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HomeMy WebLinkAbout2457 SANTA ANA AVE - Building Permits (2) CITY OF COSTA MESA (5014) BUILDING DIVISIONr-4. lira DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �ri 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'compensatio Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'co pensalio piurance carri d !Icy number are: Carrier: / � Policy Number: (This section need not be completed if the pe it 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 Califor.'. . d agree the�{+I should become subject to the workers'compensation provisions of Sgb!Ion 3700 f the Labor Code,I shall forthwith comply with these provedol / - / �1/ ( l P�� Applicant Signature: Date: 2 I WARNING:FAILURE TO SECURE WORKERS'•• P ' AT1ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL NES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDM• - -E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force end effect.Lic.if Class 4 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my 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 Li ense Laws.). ❑ I am exempt ' I Business and Professions Code for this reason: '7 [0.-1,r^, / Signature:rD � Date: (- LUvIJ Owner ID verified y drivers li 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by( •:of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,TItle 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 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 Safely Code,with some exceptions,requires registration with the Costa Mesa Flre Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Application apermit for such Construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 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 ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _._ —.___ _._ — — —_ of this 7 a permit athe South Coast res Quality edManagement al or other airpollution ioncontrol district3 agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Californiaia Health and Safety Cade 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 represe tatives of th City of Costa Mesa to enter upon the above-described pr inspection pu ses.I agree not to occupy or allow occupancy of any building authoriz i rpeimi{,u 'MI'nspe ion. gnat e Of Legal Owner(s) 'L/./�(ib Date And/Or Authorized Applicant Date CODE 0 INSPECTION TYPE PATE It1IID8Lk CODER INSPECTION TYPE VATS Ill_____ 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 Flre Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Signm 222 Final Be A 204 Final Demolition 250 Final Building/Occupancy � FHA CASE NO. / / ROOFING� CONTACTORS NAME:/TEAR TZ eec,F/.v 6 IA)C ADDRESS: 020ao10 Pea CM..Z,I e Rite/3 C4- RZ57a A QUALIFED ROOFER EMPLOYED BY THIS FORM HAS INSPECTED THE ROOF OF THE DWELLING LOCATED: a5C1.7 SAO-rA /60-3 A% AU01/4IUE Log' / (ITEM I MUST BE CHECKED. ITEMS 2 AND/OR 3 SHOULD BE CHECKED WHEN APPROPRIATE.) XI. THIS INSPECTION REVEALS THAT THE ROOF AND ROOF COVERING IS IN SATISFACTORY CONDITION WITH NO EVIDENCE OF LEAKS. ❑ 2.THE FOLLOWING REPAIRS WERE CONSIDERED NECESSARY AND HAVE BEEN COMPLETED IN A WORKMANLIKE MANNER.(LIST REPAIRS MADE.) ❑ 3.THIS DWELLING HAS BEEN REROOFED USING THE FOLLOWING MATERIAL: • THE ROOF WAS APPLIED IN A WORKMANLIKE MANNER AND A WRITTEN WARRANTY HAS BEEN FURNISHED THE MORTGAGEE FOR DELIVERY TO THE PURCHASER OF THIS PROPERTY. I CERTIFY THAT I AM AUTHORIZED TO SIGN THIS CERTIFICATION ON BEHALF OF fftALrz- /looF/4.i6 ,A/C- AND THAT, BY THE SIGNATURE HEREINAFTER MADE, //&wtftMs /ec. IS DULY BOUND UNDER THE TERMS AND CONDITIONS OF THE CERTIFICATION. IN THE EVENT THAT THE CERTIFICATION AS TO THE ROOF AND ROOFING , BASED ON EXAMINATION OF VISIBLE ELEMENTS,ON THE DATE OF THE INSPECTION HERINBEFORE REFFERED TO IS SUBSEQUENTLY FOUND TO HAVE BEEN INACCURATE AND THAT A PRUDENT INSPECTION SHOULD HAVE REVEALED EXSISTING DEFICIENCIES,THEN AND IN SUCH EVENT THE CERTIFIER HERBY AGREES TO MAKE SUCH EXPENDITURES AS MAY BE NECESSARY TO MAKE OR CAUSE TO BE MADE THE REPAIRS FOUND TO BE NECESSARY PROVIDED SUCH FAULTY CONDITION IS DETERMINED TO HAVE BEEN IN EXISTANCE ON OR BEFORE THE DATE OF THIS CERTIFICATION. I FURTHER CETRIFY THAT I HAVE NO INTEREST, PRESENT OR PROSPECTIVE, IN THE PROPERTY, BUYER, SELLER, BROKER, AND MORTGAGEE OF OTHER PARTY IN VOLVED IN THE TRANSACTION. DATE: 06/06/0 - SIGNATURE::/ <e9]' TITLE: al. �� Lic- 53255 WARNING SECTION 1010 OF TITLE 18, U.S.C. "FEDERAL HOUSING ADMINISTRATION TRANSACTION,"PROVIDES: "WHOEVER, FOR THE PURPOSE OF-INFLUENCING IN ANY WAY THE ACTION OF SUCH ADMINISTATION-MAKES, PASSES,UTTERS OR PUBLISHES ANY STATEMENT, KNOWING THE SAME TO BE FALSE-SHALL BE FINED NOT MORE THAN 55,00 OR IMPRISONED NOT MORE THAN TO YEARS,OR BOTH." OTHER FERDERAL STATUTES PROVIDE SEVERE PENALTIES FOR ANY FRAUD AS INTENTIONAL MISREPRESENTATION MADE FOR THE PUPOSE OF INFLUENCING THE ISSUANCE OF ANY GAURANTY OR INSURANCE OR THE MAKING OF ANY LOAN BY THE ADMINISTARTOR OF VETERAND AFFAIRS. FORM NO.30,REV. 4/72 • ROUGH GRADING COMPACTION REPORT SITE PLAN RESIDENTIAL Hou'S;No N.49.22'21 "W. 331 .15' • 81' 60' 60' 74 , I I .- I 55' 13 _ I Fp 'N Ip �Z ' I GRAPHIC SCALE 13 .o I • � . 12 N to q >o ;o �o ,'I ® ® N t 2 ZI > < 'n3'' J o 13 I ia ( Qf PENT •/O . O m N N Q n O `} 1 INCH 2�i TI. ar n rn n a Q- f- + rd m O � + a o �_ + no 1� �" G� O, N N,O 0- ® +Z p1' © i r r- � +cc in r- 12 ov: .J w v, ,nN _ J_U�IL TY=aSC�AEN� _ 2 _ ,..._ \'��/ �I I� 0 0�� o �� STA Z .C.;\62.4 in < . ..-. \ O X55' �� n�� G '�+i�- —_ % . -- —o• '� L1J C7INV . --f �- A 3. , :,Ss :1• .E. —� • cc . . J . — 7� 60' 5' CTrL;TY 4,SOF.IEt T�� �'1 /C 65' � I�. j ��• Z '\ I ' ' r N g -` -7 Q 81 eI '- lI ' J Oa 4 Q In w _ - '� � ' tn r m ' opo o - a - H • p V Z =.I o - \ I n N rn O w1 co c ',7), O :Jj L in r - I • 1 p: �z rI 13 19' ACCESS .SND P.U5.E. I 6 65' - --. . c N.49'22'21 "W 331 . 15' 1 Approximate Test Locations _ PROJECT ENGINEER RESIDENTIAL HOUSING • ANACAL ENGINEERING CO . CIVIL ENGINEERING & LAND SURVEYING 1900 E. LA PALMA AVE. ti SUITE 202 — ANAHEIM , CALIFORNIA 92805 PHONE : (714)774- 1763 FAX: (714)774-4690 E—MAIL ADDRESS: anacalaearthlink.net COAST GEOTECHNICAL _ W.O. 202902 Plate 1 6 1;471'l•? CITY OF COSTA MESA • . 4 BUILDING DIVISION O r1 fir,\ F i � I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t j r/.� • PERMIT 4-`otoomnsoo.4.. E04-00525 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2547 SANTA ANA AV Status: ISSUED Suite No Applied: 05/06/2004 Vicinity: Issued: 05/24/2004 Parcel Nunmber: TPN003168 ISSUED BY: (if Applicant LEONE, VINCE Address: - ., o'-'- , Phone: 562 795-5754 . - Zip: Owner: /ENCORE BUILDERS- Address P 0••,OX 1183 . _ / - Phone: 562-618-5278 / , " ',LOS ALAMITOS,CA Zip: 90720 �y , \ ,,.' ., 'v,y` • Contractor: LEONE ELECTRIC INC • Address:- 10841 BLOOMFIELD STREET .. - - \, - ; Phone: - - - • � . LOS ALAMITOS,CA. ' , 'Zip: 90720 - _/ ' , - License: 794439 - , - ._ i, 1 - __ / _ -\ SCOPE OF PERMIT �- ' - / 2146 SQ. FT.SINGLE FAMILY.DWELLING..476.SQ.FT.ATTACHED.GARAGE. 1ST FLOOR-982 ' : .. ' :SQ. FT.2ND FLOOR 1164 SQ. FT.4 BEDROOMS,'2:5 BATHS'FIREPLACE`IN LIVING ROOM.PLAN; ' '' AREV.REF.:B03-01682- _ ELECTRICAL TO INCLUDE:2146 S:F.NEW S.F.D.,2 LIGHT FIXTURES,3 OUTLETS,AND 1 , r , I •_ • .- FEE SUMMARY' i ' Quantity i Quantity f r ^- / ' ISSUE FEE \ V-2. $23.50 l Temp Dist System/Lighting ;$0 00 ;0' , / , Temp service test' ",v\ , $0.00 i Y-Busway/100 ft $0.00 /0 N Res,a/c package N�i•$0.00 ,p -,r„ Standing Section $0.00/ �.0 '-,,./0 �' New Res.(1-2units) $120,18 2146 t< - .Misc Electridal:Equipment $0.00 0 - New Res(3+units) �_ \$0.00- 0 :_ ,r. . Transformers up:to 1 kva/kw . ,,$0.00 0 ) ' Pool/Spa \ v / $0.00 -0tx. R = ' -up to1'kva/kw ,$0.00 0' - I, Lighting Fixts�,�� �•$220:� 2--- ‘ G � : up to 50 kva/kw $0.00 ;, 0 / Recept Outlets- ' , /', $3.30 ����3 `'. ,'- - � - up-to-100 kva/kw, �� $0.00 : 0' !� Switches \„�� N- $1.-10N .1 > - , over100•kva/kw� _$0.00 l0 ,i -,/ Non Res Appl , ,N ',,_/$6.06"2/- -N 0--...2, . Low Voltage Equipment i ' - $0.00 / 0 I, ' ` Res Appl N-,- N $0.00 ,',"•/ ,0. ------ - Low Volt Wiring-System/Ckt $0.00' ,'0- Service to 200a N<-�`$0.00 /, ' c 0 , - - Misc.Conduit • , $0.00, , V' Service to 1000a - $0.00 - -i 0 2 •_ Misc.Conductor Service over 1000a $000_:;-- 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--z-- ' Christmas Tree Stand , - - $0.00 0 Motors to 50hp $0.00 -0-_/-- 2 - :FireworksStandf' - ' $0.00 0 Motors to 100hp $0.00 0 -- .: -Other Electrical 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 for a period of 180,days. ' INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) . DECLARATIONS WORKERS'COMPENSATION DECLARATION: _• ' '• ;:.t 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 mai ain workers' o pensation insurance,as required by section 3700 of the Labor Code,for the performance of hp-yrork forrr hick���hhhis permit is issued. M corp nsa/tiOn lnsu nce car7er�dpolicynumber are: ��. o g ) (This s:, �, pc10 Yp n L1{ PONcy Number: C/ �lSl (This section nee not completed if p rmit is✓slued at one hundred dollars($100)or less.) - - ❑ I certify that in th pert rmance of the work for w /this permit is issued,I shall not employ any person in any manners as to b come subject to the workers' compensation la s of alifornia,and agree that Ir should become subject to the workers'compensation provisio ction 3 00 o the Labor Code,I shall forthwith comply with then pr viyipRs.t - / 5 0/L pelican(Signature: `NII/41 Jl(l'� , ', a WARNING:FAILURE TO SECURE WORKERS'COMPENSA ION COVERAGE IS NLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRI NAL PEN TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF T LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DE LARATION: I hereby affirm that I am lic ns under provisions of h pter 9(commencing with Section 7000)of Division 3 of the Businessnd Pr fessions Code,and my license is in full force and effect.Lic.# n Class# Contractor's Signature: A/4'I .j9Y,. 00, 't iv u , CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,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 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COM; LANCE 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 agr.e to cot sly 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-des ted pr“arty for inspection pure I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. fignatufrig•. ) Date _A ,- . X16 -;'c7Aitliated!ApplicaMtfl 0laW CODE 1., INSPECTION TYPE PATE INITIALS CODE. INSPECTION TYPE PEE MTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final • - 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical - lCl� 201 Final Block/Retaining Wall • 212 Final Fire Prevention - • • 202 Final Factory Fire Place • 220 Final Planning Approval - 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy - I. , CITY OF COSTA MESA 4 tBUILDING DIVISION - >•f „,, ,111 DEVELOPMENT SERVICES DEPARTMENT PER NUMBER .4, J . PERMIT S324Partmso 44. MO4 00233 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2547 SANTA ANA AV Status: ISSUED Suite No Applied: 05/06/2004 Issued: 05/24/2004 Vicinity: Parcel Number: TPN003168 ISSUED BY: Applicant: DAVID DEKONING Address: Phone: 562-799-0838 Zip: Owner ENCORE BUILDERS , Address: P O BOX 1183 - Phone: 562-618-5278 LOS ALAMITOS,CA Zip: 90720 - , . Contractor URBAN MECHANICAL Address: 11132 ESSEX DR . Phone: 562-799-0838 LOS ALAMITOS,CA Zip: 90720 License:594181 SCOPE OF PERMIT 2146 SO.FT. SINGLE FAMILY DWELLING.476 SQ. FT.ATTACHED GARAGE. 1ST FLOOR- 982 SQ.FT.2ND FLOOR 1164 SQ. FT.4 BEDROOMS,2:5BATHS. FIREPLACE IN LIVING ROOM.PLAN AREV.REF.:803-01682 - " • MECHANICAL TO INCLUDE: 1 INST FAU"<100K BTU, 1 FACTORY FIREPLACE,AND 6 VENT FANS/SINGLE DUCTS AND 3 TO 15 HP COMPRESSOR/ABSORPTION UNIT --- FEE SUMMARY - ' Quantity 7. Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 - 0 Inst FAU<100 k BTU $14.80 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 $0.00 0 r ' Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 -0 • • " Up to 3 hp/100 k BTU-. $0.00 0 Factory Fireplace -$10.65 1 3 To 15 hp/500 k BTU - , $0.00 , 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU - - 50.00 0 VAV Box $0.00 d -" • 30 To 50 hp/1,750 k BTU- , $0.00 0 Vent Fan/Single Duct ' $43.50 6 - Over 50'hp•/Over 1,750 BTU $0.00 0 Appliance " $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 - 3 To 15 hp $27.15 1 Inst or Relocate Appl Vent $0.00 - 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm 50.00 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 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all. required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this pe FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ' - ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 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 worke mp s tion In rance carder and policy number are: Carder: 4,/H ( � eQ Policy Number: ,kr—C-71/02141;a70/ (This section need not be completed if the permifls valued at one hundred dollars($100)or less) O I certify that In the performance of the woik for wh this.e 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 ..'V.:cam. :..act to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. // G 7 `7 J Applicant Signature: /i Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVE-p.'UN(AWFUL AND SHALL SUBJECT N4 EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COM•ENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Lic.M 5't 7�/ Class# C Z U Contractors Signature: Date: // .-Z Z— 0 c/ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 ❑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. Air S r/•C'wner(s) / D, And/Or A hy:".plicant Date CODE1 INSPECTION TYPE Pali INTfTIAI$ SOH L INSPECTION TYPE 1 Pali L 1t�eLE 1616 Fixed System Final Fire Prevention 206 Final Mechanical A•x3.05 ton/ 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 BuildinglOccupancy • ' CITY OF COSTA MESA 4` 4oBUILDING DIVISION 4im " • DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 % i PERMIT J77 .Pom%' `� . PO4-00314 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2547 SANTA ANA AV Status: ISSUED Suite No Applied: 05/06/2004 Issued: 05/24/2004 Vicinity: " ISSUED BY: Parcel Nunmber: TPN003168 Applicant: STANFORD, RICK Address: - - Phone: 714-870-1890 Zip: Owner: ENCORE BUILDERS" Address P O BOX 1183 Phone: 562-618-5278 LOS ALAMITOS,CA Zip: 90720 Contractor: RRS PLUMBING CO INC Address: 1320 SORRECTO PL - Phone: 714-870-1890 FULLERTON,CA Zip: 92831 License: 767849 • .Arch / Eng: Address: • Phone: ' Zip: , License: SCOPE OF PERMIT 2146 SQ.FT. SINGLE FAMILY DWELLING.476 SQ. FT.ATTACHED GARAGE. 1ST FLOOR-982 SQ. FT.2ND FLOOR 1164 SQ.FT.4 BEDROOMS,2.5 BATHS.FIREPLACE IN LIVING ROOM.PLAN AREV.REF.:803.01682 - PLUMBING TO INCLUDE:2 BATHTUBS, 1 DISHWASHER, 1 GAS(1-4)OUTLETS, 1 LAUNDRY TUB/WASHER, 1 SHOWER, 1 KITCHEN SINK,4 WASH BASINS,3 WATER CLOSETS,AND 1 WATER HEATER. . FEE SUMMARY AMT QTY AMT QTY - AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation 30.00 0 Landscape Irrigation $0.00 0. Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $19.60 2 Pressure Regulator - $0.00 0 Urinal ' $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00- 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 • Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank , - ,- -$0.00" -0 - Wash Basin $39.20 4 r Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 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 abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS WORXERS'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. pi 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: 7 e .9 1 IThCi 1' Policy Number: Z-O'?'9A22- 902-- (This section need not be completed i1 the permit is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: •7--lis-'{)Cff WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UMAW Flt AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADOmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business end Professions Code,and my license is in fug force and effect.Lin.s i Class 0 G 3 A Contractors Signature: / .'W Date: r- 7 --Gi�/' Ear re 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 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 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 Ucense Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors Ucense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(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 e 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). plica....or ..._..._ unds, orneed 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 wit the applicant or present or future building occupant require for the work which is the subject of this a plication a.agermit for such construction or modification from the South Cmact Air Quality Management District or from any other lair 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? 0 Yes— 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. •.re Of Legal• •- s) Date 5--21C-07 And/0 A wiz:, ••plic Date CODE I INSPECTION TIDE PATE =AU LODE( INSPECTIONTYPE PATE R41MA 1616 Fixed System Final Fire Prevention 206 Final Mechanical p w 1266 Pool Spa Final 208 Final Plumbing 6-, •0 S Cl1Y 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