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Home My WebLink About329 19TH ST - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 77 FAIR �RIVE, COSTA MESA, CA 92626 �ob Address: 329 E 19TH ST Suite No Vicinity: Parcel Nunmber: REARYARD 11725417 npp�icant: STEPHANIE ELLISON Address: 905 NORTH EUCLID ST SUITE H ANAHEIM CA Ownec GEARY, RICHARD A Address 329 E 19TH ST COSTA MESA, CA Contractor Address: ISSUE FEE Temp service test Res. alc package New Res (1-2 units) New Res (3+units) Pool I Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Motors to 10hp Motors ro 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole ELECTRICAL PERMIT Phone: 714 634-3300 Zip: 92801 Phone: Zip: 92627 ROYAL POOLS OF AMERICA, DBA ROYAL POOLS 905 NORTH EUCLID ST SUITE H Phone: 714 6343300 ANAHEIM CA � Zip: 92801 License: 231426 Status: ISSUED Applied: 071t 8/2000 Issued: 07I78I2000 ISSUED BV: � � � �l I •' SCOPE OF PERMIT ELECTRICAL FOR THE CONSTRUCTION OF A TOTAL OF 550 SF POOL AND SPA IN REAR YARD OF EXISTING SFD. 523.50 $0.00 $0.00 $0.00 $0.00 $49.50 $0.00 50.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 80.00 $0.00 $0.00 $0.00 $0.00 Quantiry FEE SUMMARY 7emp Dist System / Lighting Busway It 00 ft Standing Section Misc Eleetrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva�kw ..................over 100 kva/kw Low Vol[age Equipment Low Volt Wiring System I Ckt Misa Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Chrislmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity E0.00 0 80.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES E73.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21•92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period o( 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 requlred Inapactlona and final epprovel must be obtainad. Failure to ob�ain inspectlons end final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSA710N DECLARA710N: � I hereby aHirtn unaer penalry ot perjury one ot the IWlowing dadaretlons: , ❑ 1 have end wlll maintain e ceNficate oi consent to self-Insure tor workere' compensetion, as providetl tor Dy section 3700 at t�e Lebor Coda, for the pertortnanca ol the work tor which this permit is issuetl. ❑ I have and wI0 maintain wakers' compensetion insurance, az requiretl by secUon 3700 ot ihe Lebor Code, for Ihe pertormance ot Ne work for which ihis permit Ls lswed. My workers' wmpensation Insurance cartier end policy number ere: � Cerder: Policy Number: (ih/s secfion need nof be completed ll the perml(!s vslued el one hundred dollers (S100) or Iess.J ❑ I certiy t�at in the pertortnanca ot the woM for whlch this Dermit is iuuetl, I ahell not employ eny person in eny manner so es to becoma subject to t�e workers' compensetion lews of Calitomia, entl agree thet If I shoultl become subject to Ihe workero' compensetlon provislons of Sectlon 3700 af the Le6or Code, I shall lorthwlth comply with these provisions. I Applicent SigneWre: Date: � WARNING: FAILURE TO SEW RE WORKER5 COMPENSATION COVERFGE IS UNLAWFUL PND SHALI SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES PND dVIL FlNES UP TOONE HUNDRED T/10USAND DOLLNiE (5100.000�, IN AODRION TO THE CQST OF WMPENSATION, DFAW6E50.S PROVIDEO FOR IN SECTION 37060F THE LABOR CODE, IMEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLAHA710N: I �ereby eXirm Ihat I em licensed under provi5ions of Chapter 9(commencing wlih Section 7000) ol Divislon 3 ot ihe Business entl Professions Cade, antl my license is In full torce ana eflect. Lic. a Class a ConiractoYs Signature: Date: CONSTRUCTON LENDING AGENCV: ❑ I hereby aHirm that thera is e construction lentling agency for the performance of �he work br which ihis permit is issued. (Soc. 3097, Clvil Code). Lender s Name: Signature: _ OWNER-BUILDER DECIARATONS: Lender's AdUress: Date: I hereby eHirm Nat under penalry ot per�ury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry.which requires a permit to consWct, alter, improve, Aemolish, or repair any sWcture, pnor to its issuance, elso reqWres lhe applicaM tor such permit lo file e signetl slatenlenVthekhe or she is licensed pursuam ro tha provisions ot the Cqntraciore Ucense Law (Chepter 9(commencing wlih Section 7000) ot Division 3 of Ihe Business anE Protessloris�CoCe)'or,Nat he or she is exempt theretmm and the �asis br the ellegetl exemption. Any viWatlon ol Sectlon 7031.5 by any applicant for a pertnit sub�ecis ihe eppliwnt to e�p�perie�ry W,notl ora than frve hunAretl tlWlars (5500).): _ ❑ I, as owner ot t�e proparry; or.my employees yrith wages as their sole compensation, WILL DO 7HE WORK, and the structure Is not intended or ofteretl br ula (Sec. 7044, Busineu��end Prolessions CodarTha.Contreaors License Law dces not apply to an owner ot propeM who builds or impmves thereon, and who does such work �Imsetl or herself or through his or he� o'vm.employees, provided Ihat such impmvemenis ere not intended or oflaretl for sale. If, however, the bulltling oi improvement is soltl within one year of completion, Ne owriei-bullder will have the burden of proving thet he or she did not build or improve tor purpose ot sale.). ' ._ ❑ I, es owner oi the properry, am E%CCUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to conswct the D�olect (Sec. 7044, Business'antl Professions Code: The conirectors Licensa Law does not apply to an owner of propehy who builds or improves ihereon, and who conirecis for such project with a conirector(s) license pursuant ro the Contrectars Licensa Lews.). , ❑ I em ezempt untler sac. Business and Professions Cotle lor Ihis reason: Signeture: Date: Owner ID veAfiad by tlrivefs license. ❑ Yes ❑ No Drivefs License Na. Verification ot Ownership by (type ot tlocument, i.e. - properry Wu bill or deed): Expires: DIVISION OF INDUSTRIAL SAFETY VERMR CER7IFICA710N: ' ❑ I �ereDy ceNly that no excavatlon tNe (5) or rtwre feet in tlept� into which a person Is reQuiretl to tlescen0, wlll ba mede in connection with work authorizetl by this pertnit, end ihat no building structure, scatlolding, falsework, or demolitlon or Alsmentling thereof, wlll be more ihan Ihirty-sis (36) feet Ngh. (Chap. 32, Grp 2, Art 2, Sec. 347, Tltle B, Calliornia Atlministretive Code). ❑ As awner-builder, I will not employ anyone to tlo work which would require e pertnil from lhe Division of Industriel Salety, as noteC ebove, unleu such person has a permit to do such wark irom Ihe dlvision. , Signawre: Dete: Divislon ol Industdel SateN Permit Number. CERTFICATE OF COMPI.IANCE AND AUTHORIZA710N OF ENTAV: I certify under penalty ot per�ury Ihet I have read this application and s�ate thai the information given i5 correct. I agree to compty with all stale laws entl dty ordinances relating to Duiltling consiruc�ion, anC authorize representatives ol the Ciry ot Costa Mesa to emer upon 1he a0ove-described property far inspection Duryoses. I egree not to occupy or ellow occupancy ol eny building euthonzed by thls pertnit until tinal inspectiwi. SignaNre Oi Legal Owner(s) MNOrAuthorizetlApplicam Dete � CODE �. INSPECTIONTYVE 1616 Fisod System Final Fire Preventlon 1266 Pool Spa Final 200 Finel Ro-Roof 201 Finel BIaWReteining Well 202 Finel Fectory Fire Place 203 Final Sign 204 Final Demolition 2a4&d8 PdIE INI�I,�` CO�E� INSPELTIONTYGE 208 Finel MecheniCel 20B Final Plumbing 210 Finel Electrical 212 Final Fire Preventian 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy (774) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 �ob Address: 329 E 19TH ST Suite No Vicinity: REAR YARD Parcel Nunmber: 11725417 Applicant: Address: Owner: STEPHANIE ELLISON 905 NORTH EUCLID ST SUITE H ANAHEIM CA GEARY, RICHARD A Address 329 E 79TH ST COSTA MESA, CA PLUMBING PERMIT Phone: 774 6343300 Zip: 92801 Phone: Zip: 92627 Contractor: ROYAL POOLS OF AMERICA, DBA ROYAL POOLS Atldress: 905 NORTH EUCLID ST Arch / Eng : Address: SUITE H ANAHEIM CA Phone: 714 634-3300 Zip: 92801 License: 231426 Phone: Zip: Licensa: SCOPE OF PERMIT CONSTRUCT TOTAL 550 SF POOL AND SPA IN R R YARD OF EXISTING SFD. ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Den[al Units Dishwasher Drein, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (7-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptors (Sand Auto ) AMT 523.50 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $6.15 $0.00 50.00 $0.00 $0.00 $0.00 FEE SUMMARY AMT LaundryTublWasher $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $o.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $30.25 Spa (public) $0.00 Qn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 COMMENTS / SPECIAL CONDITIONS Status: ISSUED Applied: 07I78I2000 Issued: 07/182000 ISSUED BY: SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (foilet) Water Heater / vent Water Piping (inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION nnnT so.-oo $60.75 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 50.00 50.00 50.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: 5120.65 Qn 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 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 1 BO days, or if work is suspanded or abandoned tor a period of 180 days. INSPECTIONS: In ortler tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inapeetlone and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit/ FOR INSPECTIONS CALL: (714) 7545626 / WORKERS'COMPENSAnON DECLARAnON: I hereby attirm under penalry of perjury ane oi the tdlowing dedaretions: ❑ I heve and will mainWin a certificate of consent to self-Insure for workere' compensation, es provitled lor by section 3700 of tha Labor Coda, lor the pertortnance of the / work for whiCh �his pertnit is issued. . �� I have entl will maintain workers' compensa6rn insurance, es requiretl by secUon 3700 of the Lebor CoOe, tor the peAortnance of the work for which this pertrtit is issued. My workers' compenution Ins flnce cartier end policy number ere: ,'-• �/ p�' / Carrier. ��'�- �U✓l� PollcyNumber.��'�9 W1�-- � �/=��7 (fhis section need not be comp/etetl i! the pemdf is valued et one huntlred dol/ers (5100) or /ess.) ❑ I certify Ihet In the peAormance o�he work for which this pertnit is issued, I shall not emplay eny pereon In eny manner so es to become subject to the workers' compensation lews oi Califomia, d agree t�at Ii I shoul sub�ect to the workers' mmpensation provisions ot Sectlon 3700 of the LeDor Cotle, 1 shall torthwlth compy with these provisions. p Applicant Signature: Date: � �a ' QO � WARNING: FAILURE TO SECURE WO RS' CQMPENSAPIXJ RAGE IS UNLAW FUL AND SHALL SUBIECT AN EMPLOYER TO CiiIMINAL PENALTIES PND GVIL FW ES UP TO ONE HUNORED THOUSAND OOLLARE (St00.00D), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED f-0R IN SECTION 31O80F THE LABOR CODE, INfEREST. ANO ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm ihat I em licensed untler provisli larce end ettect Lic. M_� Coniractals Signature: wlth ion 00) of Divislon 3 of fhe Busineu antl Pmfessions Cotle, antl my Iicanse is in full ciass a C� -53�.l Date: %' / X • CONSTRUCTION LENOING AGENCY: ❑ I hereby aHirtn ihat t�ere I5 a construclion lentling egenq for Ihe pedormance of the work for w�ich �his permil I5 Issuetl. (Sec. 3097, Civil Cotle). Lender's Name: Lentle/s Atltlreu: Signature: OWNER•BUILDER DECLARATIONS: Data: I hereby aNirtn that under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or counry which requires a pertnit to construct, alter, improve, tlemWish, or repair any structure, pnor to Its Issuance, also requires the applicant tor suU pertnit to file e signed sutemem that he or she is IicenseG pursuaN ro tha provisions of the Contractors License Lew (Chapter 9(commendng with Section 7000) of Division 3 ot the Business and Professions Code) or ihet he or s�e is e:empt theretrom and the basis for the alleged exemption. Any Ndatlon oi SecOon 7037.5 by eny appliceN for e pertnit SUD�ects the applicant to e civil penaLLy ot not more ihan tNe hunAred AWlars (5500).): ❑ I, as owner ot ihe property, or my employees with wages as their sole compensation, WILL DO 7HE WORK, end ihe struMure is not Intentletl or otteretl for sale (Sec. 7044, Business and Professions Code: The Coniractors License Law does not epply to an owner ot propery w�o builds or imprwes thereon, antl who does such work himselt or herself or through his or her own employees, providetl that such improvements are not intended or oHered for sale. It, however, tha building or improvement is soltl within one year of completion, the owner-buil0er will have ihe burden of proving that he or she Aia not huiltl or improve for purpose ot sele.). ❑ I, as owner ot the property, am EXCLUSIVELY CONTAACTING WrtH LiCENSED CONTRACTORS to construct Ihe prqect (Sec. 7044, Business and Pmfessions Cotle: The comractors License Law does not apOh �o an owner of Dmperty who builtls or impmves �hereon, and who contracts tor such project wit� a contractor(s) license pursuant to iha Contractors License Laws.). ❑ I am exempt under sec. SignaWre: Owner 10 verified by drivers license. ❑ Yes ❑ No Business and Professions Code for this reason: Verifiwtion of Ownership by (type ot documeni, i.e. - propeny ta�c bill or deed): DIVISION OF INDUSTRIAL SAFETY PEHMI7 CER7IFICA710N: Dnvers License No. Date: Eryires: ❑ 1 �ereby cenity that no axcavatlon frve (5) or more feet in depih into which a person Is requiretl to descend, will be metle in connection wlth work euthodzetl by this pertnit, and that no builtling struIXure, scaflolding, falsework, or tlemolition or tlismantling t�ereof, will be more than Ihirry-six (36) leet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomla Atlminisiretive Code). ❑ As owner-builder, I will not employ enyone to do work which would require a permit trom Ihe Divislon of Intlus�rial Safery, as notetl above, unless such person has e permlt to tlo suc� work tran the division. � SignaWre: Date: Division ol lndustrial Safey Pertnit Number: CEHTIFICATE OF COMPLIANCE AND AUTHORIZATON OF EMRY: I cenity under penalry ol perjury that I have reatl this application and slate that ihe iniarmation given is correct. I agree to wmply with all state laws antl ciry ordinences relating to builOing conswction, end authodze represematives of the City ot Coste Mesa ro emer upon the ahove-descnbetl praperry lor inspection purposes. I agrea not to occupy or allaw acupancy oi any builtling au�horizetl hy t�is pertnit until tinal Inspection. COOEI, INSVECTIONTYPE 1616 Fixotl System Final Flre Prevention 1266 200 201 202 203 Pool Spa Final Final Re-Roof Final Block/Reteining Wall Final Factory Fire Place Final Sign 204 Final Demolition 2446d6 Date ' 7•/k• �0 ' Date yOUE 1 INSPECTION TYPE 206 Finel Mechanicel 208 Finel Plumbing 270 Final Electdcal 272 Final Fire Prevention 220 Finel PlBnning ApDroval 222 Final Si�e 250 Finel Builtling�Occupancy Q� i I[+�AI.i I � � � � (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 ,lob Address: 329 E 19TH ST Suite No Vicinity: REAR YARD Parcel Number: 11725417 Applicant: Address: STEPHANIE ELLISON 905 NORTH EUCLID ST SUITE H ANAHEIM CA Owner: G�1RY, RICHARD A Address: 329 E 79TH ST COSTA MESA, CA Contractor. Address: Arch / Eng : Address: MECHANICAL PERMIT Status: ISSUED Applied: 07/18/2000 Issued: 07I78I2000 ISSUED BY: � Phone: 714 634-3300 Zip: 92801 Phone: Zip: 92627 ROYAL POOLS OF AMERICA, DBA ROYAL POOLS 905 NORTH EUCLID ST SUITE H '� Phone: 714 6343300 ANAHEIM CA , Zip: 92801 License: 231426 Phone: Zip: License: SCOPE OF PERMIT CONSTRUCT TOTAL 550 SF POOL AND SPA IN REAR YARD OF EXISTING SFD. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt CoolinglHeat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Fadory Fireplace Hood wlMech Exhaust VAV Box Vent Fan I Single Dud Appliance Fire Dampers Smoke Dampers Insl or Relocale Appl Vent Air Handlers < t0000cfm AirHandlers> 10000cfrn Floor Furnace Floor or Suspend Heater $23.50 $14.80 $0.00 so.00 $0.00 $0.00 $0.00 50.00 so.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Repair / Alt Absorbtion Unit Repair I Alt Refrigerelion Unit Ventillation System Evaporative Cooler Commercial I ncinerator Domestic Incineralor Compressors I Absorption Systems Upt03hp1100kBTU 3To75hp/SOOkBTU 15 To 30 hp / 1,000 k BTU 30 TO 50 hp / 1,750 k BTU Over 50 hp I Over 1,750 BTU Boilers Up to 3 hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fea Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity $0.00 0 $0.00 0 50.00 0 80.00 0 $0.00 0 50.00 0 so.ao 0 $0.00 0 50.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $O.UO $0.00 538.30 NOTICE: The work authorizad by this permit shall comply with all appticable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permil shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 780 days. INSPECTIONS: In order for the work euthorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepeotlone and Iinal approval must be obtained. Failure to obtain inspections and finel approval will result in the expiration of this permit� FOR INSPECTIONS CALL: (714) 7545626 �/ WORKERS'COMPENSAnON DECLARAnON: � I hereby aHirtn untler penalry of perjury one ot the idlowing CeUaretbns: � 1 have entl will maintein e ceNficate oi consent lo sell-Insure lor workers' compensetion, as provided tor by section 3700 ot the Labor Code, tor the pertortnance of the work for which this pertnit i5 issued. . ❑ I have and will mafntein workers' compensaUon insurance, az requiretl by section 3700 of ihe Lebor Code, for the peAortnance of ihe work for whidi WS pertni� is iswetl. My workecrg /��oo m/pQ ns,�atio.n_ Ins�rrence cerrier end pollty number ere: ��[ qq �, �L p Cerriar. 7JI�[L. �WK.G� PolicyNumber: D4"f' // GGII.(� D� I/�✓Z� (This secNon need not �e comp/efed7! Me pertnil ls va/uetl et one huntlretl tlollers (5100) or less.) ❑ 1 certity thet in Ihe peAormance ai the work for which Ihis pertnit is issued, I shall not emplay eny parson in eny manner so as to become sub�ect to Ihe workera' compensation laws oi Celilom , erM egrea thet If I should bacame sub�eci to the workers' mmpensation provisions oi Section 3700 ot t�e Lebor Cotle, 1 shell lanhwit� compty wllh Ihese provisions. Applicant SlgnaNre: �— � oe�a: 7/�- DG WAHNING: FAILURE TO SECURE RKERS' COMPENSATI ERADE IS UNUWFUL AND SHnLL SUBIECT M! EMPLOVER TO CRIMINAL PENALTIES AND dVIL FlNES UP TO ONE HUNORED TMOUSAND DOLLARE (5100.000). IN ADDfT10N TO THE COST OF COMPENSFTION, AMMGES FS PROVIDED FOR IN SECTION 31080F THE LABOR ODOE. IMEREST, PND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: i I hereby aNirm that I em Iicense0 untler provislons of Chapter 9 mmencing w actian 7000) of Division 3 of Ihe Business antl Protessions Code, antl my Ilcense is in tull torce entl eNect. Llc. a 2S Class x G-5.3 � Contradofs Signeture: Date: 7—/ $� —00 � CONSTRUCTION LENDING AGENCY: I ❑ I hereby aflirm t�a� Ihere is a consVuction lending egency lor t�e pertormance of Ihe work tor which this permit is Issuetl. (Sec. 3097, Civil Cotle). I Lender's Neme: Lentler's Adtlress: � Signature: Date: � OWNER-BUILDER DECLARATIONS: ' I hereby atlirm Ihat under penelry ot per�ury that I am EXEMPT fROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Protessions Code: Any ciry or counry which requires e permit to consWct elter, Improve, demolish, or repeir eny sirucNre, prior to its issuance, also requires the eppliwnt for such permlt to tile e signed stetement thet ha or she Is Ilcensetl pursuent ro the provisions of the Contrectors License Law (Chapter 9(commenGng with SecUon 7000) of DlNsion 3 oi t�e Business end Professlons Code) or tha� �e or she is ezompt therefmm and the basis lor the allagetl esemptlon. Any violation ot Section 7031.5 Dy any epplicent Por a permit subJects the applicant to e civll penaly ol not more than five hunCreA tlollars (5500).): ❑ I, es ownar ol the property, or my employees wl�h wages as their sole compensation, WILL DO THE WORK, end the structure is not intended ar aHereO for sale (Sec. 704A, Business and Professions Cotle: The Conirectoro Ucense Lew tloes no� apply to an owner oi property who builtls or improves t�ereon, end who does such work himself or hersalt or t�rough his or �er own employees, provitletl that such impmvements are not intended or oHered far sale. If, however, ihe building or Improvemem is sold within one yeer oi completion, the ov+nervbuilder will have the burden ot proving that he or she tlitl not build or improve tor puryose of sale.). ❑ I, es owner of the praperty, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conslruct the project (Sec. 704d, Business antl Professlons Cotle: 7Te conirectors License Lew tloes nm appty to an owner of properry who builtls or improves thereon, and who contracts for such project with e contractoqs) license pursuant to the Contrecmrs License Lews.). � ❑ I em exampt under sec. Busineu entl Professions Code for this reasan: Signature: Date: �� Owner ID verified by tlrivers license. ❑ Yes ❑ No Drivals License No. Expires: Veriticetion ol Ownership by (type ot document, i.e. - properry tez blll or deed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ' 0 I hereDy cenity that no excavatlon tNe (5) or more leet in tlept� inio which a person is reQWreO to tlescen4 wlll be mede in canneaion wit� work euthodzetl by t�ls permit, an0 that no building structure, scaXoltling, felsework, or demolition or Olsmantling thereol, wlll be more than thirty-six (36) teet high. (Chap. 32, Grp 2, Art 2. Sec. 3d1, Tltle 8, Celifomle AdminisUetive Code). ❑ As owner-builtler, I wlll not employ enyone to do work w�lch woulG require a permit trom Ihe Division of Intlus�nal Satery, as noted ebove, unless such person has e pertnit ta do suc� work irom Ihe tlivision. - Signature: Date: � Didslon of Industriel Safery Pertnit Numher. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: . 1 W i0 lhe epplicent or present or luture bulltling acupant nee0 to lile entl ceriity e Business Plan br emergency response to release or lhreetene0 release of e hazardous material? ❑ Ves ❑ No (Section 25505 ot the Calilomie Health antl Sefery Cotle requires, wlt� some exceptions, that a Business Plan be filetl with the Cos�a Mesa Fire Depariment by every business which hes at eny one time tlunng e repaned yeer e puantiry of hazartlous metenals equal to or greater than a weight ol 500 pounds, or e volume o155 gallons, or 200 cubic feet of compressed gas at standard tempereture anA pressure). 2 Does or will Ihe applicant or present or luWre building occupant neetl to file e regisiration fortn lor acmely hazardous materials7 ❑ Yes � No i (Section 25533 0l the Califarnle Healt� antl Salety Cotle, with some axceptions, reqWres registration with ihe Coste Mesa Fire Department by esch bu5lness which at any ona time hes on hand e puentiry ot acutely hezertlous meleriels equel to or greater than e welght of 500 pounas, or e volume ol 55 gellons, or, 200 cubic teet ol compressetl ges et srentlard temperaNre end D�essure). � 3 Does or will tha epplicent or present or tuWre Duiltling occupent naetl to prepere an RMPP (Risk Managemem end Prevention Program for ecutely hazartlous materials)7 ❑ Ye9 ❑ No i (Section 25534 oi Ihe Celifornla Haelih enC Sefety Code provides ihet the Cosie Mese Fire Depanment may require Ihe preparetion, cenlfication end liting with the Fire DeOariment of en RMPP by businesses w�ich ere required to register aately hazerdous materials with Ihe Fira DeparimenL � 4 If en RMPP is presently required, has Section 25534 of Ihe Celilarnia Heallh end Safety Code been fully complied with? ❑ Ves ❑ No � 5 Does or wlll Ihe applicant or present or tuture building occupent requlre far the work which is ihe subject ot Ihis e 0��ion a germit for such constructian or modification tmm the Sauth Caast Alr Ouflllty Menagement Dlsldcl or Irom eny othar elr polWtion cantrol tlisttict or agency? � Yes �J No � (Section 65850.2 ot tha Calllomia GwemmeN Catle repWres that the requested inbrmation 6a tumishetl on applicetions tor nomresidential building portnits). _._.__...._...__... -_ 6 Will any parl ot tha feciliry to De cronstructed unAer this pertnit be wlthin 10001eet Irom ihe outer boundanes of a school? ❑ Ves ❑ No i (Ii yes', tha faciliry must meet the requirement of Seciions 25534 and 42303 of the Calitomia Health and Satery Code). 7 If a pertnit trom the South Coest Air Oualiry Management Disirict or other air polNtion contml tlistrict or agency is required for the work which i5 the subject ot this epplication, have all of the disclosures prescnbed by Califomia Heelth antl Safery Code Section 42303 been made? ❑ Yes ❑ No i B (If yes", etlec� cenificete ol wmplianca trom the appmpdate eir polNtion wntrol oHicer). ' CERTIFICA7E OF COMPLIANCE: I cenity Ihat under penalry oi perjury the inlormation given above is correct. I egree ro comply with ell steta laws end ciry ortlinances regartling Herardous Materials and Emiuions. ' Signature: Date: CER7IFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTAV: I certity under penalry ot perjury thaf I hava raad Ihls eppliwtion and s�ate that the inlormation qiven Is correct. 1 agrea to rnmply with ell state laws and dry orOlnances relating to building construction, and authorize representatives of the Ciry of Casta Mesa to enter upon the ebove-describetl property for inspection purpases. I egree noI to occupy or ellow occupancy ol eny 6uiltling authorizetl by this pertnit until final InsDecUon. 'gneture Of L l,�v�y�rf,q) p� Date - ��!/� 7�� D C� � ArM/OrAut�orizedApPfi� �� Date 40pE �. INSPECTONTYFE Q�¢ ��u/y�-/1��A�-��-s� �� INSPEC710NTYPE , Qd¢, �$ 1616 Fi:otl System Final Fire Prevention / 206 Final Mec�anical � 1266 Pool Spa Finel ,%"�a ^r 200 Final Plumbing 200 Final Ro-Rool 210 Finel Elec�rical 201 Final Block/qetaining Wall 272 Final Fire Preveniion 202 Final Factory Fire Place 220 Final Planning ApOroval 203 Final Sign 222 Final Sita 204 Final Domolition 250 Final Builtling/Occupancy zaae-<e (714) 754•5273 • Fax (714) 754-4856 77 FAIR DRIVE. COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 329 E 19TH ST Suite: Vicinity: REAR YARD Parcel Number: 11725417 npp�icant: STEPHANIE ELLISON Atldress: 905 NOR7H EUCLID ST SUITE H ANAHEIM CA Owner: GEARY, RICHARD A Address 329 E 197H ST Zoning: Phone: 714 6343300 Zip: 92801 Phone. COSTA MESA, CA Zip: 92627 Contrador: ROYAL POOLS OF AMERICA, DBA ROYAL POOLS Address: 905 NORYH EUCLID ST SUITE H Phone: 714 634-3300 ANAHEIM CA Zip: 92607 License: 231426 Arth : Addre55: Phone: Eng: Address: Status: ISSUED Applied: 07/18/2000 Issued: 07I18/2000 ISSUED BY: ��_ Phone: Zip: License: License: . SCOPE OF PERMIT CONSTRUCT TOTAL 550 SF POOL AND SPA IN REAR YARD OF EXISTING SFD. Plan Check: $208.81 Permit: $321.25 SMIP Res: $2.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $532.06 SETBACKS MAIN STRUCTURE Front 0. 0 ACCESSORY Fmnt 0.0 PARKING Existin : 0 NOTES: Rear 0. 0 Rear 0. 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 LeR 0. 0 Pr000sed: 0 Calc Valuation: Claim Valuation: Right 0-0 Right 0. 0 S2o,000.00 Szo,oOo.00 NOTICE: The work authorized by lhis permit shall compty with all applicable handicap accass requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) • EXPIRATION: This permit shall aUtomatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period of 180 deys. INSPECTIONS: In order for the Work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepectiona end final epprovel must be obtained. Failure to obtain inspections and final approvel will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 / . . WORKERS' COMVENSAnON DECLAfiAnON: I hereby eMirtn under penalry of perjury one ol Ihe tollowing dederetions: ❑ I heve end will maintaln e certilicate at consent to setl-Insure for workers' compensetion, es provitletl for 6y section 3700 of ihe Le�or Cotle, for the Oerlortnance of the work for which ihis pertnit is fssued. � I have and wlll malntain workers' compenselion insurence, es required by section 3700 of ihe Lebor Code, for the peAortnence of Ihe work tor which ihis pertnit is issuetl. My workers' cro 00 98tion InsurenCe cnrtier end policy number 9re: �/ «�a�: S��wd POIIcyNumber. O�Y' �9y l(�r�*--� Do,�95s-/ h!s section need not be comple(ed i! (Ae permil is velued et one hundred dollars ($100) ar Iess.J � ❑ I cenify that in the peAartnence of he work for which this permit is issued, I shall not employ eny persan In eny menner eo es to became suD�ect to �the workers' compansetlon lews ot Celllomle, er agrea �hat If I shou Cbecon subJect to t�e workere' compensetlon provislons of Sectlon 3700 of the Lebor Cade, I shall forthwit� comply with these provisians. p i Applicent Signeture: Dale: �'� 0' O� � WMNING: FAILURE TO SECURE WORI ERS' COMPENSATION CO ERAOE IS UNLAWFUL AND SHAL� SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED T110USAND DOLLARE (5100,000), IN ADDRION TO TNE WST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE, IMEREST. AND ATTORNEV'S FEES. I LICENSED CONTRACTORS DECLARATION: i I hereby eNirm Ihat I em licensetl under provislons of Chapter 9(commencing with Section 7000) of Division 3 0l the Business antl Protesslons Code, and my license is in full force antl eHect. L1c. s 2 Cless n E- `j3 i Conirec�ofs Signamre: Date: 7—/P �DO ' CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirm t�et lhere is e wnstruction lending egency tor Ihe pedormence ot t�e work for w�lch �his permll Is issuetl. (Sec. 3097, Civil Code). LenOer's Nama: Lentlefs AAdress: Signafure: Date: OWNER-BUILDER DECLAFiAT10NS: I hereby eHirm that under penalry of per�ury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the lollowing reason (Sec. 7031.5, Business end Protessions Cotle: Any city or counry which requires e permit lo consiruct, alter, improve, demolish, or repair any structure, pnor to Ils Issuance, elso requiras the flpplicant for such permit to file e signetl statement tha� he or she is licensetl pursuant to ihe provisions of the Contradors License Lew (Chepter 9(commencing wlth Sedion 7000) of Division 3 ot ihe Business en0 Professions Cade) or ihet �e or she is e:emp� t�erefrom and the basis for the allegetl ezemption. Any Wolatlon ot Sedlon 7031.5 Dy any applicent for a permii sub�ects ihe epplicant to e chAl penalry of not more t�an frve hundred tlWlars (5500).): � ❑ I, as owner ot the pmperty, or my employees with wages as their sole wmpensation, WILL DO THE WORK, and the structure Is not intendatl or oNeretl for sale (Sec. 7044, Business and Professions Cotle: The Coniractars License Law does not appty to an owner oi properry who builtls or improves Ihereon, and who tloes suc� work himsetl or herself or through �is or her own employees, provided ihat such Improvemenis are not intendetl or oHere0lor sale. If, �owaver, the building or improvement is soltl within one year of completion, the owneo-builder will have ihe burden of proving thai he or she tlid not �uild or improve lor purposa of saleJ. � ❑ I, as owner oi the pmperry, am E%CLUSIVELV CONTRACTNG WI7H LICENSED CON7RACTORS to construct the pro�ect (Sec. 7044, Business and Professions Cotle: The contractors Llcense Lew does not apply to en owner of pmperry who �uiltls or improves thereon, entl w�o contracts for such project with a contractor(s) license pursuant to the Contractors License Lews.). , ❑ I em exempl under sec. Business antl Protessions Cotle for this reason: Signawre: Date: � Owner ID vedtiea by drivefs licensa. � Yes ❑ Na Dnver's License No. Expires: � Venfication of OwnerShip by (type at daument, i.e. - pmperry tax bill or deetl): � DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTFICATION: � ' ❑ I hereby ce�lty Ihet no excevetlon Ilve (5) or more teet In depih Into which a pereon Is requlred to descend, will ba mede In connection with work euthorized by thls permit, end that no Dulltling sirudure, sceMoldlnq, talsework, or tlemolition or dismentling ihereof, wlll be more ihen t�lrty-six (36) teet �Igh. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Celltornia Atlministretive Code). ' ❑ As owner-bullder, I wlll not emplay anyone to do work which would require e permil trom the Division ot Intlusirial Safory, es noted ebove, unless such person has e pertnit to Go such work trom the tlidslan. , Slgnature: Dete: Division ot Intlustrial Selery Permit Num�er: CERTIFlCATE OF COMPLIANCE IWD AIfTHORIZATION OF ENTRY: I certify under penelry of perjury the� 1 heve read this appliCation anA slate Ihat the information given is I correct. I agree to comply wilh all stete laws and ciry orOinances relating to building wnstruction, and authorize represemetives of the Ciry of Costa Mesa to enter upon Ihe above-described property lor inspection purposes. I agree ny� �o occupy or allow accupancy ot any bulltling eut�orizetl �y thls pertnit unW Ilnal inspection. COUE t• INSPECTION TYYE t6t6 Fixotl System Flnal Fire Preveniion 1268 Pool Spa Final 200 Finel RaRoot 201 Finel 81ocWReteining Wall 202 Finel Fectory Fire Place 203 Final Sign 204 Finel Demoliii0n 2sa&48 CppE 1 INSPECTION TYPE 206 Final Mechanical 208 Finel Plumbing 210 Final EloctdCel 212 Final Fire Prevemlon 220 Finel Plenning Approvel 222 Final Site 250 Finel Building�Occupency q Dayte /'/0 �(7� - Date PI�IE INimRlS ��