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Home My WebLink About775 16TH ST - Building Permits(714) 75d-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: 775 W 16TH ST MURRAY SCOTT CONSTRUCTION Parcel Nunmber: 42413104 Applicant: SCOTT, MURRAY J Address: 17595 HARVARD AV BOX C537 IRVINE, CA Owner: SCOTf, MURRAY J Add�ess 77595 HARYARD AY BOX C537 IRVINE, CA Contractor: O WNER-BUI LDER Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool ! Spa Lighting Fixts Recept Outlets Switches Non Res Appl status: FINALED Applied: 0920I2005 Issued: 09I20I2005 ISSUED BY: I� �' L.1 Phone: 774-269-9233 Zip 92614 Phone: Zip: 92614 ^ 1� l�L C v Phone: Zip: License: 000000 SCOPE OF PERMIT ELECTRiCAL PERMIT FOR 9 MOTORS TO 10 HP AND 1 MOTORS TO 50 HP. SUPPtEMENTAL PERMIT TO E05-00372 523.50 50.00 50.00 so.ao 50.00 50.00 50.00 50.00 50.00 50.00 Quantity 0 0 0 0 0 0 0 FEESUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 1 kvalkw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 NOTICE: The work authonzed by this permit shall comply with all applicable handicap access raquirements under Calitornla statutes and related regulations. (Ord. No. 92•28, § 1, 12-21-92) EXPIRA710N: This permN shall automatirally expire and become void it work is not commenced wi(hln 7H0 days, or if work Is suspended ar abandoned for a period of 1B0 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all epplicable codes, and all requlretl Inspeetlona end finel epproval must be obtained. Failure to obtain inspections and linal approval will result in the expiration ol this permit. FOR INSPECTIONS CALL: (714) 754-5626 2aae�+e �eroo� WORKERS' COMPENSA710N DECLARA710N; I hereby aXirtn under penalry ol perjury one ol th9 tollowing tledarations: ❑ I heve entl wlll maintaln e ceNficete ot con5ent to sel4lnsure lor workers' mmpensation, as pmWded for by section 3700 ot the Lebor Code, tor Ihe peAormance oi tne work tor which Ihis permit is IssueA. ❑ I have end will maintain workers' compenseU� ��surance, as requiretl by sectlon 3700 oF the Lahor Code, lor the peAormance ot the work lor whicti this pertnit is issuetl. My workers' compensatlon Insurance carder and pollcy number ere: CeMer. Policy Number: (Th/s sec(lon neeO nof be comp/eted i/ the permif �s velued et one hundred dollers (5700) or /ess.) ❑ I ceniy thet in Ue paAormence ot t�e work lor which Uis pertnit (s issuetl, I shell not employ eny pereon In eny menner so es to become sub�ect to the workero' wmpensation laws of Calitomia, enE epree �het il I s�oultl Oecome sub�eci to the workars' wmpensatlon prwlslons of Sectlon 3700 of the Lebor Cotle, I shall IorlhvAth comply wlth �hese provisions. Appllcent Sipneture: Dete: WARNINO: FAILURE TO SECURE VIORKER$' COMPENSATIOM COVERAGE IS UNLAW FUL M1D SHML SUBJEGf Ml EMPLOVER TO CRIMIN�L PENALTIES AND CML FlNES UP TO ONE HUNDRED TIKKISAND DOLLARE (5100,000). IN A�ORION TO TME COST OF Ca.�ENSATION, DAM4GE5 AS PROVIDED FOR IN SECTION 3]OB OF THE LABOR CODE, INTEREST, AND ATTORNEY5 FEES. LICENSED CON7RACTORS DECLARATION: I hereby eNirm Ihet I em licensed untler pmvisiona of Chaptar B(commnncing with Section 7000) al Dlvislon 3 of tho Business end Pmtesslons Code, end my license is In full iorce end eMecf. Lic. N Class q COMractofs Signemre: Dete: CONSTRUCTION LENDING AGENCY: ❑ I hereby eMirtn Ihat there is e wnstruction 19ntling egency lor iha peAartnance of t�e work tor whlch ihls pertnit is luuetl. (Sec. 3097, CIWI Code). Lentlefs Neme: LenOels Adtlress: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hareby eHlrtn thet under penalry of perjury thei l em E%EMP7 FROM THE CONTRAC70RS LICENSE LAW tor the following reason (Sec. 7031.5, Business enA Professlons Code: Any ciry or counry whic� requires a permit ro construct, alter, improve, tlemolish, or repair eny strucWre, pdor to its issuance, also requires �he aDG�lcant tor such pe�i1 to flle e signetl statement thet ha or she Is IicensBd pursuant ro the provisions ot the Cantrectors License Lew (Chepter 9(commencing with Section 7000) ot Division 3 a� the Buslness end Professions Code) or Ihet �e or she is e:empt therefrom entl t�e basis for the elleged exemption. Any violatian of Section 7031.5 by eny epplicant far e pertnit sub�ecls t�e epplicent to e Uvil penalry ot not more than five hunAretl tlWIeB ($500).): ❑ I, as owner ol th roperty, or my employees with wages as their sole compensation, WILL DO 7ME WORK, antl the siructure Is nat Inientletl or oftered for sale (SeG. 7004, Business Pr essions CoCe: The Cunhactors License Lew does noi aDPh to an ownar oi properry who builds or improves thereon, antl who does such wo�k himself or hersel his or her own employees, provided Ihat suc� improvemenis are not intended or ottered for sale. If, however, Ne building or improvement is soltl wi�hin one + ation, tl�e.owna�-builder wlll have the burden of proving that he or she ditl not build or improve for purpose o1 sale.). • ❑ I, 85 owner of �h pe at� E%CLUSIVE Y�CONTRACTING WITH LICENSED CONTRACTORS Io consiruct Ihe proleci (Sec. 7044, Business antl Profes5fon5 Code: The contr rs LlcensB Lew does n0� P' en owner ol property who builds or improves thereon, and who conirects for such prolect with e contractor(s) liCenSe pur5uant to Iho Cont(@�tors License L.ews ❑ I am oaempt under sec. � �� Business and Professions Code far this reason: Signamre: "'p Date: Owner ID verified by driveYs Iicense. 0 Yes ❑ No Orivefs License No. E�cpires: Vedticetlon ol Ownership by (type o1 daument, i.a. - praperry tau bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMR C�NTIFICATON: ❑ I hereby certity that no e:cavatlon live (5) o! more feet in depth Into which e person is requlreC to descend, will be matle In connection wlih work euthorized by thls permlt, end Ihet no builtling siructure, sceflo�ding, talsewollc, or tlemolillon or dismantling thereof, wlll be more ihan thirty-si: (36) leet high, (Chap. 32, Grp 2, A� 2, Sec. 341, Title B, Californla Atlminlstrative Code). ❑ As owner-bulltler, I wlll not employ enyone to do work which woultl require e permlt from ihe Division ol Indusirlal Selety, es notetl ebove, unless such person has e pertnit to do such work tram the divislon. Signature: Date: DiWSIon oi Industrial Safery Pertnit Numbar. CERTIFlCATE OF COMPLIANCE AND AUTMORWtt10N OF ENTRV: I cartlty under penalty of perjury that I hevo reatl Ihis apDlicetlon and stete that Ihe infortnation given Is wnect. I egree to compy wit� ell stete laws and dry ordlnences releting to building consWctlon, end au�horize representetives ol lhe Clry ot Costa Mesa to enter upon the ebove-tluscri6eA property for inspection purposes� � eqree not to occupy or allow occupancy ol eny building euthonzed by t�is permit until linel inspection. Signewre Ot legai U+'ner(s) Date And/Or Aulhorl2etl APDlicant Data COOE 1. INSPECTIONTYPE 1618 Flxetl System Flnel Fire Prevemion 1268 Paol Spe Finel 200 Flnel Re-Roo1 201 Flnal BIocWRetaining Wall 202 Final Factary Fire Place 203 204 Finel Sign Final Demoliti0n �� Ej INSPECTIONTYPE 208 Final Mechenical 208 Finel Plumbing 270 Finel Elocirlcel 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Slte 250 Final BuiltlinglOccupancy � ll� � ' ° �;� Res App1 Service to 200a Service to t000a Servicp over 1000a Motors to 1 hp Motors to 70hp Morors to 50hp Motors to 100hp Motors over 100hp drops 50.00 Sub panel to 200a Pole Light Pkg Sign Circuits Temp pwr Pole Intermed Pole so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 s>>o.�o s $24.60 1 50.00 0 50.00 0 0 tnvestigation Fee 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 Low Volt Wir'mg System / Ck! Misa Conduit Misc. Conductor Circus ( gen or ritle) Circus (mech ritle or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee $0.00 Plan Check Fee Reinspection Fee so.00 a $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 TOTALCALCULATEDFEES 5158.80 COMMENTS / SPECIAL CONDITIONS Communication � I� � � CITY OF COSTA MESA BUILDING D/VIS/ON DEVELOPMENT SERVICES DEPARTMENT PERMIT (7�a) 754-52�3 • Fax (7�4) 75a-a856 • wv+w.ci.costa-mesa.��SCTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 775 W 16TH ST MURRAY SCOTT CONSTRUCTION 42413104 Applicant: SCOTT, MURRAY J Address: 17595 HARVARD AV BOX C537 IRVINE, CA Owner: SCOTT, MURRAY J Address 17595 HARVARD AV BOX C537 IRVINE, CA Contractor: OWN ER-BUILDER Address: 1SSUE FEE Temp service test Res. a/c package New Res (1-2 units) New�Res (3+units) Pool I Spa Lighting Fi�As � Recept Outlels Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 7000a \ Motors l0 1 hp Motors to 10hp Motors lo SOhp Motors to 700hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole Phone: 714-269-9233 Zip 92614 92614 Phone: ELECTRICAL PERMIT FOR 9 MOTORS TO 10 HP AND�1 MOTORS TO 50 $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 10.70 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 Temp Dist System / Lighiing usway /100 N anding Section 0 Mi c Electrical Equipment 0 Tra sformers up to 1 kva/kw ..... .........up to 10 kva/kw 0 ..... ...........up to 50 kva/kw 0 .. .............up to 100 kvalkw 0 ..................over 100 kva/kw 0 Low Voltage Equipment Low Voll Wiring System / Ckl 0 Misc. Conduit 0 Misc. Conductor 0 Circus ( gen or ride) 0 Circus (mech ride or lights) 9 Christmas Tree Stand 1 Fireworks Stand 0 Other Electrical Fee ' 0 0 0 0 0 PERMIT NUMBER E05-00980 7 FAIR DRIVE, CO MESA, CA 92626 Status: IS UED Applied: 09/2 005 Issued: 09Q0 005 ISSUED BY: �uantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES E158.80 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 penod of 180 days. INSPECTIONS: In order for the work authorized untler this permit to be considered legal, such work must compty with all applicable codes, and all requlred Inepecliona end final epproval must be obtained. Failure to obtain inspections and Final approval will result in tha ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � zaaeee IB�oo� WORKERS' COMPENSA710N DECLARATION: ' I hereby aHirtn untler penalry of perjury one of Ihe following declarations: . ❑ I heve and will maintein a certificate af consent to self-Insure for workers' compensation, es provitletl tor by section 3700 of the Lebar Code, for the perlormence of the woM for which ihis permit is issuetl. ❑ I heve and will maintain workers' compensation insurance, as required by section 3700 of the Lebor Cotle, lor the pertartnance of the work For whlch this permit is luued. My workers' compen5ation Insurance carrier entl policy number ere: Carrier: Poliry Number. ��is /aection need not be completed i/ the permit is velued et one hundred dollars ($100) or Iess.J . �/ I certity that in the perfortnance of the work lor whic� this pertnit Is issued, I shall not employ any person in eny mannar so as to 6ecome sub�ect to the workers' compensetion laws of Cali ml , anC gree that It I should become suD�ect to the workers' campensation provisions ot Sectlon 3700 of the Lebor Catle, I shell forthwith comply with ihese provi � n AppGcanYSlgnature: �Dates-�zq � Z O� O�� WARNINO: FAILURE TO SECUR ORNERS' C(MAPENSATION ODVERAGE IS UMAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENAlTIES AND GVI� FlNES UP TOONE HUNDRED TFIOUSAND DOLLARE (5100, , IN AODRION TO THE COST OF COMPENSATION, �AMAGES AS PROVIOED FOR IN SECTION 31O60F TNE IABOH CODE, IMEREST, AND ATTORNE`fS FEES. LICENSED CON7RACTORS DECLARATION: I hereby eKrm ihat I am licensed under proNsions ot Chapter 9(commencing with Sedion 7000) of Division 3 0l tha Business antl Professions Cotle, and my license is in full force and eXect. Lic. A Cless # Comracrors SignaWre: Date: CONSTRUCTION LENOING AGENCV: ❑ I here6y aHirm that there is a consiruc6on lending agency for Ihe peAortnance ot the work for which this pertnit is issuad. (Sec. 3097, Civil Coda). Lenders Name: Lenders Address: Signature: Data: OWNER-BUILDER DECLARA710N5: I hereby eFtirtn that under penalry of perjury Ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec, 7031.5, 8usiness antl Protesslons Cotle: Any ciry or county which raquires a permit to construct, alter, improve, tlemolish, or repair any structure, pnor to its issuance, also requires t�e applicant for such permit ro file a signetl statement t�et he or s�e ISlicensed pursuanl to ihe provisions ol the Contrecbrs license Law (Chapier 8(commencing wilh Sectlon 7000) ot DiWsion 3 oi lhe Business end Professions Code) or that ha or she is ezempt theretmm and the basis Por the allegetl e:emption. Any viWation of Settion 7031.5 by any epplicant br a pertnit suhjecis �he aDP�� o e civil penelry of not more ihen Tive hundred dollars ($500).): ❑ I, as owner ot t�e property, or my employees wlih wages as their sola compensatlon, WILL DO 7ME WORK, and the structure Is not IntentleU or ottered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner ot properry who builds or Improves ihereon, antl who does such work himself or herself or ihrough his or her own employeas, provitled that such improvements ere not IntenCed or oflered lor sale. Ii, however, the 6uiltling or improvamen� is sold within one year of completion, the ownar-builder will have the burtlen oi proving ihat he or she did not 6uiltl or Improve for purpose ot sale.). � .� I, as owner oF the property, em EXCLUSIVELV CONTRACTNG WITH UCENSED CONTRACTORS ro canstruct the project (Sec. 7044, Business antl Pmteuions Cotle: The contrectors License Law tloes not epply ta en awner ol propeny who builds or Improves Ihereon, and who contracts for such pro�ect wiih e contractor(s) license pursuant to the Gontretlor5 Litense Laws.). 0_ I am e:emp� updey�c. i1i Business and Pmfessions Cotle tor this reason: _. _ , Owner ID varifieb drivels license. ❑ Yes ❑ No Orivers License No. Verificatian of ership by (type at document, i.e. - pmperty tex bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATON: ❑ I hereby cetlify ihat no excavation five (5) or more feet in depih into which e person is requiretl to descend, will 6e matle in connection with work euthorized Dy this permit, and �hat no building structure, scafloltling, falsework, or demolition or dismantling thereot, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, Title B, Califomia Atlministrativa Cotle). ❑ As owner-builder, I will not employ anyone to tlo work which would require a permit irom ihe Division of Intlus�nel Safety, es natetl above, unless such person hes a pertnit to do such work from ihe tlivision. Signatura: Date: Division of Industrial Safery Pertnit Number: CER7IFlCATE OF COMPLJANCE AND AUTHORIZA710N OF ENfTiV: I certiry under penalty of perjury that I have read this appllwtion entl siate that the information given Is corred. I agree to comply with all tata aw�V¢nd city ordinances relating to building constmction, and euthorize representatives of ihe City of Costa Mesa to enter upon Ihe above-descnbed propetly lor ins c�o �/965es. I egree not to wcupy or allow occupancy of eny building authorized by this permit until finel inspection. V 9� 20 � �'.S Si atureOf.Legal�Ownar(s) �-.Date---"' � �_ nd/Or Authorized Applicant Date COpE t, INSPECPONTYPE pdjE � N�$ . 4QyE1 INSPECTIONTYPE 1616 Fixetl System Finel Fire Prevention 206 Final Mechanical 1266 Pool Spa Final � Final Plumbing 200 Finel Re-Root 210 Final Electdcal 201 Final Block/Retaining Wal 212 Fina ' e Pre on 202 Final Factory Fire Place 220 Final Plannin Approv � 203 Final Sign 2 Final Site 204 Final Demolition 250 Final Builtling/Occupancy Il�LS e (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ELECTRICAL PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Viciniry: Parcel Nunmber: 775 W 16TH ST MURRAY SCOTT CONSTRUCTION 42413104 Appliwnt: SCOTT, MURRAY Address: 17595 HARVARD AV BOX C537 IRVINE, CA Owner: SCOTT, MURRAY J Address 17595 HARVqRD AV BOX C537 IRVINE, CA . Conlractor. Address: ISSUE FEE Temp service tesl Res. a/c package New Res (t-2 units) New Res (3+units) Pool / Spa Lighting Fi�Rs Recepl Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 70hp Motors to SOhp Molors l0 100hp. Motors over 100hp Communication drops Sub panel l0 200a OWNER-BUILDER Phone: 714-269-9233 CELL Zip 92614 Phone: 714-269-9233 CELL Zip: 92625 Phone: Zip: License: 000000 Status: ISS U E D Applied: 04/26/2005 Issued: 0523Y2005 ISSUED BY: `� ,/ `� � SCOPE OF PERMIT REVISION TO PERMIT ON 09/19/05 TO ADD 9 MOTORS TO 10 HP AND t MOTORS TO 50 HP. NEW 800 AMP SERVICE PANEL AND REWIRE EXISTING BLDG FOR "MURRAY SCOTT CONSTRUCTION." � ELECTRICAL TO INCLUDE: 59 LIGHT FIXTURES, 50 OUTIETS, 10 SWITCHES, 7 SERVICE TO 1000 AMPS, 9 MOTORS TO 10 HP, 11 MOTORS TO 50 HP, 2 MOTORS TO 100 HP, 2 SUB PANELS TO 200 AMPS, 2 TRANSFORMERS UP TO 100KVA/KW AND 1 LOW VOLTAGE EQUIPMENT 10 E�IPMENT MACHINERY - NO OTHER WORK AUTHORIZED WITH THIS PERMIT. $23.50 $0.00 $0.00 50.00 $0.00 $0.00 $50.47 $43.90 $11.00 50.00 $0.00 $0.00 $62.15 $O.OD $O.OD 5221.4p $2952D $99.00 50.00 $0.00 $61.00 �uanlity 0 0 0 59 50 10 0 0 0 7 0 0 18 12 2 0 0 2 FEE SUMMARY Temp Dist System / Lighting Buswayl100 ft Standing Section Misc Eleclrical Equipment Trans�ormers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Law Volt Wiring System I Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) Cirws (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation fee Plan Check Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $99.00 2 $0.00 0 $1820 1 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 so.00 5492.41 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 1247-g2) EXPIRATION: This permit shall automatically expire and become void it work is not commencetl vnthin 180 days, or it work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicabla codes, and all required Inspeetlona and final epproval must be obtained. Fallure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 750.5626 zaasae �eroo� WORKERS' COMPENSA7ION DECLARATI�N: I hereby aftirm under penalry of perjury one oi iha following declaretions: ❑ I heve antl will maintain e certificate of consent to self-Insure for workers' compensatlon, es provided for by section 3700 0l ihe Labor Code, br the pertormance of the work For whiCh IhiS permil is issuetl. ❑ I have and will maintain workers' compe�salion insurance, as required by section 3700 of ihe Lahor Code, for ihe peAortnance of the work for which ihis pertnit is issuetl. My workers' compensatlon Insurence carriar anG policy number are: Carner: Policy Number: (This secfion neetl not be comp/eted i/ the pB�it is velued at one hundretl dollers ($f 00) or /ess.J . _8'_I�certiy that in the pertortnance of th work for which this permit is issued, I shall not employ any person in eny manner so as to become subject to the workers' compensetion laws of CeliFomi i �a rea thet tl I should become sub�ect to the workers' campensation pmvislons ot Section 3700 ot the Lebor Code, I she0 forthwith comply with these provisions. � 7%�}' � APPII�_ent Signetu e: � ��,�� Dete: � � �,� � �9'�.) WARNINO: FAILURE TO SECURE WO RCERS' CAMPENSATION WVERAOE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED TFqUSAND OOLLARE (Et W,OW). IN�DITIIXJ TOTHE COST OF COMPENSAT70N, DAA41GE5 AS PROVIDED FOR IN SECTION 3�O60F iHE LABOR WDE, If�lrEREST, AND ATTOFNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I am licensed under pwNsi< force antl eHect. Lic. p �%ZS ContrectoYs Signature:-------J� of C�apter 9(tommencing with Section 7000) of Division 3 of lhe Business and Professions Code, and my licensa is in full Class N h' Date: _ CONSTRUCTION LENDING AGENCY: ❑ I hereby aNirm that ihere is a construction lentling agency tor tha pedortnance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Signeture: _ OWNER•BUILDER DECLARATIONS: Lender's Address: Date: I hereby aftirtn thet under penelty of perjury lnat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor tha following reason (Sec. 7031.5, Business and Professions Code: Any ciry or county whic� requires e pe��t to consirucf, alter, improve, demolish, or repair any sWCNre, prior to its issuance, also requires Ihe applicant for such permif to file e signetl statement thet he or she Is licensetl pursuant to ihe provisions oi the Coniractors License Law (Chapter 9(commencing wllh Sectlon 7000) of Division 3 ot the Business and Protessions Code) or thet he or she is exempt tharefrom antl the basis for the alleged e:emption. Any violatlon of Section 7031.5 by eny epplicanl tor a permit subjects the applicant to a civil penalty ot not more than five hundred dollers ($500).): . ❑ I, es owner of t�e property, or my empl0yees with wages es fheir sole compensa�ion, WILL DO THE WORK, and Ihe strucNre is not Intended or oHeretl for sale (Sec. 7044, Business and Professions Code: The Coniractors License Law does not apply to an owner of property who builds or improves ihereon, anC who does such work himself or herseN or through his or her own employees, provided that such improvements are not intentletl or oflerad for sale. If, however, the building or improvement is sold within one year of completion, tha owner-builder will heve ihe burden of proving ihat he or she did not build or improve tor purpose ot sale.). ' �I, as owner of �he properry, em E%CLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to construc� the project (Sec. 7044, Business and Professions Cotle: The coniractors License Law do6s not apply to an ownar of property who bullds or improves ihereon, antl who coniracts for such pmject with a contractor(s) license pursuent to the Contractors Lice�se Laws.). ❑ I am ezempt untler se Business and Professions Code tor ihis reason: Signaturei;= � �—Date:---.- �— /a� O OwnerlDvenfiedbydrivel license. ❑Ves ❑No (DriversGcense,No. . ��, �Ficplres��/2�-f� —�� Verificetion oi Ownershl by (type af document, Le. � property taz bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity ihat no excavation five (5) or more feet in tlepth into which a person is required to descend, will Oe made in connection with work authonzed by ihis permit, and that no building structure, sGaHolding, felsework, or demolition or dismantling thereot, will be more than thiRy-six (36) feat high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Celifomia Adminisirative COde). ❑ As owner-bullder, I will not employ enyone to tlo work which would require a permit fmm the Division of Indust6al Safery, as noted above, unless such person has e permit to do such work from the division. Signature: Date: Division of Indusinal Safery Permit Num6er: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION Oi ENTRV: I cetlify under penalry ot perjury that I have read ihis application end stata that �he iniormation given is correcL I egree to c� pl wi�h I state laws and ciry ortlinances relating to 6uilding constmction, and euthonze represematives oi the Ciry of Coste Mesa lo enter upon ihe above-descnbed pr � i ' pection puryoses. I agree not to occupy or allow occupancy ot any building authorized by this permi until tinal inspection. � �=��- o.� �SigneWre'Of Cegel"Owner(S)::� �Dete.�= i AnNOr Authonzed Applicant Date COUE�. INSPECTIONTYFE QBj� IM�R16$ �QD€; INSPECTIONTYPE 7616� F xi ed System Final Fire Preverntion 206 Final Mechani 1266 � I, ,Po%I Spe Final � � � n � 208 Final Plumbin 200 (/Finel Re-Rbot �� `n� I Fl�,�^ 210- FInal.Elecirical �` � � � �� +`� `� � � �� 212�Fnal Fire Prev 201 �F'inel'BI \\ etainilnr ell v �J� I i � � I � 202 1 Final Factory:Fire Place ��220 Final Planninq 203 " Finel Sign 204 Final Demolition 222 Final Site Q�IE INTRIRLS �I�r 9 ��/� . � ao �� ennon / // , % 1 . �t � �' � L = � �/ I �l Approvel� ` LI I� —r l_; � 250 FinalBuilding/Occupency 1� _ % (714) 754-5273 • fax (714) 754-4856 • www.ci.costa-mesa,G�lL�TRICAL PERMIT �� FAIR DRIVE, COS7A MESA, CA 92626 t tl. Job Address: Suite No Vicinity: Parcel Nunmber: 775 W 16TH ST MURRAY SCOTT CONSTRUCTION 42413104 Applicant SCOTT, MURRAY Address: 17595HARVARDAV.- . - � .�_ � � BOX C537 ;, {.� ,�'„� � Phone: 714269-9233 CELL," �, IRVINE, CA,� �� Zip 92614 - � � - .� ,�� , - . , � � Owner � SCOTT MURRAY�J - � � J . ,- ..,. / � - - - , Address- ,17595HARVARDAV%'.�;� "- .� �� , ... .� ; >.�. . �'80XC53Z�.�,:'� - Phone: 774-269-9233CELL � , ... �'..: . . � � IRVINE; CA>. "�' Zip: 92625 ' Contracror. `OWNER-BUILDER �.� Addiess ��; i � :• .. k 4.,,. .. s' Ph no e - � . � . . � . . , . ... h. .i. _ _ . � . . !, _ , . v ' Zip � , . _ -- , ' - � ' - � License:000000 ISSUED BY: 1 ' . yy.� .. Status: Applied: Issued: ISSUED 04/26/2005 OS/23/2005 '� � ' SCOPE OF�PERMIT ;� �',NEW 800 AMP SERVICE PANEL AND REWIRE EXISTING'BLDG FOR "MURRAY SCOTT _ . . . _ _ ... . . . _._ ,CONSTRUCTION:' =- � - - - - - - �. - 7_-.-=. . .. . - . - ' ELECTRICAL TO INCLUDE: 59 LIGFiT FIXTURES, 50 OUTLETS, 10�SWITCHES, 1 SERVICE TO 1000 � AMPS, 9 MOTORS TO 10�HP, 91 MOTORS�TO 501-IP; 2 MOTORS TO�'100 HP, 2 SUB PANELS TO 200 ' . AMPS, 2 TRANSFORMERS"UP TO 100KVA/KW AND t:LOW.VO�TAGE EQUIPMENT. ' NO OTHER WORK AUTHORIZED WITH THIS PERMIT. ♦, � ., �.. FEE SUMMARY " � • " . . Quantity - - -- . Quantity �. ISSUEFEE� � , $23.50 .. � � Temp�Dis(System/Lighting $0.00,�� .0 � Temp service test , t � $0.00 , . -Busway 1100 ft �';_ $O.00,y: 0 , � Res. a/c package � , �$0.00 , i .,�-.,�� ` � - Standing Section`:� - � �� ,r$0.00� ' 0 : � - New Res (1-2 units) � . $0.00: i �, : 0'^--. � • _ `Misc Electilcal EquipmeM = �`".: $0.00 0 ' � � New Res (3+units);�, �"' $0.00 ; `'��0 �' ' �Transforme�s up to 7,kva/kw„ ' �,'$0.00.� . 0 � - Pool / Spa � . �: , ` - $0.00 � .' � �0.�, ' " � ..:.............up to 10�kvalkw. `'%<`= �$0.00, .', p � = , - Lighting Fixts � � $50.47 � , 59 ��-�� • ..................up to,50�kva/kw��'' .$0.00 ' 0 �� Recept Outlets � $43.90 ' ' . 50 �' �, � ............::...up to 100 kva/kw `� $99.00 � � 2 � � Switches �' '` $11�.00 : � ,� , 10 . • . . ..................over 100 kva/kw �.' �'� $0.00 , �0 Non Res Appl ' � $0.00 �' . . � 0 - Low Voltage. Equiprrient , ��, $18:20 � �� ,t � � � 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 $62.15 '� ' _ -1 , � � � �Misa Conductor " � - � `'" $0.00 0 Service over 1000a $0.00 � 0 �' Cirws ( gen pr ridey -� �' ' �$0.00 0 Motors to 1hp $0.00 0 �� , �� . ,.,-.' "Circus (mech ride.ar lights) $0.00 0 Motors to 10hp $110.70 9 " -• . Christmas Tree Stand $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: 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 780 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 reqWred Inspeetlons and final�approval must.be.obtained. Failureto obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALC: (714) 7545828 2446-66 (N00) WORKERS'COMPENSAnON DECU1RAnON: — ' � . . ' I hereby attirm untler penalry of perjury one oF tha tollowing declarations: t - ' , .' :. _ �, ❑ I have and will maintein a cBNiticoie of Consqni to self-Insure for workers' compenselion, as provided for by seclion 3700 of �he Labor Code, for Ihe petlormance of �he work tor which �his pertnii is issuetl. - � � � , ❑ I have antl will mainlflin workers' Compensation insurance, as required by section 3700 0l �he Lebor Code, for Ihe peAortnanca ot ihe work tor which Nis pertni� is issued. My workers' compensetion Insurenca carrier entl policy number ara: Carrier: Policy Number: (This section need not be complefed i! the permil is value0 at one huntlretl tlollars (3100) or less.) '�I cetlify t�e� in Ihe pertormance ol��he work for which Ihis permit is issued, I shall not employ any person in any menner so as to become subject to ihe workers' wmpensation laws of Celif rnl ,� egree t�al If I shoultl become subject ro ihe workars' compensation provisions of Section 3700 of Ihe Labor Code, I shall forihwith comply with these pravisi ^� Appl��rieNre: Da�e: � 3 %LIy (L��} �� a+,«^- ^ WARNING: FAILUFE TO SECIIRE ORKERS' COMPENSpT10N COVERAGE IS UNL4WFUL AND SHALL SUflIECT AN EMPLOYER TO CRIMINAL PENALTIES F CIVIL FlNES UP TOONE HUNDREO THOUSNND DOLLARE (5100,000)' ADDITION TO THE CqgT OF CONPENSATION, DAMAGES AS PROVIDEO FOR IN SECTION 3]O6 OF THE LABpR CqDE, IfJrEREST, PND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHilm that I am licensed under provisions of CheO�er 9(commencing with Section 7000) of Division 3 of the Business end Protessions Code, end my license is in full torce end ettecL Lic. M Cless k Con[ractor's Signeture: Dete: CONSTRUCTON LENDING AGENCV: � ❑ I hereby attirm thet Ihere is a consimction lerydinq agency for the pertormance of Ihe work br which this permit is issued. (Sac. 3097, Civil Cotle). Lenders Name: Lentler's Address: SigneNre: ._ .. . _ _. . _ Da�e: OWNER-BUILDER DECLARATONS: I hereby ettirtn lhat unGer penalty of perjury ihet I�m E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Pratessions Cotle: Any city or county which require5 e permit to conslruct, alter, improve, demolish, or repair any 5iructure, pnOr lo it5155uanc8, al5o requir05lhe applicant for SUCh pertnit to file a signed statement that �e ar she is licensed pursuent lo ihe provisions of ihe Contractors License Law (Chapter 8(commencing with Section 7000) of Division 3 of the Busineu and Protessions Code) or tha� he or shg is exempt therefrom and the basis for the alleged e:emption. Any violation of Section 7031.5 by any appliwnt for e pertnit subjects the applicant to e civil penelry oi not more than tive hundred dollars ($500).): �� I, as owner of Ihe pmperty, or my employees with weges as ihelr sole compensation, WILL DO THE WORK, and Ihe siructure is not intended or oHered for sale (Sec. ��7044, Business antl Protessions Coda: The Contracbrs License Law dces noi apply to an ownar of propetly who builds or improves Ihereon, and who dces such work himself or hersetl or ihrough his or her own employees, provided that such improvemenis ere not imended or oHered br sele. II, however, Ihe building or improvement is sold wi�hin one year oi completion, the owner-builder will �ave the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of Ihe property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTFACTORS to construct ihe projecl (Sec. 7044, Business antl Professions MCode: Tha contractors Ucense Law does not appty to an owner ot properry who 6uilds or impmves thereon, antl who coniracis tor such project with a contractor(s) license pu�suant to ihe Comrectors License Laws.). ❑ I em exempt uytl9r�ec` Business antl Professions Code for this reeson: license. ,� Yes ❑ No Verificetion oi Ownership Dy (type of tloCurtiBnt, i.a. - pmperty tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CQpTIFICATION: ❑ I hereby cetlity Ihet no excavetion five (5) a more feat in depth in�o which a person is required to descend, will be metle In connection wilh work authonzed by this permit, end ihat no builtlinq simcture, scaHolding, falsework, or demolition or dismantling thereof, will be more �hen �hlAy-six (36) fee� high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Celifomle Administrative Code). ❑ As owner-builder, I wlll not employ anyone to do work which woultl require e permit irom ihe Division of Intlustrial Satery, as notad above, unless such person has e permit to tlo such work from the division. Signature: Date: Division of Indusirial Setery Permit Number. CERTIFlCATE OF COMPLIANCE AND AUTHORI7pTON OF EN7RY: I certity untler penalty of perjury �ha� I have read ihis application and state Ihat the infortnation given is corred. I agree to comply with all sjete ews end ciry ortlinances relating to building construction, and euthodze representatives of the City of Casta Mesa to enter upon the above-described property for inspQit' �6ses, I agree not to occupy or allow occupancy of eny building authodzed by this Dermi� until final inspection.� � z3 %�> -.z�� b . � ��Of,Legal'.Owner(s) . '�� And/Or Authonzetl Applicant Date COOE t. INSVECTONTYPE � �� ' 1616 Fiaed System Final Fire Prevention 1266 Pool Spa Finel 200 201 202 203 204 Final Re-Roof Final Block/Retaining Wall Final Factory Fire Place Finel Sign Final Demoli�ion �� IMRIALS " $�QQ[j "INSPECTIONTYPE ' ' � �' ' �E IIiT�I.S 206 Finel Mechanical � 20B inel PlumDing 270 inal ctrical 212 inal Fir rev ntion 22 'nal nning Approval� 222 Final Si�e 250 FinalBuiltling/Occupency (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mese.ca.us 77 FAIF DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address Contractor: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool I Spa Lighting Fixls Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Motors to 10hp Molors to SOhp Motors to 100hp 775 W 16TH ST MURRAY SCOTT CONSTRUCTION 42413104 SCOTT,MURRAY 17595 HARVARD AV BOX C537 IRVWE,CA _ � SCOTT,MURRAYJ 17595 HARVqRD AV BOX C537 IRVINE, CA , - OWNER-BUILDER Phone: 714-269-9233 CELL Zip. . 92614 Phone: 714-269-9233 CELL Zip: 92625 - Phone: Zip: License: 000000 ISSUED BY: Status: FINALED Applied: 04/26/2005 Issued: OS/23/2005 SCOPE OF PERMIT VOID REVISION MADE ON 09/19/O5, FIXTURES TO BE ASSESED UNDER A NEW PERMIT, PERMIT NO E05-00987. ' REVISION TO P,ERMIT ON 09/19/05 TO ADD 9 MOTORS TO 10 HP AND 1 MOTORS TO 50 HP. NEW 800 AMP SERVICE PANEL AND REWIRE EXISTING BLDG FOR "MURRAY SCOTT CONSTRUCTION" ELECTRICAL TO INCLUDE: 59 LIGHT FIXTURES, 50 OUTLETS, 10 SWITCHES, 1 SERVICE TO 1000 AMPS, 9 MOTORS TO 10 HP, 11 MOTORS TO 50 HP, 2 MOTORS TO 100 HP, 2 SUB PANELS TO 200 AMPS, 2 TRANSFORMERS UP TO 700KVAIKW AND 1 LOW VOLTAGE EQUIPMENT 10 EQIPMENT MACHINERY ,., � . , NO OTHER WORK�AUTHORIZED WITH THIS PERMIT. $23.50 50.00 $0.00 $0.00 $0.00 $0.00 $50.47 $43.90 S11.Op 50.00 30.00 $0.00 $62.15 $0.00 $0.00 $ 7 7 0.70 $270.60 $99.00 Quantity 0 0 0 59 50 10 0 0 0 1 0 0 9 11 2 FEE SUMMARY Temp Dist System / Lighling Busway I100 ft Standing Secfion Misc Eleclrical Equipment Transtormers up to � kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kvafkw ..................over 100 kva/Icw Low Voltage Equipment Low Volt Wiring System / Ckl Misc. Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Chri5tma5 Tree Stand Fireworks Stand Other Electrical Fee Quantiry 50.00 0 40.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 599.00 2 50.00 0 578.20 1 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 �� a��,�► �--�v �4��( �M�� NOTICE: The work authorized by this permit shall comply with all applicable handicap access raquirements under Calitomia statutes and related regulatlons. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This pertnit shall automatically expire and become void if work is not commenced wlthin 180 days, or if work Is suspendetl or abandoned for e period of 180 days. INSPECTIONS: In order foi the work euthonzed undar this pertnit to be consideretl legal, such work must comply with all applicable codes, and all required Inepectione and Iinal approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration ol this permit. FOR INSPECTIONS CALL: (714) 7545826 WORKERS'COMPENSAnON DECLARAnON: - . I hereby attirtn under penalry of parjury one of the following tleGaretions: j" � � ❑ I have and will maintain a certiticate ot consent to setl-Insure tor worker5 compensatlon, es provitletl tor hy seciion 3700 0l the Labor Code, br ihe peAortnance oi the work for which this pertnit Is issued. _ � ❑ I �ave antl will mainWin workers' compensafion insurance, as requlretl by section 3700 of Ihe Lebor Code, for Ne peAortnenca ot Ihe work for which thls pertnit is issued. My workers' compensation Insurance carder antl policy number are: Cerrier. Policy Number: (This section need nof be comp/eted /l (he permit is veluetl af one hundred dollers (5100) or /ess.J . , ❑ I certity that in ihe perfortnance ot the work tor which Ihis pertnit is issueQ 1 shall not employ eny person in any menner so es to becoma sub�ect to the warkers' compensation laws oi CaliFomia, end egrea Mat il I shoultl become suhject to the workers' crompensation proNslons ol Sectlon 3700 of the Le�or Cale, I shell forthwith compty with ihese provisions. Appliwnt Signature: Date: WFPNING: FAILURE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNLAW FUL PND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDPED THOUSANO DOLLARE (5100,000), IN ADDfTION TOTHE COST OF COMPENSRTION, DAI.NGES AS PROVIDED FOR IN SECiION 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirtn that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe 8usiness end Professions Code, end my license Is in full force end eftect. Lic. M Class a Conirectors Signature: Date: CONSTRUCTION LENDING AGENCY: � I hereby affrtn that there is a construclion lending agency tor the pertortnanca of the work lor which ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lendefs Address: SignaNre: Date: OWNER-BUILDER DECLARATONS: I hereby flttirtn ihat under penelry ot perjury that I am EXEMP7 FROM THE CONTAACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Busineu end Professions CoOe: Any ciry or counry which reduires a pertnit to construct, elter, improva, demdish, or repair any strucNre, prior to its issuance, elso requires the epplicaN for such pertnit to file e signeA statement that he or she is licensed pursuam to the provisions of the Conirectors License Lew (C�apter 9(commendng with Sectlon 7000) of Dhnslon 3 of Ihe Business and Profeuions Catle) or that he or she is azempt t�erefrom and the basis tor the elleged eaemption. Any violetion ol Section 7031.5 by any epplicant tor e pertnit subjects the applicant to a civil penalry ot not more Ihan five hundretl tlollars ($500j.): ❑ I, as owner of the property, or my employees with waqes es their sole compensation, WILL DO THE WOfiK, antl the structure is not intendetl or oHered for sale (Sec. 7044, Business and Professions Cotle: The Contractors License Lew dces not apply to en owner of properry who builds or improves Ihereon, and who tloes such work himself or herself or Ihrough his ar her own employees, provitled that such improvemems are not intentled or oflered for sale. N, however, Ihe building or improvement is sold within one year of completion, the owner-builder will have Ihe burden oi proving that he or she did not 6uild or improve for purpose of sele.). ' ❑ I, es owner oF the property, am E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS lo construct the projecl (Sec. 7046, Business and Professions Code: The contractors License Law tloes not apply to en owner of properry who builds or Improves t�ereon, end who comrects for such project with a comractar(s) license pursuant b the Contractors License Laws.). ❑ I am exempt under sec. 8usines5 end Professions Code for this reason: Signature: Date: Owner ID venfied by drivers licensa. ❑ Yes ❑ No Dnvafs LicenSe No. Verilicatian oi Ownership by (rype of tlocumem, i.e. - property tex bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATON: Ezpires: ❑ I hereDy certify that no excavation five (5) or more feet in Oepth inio which a person I5 required to tlescentl, will De matle In connection with work authorized by this pertnit, and that no building structura, scaHolding, lelsawork, or demolition or dismantling ihereot, will be more than thirty-sl: (36) feet high. (Chap. 32, Grp 2, Art 2, Sac. 341, Ttle 8, Califomla Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require e parmit tram t�e Division oi Intlustriel Satery, es notetl above, unless such person has e pertnit to do such work from the division. SignaWre: Date: Division of Indusirial Safery Pertnit Number: CERTIFlCA7E OF COMPLIANCE ANO AUTHORVA710N OF ENTRY: I certity under Denalry ot perjury that I have read Ihis application end state thal the informetion given is correct. I agree to comply wi�h ell state laws and ciry ordinances relating to building construction, end authorize represeniatives oi ihe Ciry oi Costa Mesa to enter upon the above-descri6ed property for inspection purpases. I agree not to occupy or allow occupency of eny �uilding emhonzed by Ihis permit until finel inspection. Signature Of Legal Owner(s) Dete And/Or Authonzetl Applicent Date COOEI. INSVECTIONTYPE . 1616 Fi:ed System Final Fire Prevention 1266 Pool Spa Final . �200 Final Re-Root �201 Finel BIocWRetaining Wall 202 Final Factory Fire Plece 203 204' Final Sign _ Final Demolition - • � _ Q� INTITIALS 40UE 1 . INSPELlION TYPE 206 Final Mechanical 20B Final Plumbing 210 Final ElecMcal 212 Final Fire Preventlon 220 222 250 Final Planning'Approval Final Site Final Building/OccuDency � GAIE It�dLfl CITY OF COST,A� MESA REFUND REQUE$T FORM From: ❑ inance Vendor #: �uildingSafety permit#'. C0� " 3'�2 ❑ Publ c Services Amount: $ aD a.�i � ❑ CommuniryServices Date: � 1D��.� �3,7��p� Name and address of applicartt: ��/��_� ��-" 'I! i7S9S /�,� ��i,�� ,. i� �� 5' 7 � G�TI�� G� QzEi_� Phone: y�ll ��? ��.5 � n_ ,/ q� .2Q— �� r¢ � Applicant's Signature Date REASON FOR REFUND: � l� ��r�cu � -Ci �� f �� -t� �-z--. I ��,�L� � nC(�,� (�1 ma�r5 �ro �o�}p � I r�a�ro� +v � h�� Cl n-2U' �.er/�� -�'. APPROVALS: Finance: City Manager._ 2ao1�21 MW orvUNE (714) 754-5273 • Fa% (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 775 W 16TH ST Suite No Vicinity: GAS OUTLETS FOR HEATERS Parcel Nunmber: 42413104 Applicant: DEGEARE, RON Address: 1575 MACARTHUR BL SUITE 17 COSTA MESA, CA PLUMBING PERMIT Phone: (949) 646-0622 Zip: 92626 Owner: FRANKLIN, MICHAEL D Address 505 NARCISSUS AVE Phone: CORONA DEL MAR, CA Zip: 92625 Contractor: RONCO PLUMBING SERVICE INC Address: 1515 MACARTHUR BL SUITE 11 Arch / Eng : Address: COSTA MESA, CA Phone: (949) 646-0622 Zip: 92626 License: 256334 Phone: 2ip: License: ISSUED BY: Status: ISSUED Applied: O7/16/2001 Issued: O7/16I2001 SCOPE OF PERMIT PLUMBING PERMIT TO INSTALL GAS OUTLETS FOR INSTALLATION OF SPACE HEATERS FOR "OCG INC". ISSUE FEE BackFlow irrigation Backflow Preventer BathWb Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Ezpansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $O.DO $0.00 So.ao $0.00 $0.00 $0.00 50.00 $6.75 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 FEE SUMMARY AMT Laundry Tub I Washer $0.00 Landsrape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per t0 k) $Q00 Receptors $0.00 Septic Tank $0.00 SewerCapforDemo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink. commercial 50.00 Sink, Floor 50.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(i-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent Sys[em Water Closet (Toileq Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.�� $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCUTATED FEES: E29.65 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply vnth all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § t, 7241-92) EXPIRATION: This pe�it shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 day5. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and finel approval must be obtained. Failure to obtain inspections and final approval wili result in Ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2dA&48 (8�00) WORKERS'COMPENSAnON DECLARAnON: I hereby aHirm under penalry of perjury one ol ihe following declarations: ❑ I have and will maintain a cenificate of consent to self-Insure for workers' compensation, es provided tor by sectlon 3700 of Ihe Lebor Cotle, tor ihe peAormence of the rk tor which this Dermit I5 issuetl. I have end wlll maintain workers' compensation insurance, as required Dy section 3700 of the Lebor Catle, for t�e perfortnance ot Ihe work lor w�ich this pertnit is iuuetl. My workers' wmpensation Insurence cerrler end pollcy number ere: 1_,M'�,♦t �q7 � Cartier. IN�£.'�/�A��TY ��S �• D� N•�T�✓�.1��✓� PalicyNumDer. rWG �I D�J�� OV (This section need nof be compl tetl il the permif is va/ued et one hundred dol/ers ($f 00) or /ess.) ❑ I certiy Ihat in the peAortnanco ol Ihe work for which I�is pertnit is issued, I shall not employ any person in any manner so es to become suGject to t�e workers' compensation lews ol Calilomie, entl egree that N I s�ultl b$aOFi�suD�ect ro the worker5' tompansation provisions of SBction 3700 01 Ihe Labor Cade, I shall forthwith Applicant Signeture: TlqUSAND DOLLARE (5100.000), IN ADOfiION TO THE COST LICENSED CONTRACTORS DECLARATION: I hereby aHirm that I am force end eflect. Lic. a_ CONSTRUCTION LENUING AGENCY: J X�� rDate:—� �� –�� UNLAW FUL AND SMALL SUBIECT AN EMROVEP TO CRIMINPL PENALTIES AND CML FlNES UP TO ONE HUNDRED ON, ONMGES AS PflONDED FOP M SEGTON 3/OB OF THE UBOR COOE, IMEREST, AND ATTORNEI^S FEES. Chepter e(cojm QenJc� � h Seclion 7000) of Division 3 of Ihe Buslness �7i✓// / Clessa_ �f�� -_-- --' ❑ I hereby aHirm that there is a conslmction lending egoncy for the pertormance of ihe work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lentler's Adtlress: Signa�ure: OWNER-BUILDER DECLARATIONS: Date: license Is in tull I hereby aNirm that untler penalty ot per�ury Ihet I am E7(EMPT FROM TME CON7RAC70RS LICENSE LAW for ihe tollowing reeson (Sec. 7031.5, Business flnC Protesslons Cotle: Any ciry or counry which requires e permit to construct, elter, improve, tlemolish, or repair any structure, Drior to its issuence, elso requires the applicant 1or such permi� to lile a signed stetement that he ar she Is Iicensed pursuant to ihe provisions ol the Contractors License Law (Chapter 9(commencing wlth Secllon 7000) of Dlvislon 3 ot ihe Business and Profession5 Code) or l�at he or 5he is exempt t�erefrom antl Ihe ba51s for Ihe fllleged e:emption. Any Wolellon ot Sectlon 7031.5 by eny appllcant for e permil suD�ects the applicant ta e civil penalty of not more ihan Ilve hundrad dollars ($500).): ❑ I, as owner ol the pmperty, or my employees with wages es their sole compensatlon, WILL DO THE WORK, end the strucwre is not Intentletl or oHeretl tor sale (Sac. 7044, eusiness and Professions Cotle: The Contrectors License Lew does not apply to an owner of proDerty who builds or imD�oves thereon, and who doas such work himself or harself or t�rough his or her or.n emplayees, pravided Ihet such improvements are not IntendeA or oMeretl lor sale. If, however, the building or Improvement is soltl within one year oi completion, the owner-builder will heve the burden of proving that he or she did not buila or improve for purpose of sele.). ❑ I, as awner of Ihe proparty, em EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct Ihe Oroject (Sec. 7044, Business entl Profeuions Code: The contractors License Lew does not apply to an owner ol propeny w�o builtls or improves thereon, entl w�o contracts lor such prolect wtlh e contractor(s) license pursuant to Ihe Contractors License Lews.). ❑ I am exempt under sec. Business and Prolessions Code for this reason: SignaNre: Date: Owner ID veniie0 6y driver's licanse. ❑ Yes ❑ No Dnvels License No. Veri(icetion oi Ownership by (type ol tlocument, i.e. - property tez bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I hereby cartity thal no exwvetlon iive (5) or more teet in tlepth imo w�ich e person is requiretl to Oescenq will be mede in connectlon with work authodzetl by this pertnit, and ihat no Duilding structure, scaftolding, felsework, or tlemolition or tlismantlinq ihereoi, will be more Ihen ihirty-six (38) feet �igh. (C�ap. 32, Grp 2, Art 2, Sec. 341, Title 8, Celifomia Administrative Code). ❑ As ownar-builder, I will not employ enyone to tlo work which would require e pe�mit from the Division of Industrinl Setety, es noled ebave, unless such person hes e pertnit to do such work irom the division. SignaNre: Dete: Division of Industnal Setery Permit Number: ICERTFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalry of perjury that I have read Ihis epplication enC slate that Ihe information given is I correcL I agree to comply with ell slate lews end ciry ordinences rela�ing to Uulltling consimction, antl authorize representa�ives oi Iha Clry ot Costa Mesa to enter upon ihe flbove-described property tor inspection purposes. �ree noI lo occupy or ellow occupancy of eny building authonzed by Ihis pertnit until finel Inspection. GODE /. INSFECTIONTYVE 1676 Fixed System Final Fire Prevention 126fi Pool Spe Final 200 Final RB-Roof 201 Finel BIocWRetaining Well 202 203 204 Final Factory Fire Place Final Sign Final Demolition � �E �� CODE� INSVECTIONTYPE 206 Final Mec�anical 200 Final Plumbing 210 Final Elecirical 212 Final Fire Preventlon 220 Final Plenning Approval 222 Final Site 250 Final Building/Occupency pdg It�lLS 1 - S -p (ii1L Ca�ta 1VYesa uilding Department ' • 'y , ,. 111 EAST 20th STREET �� _ COSTA MESA, CALIFORNIA FOR APPLICANT TO I+'II.L IN aaar�esg �� i%�� — ST COS� MOSfl� C8�I1fOTTlla, Address bY"o, l.V ,( i 1� >�, ` " Tel. �,. I B .g(,7 cicr Cnsz,-A-MEs+�. No. Arohitecto \ '' Lia „� Engineer �AV�D v��TkE=LyNo. eC(oi� � Addr¢ss 11-.3'S ��`r�� "✓D' �'�- City Lfc. ractor � ��5� No. �f..Lg� Address i�iCp ��i�-1�1�7 .. �54'a�i•. c� ..w r�. �r wryibrs, / ach n�etes and Bounds) a�� i 6_ 3�0- �'`l� � ? No. ot Bldgs O of Lo! f 1.(e '� 7C0 I Now on Lot of No.of No.of ting 81dg. "- Famflies Rooma - iack Line from r � Rear Vard �erolSfrnnt! J � Si�1wYaM�l��.k f�T ■ l�� eswm�ng Size � Q � ��riorWall _ ring Cd l,_: of New I hereby acknowli and state that the with all City On building construct Signatureof Permittee � Authorized Agt. Valwation $ 'a��'� � � FORM 204 G•H 2M 5-t Moving � I Demolish � No. ot �� Rooms Stories ' Roof Tv, cover�n9 L'oMP�� u�u� Sl�i-oP � r9FF� '. APPLICATION FOR PERNIIT 728:� BUILD,ING '� � d'+ OR O�FICE USE ONLY Receipt No. .. PermiL No. /,3d 7� Received by Date Rec'd. Date Issued 7� = a -s"s� S"—iv�s-. Buildin � Address Costa Mesa, California Nearest Cross St. Date CORRECTIONS � �� ArrRovar.s Foundation Location I Inspeetoi Forms, Materials, that I have read t}ds Application Ltl1°. 1°`. ie is coxrect and agree to comply Lath. Ext. ices an 5tate Iaws regulating ��5. Plaster, Int. �r ]� Plaster. E�ct Plan Check Total Fee I Bond B � � FINAL < 0 m 'r� 0 � Show locatlon and distancea irom property line and between buildinga 0 I. � . � .. � ' . • . �� . 1 � . . � ��! r-`• ' . � \ � 1 � - ._. �. . . " • .. : -_ , ;._ _ , .i � �