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HomeMy WebLinkAbout305 19TH ST - Building Permits ' 1 t CITY OF COSTA MESA , • :=4. BUILDING DIVISION J . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT �� B99-01566 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 305 E 19TH ST Status: ISSUED Suite: Applied: 09/29/1999 Vicinity: Issued: 09/29/1999 Parcel Number: 11725422 Zoning: • Applicant: NOURI, MAHIR ISSUED BY: (/ - - Address: 305 E 19TH ST _ hoe?= , Pn949483-7668r _ COSTA MESA,CA-----:-/-""---. - Zi 92627 -\ Owner: ADAS„NASAR \� Address 30519TH ST� �-1 '_1 1�_ ,A �/�/ I �a , 7%/7-7:7\ j Phoney-9494487668 . 0 `, 11 ��COSTA MESA�CA �� _----Z�p: 92611-------------__ ..,� • sir �, � , , % \ Contractor: / 0 Address: y /� // � Phone: �� 7-, '�,// /7.7? /["7 Ill ��. V \\\ Zip. Licenser \� - "Arch_: /U: , / r / ' �/ �r--�'-�' rI• Eng' { -�� ( i- yX\ Address: , _ i �"-.�� Address. ,I �"� , r�i'� / r Phone ncCY..�nn, _ • 'moi Phone. � ,l l� Zip: / ( e�..--.1. �"r License: -1 i '1 : \A -. ' j yi \-17,--- SCOPE OF PERMIT V v ', I°'- ��' -� ' I. ,-ADD SHOWER ENCLOSE EXIST REAR EXTERIOR DOOR CREARAAOOR, g. �I I V / Nt'.41-'fD;kk- �- tIRSt: :IsiN t'�_�•i If -', L�I:�ic a N,r �&I ', � .�-,n - � I _ _ FEE SUMMARY j- r, , , = , Plan Check;.;, ' $15.28 s„ Calc Valuation: /,I i $450:00; • Rerm,t,.,v., $23.50 „1.iµ ,.,1 �.1 ;�, �_ f __Claim Valuation: 1,ilfr/ 4L"`_sa5d6o/ 1/2 �t SMTP Res ,r, , $0.50 • ; .I 1i l I L't.SMIP.Coni\y4C..' $0.00 �' = —5 — �. •,ctV ` Other: ,.A $0.00 - L lb J /`11 , I\sp�tio,\\\ \$0.00 ; �' 72_ • �\ y � � Total ,, ��$39.28 •., �' �. c 2 ..* �� k. \'\.,\ ., i ��, / PLANNING&ZONING /� /9/ SETBACKS � . '6r."--t /i / f �4 7 MAIN STRUCTURE Front-Th 0 0�=� `Rearr 0-'0 '� c Lefti .0=0:' Righh 0 0 �) i/-� ACCESSORY\\\Fr ntJ/ 0�j Rear N0 0 ` ,/ Lfl - R4\0- 9iv/7 Ply /J'/ PARKING 'Existmq:\*-a'/ -/ Required: 0 • - Proposed. 0_- V // jl/ NOTES: • .4 r /:-- � . -•;r , , ������12/ ____-_-7-72--...--- .,._ c -f--�Y-r.c-i— r'l/� 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 DECLARATIONS WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed A 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: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL MD SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,0(10),IN ADDMON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.p Class A Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is 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: v 1 OWNER-BUILDER DECL)ARATIONS:—. ter, If a Iju) I hereby affirm that under penalty of pequry,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 perinit,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 Isllcensed 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 en 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 C• r. :s LIc=• :ws.). 1 am exempt under s" Business and Professions Code for this reason: Signature: No. eyes: a 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code)._-- ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: • HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 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 materiel? 0 Yes 0 No (Section 25505 of the California Health end Safety Code requires,with some exceptions,that a Sualhess Flan be filed with the Costa Mesa Fire Department by every business which has et any one time during a reported year a quantity of hazardous materials equal to orgreater 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 acutelyhazardous materials? 0 Yes 0 No (Section 25533 of the Califomia:Heilthand 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'ktutely 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 Menagemeht 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? ❑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 aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 10 Yes LJ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of 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 end 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 pro•erty for inspection purposes.1 agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / aria a Cr Leg mer Ve-q tel // y 7 �A NOr • thorized Appli p� ODE t. INSPECTION TYPE OAIE MAUS CODE t INSPECTION TYPE E9IE INTRIAL9 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 CITY OF COSTA MESA0 " ,t9 Vii, BUILDING DIVISION Iv rq" DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J'.y Vis° PERMIT '�wnm B99-01567 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 305 E 19TH ST Status: ISSUED Suite: Applied: 09/29/1999 Vicinity: Issued: 09/29/1999 Parcel Number: 11725422 • Zoning: /�'� Applicant: NOURI, MAHIR ISSUED BY: C/ Address: 305 E 19TH ST �' Phonerc949"483-7868: COSTA MESA,CA' _' ' " /_-- -��� /�/� - Zip: 92627 f-� �� I I Owner: ADAS, NASIR"' c A /V Address 305"E l9THSTV\�� �) \_..1-1 ..i_ I t_.,,/ �` / j/t! \ \ �/,/�J949-483=7668'- ``\ �� �' �jCOS IA MESA,CA. „.---_-.. 4"-t-7 "—Zip: --92-8--27-cm'' � "-,�� ���- f Contractor r '////� \ � V � • tiill Add ess: \�� � �� ; 11/..- /_4, ,�\ „17 /c) / / Phone: �9 V i Zip._ i . License:: �\. ..--Th \�, BArch ///�— 1 I• Eng: I i �VAi V A - \_k�\ Address:, / /� ,I �'--� �7 Address 'I ( \V)��\ \ �1 ) , - cL5e �' 47 1 / �t; ,....,_17 5'.. fN --,v �\_7)'\i' • -I , tib v V A - j' — / SCOPE OF PERMIT A ' /Irl', r"-� Hi I REPLACE EXIST WINDOWS AND DOORS - ---- ¢1'� - 71\ '4, / TEAR OFF ROOF 1/2"RECii46.T#AND REROOF N/ITH COMP SHINGLES ' is / - I 1� y t/ `7 �k . i l-� _ L - i '\: FEE SUMMARY ..--'::71 ' /'1 �.'.• Plan Che0W $0.00 �, Calc Valuation ) �--. ���-�- ��s •-�3�1- �_ ,. � I,� $3.000 00/r Permit.r; ' $83.25 I__ 1 -Claim 4//c $0 < <"�; _ --�'• /• Inspection: \ $0.00 _ . v �\ .a� // //,/,/ \,Total: $83,7,5 • x_c`' , t /// �. ,, , / ��.•, PLANNING'S ZONING f x"" / SETBACKS 'K.',:::-.)...., "" �/ :// ,/� MAIN STRUCTURE Front 0-,0 ,Rear 0 05.' -- Left 0 0 Right .0-'0- '7/ /'' ACCESSORY Front 0,0 ' \ Rear-T-0-0 ` � + . Left 0 0 Right\t,,-0-0 // v�� ‘.<-_, / ' // v -- ' , - , (V /j2/ PARKING Existing 0‘ / Required: 0 _ Proposed 0,` �/✓/ .� _ � .. _ C ��i� NOTES: � ' - �_ 1 - .-��j� 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 DECLARATIONS j WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (7711s section need not be completed i/the permit Is valued at one hundred dollars($100)or less.) ❑ 1 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: W ARNINGt FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL Rt IRIECT AN EMPLOYER TO GRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S1x,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.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,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 cityroocoun fy which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant tor 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 Professiahs 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, 0./y/employees with wages 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 purs t tot.. .a. License Laws.). ❑ -am exe pt d: •e• !!!/// Business and Professions Code for this reason: //o' G, Signature: ��'� �8te: tit 'L Owner ID verified by drivers r A7 es 0 No s (cane N . (EEpiree: d¢_06.-0 3 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 teat 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) or c -., frat.._.. for acutely l ....m. s.-... ...- ...,.... ...... . ........... PP Pbuilding P9 ❑Yes 0 No 2 Does or will thea applicant or resent or future occupant need to file a registration form scutal hazardous materials? (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 0 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(his a plication appermit for such ion constructor modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 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 applicatiioand 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 th City of Costa Mesa to enter upon the above-described property for inspec •n purposes.I agree not to occupy or allow occupancy of any building authorized by this permit 4uglil final inspection. A.-_ u? til .� er(s) g/2.47/Date And/O ..r ,F. nt C a -- CODEa INSPECTION TYPE aim INTmAL¢ CODE I INSPECTION TYPE PEE INTIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 244616 �% t ea" CITY OF COSTA MESA - - o vrir."1 BUILDING DIVISION PERMIT NUMBER 4- DEVELOPMENT SERVICES DEPARTMENT PERMIT A'"°^^�� E99-00932 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 305 E 19TH ST status: ISSUED Suite No Applied: 10/8/1999 Vicinity: MASTER BEDROOM&KITCHEN AREA Issued: 10/8/1999 Parcel Nunmber: 11725422 ISSUED BY: Applicant: ADAS, NASIR Address: 305 E 19TH ST CA Phone: (949)483-7668 COSTA MESA Zip: 92627 Owner: ADAS, NASIR Address 305 E 19TH ST CA Phone: (949)483-7668 COSTA MESA Zip: 92627 VT* SISAll' Address: Or + Phone: Zip: License: • SCOPE OF PERMIT ELECTRICAL PERMIT FOR REMODEL FOR EXISTING SINGLE FAMILY RESIDENCE.INSTALL 15-LIGHT FIXTURES, 5-OUTLETS,6-SWITCHES,&UPGRADE EXISTING SERVICE UP TO 200 AMP. REF: B99-01566 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 - Busway/100 ft $0.00 0 Ree a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 - Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 , Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $16.50 15 up to 50 kva/kw $0.00 0 Recept Outlets $5.50 5 up to 100 kva/kw $0.00 0 Switches $6.60 6 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $30.50 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc,Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to lhp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $82.60 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS • 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 permit. FOR INSPECTIONS CALL: (714)754-5626 • QECL4RATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not 6e completed if the permit Is valued et 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: 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 Do I ARE(Sl W.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37C6 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.Lis.# Class k Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to 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 tor 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,Busihessagd 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 cdmpletioh_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;arR.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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: - :1" Date: / o f slog Owner ied by drivers license. 0 Yes 0 No Driver's License No. Expires: ?if t'7 c,,2.• I 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 wit 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 Califomia 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 Califomia 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 Califomia 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 U No (Section 65850.2 of the Califomia 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 Califomia 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 ell state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. / r.�� f q Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE I tNSPECTIONTYPE PATE KO MLS oaf INSPECTION TYPE MLIE Rif1TIfL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final 208 Final Plumbing _ 200 Final Re-Roof 210 Final Electrical _ 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BuildinglOccupancy 2446.46 r1 oma'• M CITY OF COSTA MESA ` , BUILDING DIVISION PERMIT NUMBER ' ""'•' ' DEVELOPMENT SERVICES DEPARTMENT frqt� �• PERMIT M99-00469 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 305 E 19TH ST Status: ISSUED Suite No Applied: 10/8/1999 Issued: 10/8/1999 Vicinity: MASTER BEDROOM 8 KITCHEN AREA Parcel Number: 11725422 ISSUED BY: Li Applicant ADAS, NASIR Address: 305 E 19TH ST CA Phone: (949)483-7668 • COSTA MESA . Zip: 92627 Owner: ADAS, NASIR Address: 305 E 19TH ST • CA Phone: (949)483-7668 COSTA MESA Zip: 92627 Contractor ♦ 10 ' Address: Phone: ' Zip: Yold r• $ • _License: 014 Arch/Eng: ' Address: Phone: Zip: License: SCOPE OF PERMIT MECHANICAL PERMIT FOR REMODEL FOR EXISTING SINGLE FAMILY RESIDENCE. INSTALL NEW FAU UP TO 100K BTU. REF: B99-01566 FEE SUMMARY Quantity 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 Ref rig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Ref rig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000dm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $38.30. COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 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: Carrier: Policy Number: • (This section need not be completed if the permit is valued et 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 1 should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,1 shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000).IN ADDm0N 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.x Class if Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,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 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).): e`95j 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,,Biisiness 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 wlliln'one yeacof completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). tq tr,_, ❑ I, as owner of•the propertyLam EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code:The contraclorsUcenss aw 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 theeConireclors'License Laws.). O I am exempt under sec. �4� Business and Professions Code for this reason: Signature: -d9 ( Expires: z-f,(2-o2q. 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 B,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 materiel? 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 feel of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 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 en RMPP(Risk Management end 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 Califomia Health and Safety Code been fully complied with? ❑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$Rermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ID 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 Cale). 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 Materiels and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have reed 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) Date And/Or Authorized Applicant Date ggggs UISPECRONTYPI QAIE MAL5 CODEI INSPECTION TYPE gr ff. 1ISML5 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 Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site - 204 Final Demolition 250 Final BuildIng/Occupancy 2446-46 •'' � • CIN OF COSTA MESA 10W-�� BUILDING DIVISION • f' •"""' ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER .t• � PERMIT -CWPORATOPqq-nn5An (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 305 E 19TH ST Status: ISSUED • Suite No • Applied: 09/29/1999 Issued: 09/29/1999 • Vicinity: ISSUED BY: l Parcel Nunmber: 11725422 - __ --_ - _ Applicant: NOURI, MAHIR` - �= - , ' t_- / - t Address: 305E 19TH.ST- ,�� 1 ' - , t / !"-- �(i\ A:.� ii Phone:__949-483-766\ (� _ COSTA MESA,CA- / ' i,, ADAS, NASAR 2/7::::::::(41;- % �� y \� \\ Address 305.E,19THST�% ��/ ��,2 Phone: 949-483-7668 �� ��\ /�•/ /'2 COSTA MESA,CA Zip 92627 �� 'c /�`V N'N', ( / ft: _ ,-\v `.. / ` '�'` Contractor /1//177 - . . A ,' vV �. '-` . . ' /Address / �' / '� _ / ' ) ./ A�'' ->�-Phone:. _ _ A . l / /, I:. . - Zip: ''e ` '\ '1 • \- //�/ License: / 1 S A. Arch/Eng:F/ � _ _ - - . - __ ____ f 1 4, . Address:' % - - - „y �- -J_ �- 0'A .. '✓ J ' 1 r j, p .% - .. �� _ / � , • Zip: .M Licensees r -� = SGOPE'OFPERMIT� '' ' .1/1 - ADD SHOWER ENCLOSE EXIST.REAR EXTERIOR DOOR,CREAT A DOOR. REP[LACE EXIST 2 , - i ,, '1\WINDOWSAND DOORS. ,Lyy - //// �' /'\�\ 7 l`I � • - // / y :, '\\ :v\ A' ..FEE SUMMARY 3', / ' ' V ��AMT QTY . i;,„ ,-; rs-,.AMT QTY %-/ A /AMT QTY ISSUE FEE\ $23.50 Laundry Tub/Washer's; $6:00.2, 0 Sump Pump , / '-$0.00 0 Backflow'irrigation . ' $000.0 0 _Landscape Irrigation ,.-moo $000-t 0 - - Swlnimirig Pool'- ,-, $0.00 0 Backflow Preventer /- $0.00•„,'\'',0 N -� 'P-Trap $0.00 - 0 •"' Trap Primer, $0.00 0 Bathtub V'�>V /$0.00 V0N - =;Pressure Regulator- , 9 $0.00 �0 ' ,)UrinahG7 ,A ,/, 2/ $0.00 0 Clarifier System �- , U$0.00," 0 , Process Piping(per 10 ft)// $0.00 - 0•-•'•-- j:%Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc), <$0.00 -, --O mss_ _ Receptors- " - 2 $0.00 ` 0 - Vacuum Brkr Bkflow(54) $0.00 0 Dental Units \�s $000 0- _ SepticTank. „ $0.00 -''0 - .-( Wash/Basin/./ $9.80 1 Dishwasher N„�$0 00„K. 0, ` T_, Sewer Cap for Demo - _-$0.00 - 0 A `Wash Basin Set- $0.00 0 Drain,Floor \50:00 •' '0'' /' Sewer Connect - $0.00 0- . '. Waste and Veit System $0.00 0 Drain,Rainwater $6.00 0-�, ' . - Sewer .- .1. Shower' . ' . - $9.80 'p``-� Water Heater/vent $12.30 1 Drinking Fountain $0.00 ' -;0 - . Sink,bar,' ', .' $0:00 -0 i..: 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/-- _ - ,,,$0.80•11.0-- Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen _ $0.00 0 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) 50.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $65.20 COMMENTS/SPECIAL CONDITIONS • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 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 carder and policy number are: Carrier: Policy Number: (This section need not be completed if the permit Is valued et 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: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100.000).IN ADDMON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.tic.a Class a 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 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 pursu.•• o t, Contractors License Laws.). Sic I am exemjc l Business and Professions Code for this reason: Signature: i / �r�.... cos: al-Qb-d° Verification of Oviriership by(type of document,i.e.-properly tax bill or deed): ll ii DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Ct.'( )c El hereby certify that no excavatiomfive(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 Califomia 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 wit the applicant or present or future building occupant require for the work which Is the subject of this a plication 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? 0 Yes LI 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? 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 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 end 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 pr.•=rty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 4 4 eS ate.Of Lega .,: .legal Owner(s) OAii /r arate w '_:..-...-•:•,-..., . D te CODE I, INSPECTION TYPE PATE 1NTITIAL$ CODE INSPECTION TYPE PATE INTITIAL$ 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1286 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 204648