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2087 GARDEN LN - Building Permits
.O4111 CITY OF COSTA MESA 66 BUILDING DIVISION Y it DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �. 7; I1 PERMIT ' moo f P01-00670 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No Applied: 11/13/2001 Issued: 11/13/2001 Vicinity: ISSUED BY: • Parcel Nunmber: 42623302 Applicant: ROELLE, MICHAEL Address: 5057 LANTE AVE ' Phone: 626-960-0344 BALDWIN PARK,CA Zip: 91706 Owner: CEFALIA, STELLA AND JOE . Address 1649 BAYSIDE DR • Phone: 949 720 1143 CORONA DEL MAR, CA Zip: 92625 Contractor: MICHAEL G ROELLE PLUMBING Address: 5057 LANTE AVE Phone: 626-960-0344 BALDWIN PARK,CA Zip: 91706 License: 743562 Arch / Eng : Address: • • Phone: Zip:, License: SCOPE OF PERMIT PLUMBING FOR NEW SFR. PLUMBING TO INCLUDE:2 BATHTUBS, 1 DISHWASHER, 1 GAS SYSTEM (1-4 OUTLETS) ,2 OUTLETS OVER 4, 1 LAUNDRY TUB, 1 SHOWER, 1 KITCHEN SINK,4 WASH BASINS,3 WATER CLOSETS, 1 WATER HEATER, 1 WATER SERVICE.APPLICANT NOT DOING SEWER CONNECTION. REF: B01-00310. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $19.60 2 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $39.20 4 Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $29.40 3 Drain,Roof $0.00 0 Shower $9.80 1 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $9.80 1 Gas(1-4 outlets) $5.15 1 Sink, kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $2.20 2 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $181.35 NOTICE: The work authorized by this permits )NimENTits j e eakitinefflaarequirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I ha nd will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the for which this permit is Issued. I have and will m9lntain work,_.'co.••:nation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'com'pptsa�M' n 1I• r d policy number are: Carrier: �l/_NA y ( • a-A Policy Number (This section need not be cccbibrhrnnnpleA•if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree th t if I • me subject to the workers'compensation provisions of Section 700 of t Labor Code,I shall forthwith comply with these provisions. /�/1 j� Applicant Sinature: r----1.72.r-lC A/ .`C 1/ Date: 'tj 1 3 v I WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES D CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE($100p00),IN ADDITION TO THE COST OF COMPENSATON,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provis`o;E of• :pt- ncin•with Section 7000)of Division 3 of the Business and Proles ions Code,and my license is in full force and effect.Lic.4 _e//. . .0 .r 1/ Class N Contractors Signature: +l�tallz Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Ls licensed pursuant to the provisions of the Contractors Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a perr+: subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors Ucense Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors Ucense Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: _ _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Vas ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Ouality Management District or from any other air pollution control district or agency? D Yes IU No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ....on control ..i..i.t'or' g c.. 7 ifa a permitn athe South Coast res Quality cri ed Management District or other airpollution oon4district03 or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature?Le.• ,Fpr(s) ,iii I[ ( I 13) x� Date And/Or Authori ed Appli nt K// U I Date CODE I INSPECTIONTYPE UTE INTTTIALS CODE( INSPECTION TYPE 2TE D 1616 Fixed System Final Fire Prevention 206 Final Mechanical (] 1266 Pool Spa Final 208 Final Plumbing 4-,18-01 Rd 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 4 4`Cali M6 A CITY OF COSTA MESA BUILDING DIVISION :• „ 4;isZDEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER tl � PERMIT M02-00038 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: . 2087 GARDEN LN Status: ISSUED Suite No Applied: 01/24/2002 Issued: 01/24/2002 Vicinity: UNIT E Parcel Number: 42623302 ISSUED BY: Applicant: COOTER, LYLE Address: • Phone: 714-978-7970 Zip: Owner: CEFALIA, JOE Address: %JOE, &STELLA A CEFALIA CORONA DEL MAR,CA Phone: 949 720 1143 1649 BAYSIDE DR Zip: 92625-1832 Contractor: PRO HEATING &AIR Address: ARS AMERICAN RESIDENTIAL SVS OF CA YORBA LINDA, CA _Phone: (714)283-8262 22921 SAVI RANCH PKWY Zip: 92887 License:764099 • SCOPE OF PERMIT MECHANICAL AND ELECTRICAL FOR NEW SFR.ELECTRICAL TO INCLUDE 1 MOTOR TO 4 HP. MECHNICAL TO INCLUDE: 1 -4 TON NC AND 1 FURNACE TO 115;000 BTU'S. REF: B01-00310. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $18.20 1 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep: Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace ; $0.00_- 0 3 To 15 hp/;500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $27.15 1 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee • $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $68.85 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(8/00) DECLARATIONSI WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the w for which this permit is issued. • I have and will mai Iain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'comp` Insurance carrier and policy number are: v ✓�— G 2 D V 3 geP Carrier: on/�/y/''��� r ( GIO/Ly,IL// PolicyNumber: CXJ l�/ (This sect/' eed not be completed tit/ permit is valued at one hundred dollars($100)or less.) • ❑ 1 certify that in the performance of the work for which this permit's.issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that it I sh come subject to the workers'compensation provisions of Se tion 3700 of the Labor Code,I shell forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'CO SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under.revisions of Cha•er 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# P•0 Class# C7,.., C^ Contractor's Signature: Date: / !L� ca,a� CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions • Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_nermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LLII yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (It'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No . ... taca 8 (If'yeattach attachhcertificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ___________--- Ignature Of Legal Owner(s) f Date And/Or Authorized Applicant '/ - Date CODE fr INSPECTION TYPE RATE INTITIAL$ CODE• INSPECTION TYPE ^2&ii 1616 Fixed System Final Fire Prevention 206 Final Mechanical �•,i -Oe. �1 rdk 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place . _ 220 Final Planning Approval . _ 203 Final Sign 222 Final Site 204 Final Demolition . 250 Final Building/Occupancy CITY OF COSTA MESA BUILDING DIVISION r >'la r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J. PERMIT l6. M02-00024 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No Applied: 01/22/2002 Issued: 01/22/2002 Vicinity: • Parcel Number: 42623302 ISSUED BY: Il-------- Applicant: CEFALIA, JIM Address: %JOE,&STELLA A CEFALIA CORONA DEL MAR,CA Phone: 949 720 1143 "" 1649 BAYSIDE DR Zip: 92625-1832 -.\ -li): . a . Owner: CEFALIA, JOE ,, 1' J Address: %JOE,&STELLA A CEFALIA ; CORONA DEL MAR,CA Phone: 949 720 1143 1649 BAYSIDE DR Zip: 92625-1832 Contractor: Address: Phone: Zip: - License: SCOPE OF PERMIT MECHANICAL FOR FACTORY FIREPLACE INSTALLATION. REF:801-00310. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU 4100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU 7100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep, Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $10.65 1 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp 1 1,750 k BTU $0.00 '0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 , 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 • Reinspection Fee $0.00 TOTAL CALCULATED FEES $34.15 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-48 WOO) DECLARATIONS • WORKERS!'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - - ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit/s valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: ' I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS I hereby affirm that under penalty of perjury that I am.EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to"construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed,pursu'ant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more.than five hundred dollars($500).): w7 ❑ I,as owner of the property,or my employees wlih wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,lltle 8,California Administrative Code). ❑ As owner-buildersl-wi •• :Troy anyone zo work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to d•suchr u .. :.d • ,f n. Signature: Date: Divis' of Industri- -afety Permit Number: AZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file end certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LU No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomla Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If'yes'',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agre comply with I state laws and city•dinences relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-de pr nspection as. ..ree not to occupy or allow occupancy of any building authorized by this per mjl until e inspection. / Signet Gq- - - - ate And/Or Authorized Applicant Date CODER INSPECTION TYPE, GATE URRULS CODE! INSPECTION TYPE /�PAfr nr... ' 1616 Fixed System Final Fire Prevention 206 Final Mechanical Z f 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy a� CITY OF COSTA MESA v ) 40 BUILDING DIVISION 7 >:J ..� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER :1 /f I . PERMIT 4. ! � A01-00889 Stibo(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No • Applied: 10/16/2001 Vicinity: Issued: 10/16/2001 Parcel Nunmber: 42623302 Applicant: CEFALIA, JIM ISSUED BY: Address: 1649 BAYSIDE DR Phone: 714-270-6150 CORONA DEL MAR,CA Zip: 92625 Owner: CEFALIA, STELLA AND JOE Address 1649 BAYSIDE DR Phone: 949 720 1143 CORONA DEL MAR,CA Zip: 92625 . Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 SCOPE OF PERMIT TEMP POWER POLE FOR PROJECT CONSISTING OF 5 SFD. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 • Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to.100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl . $0.00 • - • 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 , 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 . 0 Misc. Conduit $0.00 0 Service to 1000a• $0.00 0 Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee, $0.00 Pole Light Pkg $33.50 1 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $57.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with an applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 / 2446-46(6/00) U DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have end will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued et one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37090F THE LABOR CODE.INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.# Class ft Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: - - ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Busines nd Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a pem+' subje the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work II self or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or Improvement is old within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an own: •roperty who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to •: -•n r: tors ' :.• e Laws./ ❑ I am exemp . .er sec. �j-r mess and Professions Code for this reason: /� Signature: ��/ Date: Owner E) drivers lF.' ❑Yes 0 No Driver's License No. fres: V. '- :/ion of Ownership•' type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: t 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 3 ❑YBo ❑ orDoes will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / -ignat eget r r . Date And/0 zed A n Dat •• --4 r•• a- QM 1E0612 CON! 1NSPECT1ON TYPE PATI 21:1IIIAL4 •• • Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing /� 200 Final Re-Roof 210 Final Electrical 7 -12-OoZ nog 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OE COSTA MESA - BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER • PERMIT OPigh,. B01-01465 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite: Applied: 09/19/2001 Vicinity: Issued: 09/19/2001 Parcel Number: 42623302 Zoning: Applicant: CEFALIA, JIM ISSUED BY: Address: 930 W OCEANFRONT Phone: 949-673-5535 NEWPORT BEACH, CA Zip: 92661 • Owner: CEFALIA, STELLA AND JOE Address 1649 BAYSIDE DR - - Phone: 949 720 1143 CORONA DEL MAR, CA Zip: 92625 1 .J� Contractor: Address: Phone: Zip: License: Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT DEMO PERMIT FOR THE DEMOLITION OF A SFD&LATER CONSTRUCTION OF 5 SFD.AQMD REPORT SUBMITTED. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $7,500.00 Permit: $153.25 Claim Valuation: • $7,500.00 SMIP Res: $0.75 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $154.00 • • PLANNING &ZONING SETBACKS- MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-4a(6/00) • DEf4ARATIONS WORKERS'COMPENSATION DECLARATION: • • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: _ Policy Number: (This section need not be completed if the permit is valued of one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($103.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class x Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: it bs I hereby affirm that under,penallydf perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which.requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that heor she is.licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)'or.that•he or‘she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a pem4' subjects the applicant to a civil penalty otnotmore then five hundred dollars($500).): O.d ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or he[own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursu;• o the ....actors Li 7. e Laws.). ❑ • exe •.t u..: - Business and Professions Code for this reason: ����� Xi�j✓►� �;license.it— : Exp'JOJS V :lion of Ow ship by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Calitomia Health and Safety Code requires,with some exceptions,that a Business Plan be fled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Calitomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be tumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF NTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to com 1 with all sta aws and city o• -.nces relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described p or in •tJ s tee not to occupy or allow occupancy of any building authorized by this permit until final ins ction. ^ner(s) ate And/Or Authorized Applicant Date POOE X INSPECTION TYPE PAIL INTRIALS CODEX INSPECTION TYPE PATE INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign222 Final Site 204 Final Demolition 250 Final Building/Occupancy Wir RP' Spectra atement SAMPLE REPORT SEPTEMBER 17,2001 TO: JIM CEFALIA COMPANY: CEFALIA CONSTRUCTION ADDRESS: 930 W OCEAN FRONT NEWPORT BEACH,CA PHONE: 949 673 5535 FAX: 714 270 6150 JOB 0: 1623 JOBSITE: 2087 GARDEN LN COSTA MESA, CA SCOPE OF WORK: Submit bulk sample(2)to an independent laboratory for analysis. ASBESTOS CONTAINING MATERIALS: Sample no. 01 tested Negative for the presence of asbestos— Sample no. 02 tested Negative for the presence of asbestos o ACOUSTIC • LINOLEUM Enclosed is a copy of the laboratory analytical 7M North lemon Strut erne.COMMIS SIMM 771MOSS 714 7711W.. • • MG COMPANY 4 FAX el0, Sep. 17 20 .,0:S0AM P1 • =tile ivironmenta)Monitoring Group • CERTIFICATE OF POLARIZED LIGHT MICROSCOPY ANALYTICAL REPORT IT NAME; SPECTRUM ABATEMENT EMC Project#SE327086 784 North Lemon Orange,CA 02887 RCT SITE: Job#1823/Jim Cefe(ik Date Reported:09/10/01 following samples of materials suspected of containing asbestos were tattooed from the locations listed below and lyzed tot asbestos content. Percentage and type of asbestos were determined by using the principles of Polarized Light auseopy and dispersion staining,roving N1OSN approved Mcthod7403. The method is Anther defined in the E.P.A. /M4-82-020,"Interim Method for the Determination of Asbestos in Bulk Insulation Samples". The results,claws and ations of the samples nue listed in the report helot/v. type Of Asbestos MS Fibrous total%Infamous $e no. Lab no. Sample Oats Smote Laudon Material Mineral Passe sbntos rye %hent type Mineral imsimes 20277 oanonOt Laving room Acoustic Ceiling None Detected 10-is% 80.85 . 20278 08/10101 Kitchen Linoleum None Detected 10.16% 8496% • r _ SaiguLaradadkuw � a.s Sean Tree Laboratory Analyse late: our bnliuy to In dtg sic of%ampb unlock written nottgeetlon 1r roocrvM In nm cetoc wipun 30 eayc mete return. Page:1 DBE MRA AAR PAT ENVIRONMENTAL CONSULTANT 280 N. MAIN STREET., ORANGE,CA 02868 • TEL: (714) 5a2-0908 1nAX, (714) h32•552$ regi • CITY OF COSTA MESA - BUILDING DIVISION F "- .,� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT JaiPionona IIPLa ' B01-01613 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite: Applied: 10/11/2001 Vicinity: PERIMETER WALL Issued: 10/11/2001 Parcel Number: 42623302 Zoning: Applicant: CEFALIA, JIM ISSUED BY: Address: , Phone: 949-673-5535 Zip: Owner: CEFALIA, STELLA AND JOE Address 1649 BAYSIDE DR 3 Phone: 949 720 1143 L� CORONA DEL MAR, CA Zip: 92625 �/- Contractor: Address: Phone: Zip: License: Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT APPROX.500 L.F. PERIMETER TRACT WALL FOR 5 UNIT SINGLE FAMILY DEVELOPMENT ON GARDEN LANE.WALL IS 2 FT. RETAINING WITH 6'BLOCK ON TOP. REF:G01-00003.STRUCTURAL CALC'S ATTACHED TO GRADING PLAN AND FILED.WALL LOCATION IS SHOWN ON GRADING PLAN. FEE SUMMARY Plan Check: $254.31 Calc Valuation: $25,000.00 Permit: $391.25 Claim Valuation: Woo SMIP Res: $0.00 SMIP Corn: $0.00 Other: $0.00 • Inspection: $0.00 Total: $645.56 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 •Required: 0 Proposed: 0 NOTES: COLLI_KJ 10/11/2001 STRUCTURAL CALC'S FILED WITH GRADING PLAN AS WALL LOCATION IS SHOWN ON GRADING PLAN. GRADING PLAN IS G01-00003. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ve and will maintain workers'compensation insurance,as required by section 3700 of the labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Ca er: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) 0 I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws• and a• ee that If I sho Id •• •me subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the . • / //''�� Applicant Signatur: _ �— Date: 10 — I l r 0 \ WARNING:F -'O SECURE WO- 'ti'COMPENSA • COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED • . •• -E($100.000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I her y affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full f e n effect.Ljc.0 Class a t o ors Signature: Date: JO --. I I- (3 1 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lender's Name: ��- Lenders Address: Signature: ll)/.c'/r>•- Date: ---‘,---)t tr.) un ir.-_ OWNER-BUILDER DECLARATIONS:(2Q( I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a.permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Bust s and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a perms' su ' cts the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work mself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is vAi old within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursue• • •Contractors License Laws.). ❑ I am exempt und., ec / — Business and Professions Code for this reason: Signature: ' ��� Date: `O — I I r. 0 I Owner I• - I'4 by driv •• •' se. •■ Yes 0 No Drivers License No. Expires: V, • •n of Owne hip by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, _ or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? D Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application agermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residentlal building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. „If Or Authonzed Applicant Date r i "AEC INSPECTION TYPE RAIL fU AL$ CODE I INSPECTION TYPE 12,8.11 =Ma Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site i 204 Final Demolition 250 Final Building/Occupancy • ,I!. t • CITY OF COSTA MESA '• ' o• 4@@ BUILDING DIVISION F '�I$ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER !L�Plira PERMIT Jet B01-00310 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite: Applied: 03/12/2001 Vicinity: UNITE Issued: 10/05/2001 Parcel Number: 42623302 Zoning: Applicant: CEFALIA, STELLA ISSUED BY: ' Address: 1649 BAYSIDE DR Phone: 949 720 1143 CORONA DEL MAR,CA Zip: 92625 Owner: CEFALIA, STELLA AND JOE Address 1649 BAYSIDE DR Phone: 714-270-6150 CORONA DEL MAR,CA Zip: 92625 Contractor OWNER-BUILDER Address: Phone: Zip: License: 0 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT 2358 SF NSFD. 1050SF 1ST FLOOR, 1308SF 2ND FLR,640SF GARAGE 75 SF PORCH. PLAN 1B.UNIT5. SEE DR-00-29NT-15991 FEE SUMMARY Plan Check: $1,075.46 Calc Valuation: $217,218.00 Permit: $1,654.55 Claim Valuation: Moo SMIP Res: $21.72 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $2,751.73 • PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 20-0 Rear 40-0 Left 28-0 Right 5-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 16 Proposed: 18 NOTES: • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-48(MO) , L. •DtCLARATIONS I I WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ' ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensator insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed i/the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUalECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.N Class X Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER•BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit • to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Busine and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a pem+' sub is the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. /44 ,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,end who does such work mself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or Improvement is ld within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). s owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, .•d who contracts for such project with a contractor(s) license pursua o the Contractors Licen : :ws.). 7 Of ❑ lamexe ••:! .._--'-- ' $ .ines •fession- ode fort re ' Signature: " /��' �oAe L --e. , - Date: _���`� Owner • •died by driver's license. ❑Yes 0 No Drivers Licen - o. Expires: V: ' . Ion of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application agpermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 13 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occu•ancy o any building authorized•' this permit until final inspection. Si•natu : . Legal•--1-r i/ r D /1111 And/Or •utTrd Ap:leant Dat• CO, I INSPECTIONTYPE pATE (NTITIALS SODEE INSPECTIONTYPF IMIE INIIIIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site AI 204 Final Demolition 250 Final Building/Occupancy •®__ //�/" r ' • t .. NEWPORT-MESA UNIFIED SCHOOL DISTRICT N2 3956 CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 To: (X) City of Costa Mesa District Receipt No. ( ) City of Newport Beach ( ) County of Orange Plan Check No.,8O/DO3/c r Applicant: /Ir.b" e r Address: Telephone Number: 7/ Y - 2-70 — lc/ Sr) ` pfi--.0x4 eft cZ� 2_,N���20 Tract/Parcel and Lot Number(s): �7 / ` Location of Project: Number of Square Feet of: ,�•�/ ZCommResidential Space .23515$1.84 Total s ' `T '32, 72- Commercial ercial and Industrial Space x $ .30 Total Commercial'lndustrial Project is: (Check One) Warehouse _ Motel Preschool R 8 D _ Bank _ Auto Repair Movie Theater _ Neighborhood Shops __ Hospital Mini-storage Racquet/Health , Large Office Heavy Industrial _ Hotel ___ Office Bldg. Regional Shops _ Medical Office _ Restaurant Light Industrial _ Office Park _ Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport-Mesa Unified School District. By: Authorized Represenhtive The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not true,then this certificate shall automatically terminate and the appropriate City/County shall be notified! 68 2601/11:31 6H/1 4338.72 cf �O/ RCPTN:01 6186336 L Date: _ Applicant p H&.- CITY OF COSTA MESA . . 04 a. BUILDING DIVISION F t' ;. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 01.5411. • PERMIT E02-00068 IMO (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED - Suite No 7 Applied: 01/25/2002 Vicinity: Issued: 01/25/2002 Parcel Nunmber: 42623302 Applicant: RADOGNE, TINA ISSUED BY: Address: 1656 BABCOCK Phone: 949-642-2431 COSTA MESA,CA Zip: 92627 - Owner:, CEFALIA, JOE • Address %JOE, &STELLA A CEFALIA CORONA DEL MAR,CA Phone: 949 720 1143 1649 BAYSIDEDR Zip: 92625-1832 ' Contractor: BOYER, TOM CO Address: 1656 BABCOCK . Phone: (949)642-2431 COSTA-MESA, CA Zip: 92627 . ' License: 566902 • SCOPE OF PERMIT ELECTRICAL FOR NEW SFR'RESIDENCE SQUARE FOOTAGE IS 2358. 1 OUTLET, 1 SWITCH, 1 LIGHT FOR GARAGE:REF: B01-00310 - - - - - - FEE SUMMARY ' Quantity - - . . - - Quantity . ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway"/100 ft $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $132.05 2358 _ Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 ' Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 . . ` -up to 10 kva/kw $0.00 0 Lighting Fixts $1.10 1 - up to:50 kva/kw $0.00 - 0 Recept Outlets $1.10 1 . • , ' up to 100 kva/kw. $0.00 , 0 ' Switches $1.10' r•- 1` over 100 kva/kw _ $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 ' Service to 1000a $0.00 0 . Misc.Conductor $0.00 0 Service over 1000a N $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 , Christmas Tree Stand $0.00 '0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 - . 0 Motors to 100hp $0.00' . 0 Other Electrical Fee - $0.00 Motors over 100hp $0.00 0 - Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $158.85 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord:No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • ❑ I.have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the-performance of the work for which this permit is issued. TI have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Myww r'k-ers,',comp`ensation inssurranc`e,carrier and policy number are: (� Carrier: -ik-�. LCm�,I `-Onk-ALW\ 'Ic'ts iti YPA-• -'SU f"L'i Policy Number: \1/4Dl J\SC'� (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) • ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calitorn' , nd agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p visions. (Applica`nt Signature:— . A Date: \-0-"C3 tDt WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Sessions Code,and my license is in full force and effect.Lic.# G- Class# C.� C.,(Contractor's,Signature: hQ, t< Q, Date: CONSTRUCTION LENDING AGENCY: • ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant Cr present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air duality Management District or from any other air pollution control district or agency'? Yes (D No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described ppprroopperty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. O,�ign!,a�I-tuurr�e`'O`tp-LLegal Owner(s) �S Date `ref` �An rA Authorized Applicant Date CODE t INSPECTION TYPE PATE *TRIALS CODE. INSPECTION TYPE PATE 1NTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final - 208 Final Plumbing .. 200 Final Re-Roof 210 Final Electrical 7//J�/Aa 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition- 250 Final Building/Occupancy • 9 CITY OF COSTA MESA 66 BUILDING DIVISION „ ,i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT • E02-00059 %bunny.1 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No E Applied: 01/24/2002 Vicinity: UNIT D Issued: 01/24/2002 Parcel Nunmber: 42623302 Applicant: COOTER, LYLE ISSUED BY: Address: Phone: 714-978-7970 Zip: Owner: / CEFALIA, JOE Address %JOE, &STELLA A CEFALIA • CORONA DEL MAR,CA Phone: 949 720 1143 " 1649 BAYSIDE DR Zip: 92625-1832 Contractor: PRO HEATING &AIR Address: ARS AMERICAN RESIDENTIAL SVS OF CA YORBA LINDA,CA Phone: (714)283-8262 22921 SAVI RANCH PKWY Zip: 92887 • License: 764099 SCOPE OF PERMIT -- - . MECHANICAL AND ELECTRICAL FOR NEW SFR. ELECTRICAL TO INCLUDE 1 MOTOR TO 4 HP. MECHNICAL TO INCLUDE: 1 -4 TON A/C AND-1 FURNACE TO 115,000 BTU'S. REF: B01-00310. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 - Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 - 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 •. 0 • up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 - o up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 _ 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $12.30 1 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $35.80 Intermed Pole $0.00 0 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)7545626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the rk for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'c s tion ura c rrier nd policy number are: Carrier: t > Policy Number: (This section nee no ••- =ted if thi rmit is valued at one hundred dollars($100)or less.) /V) '- 7 v 3(6 7 ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should becom subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. ? /� �� Applicant Signature: Date: (Y WARNING:FAILURE TO SECURE WORKERS'COMPE S VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100.000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Cfode,and my license is in full force and effect.Lic.4 S air A Class 4 Contractor's Signature: Date: eft_ A- CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more then five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,end who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt under sec. Business and Professions Code for this reason: _ Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes Ll No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Dale: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Owner(s) D t�e °_ And/O uthorizedApplicant /�, Date CODE II INSPECTION TYPE PEE INITIALS CODE INSPECTION TYPF DATE INTRIAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 7//c Ve s 2- 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 _Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - -. . 250 Final Building/Occupancy • • 9 CITY OF COSTA MESA 4 BUILDING DIVISION - Y:j ..w, DEVELOPMENT SERVICES DEPARTMENT PERMIT NOIMBER - J. in . PERMIT (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,cosSOthaaPfka92626 GRADING PERMIT Job Address: 2087 GARDEN LN Status: PENDING Suite: Applied: 03/26/2001 Vicinity: Issued: Parcel Nunmber: 42623302 Zoning: ISSUED BY: G Applicant: CEFALIA, STELLA AND JOE Address: 1649 BAYSIDE DR Phone: 949 720 1143 CORONA DEL MAR,CA Zip: 92625 Owner: CEFALIA, STELLA AND JOE Address 1649 BAYSIDE DR Phone: 949 720 1143 CORONA DEL MAR,CA Zip: 92625 Contractor: - -Address: Phone: -, -� Zip: , License: ' Eng : ROBIN HAMERS Address: • Phone: 949-548-1192 Zip: License: SCOPE OF PERMIT CUBIC YARDS GRADING FOR NEW 5 SFR.. 450 FEE SUMMARY Plan Check: $33.00 Calc Valuation: so.00 $0.00 Permit: $107.00 Other: $0.00 $0.00 Inspection: $0.00 $0.00 Total: $140.00 PLANNING &ZONING NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-48(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: y hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. - ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.4Class it Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM'THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a perry' subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or heiselt'or,through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is sold within one.year.of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors Licenselaw'doetnot apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursue. '"Contract. license Laws.). axe •• sec. �-� Business and Professions Code for this reason: Si tura' -�_ �• Z�xpires V: 'i Ion of Ownership by(type of document,i.e.-property tax bill or dee• . DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No B (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree n.t to occupy or allow occupancy of any building authorized by this permit until final inspection. i/ .L_ Z, 0 '1Or Au •rtzed Applicant •'re •.•1 INSPECTION TYPE INTITIALE COPE INSPECTION TYPE PATE INTMALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention J 202 Final Factory Fire Place 220 Final Planning Approval �/ 203 Final Sign 222 Final Site - ZS--- S/!Y�/ 204 Final Demolition 250 Final Building/Occupancy J II CITY OF COSTA MESA t4/� 9 BUILDING DIVISION o> :r ,a" DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F 1 �j •• PERMIT J �' m'l B01-00309 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite: D Applied: 03/12/2001 Vicinity: UNIT D Issued: 10/05/2001 Parcel Number: 42623302 Zoning: Applicant: CEFALIA, JOE ISSUED BY: _a±• Address: 1649 BAYSIDE DR - -�,, /2 - ;Phone: 949 720 1143 CORONA DEL MAR;CA-' . - Zip: 92625 Owner CEFALIA, STELLA AND JOE Address X1649 BAYSIDE DR, ' / • _ - , Phone: 949 720 1143' ' CORONA DEL MAR,CA Zip: 92625 - - Contractor: OWNER-BUILDER Address: - ' Phone: _ - - Zip: License: 0 v \ Arch : - _ Eng: Address: - Address: l„ , Phone: - ,, Zip: : License: License: SCOPE OF PERMIT _ / 1752 SF NSFD.706SF 1ST FLOOR, 1046SF 2ND FLR,"430SF GARAGE,23 SF PORCH. PLAN 3A. UNITD ' , SEE DR-00-29NT-15991 • - FEE SUMMARY ' _ Plan Check: $864.34 Calc Valuation: , $159,864.76 Permit: $1,329.75 Claim Valuation: $o.00 • SMIP Res: $15.99 SMIP Corn: $0.00 • Other: $0.00 Inspection: $0.00 Total: $2,210.08. . :- . " - PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 40-0 Rear 15-0 Left 10-0 Right 5-0 ACCESSORY Front 0-0 - Rear 0-0 Left 0-0 Right 0-0, PARKING Existing: 0 - Required: 16 Proposed: 18 NOTES: - • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requIred Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6N0) • • DECLARATIONS " ' t WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is isaled. My workers'compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($105,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37050F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Uc.a Class 4 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: - Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Busine and Professions Code)or that he or she I&exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a perrr4' sub is the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work self or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors Ucense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuan(to'the Contractors License Laws). i ❑ tem exerppt under sec. : mess and Professions Code for this reason: Signature: 0C---// d c ( a � Date: Owner I ed by drivers license. ■ Yes 0 No Drivers License No. Expires: Ve' tion of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisapplication agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .................. 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the,subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with al state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with at state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occ py or allow occupancy of any building authorized by this permit until final inspection. a Signatur; e eget Own:rr� /L Dote i �/ _...• And/Or Authori .'ppllcent eat: CODE YINSPECTION TYPE PATE MALI CODE( INSPECTION TYPE PATE INTIDALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical _ 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place Final Planning Approval �� 203 Final Sign \ 222 Final Site WAIVE- /7 204 Final Demolition \ 250 . Final Building/Occupancy `H I 1 _ > . :. CITY OF COSTA MESA - t BUILDING DIVISION h ..�I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J 2 PERMIT M02-00023 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT • Job Address: 2087 GARDEN LN Status: ISSUED Suite No D Applied: 01/22/2002 - Issued: 01/22/2002 Vicinity: • Parcel Number: 42623302 - ISSUED BY: " -.......--- Applicant: CEFALIA, JIM ---;,.y{.?:--": �� - - Address: %JOE,8 STELLA: A" CEFALIA- �' \ 7, .� CORONA DEL-MAR,CA _- Phone:-949 720 1143 1649-BAYSIDE DR'. _-- ' Zip: 92625-1832 - - - ,N Owner: - 4'CEFALIA, JOEL; - Address:, %JOE,8 STELLA A CEFALIA - N CORONA DEL MAR,CA Phone: 949 720 1143 ' - ` N' - • 1 . 1649 BAYSIDE"DR Zip: 92625-1832 Contractor: ' : -/ . Address: - •P,hone: t �„ -��, , - _ , SCOPE OF PERMIT / MECHANICAL FORFACTORY-FIREPLACE INSTALLATION. N - , - REF: 801-00309.: ii,• - - . - . ' . - .. _ ._, FEE SUMMARY . - - Quantity . ' ' Quantity ISSUE FEE $23.50- " - - .- - Repir/Alt Absorblion Unit I $0.00 . 0 Inst'FAU<100 k BTU $0.00'. -0- ' -- Repair/-Alt Refrigeration Unit ' $0.00 0 i Inst FAU>100 k BTU $0.00 0 Ventillation System 4 $0.00 0 ' Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler - $0.00 0 Inst/'Rep. Recess Wall Htr $0.00 0 Commercial.Incinerator $0.00 '0 Refrig Sys<100 k BTU • $0.00 0 Domestic Incinerator - , '$0.00 . 0 . Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems , , 4 Gas Piping $0.00 0 . . ' . ,,-.Up to 3 hp/100 k BTU , ' $0.00 :0 Factory Fireplace- ,. $10.65 1 3 To15hp/500 k BTU - $0.00 , - 0 Hood w/Mech Exhaust-- ' v $0.00 0 15 To 30h /i,000 k BTU c ,/, $0.00' '0 ' 30 To 50 h /'1 750lcBTU - /,/' ` �'. P � .. �' 50.00 .0 Vent Fan/Single Duct - $0.00 -0 '- Over 50 hp/Over.1,750 BTU 7 ' ' $0.00/' 0 Appliance '$0:00-/ 0 - - - Boilers Fire Dampers ' �-N $0.00,-,A�., _ :- Upto-3 hp- /j„ ,,$0.00 0 Smoke Dampers - - . ,'. $0.00 ' 0 3 To 15 hp , $0.00 0 Inst or Relocate Appl Vent' $0.00 0 - - 15 to 30 hp - - - , . - $0.00 0 Air Handlers< 10000cfm ' . $0.00 . 0- 30 to 50 hp , . $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace - $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 " Investigation Fee - - $0.00 Plan Check Fee - $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $34.15 COMMENTS/SPECIAL CONDITIONS • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-48(aN0) DECLARATIONS WORKERS'•COMPENSATION DECLARATION: .. _ I hereby affirm under penalty of perjury one of the following declarations: - , ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. - ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: - Carrier: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE CAST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: � . I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Lice N_ Class II Contractors Signature: " Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: t Lenders Address: Signature: ' Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who does such work himself or herself kir through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one.year inof completion,the owper-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). � ❑ I,as owner of the p1rroperty,-am;EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors'Llcense Law does.not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant t0 the Contractors"LicenssgLaws.). ❑ I am exempt under sec. "Cbt[ Business and Professions Code for this reason: Signature: " Date: Owner ID verified by drivers license. 0 Yesi 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that n0 building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-buil , will of e •• anyone to do w. which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to d uch wo rop' :divis'•.r- Signature: _ Date: Divisio dustrial ' Permit Number: 'HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code.with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 ❑ o ❑ Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No __._ _�.._ ._..._...._ modification 5 Does or willo the ap stcAir or in building o from at other for the work which Is the subject this a estion 00 Nnit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? �Yes ❑No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No e...attach certificate o. o.. la. e fromthe p... riot...i.fol ti nco tr.l officer................. . e (If yes",attach of compliance the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is • correct. I a• -. o c• ply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-•„cribed• •p:•• - - • :W.:,• •• :e :: ••to occupy or allow occupancy of any building authorized by this per it until fin inspection. Signature 01 Legal Owner(s) ate • And/Or Authorized Applicant Date CODE I INSPECTIONTYPE QATE INTITLAI4 CODE INSPECTION TYPE ll. 1616 Fixed Sy$tem Final Fire Prevention • 206 Final Mechanical I /2- S Ar 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 ' Final BIocldRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy :a) CITY OF COSTA MESA 4 BUILDING DIVISION > • ,r. ,i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER lei wl.ws. I PERMIT /E02-00067 4tbsomopo 64 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No D Applied: 01/25/2002 Vicinity: Issued: 01/25/2002 Parcel Nunmber: 42623302 Applicant: RADOGNE, TINA - ISSUED BY: Address: 1656 BABCOCK '•'- ' Phone: 949-642-2431 COSTA MESA;CAI: • Zip: 92627 - Owner/ C,EFALIAvJOE . ' �� Address %JOE,&STELLA A CEFALIA` ' - CORONA DEL'MAR,,CA Phone: 949 720 1143 1649 BAYSIDE DR Zip: 92625-1832 ' Contractor 'BOYER, TOM CO Address: 1656 BABCOCK .' . -Plione: (949)642-2431. - - COSTA MESA,CA' Zip: 92627 . ' - ,�' License: 566902 �� - - -.. . - SCOPE OF PERMIT ,- __ .. _ ,. . N i r ELECTRICAL FOR NEW SFR. SQUARE FOOTAGE OF RESIDENCE-IS 1752. 1 OUTLET, 1 SWITCH,I LIGHT FOR GARAGE'REF:-BOt-00309-- - - '- .. - - - -' , '_FEESUMMARY . Quantity - -',� !: - - . Quantity ,- ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 ,' " Temp service test $0.00 Busway//100 ft" . ' $0.00 0,' , Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $98.11 1752Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 ' -Transformers up to 1 kva/kw $0.00 ' 0/ ' • Pool/Spa ' , $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts, ' t$1.10 1 - up to 50 kva/kw $0.00 ' 0 • Recept Outlets $1.10 . 1 .. up to 100 kva/kw-_. _ $0.00" ' 0 Switches ' $1.10 - 1`" over 100 kva/kw $0.00 0 Non Res Appl • - $0.00 . 0 Low Voltage Equipment $0.00 ' ' 0 ' _ Low Volt Wiring System/Ckt - : $0.00 ', '-0 Service to 200a " ' / $0.00-, ' ':•0 - Misc.Conduit $0.00 ' 0 / Service to 1000a .,$0.00 '0 . - Misc.Conductor . '. $0.00' i 0' ' Service over 1000a A $0.00 ; 0 - Circus(gen or ride) Motors to 1hp ", -$0.00 0 Circus(mech ride or lights) $0.00 ' , 0 Motors to 10hp N, $0.00 � "' -0 i • - - Christmas Tree Stand A ' ' $0.00". -//0 Motors to 50hp �'-$0.00 0 Fireworks Stand - $0.00.-" 0 Motors to 100hp $0.00; • - 0 ' ', , :Other Electrical Fee : $0.00 Motors over 100hp $0.00"' 0 Communication drops $0.00 '--0 - Investigation Fee • ' N - - $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $124.91 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(a100) DECLARATIONS WORKERS'COMPENSATION DECLARATION: - • I hereby iiru under penalty of perjury one of the following declarations: - • - ❑- I ve and will maintain a certificate of consent to self-Insure for workers'compensation,es provided for by section 3700 of the Labor Code,for the performance of the ork for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My work rs'compensation In urance carrier and policy number ape ' Carder: CAFftYw :Jvrl 109.acG.Y1C(. kt;nok Policy Number: 1LO'7S 54 (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) • ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California d agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with thes Ovisions. I Ap—Sign to ure: kV. ��x Date: �_ at WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed u der provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Buess and Professions Code,and my license is in full - force and effect.Lic.# cJ O l Class#LAO 14'l!t �Contract�gnature:' 4-1/4-1-a Date: k--2S t- CONSTRUCTION LENDING AGENCY: ' ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: A Lender's Address: Signature: - "*q _ Date: OWNER-BUILDER DECLARATIONS: • I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed puP4uant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-bbuilder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). , ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Driver's License No. Expires: - Verification of Ownership by(type of document,i.e.-property tax bill or deed): • DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 6,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS MID EMISSIONS CERTIFICATION: ' 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires;with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to tile a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes U No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above--pdescribed property for for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. , LW '/ 'Sig ur 1 La al Owner(s) Date {_And/ r. uthorizztl Applicant— Date SDDE, INSPECTION TYPE pail INTPSALS CODE, INSPECTION TYPE 2AIE ILLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 200 Final Plumbing 200 Final Re-Roof 210 Final Electrical 7E112- 201 ®Z201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place . • . 220 Final Planning Approval . 203 Final Sign 222 Final Site - 204 Final Demolition. , . ._ 250 . Final Building/Occupancy l < ' M` CITY OF COSTA MESA 4q BUILDING DIVISION f � � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER Pica PERMIT tE02-00058 R 04. (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No D Applied: 01/24/2002 Vicinity: UNIT D Issued: 01/24/2002 Parcel Nunmber: 42623302 • Applicant: COOTER, LYLE _ - - • - -- . ISSUED BY: Address: - -�,::•,..- , / Phone:' 714-978-7970 - ��� / Owner.,/,CEFALIA,'JOE ���i` •, Address /%JOE &STELLAA CEFALIA�� CORONA-DELMAR,-CA Phone: 949 720 1143 1649 BAYSIDE R. Zip: 92625-1832 ��'• i �' ` ///4 ` "Contractor: PRO-HEATING & AIR - �' � � Address: ARS AMERICAN.RESIDENTIAL SVS OF CA - ' YORBA LINDA, CA r Phone: (714)283-8262. - \� 22921 SAVI RANCH PKWY" ' - - Zip: 92887-; - • - License: 764099 - - SCOPE OF PERMIT ' ,/ ' .MECHANICAL AND ELECTRICALYFOR NEW SFR. ELECTRICAL TO-INCLUDE 1`MOTOR TO 4 HP. MECHNICAL TO INCLUDE: 1 -4 TON-A/CAND•I-FURNACE TO 115;000 BTU'S., .,/ 'REF: B01-00309. - 1- - _ � � . .. . FEE SUMMARY/ Quantity - ' . Quantity ISSUE FEE $23.50 Temp.Dist System/Lighting $0.00 0 " ' Temp service test $0.00 Busway/100 ft $0.00 ' 0 , Res •a/c package, • $0.00 ;Standing Section '$0.00 New Res(1'-2 units)' '•" ' $0.00 0 t/.!''r`' Misc Electrical Equipment $0.00 ` .0 New Res,(3+units) A\:-'.$0.00 0 Transformers up:to 1 kva/kw $0.00 /-/ 0 Pool/Spa $0.00 0 ,, _ up to 10,kva/kw ,$0.00'. 0 Lighting Fixts `- - $0.00: •.I•'"'0` - up to 50 kva/kw, $0.00" 0 ' , ' • Recept Outlets =' - 0.00 ,� 0 - up to 100 kva/kw , - $0.00 -' N.0 -�' Switches ,,, / $0;00 ', ',0 over 100 kva/kw - $0.00 ;'--0 Non Res Appl . ' $0.00 ' '0-' - ' Low Voltage Equipment - $0.00 , _ 0 - Res Appl . $0,00 0- ' Low Volt Wiring System/Ckt , $0.00 , 0 Service to 200a $0.00 , 0 - - - T Misc.Conduit $0.00 '• /0 i Service to 1000a $0.00 - 0 Misc.Cond actor . .' $0.00.. 0 Service over 1000a `., -$0.00 - ' ' 0 ' - Circus(gen of.ride)", - 50.00-'- %0 Motors to 1hp ` $0.00'- • • 0 - ., Circus(mech ride or 'lights) -'50.00: 0 Motors to 10hp $12.30'-'N-.- 1 " :Christmas Tree Stand -i- $0.00 0 ' Motors to 50hp $0.00 "-7 -0 - 'Fireworks Stand _.. - - x$0.00 0 Motors to 100hp $0.00 �0�L :. .. Other_ElectricalFee'' 2. $0.00 Motors over 100hp $0.00 Communication drops $0.00 0 ' Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $35.80 Intermed Pole $0.00 0 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • 2446-46(6/00) • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: •• • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Jr!have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: 4/ 7 45,3�6� Carder: t,Q t"A.A PolicyNumber: (This section need not beompleted if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: �- Date: / , 2 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND On 1 ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: . I hereby affirm that I am licensed under provisions of q Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a 7 6 d4) y Class A City Contractors Signature: Date: I — 214- LM a—' CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: • I hereby affirm that under penalty of perjury that I ani1EjEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:Tly Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.it,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Cale provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. — 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes jU No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /• lure Of Legal Owner(s) And/Or Authorized Applicant Data cocaI UNSPEC Qy7YPE PATE MUM CODE! INSPECTIONTYPE RAIL R LS 1616' Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing• - (� 200 Final Re-Roof 210 Final Electrical 7/rte?/1P /f HB 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place • . 220 Final Planning Approval - • • 203 Final Sign 222 Final Site • 204 Final Demolition - . - .. 250 Final Building/Occupancy • CITY OF COSTA MESA k BUILDING DIVISION > / ,r : DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 fl • PERMIT M02-00037 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No D Applied: 01/24/2002 Issued: 01/24/2002 Vicinity: UNIT D Parcel Number: 42623302 - - ED BY: Applicant: COOTER, LYLE-12/2'- , Address: � .� - ' . - �i%. " � ,,/,-:17 , Phone: '714-978-7970 = ' ' Zip: --J �. . Owner. , 'CEFALIA, JOE Address:' %JOE,&STELLA A CEFALIA i CORONA DEL MAR,CA Phone: 949 720 1143 ,,jA��_% ` ' 1649 BAYS/IDE/DR Zip: 92625-1832 �7;�../ I . . Contractor: ' PRO-HEATING &AIR Address: ARSAMERICAN-RESIDENTIAL SVS.OF CA ? YORBA LINDA• ,CA, , 22' Phone.(714)283'4262 ,- 22921 SAVI RANCH PKWY ` ' ••Zips ' .92887 - . - r License:764099 -. , • SCOPE OF PERMIT \-" MECHANICAL AND ELECTRICAL FOR.NEW SFR. ELECTRICAL TO INCLUDE 1 MOTOR TO 4 HP. . MECHNICAL TO/INCLUDE:-1--4 TON"A/C'AND,1 FURNACE T0.115;000 BTU'S., , - REF: B01-00309 . - . - . _ "-, ."-,N '-:Quantity' - - -.---/' i'- , , Quantity • ISSUE FEE $23.50 Repair,/Alt'Absorbtion Unit $0.00 0 ' Inst FAU <100 k BTU " $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 • Inst FAU>100 k BTU $18.20 1 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler Inst/Rep:Recess Wall Htr $0.00 0 . Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU �. $0.00 0 -- `Domestic Incinerator ,7 -'! $0.00 -0 Refrig Sys,>100-k BTU , $0.00 0 - Compressors/Absorption Systems- " // Gas Piping ' , A'` ), $0.00 0 - . Up to 3 hp'/,100 k BTU / / ' $0.00: 0 Factory Fireplace , vx $0.00. 0k. ' 3 To 15 hp/500 k BTU=(r ''.'2,;',/ -' - $0.00 -0 Hood w/Mech Exhaust ,$0.00' ' 0 15 To 30 hp/1,000 k BTU- ,/ $0.00 i 0 VAV Box \ / �/ ' $0,000 0 • . - ' 30 To 50 hp/1,750 k BTU; '7' �, ,$0.00' 0 Vent Fan/Single.Ductv///" /;"7 $0:06::":141,-,.01,- - -- Over 50 hp/Over 1,750-BTU - - : DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one o1 the following declarations: - - ❑ I Piave and will maintain a certificate of consent to self-Insure for workers'compensation,es provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. AI have and will maintain workers'corn sation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance arrler and policy number are: r P. Carrier: - F n f-(9 Policy Number: (This section nbed not be completed a permit is valued at one hundred dollars MOO)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. / Applicant Signature: Date: y— -'7I I-' WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOILARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# i rJ ContractoYs Signature: - Date: CONSTRUCTION LENDING AGENCY: • ❑ I hereby affirm that there is a construction lending ages for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: - Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employeelwith wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes 10 No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of wner(s) / Dim 4a And/Or ed Applicant Date CODE! JNSPECTION TYPE PAIL IIIIID91S CODE! INSPECTION TYPE DEEV�LS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 6_aa-o0. BN 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place ,, 220 Final Planning Approval _203 Final Sign 222 Final Site _ 204 Final Demolition - - . 250, Final Building/Occupancy .4•5yC �y„ CITY OF COSTA MESA `4 BUILDING DIVISION Y4:J,,;,,. �� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t• r* .I PERMIT et IP01-00669 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No D Applied: 11/13/2001 Issued: 11/13/2001 Vicinity: ISSUED BY: • Parcel Nunmber: 42623302 Applicant: ROELLE, MICHAEL' . Address: 5057 LANTE AVE -,- / i /- Phone: 626-960-0344 BALoyvin PARK,CA - Zip: 91706 / Owner: CEFALIA,•STELLAAND JOE , Address 1649 BAYSIDE DR' ; Phone: 949 720 1143 , CORONA DEL MAR,CA Zip: 92625 Contractor: . MICHAEL G ROELLE PLUMBING-- •' , Address: 5057 LANTE AVE - " f, . ' Phone: 626-960-0344 - - BALDWIN PARK,CA Zip: 91706 - License: 743562 7 " • • Arch / Eng : _ / Address: Phone: • Zip: -- - License: . - - / SCOPE OF PERMIT PLUMBING FOR NEW SFR.PLUMBING TO INCLUDE:2 BATHTUBS, 1 DISHWASHER, 1 GAS SYSTEM (1-4 OUTLETS),2 OTULETS OVER 4, 1 LAUNDRY TUB, 1 SHOWER, 1 KITCHEN SINK,4 WASH BASINS,3 WATER CLOSETS, 1 WATER HEATER,-1 WATER SERVICE. NOT DOING SEWER CONNECTION PER APPLICANT. REF: B01-00309. " FEE SUMMARY 'Sr AMT QTY AMT QTY ISSUE FEE ,v `. '$23.50 -, Laundry Tub/Washer $9.80 1 - Sump Pump- - $0.00 0 Backflow irrigation `, $0.00 , 0 , . Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer .. $0.00 0 , P-Trap $0.00 0 Trap Primer - / $0.00 0 Bathtub $19.60 2 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System \-$0.00 0 , ' Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00' 0, " Septic Tank $0.00 0 Wash Basin $39.20 4 Dishwasher $9.80 1. i i Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 " 0- Water Closet(Toilet) $29.40 3 Drain,Roof $0.00 0 Shower $9.80 1 Water Healer/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $9.80 1 Gas(1-4 outlets) $6.15 1 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $2.20 2 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $181.35 NOTICE: The work authorized by this permit ttonnwielFathealegVititeetygryprogg requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS ' WORKERS'COMPENSATION DECLARATION: I hereby rm under penalty of perjury one of the following declarations: I ave and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the ork for which this permit is Issued. I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued et one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that sh me s bject to the workers'compensation provisions of Section 700 of the bor Code,I shall forthwith comply with these provisions Applicant Signature: /L.t.r-Lu r Date: I 0 WARNING:FAILURE TO SECURE WORKERS'COMPENSATI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P TIES AND L FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Prof salons Code,and my license is in full force and effect.Lic.Si Class N Contractors Signature: ,4 r -1✓ Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there:ls a construction lending agency for the performance of the work for which this permit Is Issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: n Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is Ilcensel pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a perm' subjects the applicant to a civil penalty of not more than fwe hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Cade:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(35)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Wit the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feel of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). — _...._ —_t._ _..._r..._._.._ _.._ _ ._ _ .._... 3 O�r will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and PrevenDon Program for acutely hazardous materials)? No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification from the South Coast Air'Duality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No B (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signal re La �� I / �T ) t� And/Or Authorized Applicant /✓'1 Dat CODE t INSPECTION TYPE EAU 1NTIMJ CODE( INSPECTION TYPE DATE IHTIf1AL6 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing en-8-oa w 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition • 250 Final Building/Occupancy / , CITY OF COSTA MESA 4 BUILDING DIVISION >•, ,,,,. PERMIT NUMBER ,„,-�i DEVELOPMENT SERVICES DEPARTMENT F 1 l PERMIT M02-00022 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No C Applied: 01/22/2002 Issued: 01/22/2002 Vicinity: 9C11. Parcel Number. 42623302 ISS D BY: 1Applicant: CEFALIAJIM _ iv _ 1 Address: %JOE,&STELLA"A CEFALIA ,' CORONA DEL MAR CA Phone: 949 720 1143 / 1649 BAYSIDE DR \ - Zip: 92625-1832 i ; / 7 �� - " Owner. - ' CEFALIA, JOE Address: %JOE,&STELLA A CEFALIA - • CORONA DEL MAR,CA Phone: 949 720 1143 1649 BAYSIDE DR Zip: 92625-1832 i - Contractor: - �.,� Address: - .- - Zip: ..- _ - ` - License: SCOPE OF PERMIT MECHANICAL FOR FACTORY FIREPLACE INSTALLATION. ' • FEE SUMMARY_ Quantity " Quantity ISSUE FEE $23.50 - Repair/AltAbsdrbtion Unit - $0.00 0 Inst FAU<100 k BTU $0.00 0 _ Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 -0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 ' 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator ' - $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems , Gas Piping $0.00 0 -' - '-.Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $10.65 1 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust , $0.00 0 • 15 To 30 hp/1,000 k BTU - $0.00 0 VAV Box - \-,',-$0.00. -_Q •' 30 To 50 hp/1,750 k'BTU • 'i'7 • $0.00 ;0 / Vent Fan/Single-Duct ' -v$0.00 0 Over 50 hp/Over 1,750 BTU:' $0.00/ 0 Appliance . ,. , ' '$0.00/ 0 Boilers Fire Dampers - . - $0:00 "0„ Up to 3 hp , - ," $0.00 0 Smoke Dampers - $0.00 -0 .3 To 15 hp - - - $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm - $0.00 0 Over 50 hp $0.00 0 Floor Furnace . $0.00 0 - Other Mechanical Fee - Floor or Suspend Heater - $0.00 0 Jnvestigatiori.Fee - $0.00 Plan Check Fee $0.00 Reinspection Fee ' $0.00 TOTAL CALCULATED FEES $34.15 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void It work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-48(800) DECLARATIONS WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: - ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: - . - Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) • ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California and agree that If I should become subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOUARE($100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lie.# Class N Contractor's Signature: Date: CONSTRUCTION LENDING.AGENCY:✓. ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: • I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a4ivil penaltyof not more than five hundred dollars($500).): ❑ I,as owner of the propere_or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or throughjis oIRter own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completiont the ovlber-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am E(CLUSIVELVNTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apy to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) r license purs • Utz --� .,. •r, ' - -Laws I am e . pt u •:r . • / '`A/f Business and Professions Code for this reason: Si nature: i —.411111111111111 Date: Owner s :rifled• •"ve s license. 0 Yes`II❑No Drivers License No. Expires: V--cation of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this • permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare en RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yet,attach certificate Ot compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct.I a• : to corn. with all state I:ws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-•.• •ed rm•: • 'r . ,.• purposes.I agree not to occupy or allow occupancy of any building authorized by thi permit upt5fj inspection. !, Signature Of Legal Owner(s) ) ZZ Date And/Or Authorized Applicant Date ODE f. gWSPFCTION TYPE PATE 1LII1DEl$ Mad INSPECTIONTYPE• ,/ 261E/I 1616 Fixed System Final Fire Prevention 206 Final Mechanical rte-//a _ /'•• /7 1266 Pool Spa Final 208 Final Plumbing•200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place • 220 Final Planning Approval 203 Final Sign 222 Final Site • _ 204 Final Demolition .- . . _ 250 . Final Building/Occupancy � •� CITY OF COSTA MESA 4'x' '9 BUILDING DIVISION O4 :j putmerrnis..ir DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER kIn wrairai / PERMIT 4iNtriestannee IP01-00668 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No C Applied: 11/13/2001 Issued: 11/13/2001 Vicinity: ISSUED BY: Parcel Nunmber: 42623302 Applicant: ROELLE, MICHAEL.' ' i Address: 5057 LANTE AVE ce- V Phone: 626-960-0344 // BALDWIN PARK, CA - - Zip: 91706 - - � Owner:,�CEFALIQ, STELL'"A AND JOE Address `16.49 BAYSIDE DR' / , Phone: 949 720 1143 CORONA DEL MAR,CA Zip:- 92625 1 Contractor: MICHAEL G ROELLE PLUMBING - - Address: 5057 LANTE AVE -- - - • I Phone: 626-960-0344' - - BALDWIN PARK, CA Zip: 91706 ` . _ License: 743562 ' Arch / Eng: . , G -/ c Timi Tr' it , Address: Phone: , . .. .. Zip:. . License:"_ - _ SCOPE OF PERMIT PLUMBING FOR NEW SFR. PLUMBING TO INCLUDE:2 BATHTUBS, 1 DISHWASHER, 1 GAS(1-4 OUTLETS),2 OUTLETS OVER 4, 1 LAUNDRY TUB/WASHER, 1 SHOWER, 1 KITCHEN SINK,4 WASH BASINS, 3 TOILETS, 1 WATER HEATER,.1 WATER SERVICE, 1 DISHWASHER.APPLICANT NOT DOING SEWER CONNECTION. REF:.B01-00308 ' FEE SUMMARY ' • /AMT' QTY - AMT QTY - AMT QTY ISSUE FEE $23.50 - Laundry Tub I Washer $9.80 1 . Sump Pump - $0.00 0 Backflow irrigation , $0.00 • 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 -7 0 -, P-Trap i $0.00 0 Trap Primer $0.00 0 Bathtub $19.60 ., 2 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System -$0.00- , 0 ' Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 - .. Receptors $0.00 . 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 - Septic Tank $0.00 0 - Wash Basin $39.20 4 Dishwasher $9.80 i1, Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 . - Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $29.40 3 Drain, Roof $0.00 0 Shower $9:80 1 Water-Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $9.80 1 Gas(1-4 outlets) $6.15 1 Sink, kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $2.20 2 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $181.35 NOTICE: The work authorized by this permit stgeqi9 pt to NA:engem requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. . INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections end final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(9/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the I for which this permit is issued. �r1 have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: ✓ Policy Number. (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ 1 certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agre at if I be e subject to the workers'compensation provisions of Saµion 3700the Labor Code,I shall forthwith comply vAth these provisions. 1 3 b ' 11 J Applicant Signature: ' w..( Date: 1 dtt WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOl1ARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter mencing with Section 7000)of Division 3 of the Business and Pr.essions Code,and my license Is in full force and effect.Uc.a Class a Contractor's Signature: - ""'L�-NA .. I Date: I • CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 1 hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,.or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a porn* subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.if.however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: , _ Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the DMsion of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? BNo (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Ls the subject of this gppplication apermlt for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 —ire permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No B (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above Is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.poI agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signatu a Of al ner(s) I / I 3 � q(]late And/Or uth rind pplicant f/ ate LODE I glsPECT1oNTYPE • PALE MALS ;ODE T INSPECTION TYPE PATE INIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical p 1266 Pool Spa Final 208 Final Plumbing In-ag-oa Eh/ 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retalning Wail _ 212 Final Flre Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy ,a�a. 9 CITY OF COSTA MESA - 4 BUILDING DIVISION Y 4 .4ef . DEVELOPMENT SERVICES DEPARTMENT /WIT NUMBER I. i r PERMIT 4. 1.11,41 E02-00066 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No C Applied: 01/25/2002 Vicinity: Issued: 01/25/2002 Parcel Nunmber: 42623302 Applicant: RADOGNE, TINA ISSUED BY: Address: 1656 BABCOCK - , Phone: 949.642-2431 COSTA MESA,CA' - ", ' Zip: 92627 1 Owner:,' CEFALIA, , Address %JOE, &STELLA A CEFALIA N. ' CORONA DEL MAR,CA Phone: 949 720 1143 1649 BAYSIDE DR Zip: 92625-1832 contractor: •BOYER, TOM CO - Address: 1656 BABCOCK , _ ; " - \ 'Phone: (949)642-2431-, COSTA MESA,CA- ' Zip: 92627 . / License: 566902 - - • SCOPE OF PERMIT ELECTRICAL FOR NEW SFR. SQ. FOOTAGE FOR RESIDENCE IS 2309.1 OUTLET. 1 SWITCH AND 1 LIGHT FOR GARAGE:REF:'B01-00308.- - • , ' / FEE SUMMARY- Quantity - - - Quantity / , ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 ,' Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section. . $0.00 0 New Res(1-2 units) $129.30 2309 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 -• .Transformers up to 1 kva/kw $0.00 ' 0 Pool/Spa $0.00 0 • up to 10 kva/kw $0.00 , 0 Lighting Fixts - . -$1.10 1 up to 50 kva/kw $0.00 . , 0 , Recept Outlets- ..$1.10 1 , - up to 100 kva/kw $0.00 , 0 Switches ' $1.10 '- -1' over 100 kva/kw $0.00" 0 Non Res Appl - ' '-$0.00 . 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 ' " .-0 Low Volt Wiring System/Ckt $0.00 i„,.0 Service to 200a $0.00 " " •0 - Misc.Conduit $0.00 0 ./ Service to 1000a ', , ,$0.00 , -0 ' - - Misc.Conductor $0.00- _ 0' ' / Service over 1000a \ $0.00 ; ,0 - _ 'Circus(gen or ride)- ','yV-;$0.00 " '-'O '/ Motors to lhp $0.00. 0- ` , - Circus(mech ride or lights) -$0A0 .;- 0/ Motors to 10hp -x$0.00 -0- / Christmas Tree Stand ' r--$0.00'-j 0 Motors to 50hp -$0.00 0 ; Fireworks Stand - ,x$0.00. 0 Motors to 100hp $0.00 - 0 "` " Other Electrical Fee-" % DECLARATIONS WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: • 0 I ha end will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the for which this permit is Issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My wwoorkera'comp/ennsation Insurance garner and policy number are: Carrier: �/tlh • l .('1hOP7Y-L,�Ufl 11YYi>t`C( •t'Ut'hG( Policy Number: I LerlS 1 el (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith _amply with these visions.h �" ApplicanLSIgnature:_C� . Cli Date: \ -1-C 01—, WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000).IN AMNION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Llc.4 ►_4 • Class 4 On N\L Contra ton's Signature:_ . s !91. *slut Date: 1- 2S L't CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed purrssgqaant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is eTSmpt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ i,as owner of the property,or my employees with wages as their sole compensation,WILL 00 THE WORK,and the structure is not intended or offered for safe(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIJELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Jg Date: Owner ID verified by drivers license. 't]Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,Scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one lime during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Cada,with some exceptions,requires registration with the Costa Mesa Flre Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare en RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 Orilla California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant Or present or future building occupant require for the work which Is the subject of this application appennit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _._.ont.r._.._ agency ..._._._.___ 7 If a permit athe South Coast s Qualityced Management Californiaeal or Sr air pollution intr4l district3 aadery is re for the work which is the subject of this application,have all of the disclosures prescribed by Celifoia Health and Safety Code Section 42303 been made? 0 Yes 0 No attach _. __..._.__.._.._ .._._ _ _—...- ____ 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date r L ititi (- 13 "t72 And�Or.Mthodzed'Appl(wnt- Cafe cots imam= PAI. gMUASI CODE( IdSPECTION TYPE PAIL EOUBL6 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing .. h - 200 Final Re-Roof 210 Final Electrical T� 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place . 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition .. . 250 Final Building/Occupancy • CITY OF COSTA MESA 49 BUILDING DIVISION ). .j r..ai .,fir DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. 11.114 PERMIT M02-00036 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DANCE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No C Applied: 01/24/2002 Issued: 01/24/2002 Vicinity: UNIT C Parcel Number: 42623302 ISSUED BY: Applicant: COOTER, LYLE- Address: cote-Phone: 714-978-7970 - ' Zip:Owner- '.0FALIA, JOE �,�Address: %JOE,&STELLA ACEFALIA • , CORONA DEL MAR,CA Phone: 949 720 11431649 BAYSIDE DR Zip: 92625-1832 ' i ' Contractor: " PRO HEATING &AIR - Address: ARS AMERICAN RESIDENTIAL SVS OF CA- - - • ' YORBA LINDA,CA ' \ Phone: (714)283-8262 .. . , 22921 SAVI RANCH PKWY Zip: 92887 N License:764099 " • SCOPE OF PERMIT • / MECHANICAL AND ELECTRICAL FOR NEW SFR. ELECTRICAL TO INCLUDE 1 MOTOR TO 4 HP. . MECHNICAL TO INCLUDE:;t -4-TON NC AND 1 FURNACE TO.115,000,BTU'S. REF: B01-00308. ' - " ‘ FEE SUMMARY - ' Quantity - - Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $18.20 1 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 _ Domestic Incinerator $0.00 -0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping' , $0.00 0 Up to 3 hp/100 k BTU ! $0.00 0 Factory Fireplace vN\ ,j$0.00. _0,,: - - 3 To 15 hp/500'k BTU= $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00, 0 VAV Box 50.00': 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct - ' $0.00 1 :0 Over 50 hp/Over 1,750 BTU ' / . / „ $0.00 0 Appliance . $0.00 0 Boilers . . Fire Dampers $0.00- 0 Up to 3 hp $0.00 0 Smoke Dampers . ' • $0.00. 0 3 To 15 hp , -' $27.15 1 Inst or Relocate Appl Vent , $0.00 0 15 to 30 hp • , . $0.00 0 Air Handlers< 10000cfm - . $0.00 ' 0 30 to 50 hp . : ,- $0.00 0 Air Handlers> 10000cfm - $0.00 0' - Over 50 hp - $0.00 0 Floor Furnace $0.00 0 , Other Mechanical Fee,_ Floor or Suspend Heater $0.00'- 0 Investigation Fee ' . $0.00 - Plan Check Fee ' - $0.00 - Reinspection Fee $0.00 TOTAL CALCULATED FEES $68.85 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244848(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. j� I have and will mint- workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'com•:n--lion Insuran =carrier and poll number are: ,, �//���/ / Carrier: LG,'-rv`� Policy Number: 7A /, �7 G A) "( (This section need 'of•e Zomp/eted If the permit is valued of one hundred dollars($700)or less.) ❑ I certify that the performance of the work for which this it is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. �.., v,rf� Applicant Signature: Date: // �2t' 4'1----. WARNING:FAILURE TO SECURE WORKE ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100000),IN ADDII 0 THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,MD ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed und1e provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Lic.8 it�'%9 Class tt Ay Contractors Signature: Date: am,Lab ti CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: it- Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employies with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law Jdoes not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 6,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _._.r........___.___.�.__.._.._ ._ _ _ _.... _..__ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Flre Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a$ermconstruction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will-any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No - 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal•.• er(s) / Date i And/Or Au•"r,b+'••pllcant bate c00E E, INSPECTION TYPE PATE MEW OWE INSPECTION TYPE DATE =ALB 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1.-a •oa 2n1 1266 Pool Spa Final 208 Final Plumbing - 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wail 212 Final Fire Prevention _ 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site , 204 Final Demolition _ 250 Final Building/Occupancy `p4" 9 CITY OF COSTA MESA , k BUILDING DIVISION F 11 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER in PERMIT � ' E02-00057 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No C Applied: 01/24/2002 Vicinity: UNIT C Issued: 01/24/2002 Parcel Nunmber: 42623302 Applicant: COOTER, LYLE - - - ISSUED BY: Address: _ Phone:, 714-978.7970 , Zip: / /)// '• Owner:,',.CEFALIA:'JOE - ' :•:...-::::-. Address'",;%JOE,&STELLA A CEFALIA` A' -\ % , v: / •', / , CORONA'DEL'MAR, CA Phone: 949 720 1143 .�-\,,,,:-.:5-.. = '/ .: v'N.,. 1649 BAYSIDE DR Zip: 92625-1832 H. / ' . Contractor / PRO HEATING &AIR - E,, ' Address: ARS AMERICAN. -RESIDENTIAL SVS OF CA - ,s‘ l : YORBA LINDA, CA i ':.-Phone: (714)283-8262 - • 2 / 22921 SAVI RANCH PKWY'" - - Zip: '92887 . - ' . �' - License: 764099 _ " r ' - SCOPE OF.PERMIT ,/ . .MECHANICAL AND ELECTRICAL FOR NEW SFR. ELECTRICAL TO:NCLUDE 1'MOTOR TO 4 HP.: ' MECHNICAL TO INCLUDE:21 -4'TON-A/C-AND-Y FURNACE TO 115;000 BTU'S. \ _ l' REF: B01-00308. ' - ��� - FEE SUMMARY' - ,Quantity Quantity, - - - ISSUE FEE ' , .• $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 -0 Res:-a/c package, , $0.00 -.:'''':',Standing Section New Res-(1-2 units) ..',2.' $0.00 0 '-"'--2``• Misc Electrical Equipment $0.00/ 0 , New Res5(3+units) \ $0;00 ' 0 - Transformers up,to 1 kva/kw $0.00// 0 . % i Pool/Spa. y/'., 'v$0.00 - 0 - _ ," - up to 10kva/kw , "$0.00 0- , / - / Lighting Ras - - $0.00 I 0"` up to 50 kva/• kw «_ $0.00' 0' Recept Outlets;\-\, /�j.$0:00- .,: 0 " - ' up to 100 kva/kw s -=$0.00,-'„'. 0 ' Switches $000 �0 over 190 kva/kw . $0 00 i ,0, Non Res Appl . \A . ' $0.00 -,1-'6:'.- _ - , Low Voltage Equipment.- $0.06 -;'r -0 '� ' Res Appl _ $0.00 - �0 Low Volt Wiring System/Ckt ' . $0.00-, , - 0 Service to 200a $0.00 " " ,0 - . ' 'Misc.Conduit Service to 1000a 7 $0.00, = ' • 0 _ Misc.Conductor - - $0.00. , 6/Service over 1000a $0.00 0 - - Circus(gen or ride), ' --$0.00', i/0 Motors to 1hp $0.00' -" 0 - ' . Circus.(mech ride or lights) .....--'$0.007 0 Motors to l0hp $12.30 . 1 -- Christmas Tree Stand -7,- $0.00 0 Motors to 50hp $0.00 _ ' 0` - ' - 'Fireworks Stand - -' $0.00 0 Motors to 100hp $0.00 -, -0 ' _ - Other Electrical Fee 2 H. - $0.00 Motors over 100hp $0.00 Communication drops $0.00 0 - Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $35.80 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) , EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-48(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: . • I hereby affirm under penalty of perjury one of the following declarations: = ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for.the performance of the /work for which this permit is issued. ,ip I have find will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. // My workers'cam ation Insure crier and policy number are: , Carrier: pp//ff������ /// Policy Number: v/ ?c6 7 (This section nee v b completed ie�per'mit is value hundred dollars($100)or less.) ❑ I certify that in the performance of the work for w ' •this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and ogre if I should become subject to the workers'compensation provisions of Section 3700 of the Labgr Code,I shall comply with these provisions. / ����-- Applicant Signature: Date: 1 WARNING:FAILURE TO SECURE PENSATION COVERAGE I5 UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of hapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# , At- Class# Contractor's Signature: F---- Date: C� / Z01.--r CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: - Lender's Address: Signature: _ Date: 5,- OWNER-BUILDER OWNER-BUILDER DECLARATIONS: / I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)orthat he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than fiveirdred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. __ Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_Eermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is'the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. • Signature Of Legal Ow //�a Dat And/Or Auth plicant Date MEL INSPECTION TYPE all 1tIDAL5 CODES INSPECTION TYPS DATE PITR1ALS 1616 Fixed System Final Fire Prevention - 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -. 200 - Final Re-Roof 210 Final Electrical 7,ya/*.J Rc 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place - • , 220 Final Planning Approval . • 203 Final Sign 222 Final Site . 204 ...Final Demolition . - -. - _ _ 250 Final Building/Occupancy . 1 CITY OF COSTA MESA 4� BUILDING DIVISION • 4I$ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER :�' ref I PERMIT Q so'441B01-00308 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite: C Applied: 03/12/2001 Vicinity: UNIT C Issued: 10/05/2001 Parcel Number: 42623302 Zoning: Applicant: CEFALIA, JOE • ISSUED BY: Address: 1649 BAYSIDE DR , - - -Phone: 949 720 1143 ' - CORONA DEL MAR,-.CA- Zip: 92625 - Owner CEFALI,A,"STELLA AND JOE , Address ,1649/BAYSIDE DR _ .� Phone: 949 720 1143- - ,CORONA DEL MAR,CA - Zip: 92625 Contractor: OWNER-BUILDER Address:. - Phone: Zip: License:- 0 . Arch : .. - . Eng: , Address: Address: Phone: - Phone: ' Zip: License: "License: ' , SCOPE OF PERMIT . 2309 SF NSFD. 1044 SF 1ST FLOOR,1265 SF 2ND-FLR,430 SF GARAGE;61 SF PORCH.PLAN 28. UNIT C. SEE DR-00-29M-15991 FEE SUMMARY Plan Check: $1,042.70 Calc Valuation: $208,077.82 Permit: $1,604.15 ' Claim Valuation: so.00 SMIP Res: $20.81 . SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $2,667.66 '- '\ PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 14-0 Rear 10-0 Left 5-0 Right 10-0 ' ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 16 Proposed: 18 NOTES: / • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS • ``.^r` ` WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued, My workers'compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) , ❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,end agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: ' I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Busine and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a perry' s b' s the applicant to a civil penalty of not more thanfive hundred dollars($500).): zI,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is I,did within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant.to the Contractors License ws.). ❑ I am exempt und� �--ernse�c�. Business and Professions Code for this reason: Signature: 1ny/ ' C. io- /47- Date: Owner I epfied by driver's license. ❑Yes 0 No Driver's License No. Expires: Verifica otS of Ownership by(type of document,i.e.-property tax bill or deed): V DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describedpr�pr7operty for inspection purposes.I agr /rot to occupy or allow occupancy of any building authorized by this permit until final inspection. / _, ignatore aAg-, - �G L An. %Authoriz:'•Applicant / _ to�/ 6C(DE a INSPECTION TYPE ME INITIALS CODEC INSPECTION TYPE DATE INfRALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval A 203 Final Sign 222 Final Site /f 204 Final Demolition 250 Final Building/Occupancy /t . . 1.1 • CITY OF COSTA MESA a i ' ` BUILDING,DIVISION Ft! sl DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER ' t ,-.1-1 / •• PERMIT / -' aanrzo.4. VB01-00307 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite: B Applied: 03/12/2001 Vicinity: UNIT B Issued: 10/05/2001 Parcel Number: 42623302 Zoning: Applicant: CEFALIA, JOE ISSUED BY: ______„„„d:r)L__. Address: 1649 BAYSIDE DR - - . _ - Phone: 949 720 1143 CORONA DEL MAR,-CA- - Zip: 92625 Owner CEFALIA;.STELLA'ANDJOE ' ' , ' N issis Address 1649 BAYSIDE DR / - - - - //...,', - Phone: 949 720 1143,- . - .CORONA DEL MAR,CA - Zip: 92625 - Contractor vOWNER-BUILDER Address:. Phone: ' ' Zip: ' License:- 0 - .. Arch :. ' - - Eng: Address: - - - Address: - - , ( ._Phone: _ . . ', Phone: Zip: - License: License: SCOPE OF PERMIT _ 2309 SF NSFD.1044 SF 1ST FLOOR, 1265SF 2ND FLR;430 SF,'61 SE PORCH. PLAN 2A. UNITB SEE DR-00-29A/T-15991/MM-01-26 . _ . -- __-- FEE-SUMMARY.', Plan Check: $1,042.70 Calc Valuation: $208,077.82 " Permit: $1,604.15 Claim Valuation: , $o.00 SMIP Res: $20.81 • SMIP Corn: $0.00 • Other: . $0.00 ' , Inspection: $0.00 'Total: ' $2,667.66 y i:-. /, '*•. , PLANNING'S,ZONING SETBACKS ' MAIN STRUCTURE Front' 16-0 ,Rear, 14-0 Left 4-0 - Right . 28-0- ACCESSORY Front' '0-0 : 'Rear 0-0 Left - 0-0 - Right , 0-0 '' PARKING Existing: 0 - .. Required: 16 ` Proposed: 18 - NOTES: - 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 period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) r DEUARATIONS f. ' WORKERS'COMPENSATION DECLARATION: I hereby affirm under,penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIEGT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: ' ' Lender's Address: Signature: - ♦ Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a perms. subject the applicant to a civil penalty of not more than five hundred dollars($500).): as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is /fold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply o an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursu to the Contra ors License La ❑ I am ex p der sec Business and Professions Code for this reason: 1 Signature: „Ol Date: e*** ,z / 4-TA/ Owne erified by drivers lie 0 Yes 0 No Driver's License No. Expires: V (cation of Ownership by type of document.i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,wit be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .........._....__ — ..... __upa _._ __._ 0. ...__ _ _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No ___...up _ b _..._._.....e.r.....-_.os such _ ........icat.__... 5 Does or willo the icAir or ior n busting occupant requirer for the work ntch the subject of this a estion aggeNnit for scconstruction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? �Yes U Na (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signal - •f Legal • ner(sDam// 9 feed Aut �ed Applicant Date O / .iraaE INSPECTION TYPE gall IfITBIALS CODE( INSPECTION TYPE MI IIRII 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign222 Final Site 204 Final Demolition 250 Final Bullding/Oocupency O CITY OF COSTA MESA , 4BUILDING DIVISION • > :� ,i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 PERMIT E02-00056 `°biome eP (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT ' Job Address: 2087 GARDEN LN Status: ISSUED Suite No B Applied: 01/24/2002 Vicinity: UNIT B Issued: 01/24/2002 Parcel Nunmber: 42623302 Applicant: COOTER, LYLE - - . _ ISSUED BY: Address: ,,��_ ,. _ '-,/' ,- -Phone: 714-978-7970 - - j Zip: Owner / CEFALIA,JOE Address %JOE,8 STELLA A CEFALIA CORONADELMAR;CA Phone: 949 720 1143 1649 BAYSIDE DR Zip: 92625-1832 ' Contractor:_ 'PRO HEATING &AIR • .- Address: ARS AMERICAN RESIDENTIAL SVS'OF CA ' YORBA LINDA,CA ,,- , -..Phone: (714)283-8262 N 22921 SAVI RANCH PKWY - Zip: 92887 License: 764099 C i n.- ;- .- SCOPE OF PERMIT MECHANICAL AND ELECTRICAL FOR NEW SFR.ELECTRICAL TO INCLUDE 1;MOTOR TO 4 HP. MECHNICAL TO INCLUDE: 1 -4 TON-AIC-AND'1FURNACE TO 115,000 BTU'S. - , ' ' REF:B01-00307. ' . ' FEE SUMMARY,/ .Quantity Quantity . ' • ISSUE FEE '. $23.50 Temp Dist System/Lighting $0.00 0 ' ' Temp service test $0.00 Busway/100 ft $0.00 ..0 , Res:a/c package . + $0.00 ::;.y,• :Standing Section $0.00 6 -0• ' New Res`(1-2 units)' ' „ $0.00 0 ....,0,- " ' Misc Electrical Equipment $0.00,- 0 New Res„(3+units) \‘40.00 0 Transformers up•to 1 kva/kw $0.00 -/ 0 Pool/Spa ' '_$0.00 0 , - - up to 10 - _ $0.00,-' 0` . ' 7 Lighting Fixts - $0.00, 'I----7-'0- . up to 50 kva/k'w - -$0.00 0 / , Recept Outlets - $0.00': - 0 - up to 100 kva/kw „ $0.00 - ' 0 .' Switches - ' $0.00 - ;0 / over 100 kva/kw x'$0.00 , 0 Non Res Appl • $0.00 . . `0 ' . Low Voltage Equipment $0.00 . 0 Res Appl $0.00 - 0 Low Volt Wiring System I Ckt - " .$0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00. , 0 - Service to 1000a $0.00 0 Misc.Conductor . c $0.00 ' , 0' Service over 1000a $0.00 ' 0 - - Circus(gen or ride) ' -" ' $0.00-' 0 Motors to 1hp $0.00 - 0 Circus(mech ride or lights) $0.00. ' 0 Motors to 10hp $12.30 Christmas Tree Stand ,, $0.00 0 Motors to 50hp $0.00 - -0---- • Fireworks Stand / --WOO 0 Motors to 100hp $0.00 0 _ • - Other Electrical Fee $0.00 Motors over 100hp $0.00 0 - . _ - - Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $35.80 Intermed Pole $0.00 0 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)7545626 244646(9/00) DECLARATIONS . WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: . ' • - • ❑ I have and will maintain a certificate of consent to self-Insure for workers'•compensation,as provided for by section 3700 of the Labor Code,for the performance of the 1 work tor which this permit is issued. VJ I have and will ,Qi :in workers'compensation insu nce,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. J— My workers'••1'f sation Ls ance carrier nd !icy number are: ,/ 1—Carrier • 1 (6 Policy Number: 2/IG 7oyr- ' • (This section need not be completed i/the permit valued et one hundred dollars($100)or less.) • ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should be me su aih4t ars'compensation provisions of Section 700 of the �Labor rCCode,I shall forthwith comply with these provisions. � ./ Applicant Signature: Date: cW ? OQt WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND IL FINES UP TO ONE HUNDRED THOUSAND DO LARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Felt Code,and my license is In full force and effect.Lic.w Class it �P Contractors Signature: Data: / .2-174-j CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury tfTat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Lbw does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Celifomia Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification D from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the fadlity must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with at state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of gal.Owner(s) Date /-24 -r -a— And/Or Au onzed Applicant ate coot t INSPECTION TYPE PAID INIEIALS DOPE 4 INSPECTION TYPE 1[ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ,` p 200 Final Re-Roof 210 Final Electrical 7//4/dc ,Pl/.d 201 Final Block/Retaining Wall 212 Final Fire.Prevention 202 Final Factory Fire Place • 220 Final Planning Approval . 203 Final Sign 222 Final Site 204 Final Demolition . , - 250. Final Building/Occupancy . CITY OF COSTA MESA 4BUILDING DIVISION Y : DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the G.�work for which this permit is issued. py I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. /r My workers't��� ``� compensationenInsurance carrier and policy number are: Min I S I SC Carder: 5\C)A.Q `,fl V"QJ(1kkc,� \'(\CDOS-1-cO. tLA-10A Policy Number: i , 1 (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) • ❑ I certify that in the performance the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomi ,a d agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these Acovisions. Lpplican(Signature:- - n y 4lQn Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Cale,and my license is in full Force and es Sig atureSc..#. I\en � Classat : # CU) 0 -- CC�ntr>—Signature\ 11\�n ��G�}" �`n�\l-�n(��� Date: 1-85-01-- CONSTRUCTION '�'C)'L CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjurythat I Ain EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a pemiii J 'construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or She is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a.civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my emey`ees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the Owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No • (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). i 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pro for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SI nature Of Legal Owner(s) Date And/OY Authorized Applicant— Date ; CODE t Ifi$PECT10N TYPE QATE 1tBIDAI& CODE IN6PECTIONTYPE RATE MALI 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing .. 200 Final Re-Roof 210 Final Electrical 7//e7/Oa 201 Final Block/Retaining Wall _ 212 Final Fire Prevention 202 ' Final Factory Fire Place • - 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition , . - 250 Final Building/Occupancy ' I. CITY OF COSTA MESA ' 411111V"' BUILDING DIVISION ••:� 4•'c DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J• rill PERMIT M02-00035 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No B Applied: 01/24/2002 Issued: 01/24/2002 Vicinity: UNIT B Parcel Number: 42623302 ISSUED BY: Applicant: COOTER, LYLE -,c/'- Address: �' • Phone: 714-978-7970 / _ \\ Owner: . CEFALIA, JOE - -N' Address:- %JOE, &STELLA A"CEFALIA . �CORONA-DEL MAR,CA Phone: 949 720 1143 -'/'%/ / 1649 BAYSIDE DR Zip: 92625-1832 " N , Contractor: -PRO,HEATING &AIR Address: ARS AMERICAN RESIDENTIAL SVSIOF CA „ , � • • .YORBA LINDA,CA - Phone: (714)(714)283-8262 -' _ 22921 SAVI RANCH'PKWY , Zip: 92887 - License:764099 _�� _ ' � _ % . . . ' SCOPE OF PERMIT • - MECHANICAL AND ELECTRICAL FOR NEW SFR.ELECTRICAL TO INCLUDE 1 MOTOR TO 4 HP. . / / MECHNICAL TO"INCLUDEr Y-4 TON"A/C'AND.1 FURNACE T0,115;000 BTU'S. N ' . .u� . . . - �� ._ .i ' REF: B01-00307. , - FEE SUMMARY ' ' ' - - Quantity--- - -- _ - /' ' - - - _ Quantity ' ISSUE FEE $23.50 ' Repair/Alt Absorbtion Unit $0.00 0 . Inst FAU <100 k BTU $0.00 0 Repair/AIL Refrigeration Unit ' $0.00 . 0 Inst FAU>100 k BTU $18.20 1 Ventillation System " $0.00 0 • " Repair/Alt Cooling/Heat . $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall HP. $0.00 0 Commercial Incinerator $0.00- 0 - Refrig'Sys<100 k BTU $0.00 0 �.,.i:is - 'Domestic Incinerator $0.00 '0 ys Refrig S >100 k BTU $0.00 0 . - Compressors/Absorption Systems- Gas Piping' - '` - $0.00 0 - Up to 3 hp 7 100 k BTU „ ' $0.00 0 Factory Fireplace ��-���$0.00_,,0 ,� - 3 To 15 hp/500 k,BTU-: "- - $0.00 .0 Hood w/Mech Exhaust > '\$0.00 0 15 To 30 hp/1,000 k BTU. ." ' ' $0.00," 0 VAV Box - ':N', �//' "$0.00 „,0 ' ' 30 To 50 hp/1,750 k BTU ' .$0.00 0 Vent Fan/Single Duct t 7--",- /', $6:00,::---_-0 - - Over 50 hp/Over 1,750 BTU - ,' -$0.00 0 Appliance ,/.$0,00 0, / ,-, =Boilers " Fire Dampers `� - = $0.00" 0 _ ,. _ Up to-3 hp - ,$.00 0 Smoke Dampers $0.00, . 0- 3 To 15 hp - " - ' $27.15 1 Inst or Relocate Appl Vent' , $0.00 " . 0- 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 ,0 , 30 to 50 hp $0.00 0 Air Handlers> 10000cfm N.$0.00 0- Over 50 hp - $0.00 0 Floor Furnace $0.00" 0- __ / ,'\ N , Other Mechanical Fee, - Floor or Suspend Heater $0.00 0" Investigation Fee $0.00 -- ' - Plan Check Fee--- $0.00 - Reinspection Fee $0.00 TOTAL CALCULATED FEES $68.85 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1,12-21-92) EXPIRATION:. This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) . DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as providedfor by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. - ❑ I have and will maktain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued: My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be&mp/eted if the permit is valued at one hundred dollars($100)or less.) 0 I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED THOUSAND(MARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I a ZEXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mare than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,Cafifomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTiFICATiON: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _..._ 2- Does or will the applicant or present or future buildinnoccupant occupant neetl to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a,ppermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? U Yes LJ No (Section 65850.2 of the California Government Code requires that the requested Information be fumished on applications for non-residential building permits). e Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penally of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,end authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date RODE I INSPECTION TYPE RATE MIKE COD€E INSPECTION TYPE gA1F 1NIIIIALI • 1616 Fixed System Final Fire Prevention 206 Final Mechanical ^�1p q o 1266 Pool Spa Final 208 Final Plumbing 2 D�`, `OO &1,( • 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place 220 -Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - _ 250 Final Building/Occupancy CITY OF COSTA MESA ., - 41 BUILDING DIVISION > •1OltraiTKUil DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F17 PERMIT M02-00021 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED • Suite No B Applied: 01/22/2002 Issued: 01/22/2002 Vicinity: Parcel Number: 42623302 __ -- • ISSUED BY: � Applicant: CEFALIA, JIM / ?' - Address: %JOE &STELLA A CEFALIA-- it / , CORONA-DEVMAR CA_-m "` Phone:-949 720 1143 /1,, ,J• =�� 1649 BAYSIDE DR r Zip 92625-1832 ' t r - \IN / .�'r t' A� • - A /;_Lr// ; V _. - C C ,, Owner i'CEFALI'A; JOE �" Address:/%JOE,&STELLAA CEFALIA CORONA-DELMAR,CA Phone: 949 720 1143 1649 BAYSIDE"OR Zip: 92625-1832 /;--,' , / .Contractor ,'�%, Address , : • �. i r i 5 r _Phone ,7,, Z V iA\k : �1 License. SCOPE OF PERMIT '.. / • MECHANICAL FOR FACTORY"FIREPLACE INSTALLATION..REF: B01-00307.` • / /' - `,/. 7,''1 . /• L"r . jFEE SUMMARY i.'1-:- • Quantity - - Quantity ISSUE FEE $23.50 _ Repair,/Alt Absorbtion Unit $0.00" '0 ' Inst FAU<100k BTU. $0.00. 0 - Repair/Alt Refrigeration-Unit ,''$0.00 `0' Inst FAU>100 k BTU. $0.00 r-'0"- '-" -' - " Ventillatiori System ' Repair,/Alt Codling/Heat' $0.00 "0 - ' Evaporative`Ceoler - " $0.00 -0 Inst/,Rep. Recess Walrldtr $0.00 0 Commercial Incinerator $0'.00. : 0 r Refrig-Sys<100 k BTU ., t $0.00 0 Domestic Incinerator r., ' $0.00- 70 .. ,-;'*/ Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems ; .. ' Gas Piping $0.00 0 Up to 3 hp/100 k BTU Factory Fireplace $10.65 1 ,, •?.. ' .3 To 15 hp/500 k BTU '."$0:00 .-0 / Hood w/Meeh Exhaust ,'A„;., $0.00 0 •x• 15 To 30 hp/1,000 k BTU ,/, $0.00 :0 / VAV Boxy,ti`=� L ` $0.00 0 _ . , 30 To 50'hp:/1 750 k BTU /,/,'" r "' 1 $000 0 Vent Fan/Single Duct?a \/$0.00 0 ty:�,� , • 'Over 50.h p7'6 ver '',750 BTU /�-, $0.00' /r0 Appliance A' $0.00 0 ` Boilers Fire Dampers / '.$0.00 0 ''Up to 3 hp r ,$0.00 0 rs Smoke Dampers -, ':'/ $0.00-t-'.0 -3 To 15 hp" / /"$0.00 0 Inst or Relocate Appl Vent ,$0,00 '0,, '`.. - 45 to 30 hp - $0.00 0 Air Handlers< 10000cfm.7 " $0.00-- 0 C, - , 30 ib 50 hp ' . ' $0.00 0 Air Handlers> 10000cfm , '$0.00 '0 - ' - Over 50 hp , � , $0.00 0 Floor Furnace $0.00 ;'0 Other Mechanical,Fee Floor or Suspend Heater ''$0.00 ..0 ' • . Investigation Fee . $0.00 , Plan Check Fee r r - $0.00 Reinspection"Fee- , $0.00 :7- - . i.- 'TOTAL CALCULATED FEES $34.15 COMMENTS/SPECIAL CONDITIONS • • • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: - • I hereby affirm under penalty of perjury one of the following declarations:- • Q I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. - ❑ 1 have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: ' Carrier: Policy Number: - (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑' I certify that in the performance of the work for which this permit is issued,t shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: m. o I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: - -` Lender's Address: Signature: '1 Date: OWNER-BUILDER DECLARATIONS: -ft I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more tan five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner otthe properlyjam,EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors�Ucense1Law'dbes not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Condactois License Laws:). ❑ I am exempt under sec. . Business and Professions Code for this reason: Signature: '4.,- Date: Owner ID verified by drivers licenr0 Yes.."'2;❑'No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, will -n. • ploy anyo.e . do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit t01 su w. 'f+� : .f. -- Signature: Signature: Lam! Date: Di In.. nal afety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes p No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I a_r..' :comply with .I state laws and city ordinances relating to building construction,and authorize representative of the City of Costa Mesa to enter upon the above-d cribed .ro.. in . I agree not to occupy or allow occupancy of any building authorized by this•p mit until Y al inspection. i Signatures Owner(s) Date And/Or Authorized Applicant Date WOE# INSPECTION TYPE DATE INmjj,$ CWF! INSPECTION TYPE • PATE/ 1616 Fixed System Final Fire Prevention 206 Final Mechanical / f rt' 1266 Pool Spa Final 208 Final Plumbing .. 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall . _ 212 Final Fire Prevention • • 202 Final Factory Fire Place • 220 Final Planning Approval 203 Final Sign 222 Final Site t - 204. Final Demolition ., 250, - Final Building/Occupancy. • CITY OF COSTA MESA 4 • BUILDING DIVISION )• • r.;.ru ,r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 41 ,.E / PERMIT ^ilbermuns•'* IP01-00667 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No B Applied: 11/13/2001 Issued: 11/13/2001 Vicinity: 4V / Parcel Nunmber: 42623302 ISSUED BY: Applicant: ROELLE, MICHAEL Address: 5057 LANTE AVE .- - / �- - _ Phone: 626-960-0344 /. BALDWIN PARK,CA -- . , Zip: 91706_ ;N gia Owner: 'CEFALIA, STELLA AND JOE Address 1649 BAYSIDE"DR- - , Phone: 949 720 1143 , CORONA•DEL MAR,CA Zip: 92625 Contractor: MICHAEL G ROELLE PLUMBING,, -- . • Address: 5057 LANTE AVE - Phone: 626-960-0344 _ - BALDWIN PARK,CA Zip: 91706 . . License: 743562 � , , Arch / Eng: . / .. -j- - - Address: - . Phone: , Zip: , ' License: . - - �' SCOPE OF PERMIT PLUMBING FOR NEW SFR.2 BATHTUBS, 1 DISHWASHER, 1 GAS(1-4)OUTLETS,2 OUTLETS OVER 4, 1 LAUNDRY TUBANASHER, 1 SHOWER, 1 KITCHEN SINK,4 WASH BASINS, 3 WATER CLOSETS, 1 'WATER HEATER, 1 WATER SERVICE.APPLICANT NOT DOING SEWER CONNECTION.REF: B01-00307 FEE SUMMARY , AMT QTY AMT QTY AMT QTY ISSUE FEE $23,50 Laundry Tub/Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation . $0.00 " 0'' = ` ,Landscape Irrigation $0.00 0 -Swimming Pool $0.00 0 Backflow Preventer $0.00 ".0 P-Trap $0.00 0Trap Primer $0.00 0 Bathtub - $19.60". - 2" Pressure Regulator $0.00 0 ' Urinal $0.00 0 Clarifier System , $0.00 0 , - Process Piping(per 10 ft) $0.00 0 Vacuum Brki Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) `,$0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(54-) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin' $39.20 4 Dishwasher $9.80 1 - Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0, - Sewer Connect , $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $29.40 3 Drain,Roof $0.00 0 Shower , $9.80 1 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $9.80 1 Gas(1-4 outlets) $6.15 1 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $2.20 2 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $181.35 (.UMMtN I S /SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. . INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is Issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree if I should become subject to the workers'compensation provisions of Section 3700 f the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: "--7—Y.2Q( Date: I ' l 3 °I WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL MD SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,003),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and rs n /� Classa Contractors Signature: �--2'7I�e C/J" �,."� Date:: I / 1 o CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fora per4' subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: • Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous materiel? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yeo (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully compiled with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Alr Quality Management District or from any other air pollution control district or agency? UT Yes L]No (Section 65850.2 of the California Govemment Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature f Le 1,tr(s) I t I 12q O Date And/Or Authorized Applicant Dale 800E I INSPECTION TYPE PATE INTRUL4 BODE! 18SPECRON TYPE QdIE IILI AU 1616 Fixed System Final Fire Prevention 206 Final Mechanical / ^ 1288 Pool Spa Final 208 Final Plumbing f `.1 R'o . S1'' 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Ortupancy 1 - _ . . . • CITY OF COSTA MESA �'° - BUILDING DIVISION > .,t DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 41 ,s / PERMIT ' .lk e B01-00306 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite: A Applied: 03/12/2001 Vicinity: UNITA • Issued: 10/05/2001 Parcel Number: 42623302 Zoning: Applicant: CEFALIA, JOE ISSUED BY: , jam. . v Address: 1649 BAYSIDE DR - - Phone: 949 720 1143 - _ CORONA DEL MAR;CA Zip: 92625 / Owner: CEFALIA, STELLA`AND'JOE • 2 - - . Address 1649_ BAY/SIDE DR+ - ' - Phone: 9497201143.:. CORONA DEL MAR,CA Zip: 92625 - - - Contractor OWNER-BUILDER , - Address: - Phone: - Zip: License:- 0 ' " • Arch : ERIC KOUGH i Eng: • Address: 2915 RED HILL AV Address: ' SUITE B201 ' I Phone: Phone: , ' COSTA MESA CA - Zip: 92626 License:- C26497 . License: SCOPE OF PERMIT.. 2358 SF NSFD. 1050 SF 1ST FLOOR, 1308 SF 2ND FLR,430 SFGARAGE;�75 SF PORCH. PLAN 1A. UNIT 1. SEE DR-00-29/VT-15991/MM-01-26. ' ' - ..FEE SUMMARY ', - - Plan Check: $1,060.90 i ' - • Calc Valuation: $213,740.00 Permit: ' $1,632.15 / Claim Valuation': so.00 • SMIP Res: $21.37 SMIP Corn: $0.00 Other: ' $0.00 .. , Inspection: $0.00 Total: - $2,714.42' r'. �, - "" PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 20:0 , Rear 12-0 Left 4-0 Right " 29-0 ' ACCESSORY Front 0-0 Rear 0-0- Left 0-0 Right. 0-0 • PARKING Existing: 0 Required: 16 Proposed: 18 • NOTES: - • NOTICE: The work authorized by this permit shall comply with an applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.48(WOO) . . 1 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This sect/on need not be completed l/the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL MD SHALL SUBJECT AN EMPLOYER TO CRMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLIARE($100,000).IN ADCrfON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37080F THE LABOR CODE,INTEREST,MD ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Uc.0 Class it Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,CMI Code). Lenders Name: - Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she isflicensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of DMslon 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a writ. subjgpa the applicant to a civil penalty of not more than five hundred dollars(5500).): Sr I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is �old within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). C I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ l am ex pt der sec. Business and Professions Code for this reason: ,, / Signature: e L' iY.r'— • Date: 4it. f� O� Owner I ted by drivers license. 0 Yes 0 No Driver's License No. Expires: Ve on of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap 3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,es noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 yseosr will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .... .._.__.____. .�_...._..._�_ . 4 If an RMPP is presently required,has Section 25534 of the California Health and Safely Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes L]No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). a...._.._...i._ .._._—._ __._.___ 7 Ifa a potion from the South Coast s QualitycedManagement al or dhSr airtpollution tioncontrol 303 or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Californiaia Health and Safety Code Section 42303 been made? ❑Ves 0 No 8-11f yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.// natures Of L ne a And/Or Autho zed Applicant ate COpE/, CTION TYPE UTE Ri1O6E CODE! INSPECTION TYPE Q Ii MEW 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BIocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign222 Final Site 204 Final Demolition 250 Final Building/Occupancy • •• 24277 C LS i N SS COSTA MESA BUILDING-SAFETY DEPARTMENT • CITY BF Z 11 P.O.BOX 317 COSTA MESA,CALIFORNIA JUN 1 1965 For Applicant to Fill In Completely PLICATION FOR PE*J. • TYPE OR PRINT Tpa.A, .Y ?'' BUILDING �iTT (�o /I. Or 0 ce Etc • • ADDRESS (J,0 D / ,,,,C�-/1 jiLQ RECEIPT NO. PERMIT NO. COSTA MESA. CALIFORNIA :/(4 2 7? .w..� 6 - RECEI BY pA REM/ ED DATE ISSUE'D-` . OWNER LI AME S /4144,,,--,iq sew "' 7l 6"9 / '/3":"1" ' MAIL ?? BUILDING 2f q/ 7 /'C RTs-. / - ` • _ADDRE98 �...]n t G 1./I.1�/ ST ADDRE99 /C© v CC., •�/ (t(� �// / • FIRE �J .. • Gin44-LE/pPnF res,* t A . NO. 6 La-fa ZONE /-E T GROUP (Z ��_ ARCHITECT TEL. "7" APPROVED l OENGIN OR ENGINEER F a. SCA i/L 'NOS./2•/L BY 41. - / AAT' / _ ADDRESS /4 E. /+' ZONING �I/1� j `�, F AL�'��A A �W' • ZONE I NO.OF DB6 OF NC 1 '^[ 42_, LV (.44 � ,( '> • 2. PLANS BBILDINp a S CONTRACTOR UAM Cs f?/1/� jT fO�� - R �{-fr ' LEGAL /ryi c� 1/ (J stit ADDRESS 07-3 Of Gcy-�47 qT _ DESCRIPTION Ir I/Q( (0'/ ( (�17)p/ • i GIT! yE �[7i?/ /ftACA A.P.NO. O g-0^ IOYr6 ��/ NOTE: NO EAVE OVERHANG SHALL BE LESS THAN • LC. NO"ATE /"]/`7;.2' TEL..2/ NO. 6i 44 -_c? 7� SO"TO SIDE Et REAR P.L VES SIZE p NO.OF BLDGS. NOW LOT AL L/ X / /Z LOWED (U.B.C.REQUIREMENT) OF LOT CI USE OF ] +1 // c YARDS APPROVED- YARDS APPROVED EXISTING BLDG. .1 FA All Ly owage,I MAIN BUILDING _ ACCESSORY BUILDING (FROM C/L STREET) SETBACK LINE FROM 'f CENTER OF STREET 41c REAR YARD 12.) G FRONT SFT. FT. • • SIDE YARDI LEFT 51 I RIONT • I p g A R.HIDE ig FT. FT. DESCRIPTION OF WORK L.SIDE SFT. Fr. • K. p a / rI • f . ,; • NEW L ALTERATION _ ADDITION . REAR (p FT. ' DISTANCE BET. BET.MAIN @ REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS. DATE SZE�INGup i 4991ca ROOMS STORIES .3-. C.U.P.#_,/7� � APPROVED� `��� EXTERIOR 9WALLMyGGO I ROOF /10 L k APPw? O /1 -II-4 //! S • COVERING JJ�/ COVERING r( B! W 10/ DATE (n (O • USE OF BUILDING AND WORK.TO BEPERFORMED'.d,L•;�'Iv:::t 'i Oii - " "'O": C2:G;IL' HOLD'FO }SIS- Iyi E r",i ..��JJ . �C L:RL QU;R_.,)_. TS SF •GA i?A c f- r3 e.--4 y� a • "•2 / 8 f SO.FT. OD•gc ��4— N ' 1 _ I HEREBY-ACKNOWLEDGE THATHAVE READ THIS'APPLICATION'," I c., �. ., THE AMOUNT.SHOWN UNDER VALUATION IS FOR THE .. i "1 'AND STATE THAT THE A OVE*IS CORRECT-AriesAGREETO COM • PURPOSE Or 'ESTABLISHING A''PERMIT. FEE ONLY. "" O PLY WITH ALL CITY 0 NOES AND STATE LAWS REGULATING BUILDINGCONSTRU O VALUATION ^ --sd; "'�-'- / / PERMIT FEE $ Y✓L SIGNATURE OF /VE/�1�� JF�S .- "7���j�y1 pERMITTEF Zl/J ��/ i3 I� 7 ' ✓' PLAN CHECK $ 4 tS • • AUTHORIZED AGENT _ • _ big . .J'D TOTAL FEE 5 �/ cg , • / k.h� z,L .L_. v A 24277 i CU? L! C; 'i $ COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 317 COSTA MESA,CALIFORNIA UN 111965 For Applicant to Fill In Completely A PLICATION FOR PE'sa • TYPE OR PRINT 'liji,L I.. II F.t or O cB r r' S . • ES ADDRS U Dp ,.i��� -� n. T. RECEIPT NO. PERMIT NO. COSTA MESA. CALIFORNIA t/(A Z 7? RLCLI BY A R[C Ej DATE ISSUED OWNERI IAMEC 6 ,4ivv,s Az soar nY /y7 /� '{7� -`/,s—/�O`� MAIL �f Lay T ADDRESS 2 © V r SCP C9 I .f/U y L�(V� _ADDRESS 3...3n / C. L� Y S/, / FIRE u �//,r T /� TEL ZONE E GROUP [T _CITY4Y6%f/,3wf/ "E'4 LAT . NO. 64 fl �_• , ARCHITECT 11 / TEL. 7�" APPROVEDtAg7 /OR ENGINEEFW . ,SCA //INn NO,S.?a -its es BY /�,J�DAT�p ` _ e��/ —7-r- 7- w �( ./ ZONING `\ ADDRE559/4 C. %4 //HL !'/VA//f%/•/ ZONE NO.OF USE.OF NES /} �2. PLANS I BUILDItg GPS CONTRACTOR UAM�S rT/v�J�ff�fG�� / � /J � /] ^ �I � T LEGAL (Pal c L EAS pl Y6 ADDRESS.�30) �1:-/77 !T DESCRIPTION(Pal LFr J/' •� CITY ,4C ,7.fr / //CA L� AP.NO. I D•3- n- (0?-4--&"3' '! / NOTE: NO EAVE OVERHANG SHALL BE LESS THAN LIC.NO.ATE �4 7 ;) 2i NO. G 1/! '- 5)75 90'70 SIDE ft REAR P.L. VES SIZE �r NO.OF BLOCS. ALLOWED (U.B.C.REQUIREMENT] OF LOT 4 D X Z I NOW ON LOT ^ YARDS APPROVED YARDS APPROVED I USE OF EXISTING BLDG. .1 /1'i/ y FJF— IN y MAIN BUILDING ACCESSORY BUILDING r/{ (FROM C/L STREET/ SETBACK LINE FROM I I CENTER OF STREET 4/3- REAR YARD �.ZI FRONT SFT. • FT. SIDE YARD I LEFT L / I RIGHT /8 ' R.SIDE ` O FT. FT. DESCRIPTION OF WORK L.BIDE �n/^1FT. / FT. NEW K ALTERATION ADDITION / REAR S /O r/ FT. DISTANCE BET. BET.MAIN Q MAIN BLDGS. ACCESS.BLDGS. REPAIR MOVING DEMOLISH BUILDING I I�NO.OP .+� VAR.SV--/7-45 A DATE 6 �'J_4S SIZE y� trrryy69 L ROOMS ROOF /SjTORIESS J_ C.El.P..l APPROVED/�EXTERIOR / c COVERING _fl'VGG`II COVERING age BY (.4).17 I0' DATE S -ti L V USE OF BUILDING AND WORK TO BE PERFORMED. = •� - .• HOLD_ FO1t?Cr;AL R QUiFL'i,; :.;`c 1. .A 1 at. t t c te•- rig L _ SO.Fi. I HEREBY ACKNOWLEDDE THAT I HAVE READ THIS APPLICATION, • THE AMOUNT.SHOWN UNDER VALUATION IS FOR THE . i AND STATE THAT THE A OVE IS CORRECT AND AGREE TO COM• PURPOSE OF 'ESTABLISHING A "' O 'PERMIT•FEE MILT. ' PLY WITH ALL OTT O ?ICES AND STATE LAWS REGULATING VALUATION /�(SQ BUILDING CONSTRU 0 . /7 ✓l. IN // / : PERMIT FEE 5 SIGNATURE OF C//L/ I II PERMITTEE 1� � :}l` �//af'ti f/��jf S3 II 7 " ✓ _LANC EC Q AUTHORIZED AGENT • ��/r Jc .. .. _ . .. TOTAL FEE 5 142 I , 9�.501 "- CITY OF COSTA MESA 4 rBUILDING DIVISION o F • , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT M02-00034 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No A Applied: 01/24/2002 Issued: 01/24/2002 Vicinity: UNIT A Parcel Number: 42623302 - ISSUED BY: Applicant: COOTER, LYLE '"7;-//_- _ . , Address: ' Phone: 714-978-7970 " - i' Zip: - - i Owner: CEFALIA, JOE ' Address:' '%JOE,&STELLA ACEFALIA ':-;�<,,,� j� V AAA / ` � CORONA DEL-MAR,CA Phone: 949 720 1143 1649 BAYSIDE/DR Zip: 92625-1832 ',�.v', ' , Contractor. `PRO HEATING &AIR Address: ARS AMERICAN RESIDENTIAL SVS'OF CA ' ' YORBA LINDA,CA . -Phone: (714)283-8262 - II - 22921 SAVI RANCH PKWY , ' ' Zip:' - 92887 - ' License:764099 - _ -/ / SCOPE OF PERMIT ' MECHANICAL AND ELECTRICAL FOR NEW SFR.ELECTRICAL TO INCLUDE 1 MOTOR TO 4 HP. . ' MECHNICAL TO INCLUDE:.--4 TON A/CaND.1 FURNACE TO 115,000 BTU'S. / -- - i . . REF:BOA-00306. _ . .. . . . - _ , FEE SUMMARY Quantity " _- - / / Quantity ISSUE FEE $23.50 Repair,/Alt'Absorbtion Unit 2 $0.00 0 Inst FAU <100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst.FAU>100 k BTU $18.20 1 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler , '$0.00 0 • Inst/'Rep. Recess Wall Htr $0.00 0 . .1.-, .•Commercial Incinerator '' $0.00 0 Refrig Sys<100 k BTU • • $0.00 0 _ - Domestic Incinerator $0.00 0 - Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems' 2 Gas Piping` ` $0.00 0 -Up to 3 hp/100 k BTU 7/•� ' $0.00 0 Factory Fireplace , • \'7\:,\-;•$0.00_ 70 ,•7'-'' 3 To 15 hp/500'1c:BTU _ - , - $0.00 0 Hood w/Mech Exhaust ,$0.00 0 ' 15 To 30 hp/1,000 k BTU . ' $0.00 ' 0 VAV Box $0.00< 0 30 To 50 hp/1,750 k BTU 10.00 0 Vent Fan/Single.Duct '% . $0.00` .0 ' Over 50 hp/Over.1,750 BTU - 7 $0.00 0 Appliance $0.00 0 ' , Boilers • Fire Dampers 7 $0.00 0 _ . Up to 3 hp ' $0.00 0 Smoke Dampers • ' $0.00 0 - 3 To 15 hp $2 15 1 Inst or Relocate Appl Vent ' . $0.00 0- 15 to 30 hp, - "i $0. 0 • Air Handlers< 10000cfm ' $0.00 0 , ' ' ' 30 to 50 hp - / $0.0 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp - $0.00 0 Floor Furnace $0.00 0 . . Other Mechanical Fee Floor or Suspend Heater $0.00 .0 - Investigation Fee ' $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $68.85 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28;§1, 12-21-92) EXPIRATION: This permit shall automatically expire InII work is not commenced within 180 days,or H work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244e48(Woo) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. /'''�q I have and will malhtain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: % ` G /q Carrier: P/'rv`z�—'�}, �--4 Policy Number: 14) G / t O 7O S/ (This section need not bPcompleted if the permit is valued at one hundred dollars($100)or less.) • ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. ' ApplicantSignature: -- Date: /-` / -- Z__- WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# 7 6 V D'N Class# /.- Zit2 Contractor's Signature: o/" Date: / 3/ 0 3 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: _ Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of pdriury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applatint to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property;or cly employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) lirse puskant to the Contractors License Laws.). 0'1 I ern Zxempeonder sec. ) _ Business and Professions Code for this reason: ¢$Ipnatureil-2- Date: Vwnert J4i iedLy driver's license. 0 Yes 0 No Driver's License No. Expires: *'. Verification o Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: • HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 Of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes U No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No , (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection pure a e+roFto occupy or allow occupancy of any building authorized by this permit until final inspection. /7 z,//-- ? 9°?-_. Sign ure Of Legal Owner(s) • / Date And/Or Authorized Applicant Date CODE I INSPECTION TYPE DALE IhrEM61.E, RAIE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final - 6- -oa R N • 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall . 212 Final Fire Prevention 202 Final Factory Fire Place • -- 220 Final Planning Approval • 203 Final Sign 222 Final Site 204 Final Demolition .. - 250 Final Building/Occupancy '0 -9 CITY OF COSTA MESA . < BUILDING DIVISION ori. F i I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER jj • PERMIT 4P01-00666 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2087 GARDEN LNj Status: ISSUED Suite No A ! Applied: 11/13/2001 4 Issued: 11/13/2001 Vicinity: • ISSUED BY: Parcel Nunmber: 42623302 - Applicant: ROELLE, MICHAEL - Address: 5057 LANTE AVE _ - t Phone: 626-960-0344 BALE CA - -- ' Zip: 91706- = Owner:." CEFALIA STELLA AND JOE ' Address 1649 BAYSIDE DR ' Phone: 949 720 1143 CORONA-DEL MAR,CA Zip:' 92625 , Contractor: MICHAEL G ROELLE PLUMBING_ -- - - Address: 5057 LANTE AVE , - ' - Phone: 626-960-0344 - , 'BALDWIN-PARK,CA Zip: 91706 . . • - License: 743562 , Arch / Eng : � �' --- Address: .. ._ " _. _ Phone: Zip:, -i - _License: . - - SCOPE OF PERMIT PLUMBING FOR NEW SFR. 2 BATHTUBS, 1 DISHWASHER, 1 GAS(1-4)OUTLETS,2 OUTLETS OVER 4, 1 LAUNDRY/TUB , 1 SHOWER, 1 KITCHEN SINK,4 WASH BASINS, 3 WATER CLOSETS, 1 WATER HEATER, 1 WATER SERVICE.APPLICANT NOT DOING SEWER CONNECTION. REF: 601-00306 , FEE SUMMARY AMT .',QTY AMT "QTY - AMT QTY ISSUE FEE $23:50 - , Laundry Tub/Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation. $0.00' = 0 , Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer, $0.00, , 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $19.60 ' 2 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 ' -0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00.. 0 Receptors $0.00 •0 Vacuum-Brkr Bkflow(5+) $0.00 0 Dental Units $0.00. 0 Septic Tank ' ' $0.00 0 Wash Basin' $39.20 4 Dishwasher $9.80 - 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0. Sewer Connect • $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 - Sewer Private Line $0.00 -0 - Water Closet(Toilet) $29.40 3 Drain,Roof $0.00 0 - Shower - $9.80 -" 1 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $9.80 1 Gas(1-4 outlets) $6.15 1 Sink, kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $2.20 2 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 . TOTAL CALCULATED FEES: $181.35 'C LUIVIMtN I S I SYtI.IAL LUNUI I IONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permitshallautomatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. . INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-48(Stoo) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which t Is permit is issued. I will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. y workers'compensation Insurance carrier and policy number are: Card : Policy Number: (This section need not be completed It the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and gr that i Id me subject to the workers'compensation provisions of Se Ion 3700 of the Labor Code,I shall forthwith comply with these provisions.-A j 2 Applicant Signature: '—•'%�/LwLLf Date: )1 ' 7 ( 0 WARNING:FAILURE TO SECURE WORKERS' ENSAT1ON COVERAGE IS UNLAWFUL MID SHALL SUBJECT AN EMPLOYER TO CRIMI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOU ARE($100,0130).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and LJc.e Class# Contractors Signature: _—l'ntWgi / Data: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which'requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of DMsion 3 of the Business and Professions Code)or that he or she isexempt therefrom and the basis for the alleged exemption,Any violation of Section 7031.5 by any applicant for a perrr4'. subjects the applicant to a civil penalty of not more then five hundred dollars($500).): ❑ 1,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the over-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bit or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? ❑Ves 0 No __ ..._....f..-....._.__ _ _ 5 Does or willo the applicant or present or future building occupantm require for the wonk which is the subject of this application epeNnil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes LI No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penally of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Lege w`M(sc)(3�, cuJ /� _ // Date And/Or Authorized App ant / Date 9ODE r INSPECTION TYPE PATE lynnALS PDF It INSPECTION TYPE DATA INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 4.28-0a. QN 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA ` • BUILDING DIVISION • ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 f PERMIT E02-00055 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No A Applied: 01/24/2002 Vicinity: UNITA Issued: 01/24/2002 Parcel Nunmber: 42623302 Applicant: COOTER, LYLE - - ISSUED BY: Address: > 7/ - _ �.;. Phone: 714-978-7970 Zip: Owner ' CEFALIA, JOE ' : - Address %:10E,&STELLA A CEFALIA- CORONA-DEL-MAR,CA Phone: 949 720 1143 1649 BAY/SIDE DR Zip: 92625-1832 Contractor: PRO HEATING &AIR - .. Address: ARS"AMERICAN RESIDENTIAL SVS-OF CA-' _ '\ . YORBA LINDA,CA , ',.•Pti ne: (714)283-8262 . 22921 SAVI RANCH PKWY • Zip: 92887 • _ ' / License: 764099 - - - ' ' • - - ' . SCOPE OF PERMIT MECHANICAL AND ELECTRICAL FOR NEW SFR. ELECTRICAL TO INCLUDE 1,MOTOR TO 4 HP. . • MECHNICAL TO INCLUDE: 1 -4 TON-AJC AND'T FURNACE TO 115,000 BTU'S. . , " REF:1301-00306. FEE SUMMARY,v Quantity Quantity- ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res:a/c package . $0.00 - "Standing Section New Res(1-2 units) ' $0.00 0 .. Misc Electrical Equipment $0.00 0 New Res(3+units) ,' $0.00 0 - Transformers up-to 1 kva/kw $0.00 . ,'0 , Pool/Spa .$0.00 _ 0 . up to 10'kva/kw '- .S0.00' • 0- . ', Lighting Fixts $0.00 '0• ' up to 50 kva/kw $0.00' 0 Recept Outlets $0.00' 0 up to 100 kva/kw , $0.00 - 0 Switches . : : $0.00 ' : 0 • over 100 kva/kw . , $0.00 0 .' Non Res Appl ' $0.00 . '0 ' Low Voltage Equipment $0.00 ' 0 Res Appl $0.00 . 0 ' Low Volt Wiring System/Ckt $0.00 0 / Service to 200a $0.00 0 Misc.Conduit '. $0.00 • 0 Service to 1000a $0.00, _ 0 Misc.Conductor $0.00 , 0 Service over 10003 N., -$0.00 ' .0 . Circus(gen or ride) ' - $0.00 '' ,70 Motors to 1 hp ' $0.00' - 0 Circus(mech ride or lights) '$0.00. 0 Motors to 10hp $12.30 1 . Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 " - ' Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 . Other Electrical Fee , ' $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 'Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 • Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $35.80 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5826 2446-46(aroo) DECLARATIONS WORKERS'COMPENSATION DECLARATION: .. . - I hereby affirm under penalty of perjury one of the following declarations: .. • ❑. Ive and will maintain a certificate of consent to self-Insure for workers'compensation;as provided for by section 3700 of the Labor Code,for the performance of the rk for which this permit is issued. 1 have and will maintain workers'compensation insurance,as req d by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compp'nance carde d policy rumba are: / �/ ` / y Carder: r I C R-il Policy Number he (��/ (Via- O/ (This section need not e c feted if the permit is valued at one hundred dollars($100)or less.) ❑ -I certify that in the performance of the work for which this•-rmit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I s,:.• •become subject to the workers'compensation provisions f Section 3700 of the Labor Code,I shall forthwith comply with these provisions. mat/ Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS' r '' '• COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER T CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($102030),IN ADDITIO rior E CAST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under proviso s o h.;ter 9(commencing with Section 7000)of Division 3 of the Business and Prole/�s/1onxs.-C�ode,and my license is in full force and effect.Lia# i Class# ` // Contractor's Signature: / Date: 1---6=Cb� r CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: . I hereby affirm that under penalty of perjury that flim EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or,her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business end Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. 1 Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomla Health and Safely Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L-I No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws end city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Lege Os) / gate — Andy rized Applicant /— r�r//((I` `Date • CODE t INSPECTIONTYP6 DATE MAO . CODE# INSPECTION TYPE PAIS ILLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 7//cia ea& 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place , . . 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition .. .. . ., 250 Final Building/Occupancy . "l.. CITY OF COSTA MESA = 4 BUILDING DIVISION 1.:s „-. .4r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER I. I w..rsavarrrrns i 4 r' • PERMIT E02-00064 - (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No A Applied: 01/25/2002 Vicinity: Issued: 01/25/2002 Parcel Nunmber: 42623302 Applicant: RADOGNE, TINA ISSUED BY: Address: 1656 BABCOCK - * - - - _ � i Phone: 949-642-2431 COSTA MESA;CA' % Zip: � /� / ii i Owner !CEFALIA,`JOE - N Address ' %JOE, &STELIA'A CEFALIA v��- CORONA DELMAR,-CA Phone: 949 720 1143 1649 BAYSIDE OR Zip: 92625-1832 v Contractor: BOYER, TOM CO , Address: -1656 BABCOCK _ , . Phone: (949)642-2431. - COSTA MESA,CA" / y Zip: 92627 , ' License: 566902 - . SCOPE OF PERMIT �/ ELECTRICAL FOR NEW SFR..RESIDENCE SQUARE FOOTAGE IS 2358. 1-OUTLET, 1 SWITCH AND 1 ' LIGHT FOR GARAGE:REF: B01-00306.- ' -- - ' '- , ' - FEE SUMMARY N N , ' Quantity / - -' - Quantity ISSUE FEE $23.50 Temp Dist System/.Lighting $0.00 0 ;' Temp service test $0.00 Busway/100 ft $0.00 0 - Res. a/c package $0.00 Standing Section . $0.00 0, New Res(1-2 units) $132.05 2358 Misc Electrical Equipment $0.00 '0 New Res(3+units) $0.00 0 - Transformers up to 1 kva/kw $0.00 - ,0 ' Pool/Spa '-, ` ' ` $0.00 0 :up to 10 kva/kw $0.00 / /A Lighting Fixts^, $1.10 1 - up to 50 kva/kw $0.00 - ,' 0 Recept Outlets-, x-,$1,10 1 , . - • up to•100 kya/kw.- . $0.00" 0 , . Switches 1 ,, $1.10-. 1' ' over 100 kva/kW $0.00 0' / Non Res Appl , /;,-$0.00 , 0 - Low Voltage Equipment -$0.00" " 0 / Res Appl ,, , , $0.00 - :0 Low Volt Wiring System/Ckt. / $0.00 /-0 Service to 200a $0.00 '0 Misc.Conduit ' "' $0.00 ' / 0' /� / Service to 1000a . ,$0.00 - ' 0 _ . Misc.Conductor / , $0.00 , 0 / Service over 1000a A / , $0.00 0 - Circus(gen or ride) -' $0.00 - 0 7 Motors to lhp .- .$0.00 0 Circus(mech ride or lights) ' ' -$0.00 , 0 • Motors to 10hp N.,.:=$0.00 /- - " 0 , - Christmas Tree Stand _ //$0.00 7 /0 Motors to 50hp -$0.00 0 . / Fireworks Stand Motors to 100hp $0.000 Other Electrical Fee ' - / $0.00 Motors over 100hp $0.00 0 / - " - . - Communication drops $0.00 0. - Investigation Fee- -- $0.00 Sub panel to 200a $0.00 0 - /Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $158.85 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6`00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. lr I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My w,rkers'compensation Insurance,carrier and policy number are: (` Cartier: �t(.4-K' (.Ccher1-C44 �h \�)•(OM'CQ SL)Ca Policy Number: ,&l5\� ' (This section need not be completed it the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance o the work for which this permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California a d agree that it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these visions. ApntSlgneture:, \� Date: 1-- -UZ WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am I' nsedf ender provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busl and Professions Code,and my license Is in full force and effect t ic.# O"I� Class# (�1t? �( l .Contraclor's Si nature: ��ff((Al.z. I L410 .7A- _ Date: 1— i i.i -- v CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pdPouant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Processions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the ownjr-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. b Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, _ or 200 cubic feet of compressed gas at standard temperature and pressure). � __ _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0 N (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes ❑No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described� property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. !f, : $$Igo lure Of Legal Owner(s) AA - M� Date (-DO't . �` p-An r Authonzed Applicant Date CODE a INSPECTION TYPE RATE MEALS PODF( INSPECTION TYPE Mg 5(TIDALI 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing .. 200 Final Re-Roof 210 Final Electrical 7//olit* 201 Final Block/Retaining Wall 212 Final Fire Prevention - 202 Final Factory Fire Place 220 Final Planning Approval . 203 Final Sign 222 Final Site 204 Final Demolition 250 .Final Building/Occupancy , L' 9 CITY OF COSTA MESA t ` BUILDING DIVISION '- F •,, t' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER al 4• laraaa1 j PERMIT Rano M02-00020 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2087 GARDEN LN Status: ISSUED Suite No A Applied: 01/22/2002 Issued: 01/22/2002 Vicinity: Parcel Number: 42623302 - ISSUED BY: Applicant: CEFALIA, JIM -- - ' - . Address: %JOE, &STELLA A CEFALIA CORONA DELMAR CA.-- '. Phone: 949 720 1143 1649 BAYSIDE DR - Zip: 92625-1832. - '\ Owner. CEFALIA, JOE -; Address: ' • %JOE,&STELLA A'CEFALIA CORONA DEL MAR, CA Phone: 949 720 1143 ,. -.. :\.:\\-, - 1649 BAYSIDE DR Zip: 92625-1832 Contractor: .OWNER BUILDER - Address: ----\ . -Phone - '�I �'` , i , . Zip License:000000 - �\', '/ A2 J �< - SCOPE OF PERMIT MECHANICAL FOR FACTORY FIREPLACE INSTALLATION. REF:B01- - - - ``FEE SUMMARY ` '- -.- - - , ' • ', Quantity - - Quantity ISSUE FEE $23.50 Repair/Alt Al5sorbtion Unit , $0.00 0 InsLFAU<100 k BTU $0.00- - 0. -. - , , .N Repair/AltRefrigeration-Unit . ,, $0.00 ` 0- InstFAU,>100 k BTU $0.00t' 0'r' _` -, •• - , Ventillatiori System -- $0.00 0 Repair/Alt Cooling/Heat $0.00 ,, .-... ' Repair/Alt Cooling/Heat $0.00 0- - Evaporative Cooler .''$0.00, 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator - $0.00 . 0 Refrig Sys<100 k.BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping - $0.00 0Up to 3 hp/100 k BTU ' . $0.00 0 Factory Fireplace - $10.65 1 ._-3 To 15 hp/500 k BTU /" '/ ,$0:00 ..0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU - " $0.00 /0 VAV Boz, -, $0.00 0 30 To 50 hp/-1,750 k BTU ' '/' - $0.00 0 Vent Fan/Single Duct , x'$0.00, 0 _'` Over 50 hp/Over ,750vBTU -%/?i ; r $0.00• .0 Appliance ‘ $0.00 .D - - Boilers . ./ / „/ Fire Dampers ..y'\ �%-$0.00c 0 Up to 3 hp - - '\ $0.00 0 Smoke Dampers,' - - $0.00;'-;0�, - c 3 To 15 hp < ,.> (/ / $0.00 0 Inst or Relocate Appl-Vent ' $0.00 '-0- -15 to 30 hp • Air Handlers< 10000cfm' .' $0.00 0 - 30 to 50 hp Air Handlers> 10000cfm' N - $0.00 0 Over 50 hp ' - ' - $0.00 0 Floor Furnace $0.00 , 0 - Other Mechanical Fee - ' - ../ Floor Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee - $0.00 Reinspection Fee , „ $0.00 ' , , . _, TOTAL CALCULATED FEES $34.15 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS ' WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: • • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. - ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carder: Policy Number (This section need not be completed i/the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,0X),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there if construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: -w� Date: OWNER-BUILDER DECLARATIONS: - C.ca. I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mare than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business.and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or hersel4orlthrou§h his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one;year of' u completion;the owneribuilder will have the burden of proving that he or she did not build or improve for purpose of sale.). �4J ❑ I,as owner of the property/am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does n`ot.apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuantto the Contractoist'ira_ se nLaws.). ❑ I am exempt under sec. - Business and Professions Code for this reason: Signature: - QTa,n Date: Owner ID verified by drivers license. ❑Ves 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.;property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I III no_.• oy an work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to o'such .•rk f'7 Signature: / Date: Divis'• • dustrial ety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare en RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0 N (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisapplication aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes 1J No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree • • ply with • tate laws and cis .-:mans relating to building construction,and authorize representatives of the City Costa Mesa to enter upon the above-desci•:d pr••e-rte.: ' - agree not to occupy or allow occupancy of any building authorized by this per it until finp ins ion. I� Z " Signature• egal Owner(s) ate And/Or Authorized Applicant Date LODE! INSPECTION TYPE RAM , 1t�8LS LOGE! INSPECTION TYPE• r ��U'! 1616 Fixed System Final Fire Prevention . . 206 Final Mechanical / Z v 7' 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • • 202 Final Factory Fire Place . • 220 Final Planning Approval • 203 Final Sign 222 Final Site 204 - Final Demolition .. . . 250 - Final Building/Occupancy Date: March 1, 2002 To: City of Costa Mesa Building Department From: Eric Kough, A.I.A. Project: Garden Lane 2087 A thru E Costa Mesa, CA Re: Field fixes for Shearwalls The field fixes for missing or mislocated holdowns which were requested 2/5/02 appear to be in conformance and meet the general intent of the drawings. If you have any further questions, please feel free to contact me at 714-273-4803. i cziotski • : ,:,:,..\ \ wC- C97 r Ali f(11 ' 9 Q /'• RENEWAL �.