Loading...
HomeMy WebLinkAbout456 19TH ST - Building Permits� � � . , , � CITY OF COSTA MESA — . ` BYILD/NG DIVISION i � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wvnv.ci.costa-mesa.ca.us r �.�� � FOR INSPECTIONS CALL: (714) 754-5626 � PERMIT NUMBER: B09-00200 PERMIT TYPE B ROOF2 STATUS: ISSUED APN: 42632119 DATE ISSUED: 09/15/2009 ISSUED BY: JOB ADDRESS: 456 E 19TH ST CM Vicinity: HOUSE ROOF ONLY Squares: 0 Suite/Unit: Valuation: $5,300.00 SCOPE OF WORK: TEAR OFF (�)`ROOF MATERIALS, INSTALL 1 LAYER OF 30# FELT ON A 3:12 PITCHED ROOF AND REROOF WITH 30 YEAR COMP $HINGLES ON HOUSE ONLY, APPROX 20 SQUARES. REPAIR AND REPLACE SHEATHING AS NEEDED. � � . � OWNER: VOTAW,STEVEN PHONE: 949-646-3785 APPLICANT: LEHMAN, JEFF , PHONE: 949-646-3571 ' CONTRACTOR: J S L ROOFING' INC Address: 2415 MARGARET DRUnit:' Ciry/State2ip: NEWPORT BEACH, CA 92663 ARCHITECT: ENGINEER: FEE SUMMARY Reroof Plan Check: Reroof Permit Fee: Reinspection Fee: Bldg Std Admin Fund TOTAL FEES $0.00 $12525 $0.00 $1.00 $126.25 Address: 456 E 19TH ST Cily/StatelZip: COSTA MESA, CA Address: 2415 MARGARET DR City/State/Zip: NEWPORT BEACH, CA License No. License No. 19: W:I�i License No. 747706 949-846-3571 CELL: PHONE: PHONE: Unit: Unit: : NOTICE: The work auNorized 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: PERMIT EXPIRES 186 DAYS FROM DATE Of ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and tinal apprqval must be obtained. Failure to oblain inspections and final approval vrill result in the expiration of this permit. COpEt, INSVELTIONTYPE QAjE INTfML CO�E/ INSPEC710NTYPE QRjF� INiIIU 7878 Fixetl System Final Fire Prevention p06 Final Mechanical 1288 Pool Spa Final \ 208 Final PlumEing 200 Final Re-Roof —1� �� 1 210 Final Electncal 201 Final BIocWRetaining Wall J 212 Final Fire Prevention 202 Final Factory Fire PlaCe \ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BuilOing/Otcupancy � . � WORKERS"COMPENSATION DECLARATION: I hereby affirm untler penalry ot perjury one of the lollowing declarations: ❑ I have and vrill mainlain a certificate ol consent to self-Insure for workers' compensation, as provided lor by section 3700 of the Labor Code. for the peAormance of �he work !or which this pertnil is i55uetl. ❑ I have and will maintain v.orkers' compensation insurance, as requiretl by section 3700 0l the Labor Cotla, lor the peAormance of the work lor which Ihis permil is issued. My workers' wmpensation Insur e carrier and policy Curr +'�r. `i J � (i(�� ��'V �� (iNssequnnaetlrrol4cprpleled/Na ava/uMetarelrwMretltlotlaisl51001aIess.1 �y�.�7ulHffir. ❑ I cetlify t at in the peA ance of the work for which this pertnit is issued, I shall ot employ an person in any manner so as to become subject to t�e wor er ' compensai' n laws ot Califomia, and agree that if I should become ' ct to the ers' compensation provisions of Section 3700 of the Lab C e, I shall f 'th comply vrith these pr4visions. d (� �l ` �c9 l re � WA AILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS LAW UL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND AlTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affrm that I am licensed untler provisions of Chapter 9(commencing wilh Seclion 7000) of Division 3 of Ih Business antl Professions Code, and my license is in tull ^force antl eflecl. �, _ ,,.., ._ a� l � lass # �� ,✓ �i � O Wr - ❑ I hereby 6ffvm that there is a consWctbn lending agency lor the peAortnance ot the wvrk for vfiich tltis pertnit is issued. (Sec. 3097. Civil Cotle). Lender's Name: Lender's Atltlrass: Sipnalure Dale OWNER-BUILDER DECLARATIONS: I �erehy affirm that under penalty of perjury lhal I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for lhe (ollowing reason (Sec. 7031.5, Business and Professions Cade: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any strucWre, pnor to its issuance, also requires the applicant (or such permit lo fle a signed statement that he or she is licensetl pursuanl to the provisions o( the Contractors License Law (Chapter 9(commencing vrith Section 7000) of Division 3 of lhe Business and Pro(essions Code) or that he or she is exempt t�erefrom antl lhe basis for lhe allegetl exemplion. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalry of not more than five hundred dollars ($500).): ❑ I, as ovmer ol the property, or my employees with vlages as their sole compensalion, WILL DO THE WORK, antl the structure is not intended or offeretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of propeny who builds or improves thereon, and who does such vrork himsel( or hersel/ or through his or her own employees, provitletl Ihat such improvements are not intended or oRered for sale. If, hovrever, the builtling or improvement is sold within one year of complelion, the owneo-builder will have the burden of proving that he or she did not build or improve for purposa of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRAC70RS ro conswct the project (Sec. 7044, Business antl Protessions Cotle: The contractors License Law does not appty to an owner o! property who huilds or improves thereon, antl who contracls for such project with a conlractw�s) license pursuant to 1he Contractors License Lavrs.). ❑ I am exempt under sec. Business antl Professions Cotle for this reason: SipnaWre Dale ]057<6 (3/0]) � � Ovmer ID venfied by driver's license. ❑ Yes ❑ No '� . Driver's License No. Expires: Veri�cation o( Ownership by (type of document, i.e. - property lax bill or tleed�: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 he2by certify Ihat no excavation frve (5) or more feel in tlepth into which a person is required lo descentl, will be matle in connection with vrork authorizetl by this permit, and Ihal no building stnicture, sc�ldding, falsev+ork, a demolition or dismantling thereof, will be more than thirty-six (36) (eel high. (Chap. 3.2, Grp 2, M 2. Sec. 341, Title 8, Califomia Adminisira�ive Cotle�. ❑ As ovmer-builtler, I will not employ anyone to do work which would require a permit from the Division o( Induslrial Safety, as noted above, unless such person has a permit to tlo such work (rom the division. / Odipnt's Signawre Da�e Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the appliwnt or present or fuWre building occupan� need to fle and certify a Business Plan for emergency response lo release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health antl Safety Code requires, wit� some exceptions. that a Business Plan be filed with the Cosla Mesa Fire Department by every business which has at any one time tluring a reported year a quantity of hazardous matenals equal lo or grealer Ihan a weight o( 500 pounds, or a volume of 55 gallons, or 200 cubic leet of compressed gas at stantlard temperature and pressure). 2. Does or will the applicant or present or future building cecupaN neetl to file a regislrelion form for acutety hazar0ous materials? ❑ Yes ❑ No (Section 25533 of the Calilornia Health and Salety Code, with some excep[ions, requires registration with the Cosla Mesa Fire Deparlment by each business which at any one time has on hand a quanlity of acutely hazardous materials equal to or greater than a vreight 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 presenl or future huilding occupanl neetl to prepare an RMPP (Risk Management and Prevenlion Program (or acutely hazardous matenals�? ❑ Ves ❑ No (Section 25534 0( the Calilornia Heallh and Safety Coda provitles lhat the Costa Mesa Fire Department may require the preparation, certifiwtion and filing with the Fire Deparlment of an RMPP by businesses which are required ro register acutely hazardous materials with the Fire DepanmeN. 4. II an RMPP is presently required, has Section 25534 0l the Cali(ornia Health antl Safely Code been fully complietl with7 ❑ Yes � No 5. Does or will ihe appliwnt or present or fuwre building occupant require for the vrork which is tha subjecl of this application a permil tor such construction or motlification fmm ihe SoWh Coasl Air Qualily Management DisMct or from any other air pollution contml district or agency7 ❑ Yes ❑ No (Section 658502 of Ihe Calitomia Govemment Code requires that lhe requested intortnation be fumished on applications for noo-resitlential building permits�. 6. Will any part of the taciliry to be consWcled untler this pertnit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No Qf'j�es", the faciliry must meet the requirement of Sections 25534 and 42303 o( lhe Califomia Health antl Safety Code). 7. If a permit from ihe South Coasl Air Quality Management Oislrict or other air polWtion control tlistrict or agency is requiretl for Ihe avrk which is the subject o! this application, have all of t�e disclosures prescribed by Calilomia Health antl Safety Cotle Section 42303 been made't ❑ Yes ❑ No 8. Qf yes", attach certificate of compliance from the appropriate air pollution GonIr01 offcer). CER7IFICATE OF COMPLIANCE: I certily that untler penalty of perjury lhe infortnation given above is correcL I agree to comply with all state laws and city oMinances regarding Hazardous Mateiials and Emissions. Sg^awre CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penally of perjury that I have read this application and stale that the in(ormation given is correcL I agree to comply with all state laws and city ortlinances relating lo uilding construction, antl authorize representatives ot the City of Costa A�sa t�ter upon the above4escribed pmperty for inspection purposes/f agree to occupy or allow occupancy of any builtling authorizetl by tl�is qynmt unC al inspection. Dale �CS=� Job Address: 456 E 19TH $T Suite No Vicinity: Parcel Nunmber: 42632119 Applicant: TOM, STEVEN Address: 970 E MAIN ST UNIT 200 GRASS VALLEY, CA Owner: VOTAW, STEVEN Address 456 E 19TH ST COSTA MESA, CA PLUMBING PERMIT Phone: 800-833-4572 Zip: 95945 Phone: Zip: 92627-2314 Contractor: WATER HEATERS ONLY INC Address: 970 E MAIN ST UNIT 200 Phone: 800.833-4572 GRASS VALLEY, CA Zip: 95945 License: 374573 ISSUE FEE 0 BackFlow irrigation 0 BackFlow Preventer 0 eathtub SCOPE OF PERMIT CHANGE-OUT OF AN EXISTING WATER HEATER IN A SFD. 1 WATER HEATERNENT NO OTHER WORK AUTHORIZED WITH THIS PERMIT. AMT QTY 523.50 50.00 $0.00 $0.00 Status: FINAIED Applied: 01/292007 Issu,,e�d: 0/1/292007 ISSUED BY: /S�1 �/ _ �� ` ; �� � Y t .' . i FEE SUMMARY AMT gTY. Laundry Tub I Washer $0.00 0 Landscape Irrigation $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 AMT QTY 0 Sump Pump 50.00 0 Swimming Pool 50.00 0 Trap Primer $0.00 L Urinal $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: Thls permlt shall automatically ezpire and become void if work Is not commenced wlthin 180 days, or If work is suspended or ebandoned br a period ot 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all epplicable codes, and all requlretl Inapeetlone and finel epproval must be obtained. Failure to ob�ain inspec�ions and tlnal approval will resul� In �he expiration of ihis permit. FOR INSpECTIONS CALI: (714) 754-5626 oawn �app� WOHKERS'COMPENSAnON DECLARAnON: I heraby aHirm untler penalry of perjury one of Ihe followinq dadarelions: ❑ I have enA will malnteln e ceniflcete oi wnsent to selt-Insure for workers' compenseHon, es D��tled for by sectlon 3700 oi Ihe Labor Code, for the partormance ol ihe work lar which thls permit Is issuetl. ❑ I heve end will maintain workers' compensatlon Insurance, es requiretl Dy sectlon 3700 of the Lebor Code, for the peAortnance of the work for which this pertnit is issuetl. My workers' compensation Insurence carder end poliry number are: Cerrier: Policy Numbar. (Thls sect/on need nat be comple(ed il fhe peimit Is velued ef one �undred tlW/aro ($100) or less.) ❑ I certity ihet in Ihe pertartnance o1 Ihe work tor which Ihis permit is IssueQ I shall not employ eny pereon In eny manner so es to Decoma subject to the workers' compensetion lews of Callfomle, and egree that tl I s�ould become sub�ect ro Ihe workers' compansetlon prodslons of SecNan 3700 oi the Lebor Cade, I shell torthwit� compty wilh ihese proNslons. Applicent Slgneture: Defe: WARNINO: FAILURE TO SEWRE WORKERS' COMPENSAT7IXJ COVERAGE IS UMAWFUL AND SHALL SU9IECT PN EMPIOVER TO CRIMINAL PENALTIES PND CML FlNES UP N ONE HUNDRED THOUSHND DOLLARE (5100,000), IN ADDITION TO THE CQST OF COMPENSATION, DMIAQES AS PROVIDED FOF W SECTION 3]OB OF THE UBOR COD� IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLAPATION: I hereby eHirm t�at I em Iicensed under pravisiona oi Chapter 8(commencing wlih Seaion 7000) ot DlWsion 3 oi the Busineu end Prafessions Code, end my license Is In fu0 loroe end eHecL Uc. M Class N Conirector9 Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ I �ereby ettirm thal t�ere Is e construction lending agenty (or ihe pertormence ol Ihe work br which t�ls permll is Issued. (Sec. 3097, Civil Code). LentleYs Neme: Lentlefs Atltlress: Signeture: Date: OWNER•BUILDER DE A NS: � I hereby afllrtn Ihat under t m EXEMPT PBOM T}iE CONTpACTORS LICENSE LAW for the tollowing reason (Sec. 7037.5, Business entl Professions Cotle: Any dry or counry w re t, alter, improva, demolish, or repelr any structure, pdor to Its luuance, elso requires ihe appliceN tor such permit �o flle e signed statement he o ns u u o Ihe provisions of the Contrectors LJcense Lew (Chepter 9(commenGng with Sedlon 7000) of DlNsion 3 oi the Buslness end Professions e) or t s exe �erefrom and the basis lor Ihe ellege0 exemption. Any violetian of Section 7031.5 by any epplicent for e pertnit sub�ects the epplicent to e cMl penal n ndretl dollars (5500).): ❑ 1, as owner of the properry, or my emplayees wit es es thelr sole compensetion, WILL DO THE WORK, and Ihe structura Is not Intended or aHeretl tor sale (Sec. 7044, Buslness end Profes5lons Code: The Contractors License Law does not apply to en owner of property who bulltls or Improvas thereon, antl who does such work hlmself or herself ar t�rough his or her own employees, providetl thet such improvements are not intendetl or oflered br sale. H, however, the building or improvement Is soltl within one yaer of completion, tha owner-builder will have the burden of proving that he or she dId not build or improve for Durpose of sale.). ' ❑ I, as owner ollhe D�aPerty, am E%CLUSIVELY CONTAACTNG WRH LICENSED CONTiiACTORS to consiruct the project (Sec. 7044, Business end Professions Catle: The coniraqors lJcense Lew tloes not appty to an owner ot properry who builds or improves thereon, and who contracts for such prqect with e contracror(s) license pursuant to the Contracrors Llcanse Laws.). ❑ I em exemp� un0er sec. Signature: Owner ID verltied by tlAvefs Ikense. ❑ Yes � No Business end Pmtesslons Code for ihis reason: Vedticatlon ot Ownershlp Dy (type ot document, i.e. - properry teu bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON: Drivels License No. Date: 6cpires: ❑ I hereby certiy that no excevetion frve (5) or more teet in depth inio which a pereon is requiretl to tlescend, wlll be made In connedlon with work euthorized by this permit, and that no building structure, scafldding, talsework, or demoliiion or tlismantling thereot, will be more Ihen thirty-six (36) teet �Igh. (Chep. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Celllomla Adminblreiive Code). ❑ As ownar-bullder, I will not employ enyone lo do work which would raquire e pertnit Irom Ihe Dlvlsion of InOustrial Safery, es noted abova, unless such person hes e permit to do such work Irom Ihe division. Signeture: Dete: Divislon ol Intlusirial Safery Pertnil Number: CERTflCATE OF COMPLIANCE AND AUTHORIIATION OF ENTTiY: I certily untler penalty ol perjury ihet I heve roed this epplication and stete Ihet the Inlormation glven Is wrrect I egree lo comply with ell stele laws end ciry ordinanCes relating to building construction, anC eulhodze represematives ol the City of Coste Mesa to enier upon Ihe ebove-descnbed property tor Inspection purposes. I agree not to occupy or ellow occupenty ol eny building authodzed by this pertnit uNil finel Inspection. Slgnature Of Legel Owner(s) And/Or Autharized Ap011cant Date 400E �. IMSPECl10NTYVE Q�j�, I�LS 7818 Fl:ed System Final Fire Prevention 1268 Pool Spa Finel 200 Flnal Re-Roof 207 Flnel &ocWRetelnlnp Wall 202 Finel Fectory Fire Plece 203 Flnal Slgn 204 Final Domditlon COOE I INSPECTION TYGE 208 Flnal Mecheniwl 20B Finel Plumbing 270 Finel Elec�riCal 212 Finel Flre PrevenUon 220 Finel Planning Approval 222 Final Slte 250 Finel BuildingiOccupenry � I�� • � ti Job Address: 456 E 19TH ST Suite No Vicinity: Parcel Nunmber: 42632119 Applicanc TOM, STEVEN Address: 970 E MAIN ST - --"-�� �-�-`-. - UNIT200 � � - -�' PFione: 800�-833-4572" � � : .,��'".. GRASS VALLEY; CA,G '�` � Zip: 95845 I�� , i. ---' - - , � �-, ; � ( ` . Owner: VOTAW,87EVEN - � � Address 456��E 79TH ST� \ i � -- - � / � � A �/ - . �� i� i A �) � /: ,�� _ �Phone: � � �COSTA MESA„CA%,= �"; ,. � Zip: � � ii"% " ; , ,,; j, ;;.�,> % r._,. 92627-2314 Contracror. WATER<H�ATERS ONLY INC /'Address "� 970 EMAIN'ST � !�� i � � � UNIL200 , Phone: "800-833-4572 =i , ISSUED BY: � .. . GRASS VALLEY, CA Zip. - 95945 - - � �.License: 374573 � ;� � � ,. ,. ...--" '�� .. � , ;�l�T`' %' ; r-' " "'� - � SCOPE OF PERMIT � ;,. �, CHANGE-OU7 OFAN EXISTING WATER HEATER IN A SFD. . . . ;,. _ ��1 O % 1 WATER HEATERNENT ../ - - -'_ -- - - - - " - Status: ISSUED Applied: Ot/29/2007 Issued: Ot/292007 , EX IRE DATE`��'� ��� ,� , / - _ � „ . '' \ 'f NOOTHERWORKAUTHORIZED�WITHTHISP.ERMIT.-.- -� -- -� ,� �- . i ' - ;'� „�' � r � ��� � ' ,�i i�� ��;i. "�� i ,��'r- v,. _ �' ISSUE FEE Backflow irrigation �` ; Backflow Preyenter ;, Balhtub Clarifier System � � Connecl Qce,Soda;gtc) � Dental�Units ' ` �' Dishwasher� -� Drain, Floor � � Drain, Rainwaler� Drain, Roof�` ;�z Drinking Fountain ,-� AMT': $23.50 ` $0.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 � -- - � -FEE SUMMARY - - _ ' -- QTv AMT an � Laundry:Tub / Washer - 50.00 � 0;, _ Sump Pump . 0 Ir"=-Landscape,lirigation; �� _�$0.00 ,' ��0�. ;�-= _ _'� Swimmin9Pool 0 '"'��-P-Trap - .- • 50.00" ' 0. ._ TrapPrimer 0� Pressure Regulator ��$0.00 �� 0 Urinal 0! Process Piping (per 10 ft) -50.00 0 Vacuum Brkr Bkflo'w(1-4) 0� Receptors .�$0.00 . 0 'Vacuum Brkr Bkflow(5+) 0 Septic Tank �" `'$0.00 0 Wash Basin �, �', 0' Sewer Cap for Demo $0.00 0 Wash Basin'Set' � 0�; Sewer Connecl'`,,, -� �, $0.00 0 Waste and Vent System 0; Sewer�Pri`vate.Line� � � �v$0:00 0 WaterCloset�(Toilet) �'� Oi Shower,%�1 " �$000 .�0 Water-Heater/vent Expansion Tank`. $0 00 '�j0 �'�"�" �� Smk corrimeraal � $0 00 '�0 -'''� Water Re-I�ng�(�Inst or Rep.) Gas EaRhqueke Valve � $0 00 - �0 � � � � 8mk Flooi -, , $0 00 , 0 . ' Water Service � Gas(1-4outlet's) ��,`� ✓$000� 0��., � , ��Smk �kitchen; - - � , $0,00 = 0 !�iWaterSoftener /'- ' � Gas(Over4outlets)c_A �$0001; �0� �. ��`Snk;service/mop ,,, ,$0.00 �0. ; . ' OTHER � � /, � as epipe �`��\ . / 0;��., �`Spa(private)�.'� _ � -$0.00". '.0`. �� � VIOLATION - Gas Service � � �$O.00�I ,0 , Spa�(public)-� � - �$0.00 0 � ' �. PLAN CHECK Interceplors (Grease, Oil)A, $0.00 � �0 �` ���� r ��` � ` � "� - � � � REWSPECTION � Interceptors (Sand Auto ) �$0;00 �_ � 0 � -�� ,_, ', j . - -� r _ _ �� �..�\\,��'�!",/� � i �� � < .: AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 � : TOTAL CACCULATED FEES: 535.80 -_}�.� i. ��.,� �C.:.-',-i.rJ��iCi.-'-'" _ QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NO710E: 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 it work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authonzed under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapectlone end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2646-4fi(6�00) � WORKERS' COMPENSA710N DECLARATION: I hereby aHirtn�untler penalty oi perjury one of the following declaretions: ❑ 1 heve end will maintain a certificate of consent to self-Insure for workers' compansa�lon, as provided for by section 3700 of �he Labor Code, for the peAormanca ot ihe work tor which t�is permit is issued. • ❑ 1 have end will maimain wodcers' compensation insurance, as requiretl by section 3700 oi the Labor Code, for t�e pedortnance of the work for which Ihis pertnit Is issuetl. My workars' compensation Insurenca carriei end policy number are: Cerrier' f Policy NumbBr. (This ction need not be completed i/ the permif is valued et one hundred dollers ($100J or /ess.) n- a� I cetlify ihat in the performanc f Ihe work for which this permit is issueQ I shall not employ any person in eny manner so as to become sublect to the workers' compansation laws of Califor , an egree ihat if I should become suh�ect to Ihe workers' compensation provislons of Section 3700 of Ihe Labor Cotle, I shall forthwith comply_Wit�se provisio �'"' ApPlicanCSiguature: �—. .g�e:_ ! — Z�j _ D � WARNING: FAILURE TO SECURE WO RS' COMPENSATION COVERAGE IS UNLAWFUL AND SHP1L SU&IECT AN EMPLOYER TO CRIMIWII PENALTIES AND QVIL FlNES UP TOONE HUNDRE� T/qUSAND DOLURE (5100,000), IN ADDRION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE,1IJrEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hareby aflirm that I am licensed under rovisions oF Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, antl my license is in full force end eflect LiceN�. .� %� 7� _ Class a �.� .� . E� CONSTRUCTION IEND{NG AGENCY: ❑ I hereby afrirm that ihere is a consiruction lending agency tor the peAormance oi t�e work for which this permit is issued. (Sec. 3097, Civil Code). Lentlers Name: Lenders Atltlress: SiqnaNre: Date: OWNER-BUILPER DECLARATIONS: I hereby eltirm ihat untler penalty of parjury Ihai I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business antl Protessions Code: Any ciry or counry which requires e permit to construct, alter, improve, demolish, or repair any simcWre, prior to its issuance, also requires the applicant for such permit to file a signetl statement that he w she is licensetl pursuant to the provisions ot Ne CONrectors License Law (CheDler 9(commencing with Section 7000) of Dlvision 3 ot the Business antl P�otessions Code) or thet he or she is exempt iherei�om and the basis for ihe alleged exemption. Any violation oi Section 7031.5 by eny applicent for e permit subjects Ihe applicant to a civil penalry of not mo�e than five hundred dollars.($500).): ❑ I, as owner of the property, or my employees with�wages as iheir sola compensation, WILL DO 7HE WORK, antl ihe stmcture is not intended or ofleretl for sale (Sec. 7044, Bu9iness and Professions Code: The Coniractors Licensa Law doas not apply to an owner of property who builds or improves ihereon, antl who tloes such work himself of hersetl or ihrouqh his or her own employees, providetl ihat such improvements ere not imended or oNered lor sale. If, however, ihe building or improvement is sold within one year ot completion, the owner-builtler will have the burden of proving ihat he or she did not builtl or improve for purpose of sale.). ❑ I, as ownd� o� the property, am EXCLUSNELY CONTRACTING WITH LICENSED CONTRAC70RS to construct the pmjecl (Sec. 7044, Business entl Pmtessions Cotla: The contractors License Law tloes not apply to en owner of pmperty who builds or improves thereon, and who contracts for such project with a contractor(s) license pu�suant to the Coniractors License Laws.). ❑ I am exempi untler sec. Business antl Professions Code br ihis reason: SignaNre: Date: Owner ID venfiad by dnver's licanse. ❑ Yes ❑ No Driver's License No. Verification of Ownership by (type of document, i.e. � propetly tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I hereby Ceriify Ihat no excavation five (5) or more teet in depth into which a person is required to descend, wiil be made in connection with work authonzed by this pertnit, and ihat no builtling structure, scaHolding, falsework, or demolition or dismantling Ihereof, will be more ihan ihirry-six (36) tee� high. (Chap. 32, Gry 2, Ah 2, Sec. 341, Ttle B, Califomia Atlminisiretive Code). ❑ As owner-builder, I will not employ anyone �o do work which would require a permit trom ihe Division of Induslnal Safery, as noted above, unless such person has a permit to do such work irom ihe divisian. Signature: Oate: Division oi Intlus�rial Satery Permit Number: CERTFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cenify under penalry of perjury that I have read ihis application antl state that ihe information given is corrad. I egree to comply wi�h ell staie laws and ciry ordinances relating to 6uilding cons�ruc�ion, and authorize representatives ot the Ciry of Costa Mesa to en�er upon ihe ebove-tlescribed p�operty for inspection purposes. I egree not to acupy or allow occupency of any building au�horizetl by ihis permit until final inspec�ion. Legal COUE 1, �xc� �srrloNTYVE 161fi Flzed 5ystem Final Fire Prevention 1266 200 Pool Spa Final Final Re-Roof � 201 Final BIocWRetaining Well 202 Final Fectory Fire Placa 203 Final Sign � 204 Final Demolition o"re miiue�5 � 5 :� �uaactiy�aaier.�u�� 206 208 270 212 220 222 250 Final Mechanical . z9 =- �7 o`�,e„�- PAIE INTffIpLS Final Plumbing Final Electrical Final Fire Prevention Final Planning Approval Final Site Final Builtling/Occupancy � 0 _ Zi ��� FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT oec 1 s iss3 P.O. BOX 817 COSTA MEBA, CALIFORfiIA , FINANCE DEPT. � f�ljY Of COSTA MESA For Applicant !o Fill In Complefely AP CATION FOR PERMIT TYPE OR �PRINT . . � BUILDING For Office Use Only : BUILDING L� � /O � � � . � ADORE59 .� � ' . I RHCEIPT NO. I PERMIT NO. � COSTA MESA, CALIFORNIA . � TEL. ZONH . TYPE V GROUP CITY OS l eS NO. � � APPROVED /� . ARCHITECT � TEL. �� BY ATE. OR ENGINE6R � E NO. . AL 63 � 19 r f- aN�Na ti ._ z I no. oe � use or rvew �y , ./� . .. r PUNe �. Bu1LDlna _CONTRACTOR W � r . ..;_ _ . . _ _ _� �.' �/� � �� LE6AL ADDRESS �j DEYCR�Il10N CITY � OS � � S� A. P. NO. � � � NOTE: NO EAVE OV ERHANG SHALL BE LESS THAN � LIC.TNO. ��' - NO. � 30" TO SIDE @ REAR P. L. ' - ' 1 SIZE �.'� �' 1 '"� � ``� �� How oN WT /,�ji , ALLOWED (U. B. C. REQUIREMENT) �+ � OFLOT USEOF - 1'O.RDSAPPROVED - VARDSAPPROVED . !� - EXISTING BLD6. . MAIN BUILDING ACCESSORY BUILDIfJG �� . �. (FROM C/L STREB ) - � SETGACK�LIN¢ PROM t� REAR YARD oZ FRONT (' FT. ;� CENTER OF 8TR66T ,J SID6 YARDI LEFT D` '�I-RIfdHT ! R.81DE FT. FT. DESCRIPTION OF WORK �. s�oe ��. `� Fr. NEN/ A4T6RqTION ADDITION �N REAR ) FT� � FI'. , " D18TANCE BET. �.� BET. MAIN d . REPAIn � MOVIN6 DEMOLISH MAIN BLDGB. ACCESS.9LD63. � VAR.�- DATE BUILDIN6 NO.OF � ' SIZE �UX �ROOMH 'ST R16S / C.U.P.A ' APPROVED COVERINGWALLS UCeO I COVERIN6 'y` U�/ AYPROViD -�l A E � �� US60FBUILDINaANP ORKT EPERRORMHD ' ' � �� , , � - �c d 7— �' � , � ��� s4.�. o 1 HEREBV ACKNOWLEDOB THAT 1 HAVB REAO THIB APPLICATION THE AMOUNT BHOWN UNDER VwWAT10N 19 FOR THE F ANO 6TATE THAT THG ABOV6 IB CORqECT ANO AOPEB TO COM. PUPP096 OF 68TABLIHHIN6 A PERMIi FE8 ONLY, p� ' PLY WITH ALL CITY OROINANCiB AND BTATC LAWG R80YL.�T 6 yALUATION BOILOIN6CONHTRU /��_ N PERMIT FEE $ � 91GNATIJREOP �.��� � Z / �7 . . PERMITTE � LJ!/.O -- ` F - � . s $ �� . PLAN CHECK $ /'—" 0 i AUTHORIZ6D Afi[NT . +( W � TOTALFEE $ �X � .