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HomeMy WebLinkAbout2048 MANDARIN DR - Building Permits (2) ate' CITY OF COSTA MESAi. 0 '4 BUILDING DIVISION � F I "" 'h ' DEVELOPMENT SERVICES DEPARTMENT C 'l/ .• PERMIT PERMIT NUMBER B98-01406 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2048 MANDARIN DR Status: ISSUED Suite: Applied: 08/07/1998 Vicinity: Issued: 08/07/1998 . ParcelNunmber: 13953409 Zoning: R1 R1 Applicant: VANBOERUN, JEFF Address: � l,,jig'Phone:'" 714;846-8625__ <221 - , Zip: Owner CHOMEAU HENR1 ' , r- Address CHOMEAU;PATRICIA - \' �' ' // v 'T -N. COSTA MESACA\ j -_ - -Phone �� �: L�, ( /�CIN / ,”/ 77;2048 MANDARIN DR ��� -� Zip: 92626 -/-'!....-_1\.,,,:--,,.* C\�; \� Contractor.' ) i vA 2 \.:-, A\\ Address: / (\/ / n /�/ Phone' 1` \" / \ \ . /,� dr Zip: \�\ �N� C.� N,7" License�' �! \� \j/„..--\ , /Arch/Eng ,; w DECLARATIONS , WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: ❑ I e 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 ork 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'cosnsatlopsurance earner and policy number are: //� / Caller: Policy Number. O nV/ 0:(1- (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, ree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith • with these provi O2 • re: — Date: ING:FAILURE TO sEgiRE RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(61 06.000) ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em licensed uncle pr. Ions o Chap. • (commencing with Section 7000)of Division 3 of the Business an rofesslons Code,and my license is In full forceC.49 / .a I Class p ontractoes Signet . .ri7rlr illb Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: 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 fee(5)or more feet In depth Into which a person Ls required to descend,will be made in connection with work authorized by this permit,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 6,Callfomia 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 an RMPP Is presently required,has Section 25534 of the California Health and Safely Cale been fully compiled with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes ❑No (Section 65850.2 of the Callfomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certiffyy 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&amply 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. • ner(s) =tura Of Le;` �T�te ((O ( � Ig ' �•••Or=th�•••li nt Date COQE 1. INSPELTON TYPE HAM IffErnALS COOM INSPECTION TYPP DAB =ALS 1616 Fixed System Final Fire Prevention �,/ 206 Final Mechanical 1008 Pool Spa Final —IT+— 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall _ 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 241648 • t �t'L' CITY OF COSTA MESA :y' '', BUILDING DIVISION PERMIT BE �' ""^' '� DEVELOPMENT SERVICES DEPARTMENT PERMIT B99-00941 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • BUILDING PERMIT Job Address: 2048 MANDARIN DR Status: ISSUED Suite: Applied: 06/21/1999 Vicinity: FAMILY&KITCHEN AREA Issued: 06/21/1999 Parcel Nunmber: 13953409 Zoning: R1 R1 �yy� ISSUED BY: Applicant: MARTIN, GLENN • Address: Phone: (714)578-0090 Zip: Owner CHOMEAU, HENRI Address " 2048 MANDARIN DR Phone: , //COSTA MESA,CA Zip: 92626 - • N Contractor RENAISSANCE DOORS AND WIN Address: 00130 N.GILBERT Phone: 578-0090 FULLERTON CA Zip: 92633 License: 490375 - - • • Arch : • Eng: • 'Address: Address: • Phone: - Phone: Zip License: Zip: License: SCOPE OF PERMIT REPLACE TWO SLIDING GLASS DOORS IN THE KITCHEN&FAMILY ROOM WITH NEW TEMPERED SLIDING GLASS DOORS WITH SAME SIZE&LOCATION. • FEE SUMMARY Plan Check: $56.71 Calc Valuation: $4,000.00 Permit: $87.25 Claim Valuation: $4,000.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $144.46 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell required Inspections end final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS ft WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: qI 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. r❑_-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: v rv—Nes. My-CJ/*aL Policy Number: Loc Cav•' oo(214•N'N (This section need not be completed it 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. [� ApplicantSignature: Date: Co— WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOUARE(5103.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# 4 S Class# Contractor's Signature: t10 Date: Co - ", .—Q 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 t0 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. ❑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 DMsion of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: • Date: • Division of Industrial Safety Permit Number. . HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or wit 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 ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apPermlt 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? ❑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 Califomia 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. Signature Of Legal Owner(s) D to And/Or Authorized Applicant Date 000Et pISPECnON TYPE KEMAL§ ODE INSPECTION TYPE gLffi jMQUL$ 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 Sign222 Final Site 204 Final Demolition 250 Final Building/Occupancy Ple 244646 OWNER MESA VERDE BUILDERS, INC. DATE )7DJ-0( JOB ADDRESS 2048 Mandarin Drive BUILDING PERMIT NO. 27011.5 GENERAL CONTRACTOR Mesa Verde Builders DESCRIPTION OF WORK Residence W/Att.Garagr S' '0. LOT 26 TRACT 6237 FIRE ZONE VALUE $ 35,338.00 IN. .ECTIONS Sig� 5t na/ture Date GROUP I & J TYPE V ZONIR R-1 Soil GC. (Y fJ - /7 PERMITS ISSUED. Gas cera -5 7-j 47 (.(L ® ` SUBCONTRACTOR I r-2.- Date I Number I Signature Water �� _ _ ..� . or - -co Plumbing . a„Rough Plumbing . .q._ -'L-c. ,. nWI P 6- JLC. I Prop. Swr. Line (WHouse Con. ,1: lla/'j l f SA_ ______ = - AM:— Sprinkling System MW.flW ,rtr- r- reA7 Miscellaneous i Rough Heating•and Air Conditioning Temporary Service or Pole, Underground 0 Power p _ Rough Wiring 1 HeatinP,�nd Vent. , Trenches U Forms ® Steel Reinf. ® e' r-(9-c•7 / anttg, .,4 Akin./4--/V-47 17 L�j Floor System ,/"'� Bond Beam 0 Steel Reinforce 0 Sheathing 3 -,.-67 ioe &-%67 Frame and Flashing.), X .5--(5-67 Lathing—In E-4'JOut cf0 z(, d 5-3,.67 PI. 'r, Brown Coat jfr? q_„_6,7 S ural, Final ectric Heating, Vent., Refrig. and A.C., D..al w� hina FM2r afl!&arkg2 ' ,7 ►rSrtaA Plumbing, Final and Gas Test n'(I � �,An�� Electric, Final ' t?r , Building, Final «i - •C/ �` ,, CITY OF COSTA MESA /__ 4', BUILDING DIVISION .� > . �' ' DEVELOPMENT SERVICES DEPARTMENT • d� PERMIT PERMIT NU E P98-00688 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT • Job Address: 2048 MANDARIN DR Status: ISSUED ' Suite No Applied: 09/10/1998 Issued: 09/10/1998 Vicinity: Parcel Nunmber: 13953409 Applicant: PATRICIA CHOMEAU - Address: - .-.., ' • /ir �-, `Phone: 714-434-4846 -\� Zip. .'< ( � � Owner GHOMEAU, HENRI ; A ‘ "N-i �` Address CHOMEAU,PATRICIA " -:-. '-7.-•,-,>11.:,..:--.'- y' w -iy%��y _�A /, _/COSTA MESA,CA" "N- : Phone: i i iii _ N N.,,' ' ,�;\. ,3/ 2048 MANDARIN DR Zip: 92626 ' \N. ,,A/` / V -/7, . ' � �, ',"i77 / Contractor � 4 j� ��J ' Address;---./ PLY/ e - i •• Phone: ,r /f \� ' ' -.o I _ Aroh/Eng: - \ Address: _ - , I /" ,•r\- Phone:^ _ 'a'a /„ , c •'�� r. \ 1 ‘ - License: - - - -4-r \ , r , •, A/ • ' ''SCOPE OFPERMIT-� b ' relocate DISHWASH'&SINK in kitchen;RE:E98-00959&M98-00410.' - . / / M = -RY ',- r \, AMT QTY AMT--QTY .;,, ,' . AMT QTY ISSUE FEE ` ` $22 00 Laundry Tub/Washer $0.00 0 Sump Pum .' , $0.00 0 Backflow irrigation, $0:00, 0 Landscape Irrigation^ -..$0.00 0 Swimming Pool . , $0.00 0 Backflow Preventer $0.00,'. 0 P-Trap ' Wit, _ $0.00 0 Trap Primer "$0.00 0 Bathtub "$0.06.`' �0 Pressure Regulator 2 '$0.00; 0 Urinal; •$0.00 0 Clarifier System' ' -$0.00 \�0;„ . - Process Piping(per 10 ft)' x$0.00= %:0,., _ Vacuum Brkr Bkflow(1-4) ,' $0,00 0 Connect(Ice,Sodaietc) $0.00 0:.t.:.,„ -. -Receptors -- " $0.00 >0 Vacuum Brkr Bkfow(5+)," $0.00 0 Dental Units $0.00 0 ; Septic Tank $0.00 0-% ' Wash Basin/ / $000 0 Dishwasher , $8.75 /At. .--. -Sewer Cap for Demo' $0.00 '-".0 Wash Basin Set. $0.00 0 Drain,Floor ',N. :50.00'%; 0`' -. Sewer Conned-, " _ $0.00 -0. .,.7 Waste and Vent System $0.00 0 Drain, Rainwater \ $0.00 N' 0, , '' Sewer Private Line - $0.00 - 0 '-Water Closet(Toilet) $0.00 0 Drain,Roof ,, '0� - Shower $0.00 ..'0 '' Water Heater/vent $0.00 0 Drinking Fountain - - --$0.00---,>0---' / t Sink,bar/ \ -. ' '.$0.00 ' 0 Water Piping(Inst or Rep.) $0.00 0 . Expansion Tank $0.00 ` .,0., . ' Sink,commercial , ' $0.00. 0 --' , "-Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 - Sink,Floor . , , $0:00 • .0 ., -: Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 - . ' Sink,kitchen. .. . , $8.75 ,1,7/, ' Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop. ,$0.00 0 - OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $39.50 COMMENTS/SPECIAL CONDITIONS • 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 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)754-562e Ir 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. O 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 carder and policy number are: Cartier. Policy Number. (This section need not be completed It 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: WARMNG:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MIO CML FINES UP TO ONE HUNDRED THOUSAND DOLIARE(S100,0t0),IN ADD4TICPt 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# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Ls a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,CMI 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 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 License Law does not apply to an owner of property who builds or improves thereon,end who does such work himself or herself or through his of 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 properly who builds or improves thereon,and who contracts for such project with a contractor(s) license purs nt to the Contractors U s Laws.). ❑ I a xem r sec. -- Business and Professions Code for this reasyn: Signatur . /�� ef�-�_—. �C Date: 9 /a-7 P / Owner ID v 'tied by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of dooumenl,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person Ls required to descend,will be made In connection with work authorized by this permit,end that no building structure,scaffolding,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,ore 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 Ce provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire al 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&permit 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 CI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissians. Signature: Date: CERTI; ATE 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 co rt.I :gree to comply with all t aws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the y .ova- bed property for ins y0 purposes.I agree not to occupy or allow occupancy-o1 any building authorized byJM9��unfi al nspection. /�/ (/ Signature OI Legal Owner(s) Date And/Or Authorized Applicant Date LODE L gfSPFcTION TYPF DAIS MUMS CAME/ INSPECTION TYPF DME tNtALS 1,816 Fixed System Final Fire Prevention 206 Final Mechanical _ 1288 Pool Spa Final 208 Final Plumbing to-i 3-9$ N 200 Final Re-Roof 210 Final Electrical _ 201 Final Block/Retaining Wall 212 Final Flre Prevention 202 Anal Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy 244646 , $ .. 4a, CITY OF COSTA MESA • t4 '• i) BUILDING DIVISION ,/ F' ' DEVELOPMENT SERVICES DEPARTMENT �•w"�� PERMIT PERMIT BER `*eenm M98-00410 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2048 MANDARIN DR Status: ISSUED Suite No Applied: 09/10/1998 Issued: 09/10/1998 Vicinity: Parcel Nunmber: 13953409 Applicant: PATRICIA CHOMEAU _ - Address: -- -..-r i- - ' - /c" Phone: 714-434-4846 ' - �`• is/�/l, Zip: I / /yam z��/i� . vii 1 • \' / / � '� . Owner CHOMEAU,\HENRI , j - _.j/ N) / �\ \\ ' Address: C• /,/./U, '\ .•1IA��� �- ```�\ \\ i O TA V 1 - <� '<:\ COSTA MESA.CA"•/--/-•- j. Phone. ••"-----\"<-1->1.--- \\ \\` _//�\1*\_\ /,'-/2048 MANDARIN-DRQ- Zip: 92626 . Contractor/ 7/, N\'•\'•\ ., \\� / Address:-,/ //,/,,,/ � �: \ /%/ Phoney' \ `� ZIP":� I .�. �1 /,V License �� il r - \ Arch/Eng � cr -7, s. - c,", A Address: ' - -- - 4;y - // , �.. Phone: r .. v Zip: - , \ \ _ 'z License: A / - _, - A / / y `•' ' SCOPE OF PERMIT,e. ��., . v relocate hood in kitchen,RELOCATE HOOD&REHOOK GAS7e.e98-00410 8 p98-00688 ,,. •.1 r _ -f _ .±'FEESUMMARY '�': /0�_s , -^ • \ �` , Quantity - ._ _ C _ ��.�/.. - Quantity ISSUE FEE•- ` $22.00 i Repair/Alt Absorbtion Unit $0.00 0 ‘ Inst FAL)<100 k BTU $0.00, Repair/Alt Refrigeration Unit Inst FAU'>100 k BTU' '' , , $0.00 Ventillation:System / ' \ $0.00 ,0 / Repair/Alt`Cooling/Heat ! \, , $0.00 0 Evaporative Cooler Inst/Rep. Recess Wall HU \`;\ $0.00 0 - ,_,' Commercial Incinerator $0.00 ', 0 Refrig Sys<100 k BTU 'N/' $0.00 0 :Domestic Incinerator "$0.00 0 Refrig Sys>100 k BTU v/::,;$0.00 0 t • - : Compressors/Absorption Systems/ / Gas Piping `v 4$5.50 1 . -"Up to 3 hp/100 k BTU $0.00; 0 Factory Fireplace A.$0.00 0 v'3 To 15 hp/500.k BTU -- _ %% $0.00 0 Hood w/Meth Exhaust $9.50,x 1 .' _ , 4'15 To'30 hp/1,000 k'BTU, /' ' - $0.00 0 VAV Box - _ , ,'$0.00 ;0; - . v 30 To 50 hp/1,750 k BTU , / ,;$0.00 0 Vent Fan/Single Duct • /,$0 00 -0-. ‘\� -r ,vOver 50 hp/Over 1,750 BTU ,-' ` //$0.00 0 Appliance ` 740.00 .0 ' - -- , . Boilers - - _ N' Fire Dampers _N ' $0.00 0:- _Up to 3 hp ‘ - $0.00 0 Smoke Dampers V� , $0.00- 0 - 3 To 15hp. $0.00 0 Inst or Relocate Appl Vent -$0.00 0 , 1' ,, • ,. "..15 to30 hp 1' $0.00 0 Air Handlers< 10000cfm $0:00 - 0 30 to 50 hp , $0.00 0 Air Handlers> 10000cfm $0.00-- -0 - , / .A\ Over 50 hp -- ,' ' $0.00 0 • , Floor Furnace $0.00 '-"0 Other Mechanical Fee' Floor or Suspend Heater • $0.00 0 ' . , ..Investigation Fee $0.00 Plan Check Fee . $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $37.00 COMMENTS/SPECIAL CONDITIONS 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 J.-4 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 ere: Cartier: 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 parson in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSAT10N COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER to CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS(SIC0.030).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COOE,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.Lic.I Class I Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting 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 pu.- .nt to the Contractors License Laws.). ❑ I am e der sec. A Business and Professions Code for this reaso p /�� ,S� .1` Signature:gI' /Zf - �� /�-/-� 7 Date: / '/� /� T 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(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: 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 materiels? 0 Yes 0 No (Section 25533 of the California Health end Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare en RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑Yes 0 No (Section 65850.2 of the Califomia Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes-,the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South r.st 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 taws 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 corre•/• •:ree to comply with all to :ws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the a.• • ribed property for in purposes.I agree not to occupy or allow occupancy y building authorized b is permit f al Inspection. 7 •_ /L i /?1- �i. � S gnature Of Lege Owner(s) Date And/Or Authorized Applicant Date DS)DE_E INSPECTION TYPP DATE ICAl8 CODES teseecTInN TYPF Qeff 1818 Fixed System Final Fire Prevention 206 Final Mechanical 10-13-9 �o•)t9- 1266 Pool Spa Final 208 Final Plumbing. _ 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Anal Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site __ 204 Final Demolition 250 Final Building/Occupancy 244646 • 2tnj_ My 11 67P°'BOO 692 �**158.25 COSTA MESA BUILDING-SAFETY DEPARTMENT CKSA P.O.BOX 317 COSTA MESA,CALIFORNIA \ For Applicant to Fill In Completely APPLICATION FOR PERMIT Lot #26 TYPE OR PRINTTract 6237 BUILDING For Office Use Only BUILDING �7 0 e/r 474, / ( y' ADDRESS /� 7 G( /d) RECEIPT NO. PERMIT NO. COSTA MESA, CALIFORNIA 1 '7V ys Mesa Verde Builders Inc. REED/. Meng, MAfArr / OWNER 12: 2SCL X12MIA'IZO SCSX p� BUILDING ad?"^ /17(%�',. MAIL ADDRESS ADDRESS 2850 Masa Verde Drive �� TEL. 549- ZONE TYPE VGROUP(� CITY Costa Mesa NO. 0395 AI ;ECT TEL 547- APPROVED EER Kalt"pnha ellNO. 8046 BY DATE C '/N ZONING • ADDRESS 82 F 1,7 St cants Ana ZO NO. BUEOFNEW Mesa er a Pt ders ,' inc . �� I PLANS I BUILDING CONTRACTOR`� x . DELEG4CRIAL fION� Z l _ ..3-. ADDRESS I _ - _. _ . _ (O A.P.NO. CITY Costa Mesa NOTE: NO SAVE OVERHANG SHALL BE LESS THAN • STLIC..NO. 1 873 18 NATE TEL O' 549-0395 30"TO BIDHB REAR P.L. EAVES SIZE OT O 6/ X x /O O I NO.OP BLOTS. ALLOWED (U.B.C.REQUIREMENT/ OF 0 NOW ON LOT - USE OF YARDS APPROVED YARDS APPROVED EXISTING BLDG. MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET/ SETBACK LINE FROM - FRONT SLZ_FT. Fr. CENTER OF STREET REAR YARD 7 SIDE YARD I LEFT I RIGHT R.SIDE FT. FT. DESCRIPTION OF WORK L.SIDE 7 PT.Hc FT. NL ALTERATION ADDITIyN REAR 2)?-FT. FT. DISTANCE BET. BET.MAIN Q REPAIR MOVING DEMOLISH MAIN BLD S. ACCESS.BLDGS. BUILDING NO.OF VAR.AZ DATE SIZE ROOMS STORIES C.U.P.# /� APPROVED • EXTERIOR WALL I ROOF Shake APPROVED ' 1 I aCOVERING COVERING A( DA • TE USE OF BUILDING AND WORK TO BE PERFORMED New Res Residence as ' / 1 / / // yaPM.FT. 6 u I HEREBY ACKNOWLEDGE T T I HAVER THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE Ab E IS CORREC ND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. F PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATIONp BUILDING CONSTRUCTION. >#1120 � /J ��`�A-CI /J PERMIT FEE $ 04°5--I3-- N SIGNATURE OF >#11 0 w /K /AD PERMITTEE _ J.&3 A/1 cc,, S s 35733y_33Y- PLAN CHECK S I/n 7i5 s AUTHORIZED AGENT L r S- a TOTAL FEE 5/4'7 02r ...- PROJECT ADDRESS: 2048 MANDARIN DR umCITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 064291 GOVT: N SUPP : N OWNER'S NAME: CHOMEAU, HENRI ADDREss: CHOMEAU, PATRICIA PERMIT NO: B 064291 PLAN CHECK NO: N 2048 MANDARIN DR COSTA MESA,CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT ARCH/ENGINEER: 434-4846 REG.NO.: 4 ADDRESS: UNIT: JOB DESCRIPTION : T/OFF ROCK REROOF W/BUILT—UP SQ FT: 2, 500 PERMITTEE: CLAIM VALUE: 2, 500 , 00 CALL—VALUE: 2, 500 , 00 GROUP OCC; R-3 /M-1 ADDREss: CHAMPION ROOFING ( 213 ) 259-0451 3257 VERDUGO COMMENTS : REROOF 900SF W/BUILT—UP EIECTOR L A CA..900.635 **********aE+r+r*+E+r*******aE****�E*x****+tit+r+r+tSEarEE*********r*�r�E lVi /�► �4I LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed ander provisions of hap er 9(commencing with Section Z O N I N G R E U I R E M E N T $ 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. Q CITY LIC.: STATE LIC.: CUSS: _ REQUIRED S E T B A C K S .�0-x42725 42948 39 7 Dale: J}y— 9 c/� Signature: • U_e.—_CQkv MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY ND.: PW 2 2 6 8 9 2 EXP. DATE: 05/01 /94 COMPANY: GOLDENEAC,LE PARKING REQ• PROV; PARCEL: 13953409 ZNE; REF NO: 7 Certified copy is hereby furnished. I--XX Certified copy is filed with the city Building Division. PLANNING NOTES> 9 -5-\ G e > / Oate: ��' ADDlicanL�', ��-g ******************************************************************************* .-�-l� EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(S100)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify that in the performance of the work Ior 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. ZONING APPROVED BYDATE; Date: Signature: NOTICE:II,after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. DATE: CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; i T t to which this_permit is issued(Section 3097.Civ.Cl. *************************************************************D*****`O*********** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT;Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,atter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed PERMIT 54 . 00 , . 50_ I pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SHIP_/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN •I -/ any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILD ING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID-rn -- DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS 5 4 . 5 0 0 , 0 0 0 . 0 0 5 4 . 5 0 54 . 5 Or 47 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 54 . 50 OVER/SHORT: E c 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 . 00 . 5 0 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon _ ' and who contracts for such projects with a contractor(S)license pursuant to the Contractors'State License Law).I am aware ********************************************************************* that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B.8 P.C. IND IV IDUAL F E E BREAKDOWN for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: . I do hereby certify that I am aware ol and understand the requirements ol California Health and Sal ety Code Sections 25505.25533,and SFA 2500 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 2, 500 , 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END F FEES permit for construction or modification from the Air(lustily Management District.Residential construction applications are exempt from these provisions. 4 EXPIRED Date: Applicant: nn I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county , Ifl&0( EL+ 1@ Inspections ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned 7./ \`. / ``���"+e'Y"� � property?for inspection purposes, �,�-a �j Date: 10 'y — 1 J Signature, ' L Oe- �Qy� 01 00148199-00148200 TOT 54.50 - DATE: 10/04/93 TIME: 10:59 Driver's License or Social Security n: . 164646 White—Budding:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor W,r Y B ,JK � white—B. —___ —� T /: ,- f v --r • �� POC a SPA CONSTRUCTION AND PLANNING APPROVALS Permit-r Date Inspector APPROVALS Permit# Date Inspector ti 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. . . - - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd.-I 54. Forms 4. Electrical Conduit-Undrgrnd. ,-; 55. Electrical Bonding •5: 5tpel Reinforcement56. Rough Plumbing & Pressure Test • 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8: Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains . 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T. Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20, Rough Factory Fireplace APPROVALS - .Permit# ' 21. Duits,in Structure _ 70. Underground Hydro 22. Ducts, Ventilating - 71. Product Piping OGas 0 Oil 23.'Gas3ipe-Rough &I-est ,1.. . 72. Underground Flush . 24. Roof Framing •• ' - 73. 'Undergrnd:Storage Tank O Gas 0 Oil 25. Roof.Sheathing - - 74. Overhead Hydro . a•. 26.-t-Be'r.Ceiling (Structural) & Monocoat - i 75.'Dry Chemical - 27. Frame and Flashing ' 76. Dry Standpipe 28. Lathing& Siding 1 • . -• •• 77. FIXED SYSTEM FINAL • ; ; t. 29. Insulation -- , 78. FIRE PREV. FINAL - , :30. Drywall Nailing ' - HEALTH DEPT. REQUIREMENT t .31. Plaster Brown Coat,• - i. , i 79. FINAL INSPECTION 32. Electrical Power Meter-Final - . i • .80. FOOD CERTIFICATE ISSUED 33. Final ElectricNotes: -34. Final Heating& Air Conditioning.' - 1 • , t 35. Final Gas Pipe-Test ' I _ . 36. 'Hoodror canopy - . ! _ - 37. Final'Factory Fireplace ' .= . n 1. , 38. Final Plumbing - . . - _ 39. Water Service-Final , - '` ,40. Gas Service-Final , . 41. Solar Domestic-Final ' . -• I 42. Backflow Preventer_ . 43. Backflow Irrigation' & • 44. Landscape Irrigation System r• .1 i , - . .45. Sound Attenuation • • ' 46. Handicap Regulations (�. T. I .- E_X_P_I_R-E-D 47. FINAL STRUCT S DJIL'DING ' Incomplete Inspections 48. FINAL PLANNIP C�. p. •49. Electric Release t rs_ Is'tik, L7�8- �Y 50. Gas ReIe se to Scrljern California Gas Co 51. CERTIFICATE OCCUPANCY No. '--•Date.;