The URL can be used to link to this page

Home My WebLink About2032 FULLERTON AVE - Building Permits IPS CITYOF COSTA MESA BUILDING DIVISION i:'t .- 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.costamesaca.gov F1 %WA: Ipa p111.41k5 g FOR INSPECTIONS CALL: (714)754-5626 fi PERMIT NUMBER: M12-00066 PERMIT TYPE MECH STATUS: ISSUED APN: 42619120 DATE ISSUED: 04/30/2012 ISSUED BY: RMD JOB ADDRESS: 2032 FULLERTON AV CM Suite/Unit: Vicinity: SQ. FT: 0 • • Gt 0114--(1 `ktch irvL SCOPE OF WORK: MECAHNICAL PERMIT TO CHANGE OUT FAU FOR UNIT"A"AND"B". COMPLIANCE FORMS Al JACHED TO CITY PERMIT AND JOB CARD. WORK AND INSPECTIONS FOR BOTH UNITS TO BE DONE CONCURRENTLY. NOTE: FINAL APPROVAL OF PERMIT SHALL NOT BE PANTED UNTIL ACCESS TO DWELLING UNIY(S)IS PROVIDED FOR VERIFICATIO OF SMOKE AND CARBON MONOXIDE ALARMS BY THE CITY INSPECTOR.SEE ATTACHEMENT WITH INSPECTION CARD.(RESDENTIAL ONLY( OWNER: BRAATZ,CARL ROBERT Address: 499 PASEO ESTRELLA Unit: PHONE: JIMENEZ,JOSE City/State/Zip: ANAHEIM HILLS,CA APPLICANT: JIMENEZ,JOSE Address: Unit: PHONE: 951-845-5555 City/State/zZip: CONTRACTOR: BUDGET AIR INC License No. 901068 Address: 1390 E 6TH STREETUnit: STE 6 PHONE: 951-845-5555 City/State: BEAUMONT,CA ZipCode: 92223 CELL: MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $80.50 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $80.50 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. ODE A INSPECTION TYPE DRE INTIMAL$ CODE A INSPECTION TYPE ?3°91 • 12-tar rN��$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign • 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 0111 WORKERS'COMPENSATION DECLARAT Jr OwnenlD verified by driver's license. 0 Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification otOwnership by(type of document,i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized a erg' by this permit,and that no building structure,scaffolding,falsework,or demolition need wise mmmeteddtaepemtl u veryred nroro hundred Neaa(Sr00f a less) 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). li IDi 5 'er: �-\ i 0 As owner-builder, I will not employ anyone to do work which would ,.rl-certify-that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicant's Signature Dale the bor Code.I s II forthwith comply with these provisions. ke. c. -3 O 60 I� Division of Industrial Safety Permit Number: w Ap Appnature HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILUIIREE**++T SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full orce and effect. 9 a registration form for acutely hazardous materials? 0 Yes 0 No Llr,- 0 i cClass-# ' Iwo G 3 (Section 25533 of the California Health and Safety Code, with some ✓\ — I�'� n�3 0_aQ/a exceptions, requires registration with the Costa Mesa Fire Department by `l each business which at any one time has on hand a quantity of acutely 1 Conuaaora • ure (J-,Ocie€ 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 CONSTRUCTION LEND! G AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lenders Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lenders Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feel from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes', the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No 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 8. (If'yes-, attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penally of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 Signature Date 3057-46(3/07) ,pWOCAuthorized Applicant D�te Budget Air Applianr 951.84" ' 501 P4 SiniliC:erl Trrscr:p ti v:• Cer'tiGcmr of Cry!rtpliauc[': 31i1i}i Xcsirierl:irr/N!'Ac'/lhcreUiunr -CT-...G-fslT-,I)"p(: rminum'Lime:.1 nnr'3• r • • • .53- p J ,A/eJ mess 1 .1."1.-4, � 1al �!,�--te�a�...�,.„.,��u r i -Luta msula'nuF,1,• ,-t EOLIM abnl i vpr' _ '• --..l lfn>+tir %r 'in 1 krc rcnwrrnrca.l/I�d I "ihnfilnsutl C 1'IJureeal tint flow, 6vu Al!i f ducpJ.� Funvet : D AFUE - r•COY y'o I ❑SulL;tpl. Sa red Irl system added t rep1;nt fin C indoor Cuil 17SE3b. O flSYF _ r•� i�i 'tam Hurl hr I ” _ .Vn9medirw¢rSpace. ❑Cm:deluinf;Ural l D BEI( p kexislmlx 1:.6 (CZ/. u:nnlfedl _. D urs • L Egtti pmcua Type:Chugs::the equipment Lena;installed; i1 Innrc dual oucr;:acnt,use math, CF-IR-Al:141 YAC fur eachsucmtn. - ._.. . ' tvlminmm Zaxwme:rfneieaciec:•1?...;EER.,7VA AWE.7.7USK?fat tYpicm reaidanini t'.pstuw; .. Contractor(1Mtuwen:nliurl Author'sZRespunsibleltesipuer'i"Pinclnrufiuo Statement) •- .. • • • I certify that this EesiitczteofComplimtee documentation-is rccurnte and complete.' • - . . - • 3 a;n eligible tank,Division s•of the Califanul ba:ines•and lhcitssiTssCadt w asepi rc )onsibiiitp fur the design:identine4-an this Ccniftmlc of Compliance. ... .. • I cciih'Ihal the ene.,g;.'eaturc and p;rlomumec gmcif¢miom for the design idenlifted an IhirCerrifreme atGampirance..Onforin'nrlhe - requirements crTitic 24,Pun::., aiid n of tbr.Calitarnia Cude o"Hegulot ont. ' ' ' , , • • , The design features identified,on llu:.Cerlificatc of Compliance.=consissent with fife informmim!documented on othor,applicable.-•-- -- camplia-1 form: wort:glt:itr.calculation:•,plune and specificgtions suamined til the cnforcemini ugene.;for approval with itepermil .... 148tH.: As. . .. �t i i. Li2- P • . .. • _`7• JG ' ,J::. :- -.. .. - .... • .City/Sta:ctltc: tn,:,4 I.o .• . .. 7Jz-z•7� Phone: /17 tis - S • • • • • • 20111:1(eaidan:inl i:umplia ncr.Form:: • From: ?_03Z RA,aQ-r Tom Ave 05/09 '.12 10:49 #044 P.003/003 :, . IVi - cuB.0 cs `81- %a :111 ,MC- yS-/70 Z , . . 6, _' ASBESTOS ABATEMENT CERTIFICATION & CLEARANCE CERTIFICATION Project Name: (-OLP) 71)r4�..(�1 a / Unl - A - 0 �,,f ��J Project Location: Z J ZFUIk31i� f ICP Ave. �S*cl Me-�1Gf/4 Project Number: i.5-061°!Z A/ 1 / '7o `.F pA'fr1 Lor t-0wf CONTRACTOR CERTIFICATION '\��ul/� �� 11-IC Prior to commencing asbestos abatement activities, the Contractor hereby certifies that he has visually inspected the work area and that all isolation and preparation requirements of the work area have been completed In accordance with the asbestos specifications and federal, Stale and local regulations. Pre-Work Inspection By: Name: iGOH g j/1llc1 Signature: 8616 IF0 GO orf e ic- Date: t1/2 /I 2— CompanyName: 41/ l-O0/2 / Ch V. Title: SJ(ctilj/%Ser Upon the completion of asbestos abatement, the Contractor hereby certifies that he has visually inspected all surfaces of the work (including pipes, beams, ledges, walls, ceilings and floors, decontamination unit, polyethylene sheeting, etc.) and has found no dust, debris or residue. The inspection of the work area has been completed in accordance with the asbestos specifications and Federal, State and local regulations. Fms,V/ / Final Inspections By: �� Name: P OC)C#0 E ///°► Signature: Tocie'F i r,�. G o, 4 czl.._--- Date: 41/2 v/jam 9'-1/ Company Name: A/I Googly ,✓. Tille:s7-57 CERTIFIED ASBESTOS CONSULTANT CERTIFICATION The Asbestos Consultant hereby certifies that he/she has accompanied the Contractor on the visual inspection. Furthermore, the Contractor verifies that this inspection has been thorough, and to the best of his knowledge and belief. - j Pre-Work Inspection By: e: .5-Cat - istilr / - �'7 Signature: Na��—cir Date: `//Z ///2-- Company Name: 142 Environmental Consulting Services, Inc. Title:1Project Manager Final Inspection By: ame: o� L(47/7`1G �C. G/// 7/}`Signature: Date: Company Name: H2 Environmental Consulting Services, Inc. Title: Project Manager ❑ PASS Visual Roof Inspection, clear from all debris, area passes. PASS Final air sample results are less than 0.01 F/cc by PCM Analysis area passes. O FAIL Final air sample results are greater than 0.01 F/cc by PCM Analysis area fails. ❑ Final air samples were collectedandsubmitted to lab for TEM Analysis. By: Name: -501/ X19//`7r= Date: l�2(//Z ,t 3 .—T TT Signature: 0 4 Title: Project Manager J 13122 6th Street • Chino, CA 91710 (909) 628-0369 • Fax (909) 613-5845 • H2Environmental.com • • • STATE OF CALIFORNIA Project# 12-562 DEPARTMENT OF INDUSTRIAL RELATIONS Carl Braatz DIVISION OF OCCUPATIONAL SAFETY AND HEALTH Asbestos Contractors Registration Unit Temporary Worksite Notification for Asbestos-Related Work COMPANY/EMPLOYER NAME: All county Environmental& Restaration, Inc. HEADQUARTERS ADDRESS 1081 N Shepard St.#H AnaheimCA92806 Contractors State License Board License Number: B, ASB 812277 DOSH Asbestos Reeistration Number 829 ADDRESS AND PRECISE LOCATION OF TEMPORARY JOBSITE: 2032 fullerton ave. costa mesa ca 92627 NEAREST INTERSECTION: newport blvd. TYPE OF BUSINESS AT SITE: Residential NAME OF CERTIFIED SUPERVISOR: Rodolfo Gomez NAME OF QUALIFIED PERSON IN CHANGE OF AIR MONITORING, LABORATORY WORK,AND RESPIRATORS: H2 NAME OF CERTIFIED CONSULTANT: Scott W. PROJECTED JOB STARTING DATE: 4/27/2012 PROJECTED JOB COMPLETION DATE: 4/27/2012 DESCRIBE SCOPE OF JOB AND WORK PRACTICES OF JOB: ABATEMENT ISOLATE WORK AREA WITH PLASTIC SHEETING;NEGATIVE AIR FILTRATION;CONTAINERIZE WASTE;ALL SPILLS SHALL BE V:'I COVERED WITH PLASTIC,AND RECONTAINERIZED.ACCOUSTIC REMOVAL. Removal of ducts from duplex units that contains asbestos. EVALUATION OF POTENTIAL FOR EXPOSURE: Low ESTIMATED NUMBER OF EMPLOYEES ON THIS JOB: 2 ACCORDING TO TITLE 8 CCR SECTIONS 341.9 AND 1529(r) PROVIDE THIS COMPLETED NOTICE TO THE NEAREST DISTRICT COMPLIANCE OFFICE(SEE ATTACHED LISTING)- NOT TO DOSH HEADQUARTERS-PRIOR TO COMMENCEMENT OF ANT SUCH WORK ACTIVITY. NOTE: ANY CHANGE IN THE INFORMATION PROVIDED TO THE DIVISION BY THE WRITTEN NOTICE SHALL BE REPORTED TO THE DIVISION WITHIN 24 HOURS OF SUCH CHANGE E •011 M CITY OF COSTA MESA � BUILDING DIVISION • rin=Fo r�. .fir • DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER / PERMIT ° Boo-01809 ,1b (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cbISILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2032 FULLERTON AV U Status: ISSUED Suite: Applied: 11/13/2000 Vicinity: DUPLEX&ATTACHED GARAGE Issued: 11/13/2000 Parcel Number: 42619120 Zoning: Applicant: PARK, MIKE Address: 8639 BUENA TIERRA PL ISSUED BY: Phone: (800)726-7700 BUENA PARK,CA Zip: 90621 Owner: BRAATZ, CARL ROBERT Address 13061 LORETTA DR Phone: SANTA ANA,CA Zip: 92701 Contractor GOLDEN WEST ROOFING SERVICE Address: 8639 BUENA TIERRA PL Phone: (800)726-7700 BUENA PARK,CA Zip: 90621 License: 735924 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING DUPLEX WITH ATTACHED GARAGE(38 SQ).TEAR OFF EXISTING ROOFING&REPLACE SHEATHING AS NEEDED. INSTALL 1 LAYER OF 30#FELT UNDERLAYMENT&REROOF WITH 25 YEAR COMPOSITION SHINGLES. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $6,200.00 Permit: $139.25 Claim Valuation: $6,200.00 SMIP Res: $0.62 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $139.87 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)7545626 2446-46(6/00) r t I - `ti! 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 jwork for which this permit is issued.'thawbhaand 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: ,57777E ,A/z7 PolicyNumlier:- / 1fe- 02) (This section need not be completed it the permit is valued et one hundred dollars($1 00)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 at if I should become subject to the workers'compensation provisio•ns of Section 3700 of the Labor Code,I shall forthwith compl with these rout ns. / Applicant Signature: .� /4///�f) ({ Date_ ///j'02 WARNING;FAILURE TO SECURE WORKERS'COMPENS ION 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 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.e.--/93-4-9Classq, r C—.37. Conlraclor's Signature; �• ' /- ,f' Date: /4--/a -en) 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).): El 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 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 ❑No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 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 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 rmit for such construction or-Modification- from odification from the South Coast Air Quality Management District or from any other air pollution control district or agency? eU 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 ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Calitomia Health and Safety Code). _._ _._ —_C_ —__._..._.....___...._ ___..._...._ _ . 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's,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 e Of Legal�•/er(s) // Date Sr . // a--- .07,And/•r Auth• ze•Applicant 'Date- - CODE r INSPECTION TYPE QATE INTITIAL$ CODE! INSPECTIONTYPE PATE RlIID$L$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof i/' j W 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 • 3 3.4340 PAID 't,) 15-7?iw7.00 534* **I:161.99 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 a. APPLICATION FOR BUILDING PERMITS-/S7 For Applicant to Fill in Completely i BUILDING `� 1 RECEIVED DATE RE^EIVED�DEII'E7D� ADDRESS ,203 2. ACS 5LiA r6L1 //�� 01-70?- OWNER [[ /(. VI-C/l G// PERM Ti2r34c OWNER A.P.NO. J`tJ MAIL BUILDING 7 L A^ B � ADDRESS y, y}9 E/?mss/-- ADDRESS 2 03 w w aU CITY rex' 7/! Ape-s4 TNO1( 72 r5ec' TRACT 77/4 LOT 3 BLOCK ZZ Q CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH ON LENDER a. a __I V BRANCH Q s EWFLL f -- J V) OWNER m_Jill W ADDRESS VA�PLa7C �$ r��.LEO-,,- Jet ARCHITECT /� TE J/ yp,f Q OR ENGINEER /1 /�Hf/Mq NO✓6�/J �J� N '�j l yl' FIRE W 2 ADORESS�/ry 72 �Gth/ct O K/$' /s ft✓// a ZONE TYPEJ GROUP I i--r d w / APPROVED W Z CONTRACTORtt// '.S'!sr,ene, / BY DATE JZ ADDRESS/�y�' G/?`rcf W W ^ TEL. ZONE NO.OF USE OF NEt�W�,�1a��rr� ZI- CITY ( �C fy. Air-s" NO. 22-C� PLANS 2 BUILDING h.+�f.+�� STATE CITY YARDS APPROVED YARDS APPROVED twn Q LIC.NO. 6/ g ysavy LIC.NO. MAIN BUILDING ACCESSORY BUILDING / D O (FROM C/L STREET) SIZENO.OF BLDGS. OF LOT (NOW ON LOT FRONT 1716FT.O FT. USE OF EXISTING BLDG. R.SIDE SFT. 0 T. I- SIZE OF NO.OF �+ Z NEW BLDG. ROOMS STORIES L.SIDE J FT. / FT. Q EXTERIOR WALLROOF _V COVERING (COVERING REAR /D FT. 0 FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. / BET. MAIN& ,Rr'd MAIN BLDGS. ,/ ACCESS.BLDGS. * DATE 0 par ey� b C.U.P., #E APPROVED l-' APPROVE , (,) ,$Y a DATE /Vat 7L O2 /'tJ STATE I hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with _ CC all laws regulating building construction, and I shall not employ TAX I- any person in violation of the workman's compensation laws of CO the State of California. �( / / m; Z r' / SQ. FT. (O n' � / 6rO e I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UND-i VALUATION IS FOR ; Chapter 9, and that such licenses are in full force and effect,or I THE PURPCGE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provisions of the State of California Business Q and Professions Code, Division 3,Chapter 9. VALUATION co.S-0PERMIT FEE $/Dw/ D co Signature of ,(J�.7 :�= E Permittee �12� t:L st r`/d A $ w PLAN CHECK $ .5-3 ut siULD FOR SPECIAL REQUIREME 'da \ / { �S_ ,r,uthoriz AgentJ TOTAL FEE $J ✓ 9d