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HomeMy WebLinkAbout2319 SANTA ANA AVE - Building Permits "RFs, CITY OF COSTA MESA F y ��•�I� BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT °•,� PERMIT PERMIT NUMBER *""° ° B98-02091 tV/ (714)754-5273 • Fax(714)754-4656 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: ' e• SANTA ANA AV Status: ISSUED fit/P2 . Suite: Applied: 11/19/1998 Vicinity: Issued: 01/12/1999 Parcel Nunmber: 11913320 Zoning: Applicant: CEFALIA, JIM • Address: Phone: Zip: Owner: CEFALIA, JOSEPH, AND STELLA ANGELA Address 1649 BAYSIDE DRIVE Phone: (949)720-1143 CORONA DEL MAR,CA - Zip: 92625 • Contractor: ' -Address: Phone: Zip: License: Arch : JEFF CHAMLEY • Eng: ROBIN HAMERS &ASSOC. Address: 1012 BRIOSO DR Address: 234 E. 17TH SUITE 201 Phone: 949-650-0511 205 Phone: 949-548-1192 C.M.,CA C.M.CA Zip: 92627 License: 123 92627 License: 31720 SCOPE OF PERMIT , CONSTRUCT NEW 2,270 SQ. FT.SINGLE-FAMILY RESIDENCE WITH A 516 SQ. FT.GARAGE,ON LOT 4, 1029 1ST FLOOR, 1241 2ND FLOOR,516.5SF GARAGE. PLAN#2 D. FEE SUMMARY Plan Check: $227.87 a Calc Valuation: s202s30.50 Permit: $1,402.25 - Claim Valuation: so.00 SMIP Res: $20.29 SMIP Corn: $0.00 Other $0.00 Inspection: $0.00 Total: $1,650.41 PLANNING &ZONING SETBACKS . MAIN STRUCTURE Front 44-0 Rear 14-0 Left 5-0 Right 5-0 ACCESSORY Front 0-0 Rear 0-0 - Left 0-0 Right 0-0 PARKING Existing: 0 Required: 2 Proposed: 2 NOTES: 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 DECLARATIONS ' WORKERS'COMPENSATION DECLARATION: F 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: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) o 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 OVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,008),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 lull 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: 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 tile 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 hiself 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 urit Id 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 Coda:The contractors License Law does not apply to an owner of properly who builds or Improves thereon,end 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: �L �� 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 live(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: Dale: 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 end 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 ❑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? 0 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 pan 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 Emlesions. Signature: Date: CERTIFICATE 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 e com•I .' all st. : la nd city ordinances relating to building construction,and authorize represents es oft City of Costa Mese to enter upon the above-de rib prope •r In • I r oses.I agree not to occupy or allow occupancy of any building authorized b S per ntil final inspection. L Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date ODES INSPELTIONTYPE ME iMBAL6 COOP I INSPECTION TYPF DATE IRWIASS 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 /3♦ 204 Final Demolition 250 Final Building/Occupancy (P• 0.Q'�`+9 ic 244648 ;•'l` CITY OF COSTA MESA )qt. BUILDING DIVISION PERMIT NUMBER f' ' ' ' DEVELOPMENT SERVICES DEPARTMENT PERMIT E99-00291 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: '2/i'l SANTA ANA AV Status:- ISSUED Suite No Applied: 04/08/1999 Vicinity: NEW SFD W/ATT GARAGE Issued: 04/08/1999 Parcel Nunmber: 11913320 __ q y�� ISSUED BY: /3//n '! Applicant: BOYER,TOM Address: 1760 MONROVIA AV " , `- . , CA - /Phone: 949.642.2431 - COSTA MESA -' Zip: 92627 Owner: , CEFALIA TRUST - Address 1649 BAYSIDE DR Phone: CORONA DEL MAR, CA 92625 /.,.; COSTA-R4EEA A Zip: 9262 - /' /contractor. BOYER, TOM CO 'Address: 1760 MONROVIA AV . . . Phone: 949 642-2431 COSTA MESA CA _ Zip: 92627 -� , -License: 566902 SCOPE OF PERMIT , NEW 2,270 SF SFR W/ATT GARAGE.GARAGE APPARATUS AS FOLLOWS.4 LIGHT FIXTURES,5' RECEPTACLE OUTLETS AND 4 SWITCHES.RE:B98-02088••=7/ FEE SUMMARY Quantity' Quantity ISSUE FEE $22.00 - - 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) $113.50 2270 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 $4.00 4 - up to 50 kva/kw $0.00 0 Recept Outlets $5.00 5 - up to 100 kva/kw $0.00 0 Switches , $4.00 4 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 - Low Voltage Equipment $0.00 0 Res Appl , $0.00 , -10. - - Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 10001-- $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 $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 $148.50 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)754-5628 • 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. flir 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 permt is issued. My workers'rk/ mpen atlon Insurance carrier and policy number are: Carrier: ///i1At ' "-" - Policy Number: (This se con need n e completed the permit Is valued at one hundred dollars($100)or lass.) ❑ 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 comSigth these•r. :1- 7t Applicant Signature. i:._- �_ Date: / WARNING:FAILURE • ECURE WO-'<. 'COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND COLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE.INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am license nndder provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busine s and professions Code,and my license is in full force and effect.Lic.11 ` �1. O... Class 4 Contractor's Signature:. Date: Y 7 97 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 Is licensed pursuant to the provisions of the Contractors License Lew(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 drivers license. 0 Yes 0 No Driver's 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 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 greeter 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. has Section h Safe .,u.ycompli. 4 If an RMPP is presently required. S25534 of the California Health and Safety Code been fully compiled 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? 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 ❑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 properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. a_nature Of Legal Owner(s) 7 And/Or Authorized Applicant Date CODE[ VISPECTION TYPE g9IE INTIMLE CODE INSPECTION TYPE PATE INTIMAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing • /� oo 200 Final Re-Roof 210 Final Electrical % —J 3_!/ 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 2446-46 :153:-"4:-, CITY OF COSTA MESA n � BUILDING DIVISION • PER NUMBER r' ' ) DEVELOPMENT SERVICES DEPARTMENT 6. 99-00185 99-00185 (714)754-5273 • Fax(714)754-4858 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2W9 SANTA ANA AV Status: ISSUED Suite No - Applied: 04/20/1999 Issued: 04/20/1999 Vicinity: • Parcel Number: 11913320 L�/� ISSUED BY: /• I Applicant: CEFALIA TRUST Address: 1649 BAYSIDE DR Phone: CORONA DEL MAR,CA Zip: 92625-1832 Owner CEFALIA TRUST Address: 1649 BAYSIDE DR Phone: CORONA DEL MAR,CA Zip: 92625-1832 Contractor: Address: Phone: Zip: License: Arch l Eng: Address: Phone: Zip: License: SCOPE OF PERMIT INSTALL NEW PRE-FABRICATED METAL FIREPLACEIN NEW SFD. B98-02091. FEE SUMMARY • , Quantity Quantity ISSUE FEE $22.00 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 $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 $9.50 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/1,750 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 $31.50 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 4 9' IV DECLARATIONS fl 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 Ls 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 caller 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 Celifomla,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 NO SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOl1APE($100,000).IN ADOMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.ANO 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.p Class a Contractor's Signature: 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). 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).): XI,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 exe - t under sec. Business and Professions Code for this reason: ���q Signature: • � Date: 6/-70 / 9 Owner ID` lad by tln �s license. 0 Yes N No Driver's License No. Expires: Vedfcati• of Owners ip 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 Ls required to descend,will be made in connection with work authorized by this permit,end 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 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 ❑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 01 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 aRermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U 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 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,and authorize representatives of the City of Costa Mesa to enter upon the above ascribed props for inspectionyu es.I agr not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si re Of Legal err s) Date And/Or Authorized Applicant Date SoDE I gf$pFCTION TYPE DAB CODE! IBSPECTON TYPE in 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ O Lllln 1268 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 2446-48 CITY OF COSTA MESA BUILDING DIVISION PERM NUMBER DEVELOPMENT SERVICES DEPARTMENT `! arra PERMIT 99-00164 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 A MECHANICAL PERMIT Job Address: 29(/ SANTA ANA AV Status: ISSUED Suite No Applied: 04/08/1999 Issued: 04/08/1999 Vicinity: Parcel Number 11913320 1 ISSUED BY: Applicant: DANNY REAMS Address: Phone: Zip: Owner SCHLICHENMAYER, RICHARD D Address: • 2321 SANTA ANA AVE Phone: COSTA MESA,CA- Zip: 92627 Contractor: REAMS'HEATING AND NC Address: P.O.BOX 615 Phone: 562-430-5755 SEAL BEACH,CA Zip: 90740 • • .License: 162995 Arch/Eng: Address: • Phone: Zip: License: SCOPE OF PERMIT' • NEW SINGLE FAMILY RESIDENCE,RE:B98-02091,INSTALL 1 FAU, 1 NC UNIT, 1 KITCHEN • HOOD AND 2 VENTILATION FANS. FEE SUMMARY Quantity -- ' Quantity ISSUE FEE $22.00.. Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $13.25 1 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 $13.25 1 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/MechExhaust $9.50 1 "-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 $19.00 2 - 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 ' $0.06 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 Chick Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES S77.00 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)754-5828 0 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: S74T" p $9 Policy Number.- / 7 / SJ`f U —9 (This section need not be completed l/the permit is valued at one hundred dollars(S100)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: � AdoL/IM✓ Date: frO WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL MD SHALL SIJDlECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DCLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 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.# /( 2 19 r Class x !G '2- Contractors 2Contractors Signature: 1n Date: y—' —ek 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 em 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.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 contractor;License Law does not apply to en 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 em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 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 n0 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 greeter 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 er mit 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 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? ❑Yes 0 No (It'yes',the tadtity must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Cnact 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 Safely 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 at 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 properly 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/ r Authorized Applicant Date CODE! INSPECTION TYPE LAM HMO CoQEF INSPECTION TYPE 28Thp, 1616 Fixed System Final Fire Prevention 206 Final Mechanical 9 R / 1 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 244936 i _ CITY OF COSTA MESA }q,al.1,...� BUILDING DIVISION r 4 I DEVELOPMENT SERVICES DEPARTMENT t>. PERMIT • PE BER .,�� • P99-00019 (774)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 �J 1 PLUMBING PERMIT Job Address: 1.2 iii SANTA ANA AV Status: ISSUED Suite No Applied: 01/13/1999 Issued: 01/13/1999 Vicinity: BLDG D Parcel Nunmber. 11913320 Applicant CROTHERS, CONI Address: 1733 MONROVIA AV #E Phone: 949-722-9998 C.M.,CA Zip: 92627 Owner. CEFALIA, JOSEPH, AND STELLA ANGELA Address 1649 BAYSIDE DRIVE Phone: (949)720-1143 CORONA DEL MAR,CA Zip: 92625 Contractor. DW DOTY PLUMBING CONTRACTORS Address: 1733 MONROVIA AV #E • Phone: 949-722-9998 C.M.,CA - Zip: 92627 • License:- 685042 Arch l Eng: Address: • Phone: Zip: License: SCOPE OF PERMIT ' 2 BATHTUBS, 1 DISHWASHER, 1 LAUNDRY, 1 SHOWER, 1 KITCHEN SINK,2 WASH BASINS, 1 WASH BASIN(SET),3 TOILETS, 1 WATER HEATER, 1 WATER SERVICE„ 1 GAS SERVICE,5 GAS OUTLETS, 1 SEWER CONNEC. REF B98-2091. - / FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $22.00 Laundry Tub/Washer $8.75 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 $17.50 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 $17.50 2 ' Dishwasher $8.75 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $8.75 1 Drain,Floor $0.00 0 Sewer Connect $22.00 1 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $26.25 3 Drain,Roof $0.00 0 Shower $8.75 1 Water Heater/vent $11.00 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 $0.00 0 Gas(1-4 outlets) $5.50 1 Sink,kitchen $8.75 1 Water Softener $8.75 1 Gas(Over 4 outlets) $1.00 1 Sink,service/mop $0.00 0 OTHER $0.00 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 Jegal, 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 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 01 the Labor Code,for the performance of the work for which this permit is issued. ;Qr 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'compep�s/aliioon�nsuranc carrier and policy number are: A Cartier: )'Y1) Kir )C in s Pdlcy Number: 0109 SCJ 52- (This 2- (This section need not be corneletegif 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 Pr tobi Applicant Signature: Date: WARNING:FAILURE TO S RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND OC*ARE(SIN,000),IN ADOMON TO THE COST OFCOMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am livens d r pro ions 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.tic.M Class k C 3lo Contractor's Signature: / , 19" Date: I ).3-4147 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 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, em 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 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,end 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-bullder,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 ❑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,hes 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 Ls the subject of this a plication 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 ❑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). 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. i /1 Sign t Legal Owner(s) Date d/Or AuthorizdQ Applicant Date 001.1. 111250:001132E DAM DMALS COPE INSPECTION TYPF PATE 9i1ENLS 1616 Fixed System Final Fire Prevention 208 Final Mechanical /� 1266 Pool Spa Final 208 Final Plumbing JO.Q-91 l9 6N 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 Bull0ing/Occupancy 2446-46 FINAL GRACING CERTIFICATION 2aq Project Address: •. - - - 'rS, - - SANTA ANA AVENUE, COSTA MESA Lot Number: TR N0. 14706 • q . • Permit Number: 60 7Y oC1 By Civil Engineer: . I certify to the satisfactory completion of grading in accordance with the.approved plans, specifications, local and state codes. All drainage devices required by the gradin permit, • • grading plan and grading ordinance have been installed. Adequate provisions have been made for drainage of surface water from each'building•site. The minimums are: - 25.fa)) from structures within 5 feet from exterior walls. 15-c Fall for asphalt surfaces and landscaped areas. • O.55 Fall for concrete surfaces to approved disposal areas. / • n-e-fPreh-n-ontinreras-a tion,n vu the ICcwluPdrr21.1 lllc� were--set All final grading eleva- tio ns are within = ll)0 of the designed levations. Supervising Civil Engineer Reg. No. 31720 ($._na:crc) . Date • 1iirnei • QPOFESSj� �Q�QO\N B H9�F`l�2 • c7 rU ,A m I EX 4 1/2000 . \ . , ClVII �Q' 9TFCR CALIFOP� STP.!•9 and sicv