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Home My WebLink About409 BRIGHTON SPRINGS - Building Permits(774) 754-5273 • Fax p�4) 75a-aess • wvrN.ci.costa-mesa.��LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 ,lobAddress: 409 BF2IGHTON SPRINGS Suite: G006 Vicinity: CARPORTS Parcel Number: TPN98074 npplicant: ALBERTSON, NOEL Address: Owner: BRIGHTON SPRINGS HOA Address 500 BRIGHTON SPRINGS COSTA MESA, CA Contractor: DAVEY ROOFING INC Address: 17182 ARMSTRONG AV IRVINE, CA Zip: 92614 Arch : Address: 9 Zoning: Phone: 714-822-6304 Zip: Phone: Zip: 92626 Phone: (949)852-9955 License: 700710 Eng: Address: ISSUED BY: Status: ISSUED Applied: 70/30/2000 Issued: 70/30/2000 Phone: Phone: Zip: License: License: SCOPE OF PERMIT REMOVE OLD ROOF, APPLY NEW METAL, INSTALL NEW SHEATHING AS REQUIRED, COVER WITH BUR. Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY �Front 0-0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0- 0 Reauired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0-0 Right 0-0 $2,050.00 $2,050.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) �I EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. �- INSPECTIONS: In order for the work authorizad under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepectfons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � �aaws (s�ao� WORKERS' COMPENSATIO}; DECLARATION: I heraby eHirtn under penalry of perjury one of the following declarations: ❑ I have end will maintain a certificate of consent to selt-Insure for workers' compensation, es provitletl tor by section 3700 of the Le6or Code, for tha perfortnance ot ihe woM tor w�ich this permit is issuad. 4� • f ❑ I have and will mainlain workers' compensation insurance, as required by section 3700 oF the Labor Code, for [he pertortnance of the work for which this permit is issueC. My workers' compansation Insurance carnar and policy number are: Carrier: Policy Number: (7his secfion need nof be rnm0�eted i! (he Oermit is valued et one hundred dollars ($f 00) or /essJ ❑ I canity that in the pertortnance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to lhe workers' compensation laws f Califomia, and agree that I sho tl become subject to Ihe workers' compensation provisions ot Section 3700 of Ne Labor Code, I shall torthwith comply with ihese pr 'sions. (� � Applicant SignaWre: �z�4 Date: f �C7� 3 b/ � J WARNING'. FAIWRE TO SECLIRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHP1L SUBIECT Ml EMPLOYER TO CRIMINAL PENALTIES D pVIL FlNES UP TO ONE HUNDRED iMOUSAND OOLLARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SELTION 3�O60F THE LABOR CODE, iMEREST, ANO ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I here6y aHirm that I am iicansed under provisions of Chapter 9(commencing with Section 7000) oi Division 3 of ihe Business antl Professions Cotle, antl my license is in tull force and ettecL Lic. # Class x ContractofsSiqnaWre: � dL Date: /O 3(� e 0 CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn ihat Ihere is a conswction lending agency for ihe pertormance of �he work for which this pertnit is issuetl. (Sec. 3097, Civil Code). LentleYs Name: Signature: _ Lendefs Atldress: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirtn that under penalty of perjury that 1 am E%EMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business ana Professions Code: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any stmcture, prior to its issuance, also requires the aOP�icant for such pertnit to file a signed statement that he or she is licensetl pursuent to ihe provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business entl Professions Cotle) or ihat he or she is exempt therefrom and the basis for the allegetl a:emption. Any violation of Saction 7037.5 by any applicant for a permit subjacls the applicant �o e civil penally of not more lhan five huntlretl tlollars ($500).): ❑ I, as owner of the pmperty, or my employees with wages es their soie compensation, WILL DO THE WORK, entl the structure is not intended or oHeretl for sale (Sec. 7044, Business and Pwfessions Cotle: The Contrectors License Lew dces no� apply ro an owner of property who builds or improves thereon, and who does such work himself or herseli or Ihrough his or her own employees, provitled that such improvemenis are not intendetl or offered for sale. If, however, the building or improvement is sold within one year of completion, iha owner-builder will have t�e burden of proving that ha or she did not builtl or improve for purpose of saie.). ❑ I, as owner of the property, am EXCLUSIVELV CONTRACTMG WITH UCENSED CONTRACTORS b constmct the project (Sec. 7044, Business and Protessions Code: The coniractors License Law does not apply to en owner of property who builds or Improves thereon, and who contracis for such Oroject with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am ezempt under sec. Business end Professions Code br this reason: SignaNre: Date: Owner ID verified by dnvar's license. ❑ Ves ❑ No Drivar's License No. Ezpires: Venfication of Ownership by (type of tloament, i.e. - property tau bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N: ❑ I hereby certity that no excavation tive (5) or more feet in deplh into which a person is requiretl to tlescend, will be made in connection with work authorized by this permit, and ihat no building sWcture, scaHolding, talsework, or demoli�ion or tlismantling Ihereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia Administra�ive Code). ❑ A5 owner-builder, I will not employ enyone to do work which woultl require e permit trom Ihe Division oi Industrial Satety, as notetl above, unless such person hes a permit to do such work irom the division. Signature: Date: Division of Indusirial Safety Permit Number. CERTIFlCA7E OF COMPLIANCE AND AUTHORVATON OF ENTAY: I certify untler penalry of perjury that I have read this appliwtion and state that the iniortnation qiven is correct. I agree to compty with all state laws and ciry ordinances relating to building consiruction, and authorize representatives of ihe City of Casta Mesa to emer upon ihe above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authonzed by Ihis permit un�il final inspection. � tu O Legal Owner(s) ��/� D e� � — � -� , And/Or uthonzed Applicant ate COOE t. INSPECTION TYVE 1616 Fizetl System Final Fire Prevention 1266 200 207 202 203 Pool Spa Final Final Re-Foof Finel Block/Retaining Wall Final Factory Fira Place Final Sign 204 Final Demolition DRTE INTRIALS � Jf��"" COUEN INSPECTIONTViE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevenlion 220 Final Planning Approval 222 Final Site 250 Final BuildincyOccupancy on.e INLITIALS � (714) 754-5273 • Fd%(714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT �� FAIR DFIVE, GOSIA MtSA, GA 8Zti2ti JobAddress: 409 BRIGHTONSPRINGS Suite: G007 Vicinity: CARPORTS Parcel Number: TPN98074 Applicant: ALBERTSON, NOEL Address: Owner: BRIGHTON SPRINGS HOA Address 500 BRIGHTON SPRINGS COSTA MESA, CA Contrector: DAVEY ROOFING �NC �Address: 17182 ARMSTRONG AV IRVINE, CA Zip: 92614 Arch : Address: Phone: Zoning: Phone: 714-822-6304 Zip: Phone Zip: 92626 Phone: (949) 852-9955 License: 700710 Eng: Address: ISSUED BY: Slatus: ISSUED Applied: 10/30/2000 Issued: 10/30/2000 Phone: Zip: License: License: SCOPE OF PERMIT REMOVE OLD ROOF, APPLY NEW METAL, INSTALL NEW SHEATHING AS REQUIRED, COVER WITH BUR. 3 CAR DETACHED CARPORT. � - Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0- 0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEESUMMARY PLANNING 8 ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0-0 $2,053.00 $2,053.00 I NOTICE: The work authorizetl 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 it work is suspended or abandoned , for a period of 1 BO days. � li INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all I, required inspectlons and final approval must be obtained. FaiWre to obtain inspections and final approval will resuN in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 _ zans-as �dao� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 lob Address: 409 BRIGHTON SPRINGS Suite No Vicinity: KITCHEN Parcel Nunmber: 93786009 Applicant: UPTON, WILLIE LEE Address: 12 MONTANAS NORTE Owner: Address Contractor: Address: Arch / Eng : Address: ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Founlain Expansion Tank PLUMBING PERMIT Phone: 949-630-4380 IRVINE, CA Zip: 95819-4146 KOLDINGER, MARJORIE STOVALL TR %UPTON, WILLIE L GREELY IRVINE, CA Phone: 12 MONTANAS NORTE Zip: 95819-4146 Phone: Zip: License: Phone: Zip: License: SCOPE OF PERMIT LEGALIZE WATER HEATER PREVIOUSLY INSTALLED. LOCATED IN KITCHEN. AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 QTY FEESUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation 50.00 P-Trap $0.00 Pressure Regulator 50.00 Process Piping (per 10 fi) 50.00 Receptors 50.00 Septic Tank 50.00 Sewer Cap for Demo 50.00 Sewer Connect 50.00 Sewer Private Line 50.00 Shower 50.00 Sink, bar 50.00 Sink, commercial 50.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 Status: ISSUED Applied: 0'I/07/2005 Issued: 01/07/2 5 ISSUED BY: SumpPump Swimming Paol Trap Primer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent Syslem Water Closet (Toilet) Waler Heater / venl Water Piping (Inst or Rep.) Water Re-pipe AMT 50.00 50.00 50.00 50.00 S0.00 $0.00 $0.00 $0.00 50.00 $0.00 $12.30 $0.00 50.00 QTY 0 0 0 0 0 0 0 0 0 0 7 0 0 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of this permit. FOR INSPECTIONS CALL: (714) 7545628 . 2448�48I0/00) WORKERS'COMPENSAnON DECLARAnON: ' ' � I hereby aHirm under penalty of per�ury one of t�e following tleclarations: ❑ I have end wlll maintein a canificate ot consent to sel6lnsure for workers' compensallon, es pmvitletl tor by section 3700 0l iha Labor Code, for the pedormence of the woAc for whlch �his permii is IssueC. ❑ I have and wlll malntain workers' compensation insurance, as reQuiretl by sectlon 3700 0l the Lahor Code, for the peAortnance ot Ihe work tor which this pertnit is issued. My workers' compensatlon Insurence carrier end policy number are: Carrier. Policy Numbar. (7his section need not be comp/efed!! fhe permit /s valued at one huntlred tlollers (5/00) or /e55.J ity that in the pertortnance of the work for which this permit is issued, I shell not employ eny person in any manner so es to become sublect lo the workers' iensetlon laws ol Celitomia, end egree that if I shoultl become sub ect to t�e workers' compensation proNsions of Section 3700 of Ihe Lebor Code, I s�all fotlhwlth ilywiththesepravisions. - �, /^ �—�� rigneture: �.'.-' �qateti ,.:t.---- �p�t ` �AILURE TO SECURE WORKER$' COMPENSATION W ERAGE UNLAWFUL AND SHALL SUBJECT PN EMiY.pYER�TU4liIMINAL PENALTIES AND CIVIL FINES UP TOONE MUNORED DOLLARE�5100,000),INADDITIONTOTHECOSTOFCOI ATION,DAN4GESASPROVIDEDFIXiINSECilON31060FTHELABORCODE,IMEREST,ANDATTORNEV'SFEES. ' LICENSED CONTRACTORS DECLARATON: I hereby ettirm t�et I em licensetl under provisions of Chapter 9(commencing with Section 7000) ot Division 3 of ihe Business antl Protessions Code, entl my Ilcense is In full farce and ettect. Lic. a qass a Contrectors SlgnaWre: Date: CONS7RUC710N LENDING AGENCV: � I hereby ettirm fhet ihere is e consiruction lending agency for the pedormence of Ihe work for which ihis permit is issuetl. (Sec. 3097, Civil Cotle). Lenders Name: Lender's Address: Signature: Date: OWNER•BUILDER DECLARA710N5: I hereby aifirtn that under penelry ol perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business entl Professions Cotle: Any ciry or caunry which requires e permii to construct, alter, improve, tlemolis�, or repair any structure, prior to its issuance, elso requires the applicam lor such pertnit ta lile e signed stetemenl ihet he or she Is Iicensed pursuent to the provislons ot Ihe Contrectors License Lew (Chepter 9(commenUng with Section 7000) of Divislon 3 0l the Business and Pratessians Cade) or thet he or she is exempt therelrom end iho basis lor the elleged exemption. Any Wolation of Seclion 7031.5 by any epplicant for a pertnit subjects the epplicent to e civll penalty of not more than tive huntlretl tlollars ($500).): ❑ I, es owner of ihe properry, or my employees with weges es their sole compensation, WILL DO 7HE WORK, and iha structure Is not intended or offered lor sale (Sec. 7044, Business and Protesslons Cotle: T�e Contractors License Law does not epply Io an owner of Droperty who builds or improves thereon, end who tloes such work himsalt or harself or thwu9h his or her own employees, provided thet such improvements are not intended or ottered for sele. If, however, the builtling or Impwvement is sold. ithin one year oi completion, the owner-builder will have Ihe burden of proving that he or she did not build or improve for puryose of saleJ. � owner of the properry, em EXCLUSIVELV CONTRACTiNG WITH LICENSED CONTRACTORS b consWct the pwject (Sec. 7044, Business entl Professions Code: The contractors License Law does not epply to an owner ol property who hullds or Improves ihereon, entl who contracts lor such project with e coniractor(s) license pursuant to Ihe Contrecmrs license Laws.). antl Professions Coae for this reeson: by tlriver's license. ❑ Verification of Ownership by (type of tlocument, ❑ No property tex blll or DIVISION OF INDUSTFiIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby cetlity Ihet no excavation tive (5) or more feet in tlepth in�o which e person Is required to descend, will be mede in connection with work eu�honzed by this pertnit, end thei no builtling siructure, scaMoltling, talsework, or demolition or tlismantling Ihereot, will be more than thirry-six (36) teel high. (Chap. 32, Grp 2, Art 2, Sec. 341, 71t1e B, Califomia Atlministrative Code). ❑ As owner-builder, I will not employ enyone Io do work which would require e Dermi� Irom ihe Division ol Industnel Satery, as noted abova, unless such person hes e pertnit to do such work irom the divLsian. Signature: Date: Division af Industriel Selely Permit Number: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penal�y of perjury �ha� I have read this application and stete thet ihe information given is correci. I egree lo co with all state lews en ciry ordinances releting to building consirualon, and euthodze representatives of Ihe Clty ol Coste Mesa to enter upon fhe ebove�descri ed erty�Puryo . I a rg e�S�t to oc low occupency of eny building authorized by thi5 Per' until fi� inSPeCtion. ( � � -S— Stqti6tuie oi�agat;Ow hs)�— � LOate�� AnNOr Authorized � p icant Date COOE I, INSPECTIONTYPE QL� II�LS i616 Fixed System Final Fira Prevention 1266 200 201 202 203 Poal Spe Finel Finel Re-Raol Finel BIocWRetaining Wall Final Factory Fire Place Final Sign 204 Finel Demolition cooer wsPecnoxnae 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 FinalBuilding/Occupancy P� INIIDS4,4 OWNERM. D. JANES CO., INC. JOBADDRESS 09 Bryson pr AP No. INSPECTIONS SOIL WS WATEF ROUGM PLUMB�NG PROP. $WR. UNE � $PRINKLING SYSTE MISCELLINEOUS ROUGN HEaTiNG nN UNOERGROlINO �J POWER U ROUGH WIRING TRENCHES FOFMS STEEL REINF FLOOR SVSTEM . FRAME ANO FLRSHING L�THING — IN �� DATE ��-z9-79 BUILDING PERMIT N0. E SUBCONTRACTOR P�PSTER,BROWN C04T STRUCTUR>L, FINnI HERTING, VENT., REFPIG. �NO �.C„ FINAL PLUMBING.FINA� RNO G45 TEST ELECTRIC FINnL -- � BUILOING, FINAL SPECIAL REOUIREMENTS � UTILITV NOTIFIED. Gn5 i ELECT. r � — OWNERM. D. JANES;CO., INC. JOB ADDR�09 r i�' g i-� PROP. SwA. LIHE I f HOUSE CC SPRINK�ING SYSTEM MISCELLANCOl15 ROUGH ME4TING ANO AIR CON01 TEntPORnRY SEpVICE OR POLE UNOEAGAOUNO � POWER � ROUGN wIRING TRENCMES FORMS 5 FLOOR SVSTEM BONp 9EAM I�� STEEL REIN SNE]TMING FR�ME �NO FLRSHING I.RTMING — IN � OUT � PL�STER,BAOWN C04T DATE �o-z9-79 TRACT 10525 FIRE ZONE � VA SUBCONTRACTOR r: � ' LJ�JiU3 C7.5� 07 U�J/l��`s��a'"7-��/7 �3 ;�L-� � , �� / / / i � COSTA MESA BUILDINGSAFETV DEPARTMENT APPLICATTON F SIRUCTURA9L PERMIT��6:84 TL P.O. BOX 1200 COSTA MESA,CAL{FORNIA 92626 RECEIVEDB�' PERMIT For Applicant to Fill in Completely — Use Ink Only BUILDING A,p. NO. - —O.� �7 73 AOORESS 9UILOING °eNANT R M.D. Janes Co. , InC. aooaEss UNIT 00. AODREss 2950 AlrWay AVe. , D=9 SPACENO., Tf�,NO � LOT Q_/ BLK. arv Costa Mesa, 92626 No�979-337 � � NEW ADD ALTER REPAIR MOVING DEMOLISH conisrAucrioN N/A ♦ i cn�ncv FC C LiJ 4 � .�.. S F C 41 F�' Q G J Q � >- � s v� a O C a Z L[] 3 BRANCH ADDRESS ApCHITECT TE C�NTRACT�R owner ADDRE55 TEI. CiTV Np. STATE CITY LIG. NO. LIC. NO. SIZE NO.OF E OF LOT Irreg. �NOWON USE �F m EXISTING BIDG. y Separa[e perrtvts are required for electric, ptumbing and heating work: USE OF HUILDING AND WORK TO BE P£RFORMI Unit Condominium & Attached Garages. �p 1 he�eby acknowlatlge thet I have read thiz ep0llcat(on antl stete that che ebove in4ormetion is cortett end eqree to comply witfi ell laws reBulaUnB builtllnp conrttucNon, antl I s�ell noi employ any persan In vlolatlon of tl�e workman's companaallon laws of the Staro of Californla 1 hereby certify t�et 1 am proPerly Ilcensetl ea e contrector �nder the Stata ot California Buainess end Profasalons Code, Dlvlsion 3, Chaptar 9, and thex suM licenus are in fu11 torca an0 eftact, or 1 am exemOt tram e provislans of Ne Stete of California Businesa antl Pmfessiam C tle, �':ian 3, Ghepcar 9. Slgna2ure of � Permlttee or � Authorizetl A Da APPROVE� APPROVEDSETBACKS (FROMGLSTRE@T) , PLANNING AGTION DATE DATE //'/? P.PPPOVED ,/' r..r�Cl'�S � � THEAMOUNTSHOWN UNDERVALUATI T}1E PVRPO6E OF E5TABLISMING A PERMIT VALUATIQN PERMITFEE E PIAN CMECK S � $�ZI��7� TAX E � N o' � m �� 'v � IS FOR 0 ��` (((�� ONLY: � � N. n o' _ ' V � WORKERS' COMPENSATYJNDECL�IRATION: I hereby attirm under panalty of perjury one of Ihe tollowing tleclarations: ❑ I have end will maintain a certificate of consent to self-Insure for workers' compensetion, es provitle0 tor by section 370tot Ihe L�or Cotle, for the pertormence ot the work for which ihis pertnit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of Ihe Labor Coda, Por the pedortnance of the work tor which lhis permit is Issued. My workers' compensatlon Insurance carner antl pollcy number are: Carner: Policy Number: (This section need not 6e canpleted il Ihe permil is value0 et one hundred dollers ($100) or Iess.J ❑ I certity that in the pertortnance of ihe work for which this pertnit is issued, I shell not employ eny parson in any menner so es to become subject to tha workers' compensetion laws ot celif�, a�gree tbat if I s ould become subject to the workers' compensation provisions of Sectlon 3700 0l the � r Code, I shall torthwith comply with thes�` esions. �� ApplicaniSigneture: �VI� Q X4.:� /SCL..� Dete: //i ��!] �m WARNWGFqILURETOSEC RU EWORKERS'COMPENSATIONCOVERAGEISUNLAWFULPNDSHALLSUBJEGTANEMPLOVERTOCFIM PE TIESAND IVILFlNESUPTOONEHUNDRED TMOUSAND DOLLARE (510p.OW), IN ADDRION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31O80F THE LABOR COOE. INTEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I here�y aHirtn that I am licensed under provisions ot Chapter (commencing with Section 7000) ot Division 3 of I�e Business antl Professions Code, entl my license Is in full lorce end eHecL Lia #. /1 .-. �/� �. _. Class N . ComractoYs Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirtn fhat Ihere is a construction lentling agency tor t�e peAormance ol ihe work lor which �his Oermi� is issued. (Sec. 3097. Civil Cotle). Lentlers Name: Lentlefs Atltlress: Signeture: Date: OWNER-BUILDER DECLARA710N5: I hereDy attirtn that under penalry ol perjury ihat I em EXEMPT FROM 7HE CONTRAC70RS LICENSE LAW tor Ihe following reeson (SecJ031.5, Business end Protessions Code: My city or counry which requires a permit to construct, alter, impmve, demolis�, or repair any structure, pnor to its issuance, also requires Ihe epplicant for such pertnit b file a signed statemem thet he or she is licensetl pursuant to the provisions of the Comrecrors License Lew (Chepter 9(commencing with Sectlon 7000) of Division 3 of the Business ana Professions Cotle) or that he or she is exempl therefrom and the basis for the alleged exemption. Any Wolatlon o� Section 7031.5 by any applicant for e permit subjects the applicant to e civil penalry ot not more than tive hundred dollars ($500).): ❑ I, as owner ot the property, or my employees with wages es Iheir sole compensation, WILL DO 7HE WORK, end the structure is not Iniended or oflered lor sale (Sec. 7044, 8usiness and Professions Code: The Contraclors License Law does not apply to an owner ol pmperty who builds or improves thereon, and who does such work himself or herself or ihrough his or her own employees, provided that such impmvemems ere not imentleA or ottered for ula. tl, however, the building or improvemant is sold within one yeer of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sele.). ❑ I, as owner ol the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conslruct the pmject (Sec. 7044, Business ana Professions Cotle: The contrectors License law tloes not appty to en owner ot property who builtls or Improves theraon, and who coniracis for such pmjed with e contrector(s) license pursuant to Ihe Contrectors License Laws.). ❑ I am exempt under sec. Signaiure: Owner ID verified by drivels license. ❑ Ves ❑ No Business and Professions Code for ihis reeson: Venlication ot Ownership Dy (type of Oxument, i.e. � property ta�c bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Dnvefs LiCense No. Date: Expires: ❑ I hereby cetlity ihat no excavation five (5) or more feet in depth into which e pereon is required to descend, wili be made in connection wi�h work authorized by t�is permit, antl �hat no building shucNre, scattolding, falsework, or demolition or dismantling thereof, will be more ihan thirty-six (38) feet high. (C�ep. 32, Grp 2, Atl 2, Sec. 341, Title 8, Celifornia Atlminisirative Code). ❑ As owner-builtler, I will not employ anyone to do work which would require e permit irom ihe Division of Intlustnel Sefery, as no�ed ebwe, unless such person has e permit to do such work from ihe division. Signeture: Dete: Division ol Indusirial Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVATION OF EMAY: I certity untler penalry of perjury that I have read Ihis aOPliw�on antl s�ate �hat the inFormation given is correct. I agree to comply with all state laws and ciry ordinances ralating to building construction, and aut�onze representatives ot Ihe City of Costa Mese to enter upon ihe ebovedescribed praperty for inspection purposes. I agree not to occupy or ellow occupancy of eny building authorized by Ihis Oermit until final inspection. i9pZiyre Of gal Ow q� \ �7C � � AnNOr Authorized App icant COOE 1. INSPECTIONTYPE 1616 Fixed System Final Fire Prevention 1266 200 201 Pool Spa Final Final Ra-Rool FInaI8lock/Retaining Wall 202 Final Factory Fi�e Place 203 Final Sign 204 Final Demolition P'IF INi111AL5 j� -� .�pX.l,�- CODE� INSVECTIONTYPE 206 Finel Mechenical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Preventi0n 220 Final Plenning Approval 222 Final Site 250 Final Building/Occupancy