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HomeMy WebLinkAbout1928 KAUAI DR - Building Permits JrOGAAS CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. PERMIT M01-00241 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1928 KAUAI DR Status: ISSUED Suite No Applied: 05/02/2001 Issued: 05/02/2001 Vicinity: RIGHT SIDE YARD ____ ..44/ao_ Parcel Number 13951107 ISSUED BY: Applicant: YOGURTSIAN, GARO Address: P 0 BOX 2529 Phone: 714-434-0675 COSTA MESA,CA Zip: 92626 Owner CONROY 1991 TRUST Address: 1928 KAUAI PL CA Phone: (714)444-2443 COSTA MESA Zip: 92626 Contractor: G A AIR CONDITIONING/HEATING SVC Address: P 0 BOX 2529 Phone: 714-434-0675 COSTA MESA,CA Zip: 92628 License:577643 SCOPE OF PERMIT RPLACEMENT OF AN EXITING FAU& INSTALLATION OF A 3-5 HP A/C.UNIT AT THE SIDE PROPERTY OF AN EXISTING SFR. - 1 INST FAU<100 K BTU, 1 3-5HP/500K BTU COMPRESSOR. - FEE SUMMARY Quantity - - - - Quantity ISSUE FEE $23.50 ' - ' Repair/"Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator - $0.00 0 Refrig Sys<100 k BTU $0.00 0 - Domestic Incinerator ' $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems ' Gas Piping $0.00 0 Up td 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 _ 3 To-5 hp/500k BTU- . $0.00 0 Hood w/Mech Exhaust , $0.00 "0 15 To 30 hp/1;000 k BTU ' $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU�/ $0.00 0 Vent Fan/Single Duct ': ; $P.90.;`0 . ' - < Over 50hp/Over 1,750 BTU =) i ; $0.00 0 Appliance / $0.00 - 0� Boilers, �' - ,:i Fire Dampers - - , =i ; $0:00_ 0 - - ' Up to 3 hp ' . - - 'y` - $0.00 0 Smoke Dampers $0.00 '0 3 To-15 hp " $27.15 1 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee " - Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check-Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $65.45 COMMENTS /SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections end final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-461&00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) Q 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 alifomla,and a ee that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with then o isions. I Applicant Signature: !l,r7 < i 1 Tti Date: 7 - � - O1 WARMING:FAILURE T S RE WORKS PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a Class 8 Contractor's Signature: �f6ey 1i(/I L� Date: - `1 — p/ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 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? Q Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any ono time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: _ Date: CERTIFICATE Of COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ig = ur-Of Legal Owner(s) Date • d/ar Authorized Applicant Date 5 _ a _ p f CODE! INSPECTION TYPE 2ATE INTm614 CODE t INSPECTION TYPE gy¢ INTTRAL$ 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 Bldck/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 • MF q CITY OF COSTA MESA ,4yi� BUILDING DIVISION PERMIT NUMBER ' DEVELOPMENT SERVICES DEPARTMENT '4• 117041 PERMIT 4'".,;m0 le B99-01578 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1928 KAUAI DR Status: ISSUED — Suite: Applied: 09/30/1999 Vicinity: KITCHEN Issued: 09/30/1999 Parcel Number: 13951107 Zoning: Applicant: CONROY, FRANCIS P. ISSUED BY: Address: 1928 KAUAI PL CA Phone: (714)444-2443 • COSTA MESA Zip: 92626 Owner: CONROY 1991 TRUST Address 1928 KAUAI PL CA Phone: (714)444-2443 COSTA MESA Zip: 92626 Contractor: 0 t Address: Phone: Zip: License: Arch : _ Eng: Address: Address: - . ‘ s , Phone: Phone: Zip: License: License: SCOPE OF PERMIT REMODEL KITCHEN-ADD BAY WINDOW 8 SLIDING GLASS DOOR IN KITCHEN AREA. FEE SUMMARY Plan Check: $72.31 Calc Valuation: $5,000.00 Permit: $111.25 Claim Valuation: $5,000.00 SMIP Res: • $0.50 SMIP Corn: $0.00 • Other: $0.00 Inspection: $0.00 Total: $184.06 . PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY . Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: lkit • ' • 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 DECI:ARATIONS - • , WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with 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(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). 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(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 Id 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.). _ as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions ode:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exem e ec. Business and Professions Code for this reason: Slgnstureriel�.,a ._ — sires: • +"'0 L Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Calif omia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pr inspection pus. gr of to occupy or allow occupancy of any building authorized by this it f' al pettier. et (vl�Siggoa_tui_e v_OfLegal Owner(s) • �'Oete :rj: AndlOr Authorized Applicant Date CODE r INSPECTION TYPE PATE INTIALS CODED INSPECTION TYPE PAN INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall • 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign222 Final Site 204 Final Demolition 250 Final Building/Occupancy l2t9/4? #82446.46 2eAte_- fiLor 4.--7717.—E-- " 107 iI nr'�5 s �N jez I 74-1 a 363" w \e 45' 49"v44" S G D 1 ` � lA bo 6s ✓',,U I NEva I 5�� sIrJK offs: I. BAS 4JINDOW : 69 tn. wtDE ''` r`'']�jj�® � OMHER. DItENS1oMs eSTImAf P _ CITY OF COSTA MESA 2. SINK .�3"x 2Q" k0HLEt PLANNING DN. ap !N. V I0 es. SUBJECT, TO BLDG. DEPT. REG. K 6.331"14 UNDERc�ouN7 Z; BY ., --��DATE_ ® ji I. 3' CooKTop : 29'1" x Zee _--J r GE ?Rota SP 360 BA I ISLAND — 4. $ACKSPLASH: 6" gy(C!Eet a ttgAZEASEto 24" (3o" wont)in. Id-- ler— 48irt.— Cj (No1�E Octet? ON IS • • Luii sr+ C,00K 75? CChri.ROVEDA DIVISION A S ' t �yttrnasand Is'mistosrts s�to - - N 0 OUN itrof, Qf.QD MustbeteP!� ionl�n C M t. setoff., i . saa� l be heEdtoPa • mtobeoaS tate t3' M •ae d ,.. • $Haval AIINC ante andl KT Ew/ ;ill and We°TxztwsC.ty of Costa Mesa stn it the, " N E mat Ian Po' of any . become nut and pit,. " • , PAN1R`t (CEf2ls QVE &a%una litiasf+�texti roam Z y BC4 l� tmleo aaYAs ^ ( �} wotIL N CI!a ' 9/ f/99 . 9/299 C1 ----------T--"—"---: J . i 01 , �.. 1,,,,•;,-,..; t.....-L' . . 1 + _ .''•.-J:is .__"C /may = .y- .. c'.1. CI lir $! /, <>' 0 i: ii. r l ` ' r,P(_.• , \ i \ r , r 'or . . . `o�p MF • 4 CITY OF COSTA MESA r y ,) BUILDING DIVISION PERMIT NUMBER `+'�'�7�, DEVELOPMENT SERVICES DEPARTMENT iwtsee / .' PERMIT / P99-00561 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,✓✓✓COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1928 KAUAI DR Status: ISSUED Suite No Applied: 09/30/1999 Issued: 09/30/1999 Vicinity: KITCHEN Parcel Nunmber: 13951107 ISSUED BY: Applicant CONROY, FRANCIS P. Address: 1928 KAUAI PL CA Phone: (714)444-2443 COSTA MESA Zip: 92626 Owner: CONROY 1991 TRUST Address 1928 KAUAI PL CA Phone: (714)444-2443 COSTA MESA Zip: 92626 \ Contractor: ©W k,,Seg.,.... Address: - Phone: ' - . . - • Zip: License: Arch l Eng: Address: Phone: Zip: License: SCOPE OF PERMIT PLUMBING PERMIT FOR KITCHEN REMODEL. RELOCATE 1-DISHWASHER&1-KITCHEN SINK. REF: B99-01578 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00• 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $43.10 ' • COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • DECLARATIONS • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed iY the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree 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(5100,0001,IN AMMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class U Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects th applicant to a civil penalty of not more than five hundred dollars(5500).): ,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 Err d within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve far purpose of sale. as owner Of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions ode: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License aws.). ❑, -1 am exempt ec. Business and Professions Code for this reason: Aft- , So a&mar ID Date: Owner ID le by river's license. es ❑N >,_.i-DL.i%vets License Na �lExpires: ajR�.f�j Verification of Ownership by(type of document,i.e.-property tax bill or deea): 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 t0 file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Alr Quality Management District or from any other air pollution control district or agency? IJ Yes L]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? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comp) with : ate laws a . • diva,'t relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pro• y B ' spection purp..e .I :- :0 li o occupy or allow occupancy of any building authorized by this peer t until ffiyeI Inns//pection. nature Of Leg.'0 er•• . y And/Or Authorized Applicant Date COPES INSPECTION TYPE PAIL INTTRALS CODES INSPECTIONTYPE PAIL INTRIALS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical /� 1266 Pool Spa Final - 208 Final Plumbing 121y 40 /j/f)+�� 200 Final Re-Roof _ 210 Final Electrical 201 Final Block/Retaining Wan _ 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign _ _ 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 ,a gs• CITY OF COSTA MESA 0 ora*W4 BUILDING DIVISION ERMIT NUMBER -1 '�e�S,d�,, ' DEVELOPMENT SERVICES DEPARTMENT °• PERMIT E99-00907 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1928 KAUAI DR Status: ISSUED Suite No Applied: 09/30/1999 Vicinity: KITCHEN Issued: 09/30/1999 Parcel Nunmber: 13951107 ISSUED BY: Applicant: CONROY, FRANCIS P. Address: 1928 KAUAI PL CA Phone: (714)444-2443 COSTA MESA Zip: 92626 Owner CONROY 1991 TRUST Address 1928 KAUAI PL CA Phone: (714)444-2443 COSTA MESA Zip: 92626 • Contractor: a•..tl C1CX� Address: �/�"�`^�� Phone: • Zip: . -- , . . • - 1v .. License: SCOPE OF PERMIT ELECTRICAL PERMIT FOR KITCHEN REMODEL. INSTALL 5-OUTLETS,3-SWITCHES, 1-CONDUIT,& 1-MISC.CONDUCTOR. REF: B99-01578 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $5.50 5 up to 100 kva/kw $0.00 0 Switches $3.30 3 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 $18.20 1 Service to 1000a $0.00 0 Misc.Conductor $18.20 1 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $68.70 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 '1 • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed 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 Califomia,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with 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(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect,Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ 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 Id 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 l: Cotle: The contractors License Lew 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 toc the Contractors Lic se Laws.). ❑ I am exempt u Business and Professions Code for this reason: SSignati re::• 4,1•M.�� :"}Date: o.i ff . Or ,. 1 Owner ID v rifted by dri er's license. ❑Ves ❑No o.0rner's License Na. -, Expires: 10 : —0 Verification of Ownership by(type of document,i.e.-property tax bill or deed):1" 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,Gm 2.Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safely 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 far acutely hazardous materials)? ❑yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes".attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with at state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUAN 4 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 • •I •i h all state I. -n• •y o • '.noes relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described • .-y for inspection- ••s• . anot to occupy or allow occupancy of any building authorized by this per until fin ins (action. r--- -,'Signature Of. eget V.,*ors --r.,J _ ate r'-4-.-24, _ _ And/Or Authorized Applicant Date CODE♦ INSPECTIONTYPE DALE INEMAL* CODE ii INSPECTIONTYPE DATE imuLL.6 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical —�{�—/�����f`-- 1266 Pool Spa Final = 208 Final Plumbing f 1 200 Final RB-Roof 210 Final Electrical s 201 Final Block/Retaining Wall _ 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign _ - 222 Final Site 204 Final Demolition _ 250 Final Building/Occupancy • 2446-46 • CITY OF COSTA MESA ' �� yBUILDING DIVISION t1 -=,- DEVELOPMENT SERVICES DEPARTMENT �• PERMIT PER IT NUMBER "moo m m 49 1398-01532 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1928 KAUAI DR Status: ISSUED Suite: Applied: 08/25/1998 Vicinity: Issued: 08/25/1998 Parcel Nunmber: 13951107 Zoning: Applicant: BYER, TOM Address: Phone: Zip: • • Owner: CREIGHTON, WILLIAM J TR Address 1928 KAUAI PL Phone:_ - ' COSTA MESA,CA Zip: 92626 Contractor: TOM BYERROOFING Address: 17662 METZLER,LN Phone: 714 847-9332 HUNTINGTON BEACH CA . Zip: 92647 License: 575002 Arch/Eng : - Address: � • "Phone:_ r • Zip: License: SCOPE OF PERMIT Tear off reshaeth with 1/2",osb&reroof w/40year comp,shingles. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $6,248.00 • Permit: $124.75 — -/ ; Claim Valuation: $6,248.00 SMIP Res: $0.63 ' SMIP Corn: $0.00 • - Other: $0.00 Inspection: $0.00 Total: $125.38 PLANNING &ZONING SETBACKS - MAIN STRUCTURE Front 0-0 • Rear 0-0 Left ' 0-0 Right 0-0 ' ACCESSORY Front 0-0 - Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: • 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 a 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. a. 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: Cartier: Policy Number. (This section need not be completed/f the permit/s valued at one hundred dollars($100)or less.) ❑ I certify mat I ormance 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' compe -..'"• gaunt., -- • that If I should become subject to the workers'compensation provisions of Secti n 3700 of the Labor Code,I shall forthwith .- .art with th, .� s. pliant Signature: Date: AL '2CWARM TO SECURE WORKERS'COMPENSATION ERAGE IS UNLAWFUL AND SHALL SUBJECT AN OYER T RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED SAND DOLLARE($100,000),IN ADDITION TO THE MAT OF ENSATION,DAMAGES AS PROVIDED FOR IN SE nu.. OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CON : - ORS DECLARATION: I hereb . that I am I' ensed under prov'.ions of Chapter 9 : cing with Section 7000)of Division 3 of the Business and Professi. s Code,and my license is in full fo '=an• arta _ _� ass N / Cone: ors Sign:_ . Date: a 2. 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: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm tnat 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 properly, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.), ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2.Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 afrermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feel from the outer boundaries of a school? ❑Yes 0 No (If"yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Alr 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 AUTHOREZATION 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 ordinan .. Ing to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspec'on purposes.I agree•• o occupy or allow occupancy of any building authorized by this permit until final inspection. . a 1t` • =•-1• ner(s) /- Date 8 2 ), C .r.rof Aut'zed '...li:" ale COOS INSPECTION TYPF a.r ILO111AL5 LODE t IN5PFCTION TYPE Ddff gl is 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing p 200 Final Re-Roof 1 -11f 210 Final Electrical 201 Final BIOck/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 2448-48 h-t 6 - Tract 6384 P4n62-Br�w 0(2 PAY 25-617001398:=�A5� ***150.Z5 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA For Applicant fo Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING ADDRESS 1928 Kauai Place C.M. COSTA MESA. CALIFORNIA • For Office Use Only I RECEIPT NO. I (•'If{M5T( ,32 OWNERC1ub House Road Joint Ventur •I J ltCr '` MAIL t1ECE1 DJEY TE RECEIVED DAT SSUE"D ADDRESS 2850 Mesa Verde Drive �` /t,( 116.2 7 . 4,dd-47 CITY Costa Mesa No549-039 ADDRESS ARCHITECT TEL OR ENGINEER E•G. Kaltenbach NO547-804 COSTA MESA. fR CALIFORNIALI �/7 ADDRESS1823 E, 17th St , Santa Ana TYPE y GOUPP- 4 ZONE c CONTRACTOR Republic Homes Corp. APPROVED AP DATE ADDRESS 2850 Mesa Verde Drive ZONING ZONE . NO.OP USE OF NEW '/ CITY Costa Mesa 62.)....-I PLAANS 9/-BUILDING L-T/ , STANO. 197838 TEL. 549-0395 DESCRIPTION `-°`Y 62, T-0,6 .34'91- SIZE 56 x 110.66 ' x NO. OP BLOCS. OF LOT 62 95 x 100 36 ' INOW ON LOT A.P.NO. USE OF YARDS EVES EXISTING BLDG. APPROVED ALLOWED SETBACK LINE PROM1 1 ICEMER UNE I CENTER DP STREET 53 REAR YARD 15 FRONT T.-4 IN. SIDE YARD (LEFT S ' IRIGHT S' _ R.SIDE tJ FT. IN. DESCRIPTIONvvOF IIWORK L.SIDE S FT. IN. NEW I X II ALTERATION I ADDITION I . REAR .27:n 7 FT.-6: j� IN. n REPAIR I II MOVING I DEMOLISH I BYFROVED/i., Y/ / /1 DATE 7 - 19-(99 SIZE 2681 2681so. ftRNO. OFOOMS 9 STORIES 2 �j(/ 000 000/// 1�,� EXTERIOR WALI,�WOOd&I ROOF 1 'COVERING St UCCO COVERING Wood USE OF BUILDING AND WORK TO BE PERFORMED • _a ,,26Pi 1 `/iv I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CON -, =ION. VALUATION SIGNATURE •N1 // PERMIT FEE $ /O3 S.� I PERMITTEF • UO N /Wait-- _ t $ 33 o Y s� PLAN CHECK $ `��"• .75 4' AUTHORIZED�►, :" - lV / !���'�� / p� O N TOTAL FEE $��JA-O• o7-1 5 y n -3 Cflui C� `OU I w 34935 COSTA MESA BUILDING-SAFETY DEPARTMENT JUL ?C72 P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 •PP I •TION FOR BUILDING PERMIT ' For Applicant to Fill in Completely R'CEI • BY DATE RECEIVED .LDATE.ISSUED BUILDING Si /z1 Kana. 7-7' -=-7--72.7----- ADDRESS /'/(/�. C v-e. c e A.P. • NO./J9� S// � / PERF T�I$35 OWNER _ ( BUILDING /p�%y^ /�IY j MAIL Q ADDRESS // O� 11/9/ Z ADDRESS 6� yyt_Q-,w Lu TEL. / of / a U CITY 'Yr) NO. .-zggr TRACT p�p / LOT (O BLOCK H Z Z Q CONSTRUCTION NEW ADD • TER REPAIR MOVING nFMnt ISH ON LENDER am _i C 1 BRANCH _I N OWNER/0e", dalic/C/I ADDRESS /^./}/�-�,si VALUE J m ARCHITECT TEL. USE O /Y1///c CarEl s �OD O'Q OR ENGINEER NO. U N FIRE WQ ZONE TYPEGROUP ®T/ K ADDRESS a w r APPRO E' J Z CONTRACTOR 4_ • r)i<_t I, BY — ,,,,,....4/ ATE ' ^ 2i tO Z J Q ADDRESS Ill w TEL. TONE / NO.OF s USE OF NEW /0 Z� CITY NO. �� PLANS ' BUILDING 6� W O STATE CITY YARDS APPROVED YARDS APPROVED (/)X LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING D Q (FROM C/L STREET) SIZE I NO.OF BLDGS. i / OF LOT NOW ON LOT FRONT FT. _ FT / ^USE OF / ' e _EXISTING BLDG. LCS�.C..��/,.�y.,!J R.SIDE FT. _ ? FT.--S- - I— SI2E OF NO.OF �Y/{ r.. / �j. Z _NEW BLDG. ROOMS STORIES ` L.SIDE FT. 3 4j FT.�i (a.1 EXTERIOR WALL, n ROOF ,,S ( n �f- - ._COVERING 639 LO ICOVERING %%hail , REAR FT. �V FT r/'� J USE OF BUILDIN AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& y — MAIN BLOCS. ACCESS. BLDGS. Q ,d,Caa C.U.P.# APPROVED0 — ~ APPROVE 7-7-7-2. - J' / 7 ° Cl, — _.11Y /per GATE/ Z APPROVE?, O \ STATE UI hereby acknowledge that I have read this application and state 7 that the above Information Is correct and agree to comply with /_ IX all laws regulating building construction, and I shall not employ U(�/ any person in violation of the workman's compensation laws of N the State of California. s�6 ' F *Mk m n Z �'[I hereby certify that I am properly licensed as a contractor under SO. FT. o.- the the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: cc am exempt from the provisions of the State of California Business VALUATION and Professions Cotle, Division 3,Chapter 9, �' a) r / PERMIT FEE $ / D Signature of /� / /� /,�'�I///� co Permittee �/C l L%// ! $ �j /// PLAN CHECK $ i7 E U. 'Authorized Agent �'/% # n \ TOTAL FEE $