITION OF APPROXIMATELY 7584 SF (INCLUDING DEMOLITION OF A WALL NEAR THE WINDOWS AT THE FRONT OF THE BLDG TO PROVIDE FOR A NEW EXTERIOR FACADE) OF EXISTING -45,539 SF TILT -UP BUILDING SHELL TI TO SUBDIVIDE AN EXISTING INDUSTRIAL BUILDINGS INTO SIX ,UNITS (AIRSPACE CONDOMINIUM) TO ALLOW SALE OF THE UNITS INDEPENDENT OF ONE ANOTHER. ADDRESS SPAN WHEN COMPLETED: 3130, 3132, 3134, 3136, 3138 AND 3_140 AIRWAY AV. - REF: PM -03-06 FEE SUMMARY Plan Check: . $1,155.54 Permit: , $1,777.75 SMIP Res: $0.00 SMIP Com: $50.40 Other: $0.00 Inspection: $0.00 Total: , ,$2,983.69 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Calc Valuation: $240,000.60 Claim Valuation: $240,000.00 Right 0-0 Right 0-0 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 DECLARATI,OMS C-) WORKERS' COMPENSATION DECLARATION: T I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Gods, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensatfon 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 nA../ e cometed i1 the permit is valued stone hundred dollars ($1670) or less.) �l certity tpert ance of the work for w h this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensations Gallfomia, and gr th t� should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply si / //�� Applicant SlgnDate: '[� — 7 — (/.� WARNING: FAILCURE W KE S' COMPEN ATI ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED THOUSAND DO0,000), IN A ION 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 em 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. N Class» Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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: Lander's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby aHim1 that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the fallowing 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 old 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.). 1, as owner of t property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The c Ir dors 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 Dur a to the Contractors License Laws.). ❑ I am axe under ec. Business and Professions Code for this reason: Signatur Dater — _ Owner vedllad by driv 5 icense. es No Drivels License No. Expires: Verification of Ownership by (type old me—M, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (S) 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, 1 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: Dale: 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 reponed year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume o1 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 hazartlous 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 ..................................................................................................................... ildi............................................................................................................................................................................................................................................difi............... 5 Does or will the applicant or present or future building occupant require for the work which is the subject c this a plication app��ermil 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). ........................................................................................................................................................................................................................................................................................ .......................................................................................... fi WIII any pan of the facility, to he constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (11 yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Selery Code). .... . ...................._........................._...................................._........................................... .—._................... _...................... __.._............. _._._.................................................................. .......... _.._.............. _._............... _................... _. 7 If a ppemit 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 Gallfomia 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: Data: 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 ca ply 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 pr p ny for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sign t Of gal r s) Date 2_/) An r Authorized plica CODES. INSPECTION TYPE GATE HTMALS CODE. INSPECTION TYPE GATE ItlIIDA18 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 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 7 M y��- 3 Z . F- Z Z Q O tin am J J y Q W !D J J m Q UN Za W 2 aW J 0 In J D: W W O= Z_ I. - WO W X 70 39157 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 0 00 0 aa E LL APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RD BV DATE EIVE DATE ISSUED BUILDING ADDRESS 3130 AirwayAvenue PERM T OWNER The Abbey -Scherer Company A. P. NO. MAIL 3130 Airway Avenue BU'LDING s ADDRESS ADDRESS CITY Costa Mesa, Calif. NO. 540-2011 TRACT I LOT BLOCK CONSTRUCTION None W AD LENDER BRANCH OWNER ADDRESS • VALUE $ ARCHITECT TEL. OR ENGINEER FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR Owner builder BV DATE ADDRESS t ' TEL. O NO. OF USE OFBUILDINNE USE CITY NO. PLANS STATE CITY YARDS APPROVED YARD APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF BLOCS. M CIL STREET) OFLOT 106,673 Sq. ft. NOW ON LOT 2DINT t(F FT. FT. USE OFMf - Woven Wire ClothEXISTINGBLDG. g• FNEWBLZE DG. 3OO SQ. ft.ROOMS 1 1SIDE STORIES FT. FT. EXTERIOR WALL ROOF COVERING COVERING EAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. M MAIN BLDGS. ACCESS BL VAR.+ DATE C.U.P.* APPROVED in new office ad ion constructed APPROVED within our present building. I hereby acknowledge that I have read this application and state $T that the above Information Is correct and agree to comply with all laws regulating building construction, and 1 shall not employ any person in violation of the workmen's compensation laws of the State of California, I hereby certify that I am properly licensed as a contractor under SO. FT. � THE AMOUNT SHOWN UNDER VALUATIONI IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION and Professions Code, Division 3, Chapter 9. PERMIT FEE $ v�v Signature of Permittee $ 425.00 PLAN CHECK $ Authorized Agent jT TOTAL FEE $ 0 00 0 aa E LL z a U -Z za 510 am J D J N co J J m in UN Za W K d W W Z JO M Z J K W W O= Z I.— w0 N X 0O F z Q U_ J CL IL Q 0 ►- N z 0 U F_ N z 38697 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 I TliC%1 u ,Yi:** TI 7.3-7 c„-002zso� 35.CC APPLICATION FOR BUILDING PERMIT % For Applicant to Fill in Completely R EC€j�%E [j /ADDRESS O iREIVED 3130 Airwa Avenue The Abbe -Scherer Co $ �� POWNER A.P.NO.TMAIL 3130 Airway Avenue BUILDINGADDRESS ADDRESSCITY Costa Mesa Calif.NOL TRACT 6956 qU�oBUILDINGf� LOT LCONSTRUCTION W A D ALTER AE -A-- IMOVINQLENDERBRANCH s� ��OWNER ,J� CeADDRESS VALUEARCHITECT TEL. S /L $ OR ENGINEER FIRE ADDRESS ZONE 4 P- GROUP APPROVED CONTRACTOR / BY DATE:7/ / ADDRESS TEL. Z(D l� NO. OF PLAN$ Z USE OF NEW BUILDING CITY NO. L STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF BL -s. 106, 673 (FROM CIL STREET) OF LOT sq � ft • NOW ON LOT Z FRONT FT. FT. USE OF Mfpp - Woven Wire Cloth Mfg. - EXISTING BLDG. T/. FT. SIZE OFI NO- OF N W BLDG. 141 X 10 ROOMS Z STORIES 1 L. SIDE F FT. EXTERIOR WALL ROOF COVERING COVERING REAR T. FT. USE OAF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & This will be a new of MAIN BLDGS. ACCESS. SLOGS. within our present buildin VAR.* C.U.P. DATE APPROVED APPFI T SJ t to qrF 1 hereby acknowledge that I have read this application and state that the above intprmation is correct and agree to comply with all laws regulating building construction, and 1 shall not employ any parson in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION antl Professions Cnoe, Division 3, tapter 9. 23 PERMIT FEE $ ^” Signature of '} O00 /v Permittee $ PLAN CHECK $ L AU Noriaetl Ag t TOTAL FEE ADDAMOFBInLDIN(k ii ju HJ. WHY AV UNT: OWNERS N/dLE IA DRESS ABBEY SHARER COPYAppppgr. 3130 AIRAWY" AV C.M. 92626 APDL. mom ADDRESS ARCNRECT OR ENGINEER: LIC. NO-- NICK O:NICK OR M's ADDRESS: UNIT. CONTRCTORSNAIM PETRONELLA ROOFING (714)548-1645 CONTRACTORS MAUNG 2626 NEWPORT ADDREse: COSTA MESA CA LIC. No: 00460707 92627 UNIT.. 201 LICENSED CONTRACTORS DECLARATION: I Mmby affirm under penalty al puarrjeItt, dul 1,urh lnicgme-1 �dlerrpp. 1-r- .1 Closter s (oo ornmid p `�^Ih`J :S L 70) j DinWon 3 d the aTc" Rmlmeom CITY UC. NO.: LIC. CUSS: i. .i i LIC. NO.: Do.: Comreot.. OWNER BUILDER DECLARATION: I hereby shine under pnelty of perjury Mat I am aaempt from the Corerecdon license Law for Me lolbWnp reason (Secion 7031.5 Buee s and Professions Code: Any coy or county Wnidr requires a pen to mnMmcl, alter, improve, demoyeh, or repair any mud«e, prior to iN inuenm. also require the npplioern t« ach pend 10 Me a aged element Matt he or eM u licensed prevent to the pro some d Pe Contract. U.. Law ]Chader B (cd tram i N with Section ]000) d DNuim 3 d IM Beerme ad Prdemom Cade] «Intl he or she u mmmpt Iherehorn and the Mau for the dleoed memqun. Any voltlim of Soofim 7031.5 by any Mplicant to, a omen subpcte the eplicenl to a ChAl Penalty of red mora then Me hundred ddlus ]5500D. ❑ 1, as owner of the Propmy or my ampoyees wain w•a0ee as her We mmpneelion, will do Me wont, ad Me mucune is not intended or offered for sale (Sedan 70ai. Brmicam and Pro(.. Cade: TM Contredon Lim.. Law does not apply tom bene of property, wM bolds or enpmves thereon, and wino does ouch work Nmselt Cr hersM or Redgh M or Mn own amplayar, presided Ihat audit impwemmts we not intended or wmw for eew. a. however, IM Widop of mPraanaN Is sold entan one year of compmon. Me owerL Uer will have IM When of provire M or aha dol rw build or impmw for the prPcws of sale). ❑ 1, as ower d 1M property. am sucksm,* contradiN with licensed ombect«e to con Crud Me project (Salon ]oar. Bmiws ad Profeaiom Coda: The Corroders lioerhm Law does red apply a m owner of p,.peny wM WikN or bnprwm thereon ad eto cpnaada b sunt peed weh a mmrmor(s) icansed p«euam to int Camradn License Lew). ❑ I am mampr oder Srnah: B. A P.C.. ler this rsaxn: Ows: 0.: I do hereW truly Mu I am ewane of and un r the reglasmerm of Caliomu ll.enh and Sdery Coda Srfom?5505, 25533, and P553i, end Me I «arty tenure buUM «spm x / wR rel (circle ma) need to comply win end ptle codes and Me requirements b a Parrett for Or nhodScmim from the Ai u 71rannpenaM District. Resid«uW mmtrutlon eppicsoms. m«rW from tMro Dae: Apaieem: WORKER'S COMPENSATION DECLARATION: I hereby affirm urdr penalty of p.*, aro of M roBdein, dedadias: ❑ I Moe and w, pert Nana , of there for to a.Nimure for trued. c«npenamon, m prodded lor by Saxon 3]DO d int Lobar Code. f« the ped«nwha. d the work for wf:w MIs portent ls leased. r] I have ad w meWvh workers' oomo«wtlon insuanw, u ncu'ved by Sedan 3]00 d Oe Labor Code.ler De padormanPa d Oe work t« wfi'eh this Pane is hunted. MY waken' camp«umion Im«anhca amir and Policy munber ane: Cmi r: Policy Number: Ghia malar need cot he completed y Me Pmmt is for me hundred coon (5100) «Aue.J ❑ I e,cm thu in the pedarmence d IM work far luee Ihu 01or e. ®usd, I shell red 1 shot' arty prmn u any meow o la to Mcome efion p to the waken' n 37W of owe C e, I mall and eprae Item i I hose oscine subject tP IM wadmn' compnauion provieone d Sadiron 3]00 d the Labor Code, I ehdl /Mhwnh amr0ly with those provisioes. Date: Applicant: Warring: F.M. ro axon wo,Are'rorrpeneatlon covwepe la unlawful, and shell s Ivct on employer M aWrW penaltles ant c/v/I flee W M oe hundred thousand dollen (sIODDOII, M arydldn M Me coatemas of wMaetlon, deapea provided by In S.H. 37M of Ma Lebo, Cad. humNI, and admry'a /sae. CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjry Ihu then at a ooeurudon Anion, agency ler the W..dhe twork ler which the pmmi u Issued (Sedon 308], CN. C). LENDER'S NAME: LENDER'S ADDRESS: I candy Ihu I have real this no fratgn and tlua Ihu Ma eoora iN«nwon u correct. I alpee to comply with ao ray rd mWy ordin. and We hews relaiN to buklig carnUumon and hereby audw .npesarhWl+es d Ihu dly to Wer upon IM eboromemioned pope I, 'onlmPeohnn Parp.sm. LOID WATTS oda: sipeNre of OwnerlApem/ApploenUContact« (51514ti.WP) WNs*_ eN A Setetr Ormn ; Cuury-AppFaa; Pink -F.; G kJmn- -Aaawv J , CITY OF COSTA MESA - BUILDING PERMIT BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: PERM NO: b 081941 PERMIT NO: b 081440 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V -N PERMIT TYPE: SIR PURPOSE: OTH JOB DESCRIPTION T/OFF & REROOF W/BUR CLASS A SQ FT: 45,000 CLAIM VALUE: 45,000.00 CALC-VALUE: 45,000,00 GROUP OCC: F-1 / COMMENTS: X if 3i lFriii di ie iE ii ii ie iF ii ii**lE is iF*fiixiE��xic le ie iF ii if*3i#ii ji lir#ii iF lF if 3e if*lir if it 3exiErinx xxyc:E ii itrtii lfkhre iE ii;r if wire ii ii ii ifx Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42708306 ZNE: REF NO: PLANNING NOTES> > ler it lF iE x * if x dE ie'1e'lf ii lE ie ii iE iF iE i! if'1e rix iE iE ie ie if ie lE it lir iE fir ie ii le ii 117E ie iE i! if is lE x it * iE'1f 4 ie ler iE iE ii iF'li' if'lE iE lE ii ii iY if iF iE iE ie ii if vi iE fi 1E x x D E E L O P M E N T S E R V I C E S R E Q U I R E M E N•T S ZONING APPROVED BY BUILDING APPROVED BY DATE: DATE: APPLICATION ISSUED BY: DATE: iir'if ii iE if lF ii ii iFM iE iE de df iE iE iE ie iE lY drxx xx xx x xxxx x x x x w -)t irk*3i iF lixifxxxxlexxxxxiE "k LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 529.75 SMIP/NON-RES PLAN 9.45 ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 539.20 0.00 0,00 539.20 539.20 .00 REVENUE DIVISION TOTALS--� COLLECTED: 539.20 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/TUT GRADING PLAN -CHECK 529.75 9.45 ii if ie iF iF iEx iF ie iE ie it iE iFxif iF iF ii iF it if frit iFxit ii iE iE rix iE ii ii iiX is lE ii�iFxxixxii irk if ii if dt it iF iFRxx�ic it}isxis ii iF ii•ix*ir ii iFx iE ix�iEx I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFC 45000 REROOF BY VALUE COMMERCIAL NOZONE 1.00 45,000.00 END OF FEES Copy CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector t _ & SPA 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE , 7. Footings 58. Electrical Conduit-Undrgrnd.. 8. Foundation - - 59. Gas Pipe, D Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK ' 11. Property Sewer Line & House Connection. 62. Backwash & Receptor -Final • er Cap .63. Heater & Vent -Final f Drains 64. Plumbing System - Final gh Plumbing 65: Electrical -Final h Electrical -Conduit - 66. Solar System -Final ough Electric Wiring 67, Fencing -& -Access Approval I 17> I h Wiring Sign 68. APPROVED. FOR PLASTERING 8. Rough Electrical -T Bar Ceiling '69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit 4#- 20. Rough Factory Fireplace - 21. Ducts, in Structure 21. 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping D Gas D Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank DGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 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 t 43. Backflow Irrigation 44. Landscape Irriqation System �! r 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING�- 48. FINAL PLANNING - 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 3130 AIRWAY AV OWNER'S NAME: GUILDS LAKE INVESTMENT CO ADDRESS: P O BOX 4382 PORTLAND,OR 97208 ARCHIENGINEER: 714540201.1 REG.NO.: ADDRESS: UNIT: UNIT: PERMITTEE:A—ACTION FIRE PROTECTION (818)893-5656 ADDRESS: 14620 NOVICE ST PANORAMA CITY CA 91402 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under ions of Chapter 9 (commencing with Section 7000) of Division 3 0f the Business and Professions Code. and my license is i orcd it effect. CITY LIC.: Q STATE LIC.'.4 6 9^ 0 C,I�A-S$: Z!' 1 6 Dale: �— I — 13 Signature: — W �'l_ _ — WORKERS' COMPENSATION DECLARATION: Iherebyalir Ilhaveaeedili Ofc sem selbinsute ora certificate of Workers' Compensation Insurance, or a caddied copy thereof (Section 3000, Lab. Q. POLICY NO.:Z-1019824A EXP. DATE: 02/15/44 COMPANY:CAL INDEMNITY ❑ Codified copy is hereby burnished. F Cenilied ' filed with the city wilding vision. Dale: I Applicant: AIA EXEMPTION FROM WORKERS' COMPENSATION DECLARATIONAT4 section need not be if ended is for one hundred($100) or less). I codify that in the penormance of the work for which this permit is issued. 1 shall not employ a rson in any manner so as to become subject to the Workers' Compensation Laws of California. Dale: Signature: NOTICE: If. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must fon sieve comply with such provisions or INS permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance Of the work for which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of 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 lite a signed statement that Noland is licensed pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500). 1, as owner of the pmpeny or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7064. Business and Professional Code: The Contractors' State 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 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 will have the burden of proving he/she did not build or improve for the purpose of sale). I,as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The ContractorsStale License Law does not apply to an owner of pmpenp who builds m improves thereon and who contracts lot such projects with a contractors) license pursuant to the Contractors' Slate License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Dale: I do hereby county that 1 25534 and that I or any I permit for construction these provisions. Owner: am aware of and understand the requirements of California Health and Salety Code Sections 25505, 25533, and there building occupant willlwill not (circle one) need to comply with said state codes and the requirements for a or modification hom the Air Quality Management Charnel. Residential construction applications are exempt from Date: Applicant: I hereby ceroly than have read this application and shalt ordinances and State laws relating to building construction property for inspectionr purposes. Date: Ey 1--1onp3 Signature: Driver's License or somal security a: information isnett. I a ee to comply with all city and county prize represent ves of lhi oily to enter upon the above mentioned 1641.46 White—Building; Green—Code Enforcement' Canary—Applicant; Pink Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: F062122 PERMIT NO: F 062122 PLAN CHECK NO: 01501-93 L GOV': N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: FIR PURPOSE: OTH JOB DESCRIPTION : RETROFIT BACKFLOW PREVENTER SQ FT: CLAIM VALUE: 6,000.00 CALC—VALUE: GROUP OCC: B-2 / COMMENTS: BACKFLOW RETROFIT Z O N I N G S TBacKs R E Q U I R E M E N T S ' ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- 7RNT: FT IN REAR: FT IN FRNT: FT IN REAP.: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT TN PARKING REO: PROV: PARCEL; 42708306 ZNE: REF NO: PLANNING N TES> > ##9f##iEy%iE#iE######}##?E###########±E4####iE iE#%#?E###3E#iE##############if#K#Kie'le 3i•##%s'k ie D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE APPLICATION ISSUED BY: L DATE: LEGALIZATION:N F E E S U M M AR Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 81.00 65% SMTP/NON—RES PLAN 52.65 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS-----> 81.00 0.00 52.65 133.65 133.65 .00 REVENUE DIVISION TOTALS -->' COLLECTED: 81.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/TOT GRADING PLAN—CHECK 81.00 I N D T V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST FIR 81 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1.00 81.00 END OF FEES 1 01 00138914-00138914 T G T 81.00 DATE: 05/11/93 TIME: 13:47 14 CONSTRUCTION AND PLANNING- APPROVALS Permit I Date Inspector I & SPA APPROVALS Permit-,$ Date Inspector 1. Temporary Electrical Service-ar Pole _ 52. Pool & Equipment Location 2. So,! P.❑=-Undrg nd. 53. Steel Reinforcement 3. Electrical Conduit Utl hty•Undrgrnd. 54. Forms 4. E'ectncal Ccnduit•Und•grrd. 55. Electrical Bonding 5. Stop. P-n4orcement 56. Rough Plumbing & Pressure Test ! 6. EI^etv:ce' U'rLR Orrd. 157. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit•Undrgrird. I B. Foundation s 59. Gas Pipe, a Undrgrnd., Testi 9. Water Pipe-Undrgrnd. -� 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. property Sever Line &,Ho,.se Connecrit 1 62. Backv!ash & Receptor -final - 12.12. Sewer Cap 13. Root Dramz 14. Rc_c i'umb;ng 15 Rn.,gh. Electr ray -Condo t 63. Heater & Vent -Final 64. Plumbing System -Final 65. Electrical -Final 66. Solar System -Final ' f� 16. Rougn Eiectnc k%hr'n9 67. Fencing & Access Approval 17. Rough S'. n 5 9 68. APPROVED FOR PLASTERING I 18. Rough Electrical -T Bar Ceiling 69. POOL7SPA SYSTEM:°S FINAL 19. Rouqh Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit 20. RDuyh Factory F ry Diace 21. Ducts, n Structuro 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping []Gas OOil 23. Gas :-ipa Rough & -est 24, Roof Frain.^3 72. Undcrgrounci Fluri S.j4 'i " 73. Undergrnd. Storag: Tank r.7 Ga; 25 Roof Si,cathing 74 Overhead Hydro I �- �- F 75 Dry C.ien-:ca: I 76. Dry Sia ioplce 177. FIXED SYSTEA" FINAL 2F T B,. ,;; n • lSb,,cwraii & ;: nrccoat .. 27. Fram'. P ' Fidsh 79 28. Lath,nn t+i Sding 29. Insu r._on 30. O'yv. i NIF !irg i 78. FIRE PREY. FINAL HEALTH DEPT REQUiRE.'.1Er!T 79. FINAL INSPECTION j 80. FOOD CERTIFICAI-E ISSUED Notes: I 31. Plaster Grown Coat 32. Elect,iwi Po -ver Meter F,oal 33. Find E'---lrvr- 34. Final Heatmg & Air Conditioning 35. FFnal Grs Pipe-Tcst 36. bond or Cal.cpy 37. Feral F: ory Firep ace ----- - --- `----� -- - - 38. Pmol Pi-mbing F39. Aater Servic,-Final ---- - - - -- -- 1 40. Gas Service -Final 41. Salar Damcstic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System -H 45, Sound Attenuation - 46 Handicap Rcgulauons 47. FINAL STRUCTURE & BUILDING JI 48. F!NALPLANNING ---- 49. Electric Release to Edison -. 50. Gas Releasr to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date i ADDRESS OF BUILDING: 3130 AIRWAY AV UNIT OWNERS NUIE IF uIowN ABBEY SHERER AoSREss: 3130 AIRAWY AV C.M. 92626 APDL. LIUUNO ADDRESS: MC LEAN t1 SCHULTZ COF001y ARM OR VIOLS ADDRESS: 200 EAST CHAPMAN AV UM; FULLERTON CA 92631 caGRAc7ars xAME: FEL—MAR CONSTRUCTION (714)775-7735 CONNIACTORS MUINO 1021 ELLIOT PL ADOREM SANTA ANA CA DCNG, 179403 92804 UNIT: LICENSED CONTRACTORS DECLARATION: I hereby afrm under Penafy, of perjury that I son licensed under provi i«u of Chapter 9 (commands, wilh Swan 7000) of Oberon 3 of the &reimas and Pm/nsom Code and my Baume Is in ND fats end effect CITYUC.NO, 006890 uccustw B UC.NO.; 179403 EXP: 05/98 Dam: Comestm OWNER BUILDER DECLARATION: 1 hereby Yfim under Penalty a pwjay Owed I we exam, from IM Contract. Litems Lew or Cu Idowi, .(SW. 7031.5 Bosiaas ae Proleeeioms Code: Anecky or county wfiich roquvn a parents to ooupud. war, sprite, demd'eh. or news amy, sinecure. pit to tss issuance. also nominee the applicant for such parents to Be a signed statement mad M or end I. licensed mrwad to the pommons of the Commet. Litems Lew (Chapter 9 (mmmencir, with Emotion 7D00) of DNeion 3 of dM Btawnsss ere PrOlanoo, Codel or them M or she is exempt Ihoehom and the basis for the seeps nemgon. Am violedion of Sedion 7031.5 by any applicant for a Perrot subjects the applicant to a cn+l penalty of not moa than Me hundred dollen 1550011. ❑ I. we ovmer of IM propety or my employees ash sent we their sale con armaton, will do the work, and IM mosses, is; nig intended or affare for sale (Semon 70,14, Business and Pro essions Cole: The Contractors Uprose Lew does me so* to an owner of property select Wait or improvas thereon, and wlto does such work herself or worse Or through his o Me own employees. premise them such impmmtnwts am cat intended «dlerod her see, I. however• the Wilding or inprwromeN Is sold within one yeas of complMon, the owner-0uilder will have IM tandem of Pending M or she did w Wild «improve for IM purpose of seal. ❑ 1. as owner of the property. sen exawi,* onmosoa, with licensed mramemre m commit dre qqw (Semon 7044, Bnbrs end Professions Code: TM Cmlrww License Lew does nig appy o an owow of properly vem, builds or imgwas thmeon are w1, contracts 1« suds profits vel a mmrmo(a) license gamont to tM C meso; Lt.. Lew). ❑ I sen asemq undo Section: B. A P.C.• M this nevem: Data: Owner: I do hereby eartfy that I we awass of ere undemtsrd IM requirements of California HWfth artd Sweet, Code Swims 25505. 25533. W 25534, and that I or any Mum Wilding moment will / will not (omis one) need to campy with esld Yale modes and OM requirements M aPemts lorc«nWction ormeificatianhom the Air i�ly.ampemewl Diads. Residential oonYructon eppirdbmenasamq from emom prim vier. Dae: Appliaa: WORKER'S COMPENSATION DECLARATION: I hereby affirm under pamby Of pe jtsy One of the folorvinp deawim: ❑ Ihew endmoll maaena,ofinelsdoormemtosi porom is waken a«npweemon, as provilad l«by Bacton 0700dthe lab« Cods. l«the Pedomas,a d car wak la wNch this permts b issue. F] Inn. end wit maonn workae' mmDsrtsslion imuranae. m enquired by 9actkn 3700 d the Labor cod.. la dM Peamtatrre d the work I« whidA this Pemts b issued. MY w«kers' mmmmaon wnureme carrier end pdiry ntvnbr vat: Carrier: Policy Number. (This semen nee and M conprefed y that psmf is for one hundred ddlae (Sloe/ or was.) ❑ I ratty lit in he Perfamenca of IM wok or which this Permit b booed. I show w employ mr, penin to any monster so as to become eubjed to the worker¢' compensation was of Cailomia, and ,Inas that it 1 should beonn wbjW to the worlmrs' compemaion pmvbons of Section 07M of the Labor Cada, I shall Iorhenth Oompy with those provisions. Das: Applipam: Women, Fsuun the seeun sammem' corrpensatlon coverat7s la unlawNe, and shall sW(eod an wnployssW afydrW pasMltlee wid civet Ono yrs me an halNe thousasof ddbn (S10g000A J, Wooden m tlro cost of conperuadon, datrpas as, prorWa f for In Sw er. 37M of she Labor Cods, forest and attorney's fees. CONSTRUCTION LENDING AGENCY: I Mmby affirm penalty a under penalPenury Ihet them is a conservation seat agem y or dM man perforce d the wok for which this parents is owed (Becton 3057, cls. C). LENDER'S NAME: LENDER'S ADDRESS: I corny them I were meet this application and alas that the above intomatian is coma. I pens to romp, Wth d1 dry and oomly odineniose and state leve miming to Wild'u, conemnMbn and hereby animus representWh of this city to enter upon IM ebvemwioned PmDeM larime°"'ionparp°na' GENE FELLING Sipco os, of Owner/A9ent/AppcewCOnvwo (5151 41IMP) While -Bt ildinD 8 Salcey; OmemFM: Csmry-AppIl t; Nnl -Rahmwm; Ooldent edit MAs car CITY" OF COSTA MESA — BUILDING PERMIT PERMIT NO: B 083436 PLAN CHECK NO: 02012-97 A PERM NO: B 08343E GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH JOB DESCRIPTION SUPPLEMENTAL WORK FOR B-81440 /REROOF SQ FT: 44,700 CLAIM VALUE: 79,773.00 CALC—VALUE: 79,773.00 GROUP OCC: F-1 / COMMENTS: THE ABBEY SCHERER CO. jt �' jf t 1C jt 1! 1(• j! 1E i("1(' �' x it it if fit if iF 1l' )! T")l' jt' d(' it'x' it jf'If * {.' jt x' � T'!t �' � �' x it' lf"R' sits if'](' 1f if 1f fF j'("I(' �(' 1!'lE fit' ft Jit 1t' it it 1! 1t jl'!t!F 9l".f l!'R'!t )t 7C it it it it Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42708306 ZNE: REF NO: PLANNING NOTES> > LL Y 1 7C t% ! A: # # %!t k!k�t i4 � ii:E � 1!Th# � ;! irt')S �! itat�t 7r � �t �f ��! � ;! � {C !t � #+J; �r alt �!r; Y.,X Si Y: tli k�: j::i•?: Klt Ii I: Y J: ::. it S:t � # ?!'?� # R it it yF 7r i E V E L O P M E N T S E R V I C E S R E Q U I R E M E N -T S irt�iw4lwo A � � �i? i�r} DATE: BUILDING APPROVED BY DATE: APPLICATION ISSUED BY: DATE: iF if it irk,t alt iF it>r )E it is iF if it it iE it iE if*ir x xx x x x x xx x x x x it iE if if if #it iE it iE xxx xxxxxit it LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 762.25 SMIP/NON—RES PLAN 123.87 16.75 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 779.00 0.00 123.87 902.87 902.87 .00 REVENUE DIVISION TOTALS--> COLLECTED: 816.78 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 762.25 16.75 37.78 i! dtit it it iQ iF #irk it iF if ie irk alt alt if iE if if it it dE alt it'd. iE iF it it if it if it iF if if>c iF iF it iE iE>t ie iE iE it it it it iF it it iE it iF 1E iE it iE it iE tie * iE iE iE'ir iE iE iE iF it x iF it is ie I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFC 79773 ALTER BY VALUE COMMERCIAL NOZONE 1.00 79,773.00 END OF FEES CONSTRUCTION AND PLANNINGf r APPROVALS Permit # Date Inspector . & SPA 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 LIFER 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. S!r Cap 63. Heater & Vent -Final 13. of Drains 64. Plumbing System Final - 14. R ugh�Plumbing 65. Electrical -Final ' 15. ugt(Electrical-Conduit 66. Solar System -Final " 16.ih"Electric Wiring J"r 67. Fencing& Access Approval " 17. adh Wiring Sign ` 68. APPROVED FOR PLASTERING 18. gh:Efectrical-T Bar Ceiling 69, POOL/6PA SYSTEMS FINAL - 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure. 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 00il 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0Gas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding - 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power fvleter-Final 80. FOOD CERTIFICATE ISSUED 33.'Final Electric Notes: 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 43, Backflow Irrigation '� 1 44. Landscape Irrigation System _ r 45. Sound Attenuation 46. Handicap Regulations /• 47. FINAL STRUCTURE & BUILDING y/(p e7 _ Y 48. FINAL PLANNING 49. Electric Release to Edison I 50. Gas Release to Southern California Gas Go 511. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 3130 AIRWAY AV UNIT: OWNER'S NAME: GUILDS LAKE INVESTMENT CO ADDRESS: P O BOX 4382 PORTLAND,OR 97208 (714)540-2011 ARCN/ENGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE: GRAHAM BRO HEATING AND AI (714)546-1653 ADDRESS: 2952 CENTURY PL COSTA MESA CA 92626 LICENSED CONTRACTOR 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. CITYuc.: 005963 STATE LIC.:24B cLAs: C 20 EXP: 06/95 5'eate I I // s19 Y Signature— QW4 C d. WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a candidate of Workers' Compensation{ nce o c�{li �1 1 rfiof (S coon 3800. Lab. POLICY NO.: PE1 1 c61bcT 9"" 1 � EX.. DATE: ba/01/95 'OMPANY: LIBERTY MUTUAL Certified copy is hereby furnished. ff Carolled is Mea with the city Building Division. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This Section need not be Completed it the permit is for one hundred (S10D) or ass). I Cenily that in the performance of the work lot which this permit is issued, 1 shall not employ any Person in any manner so as to become subject to the Workers' Compensation Laws of Calilorma. Dale: Signature: NOTICE: II, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of 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/she is licensed pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 0l the Business and Professions Code) or that he/she is exempt therehom and the basis tar the alleged exemption. Any violation of Section 7031.5 by any applicant lot a permit subjects the applicant to a civil penalty of not more than live hundred dollars (5500). I, as owner of the property or my empployees with wages as their sole compensation, will tlo the work, and the 1-1structureis not intended or offered for sale (Saction 7044. Business and Professional Code: The Contractors' Slate License Law does not apply to an owner of a Property who builds or improves thereon, and who does such work himselflhersetf or through 1 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 will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business 11 and Professions Code: The Contractors' Slane License Law tloes not apply to an owner of property Who builds or improves thereon and who contracts lot such projects with a contractor(s) license pursuant to the Contractors' Stale License Law). I am aware that proof of (heir Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. B P. C. for this reason: Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will not (circle One) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and stale that the above information is correct. l agree to comply with all city and county ordinances and state laws relating to building construction hereby authorize representatives of this city to enter upon the above mentioned Property to, ,�inspection purposes. Dat = T-/ /-r 1 13 Y Signature. Guvn's License or Social Security a: 1641-46 Whee—Bu4deng. Green—Coda Enforcement; Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: M 069923 PLAN CHECK NO: N CONSTRUCTION TYPE: PERMIT TYPE: MEC JOB DESCRIPTION ; REPLACE GAS FURNACE IN ATTIC CLAIM VALUE; CALC—VALUE: PERM NO: M 06992: GOVT: N SUPP: N PURPOSE: OTH SQ FT: GROUP OCC; / COMMENTS: THE "ABBEY SCHERER COMPANY" Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARKING RES* PROV: PARCEL; 42708306 ZNE; REF NO: PLANNING NOTES> D E V E L O P M E N T S E R -:,Y I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: ', DATE; d / ###################### E i E ..•E E F f�E FiE +�E�Tg'S��K##1F######## #aE ############################################################################## LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 11,00 252 SMIP/NON—RES PLAN ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 11.00 15.00 0,00 26.00 26.00 .00 REVENUE DIVISION TOTALS--> COLLECTED; 26.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 26.00 I N D I V I D U A L F E E B R E'A K D O W N TYPE QTY D E S C R I P T I'0 N UNIT COST TOTAL COST MEC 1 INST FORC—AIR/GRAV_FURN > 100 K BTU 11,00 11.00 END OF FEES 01 00171716-00171716 T0T 26.00 DATE; 11/15/94 TIME: 10:41 r ' 'r' 4 CONSTRUCTION AND PLANNING APPROVALS Permit# Date l Inspector PO. t SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service.of 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 r - f 58. Electrical Conduit-Undrgrnd. 1 8. Foundation - 59. Gas. Pipe, O Undrgrnd., Test - 9. Water Pipe-Undrgrnd, ,� 60. Backwash Lines, P -Trap, O Undrgrnd- 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas 000 25, Roof Sheathing 74. Overhead Hvdro 26. T -bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final - 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating& Air. Conditioning ( 9 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace - 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING ' r 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date alt AODREssaBMLO94G 3130 AIRWAY AV owrExSNAKEIFIaa/N:ABBEY SHERER 1 AODRESS,3130 AIRAAY AV ✓" C.M. 92626 APPL.IWIIIq IDDRE55: ARCHITECT OR ENGINEER: NICK OR ENG'S ADDRESS: UC NO: LAW. OMT: CCNTRACTORSNAME:PETRONELLA ROOFING (714)548-1645 CONTRALTORlimmum0 2626 NEWPORT ADDRESS:COSTA MESA CA uthio, 00460707 92627 umT: 201 LICENSED CONTRACTORS DECLARATION: I hereby Wim under Penalty d perjury that I sat licensed undo Woh ism dang Cher 9 (m�Pr v0 with Section 7000) of Division 3 of the wdnea and Ptdesslene Code, and eny IMeme is in 1.11 tome oM eRw. h&uc. N1,0.32605 ucucLcss:C 39 uc.NO.: 0460707 EXP: 07/97 Did.: IYYRER BUILDER DECLARATION: 14.W affirm under penalty p travy I ane exan,t fern the Carved. Licame New fm it. Samm 70313 damdeh, ra aper( si,t, ssuctae_ ppmr b de uwarae, also npu'vw the a la parrnst to_fib a�sined stalarnee Mal he o, she I. Doomed p hrueN to the ero+iwons d the Codrmera License Lew ( . 9 (mnmenatg with Section 7000) of Division 3 of the Bua'vtew and Prdsa'vw Cedal or Items he a she is wants thirahom and the Issue for the e3eged nempl'mn. Arm violation of Section 7031.5 by any applicants for a petted wbpcs the applran to a cW passe ty of not mons then two wlMmc capers )SSODll. ❑ I,nowmrdlM Propenya my empbyw with wapeanthei ads mmmralion. wclheshe wak,anMtha emanumlend'nl.Med imprwrnenta ane not entitled e, fibred la sob. e, heir.. the wilding or mpmnrnon is soil wdhn one Y. of conepbtion. the ownenwilder wd1 have the dvden of PnmMn9 he or she cM nI IAdld or impmn 1. the PUTne of sells). ❑ I, as owner of the ropMy, am ncluos f* comet ihp welt fio.nwd connector to caunud tla project (Section 7044. Bnimn and Prdaabrn Cole: The Conhad ss License Lew does not sppy to an owmt of Property who odds or inpnwas (hmeon most elto comrade fe, wdh prajwa wuh a contrada(a) licensed ouruenl to the Co nremra Lioeme Leve). ❑ I sat exempt undo Section: B. A P.C.. for this meson: Dose: Cwmn I do herby caddy then I are awana of and undo stnd the mquirsmeds of Caldomie Health aM Salaly Code Sections 25505. 25533, and 25534, ntl that I or any Mum wilding oaupenl wit I well not (circle one) need to comphr with said state .dm and the nequirmens for a Peron he conswdlon or modification horn the Ai uryy a agamnt Diodd.ReskentWwntr nappimtiommr mptlmm Dwae prmslons. Gals: Applicant: WORKER'S COMPENSATION DECLARATION: I hereby alfum under penalty of prjuy one of the fdfowng dederaticm: ❑ 1 have nd sill stains a celfrate of mumu to se9imre for eonker' mer prlsallon, n prw dad la by Section 3700 of the Labor Code. la the 'it .a of the wak la wlirJt tlus pem I is meed. ❑ I heves and rel makes. wadaa' compemanion "vuurartoe, as nequbed by Section 3700 of be labs Code. for the prlammtw of the work fix which this preset Is hatted. My wrken' mmpnWbn inwrannce comer and poky rsvnber ane: C.oks Policy Numb. ' vection mad m he mNlefad f the Penn! b ler oat Hundred dalkn /SfOJI w lend mnAy IAM in the pecomuraw d the werk ler which thio pent k buec, I shell m rnploy ecy pebht n ey manner n n to become wbpd to the warken' carnpenmalion laws d Calcank, eM pre Nat J I dhould became wbied to the wotlur' lion prrkierw d Section 3700 d the lebr Coda, 1 shell lonhwkh campy wMh OAwe pmvisiom. Dose: �� ApplimN' Wim de Fallen ro ascan roAem' esnrlprens 0104"A 1 coveA I la tmdets erre cost anlNcf n employer to es as ppanuttln end SwRnas Ip b aro htndmd Mouund ddWs ffd O DDA b edd/tlon b Ms cost of ronlparwWry Iomega as pmvh4d ler In Sectln 3183 0l the Labor Cods, Infmsul, eM e0ormy'e /sea CONSTRUCTION LENDING AGENCY: I herby elfin under penalty d perjury Ihat them b a conslmctbn bndittg agency ler les Pedmnd oce the work for which this pemnh is betted (Smion 3081, CW. C), LENDER'S NAME: LENDER'S ADDRESS: I candy that I have reed this application end pale then the shove idormdion Is coned. I pmt to comply efth all dry and count' ad'vtmsnces and ebb kin releding to building cmWudion and heeby author¢e reprmnWiyae of them ay to anter upon the ebwe mentioned Progeny 1. inspection Wr vLOID WATTS D / yMti ildng A Sek y: Gree Rb; Cwny-Appfunt: Pink-Rerewa: Gddentod berm ----------- MAIN CITY OF COSTA MESA — BUILDING PERMIT --------- ACCESSORY BUILDING--------- RNT: FT IN REAR: FT IN FRNT: PERM NO: B 081440 PERMIT NO: B 081440 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH JOB DESCRIPTION ; T/OFF & REROOF W/BUR CLASS A SQ FT: 45,000 CLAIM VALUE: 45,000.00 CALC—VALUE: 45,000,00 GROUP OCC: F-1 / COMMENTS: X * iF 1f * iH * * * cE iE iE ♦E 1E fE iE dE 1E yE SE * cE cE iE iE * 1E lF 1E N -1E * if iE iE 1E # N• *!E lF lE SE dE dE cE 1E ie cE iE cE iE 1F iE it cE i! cE iF ib f! iF * iE * ie if 1E SE IE is cit iE 3f jf ik iE N -1E IE iE*iE*cE SE 1E if*1h1lcE**1ElE IE 1E*1E*iE 1E iF 1E 1E if MlEfElE**IE Z O N I N G R E Q U I R E M E N T S T S E R V I C E S R S E T B A C K S ONING APPROVED BY ----------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- RNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN EFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN ARKING REQ: PROV: PARCEL: 42708306 ZNE: REF NO: LANNING NOTES> > 1E 1E*1F*1E 1ElE lE IE iE*N-iElE**IEN-1E iE*iE*cE SE 1E if*1h1lcE**1ElE IE 1E*1E*iE 1E iF 1E 1E if MlEfElE**IE 1H dElE is N-cE CE SE lE CE dE**lE CE iE N-N-iE ♦EfECFff ie D E V E L O P M E N T S E R V I C E S R E Q U I R E M E NST—S ONING APPROVED BY DATE: UILDING APPROVED BY : PPLICATION ISSUED BY k**1E yE iE yE lE 1E N -if ibN-N-iF iF 1f iE4fE DATE:: DATE:TT 1F fE ik * N -3F dF iF EGALIZATION:N F E E S U M M A R Y STRUCTURAL)SEGMENT:Y BLDG PMT PLUMBING ELECTRIC ' MECHANIC FIRE SMIP/RES GRADING ERMIT 529,75 7.. SMIP/NON—RES LAN 9,45 SSUE FEE UILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE OTALS ---- > 539.20 0.00 0;00 539.20 539.20 ,00 .i EVENUE DIVISION TOTALS--> COLLECTED; 539.20 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 529,759,45 i� dr * rt 1E ib N -it ie ie iE 3E *!f iE If iE lF N -ie iE iE 1E ie cE ie ie iE cE iE ♦E * fE 1E 1E lE lE * yE it�if if N -1E if iE it 1E iE IE * dE IE 1E cE 1E SE cE Sb SE * * * N-!E!E !E if i! 1E if N -!E it iE it i! ff 4 I N D I V I D U A L F E E B R E A K D O W N YPE QTY D E S C R I P T I O N " UNIT COST TOTAL COST FC 45000 REROOF BY VALUE COMMERCIAL NOZONE 1.00 45,000.00 END OF: FEES / FEB G 31991 I✓ r� y A�ES Girt` - ;.::ai.M, A^. CONSTRUCTION AND PLANNING ; f4 iPROVALS Permit # Date Inspector PC }SPA APPROVALS Permit # . Date Inspector -4- 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 APPROVALS Permit # - 20, Rough Factory Fireplace 21.Ducts,in-Str6cture, - _ 70. Underground Hydro 22. Ducts, Ventilating - - - 71• Product.Piping Leas 00il 23. Gas Pipe -Rough & Test �• _' 72. Underground Fluslt 24. Roof Framing _ 73. Undergrnd, Storage Tank 0 Gas 0Oil 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 Browri Coat 79. FINAL INSPECTION 32. Electrical- Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric -. A- Notes: Z- 9 �1 ��1 .dI%`iQu, 34. -Final Heating & Air Conditioning i yl o%Jl Gt,s� ri �ea.N/. 35. 'Final Gas Pipe -Test 36. Hood. or. Canopy ` - - _,�/ s �-•- 7��/p, 4R4 37. Final Factory Fireplace _ 38. Final Plumbing 39. Water Service -Final - - 40. Gas Service -Final 41. Solar Domestic -Final - - - - - c 42. Backflow Preventer 43. Backflow Irrigation44. Landscape Irrigation System .• ," •r- " 45. Sound Attenuation 46. Handicap Regulations -47. FINAL STRUCTURE&BUILDING 48. FINAL PLANNING - 14 - r `�- 49. Electric Release to Edison•' - 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY No Date ADDREssaeaLlKru 3130 AIRWAY AV UNr: 011iNE'SNAMEIFIQ ; ABBEY SHERER IS AODRESS: 3130 AIRAWY AV C.M. 92626 ADPL."IJIO ADgiE53: A ITECTORENODIE . MC LEAN 6 SCHULTZ mm-, S2450 ARCH. q1 BAVS MRM: 200 EAST CHAPMAN AV UMh FULLERTON CA 92631 CON VORSIUUF-' FEL—MAR CONSTRUCTION (714)775-7735 CONTRACTORSM UND 1021 ELLIOT PL mss& SANTA ANA CA mix - 179403 92804 UNIT: UCENSED CONTRACTORS DMC AnON: I hmaby d6m radar peroEy d peryey p 1 am Scanned undw P orimu d Chea« s (omimenm0 whh SecOm T ) of Omand„ 3 of w Bums and Pldmaimu Coda, «d my Gores a In hon I" «d enw. CITY LIC. NO, 006890 uc.CLASS B UC.NO.:1 9403 EXP: 00/00 Dtoa: e - a y — 9 � Depeedm: qT� 4"c_ �v� 6� rWNER BUILDER DECLARATION: 1 leaaby a ino raider paroly d perjry oto I am anmpl hom tM Cmtadm lbws ler la w IdbwhN reams (Section 7031.5 Bmhwa erd Pmleerima Code: Any dy a cony Ouch nquhm a pwk Io r:anbucl, Ns, hnpra a, demdbn• r usua dry strumae, pdr m h, b,umy». abo tmlmeI. w e loPer 1« each P«me to 5b a dined a t) of i,tl 3 of ahs b licensed punuenl to tM p ]. tl d w r amrat Trane I.A. (Chep« s (mmnnnarp whh Sadbn ]000) d Minion S d on Budrom and Prp~ f Code) «RW M r me p ea«np ardme and of bee Ir w apeped mamption. Any IID. on d 6action )031.5 by enY eppinam f« a pemd eWpus tM eppTram to a d,i perohy d m mon then Tws hur,d,M do4n (f500�. ❑ I, es oww of IM Prameycr my ernploysee,dh w m tMh sob mnp«dmim, rDdo w wank and w aNCNa'e w Mandad «offered b, eeb (Section lou. Budnam eM Profmrioot Cade: The Cmrerdon Nowa led dom m appytom bw umd propmy who Imide p hnpmws thereon. er,d Mn dom auto wqk hvnsM a MnN m DArgh hb «I,er own employam, provided that ach impa+emenb Aro not imemled or dlamd for sone. tl. ltcm r. the buMW or hnpmernera b add within una yw d aompblbn, w .w I,udd« ova hew IM WcIm of pminp M a am ofd m build or hnpova lar IM Purpom of nab). ❑ I, no Oww of IM papery. em mdmNmy ratereGn0 whh 4onnsed eon0edrn to mnwoot w Robed (Section TOu, ensure ofd Pmlenioro Code: TM Cmtwtors lJ wme Lew dom not appy b en owxt of pop«ty who bnTdn or Impwm therm and wM cont for each Project, whh a vWradm(s) fcanmd pmuam to IM Camradpa Lfrnaa Led). ❑ 1 at a,empl urdw Sermon: B. A P.C., hr W. ,anion: Dela: Q w: I do hmeby caddy lhm I am swan of dd,nd«nmM w nNuumitmts d CaMornia lieekh end sdety Code Sm,uma 25503. E55DD, arM ffisSt, ofd tMI I or eov Mme Wddhq oamp r, will / wN m (ode aro) need m mrpy with acid min oodsa and IM nquvnmama lar apermitla mromclknpmodifimtbnhomtMAh eneprwa Ditlrict. Residsmbl mMmdion eppA:women axampl limn wee PrmAdona. Dace: Appllpam: WORKER'S COMPENSATION DECLARATION: 1 hereby atOrm m,dar pw0y d pwe vy unit d w blbwiM daddtlbro: ❑ I hew end"mauean a wWcma d coneen to sMuuuta br warkera' mnperlol!on. m prwNad IR by sadbn STOo of tM Lair Codes for IM pedomerm of w duh for wh d Inn Cerra It' ❑ 1 hew er,d W meinlan wmic.' oompentod. undrenca, m required by Section 3700 of w Lebon COM, for tM Padorinwa of tM work Ip whim tiv pem,E b Hued. My warbn' mrnpatdtliun hmventa wrf« «d P.S y numb« w: tamer: Perry Nmbr (Th' mdlbn roedm MoonN«W les pwldbwntwed duper jsl0^)rl j I ,tory it n it parlammca tl w wank Io wI h o,b Iaamh b bacl I aMP m ampby ery pram h, dry motor n n to r Ircatm aubpct m IM wvhan• mnwof" Iem d Ca I aM nih apron p ly ! 1 ahouM bamrw v,pjsd b tM mnpJruelbn pwbbv/d�Swion 3laD d w Lobar Cuunt: MP fmhwkn oompy wkh pwba,a AWr+m: i—�L Nlil'ti W.ft F.H. to mean wpkera' con cwvatlon ooy«spa la udarAd• and atoll aubl t r wriploya, to rAdnd pw d" atH dW tlrr w m w AmWtad tlduaard ddM f31000PPA h atrpdon m M eml er mtperuadorc dm«pm m' ovld.d for In Sectlm 3]OAoI ma Labor Cob, ItdamL did adomayl lm�. CONSIAUCTION LENgND AGENCY: I Mnby elFvm order pentlry d patjry thtl tl,era b a aorWMipn MMVN aeercy br w pedpmence d IM work tr wt,irA om pwi b bred (Swbn SOSn, Ci. C1. LENDER'S NAME LENDER'S ADDRESS: 1 Oemy Into Ina,, rmd Ne APPicason and nib ow w ansa wonmtion b acted. Ia to emlply wbh a0 onyaM meay Rdnenom end alma tem,dm'yq no buidhq mmrmion And Way emhorze rnpreasrdmism of w dry b w« upon IM abovamambrod mpady for inspection purppeee. r GENE FELLING (515146WP) WhneBuiNhpASeby: O,mn-191s; Carory-Applcanl; Rnk-Remus: Ooldenrod-Aemawr CITY OF COSTA MESA — BUILDING PERMIT • PERM NO: B 083436 PERMIT NO: B 083436 PLAN CHECK NO: 02012-97 A GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH JOB DESCRIPTION ; SUPPLEMENTAL WORK FOR B-81440 /REROOF SQ FT: 44,700 CLAIM VALUE: 79,773.00 CALC—VALUE: 79,773.00 GROUP OCC: F-1 / COMMENTS: THE ABBEY SCHERER CO. �**it*it it itiF***iticitititititititie�F�F*?F�F�F*��t�t��F**SFE*�F*�F�FUt�*��t�F�F�t+Fie*x�rFn�F***IF�t+r�t:F�t�t*�t***�F*#�F*�P Z 0 N I N GS E R T E B Q A U C I K R S E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 42708306 ZNE: REF NO: PLANNING NOTES> iE it � iE iE iE it AE if iE * iE dt-Nd6it if it it iE iE iE iE iE * iE iE iF * iE iE iE it it iE if if if iF it iE it ie iF * �! it iE iE it iE iE iE iE iE iE if it it it iE * iF 3f?E if iE iE iE iE it iE it * ♦E * it iE dE D E V E,'L 0 P M E N T S E R V I C E S R E Q U I R E M E -N V S ZONING APPROVED BY DATE: l BUILDING APPROVED BY : DATE:, y^ �i APPLICATION SSUED BY: rA < � DATE': t0' _v. I ie iE iE iE iE*iE iE***jFit iE if iE it*dtk kif3Fii�F3FiFiF it: iFiF >�iFiFiFif3F 1`F3F�iFTF3FiFiF 3F �F7FlF"i�iF iE iE oft iE if iE it iF it if ttTrp it LEGALIZATION:N F E E S U M M A R Y STRUCTUR'AT SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 762.25 SMIP/NON—RES PLAN 123.87 16.75 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 779.00 0.00 123.87 902.87 902.87 .00 REVENUE DIVISION TOTALS--> COLLECTED: 816.78 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 762.25 16.75 37.78 iE�*��r�rit*iriEiritiririEitit+rie�iFiritiEititit�Fitit**�F*iritiririr�r*irifiF+Fie*ititit�r*it*�rit�it�r�r *�itie�F*it�rititiF�rkrt�iFit* I N D I V I D U A L F E E B R E A K D 0 N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFC 79773 ALTER BY VALUE COMMERCIAL NOZONE 1.00 79,773.00 END OF FEES 86-24-1997/12:34 PM/1816.78 RMTt:61-9888162 PERMIT:983436 CONSTRUCTION AND PLANNINt;- 'APPROVALS Permit #- Date Inspector P( `y SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pooi & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit- Undrgr nd. 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, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Veht-Fmal 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing -_ 65. Electrical -Final - 15. Rough Eiecirical•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 - FIREDEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 25. Roof Sheathing -w,, �Z�f' 73. Undergrnd. Storage Tank 0 Gas G Oil 74. Overhead Hydro 75. Dry Chemical 26. T -Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 76. Dry Standpipe 26. 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 35, Final Gas Pipe -Test 36. Hood or Canopy " 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47;, FINAL STRUCTURE & BUILDING 48; FINAL PLANNING m ,�o' :TI E �y ro 49'. Electric Release to Edison ~ � 56. Gas Release to Southern California Gas Co am Uw 51. CERTIFICATE OF OCCUPANCY No. Date "`'