HomeMy WebLinkAbout2815 LORETO AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa��DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite:
Vicinity:
Primary Occ:
Parcel Number:
Applicant:
Address:
2815 LORETO AV
MASTER BEDROOM AND KITCHEN
R3 Dwellings/ Cong Res <10 Type of Construction: V-N
14133223 Zoning:
EASON, DAVID
342 PEACH TREE LANE
NEWPORT BEACH, CA
Owner: SEGOVIA, MICHAEL
Address 2875LORETOAVE
COSTA MESA, CA
Contrecror: OW NER-BUI LDER
Address:
Zip:
Phone: 949-642-8028
Zip: 92660
Phone:
Zip: 92626-5812
Phone:
License: 000000
ISSUED BY:
Status: ISSUED
Applied: 02/15/2006
Issued: 03/272006
Arch : Eng: HUSZCZ, MARIAN JOHN
Address: Address: 14200 CULVER DR
Zip:
Phone:
License:
IRVINE, CA
Phone: 949-551-3316
License: 3555
SCOPE OF PERMIT
ADD 292 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: EXPAND EXISTING BEDROOM TO CONVERT INTO A MASTER BEDROOM SUITE. RELOC.
EXISTING M. BATH. REMODEL EXISTING KITCHEN.
EXISTING 3 BEDROOM, 2 BATH S.F.D. WILL REMAIN THE SAME.
Plan Check: $418.76
Permit: $644.25
SMIP Res: $5.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $1,068.01
SETBACKS
MAINSTRUCTURE Fronl 20-0 Rear 20-0
ACCESSORY
PARKING
Front 0- 0 Rear 0- 0
Existin : 4 Reauired: 4
FEE SUMMARY
Calc Valuation: Sso,000.00
Claim Valuation: 5so,000.00
PLANNING & ZONING
Left 5- 0 Right
Lek 0- 0 Right
Pr000sed: 4
5- 0
bII�]
' NOTICE: The work authorized by this permit shall comply with all applicable handicap accass requirements under California statu�e .and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commencetl within 180 days, or if work: suspended or abandoned
for a period ot 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable cotles, antl all
raquiretl inspeetlons 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
WORKERS' COMPENSNTION DECLARATION:
I hereby aHirtn untler penalry ot perjury one oi ihe following tleclaretions: ,
� , .
❑ 1 have and will mainiain e certificata ot consent to selt-Insure lor workers' compensation, as provided for by section 3700 0l ihe Labor Code, lor tha pertormance of the
work tor which Ihis Permit is issuetl.
❑ I have and will mainW�n workers' compensation insurance, as requiretl by section 3700 of the Lahor Code, for t�e peAormance of the work for which Ihis pertnit is issuetl.
My workars' compensation Insurance wrrier and policy number are: �
Cartier: Policy Numbar:
(This secfion need not be comp/eted i! fhe permit is valued af one hundred tlollars (5700) or less.)
��I.cenity thet in the pertormenca of the work For which ihis permit is issued, I shall not employ any Oerson in any manner so es to 6ecome subject to ihe worker5'
�compensation laws oi C fomia, gre t�ould become sublect to the workers' compensation provisions of Section 3700 ot tha Labor Code. I shell forthwith
Comply wilh Ihese pfov 5.
ApplicenYSlgnatu� re: ,��� i /Dat-"� 3�Z �"( D 4'
WMNWG:�FAICUFE TO SECURE WOFKERS' COMPENSATION CAVEPAGE IS UNIAWFUL AND SHALL SU&IECT AN EMPLOVEF TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDRED
THIXISAND DOLLARE (5100.0001. IN nDDITION TO iHE COST OF COMPENSATION, DAN.AGES PS PFOVIDED FOR IN SECiION 37060F THE LABOR CODE, IMEFEST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aMirm Ihat I am licensetl untler provisions of Chapter 9(commencing with Section 7000) of Oivision 3 0l the Business and Professions Code, antl my license is in full
lorce and eflaa. Lic R Cless a
Gontractofs Signawre�. Date:
CONSTRUCTON LEN�ING AGENCY:
�i ❑ I here6y attirm t�at there is e consWction lending egency for ihe pedormance of the work for which this permit is issuetl. (Sec. 3097, Civil Code).
I Lender's Neme: Lender's Address:
�i Signeiure: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirtn tha� undef penalty o� perjury ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business end Professions
Cotle: Any ciry or county whic� requires a permit to consirucL alter, Improve, demolish, or repair any structure, prior to its issuance, also requires ihe applicant far such pertnit
to file e signed statemen� lhai he or sha is licensetl pursuant to Ihe pmvisions of Ihe Contractors License Lew (Chapter 9(commencing with Section 7000) ot Division 3 of the
Business end Professions Code) or lhat he or she is exempt therefrom antl the hasis for the allegetl Bzemption. Any violation o� Section 7031.5 by eny apPlitant f0� e permit
subjects Ihe applicent to a civil penalry of not more than live hundretl dollars (5500)J:
❑ I, es owner of ihe p�operty, or my employees with wages as their sole compensation, WILL DO TME WORK, end ihe structure is not intended or ottered for sale (Sac.
7044, Business and P�ofessions Code: The Coniractors License law does not apply to an owner of property who builds or improves thereon, antl who does such work
�imselt or herself o� �hrough his or her own employees, provided that such improvements are not intandetl or oRered lor sale. If, however, ihe building or improvement is
soltl within one year of completion, the owner-builder will have ihe burden of proving ihat he or she did nol builtl or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRALTORS to construct the project (Sec. 7044, Business antl Professions
Cotle: The coniracto�s License Law does not apply to an owner ot property who builds or impwves I�ereon, entl who coniracts for such project wlih e coNraclo�(s)
license pursuenl lo Ihe Comractors License Laws.�.
❑ I am ezempt under sea Business and Professions Code for ihis reason:
Signature: Date:
Owner ID verified by driver's license. � Yes ❑ No Drivers License No. Expires:
Verificetion of Ownership by (�ype ot document, i.e. - pwpe�y �az bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby ceRify �hat no excavation five (5) or more fee� in deplh into which a person is requiretl �o tlescenq will be made in connection with work euthorized by this
permit, antl that no building siructure, scaHolding, talsework, or demolition or dismanlling thereot, will be more than ihirty-six (36) feet high. (Chap. 3.2, Grp 2, An 2, Sec.
341, Ttle B, Califomia Administrative Cotle).
❑ As ownerbuilder, I will not employ anyone to do work which would require a parmit fmm the Division of Industrial Safery, as notetl above, unless such person has a
pertnit to tlo such work from ihe division.
Signature: Date:
Division of Industrial Safery Parmit Numbec
CER7IFICATE OF COMPLUINCE AND AUTHORIZATON OF ENTAV: I certiy untler penaliy of perjury ihat I have read this application antl state that Ihe infortnation given is
correcl. I agree to compty with all state laws antl ciry ordinances relating to building construction, antl authorize representatives of the Ciry of Costa Mesa to enter upon t�e
ebove-described properry �or inspection purposes. I agrea not to occupy or allow occupancy of any building authonzetl by this permii until finel inspection.
[�17�'�ISFi9�9Y6R�Y1��
1616 FizeC System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roo�
201 Final BIocWReta�ning Wall
202 Final Facmry Fire Place
203 Final Sign
206 Final Demolilion
�f NTRIAL
CO�EX INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Sita
250 Final6uilding/Occupancy
QAjf, IILrRIRLS
DECLARATION OF AUTHOI�ITY
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS
Street Address: � g
drN�� �
Bldg. Permit #
This Permit #
AP Number:
a�)-. �J� Iv 7 (o ,
1. 1(we), /%% /�!� �>�—r'i �"�� �4 , declare that I am the Owner of Title of the above
referenced real property, and that I(we) hereby authorize:
Nam� /�!¢�� y-�'`--'/� Telephone� eL� 47 1�Y��QLQ � __
Stre" etAddress: r� `i � Ir�%'�'4�� 7���� ��'`�"
ah,:�/v�"—�-u.�'�t ��c � sc c��/�L, `rC' Z�/ -�'t � b�O
.� , , �/
to obtain permits in my behalf, as owner/builder, for �T1� r i� i; �.a4or1� ��
at the above referenced property. !
2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Worker's
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the Ciry of Costa
Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept thal my responsibilities do not transfer to any olher person, company or
corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to mysalf or any other parties as a result of work authorized by the permits from the City of Cosla Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this �� day of �i/�� 20 Q� , at �t9S� /%%�s/� , California.
0719�a6 (rev.11/00)
Print Name
Signature:
Date: � �/��//��
Note: This auUror¢ation does not grant authorizabon to perform tlie work as owner,
it solefy provides for fimded power of attomey to secure this pertnfl in any behaff.
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
Address
Contractor:
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fizts
Recepl Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1hp
Motors to 70hp
Molors to SOhp
Motors to t00hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuils
Temp Pwr Pole
Intermed Pole
2815 LORETO AV
ADDITION
14133223
EASON, DAVID
342 PEACH TREE LANE
NEWPORT BEACH, CA
SEGOVIA, MICHAEL
2815 LORETO AVE
COSTA MESA, CA
OWNER-BUILDER
Phone: 949-642-8028
Zip 92660
Phone: 714-979-5091
Zip: 92626-5812
Phone:
Zip:
License: 000000
SCOPE OF PERMIT
PERMIT FOR ADD 292 S.F;TO EXISTING S.F.D.
REF#: 605-00246
status: ISSUED
Applied: 03/27/2006
Issued: 03/27/2006
ISSUED BY: �"l(lr1
---•
WORK TO INCLUDE: 15 LIGHT FIXTS, 10 RECEPT, 10 SWITCHES AND 1 SERVICE TO 200A.
$23.50
50.00
$0.00
$0.00
$0.00
$0.00
$76.50
$11.00
$71.00
$0.00
$0.00
$30.50
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
Quantity
Q ..
0
0
15
10
10
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist Systeiu / LiqMing
Busway /100 fl
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc Conduit
Misa Conduclor
Cirws ( gen or ride)
Circus (mech ride or lights)
Chrislmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quanlity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES $92.50
rn�u�euro � onen�e� nnun�r��uo
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiiements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspe or abandoned
for a period of 180 days. � �
INSPECTIONS: In order tor ihe work authorized under this permit to be considered legal, such work must comply wlt 0 applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result � he expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKEqS'COMPENSAnON DECLARAnON:
I hereby aHirm under penalty of perjury one oi the following tleclaretions:
❑ I have antl will maintain a cartificate of consent to self-Insure for workers' compansation, es provitled for by section 3700 ot Ne Labor Cotle, tor the pertormance ot ihe
work for whiCh �his permit is is5ued.
❑ I have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, br the pertormance of the work for which ihis pertnit is issued.
My workars' compensation Insurance carrier and policy number are:
Carner: Policy Number:
(This secfion need nof be completed i! fhe permit is valuetl e( one hundred dollars ($ f 00) or /ess.J
�—f'ce�tiry that in the pertormance of the work for which ihis pertnit is issuetl. I shall not employ any person in any manner so as to become subjecl to ihe workers'
�cortTpensation laws of Californl ee t if I should become subject to the workers' compensation provisions of Section 3700 of Ihe Labor Code, I shall forthwith
compty with Ihese provi �i'. s ��/ )�
AppLcanCSlgn�atu�ra':"�� /� �'' - �—Oate:_ � / Ei 'F'
WARMNG."FAILURE TO SECIMFINORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMFLOVER TO CHIMINAL PENALTIES AND GVIL FINES UP TOIXJE HUNDRED
TFIOUSAND DOLLARE (E100,OOD), IN ADDITION TO TME fAST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION3]06 OF THE IABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION: I
� I hereby aHirm ihat I am licensed untler provisions ot Chap�er 9(commencing with Section 7000) of Division 3 0l iha Business antl Professions Cotle, and my license is in full
torce and eHect. lic. N Class %
IConiractor's Signawre: Date: I
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm ihat there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lender'S Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby attirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe toilowin9 reason (Sec. 7031.5, Business and Professions
Code: Any ciry or counry which requires e permit to consimct, alter, improve, demolish, or repair any stmcture, prior to its issuance, also requires ihe applicant for such permit
to file a signed statement �hat he or she is licensed pursuam to the provisions of ihe Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe
Business and Professions Code) or ihat he or she is eaempl therefrom and the basis for ihe alleged ezemption. Any violetion of Section 7031.5 by any applicant for a permit
sublecis ihe epplicant m a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of ihe property, or my employees with wages as their sole compensa�ion, WILL DO 7HE WORK, antl tha stmcture is not intentled or oHered for sale (Sec.
7044, Business and Pmfessions Code: The CoNractors License Law dces not apply to an owner ot property who builds or improves thereon, and who dces such work
himself or herself or through his or her own empioyeas, provided ihat such improvements are not imended or oHered for sale. If, however, ihe buiitling or improvement is
sold within one year of completion, ihe owner-builder will have the burden o( proving that he or she did not builtl or improve for puryose of sale.).
❑ I, as owner ol the propetly, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the prolect (SecJ044, Business and Professions
Code: The con�ractors License Law does not apply to an owner oi property who builds or Improves thereon, and who contracts for such projec� with a contractor(s)
license pursuant to ihe Con(rac�ors License Laws.).
� I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by dnver's license. ❑ Yes ❑ No Drivers License No.
Verification ot Ownership by (type of tlocument, i.e. - propeny taz bill or deed):
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feat in depth in�o which a person is required to descend, will be made in connection with work authorized by ihis
permit, and that no building siructure, scaflolding, falsework, or demolition or dismantling ihereof, will be more ihan thiny-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title 8, California Atlministretive CodeJ.
❑ As owner-builder, I will not employ anyone to do work which would require a permit from Ihe Division of Industrial Safety, as noted above, unless such person has e
permit m do such work from the division.
Signature: Date:
Division ol Industrial Safety Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTMORIZATON OF ENTAV: I certify under penalty of perjury that I have read ihi5 apDlication and state ihat the information given is
correct. I agree to comply with all state laws end ciry ordinances relating to huilding constmction, and au�horize representatives of �he Ciry of Costa Mesa to enter upon ihe
above-described pmperty tor inspeclion purposes. I agrae not to occupy or allow occupancy ot arcy building autfiorized by this permit until finaf inspedion.
COOE 1. INSVELTIONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re�Roof
207 Final Block/Retaining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demoli[ion
P� �NTRIALS
40DE+ INSPECTIONTVPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrica�
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
�� °�-/�
n
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(774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.PcLUMBING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2815 LORETO AV
Suile No
Vicinity:
Parcel Nunmber: 74133223
Applicant:
Address:
Owner:
Address
Contractor:
Address:
EASON, DAVID
342 PEACH TREE LANE
NEWPORT BEACH, CA
SEGOVIA, MICHAEL
2815LORETO AVE
COSTA MESA, CA
OWNER-BUILDER
Phone: 949-642-8028
Zip: 92660
Phone: 714-979-5091
Zip: 92626-5812
Phone:
Zip:
License: 000000
SCOPE OF PERMIT
PLUMBING PERMIT FOR FOR ADD 292 S.F. TO EXISTING S.F.D.
REF#:B05-00246
ISSUED BY:
Status: ISSUED
Applied: 0327/2006
Issued: 03/272006
WORK TO INCLUDE: 1 BATHTUB, 1 SHOWER, 1 KITCHEN SINK, 1 WAHS BASIN, 1 WATER CLOSET.
FEE SUMMARY
AMT QTY AMT QTY AMT gTY
ISSUE FEE $23.50 Laundry Tub / Washer $0.00 0 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 $9.80 1 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifer System 50.00 0 Process Piping (per 10 ft) 50.00 0 Vacuum Brkr BkOow(1-4) 50.00 0
Connect (Ice,Soda,etc) 50.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) 50.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $9.80 1
Dishwasher $0.00 0 Sewer Cap (or Demo - $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Wasie and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $9.80 1
Drain, Roof $0.00 0 Shower $9.80 1 Wafer Heater/ vent $0.00 0
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 $0.00 0
Gas (1-4 oullets) $0.00 0 Sink, kitchen $9.80 1 Water So(tener $0.00 0
Gas (Over 4 oullels) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa (private) 50.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00
Intercepiors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors (Sand Auto ) $0.00 0
TOTAL CALCULATED FEES: 572.50
COMMENTS I SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply wiih all applicable handicap access requirements under California �t tu es and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or il work is suspentled or abandoned
for a period of 1 BO days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
requlred inspeotlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2466-0fiIN00)
WORKERS'COMPENSA�ON DECLARAnON:
I hereby aNirtn untler penalry oi perjury one of the tollowing tleclarations:
❑ I have and wlll meintain a cenificate of consent b selt-Insure for workers' compensation, es provitled for by section 3700 of the Labor Code, for the peAormance of Ihe
work tor which ihis pertnit is Issuetl.
❑ I have and will maintain workers' compensation insurance, as required by section 3700 of Ihe Lehor Cotle, for Ihe peAortnance of ihe work tor which ihis permit is issued.
My workers' compensatlon Insurance carrier and policy number are: .
Carner: Polity Number.
(This section need nof be Fomp/efed i! Ihe permit is valued ef one hundred dollars (3100) or less.)
� I certify thel in the p6dormance ol �he work tor which this pertnit is issuetl, I shall not employ eny person in any manner so as to become subject to tha workers'
compensatlon laws o� Cellfomia, entl gre iha ' I should 6ecome subject to the workers' compensatlon provislons of Section 3700 of fha Labor Cotle, I shall forihwlth
comply with these pro� sions.
.ApplicenLSignawre: � �D$ta.� �� /��'/fl"�n
WARNING'FA1L' RE TO SEC KERS' COMPENSATION COVERAGE IS UNtAWFUL AND SHALL SUBJEGT MIFl/,pIDVEflTO CRIMINAL PENALTIES AND CIVIL FWES UP TOONE HUNDRED
THOUSAND DOLLARE (3100, ). IN ADOITION TO THE COST OF fAMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 370fi OF TNE LABOR CODE, INTEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the eusiness and Pmfessions Code, antl my license is in full
force and ettecL Lic. M Glass a
Comractors Signeture: Date:
CONSTRUCTION LENDING AGENCV: i
❑ 1 hereby aHirm ihat Inere is a construction lending agency tor ihe performance of �he work lor which this permit is issued. (Sec. 3097, Civil Cotle).
Lendefs Name: Lentler's Address:
Signamre: Date:
OWNER-BUILDER DECLAAATIONS:
I hereby eflirm ihat under penalty of perlury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW br ihe following reason (Sec. 7031.5, Business antl Pmfessions
Code: Any ciry or county Which requires a permit to constmc6 alter, improve, damolish, or repair any strucNre, prior to its issuance, also requires t�e apDlicant for such permit
to tile a 5ignetl stelement thal he or sha is Ilcensed pursuant ro Ihe provisions ol Ihe Contractors License Law (Chapter 9(commencing with Seclion 7000) of Division 3 0l t�e
Business and Prolessions Code) or Ihet �a or she is exempt iherefrom antl the basis lor the elleged exemption. Any violation of Section 7031.5 by any applicent for a pertnit
su6jects tha applicant to e civil penalty ol not more than five hundred dollars (5500).):
❑ I, as owner of ihe property, or my employees with wagas as Iheir sole compensation, WILL DO TME WORK, antl the simcture is not intendetl or otteretl for sale (Sac.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of propetly who builds or improves ihereon, and who does such work
himself o� herself or ihrough his or her own employees, provided ihat such improvemems are not intendetl or oNered for sale. Ii, however, the building or improvement is
sold within one yeer D� completion, the owner-builder will have ihe burden o� proving ihat he or sho did not build or improve for purpose of sale.).
❑ I, es owner ol the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRAGTORS to consimct the project (Sec. 7044, Business antl Pmfessions
Code: The conlractofs License Lew tloes not apply to en owner of propetly who builtls or Improves thereon, and who coniracis tor such project with a contrector(s)
license pursuant to tne Coniractors Licensa Laws.).
❑ I em exempt under sec.
SignaWre:
Owner ID verilietl �y tlriver's license. ❑ Ves ❑ No
Business and Professions Coda tor Nis reason:
Venfication of Ownership by (type ol tlocument, i.e. � pmperty tax bill or tleed):
Driver's License No.
Date:
E:pires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certity that no excavation live (5) or more feet in tlepth into which e person is requiretl �o tlascend, will be made in connection with work authonzetl by ihis
permit, and Ihat no builtling siructure, swflolding, falsework, or demolition or tlismantling ihereof, will be more ihan t�irry-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec.
341, Title B, Calibmia Atlministrative Code).
❑ As owner�builder, I Will not employ anyone to do work which would require a permil irom iha Division of Indusirial Safery, as notetl above, unless such person hes e
permit to do such wofk tmm ihe division.
SignaNre: Date:
Division oi Intlustrial Safety Permit Number.
CERTIFICATE OF COMPLIANCE AND Al1THORIZATON OF ENTRY: I certify under penalty of perjury ihat I have reatl ihis application end state ihat ihe informatlon given is
wrrect. I agree to compy w�th ell state lews and ciry ordinances relating to builtling construction, and authonze represematives of Ne City ol Costa Mesa to enter upon Ihe
ebove-described property lor inspedion purposes. I agree not to occupy or allow wcupancy ot eny builtling authonzed by this permit until finel inspection.
COOE �. INSPECTIONTYPE
1616 Fixetl System Fin81 Fire Prevention
1266 Pool Spa Final
200 Final Re�Roof
201 Final BIocWRetaining Well
202 Final Factory Fire Place
203 Final Sign
204 Finel Demolition
PdI� U+SIDe45
COOE� INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Elecincal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
2�g INTffULS
� �
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2815 LORETO AV
Suite No
Vicinity:
Parcel Number: 14133223
ApplicanC EASON, DAVID
Address: 342 PEACH TREE LANE
NEWPORT BEACH, CA �
Owner: SEGOVIA, MICHAEL
Address: 2815 LORETO AVE ',
COSTA MESA, CA �
Contracror: O W N ER-B U I LD ER
Address:
MECHANICAL PERMIT
Phone: 949-642-8028
Zip: 92660
Phone: 714-979-5091
Zip: 92626-5812
Phone:
Zip:
License: 000000
SCOPE OF PERMIT
MECHANICAL PERMIT FOR PERMIT FOR ADD 292 S.F. TO EXISTING S.F.D.
REF#:BOS-00246
ISSUED BY:
Status: ISSUED
Applied: 03/27/2006
Issued: 03/27/2006
WORK TO INCLUDE: 1 HOOD WITH MECH EXHAUST, 1 VENT FAN/SINGLE DUCT AND 1 INST OR
RELOCATE APP VENT.
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair/Alt CoolingMeat
Inst / Rep. Recess Wall Htr
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Boz
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocale Appl Vent
Air Handlers < 10000cfm
AirHandlers> 10000cfm
Floor Fumace
Floor or Suspend Heater
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$10.65
$0.00
$7.25
$0.00
$0.00
$0.00
$10.65
$0.00
$0.00
$0.00
$0.00
Quantiry
FEE SUMMARY
Repair / Alt Absorbtion Unit
Repair / Alt Refrigera�ion Unit
Ventillation System
Evaporative Cooler
Com mercia l I n cine reto r
Domestic Incineretor
Comuressors / Absorotion Svstems
Uplo3hp/100kBTU
3 To 15 hp / 500 k BTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Up to 3 hp
3To15hp
15fo30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
TOTAL CALCULATED FEES
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permi� shall comply with all applicable handicap access requiremenis under
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 H
for a period of 180 days.
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
552.05
and related
orabandoned
INSPECTIONS: In order for the work authorized under this permit to be consideied legal, such work must comply with all applicable codes, and all
requlred inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiralion of this permit.
FOR INSPECTIONS CALL: (714) 7545626
244G46 (N00)
WORKERS'COMPENSATION DECLARAnON:
I hereby attirm under penalry ot perjury one oi 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 ihe pertormance of the
work for which this pefmit is issued.
❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cotle, for Ihe pertormance of the work for which this pertnit is issued.
My workers' compensation Insurance carriar antl policy number are:
Carrier: Policy Number:
(This section need nof be cnmpleted il the pemrit is valued at one hundred dollars ($100J or less.)
�^�I�certify that in Ihe pedormance of the work for which this permit is issued, I shall not employ any person in any manner so as �o become su6ject to the workers'
/compensation laws of Calitomia, and agree hat if}}y���}�ould become sobjad to the workers' compensalion provisions ot Section 3700 ot tha Labor Code, I shall torihwith
comply with Ihese pro�is ns C� � � � /
'AppLcant Sig� re: � .'9'✓� Date: ���—/D y
WARNINOYFAILUPE TO SE ORKEFS' COMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000). IN A�DITION TO THE COST OF CAMPENSATION, DAMAGES AS PFOVIDED FOR IN SECTION 31O60F THE LABOR CAOE, IN�EREST, AND ATTORNEVS FEES.
LICENSED CON7RACTORS DECIARATION:
I hereby attirm that I am licensed untler provisions oi Chapter 9(commencing with Section 7000) of Division 3 of the Business and Pmfessions Code, antl my license is in full
force and eflect. Lic. # Class #
Comractor's Signature: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aNirm that the�e is a constmction lending agency for ihe pedormance of ihe work for which Ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name: LendePs Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aNirm ihat untler penalry of perjury ihat I am EXEMP7 FROM THE CONTRAC70R5 LiCENSE LAW for ihe following reason (SecJ031.5, Business antl Protessions
Cotle: Any ciry or counry which requires a permit to constmct, alter, improve, demolish, or repair any simciure, prior to its issuance, also requires ihe applicant for such permit
to tile a signed statement ih�t he or she is licensed pursuant to the provisions oi ihe Comractors license Law (Chapter 9(commencing with Section 7000) of Division 3 of ihe
Business and Pmfessions Code) or thai he or she is eaempt iheretrom and ihe basis tor the alleged eaemption. Any violation ot Section 7037.5 by any applicant For a permit
subjects the applicant to a ci�il penalty of not more Ihan tive hundred tlollars ($500).):
❑ I, as owner ot the property, or my employees with wages as iheir sole compensatioq WILL DO THE WORK, and ihe stmcNre is not intended or otteretl for sale (Sec.
7044, Business and Plofessions Code: The Contrac�ors License Law does not apply to an owner of property who builds or improves thereon, antl who does such work
himsel( or herseN or ihrough his or her own employees, pmvided that such improvemenis are not intended or oNered for sale. If, however, the buildiog or improvement is
sold w�thin one year of completion, the owner-builder will have ihe burden of proving ihat he or she did not build or improve tor purpose of sale.).
❑ I, as owner of the propetly, am EXCLUSNELY CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (Sec. 7044, Business antl Professions
Code: The contractors License Law tloes not apply to an owner of property who 6uilds or improves thereon, antl who coniracts for such project with a coniractor(s)
license pursuant to the CONractors License Laws.).
❑ I am ezempt under seG. Business and Pmfessions Cotle for this reason:
Signature:
Owner ID verified by dnver's license.
❑ Yes ❑ No Driver's License No.
Verifica�ion of Ownership hy (type of tlocument, i.e. - property �ax hill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMI7 CER7IFICA710N:
Date:
Ezpires:
❑ I hereby cehify ihat no eacavation fve (5) or more fee� in tlepth into which a person is required to descend, will be made in connection with work authorized by ihis
permit, and that no building simcture, scaHolding, falsework, or demolition or tlismantling ihereot, will 6e more ihan thirty-six (36) teet high. (Chap. 32, Grp 2, An 2, Sec.
341, Tiile 8, Cal'rfornia Atlminishalive Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from Ihe Division of Indusirial Safery, as noted above, unless such person has a
permit to do such work from ihe division.
Signature: Date:
Division of Indusirial Safety Permit Number:
CER7IFICATE OF COMPLIANCE AND AU7HORIZATION OF ENTRV: I certify under penalty of perjury tha� I have read Ihis application and state tha� ihe information given is
correct. I agree to comply with all state laws antl ciry ordinances relating to building constmction, and authorize representatives of the Ciry of Costa Mesa to enter upon Ihe
above-described property for inspection puryoses. I agree not to occupy or allow occupancy of any building authorized by this permit umil final inspection.
UE N. INSPECTIONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
202
203
Final Factory Fire Place
Final Sign
204 Final Demolition
ORTE INTRIALS
COOEN INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Preven�ion
220 Final Planning Approval
222 Final Site
250 FinalBuiiding/Occupancy
DRTE INTRIALS
II-��ob �
�@_3�:��1
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COBTA MEBA. CALIFORNIA
For Appiieanf fo Fill In Completely
TYPE OR PRINT
BUILDING
ADDRESS SI
COSTA MESA. GALIFORi�11A
Y MAIL
� ARCHITECT
TEL.
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OEC 9 1960
- t1;u`:CE J�.'a,
Lo't ?S� �LPr1J :3�I.t1✓��C-�i� i:i��''�
APPLICATION FOR PERMIT
BUILDING
For Offiee Use Only
REClIPT NO. P6R!M1I.TpNO.
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AUTFiORIZED AGENT
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(CCNTQR LINH BT.)
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