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HomeMy WebLinkAbout260 KNOX ST - Building Permits • CITY OF COSTA MESA • ' •le I • ` BUILDING DIVISION µ'Vi' ,1, 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us I.I ��3 I 4. ica� FOR INSPECTIONS CALL:(714)754-5626 • PERMIT NUMBER: BX09-00146 PERMIT TYPE B_MISC STATUS: ISSUED APN: 42516303 DATE ISSUED: 07/15/2009 Zoning: , ISSUED BY: RMD JOB ADDRESS: 260 KNOX ST CM • Suite/Unit: Vicinity: AT ROOF TOP '_Primary Occ: - - Const Type :?? SQ. FT: 0 Valuation: $3,000.00 • SCOPE OF WORK: • . PERMIT TO REPAIR(E) CHIMNEY LIKE FOR LIKE,.NO CHANGE IN SIZE OR HEIGHT. WORK TO INCLUDE THE REPLACEMENT REBAR OF CHIMNEY AT ROOFTOP AND DRYWALL REPLACEMENT THROUGH OUT HOUSE, DUE TO WATER DAMAGE. OWNER: GRILLIOT JANE WKEARL JONATHAN RINEHARTAddress:: • , . 260 KNOX ST Unit City/State: COSTA MESA, CA .. Zip Code: 92627 Phone: 949-646-9763 '. ' APPLICANT: KEARL JONATHAN RINEHART: - '. - Address: 260 KNOX ST - • Unit: City/State: COSTA MESA, CA, Zip Code: 92627. Phone: 949-697-3523 CONTRACTOR: OWNER-BUILDER - License No. 000000. Address: Unit: City/State: . Zip Code: Phone Cell: ARCHITECT: License No. Phone ENGINEER: License No. Phone FEE SUMMARY Building Plan Check: $0.00 Building Permit: $83.25 Electrical Permit: .. $0.00 • SMIP Residential - $0.50 SMIP Commercial .. " $0.00 • Bldg Std Admin Fund - ' $1.00 TOTAL FEES $84.75 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. CODE# INSPECTION TYPE DATE INITIALS CODER INSPECTION TYPE, DATE IN1111AI, 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof jO-O' 1./.!v 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 WORKERS'COMPENSATION DECLARATION Owner ID verified by drivers license. Yes ❑ No I hereby affirm under penalty of perjury one of the following declarations: DvesLicerise,Nd. �{ r — Thi ❑ 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 Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 ❑ 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 by this permit,and that no building structure,scaffolding,falsework,or demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This sedan need not be completed if he perms'is valued al one hundred dolars(5t0o)or less) 2,Arlt Sec.341,Title B,California Administrative Code). Policy Number: 0 As owner-builder, I will not employ anyone to do work which would (riZf-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 Date the Labor Code, all rthwi comply with these provisions. 1 / 670 Division of Industrial Safety Permit Number: APWi grhture 1 k. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FA LURE TO 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? ❑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 force and effect. a registration form for acutely hazardous materials? 0 Yes ❑No Lit.# Class# (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 Contractor's Signature Date 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 LENDING 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 Lender's Name: hazardous materials)? ❑Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Lender's 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 ❑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 feet from the outer boundaries of a school? 0 Yes ❑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 ❑No thereon,and who does such work himself or herself or through his or her own 8 (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for 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 penalty 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 ❑il=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 contractors)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 M a to enter upon the above-described property for inspection purpose gree not to occupy or allow occupancy of any building authorized by this er it u I final inspection. 11C701 7/ /��� O1 04 hire fdwner(s) Da 3057.46(3/07) And/or Authorized Applicant Date . h , , Y�01.! CITY OF COSTA MESA r o' ►� - BUILDING'SMSION • r,,,,, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER• -4. 11.1114 ib : PERMIT "nBO5-01086 "%boonm61 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 260 KNOX ST Status: ISSUED Suite: Applied: 06/30/2005 Vicinity: Issued: 06/30/2005 Primary Occ: R Type of Construction: V-N Parcel Number: 42516303 Zoning: Is 1 Applicant: JONATHAN REINEHART KEARL ISSUED BY: Irl Address: 260 KNOX ST _ v , Phone: . 949-646-9763 COSTA MESA;TCA, - v I • Zip: 92627,/ ' Owner GRILLIOT, JANE M-& JONATHAN REINEHART - ' Address 260 KNOX ST - _' - - � ' ' - - Phone. 94&646-97832 , E le.-COSTA MESA;CAS Zip: 92627 - - - ., Contractor OWNER-BUILDER DATE Address: /�% ��� , ft„/ " i%'iv Phone: ' Zip: "'i License:,- 000000 , Arch : 'C-' Eng: QIANG XIAO Address: - - ' - - - - - Address: - 1300 BRISTOL ST#100 Phone: Phone: 949-261-7740 NEWPORT BEACH Zip: A/ License: 92612' A License: C66510 ' - .' ' 1 SCOPE OF PERMIT INTERIOR ALTERATIONS TO EXISTING-S.F.D.WORK TO'INCLUDE:-DEMOLISH INTERIOR LOAD BEARING WALL BETWEEN LIVING/DINING ROOMS,DEMOLISH INTERIOR NON-LOAD BEARING WALL BETWEEN KITCHEN AND.DINING ROOM,AND RELOCATE INTERIOR WALL TO .CREATE NEW LAUNDRY ROOM NEXT '' TO EXISTING BATHROOM. NO ADDITIONAL SQUARE FOOTAGE. • , 'v - FEE SUMMARY ; Plan Check: $108.71 l' �� Calc Valuation: ' $8,500.00 PermIt: H$167.25 '' Claim Valuation:'i / ,` $8,500.00 ' SMIP, Res: • $0.85 • SMIP Com; 'x$0.00 ' ,Other: $0100 Inspection: , $0.00-, ; Total: $276.81 ,.H` N-r / / /> . �. ( 5l' , `j' -.::::.c " PLANNING-&ZONING- ' \\-;',c/ �/7 / SETBACKS \\<",:,;\:, .� �: v�� MAIN STRUCTURE Front-0--0 - Rear 0-0 - Left 0:0 - 1` , Right 0:0'. � ACCESSORY Front 0-0 ' - Rear 0=0 _ H v Left , 0-0- - . -Right-- 0-0 PARKING Existing: 0 Required: 0 Proposed:' 0 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'aba Boned 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 ap 193b a codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the eion of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-48(600) DECLARATIONS WORKERS'COMPENSATION DECLARATION: A • 31. I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. . ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carer and policy number are: Carrier Policy Number. (This section need not be completed it the permit is valued at one hundred dollars(5100)or loss.) C"' 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: •:.\(/1/4...Lt U O C WARNING:FAILURE TO SECUR OTU(ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT NI EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000).IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Uc.# Class a Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,CM!Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:My 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 Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a dvil penalty'of not more than five hundred dollars(5500).): ❑ I,as owner.of the,property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • I,as owner of the properly,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 Ucense Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: \: a-Y—C 3(7 L< Owner ID verified by drivers license. 0 Vol 0 No Drivers License No. / , Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-sly(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 MD 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 al standard temperature and pressure). 2 Does or will the applicant or present or future builtling 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 rime 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 tire-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 willothe applicant in building District ct o al requirer for the work ontr l the or of this a Yeis on aggertnil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? �Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves 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 _CI 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 Emiss' j 1 �! / Signature: Date: J PC�i..4 70 d7 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-described property for Inspection purposes.I agree not to occupy or allow araipancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Dale coos t INSPECTION TYPE PATE AIC l3)0F E INSPECTION TYPE PATE INSMSlS 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 r 204 Final Demolition 250 Final Building/Occupancy 6 1-07 011112t, CITY OF COSTA MESA i ``' BUILDING DIVISION ,�:��� PERMIT NUMBER F t if•nblit'l?Tint�.-..� i DEVELOPMEMi SER CES DEPARTMENT PERMIT 4%...01 Q E05-00683 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 260 KNOX ST Status: ISSUED Suite No Applied: 06/29/2005 Vicinity: Issued: 06/29/2005 Parcel Nunmber: 42516303 - Applicant: JONATHAN REINEHART KEARLISSUED BY: Address: 260 KNOX ST - � - - - - Phone: 949-646-9763 COSTA MESA,CA - Zip " 92627 i . _ _ - Owner:- - GRILLIOT;JANE M.&-JONATHAN REINEHART Address /260 KNOX STC, 2 - - . Phone: 949-646-9763 COSTA MESA,CA Zip: 92627 r "'RED : D %, DATEi �;0 , Al Contractor: OWNER-BUILDER . Address: - - 'Phone: - - • Zip: License:000000 - ;1/ SCOPEOF:PERMIT, ' RELOCATE SERVICEMETER UP TO 200 AMP: - .• - • : - - , 06/30/05 REVISED:ADD 1 LIGHT FIXTURE,2 OUTLETS, 1 SWITCH AND 1 MISC.CONDUIT FOR NEW LAUNDRY ROOM. FEE SUMMARY . Quantity _ • Quantity. ' ' ISSUE FEE $23.50 " Temp Dist System_/Lighting $0.00 0 :q, . Temp service test $0.00 . Busway/100 ft $0.00 -0'-,' Res:ia/c package,' , $0.00 , I„Standing Section $0.00 /2,0f' � New Res(1-2 units) v-- $0.00 0 ' - i Misc Electrical Equipment $0.00 72;10 � New Res(34-units) _ ' x $000 0 . , _r - Transformers uplolkva/kw $0.00`! %0 _ Pool/Spa, ,,\ A$0.00 0 ° . ' ' , up ,to 10 kva/kw $0,00-4,/ / 0 c-' „: Lighting Fixts ', $1:10 1d . . - up,to 50'kva/ldv ' 7' :$0.00 0 - .. Recept Outlets--` �, $2.20`'s ., 2 . ' up to 100 kva/kw `„$0.00. '-0 Switches -y. v </-7727, $1.101- i 1 '- , - . - over100 kva/kw< $0.00 //.-0- ' Non Res Appl "- '�, ',i $000. 0.', . - , Low Voltage Equipment-. $0.00 :i/ 0 �/, Res Appl $0.00 0 - ,- - ''Low Volt Wiring System!Ckl $0.00,„ 0,', Service to 200a �.,,\i1;, $30.50 - 1 _ _ Misc.Conduit ';v $18:20 . 1- ' / Service to 1000a $0.00 7 ' '0- - ' ' -Misc.Conductor - - $0.00 -0 Service over 1000a - v ._ Circus(gen or.ride) ' $0.00 7 ,-0 Motors to 1hp x$0:00' ' 0 - ' - Circus(mech ride or lights) ,„-$6.90 -' 0 Motors to 10hp $0.00 ' 0 _ . Christmas Tree Stand - .7i'$0.00 0 Motors to 50hp $0.00 - . . 0_ _ - " Fireworks Stand -- ,j ''$0.00 0 Motors to 100hp $0.00 _.0. -'- . , - . _ Other 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 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12.21.92) - EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with I appl cable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in a Oration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'comp sation,a5 provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number em: Carder. Policy Number: (This section need nor be completed if the permit is valued at one hundred dollars($100)or less.) I certify that In the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and ogre 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: 'SLrVO 30 G7 S WARNING:FAILURE TO SECURE W RS'COMPENSATION C E IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Uc.a 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,CMI 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:My 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.My violation of Section 7031.5 by any applicant for a permit subjects the applicant to a GNU 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 Ucense Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • MC 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: ,1 Jv-2 —i r') 0 4N Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Ci 'l 2 -Ug 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 rive(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .... o _ti._ _...._.ateria� 3 Does es will the applicant or present or future building occupant need to prepare an RMPP(Risk-Management and PreventJon Program for acutely hazardous materlaLs)7 (Section 25534 of the Califomia Health and Safely 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. _... _._._..._ a If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fumy complied with? ❑Yes ❑No 5 Does or So the applicantsAiror ior n building District o from at requirer for the work which Is the subject of this tsp. stion aU Nnit for such construction or madlficetlon from the South Coast Alr Quality Management District or from any other air pollution control district or agency? Yes❑ Li No (Section 85850.2 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 c nstructed 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 end 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 Nis application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (II 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 Emis ' . \ Signature: Date: e7(2 ° S CERTIFICATE OF COMPLIANCE AN 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 stn 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 Md/Or Authorized Applicant Date POOP t, INSPECDONTYPF DATE *BMW LODE t INSPECtION TYPE PATE PLOW 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 6"i-05 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy .;0-012:s-. • CITY OF COSTA MESA 4 � ` BUILDIING DIVISION F ( r. � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT lt E05-00683 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 260 KNOX ST Status: ISSUED Suite No Applied: 06/29/2005 Vicinity: Issued: 06/29/2005 Parcel Nunmber: 42516303 W]_��/]_ Applicant: JONATHAN REINEHART KEARL ISSUED BY: • Address: 260 KNOX ST - ' - - - r Phone: 949-646-9763 i COSTA MESA;CA \, Zip - 92627 - . - _ - - Owner GRILLIOT,'JANE-M St-JONATHAN REINEHART ' Address' "260 KNOX ST'.!;"--i - , Phone: 949-646-9763 COSTAMESA;CA Zip: 92627 ' Contractor OWNER-BUILDER .. _ Address: - � • • _ _ - Zip: - - : v . 'cLicense:000000 - -/'' " ' V SCOPE OF PERMIT. `c • RELOCATE SERVICE'METER UP TO 200 AMP: - - " -- - - - " ". FEE SUMMARY ' Quantity _ , ISSUE FEE • ' $23.50 ' . ' --_ . -Temp Dist System/Lighting $0.00 0 ' Temp.service test . $0.00 - Busway/100 ft,, $0.00 0 Res.a/c package'., $0.00 1 Standing Section . $0.00 0"" ' , - New Res(1-2 units), `.`C $0.00 1 0 Misc Electrical.Equipment '$0.00 0 , - New Res-(3+units). . $0.00 . 0 Transformers up to-1 kva/kw $0.00 0 y; Pool/Spa., ' ''C C $0.00 0 -- - up to 10 kva/kw '$0.00 �,q Lighting Fixts v,v $0.00 0 - `. - up to 50 kva/kw $0.00 :'0 , / Recept Outlets y$0.00 0 --up to,100 kva/kw $0.00 - " 0 Switches • - $0.00 0 - 'over 100 kva/kw - -$0.001 ' 0 . Non Res Appl $0.00•\, S - 0' Low Voltage Equipment '':"2-$7" .$0.00" 0 Res Appl A '' , ,, , $0.00^ ` - 0 ", _ Low Volt Wiring System/Ckt .;$0.00,- , 0 % Service to 200a - K $30.50N c.H./1 ' ,. Misc:Conduit -/C $0.00 - ', 0 Service to 1000a ,,',, .'- $0.00 -- _ 0-1'-'., % v Misc.Conductor ,� "" $0.00 ' ,0 ," Service over 1000a' ='A $0.00-J, 0 ---,�,, � Circus(gen or ride) $0.00, 0/ ' Motors to 1hp \ ',� $0.00 /� `�0 ' a _ `_ Circus(mech ride or lights)(\ $0.00-- 0 ,� Motors to 10hp 'N$0.00c - / - 0, - Christmas Tree Stand A '-N-$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 - " -__ .2 - Communication drops $0.00 0 _ -' Investigation Fee ':i-ij��"$0.00 Sub panel to 200a $0.00 0. - " - -. Plan Check Fee- ' $0.00 Pole Light Pkg $0.00 0 - :-_ - 'Reins_pectiori.Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 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. i 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 4 2446-413(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: _ ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Dale: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL MID SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lk.# 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,CMI 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 DNislon 3 of the Business end 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).): 72 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.). ❑ itamaxe pt untl cam c 1Business and Professions Code for this reason: ` re� DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ___ 2 Does or will the applicant or present or future building occupant need to file a registration form-for acutely hazardous materials? 0 Yes 0 No • (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en 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 apemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes-,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). • P'--7 If a permit from the South Coast Air Duality 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 ynter upon the above-described property for ins ction pure sec.I agree not to occupy or allow occupancy of any building authorized by this permit until nal Inspection. . sets Of�gga�_, Vine `-•---.1 And/Or Authorized Applicant Date i corm0, tHJp lIPE RAIL I LA CODE! INSPECTION TYPE. RATE =MLI 1616/`/Fixed System Fin•I FI : -revantion 206 Final Mechanical 1268 Pool Spa Final C"--... 208 Final Plumbing 200 Final Re \ 210 Final Elect 201 Final -. , ti 1 t Wall / 212 al Fire raven 202 Final Factory Fire Pia— 220 Planning App` 203 Final Sign 222 Finai'Slte 204 Final Demolition250 Final Building/Occupancy