Loading...
HomeMy WebLinkAbout3059 TYLER WAY - Building Permits I C • Y 2 Ed Petrose reve,`t' 1 L-2q—P City Of Costa Mesa Building Dept. w f / P.O. Box 1200, 77 Fair Drive Costa Mesa California 92628-1200 Dear Ed, This letter is in regards to the outstanding building permits on file for my property located at 3059 Tyler Way, Costa Mesa. On January 5th, 2000 we experienced a house fire. Permits were issued to authorize the reconstruction. Subsequent permits were also issued pertaining to an addition that we elected to do at that time. Cal Western Insurance repair was the company that was selected to complete the reconstruction. The whole process did not go well, and in fact they abandoning the job. The legal battle that ensued has since been settled. They dropped their suit and I dropped my countersuit. Just a bunch of money wasted on lawyers. The lawsuit consumed the money that I had set aside to complete the addition and I have been struggling to raise enough money to complete the bathroom that is part of the addition. I believe that at this time we are able to get the permits that pertain to the fire reconstruction signed off. I don't know at what point I need to be to get the addition permits signed off. Hopefully the inspector that comes out can give us some information in that respect. I am out of town until the 5th of January and will call for inspection within one week of my return. I would like to take the time, while I have your attention, to tell you that Gary Hook was a great deal of help during a very difficult time for our family. We will always be very appreciative of his assistance. Sincerely Steve Ferris is 44S. wrt, 0 '44411,11 � - CITY OF COSTA MESA - +•I■ ' F a.___ BUILDING DIVISION PERMIT NUMBER ., f�° DEVELOPMENT SERVICES DEPARTMENTTA / •° PERMIT /800-00121 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA/CMESA,CA 92626 BUILDING PERMIT Job Address: 3059 TYLER WY Status: ISSUED Suite: Applied: 01/27/2000 Vicinity: Issued: 01/27/2000 Parcel Number: 14160453 Zoning: R1 R1 Applicant: ED HARE ISSUED BY: S As- Address: Phone: 949-868-2502 Zip: Owner: FERRIS, STEVEN Address 3059 TYLER WY Phone: COSTA MESA,CA Zip: 92626 Contractor: CALIFORNIA WESTERN INSURANCE Address: 29732 AVENIDA DE LAS BANDERAS Phone: 949-868-2502 RANCHO SANTA MARGARITA,CA Zip: 92688 License: 426424 Arch : - Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT FIRE DAMAGE REPAIR, FEE SUMMARY Plan Check: $0.00 Calc Valuation: $40,000.00' Permit: $543.25 - Claim Valuation: $40,000.00 SMIP Res: $4.00 SMIP Corn: $0.00 • Other $0.00 Inspection: $0.00 Total: . $547.25 \y PLANNING & ZONING - -- SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLAR lIONS . . - 'e •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. [2]' 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: A Ito F2--n / Policy Number: I— 27-00 (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the perform ce of the work for which this permit is issued, I shall not employ any person i any manner so as to become subject to the workers' compensation laws of Cali rnia,and agre that if I s`/y��iId become subject to the workers'compensation provi s of Section 3700 of the Labor Code,I shall forthwith comply with these provisi @. 0 / 1<iZ 00 ) '(717 7 � Applicant Signature: �w!',L/�r, /'�—Fe"-'"'^` 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 DOLLARS($100000),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 nder 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.4 42 424 Class# A - asie/t/yC. Contractor's Signature: -/ / [.r I l✓ vy) 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($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such Work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑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). torp g.i. e_ usm-materials? — ---._2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous meterlals? ❑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 ❑Na (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Li a plication 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 U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:i certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE MD 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 eget Owner(s) Date egina:4"-elt 1/27/00 And/0 Au onzed Applicant Date CODE N. INSPECTION TYPE DAT): INTmALS CODE INSPECTION TYPE 2ATE INTRIALS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical _ 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 'j 204 Final Demolition 250 Final Building/Occupancy 7- '.' 2446-46 • L�STp MFs •• CITY OF COSTA MESA BUILDING DIVISION r i I r° 'DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER • .' PERMIT Pgaaaatto\q4A M00-00232 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 3059 TYLER WY Status: ISSUED Suite No Applied: 06/12/2000 Issued: 06/12/2000 • Vicinity: BEDROOM&DEN ADDITION Parcel Number 14160453 ISSUED BY: Applicant: MACALELLO, FRANK Address: 29732 AVENIDA DE LAS BANDERAS Phone: (949)868-2502 RANCHO SANTA MARGARITA,CA Zip: 92688 Owner: FERRIS, STEVEN Address: 3059 TYLER WY Phone: COSTA MESA,CA Zip: 92626 Contractor CALIFORNIA WESTERN INSURANCE Address: 29732 AVENIDA DE LAS BANDERAS Phone: (949)868-2502 RANCHO SANTA MARGARITA,CA Zip: 92688 • License: 426424 Arch/Eng : Address: Phone: Zip: License: SCOPE OF PERMIT MECHANICAL PERMIT FOR NEW BEDROOM&DEN ADDITION.ALTER 1 HEATING SYSTEM. REF: B00-00288 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 •Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 \Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 'Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp - $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $37.20 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92.28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the � work for which this permit is issued. rI have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My wo rs'compensation Insu a carrier and p number are: ��) /, Carrier: C�/[D v"� ws. �U. Policy Number: (.�O 3/ Y�O S�/ (This section nee not be completed if the permit is valued at one hundred dollars($100)or less.) e ❑ 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 pr visions. -7 rApplicant Signature: �j�� Date: /42 —Co • WARNING:FAILURE TO SECU WORKERS'CO ENSATION 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 Mgr 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 unser•rovisions•f Chapter 9(commencing with Section 7000)of Division 3 of the Busines and Professions Code,and my license is In full force and effect.Lic.# i - Class# Contractor's Signature: - _l X77 , i.4 Date: G--nig?. —O C' • CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031,5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose,of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: • ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. ' 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at ar& 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. 4resent) If an RMPP is .... ga-- presently required,has Section 25534 oo f the CaliforniaHealth and Safer._,.. -f ty Code been fully complied 4 with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? l0 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? 0Ves ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). _---_.._ ---_o.t______ Qualit age --_opol.l_tion---_-__oc__.rage___-_-____i__gaga._ 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.vII agree not to occupy or� �/allow occupancy of any building authorized by this permit until final inspection. Si atur g // �iC7tiU(A/ //e.�Da_DO An r Authorize pplicant Date CODE I. INSPECTION TYPF DATE INTITIALS CODEC INSPECTION TYPE, DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1-4-05' Q__ ...- 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 • F 1-c '�AFSq CITY OF COSTA MESA - is 'a' � BUILDING DIVISION + i '. m i PERMIT NUMBER DEVELOPMENT SERVICES DEPARTMENT °, KS ,aPERMIT /E00-00062 rm (� i. (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 3059 TYLER WY Status: ISSUED Suite No Applied: 01/27/2000 Vicinity: Issued: 01/27/2000 Parcel Nunmber. 14160453 9 kr Applicant: ED HARE ISSUED BY: Address: Phone: 949-868-2502 Zip: Owner: FERRIS, STEVEN Address 3059 TYLER WY Phone: COSTA MESA,CA Zip: 92626 Contractor: CALIFORNIA WESTERN INSURANCE Address: 29732 AVENIDA DE LAS BANDERAS Phone: 949-868-2502 RANCHO SANTA MARGARITA,CA Zip: 92688 License: 426424 • SCOPE OF PERMIT FIRE DAMAGE REPAIR, REPLACE 11FIXTURES,25OUTLETS, 12SWITCHES, RE:B00-00121. FEE SUMMARY /'c 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 $12.10 11 up to 50 kva/kw $0.00 0 Recept Outlets $23.65 25 up to 100 kva/kw $0.00 0 Switches $13.20 12 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $72.45 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 • e t DECLARATIONS tf 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: Aeo'zy3 Policy Number: !7 i Kg() I S 7/7 (This section need not be completed it the permit is valued at one hundred dollars($10 0)or less.) ❑ I certify that In the performs a of the work for which thi permit Is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calif ia,and agree that if I shout ecome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisio s. Applicant Signature: ji2,w. ( / Date: '/27/O a 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 Drx I ARE(6100,000),IN ADDrnon 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!icons rd under provisi.ns of Chapter 9(commencing with Ser# Class it i3J 1.74 CR L / Contractor's Signature: ,urf Date: i/27/00 / — . c CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044. Business and Professions Code:The contractors License Law does not apply to en owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑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,ore 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 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aEermit 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 LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 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-descri4re ? er(s) rty for inspection purposes,I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signe yQt lrDa Lgal / 7 7 .`a And/Or Authorized Applicant / r Date CODE I INSPECTION TYPE INTITIALS CODE INSPECTION TYPE "A" INTRIAI$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final _ 208 Final Plumbing ry 200 Final Re-Roof _ 210 Final Electrical T_27--dn9 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 4L�57w9 CITY OF COSTA MESA ^ A� Q4 BUILDING DIVISION F X er .�wris � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER :4. aKill el PERMIT BOO-00288 *f0k 0R ' . (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.C«1ILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 3059 TYLER WY CSU Status: ISSUED Suite: Applied: 03/07/2000 Vicinity: NEW ADDITION AT REAR OF HOUSE Issued: 06/12/2000 Primary Occ: R3 Type of Construction: V-N Parcel Number: 14160453 Zoning: R1 Applicant: MACALELLO, FRANK Address: 29732 AVENIDA DE LAS BANDERA Phone: (949)868-2502 ISSUED BY: RANCHO SANTA MARGARITA,CA Zip: 92688 ' Owner: FERRIS, STEVEN • V Address 3059 TYLER WY /�44 Phone: (714)754-4543 S L. a o5 v , COSTA MESA,CA Zip: 92626 asts a, Contractor CALIFORNIA WESTERN INSURANCE , ., a /-,ur -�.,°'fir^ Address: 29732 AVENIDA DE LAS BANDERAS �:+�� ,�ya;.,.T� T�, Phone: (949)868-2502 * ��?' t4 RANCHO SANTA MARGARITA,CA r' h "$t 1 , 6 Jtat Zip: 92688 License: 426424 e.. d`;' (�Yj ++•''t.',. ,t;6 fv' ta;, ,. Arch : !Eng' PLUMP ENGINEERING ti:-0/4 `^��r7' Address: Address 13210 FLORENCE AVE \ .;VirEf i"} s , Phone: t L. " r sr' Th ' `F Phone 5621777-0983 . ' N/ "?SANTA FE SPRLNGS,CA 1,: ;'a ''�,*c:( Zip: License: *,w'"-, ry )*Si.'90670 'ria Licenser:' '�''fcr�':. ;`rrr,r.,.n r42 k . .,r,....„�, r°�Y�,r„?rbc'/ y.!vt... ..,./' .*-"e y0"'1 SCOPE OF PERMIT"{ ..'A` CONSTRUCT 636 SF(BEDROOM&DEN)SINGLE STORY ADDITION AT REAR OFEXISTING OUSE.ENCROACHMENT INTO REAR'.YARD SETBACK O.K.-535 SQ.FT.COVERAGE.AGLOWED 315 SQ Fi r PRa Ot POSED(i�1 r'r'.'� ',go” " { ” -f Y±- , k.,, ,x, I A" •: t '‘I';'" " FEESUMMARY ``l, ar r'" ki' WI r. Plan Check r° }fi�}e;t;'$.41.19 [L n` ryp,—.^:4t;r` 'c ! l 'r � � Calc Valuation: , .$5&4378.00 X4,m$" a. kr " ' rriHRc �y- Apt v �.r_ r�A Pe{r�mlt jg�$f78�.��75 ,. , , z ,, t ,h_ Claim Valuations. $26,000.00 SMF Com v $Q00 r, . y. " <li �ii1,1r ,` ,3j�4 i1a Other ' ^"$6;00 s'"-,' ( py."s rt.,....,,, .n Ihsp)actiion X-4:40.00 F: '> „I :. Jy ` ' -w4. Total: $1,125.38 '' rt `-4 i'r ,; + r''§ PLANNING &ZONING T ' t, 'SET ACKS I 1 'yi °r,,,,Lt.o • 'MAIN STRUCTURE font""0 0 r��•Rear °":0:' ' V Left 0-0 Right 0-0 ..r�..�. '41'4t:4:;,C ,;2 it :'IS i"`J :(1. ,,:vvjx"'.CG i i ACCESSORY ,�Fro(nt',`{rp0 0 \r,-4.R}a,( O.u0-' Left 0-0 Right 0-0 L PARKING zistin2l: 0 Renu red: 0 Proposed: 0 ''NOTES: r •' 1 BL1DTEMP 03120/2003 PERMITS FORWARDED TO INSPECTORS FOR RESOLUTION. PULLED FOR MICROFILM. f - lii r NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No. 92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6100) DECLARATIONS _ _ . - WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to 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 workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code.I shall Ionhwith 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(S100.000),IN ADDITION TO THE mai OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,anr,my license is in full force and effect.Lic.a Class Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm That there_I a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: -t1/T Lender's Address: Signature: %•r' Dale: xw 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 cr 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 live 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 properly 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 provirg that he or she did not build or improve for purpose of sate.). 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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,fafsework,or demolition or dismantling thereof,will be mere than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to CO 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 wnich 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 Safely Code provides that the Costa Mesa Fire Department may require the preparation,certification and tiling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Deportment. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollutior control district or agency? LI Yes U 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 California Health and Safety Code). 7 If a permit from the South Coast Air Qualify 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 slate 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 I INSPECTIONTYPE- CASE'..-'-- I1JI1k CMDEI—y9I9ECTION TYPE- 1616. Fixed System Ftp Fite Prevention ' 206 Final Mechanical ` 12864 Pool Spa Final t1 3;y..e-1 ,r`." . a'�N • r`; 208 Final Plumbing 200 „FinalRe-Pool f','.1'a i / y • " 'i�M;;•� - ,f 210 • ,.Anal Electrical ' , 201 - •Fine)BIock/Retaining Wall •`"ti ' -� - 212.. ' Final Fire Prevention.•"• 202 V Final Factory Fire Place •% L 220 Final Planning Approval 203 Final Sign'. �• - " f, 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 051p F CITY OF COSTA MESA afar, BUILDING DIVISION F i __air'__ ` DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ,-- ti- PERMIT *�,*'ee�.• E00-00526 (714)754-5273 • Fax(714)754-4656 • www.ci.cosla-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 3059 TYLER WY Status: ISSUED Suite No Applied: 06/12/2000 Vicinity: BEDROOM&DEN ADDITION Issued: 06/12/2000 Parcel Nunmber: 14160453 Applicant: MACALELLO, FRANK Address: 29732 AVENIDA DE LAS BANDERAS ISSUED BY: Phone: (949)868-2502 RANCHO SANTA MARGARITA,CA Zip 92688 Owner: FERRIS, STEVEN Address 3059 TYLER WY %0 /�"( !; • Phone: 0 ' ' COSTA MESA,CA Zip: 92626 SS 1 - s+is`%1 i Contractor: CALIFORNIA WESTERN INSURANCE , .2 \ t , • Address: 29732 AVENIDA DE LAS BANDERAS .-,r- t-'- - '` . ;.• �' 1 Phone: (949)868-250 \ - 4 RANCHO SANTA MARGARITA,CA Zip: 92688 - ' . 7 •. w ' ,ri License:426424 I.-tip* :�=:5 .':74; ip t*. `'Fn . I SF•fi , I,f. ''SCOP.E OF PERMItzsj /,, n 't'1'‘ .' .•«. F}; ELECTRICAL PERMIT FOR NEW.BEDROOM.&DEN ADDITION.INSTALL 4 L!GHTpFIXTURES,12 ;• _!'3!p RECEPTACLE OUTLETS,.&6 SWITCHES. ' ' ; . - r 'c'-' :':,1" W 1;,rf"' REF:B00-00288 .44.- - 1;1 I - . 14i<S 'y5 „. v ' v FEE SUMMARY r ' 4 ss S ti�.'I ,�c+.MM.f> t. �r -' ! ,r r .. ,`r: r t ;,•:4,*s4F-1. a..' Quantityr ♦:y.ii f�z> S•Quanta »:.-.tet•, 4� b ISSUE FE „..--'051.,:-. ` Sirrg .>j5'$23.50 it:,... • Temp Dist System%Lighting $0.00 0 ?, Temp service tett Y x$0.00 4r.• - , Busway/100 ft - $0.00 0 Res ie-y'a'Ekage3t*,.4g':, )'50.00 f�','f.• w• ..1 1'r,.,,,. Standing,Sedtion ,<' $0.00 0 New Res(1-2 units) if14)C:4$314t$0.00 4.47 _,..0 .•,f', „,..4.Misc EIectnna!Equipment $0.00 0 New Re's(3+dnit5) -! • k t '$0 00 f'i`0' tl?i ;;.ittansform�s up'1o;1 kva/kw $0.00 0 Pool t,Spa y.;,." t�o� $0.00^ 0 �up td-10,,kva/kw $0.00 0 Li htin FixtS� ` $4.40-.42x 4' u to 50 kva/kw $0.00 0 9 9:. t• f' j' p, Recept.Outlets $13.20 16 12 - up to:100 kva/kw $0.00 0 Switch0.0, $26.60 , 6. , , ,'over-100 kva/kw $0.00 0 Non ReM'Appl $0.00.-.: - 0 Low Voltage Equipment $0.00 0 Res Apel%�c�•, $0.00E"'$ ,0 , .:,' sr Low Volt Wiring System/Ckt $0.00 0 Service to.200a $0.00 ;+ 0 . r-';. ,IAArt;(3 r• Misc.Conduit $0.00 0 Service to 1000a s _.$0.00 j' . 0 •• / :::,34� 1,..?}` Misc.Conductor $0.00 0 Service over 1000a 'r-t ' ' $0.00 h., • Q '! ,,,pr4 9"1:! Circus(gen or ride) $0.00 0 Motors to'I hp I "• 50.00 �^X1; +0? ,Spo'r*a Circus(mech ride or lights) $0.00 0 Motors to 10hp I 0.00 0 Motors to 50hp P7 4`, j$0.00 \N';0 tti-"" > Fireworks StandTree Sfand $0.00 0 Motors to 100hp pr,$0.00 "0•a' Other Electrical Fee $0.00 Motors over 100hp,r r ,,^:, t $0.00 0 Cornmunicationdrops 4 A q- $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 PwrPoIe • $0.00 0 TOTAL CALCULATED FEES $67.70 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 2446.46 16,00) • DECLARATIONS - WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions, • Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SH Mk SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),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 Coda,and.,my license is in full force and effect.Lic.p Class Contractor's Signature: Dale: 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: K '✓- Date: nu r 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'aller,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. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly 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 Ii.California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business wnich 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,reouires 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 apg ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? e3 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 pail 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 nnntrol 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 ❑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 woe I INSPECTIOMTTFE -rr- RAIL"'— ' fIjl 9L5 CODEI—OfEGTIONTYPE•--.• 1616 Fixed System Final Flee PEtna'revention 206 ai Mechanical , �` r • 1286 <PooI.SPa Fina yj,4s,_..__3, 208 Flnal •Plumbing. • :Ht w n 200 Final Re loot • F • - Yui 210 Final Electncal Y fj,T .y1 201' .Final Block/Retaining Wall ift, '.`A z .$ 1� 21217"'6 Final Fire PreventIon'a3," ". ;N. f [ 111 b ♦e ) )... 202 Final Factory Fire Place` 1+" - 220 - Final Planning Approval ' - 203N. Final Sign /� "14 ' - / 222r Final Site •^‘-:.:w_-.v'::.ti•:r'- 204 Final Demolition 250 Final Building/Occupancy 4`601 MF 4f CITY OF COSTA MESA BUILDING DIVISION F •i ',tk IPA . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT P00-00300 4`0+ro.mco o (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 3059 TYLER WY Status: ISSUED Suite No Applied: 06/12/2000 Issued: 06/12/2000 Vidnity: BEDROOM&DEN ADDITION Parcel Nunmber: 14160453 ' ISSUED BY: Applicant: MACALELLO, FRANK Address: 29732 AVENIDA DE LAS BANDERAS Phone: (949)868-2502 I� , RANCHO SANTA MARGARITA,CA Zip: 92688 S ^ ,/I'A, Owner: FERRIS, STEVEN '0 ' Address 3059 TYLER WY :44,215, , Phone: 1�t�+1-.v `��t'v" i/ COSTA MESA,CA Zip: 92626 4` ' S . Contractor: CALIFORNIA WESTERN INSURANCE / -/ `r lyaj' Address: 29732 AVENIDA DE LAS BANDERAS -• - ; `3• f Phone: (949)868 2•502, , , ."�C"`'`»ii j.El'? +:+ ✓•'4 '1'..43C 4, RANCHO SANTA MARGARITA,CA Zip: 92688 I U %"` ..(!! ,1; ` iy'r a r License: 426424 i'�s<1., 4.rr `A ''a 4 y�A ' 5p� v..,.u.r qt{`14,14,51 4.c' t 3 1L $ Atc f SCOPE OF PERMIT r i tr� Nix!,, PLUMBING PERMIT FQp BEDROOM&DEN ADDITION.INSTALL 1 TUB,1 W_ QS)3ER, 1 WATER CLOSET$ .pr.K &1 WASH BASIN. f, y'., .'.{ i.ij;-4 : 1(;>v .I i ,•1' • fr w.tA..�.J.i 4nluJ., 4% IK.:mi,. un•{1l`✓ - NL':' REF:B00-00288 i ^:-+ ( .� yti, .' mst'' - -r•,i �'a4. t+V. l ,✓ivr�1 w -.yk r 1Y::fit;'., '1h1 ,..1 i �'.' ,r'� ..Q.� �F'' ;a r-fP,1 PP t.iiiti, " FEESUMMARYI 7 '• -' N ' -t I' QTY., I d.'11 AMT -QTY AMT OTT ISSUE FEE '' +� ���$23�50• ii�)i � . rS' Laundry Tub) $980}�1 Sump Pump $0.00 0 Backflow tmgation �c `,$0 00 0• 1 iry. Landscape Irngatianr 1 $0 Q0=3):-90 Swimming Pool $0.00 0 Backflovi FP'reventer r,ey $0 00 .� , i,� P-Trap n}." '"•W;-F $000f,° 0' Trap Primer $0.00 0 Batt3Eub i *$9.80 wt,a , .1 Pressure Regulator .- $000 id Urinal $0.00 0 Clanfier;Sys(em 1(' $0.00 tb�$ ' Process Piping(per 10 ft) $0 00,_ e 0 Vacuum Brkr Bkflow(1-4) $0.00 0 ConSeet(Ice,Soda,etc) $0.00 101, l Receptors. , , $0001r''t;0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental',Units $0.00 O*? .. "I Septic Tank• . ' ' $0.00'."��0 Wash Basin $9.80 1 Dishwasher` $0.00 r0`2},, Sewer CaO for Demo $0.00!-'" 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 b -- ''Sewer Connect s $0.00 0 Waste and Vent System $0.00 0 Drain,-Ra 0'0h-water $0.00 04x9' •.;'; •Sewer Pn'uatecLipe $0.00 0 Water Closet(Toilet) $9.80 1 Drain,Roof ,,,;,$0.007 Ora ; '' •Showef 2;'):% $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain (`"$0.001 a p, :,4,2 :Si91.9b• ap' $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank 11t' $0:00 0 "n: ' -'Sl(rik rilrn ercial $0.00 0 Water Re-pipe $0.00 0 ,Gas Earthquake Valve At,„..."9p 0 QL`;'f Sinlc,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 Outlets) A.: 'ti`soioo 0 '.''. fnkrkitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) j.; So.00 0 -Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe. ,.' s`^$'0!00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas'Service • -'''�D; .? '50.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil), S0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto)')'$0.00 0 TOTAL CALCULATED FEES: $62.70 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)7545626 2446.46(6'Ix)) • 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. ❑ 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 it 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(510 0,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060E 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,arc my license is in full force and effect.Lic.x -. _ Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: there ❑ I hereby affirm that there is a construction lending agency for the pertormance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: \ ='J--rr ( Lender's Address: Signature: -' )C'u r 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(Soc.7031,5,Business and Professions Code:Any city cr 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 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 Iw 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 awn 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 ho or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's L'cense 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)feel high.(Chap.3.2,Grp 2,An 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 Co 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? ❑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 wnich has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,(eeuires 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 far the work which is the subject 01 this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Wilt any part of the facility to bo 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 hem 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 Cede Section 42303 been made? ❑Yes 0 No B (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction.and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE I INSPECTIONmcJ'---- DAIS""'-'__"MTRIAL@- gook!—ly$PEDTNNnet- - I UIDALA- 1616 , ' Fixed System Final Fire Prevention ' 206 Final Mechanical • ' 1' • ' 1268 ' Pool See Final NTT,.jy_-1. / T.. -,� 208 Final Plumbing-) . • ''• • 200 .-, Final Re-Roof - i 210 Final Electrical • '- f 1 .', - 212 ' -FNd Fire Pteventlon-%'• ,\ 201 Fines Block/Retaining Wall ' - 1 r { 202 r-Final Factory Fire Place F �- \•• t 220 ' Final Planning Approval 203 " Final Sign 7 222 - Final Site 204 Final Demolition' �`'Y"��' 250x`"'Final Building/Occupancy CITY OF COSTA MESA BUILDING DIVISION ,i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t PERMIT E01-00018 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT -\2-k-� Job Address: 3059 TYLER WY .Stetnn--i+SSYEB Suite No Applied: 01/08/2001 Vicinity: BEDROOM&DEN ADDITION Issued: 01/08/2001 Parcel Nunmber: 14160453 Applicant: MACALELLO, FRANK ISSUED BY: Address: 29732 AVENIDA DE LAS BANDERAS Phone: (949)868-2502 RANCHO SANTA MARGARITA,CA Zip: 92688 Owner: FERRIS, STEVEN Address 3059 TYLER WY Phone: COSTA MESA,CA Zip: 92626 Contractor: CALIFORNIA WESTERN INSURANCE Address: 29732 AVENIDA DE LAS BANDERAS Phone: (949)868-2502 RANCHO SANTA MARGARITA, CA Zip: 92688 License: 426424 SCOPE OF PERMIT SUPPLEMENTAL ELECTRICAL PERMIT FOR 1 MISC CONDUIT. REF: B00-00288&E00-00526 FEE SUMMARY Quantity Quantity ISSUE FEE $7.25 • 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 $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $18.20 1 Service to 1000a $0.00 0 Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 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 $25.45 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS • I NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 // 2446-46(6ro0) 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, 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 orkers'compensation Insurance carrier and policy number are: �/ 2 rte, Carrier: £It1J tNS . CO • Policy Number: W L 3141 OCA, ( (This section need not be completed if the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of 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: J S WARNING:FAILURE TO SEC WORKERS'•• PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under rovisions 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 Nj Contractors Signature: i r Date: / 0 / CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Cede:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant/need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 01 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 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 Caste 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 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 eppermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 yes LJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si.,. • - AfL-" Own: Date / e"/ .And/• Authorized ••plicant < - Date COPE t INSPECTION TYPE PALE INIIDALS ;ODEt INSPECTION TYPE DAB R1TTUALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical _ 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy t a l CITY OF COSTA MESA BUILDING DIVISION > v: �• PE MIT NUMBER r r DEVELOPMENT SERVICES DEPARTMENT Urgi4%0i PERMIT • 00-00048 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 3059 TYLER WY Status: ISSUED Suite No Applied: 01/27/2000 Issued: 01/27/2000 Vicinity: Parcel Number: 14160453 56- ISSUED BY: Applicant: ED HARE Address: Phone: 949-868-2502 Zip: Owner: FERRIS, STEVEN Address: 3059 TYLER WY Phone: COSTA MESA,CA Zip: 92626 Contractor: CALIFORNIA WESTERN INSURANCE Address: 29732 AVENIDA DE LAS BANDERAS Phone: 949-868-2502 RANCHO SANTA MARGARITA,CA Zip: 92688 License: 426424 Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT FIRE DAMAGE REPAIR, REPLACE FAU AND KITCHEN HOOD, RE:B00-00121. 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 to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $10.65 1 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 $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $48.95 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 /9 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: n Carrier. /leo n Policy Number: 0( I< /`o d 1C 7/ 7 (This section need not be completed if the permit Is valued at one hundred dollars($f )or less) ❑ I certify that in the performs a 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 Califo a,and agree that if I sh Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisio --� Applicant Signature: / Date: '/27/oo WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SEC ON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisionsg of Chapter 9(commencing with Sectl 7000)of Division 3 of the Business and full Professions Code,and my license is in force and effect.Lic.# 416 424 te� Class s 8 ! infra Contractor's Signature:-44 / r,4 c2wfDate: CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). 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).): O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner.builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O l 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: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ore 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 aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California 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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes,I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /Signature Legal Owner(s) ! /z7 /eDote 4djOr A Ihorized Applicant // L/ Date CODE I. INSPECTIONTYPE QAIE INTITIPL$ QODEi INSPECTION Mk 9 I1L�Aff WC/�r{jmAL$ 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical - iIX' 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign _ 222 Final Site 204 Final Demolition _ 250 Final Building/Occupancy 2446-46 r • '40511-"*. ` .. CITY OF COSTA MESA t,p - 4a. it' BUILDING DIVISION >•• PERM NUMBER F t : ' DEVELOPMENT SERVICES DEPARTMENT • • PERMIT 0-00050 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 3059 TYLER WY Status: ISSUED Suite No Applied: 01/27/2000 Issued: 01/27/2000 Vicinity: Parcel Nunmber: 14160453 S ISSUED BY: Applicant: ED HARE Address: Phone: 949-868-2502 Zip: Owner: FERRIS, STEVEN Address 3059 TYLER WY Phone: COSTA MESA,CA Zip: 92626 Contractor: CALIFORNIA WESTERN INSURANCE Address: 29732 AVENIDA DE LAS BANDERAS- Phone: 949-868-2502 • RANCHO SANTA MARGARITA,CA Zip: 92688 License: 426424 • Arch/Eng Address: Phone: Zip: License: • SCOPE OF PERMIT FIRE DAMAGE REPAIR, REPLACE 1BATHTUB, 1DISHWASHER, 1SHOWER, (KITCHEN SINK,2WASH BASINS,2WATER CLOSETS, 1WATER HEATER, RE:B00-00121. 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 $9.80 1 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 $19.60 2 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) $19.60 2 Drain, Roof $0.00 0 Shower $9.80 1 Water Heater/vent $12.30 1 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: $114.20 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 I • DECLARATIONS ,c, p 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. ❑ 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'compensation Insurance carrier and policy number are: Carrier /Y 0217 / Policy Number: 6 (K 1200 /5 1 /7 1— (This section need not be completed if the permit is valued at one hundred dollars($1 0)or less.) ❑ I certify that in the performa ce of the work for which thi permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calif ia,and agree that if I shou ecome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi Applicant Signature: kV / Date: /b 7 fAN / 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 COLLARE($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 pr. 'Sion of Chapte 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 • A u/ Class# /3 t a'/j "-9 Contractor's Signature: - r I Date: I/270 'L_ 0 / 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 Cale). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 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,end that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .____II __ —d......_.._..--___.____.__ __ __ --. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? LJ Yes u No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7........I . .. . i from South Coast ualit r..ot.._ ag .. or.the hick is t .._.. f his 7 If a catiofrom tae Soueh losre prescribedri Management isHe District or other Sr air pollution controln42303 district been agency is requiredsfor the work which is the subject of this application,have all of the disclosures by California Health and Safety Code Section 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. � Signatpre f L I Owner(s) / ib / Date And/Or Authorized Applicant Date CODE I INSPECTION TYPE pA E INTMALS CODE t INSPECPON TYPE sag INTIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 9 -I a�°' -CCT 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 OWNER SEAVIEIi HOMES, INC.. DATE 6-19-62 JOB ADDRESS 3059 Tyler Way BUILDING PERMIT NO. 1Y33 — GENERAL CONTRACTOR S.V. Hunsaker & Sons VALUE 45r411.00 AP No. LOT 1+3 TRACT 4565 FIRE ZONE DESCRIPTION OF WORK Res.w/att.Gar. INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE RI F - te.y72.4.3 4-6-vA.4-1- 'R1-T1/./%e 7-3"...4 44/5 PERMITS ISSUED SUBCONTRACTOR DATE NUMBER Water ' "• ' - Sl-2.-6..z.Rough Com. Refrig. 0 Air Cond. 0 `X/ Rough Heating �,1 F--/3-67-j _ p7 FT& 4IR re ,"`\/ Rough Plumbing / Ff5 f�2, -?- - i ilk/ �_ 2 -42, �O�7 ^ Miscellaneous �J(�jlo,d Prop.Swr.Line 0-Hot-Se Con. ❑,St.Swr. ❑ "14y ��/��/j,q. p' _- c-. -sO�-- 6 1 '- 1(3 °1- Sprinkling System 1 / Construction Pole h Underground ❑ Power ❑ a ,/ �f /..a/w9Rough Wiring YGij 11/G'/1r92, /✓,r/, .47,�i/L 'y-.7v 4_z JO�� c rent es LE' Forms E-' Steel Reinf. 0 /3.2175 J-/p.ja,' /Floor System Bond Beam 0 Steel Reinforce 0 Sheathing • S/ -2,-6.2- Frame 2,-62Frame and Flashing 416,44 Prv/S-KS Lathing — In 2a - Out l0--- �11ni17F ..-2..3 4 Plaster, brown coat I(' ,�L ,/a-1- c 2- Refrig. 0 Air Cond. 0 Final R. i`ing, Final r 43 yo*2- Y:l,;"-,ibing Fixtures, Final r Final Gas Test/f—' S 2 "---Ci Electric Fixtures, Final ;7 io_ )r-( y Building, Final 7.7-t in -JX-/ 7-- OCCUPANCY OCCUPANCY .�.�� FORM BU4•5M — 7-61 1 133`. FEE RECEIVED 17334 ,JUN 15 I9a>t COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. . P. O. BOX SI7 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Co Mately APPLICATION FOR PERMIT TYPE OR PRINT r...3- BUILDING//A' BUILDING ADDRESS-30- / J /Z,E.O- z/ /T•y COSTA MESA. CALIFORNIA For Office Use Only 77 Ll law I RECEIPT NO. I PJ 1P1114133434 OWNER Seaview Homes. yes - MAIL 1602 W. Almond RECEIVE r_- I O� Ric -; J eo_TPJ! �o6Z ADDRESS / / /)�� TEL. BUILDING CITY Orange NO. ADDRESS ARCHITECT TEL....... COSTA MESA. CALIFORNIA OR ENGINEER Ramberg & Lowery No. .76�31 _ ADDRESS 2127 N. Main St., Santa Ana FIRE � /y� (I/ ZONE TYPE V GROUP�T- F CONTRACTOR S. V. Hunsaker Wj Sons APPROVED BY DATE ADDRESS 15855 E. Edna P1. ZONING ( ZONEoNO.OF USE OF NEW.C....,, CITY Irwindale n _ { PLANE 2 BUILDING ' / S T TNO. 164929 TEL ED. 87361 DLEGALESCRIPTION 4,- `/3 •-7,- Y f C 1 OSIFZELOT g {`7//-Y g P7 I NO. OF BIDOB NOW ON LOT LI A.P.NO. USE OF YARDS EVES EXISTING BLDG, APPROVED ALLOWED SETBACK UNE FROM G , (CENTER LINE OT.) CENTER OF STREET V O REAR YARD fV FRONT o 0 FT. IN. 7i SIDE YARD I LEFT C I RIGHT R.SIDE 7 FT. --- IN. DESCRIPTION IPTION OF WORK L.SIDE S FT. --� N. NEW I OALTERATION I II ADDITION If� FT. ^_ IN. REPAIR I (MOVING I II DEMOLISH I APPROVED /a�� DATE C,< /C BUILDINryy �/ �J NO. OF 7 ViX SIZE %\ V/-�jI ROOMS / STORIES 1 EXTERIOR WALL 6tUCCO ROOF COMP? / '/ M-4091 /,,, �( COVERING sjdl Ila COVERING Sh1W31r'S i,lods.e J M-40 //fJ"/ USE OF BUILDING AND WORK TO BE PERFORMED attached garage Plan 99- a I HEREBY 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 CONSTRUCTION. VALUATION SIGNATURE OF 5_L A IUNS, 4 R A •.tip _ r PERMIT FEE $ Si N PERMITTEF _ �( L. 1.� S i°1 II/ PLAN CHECK $ 2" Sat AUTHORIZED AGENTii- aL� r•-..-- ! s TOTAL FEE SD w urvrvGrc gam, NOEL DAIt 11-6-67 �10B ADDRESS 30 Tyler Way BUILDING PERMIT NO. 277$0 ,GENERAL CONTRACTOR Air Vent Awning DESCRIPTION of WORK Aluminum Patio Cover AP No. 141-604-53 LOT 43 TRACT 65 FIRE ZONE VALUE $ 1,556.00 I' 'ECTIONS Signature Date GROUP .T TYPE —V ZONE R-1 GAS SUBCONTRACTOR PERMITS ISS ED Date Number I Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. n SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND 9 POWER LI ROUGH WIRING Heating and Vent. TRENCHES 9 FORMS 9 STEEL REINF. ❑ FLOOR SYSTEM BOND BEAM n STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING - IN n OUT n PLASTER, BROWN COAT STRUCTURAL. FINAL Electric H' NG. VENT., REFRIG. AND A.C., FINAL P, JING, FINAL AND GAS TEST in ELECTRIC, FINAL ,/ BUILDING, FINAL �tt ' - '- ' I ., Pac 0 27780 I:0', 6 67crsr.� ' COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92020 For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING For Office Use Only ADscADDRESS34TYLER WIif R[CtIPT NO. COSTA MESA, CALIFORNIA -- 277An REC[ DST RECEIVER_ TH ISSUED OWNER N0i. giRR_ — I 7l 1,7 //°"� � /� BUILDING �/1LOdr6A) . Ja, ADDRESS '30 S9 TYLER ADDRESS iX/LJ/ 7�r' 7�' CITY COST), {i9 NO. .¢/1, ZONE ,,/�T'/YPQpp-ClL GROUP /�.// BR L /J�, TQL/,,. APPROVEDY �� (o /7` DATE I/�(Q--(O .OR ENGINEER rcrryr arr. NOK✓^/79b •J / ` • 1 ' /� ZONING QL ADDRE6S.3/7 �0. V��h7(tL1'/i `.('It ZO J� NO.OP W us.OF NE �A/f /� I PLANS BUILDING ��`^,(Yy CONTRACTORA/�VEMT'ALVN7 i AG'MIML/ r 7� [ n[icnu'noN L a 7 (( 3 tk 4 (7-0P J' ADDRESS/009 SO MANIC•NC-__5'TCit 41 // , / c CITY �TA/NNP/Y1, CSF A.P.NO. / y ( ' (lag - . 3 ,ATE w. P� / / NOTE: NO HAVE OVERHANG SHALL OE LESS THAN LIG..NOI,6I/9010 Ns S3O-336. - SO'TO SIDE a REAR P.L. VES SIZE LIS—A 7)- 7 `/ J(, I NO.OF ELDGS. ' ALLOWED (U.B.C.REQUIREMENT) OF LOT l ,f SSI, / {),T.. NOW ON LOT 7 YARDS APPROVED YARDS APPROVED USE OF //� MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG.S j NCT LE fit.rrJ1-Y PCS/QP ,(PROM C/L 9TR[ �Y- FRONT (Lr r? SETBACK LINE FROM Ai FT CENTER OF STREET REAR YARD in SIDE YARD I LEFT NV C I RIGHT / R.SIDE /�FT, PT. 5 DESCRIPTION OP WORK `v` L.SIDE ? 5AT. Fr. NEW TERATI N ADDITION /� REAR /O Fr. Fr. DISTANCE SET. BET.MAIN& MAIN BLDGS, ACCESS.BLDOS. REPAIR MOVING _DEMOLISH BUILDING����11�( /T,,II__ NO.OF / VAR.tj DATE SIZE -J ROOMS ' 9TGRIEe C.U.P.# APPROVED EXTERIOR WALL I ROOF /I/ ' /uurn APPROVED WC/0 //� /� G COVERING '^� COVBRIN OY ry DAT! LJ v USE OF OUILOINS AND WORK TO BE PERFORMED /y 11 D' q. , ,rPT. �Patzer (Arlt-IP rote. PilVVV S/A/4Le- FA/niw Res/D SQ.FT. X G I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j AND STATE THAT THE ABOVE IS CORM= AND AGREE TO COY. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. i15 PLY WITH AU.CITY ORDINANCE[AND STATE LAWS REGULATING VALUATION 9 w7 BUILDING CONSTRUCTION. PERMIT FEE SIGNATURE OP / r. lf PERMITTEE /654 . /do / s PLAN CHECK S^f AUTHORIZED AGENT //-4�y TOTAL FEE 5j360 g80 E SIE^w}� e E�=