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Home My WebLink About388 20TH ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • K^.vw.ci.costa-mesa.ca.us 77 FAIR DRIVE, COS7A MESA, CA 92626 BUILDING PERMIT ,lob Address: 388 E 20TH ST Suite: Viciniry: Primary Occ: R3 Dwellings/ Cong Res <10 Parcel Number: 42623113 Applicant: HART, RAY Address: Owner: HART,CLAUDE Address 388 E 20TH ST COSTA MESA, CA Type of Construction: V-N Zoning: Contrecror RAY HART GENERAL CONTRACTORS Address: 250 E 16TH STREET COSTA MESA, CA Zip: 92627 Phone: 949-795-1122 Zip: Phone: 949-795-1122 Zip: 92627-2338 Phone: 949-795-1122 License: 647755 Status: ISSUED Applied: 12/10/2003 Issued: 09/29/2004 ISSUED BY: �Jll��l �A.Jl�l \ L'lAJEJ'il' 9'. Y:I� EXP Arch : Eng: VALENZUELA, CARLOS Address: Address: 500 OLD NEWPORT BL Phone: STE 204 Phone: (949) 548-2300 NEWPORTBEACH,CA Zip: License: 92663 License: 44990 SCOPE OF PERMIT 03-22-OS REVISED SCOPE OF WORK - 1164 SFD ADD, 55 SF GAR ADD, 252 SF PATIO COVERS, REFRAME AND REROOF OF EXISTING 884 SF SFD AND 364 SF GAR. INSTALL 3 SKYLIGHTS IN (E) SFD AND 3 SKYLIGHTS IN ADD. CONSTRUCT 939 SF ADDITION TO AN EXISTING SINGLE-STORY SFD. WORK TO INCLUDE A NEW MASTER BEDROOM AND BATHROOM WITH A WALK-IN CLOSET. THE LIVING ROOM WILL BE EXPANDED AT THE FRONT OF THE RESIDENCE AND A WALL IN THE KITCHEN WILL BE DEMOLISHED TO RELOCATE THE DINING ROOM. A NEW 144 SF COVERED PATIO WILL BE CONSTRUCTED AT THE REAR OF THE RESIDENCE. ALSO INCLUDES REFRAMING AND REROOFING OF (E) SFD AND GARAGE WITH CLASS A GAF ASPHALT SHING�ES. INSTALL 3 SKYLIGHTS IN (E) SFD AND 3 SKYLIGHTS IN ADD. Plan Check: $860.70 Permit: $1,324.15 SMIP Res: $15.82 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $2,200.67 SETBACKS FEE SUMMARY PLANNING & ZONING Calc Valuation: Claim Valuation EXPIRED,,l DATE�t�----- $158,215.74 So.00 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, § t, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned tor 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 applicable codes, end all requlred Inspectlons and final epproval must be obtained. Failure to obtain inspactions and final approval vnll result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 , , 2aaa+e (aroo� WORKERS' COMPENSATION DECLARATION: I hereDy eNirm untler penelry oi perjury one of the following tleclaratlons: , ❑ I have antl will maintaln a certifcate of consent to self-Insure lor workers' compensatlon, es providetl for by section 3700 of the Lebor Cotle, for the peAormance of ihe �work lor which this permii is issuetl. � I�� III �nA�rkers' co��nsa ion Insurence, es requiretl by sectlon 3700 ot Ihe Lebor Gode, for the pertortnance oi Ihe work Por which this pertnit is issuetl. � My workers' So ens tlon I e0�ncg card r antl policy numbor ere: i5 Secbon need�nO( be com lete i/ the P�Y'Nu ber. (��' 7� p permi( is veld tl et one hundred dollars (3f 00J or /essJ � ❑ I ceniy thet in the pertor the work for w ch thls permit is issued, 1 shall not employ any person in any manner so es to become sublect to the workers' compensatlon laws o altl �, antl egree thet i I s � dbecome sub�ect to Ihe workers' compensation provisions of Section 700 the Leb�[ Code, I shell torthwith wm I with these pr vis' ns. C ` Applkarrt gnat r: OBfe�.—'„� . i � C� l WARNINQ: FAILURE TO SECU KERS' WM.ENSATI CAVEMGE IS UNIAWFUL AND SMALL SUBJECT pN EMPLOYER TO CRIMINAL PENPLTIES AND CIVIL FINES UP TOONE HUNDREO T}IOUSANO DOLLARE (5100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED WR IN SECTION 3IW OF THE LABpq CODE, IlJrEFEST, AND ATTOHNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirm Ihet I em licensad nder pro ' io f Chepter 9( ommencing with Saction 7000) of Divislon 3 of the Businessg/��j rofesslons Cotle, end my license is in full farce entl eMect L•ics. � Claee�p_ �I � GmitrSttods':Signeture:a- -�---r�"'" �Deie: '� F7 O t'm�� --' ! ''�.. CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirtn Ihat there is a construction lentling egency for ihe peAortnance of the work for which ihis pertnit is issuetl. (Sec. 3097, Civil Code). Lentler's Name: Lender'S Adtlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirm t�el untler penelry ot perjury thet I em EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business end Professlons Coae: Any ciry or county which requires e permit to consiruct, eltar, improve, tlemolish, or repair eny strucmre, pnor to its issuance, also requlres ihe epplicant for such permit to tile e signed statement that he or sha Is Ilcensetl pursuent to the proNsions ol ihe Contrectors Llcense Lew (Chepter 9(wmmencing with Sectlon 7000) ol Divislon 3 ot Iha Business antl Professions Code) or that he or she Is exempt therefrom and the �asis for the elleged exemption. Any violation of Section 7031.5 hy any eppliwnt tor a parmit subjects Ihe applicent �o e civil penalry of not more then five hundred dollare ($500).): ❑ I, as owner ol the property, or my employees wlth wages as I�elr sole compensatlon, WILL DO TME WORK, and the structure is not intandetl ar otlered for sele (Sec. 7044, Business and Professions Code: The Coniractors License Law does not apply to an owner of property w�o builds or improves Ihereon, end who does such work himself or herself ar through his or her own employees, pravitletl that such improvaments ere not imendetl ar oNered for sale. It, however, the building or improvement is soltl wiihin one year ol completion, the owneo-builder will heva the burden of proving Ihat he or she did not build or improve for Ourpose of saleJ. ' ❑ I, as owner of the pmperry, am E%CLUSIVELV LONTRACTING WITH LICENSED CONTRACTORS to construd the project (Sec. 7044, Business and Professions CaAe: TTie contrecbrs License Ww does not epply to an owner oi property who bulltls or Impmves thereon, entl who contracis for such pro�ect with a conirector(s) license pursuant to the Contractors License Laws.). ❑ I am e:empl under sec. Business and Protessions Code for this reason: SignB�ure: Dala: Owner ID vanfiea by dnvefs license. ❑ Ves ❑ No Drivefs License No. Expires: Vetlficetlon ot Ownership by (type oi dxument, i.e. - property tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cehify iha� no excavation five (5) or more faet in depih into which e person Is required to descend, will be made in connectlon wlih work euthonzed by t�is permit, entl that no building sWdure, scattolding, lalsework, or demolition or dismentling thereof, will be mora than thirty-six (36) leet high. (Chep. 32, Grp 2, Art 2, Sec. 341, T�le 8, Celifomia Atlministrative Code). ❑ As owner-�uiltler, I will not employ enyone to do work which would require e pertnit Irom the Division of Industnal Sefery, as notetl ebove, unless such person has e pertnit to do such work from the tlivision. Signatura: Divislon ol Intlustrial Safary Pertnil Number: L 7 Date: WIII the applicant or present or fuWre builtling occupent neetl to file antl cenity a Business Plan for emergency response to release or threatened release of e hazarAous metetlel? ❑ Ves � No (Section 25505 of the Calitomia Healih end Setery Code requiras, with some exce0��ons, Ihet e Businass Plen be tiled with the Costa Mesa Fire Depanment by every business which has et any one time tluring a reponed year a quantity of hazardous malerials equel ro or greeter than a weight of 500 pounds, a a volume of 55 gallons, or 200 cubic feet ot compressed gas at standard temperature end pressure). .............................................................................................................................................................................................................................................................................................................................................................................. Does or will the epplicani or present or tuture building acupani neetl to file a registretion fortn tor eately hazerdous materials7 ❑ Ves ❑ No (Section 25533 of ihe Calitomia Heall� end Salery Cotle, with some exceptions, requires registretlon with the Costa Mesa Flre Deperiment by each business which al any one time has on hend a quantity ol acutely hezerdous metanels equal to or greeter than e welght oi 500 pounds, or e volume af 55 gellons, or 200 cubic teet oi es ar Ye5 or tuture building occupant need to O�epere an RMPP (Risk Management and Pravention Program (Sedlon 25534 ot the Califomia Health and Setery Cotle proWtles ihat Ihe Costa Mesa Fire Depanment may require ihe preparation, certification antl tiling with Ihe Fire oepertment ol en RMPP,Dy businesses which are required to register ecutely hazerdous materlals wilh Ihe Fire Depanment. _ ................................................................�..__................................................................................................................................................................................................................................................... If en RMPP is presenty iequired; has Section 25534 ol,ihe Celifomia Health entl Safery Code been fully complied with? ❑ Yes ❑ No ........._ ...................................._....:......_._.___......._.............._...._.._.._...::......................................................................................................_..........................................................................................._........................._.................. Daes or wlll the applicant or present or fumre'bulldingaccu0ant require br t�e work which is the sub�ect of this a plication a permlt for such construction or modification �fOm lhB SOUih Goes� Aif Qu91i�y Menagemen� DlStdct or Irom eny o��er eir pollution wnVW tllslrici or egencyt � Ves [.] No (Sectlon 658502 ot the'Calitomia Government Code iequires t�et the requested inlormetion be furnished on applications tor non-residential building pe�mi�s). WIII any pen of the faciliry to be consiructed under this permit be within 1000 fael trom Ihe ouier boundanes of a school7 ❑ Ye5 ❑ No Qt'yes", the faciliry must meet ihe requlrement of Sections 25534 and 42303 of ihe Celibmia Healih antl Safery Cotle). ...................................... ............................... ......................_........................................................................................................................................................................................................................................ II e pertnit irom ihe South Coast Air OualitY Manegement Distnct or other air pollution control district or egency is required br the work which is the sub)ect ot this eoollcatlon. hevo all of the disclasures orescribetl bv Celifomle Health and SafeN Cotle Sectlon 42303 6een mede9 ❑ Ves ❑ No 8 Qf "yes", etlech certificate of compllanca irom tne eppropriete atr poiwuon comroi onicep. CERTIFICATE OF COMPLIANCE: I certify ihat un0er penalry of perjury Iha informetion given above is correct. I agree to compy with all stete lews and ciry ordinances regerding Hazartlous Materials antl Emissions. SlgnaWre: Date: CERTIFlCATE Of COMPLIANCE AND AUTHORIZATION ENTRY: I cert under penalry of perjury Ihai I have read this application end s�ate that Ihe infortnation given is correcl. I agree to comply wit� all state lews antl ciry rtlin ces rel ting t b� � g construction, end emhonze representatives of Ihe Ciry ol Coste Mesa to enter upon the ebove-descnbed property for inspaction pu�oses. 1 r at to occ�py w wcupency oi eny building authorized by this permit un�il tinel inspection. LOOE1, INSVECTIONTYPE � i616 Fixed System Final Fire Preventlon 1268 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demoli�ion Qejf, IMR 1C(OE! INSPELTIONTYVE 206 Final Mechanical 208 210 212 220 222 250 Final Plumbing Final Electrical Flnal Fire Prevention Final Planning Approval Final Site Final Building/Occupancy p7.tl�I:11uG1�; NEWPORT-MESA UNIFIED SCHOOL DISTRICT CERTIFICATE OF COMPLIANCE Of OEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 187 To: (x) Cily of Costa Mesa ( ) City of Newport Beach ( ) County af Orange Applicant: Address �L A 2,� 3 2 0 N° 5451 DisUict Receipt No. Plan Check N�� tJ � . Telephone Number: / ! � ! �S' � � A O"�' TracUParcel and Lot Number(s): '7 �— Z�/ r/ J Loca6on of Project: Number of Square Feet ot: Residential Space Commercial and Industrial Space CommerciaUlndustrial Projed is: (Check One) _ Warehouse _ R8p _ Movie Theater _ Mini-storage _ Heavy Industrial _ Regibnal Shops _ Light Industrial _ This project is exempt because �Z� x 31.84 x S .30 Total � i � Total �� O� �. _ Mote� ��IAY 0 3 2 Bank = Ra� y�u �ea�i�'snovsClTlf OF COSTA 9AESA Co _ Hotel Medical Olfice Office Park _ Preschool _ Auto Repair _ Hospital _ Large Office _ or�oa sa9. _ Restaurant _ Fast Food This certifies that the above-named Developer/Applicant has paid school haciflty fees in comptiance with Government Code sections 53080 and 65995. The Building Pemiils for this square footage in this proposed development may now be issued by your jurisdicBon. Checks are to be made payable to Newport-Mesa Unified School Disfid. The above representaUon as to square footage is true. Appticant agrees that if it is later detertri ed that such representations are not true, then this cer6ficate shall automatiplly terminate and the��City/ nty shall notified. Date: � / � �S c'"L App6e�M (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT �ob Address: 388 E 20TH ST Suile: Vicinity: Parcel Number: 42623113 Applicant: HART, RAY Address: Owner: HART,CLAUDE Address 388 E 20TH ST COSTA MESA, CA Sfatus: ISSUED Applied: 12/10/2003 Issued: 09/29/2004 Zoning: ISSUED BY: Phone: 949-795-1122 Zip: Phone: 949-7951 � 22 Zip: 92627-2338 Contractor. RAY HART GENER,4L CONTRACTORS Address: 250 E 16TH STREET COSTA MESA, CA Zip: 92627 Arch : Address: Zip: Phone: 949-795-1722 License: 647755 Eng: VALENZUELA, CARLOS Address: 500 OLD NEWPORT BL Phone: STE 204 Phone: (949) 54&2300 NEWPORT BEACH, CA License: 92663 License: 44990 SCOPE OF PERMIT CONSTRUCT 939 SF ADDITION TO AN EXISTING SINGLE-STORY SFD. WORK TO INCLUDE A NEW MASTER BEDROOM AND BATHROOM WITH A WALK-IN CLOSET. THE LIVING ROOM WILL BE EXPANDED AT THE FRONT OF THE RESIDENCE AND A WALL IN THE KITCHEN WILL BE DEMOLISHED TO RELOCATE THE - DINING ROOM. A NEW 144 SF COVERED PATIO WILL BE CONSTRUCTED AT THE REAR OF THE RESIDENCE. AlSOINCIUDES REFRAMING AND REROOFING OF (E) SFD AND GARAGE WITH CLASS A GAF ASPHALT SHINGLES. INSTALL 3 SKYLIGHTS IN (E) SFD AND 3 SKYLIGHTS IN ADD. Plan Check: $685.98 Permit: $1,055.35 SMIP Res: $11.05 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,752.38, SETBACKS MAIN STRUCTURE Front 2S 6 ACCESSORV Front 0- 0 Rear 54-6 Rear 0- 0 FEE SUMMARY PLANNING & ZONING Left 5- 6 Left 0- 0 Calc Valuation: Claim Valuation Right 20. 0. Right 0- 0 s�io,aso.sa So.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handirap 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 1B0 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 legat, such work must comply with all applicable codes, and ell � requlred inapectione and final epproval must be oblained. Failure to obtain Inspectlons and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 z++aae�aroo� WORKEAS'COMPENSAnON DECLARAnON: � , I hereby aHirm under penalty of perjury one of ihe tollowing tleciarations:� ' ❑ I heve and will meimain e cenificete of consent to self-Insure tor workers' compensation, es provitletl for by section 3f00 0l th6,.abor Catle, for the peAormance of the work for which thi5 permit is is5uetl. • ' �I have and will maintain workere' compensation Insurence, es required by sectlon 3700 0l the Lebor Code, for the peAortnance oi Ihe work tor which t�is pertnit is Issued. orkers' pensation Insurence carner and policy num�er are: �7(+� C ,..�!/ arn Pplicy Nu er: I/ p/"� /�'�j s_ section ne nof be cromplefed i! fhe permif is velued ef one hundred dollers (3100) or /essJ . � 1 ❑ I certify that in the peA c of Ihe work f which t�is permit is issuetl, I shell not employ eny person in any manner so es to becoma subject to the workers' compensation laws a, end egr e t t if I shoul become subject to the workers' compensetlon provislons oi Sect on 3700 of the Labor Code, I shall forihwith AFR wilh these P o ions. /� % p ceni nu�ure: � —1 �. '�./ �� W �NG FAILURE TO SE E W RNERS' ENSATIIXJ COVERAGE IS UNLAWFUL AND SNALL SUBJECi AN EMPLOVER TO CRIMINAL PENALT�IES AND CNIL FlNES UP TO IXJE HUNDRED TFIOUSAND �OLL4RE (5100,000�, IN ADOITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIOED FOR IN SECTION 31060F TME L4BOR CODE. IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRAC70R5 DECLARATION: I hereb am licen ndar pro '' ns o (commencing wit� Section 7000) of � islon 3 ot the Busine an Prolessions Coda, entl my Ilcense is in full IOf n IC. N � �� 5 M Cont ofs aNre: te: O CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirm Ihat there is a consiruction IenOinq a9ency for Ihe peAormance of Ihe work lor which Ihis permit is issuetl. (Sec. 3097, Civil Code). Lenders Name: Lender's Adaress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eMirtn that under penalry of peryury that I em E%EMPT FROM 7HE CONTRACTORS LICENSE LAW tor �he tollowing reeson (Sec. 7031.5, Business antl Protesslons Code: Any ciry or counry which requires a permi� to wnslrucL elter, impmve, demolis�, or repair any structure, pnar to its issuance, elso requires the epplicant for such pertnit to file e signed statemem thal he or she is licensetl pursuam to the provisions of the Contrectors License Lew (Chepter 9(wmmencing with Sectlon 7000) of Division 3 oi Ihe Business antl Professions Cotle) or ihet he or she is exampt therelrom and Ihe besis for t�e allegetl ezemptlon. Any violetion of Section 7037.5 by eny applicent lor a pertnit sublects the appliwnt to a civil penelry of not mora than five huntlretl dollers (3500).�: ❑ 1, as owner of ihe property, or my employees wl�h wages as their sole compensation, WILL DO TME WORK, end ihe structura Is not intentletl or otfered tor sale (Sec. 7044, Business and Professions Cotle: 7tie Coniractors License Law tloes noi apply to an owner ol property who 6uilds or improves Ihereon, and who does such work himself or herself or through his ar her own employees, provided ihat such improvemenis ere no� Intended or oflered for sale. II, however, t�e building or improvemant Is sold within one year ot completion, ihe owner-builtler will have the burden ol proving Nat he or she did noI build or ImD�ove tor purpose of sale.). � ❑ I, as owner of the property, am EXCLUSIVELV CON7RACTING WITH LICENSED CONTRACTORS to construct the projact (Sec. 70a4, Business antl Professions Cotle: The contrectors License Law does not apply to en owner of pmpeny who bulltls or Improves lhereon, and who conlracls for such project with e contrector(s) license pursuant to the Contracbrs License Lews.). ❑ I am exempt under sec. Busineu antl Professions Cotle lor ihis roason: SignaWre: Dete: Owner ID verified by drivefs license. ❑ Yes ❑ No Dnvels License No. Expires: Verification of Ownarship by (type at tlocumeni, i.e. � proparty tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more teet in depth into which a person Is required to descend, will be made in connection with work authodzed by Ihis permit, and that no building structure, scaHoltling, falsework, or demolition or tlismantling t�ereof, will be more then Ihirty-six (36) leet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Adminisirative Cotle). ❑ As owner-builder, I will not employ enyane to do work which would require e permil from ihe Divisian ol Intlustnel Safety, as notetl eDove, unless such person hes a permit to do such work Irom �he tlivision. Signature: Date: Division of Indusinal Setery Permit Number: W III the applicant or present or luture building occupant neetl to file antl cenily e Business Plen for emerpency response Io releese or threatened release of e hazerdous material? ❑ Ves ❑ No (Section 25505 ot Ihe California Health and Safety Code requires, wit� some excep�ions, ihat e Business Plan be fle0 with Ihe Coste Mesa Flre Depariment by every business which has at any one time tluring a reported year a quantity ol hazartlous matenals equel to or greater than a weight o1500 pounds, or a volume ot 55 gallons, voe5 or wm me appucant or pre58ni or iuwre owioing occupanl neea to Iile a regisiretlon torm ror ecutey nezertlous maienal5'+ �J ve5 U No (Section 25533 ot the Cailfomla Health end Safety Code, with some ezce tions, requires registretion with the Costa Mesa Fire Depertment by each business which et eny one timo hes on hend a quentlry ot ewtely hezerdous materials equePto or greeter than e welght of 500 pounds, or e voluma of 55 9ellons, or 200 cubic teet af compressed pas at stantlard temDerfl�ure end Ore55ure1. or wni tna appucant or prepare an (Section 25534 of the Califomia Health anC Safety Code provitles that tha Costa Mesa Fire Department may requli Depertment ot en RMPP by �usinesses which ere required to register ecutely hezardous materials with Ihe Fire Dep� .................................................................................................................................................................................................................................................................... 4 It en RMPP is presently required, �as Section 25534 of Ne Celifornia Healt� and Safery Code been fully complied wl ............................................................_...................................................................................................................................................................................................... 5 Does or wlll the ap0licant or present or luture builtling occupant requlre for the work which Is the sub�ect ol this �p irom ihe South Coast Alr Oualiry Menagament Disirict or from eny othar eir polWtion control tlistrict or egency7 �J (Section 650502 ot the Calitomia Govemment Code requires that Ihe requested inlormation be tumished on epplica .................................................................................................................................................................................................................................................................... 6 Will any pan of the faciliry to be constructed under this permit 6e within 1000 teel fmm Ihe outer 6ountledes of e schi Qf'j�es", the tacility must meet ihe requirement of Sections 25534 antl 42303 of the Calitomla Haalth and Setery Cotl ....................................... ............................................................................................................................................................................................... .. ......................... 7 If e permit from Ihe South Coast Air �ueliry Menegement Districl or other eir palWtion control tlistnct or egency ep�licatlon, have ell oi the disclosures Drescnbed bv Celifomia Healih end SafeN Cotle Section 42303 6een metlel Ihe preparation, certification antl liling with the Fire LJ Y89 LJ No ............................................................................. on a ermit tor such constmdlon or 8 No for non-resitlentiel builtling permits). ............................................................................. ❑ Yes ❑ No ............................................................................. �quired lor the work whiCh is Ihe si Yes ❑ No CERTIFICATE OF COMPLIANGE: I cenity [hat untler penalry ot perjury the information given above is correcL I egree to comply with ell state lews end ciry ordinances regarding Hazardous Matenals antl Emissions. Siqnature: Date: OF COMPLI D AUTHO TION F ENTRV: 1 certify under penelry of perjury Ihat 1 heve read Ihis application an0 slate ihel �he infortnation given is e to comply ith el state law d ciry or inances relating to building wnstruction, end euthonze representatives of the City ot Casia M858 to enter upon the 3d pro rty or i ection pu . I ag a not to occupy or allow occupancy of any Duilding authgp��d��permi ntil fnal inspection. (r i S gnatu L gal er(s) —� Dare �� And/Or onzed Aoolira t ate CODE �. INSPECTIONttPE Qsj: . . 1616 Fixed System Final Fira Prevention 1266 .Pool Spa Finel 200 Final Re-Root 201 Final BIaWRetaining Wall 202 Final Factory Fire Place �� COUEt INSYECTIONTYPE 208 Finel Mechanical 203 Final Sign 222 Final Site 204 Final Demolition ' ' ' ' " 250 Final'Building/Occupancy . . , - �� ; NE"JVPORT-MESA UNIFIED SCHOOL OISTRICT CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 To: �C�Ciry of Costa Mesa ( ) Ciry o( Newport Beach ( ) County of Orenge N° _ 5153 DisUict Receipt No.�,�]_ Plan Check No. 3-J • .. ��iiw��i�-�� •.. • u � Telephone Number: TracVParceland Lot Location of Project: Number of Square Feet of: Residential Space •84 �� Total � 7��. % V -p ca�.�,� � s€� � � 200� � �� Commercial and ��a�5c�a� sPaoe �'�' COSTA ��`q- Tota� CommerciaVlndustrial Project is: (Check One) Warehouse R8D Movie Theater Mini-storage Heavy IndusUial Regional Shops Light Industrial This projed is exempt beceuse _ Motel Bank _ Neighborhood Shops _ RacqueVHeatth _ Hotel _ Medica101fice _ Office Park � Preschool Auto Repair Hospital Large Ofice Office Bldg. Restaurant Fast Food This certifies that the above-named Developer/Applicant has paid school facilily fees in comp6ance with Govemment Code sections 53080 and 65995. The Building Pemits for Mis square toofage in Mis proposed development may now be issued by your jurisdic6on. Checks are to be made payable to Newport-Mesa Unified School District. ey The above representation as to square footage is We. Appticant agrees that i( k is later true, then this certificate shall automafically teminate and the app�opriate Cily/Counl�t Date: a� d � that such representa0ons are not RHGC Ray Hart General Contractor 250 Eas� 16'�' Street Costa Mesn, CA 92627 (949) 795 I122 ray�a lrgc.cc July 18, 2008 RE: Courtesy Notice of permits pending expiration. 388 East 20`h Street Mr. Petros I would like to thank you for the referenced letter. I would at this time like to request an extension. j I am preparing documents ro have the approved plans sent out from your office for duplication. At inspection for Electrical Final the inspector had requested a better set of plans as the field set had been damaged. There are other reasons for my delay, mainly at the time I was working roward final inspections my wife broke her knee cap (petla) and we moved in a bit prematurely as our other residence is two stories and the suddenly became an issue. Please contact me at your convenience so we may discuss this fuRher. Th Ray Hart / � __. ____ (714) 754-5273 • Fax (714) 754-4856 •� www.ci.costa-mesa.ea.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job nddress: 388 E 20TH ST Suite No Vicinity: Parcel Number: a2623113 npp�icane HART,CLAUDE Address: 388 E 20TH ST COSTA MESA, CA Owner: HART,CLAUDE Address: 388 E 20TH ST _ COSTA MESA, CA MECHANICAL PERMIT � � - � P Phone: 949-795-1122 � � Zip: 92627-2338 , Slatus: ISSUED Applied: 1 7 /1 52005 Issued: it/152005 ISSUED BY: EXTENSION Phone: 949-795-1122 �� Zip: 92627-2338 ' "- " Contractor: RAY HART GENERAL CONTRACTORS EXPIRES Address: 250 E 16TH STREET COSTA MESA, CA Phone: 949-795-1122 Zip: .92627 - License: 647755 SCOPE OF PERMIT CONSTRUCT 939 SF ADDITION TO AN EXISTING SINGLE-STORY.SFD.. REF.: B03-02120 � MECHANICAL TO INCLUDE: 1 fAU < 100K BTU, 1 REPAIR/ALT COOLINGMEAT, 1 FACTORY FIREPLACE, 1 HOOD WIMECH EXHAUST, 3 VENT FANS, AND 1 COMPRESSOR/ABSORPTION SYSTEM 3 TO 15 HP. � � � ISSUE FEE Inst FAU <100 k BTU Inst FAU >700 k BTU RepairlAll CoolingMeai Insl I Rep. Recess Wall Htr Refrig Sys <100 k BTU Retrig Sys >100 k BTU Gas Piping Faciory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers - . Smoke Dampers Inst or Relocale Appl Vent Air Handlers < 10000cfm AirHandlers> 10000cfm FloorFurnace Floor or Suspend Heater 523.50 514.80 50.00 313.70 sa.00 $0.00 50.00 $0.00 $10.65 810.65 $0.00 $21.75 50.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 50.00 Quantity FEE SUMMARY Repair I Alf Absorblion Unit Repair / Alt Retrigeration Unit Ventillation System � Evaporativa Cooler Commercial I nci n e rator Domestic Incineretor Comoressors / Absorotion Svslems Upto3hp/100kBTU 3To15hp/500kBTU 15 To 30 hp / 1,000 k BTU .30 To 50 hp / 1,750 k BTU, _, Over 50 hp / Over 1,750 BTU .-„ Boilers Up to 3 hp 3Tot5hp..= �._ . , 15 to 30 hp - , , 30 to 50 hp Over 50 hp , . Other Mechanical Fee Investigation�Fee � Plan Check Fee , Reinspedion Fee " TOTALCALCULATEDFEES COMMENTS / SPECIAL CONDITIONS _ _ �uantity 50.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 D so.00 0 $0.00 0 E0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 827.15 1 50.00 0 $0.00 0 50.00 0.. $0.00 $0.00 50.00 E122.20 EXP1 --.li na� � 'NOTICE: The�work authorized by.this permit shall compty with-all applicable handicap�access�.requirements under Califomla statutes and related regulations. (Ortl. No. 92•28; § 1, 12-27-92) EXPIRATION: This�permit shall automatically expire and become.void if work Is not commenced within 180 days, or il work is suspended or abandoned -for a period of 180 days. �INSPECTIONS: In order tor the work.authodzed under this pertnit,to�be.considered legal, such work.musYcompty with all applicable wdes, and;alf 'requlred,inepeetlona end.flnal'epproval'mustbe obtained. Failurato�oblain inspectlons andtinal approval will result in lhe expiraqon of this.permit� FOR'INSPECTIONS.CACC:: (714) 75Y5828 � 2aao-481amol _.. _. __... __ _ WORKERS'COMPENSAnONOECLARAnON: I hereby aHirm untler penelry ot perjury one ol the following Aeclara�bns: '• " , � . . ❑ fheve entl will maintain e certificate of wnsent to self-Insure br workers' compensetlon, es provitletl lor Dy section 3700 of the Labor Cotle, for the peAortnance ol the work lor whiCti lhi5 permll is Issuetl. ' � � �-41'heve end will mainlain �workers' compensation in5urence, es requiretl Dy sectlon 3700 0� the Lebor Gode, br the pe�tOrtnence of Ihe work for whith Ihis pertnit i5 i55ued. 4:. .. My`warkers' compensaHon Insurance wrrier and poliry numEer are: ��r""' �PdICyNumber." � • (Thi9 decllon need no! be comploted U Ne pe 1 is velueO et one hundred tlollars ($100J oi less.) y ❑ I certify thet in the Db� rma e oi lhe wc k tor which lhis permit is issued, I shall nat employ any person in eny manner so as to becoma suDject to Ihe warkers' compansation law�ol�la, an� ag�ee lh shoultl become sub�ect ro the workers' compensation provislons ol Section 3700 0l Ihe Lebor CoAe, I shall forthwith �PPuwmtiiprievre':' ' `r .`petn�, �WARNIN�FAILURE-iOS REWORKERS ENSATIONCOVERAGEISUNLAWFULANDSW1LlSUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFlNESUPTOONEHUN�RED T/IOUSAND DOLURE (E100,OW), IN r1DDR10N TO THE CO6T OF COMPENSATIpN, OAMFGES AS PROVI�E� FOR IN SECTION31V6�OF TNE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSEO CONTRACTORS DECLARATION: (commencing with Soclion 7000) of Pmfessions Cotle, and my license is in tull CONSTRUCTION LENDING AGENCY: y' �;y/ �_ v� ❑ I hereby eXirm that there is e conswcUon IenAing epenty tor lhe pertortnance of ihe work lar whic� this permit Is Issuetl. (Sec. 3097, CIWI Cotle). Lendels Name: Lendefs Address: Signature: Dale: OWNER-BUILDER DECLARATIONS: I hereby ettlrm t�al under penalry of per�ury lhat I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business end Professlons Cade: Any ciry or wunry w�lch requires e partnit to canstruct, elter, improve, demolish, or repeir any structure, pdor to Its issuance, elsa reqWres t�e eppllcant far such permit to lile e signetl statement t�et ha or she I5 licensed pursuant lo Ne proWsions of lhe Contrectars License Law (Ghapter 9(commencing with Sectlon 7000) oi Division 3 ot Ihe Business end Protessions Code) or that he or she is e:empt iherelran and t�e besis tor the ellaged ezemption. Any vidation ot Sectlan 7037.5 by eny applicam for e pertnit suhjecis t�e epplicant to e dvil penfllry of not rtwre than INe huntlred ddlars ($500).): ❑ I, es owner ol the Droperry, or my employees with wages as t�elr sole compensatlon, WILL DO THE WORK, and Ihe structure is not Intende0 or oHeretl tor sala (Sec. 7044, Busineu end Professlons Cotle: The Comractors License Law does nol appty to an awner ot property who builds or impmves t�ereon, end who does such work himself or herselt or t�roug� �is or �er own employees, providea that such imprwements are not intentleC or oHeretl tor sale. It, hor.ever, t�e building or improvement is sold wit�in ona year at wmpletion, the owneo-builtler will hava tha burden of proving ihat ha or she did not builA or Improve for purposa ot sale.). - ❑ I, as owner ot lhe properry, em E%CLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS lo construct the project (Sec. 7046, Business and Professions Code: TTe wntrectore Licanse Lew tloes no[ apply to en owner oi pmperty who builds or improvas thereon, and who coniracts tor such pm�ect wilh a contractor(s) license pursuam to ihe Contractors License Laws.). ❑ I am ezempt untler sec. Business antl Professlons Code lor this reason: Signeture: Date: Owner ID venfietl by tlrivar's license. ❑ Ves ❑ No Driver's License No. Expires: Veriflcation of Or.nership by (type of tlacument, i.e. � property tax bill or deetl): DIVISION OF INDUSTHIAL SAFETY PERMR CERTIFICATON: ❑ I here6y certiy that no excavation five (5) or more leet in depth inta which a person Is required to descend, wlll be metle in connectlon wlth work euthodzeC by ihis permil, and thet no building siructure, scaHalding, lelsework, or demoli�ion or dismantling t�ereof, will bo more than thirty-six (36) feet high. (ChaO� 3.2, Gry 2. An 2, Sec. 341, Title B, Celilarnia Atlministrative Catle). ' ❑ As owner-builtler, I will not employ enyone t0 tlo work which would require a permit from Ihe Divislon ol Industriel Sefary, as nOtetl Bbove, unless such per6on hes e permi� �o tlo such work from Ihe division. Signature: Date: Divisian oi Industnal Selery Pertnit Number. CERTIFlCATE OF COMPLIANCE AND AIlTHORIZA710N OF ENTHY: I cenity under penelty ol perjury ihat I heve read this application antl state that t�e information given is correct I agree to comply�with ell atet laws anC dry ordinances relating to building constructlon, antl aut�onze representatives ol the City ol Costa Mesa ro enter upon the ebove-descnbed property lor Inspoctior�puryoses. I egreo not to occupy or allow occupancy of eny builtling euthodzed by Ihis permit until linal inspecHon. Oi Legal COOE 1. INSPEGTIONTIPE ' ' ' 1616 Fixe� System Final Fira Prevention 1266 Pool Spe Final 200 Finel fie-Raol ' � 201 Finel Block/Retaining Wall 202 Final Fec�ory Flre Place 203 Finel Sign 204 Final Demoliiion �.1 IJIII/.IRI � COOEI 'INSYECTIONTYPE 206 Final Mechanicel � 20B Finel Plumbing 210 Finel Electrical 212 Finel FirO Prevenlion 220 � Final Planning Approval 222 Final Site 250 Finel Building/Occupency Qsff. Q�eii � r ' . � South� st Inspection and T� .,ting, Inc. 10826 South Norwalk Blvd., Santa Fe Springs, CA 90670 (562) 941-2990 • (714) 526-8441 • Fax (5621 946-0026 CEHTIFICATION Oi COMPLIANCE CONTINUED ON NE%T PAGE ❑ PAGE OF IHEflEBV EPTIFYTHA IHqyEOBSEFVEOTOTHEBESTOFMYKNOWLEOGEALLOFiHEABOVENEPOFTED TIMEIN TIMEOUT REG ORS O.T.HOURS CYLINDERS WOF NlESS OTHE WISF NOTED. I D THIS WOAI( TO COMPLV WITH THE APPAOVED PLANS. SPE FICA710N , APFlICABLE S IONS OF 7HE COVERNINGBUrIDfyG LAWS. �— _.. I � SPECIALTY OF N0. AGENCY All inspections based on a minimum. In addition, any hour minimum. Approved by of 4 hours and over 4 hours - 8 hour extending past noon hour will he an 8 Project SuperintendeN WHITE - OFFICE COPY, CANARY - ACCOUNTING COPY, PINK - INSPECfOR'S COPY, GOLDENROD - JOH SITE COPY (714) 754-52)3 • Fax (714) 754-4856 • www.ci.costa-mesa�C��TRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 ,lob Address: 388 E 20TH ST Suite No v��,�: Parcel Nunmber: 42623113 Applicant: HART,CLAUDE Address: 388 E 20TH ST COSTA MESA, CA RRIP Phone: 949-795-1122 Zip 92627-2338 � Owner: HART,CLAUDE . - Address 388 E 20TH ST � � Phone: 949-795-1122 COSTA MESA, CA� � "-� 2ip: 92627-2338 Comrector. RAY HART GENERAL CONTRACTORS Address: - 250 E 16TH STREET ISSUE FEE Temp service lesl Res. a/c package New Res (1•2 units) New Res (3vunits) Pool / Spa Lighting FiMs Recept Outlets Switches Non Res Appl Res Appl Service to 200a - Service to 1000a Service ovet 1000a - Motors to 1 hp Motors to 70hp Motors to SOhp Motors l0 100hp Motors over t00hp Communication drops Sub panel t0 200a Pole Light Pkg Sign CirGuitS Temp Pwr Pole Intermed Pole , Phone: 949-795-1122 COSTA MESA, CA . Zip: 92627 � � - ' � "License:647755 Status: ISSUED Applied: N/75Q005 Issued: 11/152005 / /� . . : / �/ -- "'1�rdY'�1V�,7Yo1� , �� .� PER��- EXPlRES � � SCOPE OF PERMIT - - CONSTRUCT 939 SF ADDITION TO AN EXISTING SINGLE•STORY SFD. REF.:803-02120 ELECTRICAL TO lNCLUDE: 7 A/C RESlDENTlAL PACKAGE, 25 LIGHT FIXTURES, 40 OUTLETS, 15 / SWITCHES, 1 SERVICE �TO 200 AMPS; AND 1 TEMPORARY POWER POLE. FEE SUMMARY $23.50 $0.00 $54.50 $0.00 50.00 $0.00 $25.65 $36.60 $16.50 $0.00 50.00 $30.50 $0.00 $0.00 50.00 $0.00 50.00 $0.00 $0:00 $0.00 50.00 50.00 80.00 $23.50 $0.00 Duantity 0 0 0 25 40 15 0 0 , 1, 0 0 . `0 : � 0 0 0 . , 0 _ .. 0 0 0 0 7 0 Temp Dist System / Lighting Busway I100 fl Standing Sedion- -^ -• Misc Eledrical Equipment � ' Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw � .................up l0 100 kva/kw -.� ..................over 100 kva/kw Low Voltage Equipment Low Voll Wiring System I Ckt Misd Conduit . ' . - Misa Conductor � � Circus ( gen or ride) " Circus (mech dde�or Iights) �.--,��- Christmas Tree Stand - " - Fireworks Stand � � � Other Electrical Fee . Investigation Fee � PIan�CheckFee - Reinspection Fee . Quantity � $0.00 0 $0.0� $ $ $. 0 � $0. $0. $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 so.00 '- a $0.00 0 $0.00 0 $0.00 $0.00 50.00 50.00 TOTAL CALCULATED FEES 5210.75 COMMENTS I SPECIAL CONDITIONS NOTICE: The�work authorized by.this permit shall comply with all applicable handicap access requlrements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become�void if work is not commenced within 180 days, or if work is suspended or ebandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to �be considered legal, such vrork must comply with all epplicable codes, aM� la I requi�ed Inapeetiona end final approval must be obtained. Failure to oblain inspections and final approval will result in the ezpiratlon ot ihis.parmit. FOR�INSPECTIONS�CALL:. (714) 7545626 C// Zue-�e(erool ....,,.,..,._....__- -- - ,... WORKERS' COMPENSATION DECLARATION: ` - - � � � I hereby aflirm under penel�y of perjury ona of iha following declera�lons:. � , .. ❑ I heve end will meintain e certificate of consant to salM1lnsure for workers' compensetlon, es pmvided br 6y section 3700 of ihe Labor Code, for ihe peAormence ot t�e �ork for whicti this permit is issued. I ha`ve,end will maintain workere' compensetion insurance, as requiretl by section 3700 ot ihe Labor Code, for the peAormance o} the work tor which �this pertnit is issuetl. y�My workers' compensatlon Insurence carder end pollcy number ere: ' Cerriar: n � ' Policy,Number.--' (This�secfion need nat ba cromplefed U(he permil /s elued ef one huntlred tlollers ($ f 00) or less.) / . ❑ I certity Ihat in the peA t the�work f0 which this permit is issued, I shall not employ any person in any manner so as lo become sublect to tha workers' compensation law�. Califom' , and eg eeA at II I should become subject to the workers' compensatlon prodslons of Saction 3700 of the hor Code, I shall torthwith comply wi�� h �he5e pr `�jga� . ApplicenfSignature L� �Date: ��/ �� WAfiNINQ:.FAIWRE TO e�yyRE 'ORKERS' COh NSATION COVERAGE IS UNIAWFUL AND SNALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND pVIL FlNES UP TOONE HUNDRED TFqUSAND OOLURE (b100,000), IN ADDfTIqJ TO THE COST OF COMPENSATIIXJ, DAM1KGES AS PFOVIDED FOR IN SECTION 3]O60F THE LABOR COOE, IMEFEST, AND ATTORNEY'S FEES. LICENSED CONTRACTOHS DECLARATION: �'.�} � ,-r :. �' I hereb eflirm that I.am.lk nsed u�Mer ro 'si � y � pa�of Chepter 9(wmmencing with Section 7000) of DivWo� 1 t� uslness�anA�mfessions Code, end my license is in full IC lorce antl eHect. LJc. � - �� e, f Ciflss �`� v /..,��.w�. Coniractofs 5ignflWw:- - I Date: � 'S -. �� ,�"'��i C�-----�_.. � � __ " CONSTRUCTION LENDING AGENCY: . . ❑ I hereby ettirtn that there is a construction lending agency for Ihe peAortnance of t�e work for whic� ihis permit is issued. (Sac. 3097, Civil Cotle). Lendefs Neme: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eMirtn that under penelry of perjury Ihet I am EXEMPT FROM T11E CONTRACTORS LICENSE LAW tor Ihe following raason (Sec. 7031.5, eusiness antl Professions Code: Any ciry or counry which reQuires e permit to consiruct, alter, Improva, demolish, or repair any strucWre, prior to its issuance, also requires Ne epplicaN tor such pertnil b tile a signetl stetement thet he or she Is Ilcensetl pursuent to ihe provisions of the Gontrectors License Law (Chapter 9(commencing with Sectlon 7000) of DiWsion 3 of the eusiness end Professions Cade) or Ihet he or she is exempt Iharalrom end Ihe besis tor the elleped exemption. Any violation of Section 7031.5 by any applicant tor e permit subjects the epplicant to a dvil penelry ol not more Ihan five hundred dollars ($500).): ❑ I, es owner of Ihe properry, ar my employees wllh wages es �heir sole compensation, WILL 00 THE WORK, antl the structure Is not intended or offared tor sale (Sec. 70a4, Busineu and Professions Catle: The Contractors License Lew does not appty to an owner ot pmperry who builds or improves thereon, antl who does such work himself or hersetl ar through his or her own employees, provided thet 5uch improvemenis ara noI inlended or oftered for sale. H, however, tha builtling or improvement is soltl within one year ol completion, tho owner-builder will have Ihe burtlen ol proving t�at �e or s�e did noi builtl or improve for purpose oi sale.). - ❑ I, es owner of the properry• am E%CLUSIVELY CONTRACTING WITH LICENSED CONTFiACTORS to conslruct ihe prolect (Sec. 7044, Business antl Professions COCe: 7�e conirectors License Lew does not epply to en owner ot propeny who bulltls or improves thereon, antl w�o conirects tor such pmject with a contractor(s) licensa pursuant to the Contractors License LewsJ. ❑ I am exempt under sec. 8usines5 entl Professions Code for ��is reason: Signature: Date: Owner ID venfied by drivei s license. ❑ Ves ❑ No Driver's License No. Expires: Veniication of Ownership Dy (type ol document, I.e. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFETV VERMI7 CER7IFICATION: ❑ I hereby certify thet no excavetion flve (5) or more teet in tlepth Into which e person Is required to tlescend, will be matle in connection with work euthonzed by Ihis permit, and that no building stmcture, scaltoldinp, falsework, or tlemolition or dismentling ihereof, will be mora Ihen ihirry-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title B, Calitamie Atlministrative Code). ❑ As owner-Duiltler, I will not emplay enyane to do work which would require e permillrom ihe Division of IndusMel Sefety, es noted above, unless suc� pereon �es e permit to tlo such work from ihe divlslon. Signature: Date: Division af Industnal Safely Permit Number: ARDOUS MATEFIALS AND EMISSIONS CERTIFICATION: Will the epplicant or present or tutuie bulltling occupem need to file end certity e Business Plan for emergency response to releese or threatenetl release of e hezardous matadel7 ❑ Yes ❑ No (Semion 25505 0l Ihe Calitomie�Health end Sefery Code roquires, wi�h some excep�ions, ihat a Business Plan be filetl wiN t�e Costa Mesa Fire Depertment by every business which has et eny one time tlunng a reported year a quanliry ol hazardous matenals equal to or greater than a weight of 500 pountls, or a volume of 55 qallons, or 200 cu�ic feet ot compressed gas et stantlard temperaWre end pressure). ........................................................................................................................................................................................................................................................................................... ....................... ................................................. Does or will Ihe applicent or present or future builtling occupant need lo file a registrelion brm for ecutely hazartlous materials7 ❑ Yes ❑ No (Sectlon 25533 0l the California Heelih and Safary Cotle. wii� some exceptlons, requires regisiretion with the Coste Mesa Fire Deperiment by each business which et eny ona time has on han0 e quantiry at ecutely hezerdous metenals epuel m or greeter than a welght of 500 pountls, or e volume of 55 gellons, or 200 cubic teet ol compressetl gas at stantlard IemperaWra antl pressure). or (Section 25534 ot tha Celifornia Health entl Safety Code pro� Depariment of an RMPP �y businesses which ere requlretl lo .............................................................._..._...........""""'_'......................................... 4 If an.RMPP is presenity reQuired, has Section 25534 of the Ci �d to prepare en RMPP (Risk Management and Prevention Program for acutely hazardous materlals)7 ihet the Coste Mesa Fire Department may require �he preparation, cetlificetion and tiling with the Fire ler acmely hezertlous matedels with the Fire Depanment. ............................................................_.............................................................................................__.............................._.............................. �ia Heatlh end SefeN COCe Ceen fulN comolie0 withl ❑ Ves ❑ No 5 Does or will the epPlMant or preseN or future builtling occupant reqWre tor tne work wnicn Is tne sub�ect m tnis a pucauon a ertnn tor sucn construcnon or moamcanon trom t�e South Coast Air Queli�y MunngemeN District or Irom eny oiher eir pollu�ion control distnc� or agency7 � Ves � No (Sadion 658502 of the Calitornia Govemment Cotle reQuires t�et the requested information be fumished on applications for non-resitlential builtling permits). ............................................................................................._..................................................................................................................................................................................... ....................... ................................................................. 6 Will any petl of lhe faciliry ro be conslmcted under ihis permit be within 10001eet tmm Ihe outer poundanes of a school? ❑ Yes ❑ No Qf yes', ihe facility must meet the repuirement ot Sections 25534 entl 42303 0l Ihe Celi/omia Haelih end Safery Code). ................................................._................................_..._._.................................................._._....................................................................._........................................................._..................._........................._.......................................__.... 7 N e permi� irom ihe South Coes� Ait Oueliry Menegement DisMct or other air polWtion comrol districl or egency is requiretl tor Ihe work which is �he subject of Ihis applicatlon, heve ell oi Ihe disclosures prescnbetl hy Gelitomia Heellh antl Sefery Code Section 42303 baen matle? ❑ Yes ❑ No ......................................................................................................... ........................................................................................................................................................................... ................................................................................................. 8 Qt yes', attach certilicete ot compllance from lhe ep0�opnate eir poltution control oHicer). CERTIFICATE OF COMPLIANCE: I certiy thal under penalry ot perjury the inlorma�ion given above is correct. I agree to comply with all slate laws and ciry ordinances regaraing Hasartlous Metenals antl Emissions. SignaWre: Date: CERTIFlCA7E OF COMPLJANCE AND AUTHORIZA710N OF ENfTiY: I certify untler penalry ol perjury that I have reatl this application and state that the information given is corred. I agree to comply w' all state laws entl dty ordinences relating to 6uilding cronsiruction, end authorize represemativas of Ihe City of Costa Mesa to enter upon the above-described property t�spection puryoses. I egree not to occupy ar allow occupenty of any Duiltling authonzed by this permit until final inspection. CODE I, 1fi16 1266 200 201 202 203 204 INSPECTIONTYVE �` ' � " Fixetl SySlem Finel Fire Prevenli0n' Pool SOa Final Finel Re-Roof ' Flnal BIocWRetalning Well Final Factory Fire.Place ' Final Sign Final Demolition Owner(s) ApPlicam ' - � QAIE ' II�6L$ , t � CODEt INSPECTIONTYPE � - � ' ' 206 Final Mec�anical 20B Final Plumbing '210 FinalElecirical� ' � ' 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupanc'y (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DflIVE, COSTA MESA, CA 92626 Job Address: 388 � 20TH ST Suite No Vicinity: Parcel Nunmber: 42623113 Applicant: HAR7,CLAUDE Address: 388 E ZOTH ST COSTq MESA, CA Owner: HAR7,CLAUDE Address 388 E 20TH ST COSTq MESA, CA PLUMBING PERMIT Phone: 949-795-1122 Zip: 92627-2338 Phone: 949-795-1122 Zip: 92627-2338 Contractor. RAY HART GENERAL CONTR,4CTORS Address: ISSUE FEE BackFlow irrigation BackFlow Preventer Bathtub Clarif er System Connect (Ice,Soda,elc) Dental Units Dishwasher Drain, Floor Drein, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) 250 E 16TH STREET COSTq MESA, CA Phone: 9437957122 Zip: 92627 License: 647755 Status: ISSUEO Applied: O5/03/2005 Issued: OS/03/2005 ISSUED BY: �la��101, La �� 9 �C i i'i L� PER SCOPE OF PERMIT 03-22-05 REVISED SCOPE OF WORK - 1164 SFD ADD, 55 SF GAR ADD, 252 SF PATIO COVERS, REFRqME AND REROOF OF EXISTING 884 SF SFD AND 364 SF GAR. INSTALL 3 SKYLIGHTS IN (E) SFD AND 3 SKYLIGHTS IN ADD. 2 BATHTUBS, 1 DISHWASHER, 1 GAS OUTLET (1-4), 1 GAS REPIPE, 1 LANDRY TUB/VJASHER, 2 SHOWER, 2 KITCHEN SINKS, 2 WASH BASIN SETS, 2 WATER CLOSETS, 1 WATER HEATERNENT, WATER PIPING (INST OR REP) REF: 803-02120 AMT 523.50 $0.00 $0.00 $19.60 $0.00 $0.00 50.00 59.80 $O.pO SO.pO 50.00 $0.00 $0.00 $0.00 $8.15 QTY 0 0 2 0 0 0 1 0 0 0 0 0 0 1 FEE SUMMARY Laundry Tub / Washer Landscape Irrigation P-Trap Pressure Regulator Process Piping (per 10 fq Receptors Septic Tank Sewer Cap for Demo Sewer Connect Sewer Private Line Shower Sink, bar Sink, commercial Sink, Floor Sink, kitchen AMT 59.80 $0.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $19.60 $0.00 $0.00 $0.00 $19.60 �TY t 0 0 0 0 0 0 0 0 0 2 0 0 0 2 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.60 $0.00 $19.60 $12.30 $9.80 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 2 0 2 1 1 0 0 0 NOTICE: The work authorizetl by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void iF work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and ell requlred inapeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � �.. .,�W,�� WORKERS'COMPENSA710N DECLARAnON: I hereby eNirm under penelty ot perjury one of the following declarations: ❑ I heve end will melnteln a cenificate of consent to self-Insure for workers compensetion, es pmvided for by section 3700 of tha Lebor Code, lor tha pertormance ot the work lor which this pBrmit is issuetl. �J have end wil maintain workers' compen ation insurance, as requiretl by section 3700 of Ihe Lebor Cotle, tor ��e pertortnance ot t�e work for which this pertnit is issued. My worker ' nseilon In rence ca 'er end pollry number ere: I� n' ^ I 5,..,/ Ca�ne�' Polic Nu ber: (J � U �(dhis'�seclio%n"�ed nof be comp/ef 1! fhe permit is ve/ued at one huntlred tlollars ($f00) or /ess.) '' ' ❑ I cenity Ihat in the nce ot the wo for which this permit is issued, I shell not employ eny person in any manner so es to become subject to the workers' compansailon I s omia, entl gr that il I should Decome subject to the workers' compensation proWsions of Sectlon 700 oi Ihe Lebor Code, I shall torthwith comply wi�h Ih 5e ovision5. ��.�c;�, �, APP�L iBoe `�'l- DateiL—� S �� WAPNING: FAIIURE TO U E WORKERS' COMPENSAiION COVERAGE IS UNLAWFUL AND SHALL SUflIECT AN EMPLOVER TO CRINJNAL PENALTIES M1D CIVIL FlNES UP TO ONE HUNDRED TFIOUSAND DOIAARE (5100,000). IN ADDITIIXJ TO TNE WST OF COMPENSATIIXJ, OAM4GE5 AS PROVIOED FOR IN SECTIIXJ 3'1080F iHE LABOR COOE, IMEREST, AND ATTOiiNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm that I em licensed undery r�ovisions ot he er 9(commencing with Section 7000) of Division 3 of Ihe Business Professions Code, antl my license is in tull force end eXecL .�lc.-1 /�`1 �%1 � Cless�a, �� . CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirtn ihat ihere is a conslruction lending egancy for the pedormance of the work lor which ihis permit is issuetl. (Sec. 3097, Civil Code). Lender'S Name: Signature: _ OWNER-BUILDER DECLARATIONS: Lenders Address: Date: I hereby ettirm Ihat untler penelry ot perjury thet I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW for Ihe following reasan (Sec. 7031.5, Business end Professions Cotle: Any ciry or county which requires e permit to con5iruct, alter, improve, demolish, or repair any strucNre, pdor to its issuance, al5o requires tha flpplicant for suCh permit to file e signed statement Ihet he or she is Ilcensetl pursuent to ihe provisions oi the Contractors License Lew (C�epter B(commencing with Sectlon 7000) oi Division 3 of ihe Business antl Professlons Code) or thet he or she is exempt therefrom and Ihe basis for the elleged exemptlon. Any violation of Seclion 7031.5 by any applicant for a permit subjects Ihe applicant ta e civil penalry of not more ihan five �undred dollers (5500)J: ❑ I, as owner of the property, or my employees with weges as their sole compensetion, WILL DO THE WORK, end the structure Is not intendetl or oHered lar sale (Sec. 7044, 8usiness end Protessions Code: The Contractors License Law does not apply Io an owner ot properry who builds or impmves thereon, entl who does such work himself or �ereelf or Ihrough his or her own employees, provided ihat such improvaments ere not intended or oiferetl for sale. II, however, the building or improvement is soltl within one year of completion, the owner-huilder will have ihe burden of proving that he or she did not build or improve tor purpose ol sale.). � ❑ I, as owner of lhe property, am E%CLUSIVELV CONTRALTING WITH LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Business antl Professions Cotle: The contrectors License Lew does not apply to en owner ol property who builtls or improves ihereon, and who contracts for such pwject with a contractor(s) license pursuant to Ihe Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for Ihis reason: Signawre: Da1e: Owner ID verifled by driver's license. ❑ Ve5 ❑ No Orivefs License No. Expires: Venfication of Ownership by (type of daument. i.e. � property t� bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cetlify thet no eacavetion five (5) or more feet in depth in�o which e person is required to descend, will be made In connaction with work euthorized by this permit, end ihat no bull0ing strucWre, scaHoltling, lelsework, or demolition or disman�ling thereof, will be more Ihen thiny-six (36) teei high. (Chap. 32, Gry 2, Art 2, Sec. 341, 71t1e 8, Californla Atlministrativa Code). ❑ As owner��uilder, I will not empioy nnyone to do work which would require e permit irom the Division of Intlustnel Setety, es noted above, unless such parson hes a permit to do such work from the division. Signa�ure: Date: Division of Industnal Salery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZATON F ENTRV: I certify under penalry of perjury that I �ave reatl this application antl state that Ne intortnation given is correct. I agree to comply wlih ell stat nd ciry or inances relating to huilding consiruction, and euthorize representatives of the City of Costa Mesa to enter upon the ebove-described propeny lor inspecti pu ses. I ggr ngtta�occupy or ellow occupancy of any building euthodzed by this permit until finel inspection. COOE t. INSPECTION TYP� V PAIE INRfIALS 1616 Fixetl Sysiem final Fire Prevention 1266 Pool Spa Final 200 Finel Re-Rool 201 Final BIocWRetaining Well 202 Final Factory Fire Place 203 Finel Sign 204 Finel Damolilion 40pE� INSPECTIONTYVE 206 Final Mechanical 20B Final Plumbing 210 Pinel Electncal 212 Finel Fire Prevention 220 Final Planning Approval 222 FinalSite 250 Finel Building�Occupancy E �T� INTffULS •��' Southv st Inspection and TE ':ing, Inc. / 10826 South Norwalk Bivd., Santa Fe Springs, CA 90670 �� 15621 941-2990 • 17141 526-8441 • Fax (562) 946-0026 N . I�- REGISTERED INSPECTORS'S DAILY REPORT TYPE OF � Reinforced Concrefe ❑ Sfrcictural Steel Assembly ❑ Quality Conirol INSPECTION . � Posi Tensionetl Concrete ❑ Fire Proofing ❑ Other REDUIHED � Reinforced Masonry ❑ Aspholf Job Atldreu � _ � Clty � Job Nome Permit No. I 155uetl By �� Type ol StruCture -;(L_~� ArChifeCi �/�— Ol � blv� \/ Material DeSCription (type. gratle. sour ) Engineer �!L '� M L Snl„� CoNroctor rr�, inspector(s) Nome SubCONroctor TESTS PERFORMEU TYPE OF SAMPLE SLUMP QUANTITY IN SET ADDITIONAL REMARKS ON SAMPLES � INSPECTION SUMMARV — LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC. INCLUDES INFORMATION ABOUT- AMOUNTS OF MATERIAL PLACED OR WORK PERFORMED, NUMBER, TYPE & IDENT. NO'S OF TEST SAMPLES TAKEN: STRUCT. CONNECTIONS (WELD MADE H,T. BOLTS TORQUED) CHECKED, ETC. Q` 1-�v..� ,e �i • in^ . ` CS � � c �s_ � - �� S s� - l � U . //`.S � � �-c�2 B� .� E r-w,« � � '� SPECIALTY CEflTIFICAT10N OF COMPLIANCE WISE NO7ED.1 APPIICABLE 51 :ST Of M1IY KNOWLEDGE ALL OF THE ABOVE flEPoflTED THIS WOFR TO WMPIV WITH THE APPflOVED PlANS, IE GOVEANING BUILDING lAWS. AGENCV CONTINUEO ON NEXT PAGE I TIME IN TIME OUT All inspections based � minimum. In addition, hour minimum. Appmved by PAGE OF S . . HOURS CVLINDEflS '(ninimum of 4 BDms and over 4 hours - 8 hour inspection eztending past noon hour will he an 8 Pmject Superintendent WHITE - OFFICE COPY, CANARY - ACCOUNTING COPY, PINK - INSPECTOR'S COPY, GOLDENROD - JOB SITE COPY