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HomeMy WebLinkAbout2550 ELDEN AVE - Building Permits 44, yin Ilk 9 CITY OF COSTA MESA - act BUILDING DIVISION F • Malt/Irak ,I DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER PERMIT bla , B06-00885 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa sDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 06/06/2006 Vicinity: GARAGE FOR UNITS A D AND G Issued: 06/06/2006 Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH Address: 245 MESA DRIVE /�� Phone: 949-646-6966 ISSUED BY: (�� COSTA MESA,CA Zip: 92626 Owner AGNES ENTS LLC Address 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA Zip: 92626 Contractor OWNER-BUILDER Address: Phone: Zip: - License: 000000 Arch : - Eng: Address: - Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT 48SF ATTACHED OPEN PATIO LATICE COVER OVER ENTRY WAY OF ENCLOSED GARAGE FOR UNITS A,D AND G. FEE SUMMARY Plan Check: $21.22 • - Calc Valuation: $773.76 Permit: $32.65 Claim Valuation: - Moo SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 — --- Total: -Total: $54.37 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 ' Required: 0 Proposed: 0 • 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 2448.4e WOO) 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 s ction need not be completed if the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,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 A�r,ovi(Sqps. 6o ' Applicant Signature: "' Date: / WARNING:FAILURE TO 5 R� ,ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI P NALTIES 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 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# 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,atso 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�-t� the applicant to a civil penalty of not more than five hundred dollars($500).): V I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with'a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am ex pe nder sec. Business and Professions Code for this reason: Signature: !r0r Date: ‘/4406 I Owner ID ve ed y driver's license. 0 Yes 0 No Driver's License No. 1 4Sign 7 Expires: 9"24 or Verification of Ownership by(type of document,i.e.-property tax bill or deed): • DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: I ❑ 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). I ❑ 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. 1 Signature: Data: Division of Industrial Safety Permit Number: • HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to filo a registration form for acutely hazardous materials? 0 Yes 0 Na (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No I 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? IP Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be tumished 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 Califomia Health and Safety Code). I 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 I 8 (If"yes'',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state I¢ws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspectiyn�urposes.I agree not to occupy or allow occupancy of any building authorized by this�rmit y�il final inspection. le 11'61 F�/r(U6 6 6/ Signatu f Legal Owner(s) ate j And/Or Authorized Applicant Date I CODE I INSPECTION TYPE PATE INTITIALS BODE I INSPECTION TYPE fad WEN& 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 I 203 Final Sign 222 Final Site / 204 Final Demolition 250 Final Building/Occupancy 6. Z-0 Mac ' CITY OF COSTA MESA 4 ! � BUILDING DIVISION >:l' .w DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ta• .11411 PERMIT B06-01325 lab (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.igUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 08/03/2006 Vicinity: COMMON AREA , Issued: 08/14/2006 Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH . Address: 245 MESA DRIVE Phone: 949-646-6966 ISSUED BY: COSTA MESA,CA Zip: 92626 Owner AGNES ENTS LLC Address 245 MESA DRIVE, Phone: 949-646-6966 COSTA MESA,CA - Zip: 92626 Contractor .OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : MARCUS KEMMERER Eng: Address: KEMMERER DESIGN ARCHITURE - - Address: HUNTINGTON BEACH,CA Phone: 714-655-3139 Phone: ' 228 CREST AV Zip: 92648 License: C29552 License: SCOPE OF PERMIT INSTALLATION OF 2 14FT HIGH ANTIQUE BELL LIGHTS IN THE COMMON AREA FOR AN APARTMENT COMPLEX. MONUMENT SIGN NOT PART OF PERMIT-.WILL BE UNDER SEPARATE SIGN PERMIT. FEE SUMMARY Plan Check: $25.19 Calc Valuation: sl,000.00 Permit: $38.75 Claim Valuation: si,000.00 SMIP Res: $0.50 - ---- - - - - • SMIP Corn:' $0.00 - Other: $0.00 • Inspection: $0.00 Total: $64.44 ' PLANNING &ZONING SETBACKS ;Qc ,, = MAIN STRUCTURE Front ' 0-6 .'.1'''', Rear 0-0 _ Left 0-0 Right ' 0-0 , ACCESSORY Front 0.1 0.:-, Rear' 0-0 Left 0-0 Right 0-0. PARKING Existing: 0; / Required: 0 . Proposed: 0 t 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. 1 FOR INSPECTIONS CALL: (714)754-5626 244646(WOO) DECLARATIONS ,.., WORKERS'COMPENSATION DECLARATION: I I hereby affirm under penalty of perjury one of the following declarations: • ' - , I ❑ 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 end 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 it the permit is valued at one hundred dollars($100)or less.) ' -- I 0 - 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'1,- 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. I Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1 W,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: . I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.4 Class a 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). Lenders Name: Lender's Address: I 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 end Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am eke pt under sec. _ _ _ Business and Professions Code for this reason: Signature: LQyI ON K Date: I 6 ! Owner ID ve d by driver's license. 0 Yes 0 No Drivers License No. N q g-sfr?7 /—"Expires: 9 1 Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: I ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. • Signature: Date: - Division of Industrial Safety Permit Number: I 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 I (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ore volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). I 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?: ❑Yes ❑No (Section 25534 of the 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 Safely Code been fully complied with? ❑Yes 0 No —.._ —__._...c____.. __.on ..._..iced.__. 5 Does or willo the tcAir or present or future building occupantm require for the work which the subject of this 0 estion apeNnit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes S No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). I 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ..tr.l..i..i.t..r. ... 7 Ifa a permit fromn the South Coast res Quality Management District or other airpollution ioncontrol district3 agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon . above-desc'bed r perty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ---AI � 1113)a6 Signature Of Legal Owner(s) Date i And/Or Authorized Applicant Date CODE I INSPECTION TYPE PATE )NTfAL$ CODE 0 INSPECTION TYPE QATE NMIDEI5 I 1 1616 Fixed System Final Fire Prevention 206 Final Mechanical • 1 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical , 201 Final Block/Retaining Wall212 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 ` 117 �//ita 1", /fPC1/. • .a • • MF CITY OF COSTA MESA 4 S. BUILDING DIVISION ourgaerrunt>:lDEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER H t It_ _awing i 4 PERMIT B06-01324 41b*Pop.ffro.4* (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.d3UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 08/03/2006 Vicinity: UNIT G Issued: 08/14/2006 Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH Address: 245 MESA DRIVE U Phone: 949-646-6966 ISSUED BY: COSTA MESA,CA Zip: 92626 Owner: AGNES ENTS LLC Address 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA Zip: 92626 • Contractor , OWNER-BUILDER Address: - Phone: Zip: License: 000000 Arch : • MARCUS KEMMERER Eng: Address: KEMMERER DESIGN ARCHITURE Address: HUNTINGTON BEACH,CA Phone: 714-655-3139 Phone: 228 CREST AV Zip: 92648 r License: C29552 License: SCOPE OF PERMIT NEW WINDOW OPENING AT 2ND FLOOR BEDROOM AND A NEW 104SF LATTICE PATIO COVER FOR APARTMENT UNIT G.WINDOW TO MEET 1997 UBC EGRESS REQUIREMENTS.WINDOW AND PATIO TO BE CONSTRUCTED CONCURRENTLY, FEE SUMMARY Plan Check: $35.10 Cab Valuation: $1,500.00 Permit: $54.00 Claim Valuation: $1,500.00 SMIP Res: $0.50 SMIP Corn: $0.00 - - Other: $0.00 Inspection: $0.00 • Total: . $89.60 • • • : PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-o , '- 'Rear- 14-0 Left _ 10-0 • Right 40.0 . ACCESSORY,- . Front 0.0 Rear 0-0 -. - Left 0-0 Right- " 0-0 c�-, PARKING Existing:• 0 , Required: 0 Proposed: 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12.21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244648(am) ' 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. - j ❑ 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 if the permit is valued at one hundred dollars($1 00)or less.) I 0 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 DOLLARE(5100,000),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: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I 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(5500).): , O 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 ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am ex pt under sec. Business and Professions Code for this reason: ,__\-) Signature: l Date: f'1V^�j Owner ID ve by driver's license. 0 Yes ❑No Drivers License No. USA'3-7 —' Expires: CVOS Verification of Ownership by(type of document,i.e.-property tax bill or deed): • DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 1 O I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. I I Signature: Date: I Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: ' I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which tat 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. I 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with?�❑Yes 0 No W 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Li Yes Ll No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No 1 (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 I 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). I 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. I Signature: Date: I CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy any building authorized by this permit until final inspection. C- 13-74 tZ Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date 'CODE 1 INSPECTION TYPE -" ' - 2,11 INTITIALs' CODES -INSPECTION TYPE MTh' MTh priThALA 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 I 203 Final Sign 222 Final Site 204 Final Demolition - , . 250 Final Building/Occupancy ' /��,ary Pp v . 0-.IIJJJ ChY OF COSTA MESA 474,-Sr.' ,Sr.' BUILDING DIVISION >:r A, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �. PERMIT B06-01165 6' (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.cet1ILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 07/12/2006 Vicinity: UNITS B-G Issued: 07/12/2006 Primary Occ: R - Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH Address: 1835 NEWPORT BL A103-174 Phone: 949-244-4880 ISSUED BY: V COSTA MESA,CA - - - --- :Zip: 92627 Owner: AGNES ENTS-LLC M-:---'-' C , ; - - C,- "�, Address 245 MESA.DRIVE/ --- -- • �'� i/,.v —, - �ii i-_ �_... I ' - Phone:: 949646-6966/ ,\ COSTA'MESA,CA\ t _ Zip 92626 / �/- /`. i ,, - V� Contractor.�WNER-BUILDERR% _ � � - V(�\),�� iii/ \ �/.-•.:-•:-';r ;`/� */ , /�:� Address:S �'� ' �� �� \ �% Phone: V•-•2,-..` \� N- -,i NNJ /Zip: N. i 7/ -' License: 000000 .; / ��`N � tidies :� CI-- /%i%7 j. Eng: \n,1/4 - i'� \)> i Add ass:A % /�j/l 1 � Address: _ A v on_ , ,vA l �%2,� Phone: • /1- '_? \' ,v,.Phone: \`y\ ,Zip: ) -- i License 'Jr / License:." ,-• • CJ -. ' SCOPE OF PERMIT "? �;//\ - , INSTALL SIDING!#NER405,.FOR APARTMENT BUILDING WITH UNITS B THRU G. - , - � � ; v, FEE SUMMARY ,i ' PlaniCheck j� / $0.00 // ,r-r,;;-- / 4. ;,-,7r,r-•-, ., c„„,Calc Valuation: • �a �_$3,20000�, Permit. .. $97.25 r H; 1-0 �J Claim Valuation 't $3200001 a . , ..lit. S M I P Res:' i $0.50 = , SMTP Com:' • $0.00 \ ` %1 Other $0.00 "-^ \ s - �./611-7 ; ' �' Inspection \( $0.00 _t_ /4t� w! k;0! , '0 / . ',__Total \, $97.75 -r � , \ \ /',r/ 7 ;, / � ` ` PLANNING &'ZONING %�;% ;< - /” / SETBACKS �i' i %%/ MAIN STRUCTURE Front',1 0-0 Rear ..0-,O,y`,. Left •-. 0-0 Right 0-027/ , -,/ II) "� \��.. - •- . N'/ ACCESSORY c✓/Front 0-0:_ i:_-•..- Rear - 0-0 . Left 0-0`? : :Right . /-0/0• ) 5 1 / ' PARKING`\ Exrstmq\0., Required '0 '1" 'Proposed: 0 'j%% � \-v / 7 \ , . - - \ N / '.7/ ‘' \ . . > - - • 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 244&48 WOO) 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: Cartier. Policy Number: (This section need not be completed if the permit is valued at one hundred dollars(8100)or less.) 44_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 Celifo ia,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith y"�comply with thovlsi Applicant Signature:- Data:. �2-0 WeRJING-FAILURE TOS RE ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN RIO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THO(JSAND DOUARE(5100, ),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR 000E,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lk.N Class 4 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:My 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. i 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 Ls sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). em exempt a sec. Business and Professions Code for this reason: IS% Inetu�-7,- ' ���f�iee..���- �zr Dyate:'— 7-0-Cb _Owner'ID verified driver's license. s 0 No Driver's License No. N�1 a 3S-7}J—( rExpires:9.-zs-'o Verification of Ownership by(type of docu nt,i.e.-property tax bill or deec.— i 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(36)feet high.(Chap,3.2,Grp 2,An 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 WIII 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 tiled 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 d 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 et 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. j 4 If en RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ur Yes 0 No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). __ .mi. .._..i_ _..—t.-_.ist._.... _.__ ._ _..r_._ _for _...__. ._... _:- 7 a a carton haveathe South Coast res Quality ed Management CaliforniaHealthal or anddhSr airhe agencyofSafety Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,end authorize representatives of the City of Costa Mesa to enter upon the above-described property o ins 'on purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until a Inspection. -7-/2.-00 rrig 'Mega!Owner(s)__ _-- - Date`, 1" And/Or Authorized Applicant Date CODEC INSPECTION TYPE DEE MAU LODE! SOLO= all gl1MI& 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 p 204 Final.Demolition .. . 250 Final Building/Occupancy 57-i Q ft/_' r '2 PP • ` 1 CITY OF COSTA MESA ' 41 . BUILDING DIVISION > t DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER b. 11.1... ./. PERMIT B07-00253 0.(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.6BUILDINU PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 03/05/2007 Vicinity: Issued: 03/05/2007 Primary Occ: U1 Type of Construction: V-N Parcel Number 43916111 Zoning: Applicant: HUGH SILER Address: 245 MESA DRIVE • Phone: 949-646-6966 �j� �- COSTA MESA,CA .- _" - ic%'•' -'Zip: - 92626- � , ISSUED BY: Owner: AGNES ENTS,LL'C':..i- i • • Address 245 MESA i' - , ' n Phone: 949-646-6966 COSTA MESA,CA' - ' - Zip:, _ 92626 _. ,- , ��\" ,/ 1 - -- ' - Contractor; " ,OWNER-BUILDERS Address:.- ,.:117-,<: Phone: ';_` , A, \ Zip: - License: 000000 V' vVA\ Arch : r n, - Eng: Address: _. Address: - - - ' " A�.a - Phone: • _ - 'Phone: -' `' 1 G r . r. _ , ), - _ , , Zip: .- •Cioense: License: . , SCOPE OF PERMIT \, _ • EXTNED THE EXITING LAUNDRY ROOM BY ADDING 28SF ( - FEE SUMMARY N . ' � . . n Plan Check: •' $63.21 • 7 �; • :;, -• . " '. ,Calc Valuation: • ' $4,000.00 Permit: $97.25 :_ _ "'Claim Valuation: $4,000.00, SMIP Res: $0.50 SMIP Corn: $0.00 r ; Other: $0.00 _ � /, \ r / , 6- v ' Inspection: • $0.00 /' ,, , , Total: •• $160.96 ' t PLANNING &ZONING SETBACKS- "? '^' MAIN STRUCTURE Front -v 0-0 Rear: , 0 0 , Left 0'b"-.._ Right 0-0// N / -1 ' � I'S i/;/ ACCESSORY Front, 0-0 1- -Ream= 0-0 "Left 0 0 - Right- '0,0 ' .� , PARKING Exisbnq 0 Required 0' o Proposed:e 0 ',2 r:"Ky % % - • � �.. ����' /�� ! r . ;�.,\,--, Z;7 7 c • 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 expiratioripf this permit. t FOR INSPECTIONS-CALL: (714)754-5626 et - 2446-46(6/00) c 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 i1 the permit is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL MID SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SEC11ON 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.# Glasse 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). Lenders 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 end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500).): ❑ I,as owner of the properly,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.). . CI<I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions ode: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.). ❑11,am ex p 'der sec. Business and Professions Code for this reason: Signature: I 1 �Da e Mt sh S lao-7 Owner ID ver by drivers license. �ess 0 No Driv�Llca sn e No. VakfC�7 Expires: 09/Ok of Ownership by(type of document,i.e.-property tax bill or deed): ...------ Verification J DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIT 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 feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health end Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safely 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 a pRemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6t Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No 4.(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? ❑Yes ❑No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that'the information given is correct.I agree to comply with all state laws end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspetiq o0 purposes.I agree not to occupy or allow occupancy of any building authorized by this permititluntil final inspe�ctiion. t . Signa Ofd ner(s) Oket And/Or Authodzed'Applicant Date, V CODE t g1SPECIION TYPE ATE EOMs LODE! IN$PEc?ON TYPE flim 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 e� 204 Final Demolition 250 Final Building/Occupancy 5-1A-01 5S ' 1 CITY OF COSTA MESA • ; BUILDING DIVISION 1.°q f,' DEVELOPMENT SERVICES DEPARTMENT 19,13 MIT NUMBER k • PERMIT P07-00130 4`.w�wd. (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.aWMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN'AV Status: ISSUED Suite No Applied: 03/05/2007 Issued: 03/05/2007 Vicinity: Parcel Nunmber: 43916111 Applicant: AGNES ENTS LLC /� L/C Address: 245 MESA DRIVE ISSUED BY: � /' Phone: 949-646-6966 / .._ COSTA MESA,CA i' ; - - Zip: 92626 Owner AGNESENTS LLC-, A , - . Address x.245 MESA DRIVE�, - V - - Phone: 949-646-6966 - A ; - -,\--.,�/ //COSTA MESA,CAS, Zip: 92626 , Contractor: OWNER-BUILDER - • Address: / /.jam - ,a V _:Av / .. A :'v Phone: - � Zip: - _ , • ' 117, •)-"' License: 000000 - ' �. � .. SCOPE OF PERMIT - --- ' \; ''' ` ' REF B07-00253 ADD 28SF TO THE LAUNDRY ROOM , 1 GAS(1-4 OUTLETS)4 LAUNDRY TUBM/ASHER 1 TANKLESS WATER HEATER . ' . ' '/ FEE SUMMARY /- , ".0 AMT QTY - AMT ' .ga - AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $39.20 4' Sump Pump $0.00 0 Backflow irrigation - $0.00 0 ' Landscape Irrigation $0.00 '0%/ ' Swimming Pool - $0.00 0 Backflow Preventer $0.00 0 P-Trapi;", ' ,,, '.. -$0.00'- / 0 - ,- -Trap Primer $0.00 0 Bathtub $0.00 0 ' - Pressure Regulator- -• -$0.00/ /05 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping.(per10 ft) $0.00 ', 0 - Vacuum Brkr Bkfldw(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 ' 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 , Septic Tank '$0.000 I Wash Basin / - .$0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo . S0.00 S0:00 0 Wash Basin Set - $0.00 ' 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00: 0 Drain,Rainwater $0.00 0 Sewer Private Line-, - $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof - $0.00 0 Shower ,%t}- '- ,$0.00 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar '$0.00„ 0 Water Piping(Inst or Rep.) '$0.00 0 Expansion Tank $0.00 0 Sink;`commercial $0.00 '-0 Water fie-pipe , $0.00 0 Gas Earthquake Valve, -' $0.00 0 - - 'Sink,Floor $0.00- ;. '0 9-."',-Water Service $0.00 0 Gas(1-4 outlets) $6.15 1 Sink,kitchen , _ $0.00 0 ' '-Water Softener $0.00 0 Gas(Over 4 outlets) -"$0.00 0. .Sink,service/thop • $0.00 - 0, ; OTHER/ $0.00 Gas Repipe '' v $0.00 0' a Spa{private) - $0.00 '0 , 2' VIOLATION// /, / $0.00 Gas Service -�� '$0.00; ,-,...0, ;-Spa(public) ,' ' s $0.00...,..„0".„-,2 PLAN CHECK /' /' $0.00 Interceptors(Grease,Oil)'\$0.00 .' 0- - _ '- $0.00 0 Interceptors(Sand Auto)" $0.00 0 -- - - _ �-i� �%i i v / ��� . -v'-- � TOTAL CALCULATED FEES: $81.15 / COMMENTS/SPECIAL CONDITIONS -- ' •.i., / I • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.'No.92.28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS • . WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number ere: . 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 Car ornia,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 q'rovis ns. Applicant Signature: ) Date: {h121'1 1 P07 WARNING:FAILURE TO SE RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF 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.0 Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: • ❑ I hereby affirm that there Is a construction tending agency for the performance of the work for which this permit is issued.(Sec.3097.Civil Code). Lender's Name: ~ Lender's Address: Signature: t'' 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.). ' 11r ,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions `, Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am e = pt.+der sec. Business and Professions Code for this reason: Signature: • A A. `r11,,,� yy��c�Date: fl.a S lei Owner ID v: l: b driver's license. c " Akitts7.3 7 Expires: a•"24-7 • y I'la"/es 0 No Driver's License No. Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 W III 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? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health.and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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? ❑Yes 0 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 prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for' spec on purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. i }IpL A lode C.2oo7 ¢RaTJtB Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE# INSPECTION TYPE PAIS MALS ODE INSPECTION TYPE DAM It_____ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 8)- m 1266 Pool Spa Final 208 Final Plumbing al-0 037 200 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 ,011 9 CITY OF COSTA MESA 4 BUILDING DIVISION Fw�„•�,,,, ,41 DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER J. 11110111PERMIT Sok. . s P06-00272 OnarEb (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2550 ELDEN AV Status: ISSUED Suite No Applied: 04/18/2006 Issued: 04/18/2006 Vicinity: UNIT B Parcel Nunmber: 43916111 Applicant: SILER, HUGH ISSUED BY: Address: 245 MESA DRIVE . Phone: 949-646-6966 COSTA MESA,CA - Zip: 92627 Owner AGNES ENTS LLC Address 245 MESA DRIVE ' Phone: 949-646-6966 'COSTA MESA,CA - - Zip: 92627 Contractor: OWNER-BUILDER Address:. Phone: ' Zip: •License: 000000 SCOPE OF PERMIT REMODEL APT UNIT"B".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E) . • STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW . DISHWASHER. REFS,: B06-00571 ' • . • WORK TO INCLUDE: 1 BATHTUB, 1 DISHWASHER AND 1 SHOWER. FEE SUMMARY ' AMT QTY - - - - - ----- - AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 1 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Sdda,etc) •$0.00 0 Receptors , $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units, $0.00 0 Septic Tank - $0.00 0 Wash Basin $0.00 0 Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 . 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 ; 0 (r - ' •Sewer Private Line ' $0.00 0 - " • Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0, • Shower $9.80 1 Water Heater/vent $0.00 0 Drinking Fountain , ; $0.00 , 0" ` - Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0:00 , 0 Sink,commercial $0.00 0 - Water Re-pipe' $0.00 0 Gas Earthquake Valve, $0.00 0 ' Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) . $0.00 0 Sink,kitchen $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) $0.00 - 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 • TOTAL CALCULATED FEES: $52.90 r(1MMGMTC /CDFCIAI rtIM111TIAMC NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes 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 i • spd or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS' WORKERS'COMPENSATION DECLARATION: -" 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 theiperformance 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 if the permit is valued at one hundred dollars($100)or less.) lyhcertlfy that irl 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- gree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro i ' ns. Applicanl.Sgneture: LDate:_ -y=.(0—fib WARNING:FAILURE TO SECUR ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000), 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./I Class N 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 4sub cts the applicant to a civil penalty of not more than five hundred dollars($500).): owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. "7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exe t un sec. Business and Professions Code for this reason: Signature:_ - (Date:"--_Nz18—D6 Cwner'ID verifi by driver's license. es 0 No Drivr9r s.License.No ,A a kKs&3"7 Ezplres:_9'Z4 ' Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: • HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑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). ....... .i. ... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U.Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 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? ❑Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that'the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described p ope y f r inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SignatureOf-Legal Owner (s),.... - (Date And/Or Authorized Applicant Date . CODE I INSPECTION TYPE DATE INTRIAL$ CODE I INSPECTION TYPE DATE INRTIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ...'2+"v6 cgr 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 0a4CCI 9 ' CITY OF COSTA MESA 4BUILDING DIVISION >: DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER 1 i PERMIT �• ; B06-00175 o (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 02/02/2006 Vicinity: • Issued: 02/02/2006 Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: MARCUS KEMMERER Address: 228 CREST AVENUE I d�//r� Phone: 714-655-3139 ISSUED BY: ``'� HUNTINGTON BEACH,CA Zip: 92648 Owner: RYAN,,GERALD R TR Address 3902 RIVER AVE Phone: NEWPORT BEACH,CA Zip: 92663 Contractor:. v Address Phone: • 'Zip: - License: Arch : Eng: Address: .. Address: Phone: Phone: • Zip: License: - License: SCOPE OF PERMIT CONDO CONVERSION INSPECTION TO CONVERTE 7 APARTMENT UNITS INTO CONDOS.. - FEE SUMMARY Plan Check: $0.00 Calc Valuation: So.00 Permit: $0.00 Claim Valuation: So.00 SMIP Res: $0.00 - SMIP Corn: $0.00 ' Other $0.00 . -- - — Inspection: $0.00 Total: $0.00 PLANNING &ZONING SETBACKS MAIN STRUCTURE, Front =„0-0 Rear '0.0 Left 0-0 ' Right 0-0 ACCESSORY Front 0:0 ` `-Rear 0-0 Left 0-0 Right '0-0 PARKING'`` Existing 0 ' Required: 0 ' Proposed: 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS 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 sell-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 Ls Issued. My workers'compensation Insurance carder and policy number ere: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE(5100,000),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 lull 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). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business end Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(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 end certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ uuebuilding.._cup_ 3 Does or will the applicant or present or future budding 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 Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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 ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection purpos: .I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 705u)0,• /gal Own ) Date nw ed-A— • CODE I INSPECTIONTYPE PAS INIm9L5 yoDEr INSPECTIONTYPE • MATE MUM 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 Fire'B-,,,ungr^^rupaory 'oL` !-61 QN ank,1.L •'CITY 5F COSTA MESA `'i ► BUILDING DIVISION °'f�'� ►� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �r�4a� PERMIT B06-01770 (714)754-5273` 7311�• Fax(714)754-4B56 • www.ci.costa-mesa.BArULDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: A Applied: 10/18/2006 Vicinity: Issued: 10/18/2006 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: HUGH SILER Address: 245 MESA DRIVE Phone: 949-646-6966 ISSUED BY: COSTA MESA,CA - — - , ,,Zip: 92626 Owner: AGNES ENT.S'LLC' Address 245 MESA-DRIVE.- �/2 PF•ie 949-646-6966 - - COSTA MESA,CAS i,! .•26 l Contractor: O NER BUILDER Address 71 - A/ji,. Phone: License: 000000 , Arai : Y Eng: Address: - Address: Phone: Phone: ` . Zip: License: , - License: SCOPE OF PERMIT • DEMOLISH APPROXIMATELY 700 S.F.WORK INCLUDES:DEMOLISH EAST AND SOUTH EXTERIOR WALLS, INTERIOR WALLS AND ROOF OF S.F.D.PORTIONS OF.THE NORTHEAST WALL WILL REMAIN AND PORTION OF NORTHWEST WALL TO ENTRY DOOR WILL REMAIN FOR UNIT A.APPLICANT WILL INSTALL A FENCE IN FRONT OF PROPERTY. APPLICANT WILL CONTA CT A.Q.M.D>P.RIOR TO DEMOLITION. ' • " 1FEE SUMMARY Plan Check:- ` $54.11 - Calc Valuation: $3,000.00 Permit: $83.25 = - Claim Valuation: $3,000.00 SMIP Res:. . $0.50 • SMIP Com: $0.00 ` Other: \ ' $0.00 • Inspection: • $0.00 t Total: $137.86 PLANNING & ZONING SETBACKS �� MAIN STRUCTURE Front '0'0, �� -RRear 0-0 Left 0-0 Right 0-0 ACCESSORY •- Front 0-0 ',�� Rear---0-0- - Left 0-0 Right" 0-0 r PARKING Existing:. 0 ..; Required: 0- Proposed: 0 . A NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS <%-' 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: Cartier: Policy Number: (This action need not be completed/l the permit is valued at one hundred dollars($100)or less.) ti_•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 Cale,I shall forthwith comply with these p Bions. t.�p�Ic¢ant Signatum: j D'ela;- I Q// y�Q6vi EVrARMNG-FAtCURE TO SECU ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MID CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(3100,000), N ADDMON TO THE COST OF COMPENSATION.DAMAGES AS PROMDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class 4 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 �ssub/je'ctsthe applicant to a civil penalty of not more than five hundred dollars($500).): M Vl7g tI; i owner of the properly,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 properly who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ am axemp oder tic. Business and Professions Code for this reason: �'� t Ignature: ' Date: �0%%)f(� ner ID venfie sheer's license. Yes 0 No •• ensLi F-r, — zpires: (9,O f Verification of Ownership by(type of docu e ,i.e.-property tax bill or dee a..,,' 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,wit 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(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? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 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 withr 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 application appermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ull Yes u No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 NO (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No B (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property s n purposes.I agree not to occupy or allow occupancy of any building authorized by this permit ntil final inspection.pg_/. IDr, zDAS igna a Of Legal.Owner(s)�-2 . - ;' 'pale "�‘, And/Or Authorized Applicant Date CODE f INSPECTION TYPE all =ALE CODE E INSPECTION TYPE 2ATE INIIIIAL$ 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 y417/Oe - qr - 250 Final Building/Occupancy - /r 1 1 CITY OF COSTA MESA BUILDING DIVISION > :l r,,, 1, DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER t. ri�� PERMIT E07-00177 (714)7'54•-052777333 • Fax(714)754-4856 • www.cl.costa-mesa.E/LECTRICAL PERMIT 77 FAIR DRIVE, /COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV . Status: ISSUED Suite No Applied: 03/05/2007 Vicinity: Issued: 03/05/2007 Parcel Nunmber: 43916111 Applicant:ddressAGNES ENTS LLC r/l/N"-} Address: 245 MESA DRIVE - -.Phone:,949-646-6966 - ISSUED BY: COSTA MESA,CA %i', - Zip-- .92626 Owner: AGNES ENTS LLC.- � NN Address 245 MESADRIVE / � - ---- _ 1_ / ,; " / ':`--\ • �Phone 949-646 6966 '-� - /COSTA MESA,CA ' Zip: 92626 - - - / -`V -. Contr�tori /OWNER/7 UILDER \ - ',`,/ ",, Address: // ��`; ;A\\ i,,,"/:-/iPhone: 4.•,1 '� Zip: _ � . ' ,License:000000 - - ,� ' o: / " ` SCOPEOFPERMIT- ' , ,'REF 607-00253 ADD 28SF TO THE LAUNDRY ROOM - "j �. 5 OUTLETS \ / - ' i FEE SUMMARY , . y - Quantity _ - //...:'', ,-. �-- Quantity , , ' ISSUE FEE $23.50 -• - - Temp-Dist System/Lighting $0.00 0 ". Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package _ $0.00 .-� Standing Section/',. $0.00 0 ,,. 7 - New Res 1-2 units) $0.00 ,••••_. 0 ... " _ - - ( vl[=; --��Misc Electrical Equipment -� $0.00 0 � � ‘, New Res(3+units) $0.00 '-- .0-'-=' --"- `:-.Transformers up to,t kva/kw-^ $0.00 0 !� ; Pool/Spa $0.00 (.- - 0 -- - - --up to 10 kva/kw- '• $0.00 0 Lighting Fixts $0.00 0 "up to 50 kva/kw $0.00 0 '' Recept Outlets $5.50 - 5 e up to 100 kva/kw , $0.00 0' - Switches $0.00 0 over 100 kva/kw Non Res-Apel $0.00 0 Low Voltage Equipment : $0.00 '-/0 ; Res Appl -', � $0.00 0 Z .' s Low Volt Wiring System/Ckt $0.00 �,0� ,,, i- / Service to 200a �, " - vN $0.00 I 0 .,�I:"c. -Mise.Conduit ,$0.00,,;',,,,,0 � _- Service to 1000a .. \�.^ '$0.00 0 • Misc.Conductor- :$0.00'p, 0 Service over 1000a . $0.00 0 - Circus(gen or ride) - $0.00', 0 '' ,'Motors to 1hp' $0 .00. 1;3. --'• 0 -Circus'(mech•rideorlights)-"_.. y$0.00 0 - � . , _- , Motors to 10hp ' , $0.00-,,� 0 - .Christmas Tree Stand - -.,50:00/ 0 Motors to 50hp "\ $0.00 0 '- '/ Fireworks Stand 52„---710,00., /' 0 i, • Motors to 100hp , - Av ` "_- $6.00 '0.-,--- ° Other Electrical Fee i $0.00 '� ' Motors over 100hp,'-`,�N ,$0:00.1'..... -0_=� �,��� J') ' , _ -� .-- VA'" `/ '// Communication dropsy -' $000 , ; 0 - - �. Investigation Fee". - $0.00"- /' Sub panel to 200a $0.00- / , 0- - --_ Plan Check Fee ` Pole Light PkC-.$0.00\--- 9 g '•;i OJ � Reinspection Fee" . - $O,OOi '�/ Sign Circuits ''$0.00, - 0-'' . , ' - ` - - -,'. ;= �/ Temp Pwr Pole "$0.00 0- --'/TOTAL CALCULATED FEES -529.00' Intermed Pole $0.00 , -;0- 'COMMENTS/SPECIAL CONDITIONS . . - . i . 7 / •/ r • NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements undepr California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) ! j EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/C0) 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 Coda,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 if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,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 DOLLARE($100,000),IN ADDmON TO THE MST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.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). Lenders Name: • Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 1 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 penally 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 �9old 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.). ' (g )I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt r sec. Business and Professions Code for this reason: �Signeture: cDeter 2oo7 Owner ID ver by drivers license. vs 0 No Dri�s'Ucense No. / Cfe5f31 Expires: 07/O1( Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: • 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aggermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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•t Of a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all stateJAws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for i pecGei'i urposes.I agree not to occupy or allow occupancy of any building authorized by this permit un 1 final inspection. {'flc ►S 700 gn eOfLegal Owner(d) Date And/Or:Authorized Applicant \Date PORE # INSPECTION TYPE DATE ILLS P00FI INSPECTION TYPE PATE ' =ALA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Fool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 'eg V 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 • ir8 9 CITY OF COSTA MESA 4 BUILDING DIVISION F 4, IPA/, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER � PERMIT ii "tbq a o4" 6-00329 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2550 ELDEN AV Status: ISSUED Suite No Applied: 04/18/2006 Vicinity: UNIT B Issued: 04/18/2006 Parcel Nunmber: 43916111 Applicant: SILER, HUGH Address: 245 MESA DRIVE ISSUED BY: Phone: 949-646-6966 COSTA MESA,CA Zip 92627 Owner: AGNES ENTS LLC- Address 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: ' License:000000 SCOPE OF PERMIT REMODEL APT UNIT"B".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E) STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHER. , REF#:B06-00571 WORK TO INCLUDE: 1 LIGHT FIXTS AND 1 EL WIRING FOR DISHWASHER. 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 Res.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 $8.80 8 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 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 . $0.00 0 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 1 hp $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 $32.30 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,o abandoned bandoned 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 applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/001 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(T-is/section need not be completed it the permit is valued at one hundred dollars($100)or less.) IMC—fceNfyithet-id 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' (/co'mpensation 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 prove i ns. ,1 p (Applicant Signature: 9 route:""---cf E,/2006 WARNING:FAILURE TO SECURE ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIM ENALTIES AND OVIL FlNES uP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37050F 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: 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).): Ib . 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. --3-7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors LIcense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am ex ptrer sec. Business and Professions Code for this reason: Signature: Date k�-aq/zb Ownar.IDve d by drivers license. Yes 0 No Drivers License•No:= 7 N9865 3 Expires: 972&'0- Verification of Ownership by(type of d ment,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFE 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,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes El 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 roquire for the work which Is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 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 Califomia Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described propk;. or' ction purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 9-Igrit, t�O'L-eget Owrier(s)� Date And/Or Authorized Applicant Date ----i CODE 0 INSPECTION TYPE ME INTITIAL$ CODER INSPECTION TYPE PAH IO15 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 • .;;Silt! CITY OF COSTA MESA /tQ BUILDING DIVISION Y• .,I . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER teIte !� PERMIT • ` a'"PK.r P06-00277 Ratio (714)754-5273 • Fax(714)754-4856 • www.ci.costa•mesa ILMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV - Status: ISSUED Suite No Applied: 04/18/2006 Issued: 04/18/2006 Vicinity: UNIT G Parcel Nunmber: 43916111 Applicant: SILER, HUGH ISSUED BY: l Address: 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA;CA -- Zip: 92627 Owner AGNES ENTS LLC - . Address 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA- - Zip: 92627 • Contractor:'. OWNER-BUILDER Address: 0 i.,, , Phone: - • . Zip: - . . _ : --License: 000000 • SCOPE OF PERMIT - - REMODEL APTUNIT"G".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE'A PORTION OF(E) ,STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN ,r.' BATHROOM,KITCHEN-AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW . DISHWASHER. ��� - REF#:B06-00576 . • '• WORK TO INCLUDE: 1 BATHTUB,1-DISHWASHER AND 1 SHOWER'. FEE SUMMARY AMT QTY . AMT QTY AMT QTY ISSUE FEE - $23.50Laundry Tub/Washer $0.00. 0 Sump Pump $0.00 0 Backflow irrigation ,. .$0.00 0, " Landscape Irrigation , $0.00` .0 Swimming Pool $0.00 0 Backflow Prevente'r .\ $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub,' , '",$9.80 1 Pressure Regulator :,- . $0.00 0 Urinal $0.00 0 Clarifier System - $0.00 0 Process Piping.(per 10 ft) .,$0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Conned(Ice,Soda,etc) $0.00 . 0 Receptors $0.00 ..- 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00. 0 Septic Tank $0.00 "0 Wash Basin $0.00 0 Dishwasher. ' $9.80�.'' 1 1.-„,---' Sewer Cap for Demo $0.00 0-.1:. _ Wash- Basin Set' $0.00 0 Drain,Floor `�`\ $0:00 '--"C: Sewer Conned- $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater ' '$0.00 0;?" 'Sewer Private Line _ " $0.00 0 - Water Closet(Toilet) $0.00 0 • Drain,Roof ' : '' $0.00',.2 0 '--..:'-,-;c:`,.:--,‘„-,Shower ' $9.80 1 _- :Water Heater/vent $0.00 0 Drinking Fountain ' - $0.00 , 0>„ ,\ :-Sink,bar $0.00 0 . Water Piping(Inst or Rep.), $0.00 0 Expansion Tank `'' `$0.00' ' 0',- ' 'Sink,commercial: $0.00 ' 0 -' "Water.Re-pipe $0.00 0 Gas Earthquake Valve '. WOO ' 0,- - , Sink,Floor - $0.00 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 L 0 OTHER $0.00 Gas Repipe $0.00'", 0 ,...t Spa(private) $0.00 - 0 .' -VIOLATION $0.00 Gas Service $0.00 0 - - Spa(public)-%- $0.00 - 0 - "'PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 -- , - - . -- TOTAL CALCULATED FEES: $52.90 RAMMGNTC I CDCRIAI rmmnITIANC 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. • de 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 expirati®of this permit. FOR INSPECTIONS CALL: (714)754-5626 . 2446-46(6/00) - DECLARATIONS WORKERS'COMPENSATION DECLARATION: - - ' I hereby affirm under penalty-of perjury one of the following declarations: ❑ I have and*111'niaintain 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 • I ❑ 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: Carder. Policy Number: • (This section need not be completed it the permit is valued et one hundred dollars($100)or less.) • ❑' I certify-thatin.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' . omp.censation 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 proy n Applicant Signatureri .oe K—I-k-Ob w�.aom ROO $WARNING:'FAILUREURE TO SECU WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($I00,0c0),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.4 Class 4 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: 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 end 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 ssuubj�5cts the applicant to a civil penalty of not more than five hundred dollars($500).): Cd':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. 1 .1:-L--7040usiness and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt y�ndj sec. Business and Professions Code for this reason: Signature:"`..)O l� Dafe:: �(�,-� cg.tae p/^Oo-7 Owner'ID verified driver's license. Yes 0 No Driv`efs"L'ii:ense•No.l046.C70.7 7 ExpireSaq- O(c Verification of Ownership by(type of doc ent,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,Califomia Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: - Division of Industrial Safety Permit Number: • HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomla 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 nt of of the Californiaby Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or,modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes L-I 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 Califomla Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). • CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for ingection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until fine inspection. N-1e-Ub g- ?maw:.tu•re,Ol.Legal.Owner(s). Date And/Or Authorized Applicant Date CODE r INSPECTION TYPE PATE INTIALE' - CVO INSPECTION TYPE PAIS I Its • 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 ,r 220 Final Planning Approval 203 Final Sign 222' - Final Site ' 204 ' Final Demolition - - 250 Final Building/Occupancy , ' CITY OF COSTA MESA _ etty • BUILDING DIVISION >:i' ",, DEVELOPMENT SERVICES DEPARTMENT • PERMIT NUMBER ti. % PERMIT P to E06-00334 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaseas TRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 EL Job Address: 2550 ELDEN AV t • Status: ISSUED Suite No Applied: 04/18/2006 Vicinity: UNIT G • Issued: 04/18/2006 Parcel Nunmber: 43916111 Applicant: SILER, HUGH • Address: 245 MESA DRIVE ISSUED BY: ‘` ':).-F0 Phone: 949-646-6966 COSTA MESA,.CA , ' Zip 92627 , Owner AGNES ENTS LLC Address 245 MESA DRIVE Phone: 949-646-6966 ' . COSTA MESA,CA .- • Zip: 92627 . • Contractor.' OWNER-BUILDER ' Address: ' C' - „L; Phone: Zip: • • - - • License:000000 `.'`- - SCOPE SCOPE OF PERMIT , REMODEL•APT UNIT"G".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE APORTION OF(E) STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN ' BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW ' •- DISHWASHER. - - 7 REF#:B06-00576 _., _. , - . . - " WORK TO INCLUDE: 1 LIGHT FIXTS AND 1 EL WIRING FOR DISHWASHER. -/ - 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 . Res.a/c package $0.00 Standing Section $0.00 0 New Res,(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 6'. New Res(3+units) , $0.00 0 - , ' `Transformers up to 1 kva/kw $0.00 0 Pool/Spa - ` ' $0.00 i 0 .'' •. - up to 10 kva/kw $0.00 , ' 0 Lighting Fixts, - '-','$8.80 8 ' up to 50 kva/kw $0.00 - 0 Recept Outlets. -` ' y$0.00 l 0 „;� _ - up to 100 kva/kw - $0.00' 0 Switches - ,•. $0;00y,1-Th'0'�'' - over 100 kva/kwT'",r` ..$0.00 0 _ Non Res Appl. -7. .-$0.00',,..,;k1;47.'01 - " 0�" ,. " _ " ".Low Voltage Equipment „$0.00, , 0 ` Res Appl - i $0.00 ,...:-.,...;,.>,,,,O, ' Low Volt Wiring System/Ckt-, , $0.00 ' 0 Service to 200a ' $0 00..E � � . • Misc.'Conduit - ' $0.00 ;'/0 Service to 100044 - • - "$0.00 = -"--6::::-:.°-- �- - Misc.Conductor . $0.00 0, . Service over 100044 ' l, $0.00 ' �' 0 - -- .Circus(gen or ride) .' $0.00 ' 0 " Motors to 1 hp '� $0.00'(; 0'-, Circus(mech ride or lights) :$0.00 •0 Motors to 10hp _$0.00 ' ')70' r 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 $32.30 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 commenceb 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 -- - • 244648(6/00) 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 pertormance of the work for which this permit is issued. ❑ I have and 'willc m compensation i o ncompensation carrier insurance,as required retl by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'wmpensation Insurance carrier and policy number are: Carrier: Policy Number: ' (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) . .�•al 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' tgcompensatiori laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shell forthwith comply with these p visio s. /� Applicant Signature: ('ibateGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER'Li—Ig^(/, • TTHOUSANDylARNNG7FDOLLARE$500,000),IN ADDITION TO THE COST EC E WORKERS' DOF COMN PENSATION DAMAGESA PROVDED FOR IN SECTION 3706 OF THEN LABOR CODAL IE,INTEREST,AND ATTORNEY'S FEES.HUNDREDES AND CIVIL FINES UP TO ONE 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# 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 Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects theapplicant to a civil penalty of not more than five hundred dollars($500).): Ol,-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. V' '-7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exe u der sec. Business and Professions Code for this reason: 'Miner ate: —u-=a" -- E Owner ID venfie y driver's license. Yes 0 No Driver's Ucense No �`-"--' ' Expires:_ q'`�"o Verification of Ownership by(type of da ant,i.e.-property tax bill or deed): (, ,. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicantor present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No • 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). I, 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 I e (If'yes",attach certificate of compliance from the appropriate air pollution control officer). I 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. i Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspectirposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sims Legal Owner(s) ••' - - - u-tg-D6 Date---- And/Or Authorized Applicant Date I CODE# INSPECTIONTYPE OATS INTITIALS ME t INSPECTION TYPE OH : INTTALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing. .f 200 Final Re-Roof - • 210 Final Electrical S/od9/D/ i�' 201 Final Block/Retaining Wall - • 212 ' Final Fire Prevention P 202 ' Final Factory Fire Place 220 ' Final Planning Approval 203 Final Sign _ 222 Final Site 204 Final Demolition 250 ,Final Building/Occupancy , 44.9p5in MF CITY OF COSTA MESA , a. BUILDING DIVISION F•4 �,. r. ,I• DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT J 0111141 41%PoRarso.9 : P06-00276 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT . Job Address: 2550 ELDEN AV Status: ISSUED Suite No Applied: 04/18/2006 Issued: 04/18/2006 Vicinity: UNIT F Parcel Nunmber: 43916111 //�,'',((\� Applicant: SILER, HUGH ISSUED BY: /SGJI ) Address: 245 MESA DRIVE ''"" VV Phone: 949-646-6966 COSTA MESA,CA Zip: 92627 Owner RYAN, GERALD R TR Address 3902 RIVER AVE . Phone: ' NEWPORT BEACH,CA ' • Zip: 92663 Contractor: OWNER-BUILDER Address: . Phone: Zip: License: 000000 SCOPE OF PERMIT REMODEL APT UNIT"F".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E) STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHER. REF#:806-00575 - WORK TO INCLUDE: 1 BATHTUB, 1 DISHWASHER AND 1 SHOWER. FEE SUMMARY • AMT QTY - - - '"'"- 'AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 1 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors . $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00- . 0 Sewer Connect $0.00 -0 - Waste and Vent System $0.00 0 Drain,Rainwater $0.00\ .\0 1 v" Sewer Private Line $0.00 0 - Water Closet(Toilet) $0.00 0 Drain,Roof ,$0.00 ' .0,- - Shower . . . $9.80 1 Water Heater/vent $0.00 0 Drinking Fountain $0.00, , 0--;-�,- .. -Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.0 - - 0 "Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0. Water Service $0.00 0 Gas(1-4 outlets) $0.00 . 0 - Sink,kitchen $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) $0.00 - 0 - REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $52.90 r`nMMCIJTC /CDCrYAI rnMnITInIJC 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 andoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) ' DECLARATIONS' WORKERS'COMPENSATION DECLARATION: - 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 carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) jr 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 Taws 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 Gcomply withithese provpS Applicant.Signeture:--P �ion �G ` IOtx Date: 'I/tub WARNING:FAILURE TO SECU WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706OF 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 Si 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). Lenders 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).): j2K_l,.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. C .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.). o I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am ex pt u er sec. Business and Professions Code for this reason: Signature: Date: LI'}t-a -OwnerlD vedby drivers license. es ❑No �Ddvers License No. Pig tg..ri&3' .-. Expires:_lRttCN' Verification of Ownership by(type of docu ant,i.e.-property tax bill or deed): 1---_______27 DIVISION OF INDUSTRIAL SAFETY P RMIT CERTIFICATION: , ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). o As owner-builder. I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). I 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 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 aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes u No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑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 II application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No ' 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: I CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for insp ion purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. i Sig tmeOftegal'Owner(s} cDat1= J And/Or Authorized Applicant Date • CODE 0 INSPECTIONTYPE PATE INTITIALS COOS INSPECTIONTYPE PATE MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical / _ , 1266 Pool Spa Final 208 Final Plumbing 8 a 4 07 E 200 Final Re-Roof 210 Final Electrical �P 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 4`, a ssit) CITY OF COSTA MESA BUILDING DIVISION F y r. ', DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT *hb,,e 06' E06-00333 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2550 ELDEN AV Status: ISSUED Suite No Applied: 04/18/2006 Vicinity: UNIT F Issued: 04/18/2006 Parcel Nunmber: 43916111 Applicant: MHUGH 245 Address: 245 MESA DRIVE ISSUED BY: Phone: 949-646-6966 COSTA MESA,CA Zip 92627 Owner AGNES ENTS LLC Address 245 MESA DRIVE Phone: 949-656-6966 COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: , Phone: Zip: License:000000 • SCOPE OF PERMIT REMODEL APT UNIT"F".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E) STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHER. REF#:B06-00575 WORK TO INCLUDE: 1 LIGHT FIXTS AND 1 EL WIRING FOR DISHWASHER. 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 Res.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 • $8.80 8 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 • up to 100 kva/kw $0.00 0 Switches $0.00 0 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 . $0.00 0 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 1 hp $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 $32.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS' WORKERS'COMPENSATION DECLARATION: 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 if the permit is valued at one hundred dollars($100)or less.) .�- 1 certify,that in the pertormance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' L....-compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p sigp$. / Applicant Signature:— _yY `Dte:-"'--4 -a-D� WARNINGcFAICURE TO SE E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,OD0),IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 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.Lie.# 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 tile a signed statement that he or she Is licensed pursuant to the provisions of the Contractors Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): '11r I,as`owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. ---7044,Business and Professions Code:The Contractors Ucense Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exam" un sec. Business and Professions Code for this reason: • Signature:__nL i /Date:—H=Br-O(, IOwner4Dvenfi*by. vers license. Yes 0 No Driverskitense No�"-uL1�C�$ Verification of Ownership by(type of docu ant,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY P MR CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes O 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? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 II an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant Or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification SU from the South Coast Air Duality Management District or from any other air pollution control district or agency? U Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑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 Califomia Health and Safety Code Section 42303 been made? ❑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 COMPUANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for'n$=ctciPnpurposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. (Fb W-1K-0 S natu Ol.Legal.Owner(s) LDate And/Or Authorized Applicant Date CODE I. INaEEQTIONTYPE pAI€ INTITIALS CODES INSPECTION TYPE, DALE, ItIML5 1616 Fixed System Final Fire Prevention 206 Final Mechanical C�L/J�w�/ 1266 Pool Spa Final 208 Final Plumbing �� v 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 4`041p 4Ft CITY OF COSTA MESA BUILDING DIVISION F• "iI' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER O PERMIT 4. IPA' er.o , ' E06-00332 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2550 ELDEN AV Status: ISSUED Suite No Applied: 04/18/2006 Vicinity: UNITi G Issued: 04/18/2006 Parcel Nunmber: 43916111 Applicant: SILER, HUGH Address: 245 MESA DRIVE ISSUED BY: Phone: 949-646-6966 COSTA MESA,CA Zip 92627 Owner: AGNES ENTS LLC- Address 245 MESA DRIVE , Phone: 949-646-6966 COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: , License:000000 .. SCOPE OF PERMIT ' REMODEL APT UNIT"E".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E) ' STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHER. REF#:B06-00574 WORK TO INCLUDE: 1 LIGHT FIXTS AND 1 EL WIRING FOR DISHWASHER. 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 Res.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 Fills $8.80 8 - - up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 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 / -" $0.00 0 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 1hp $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 $32.30 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 i�suspended abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS' 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 carrier and policy number are: Carrier: Policy Number: (This section section need not tie completed if the permit is valued at one hundred dollars($100)or less.) `wr I certify 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 it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply.with these.prowon . ApplicantSignature: � DL ate: , _N-����� WARNING:FAILURE TO SECUR ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,800), N ADDITION TO THE()GAT OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I 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# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: o I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: 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).): 'Ern,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. ------‘7044:Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does:such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). . ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exeIpnder sec. Business and Professions Code for this reason: Signature:_ Datei- -_it Q 6 Owner.ID,ve led by driver's license. Yes 0 No Driver's.Dcense No., O Q b 5837---- [-Explres:—a-06--09 Verification of Ownership by(type of doc ent,i.e.-property tax bill or deed):1------.-----"'''•-" L DIVISION OF INDUSTRIAL SAFETY P RMIT CERTIFICATION: ' El I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication 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 0 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 ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). ' CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with II 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 i ej h purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ne Of'Legal Owner(s)_ Oater.,- And/Or Authorized Applicant Date • • coot# REFECTION TYPE DATE IMmkLS CODE Y INSPECTION TYPE PATE JNMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ' 200 Final Re-Roof 210 Final Electrical 71a4I07 201 Final BIock/Retaining Wall 212 Final Fire Prevention ld 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition _ 250 Final Building/Occupancy pSTp MF 9 CITY OF COSTA MESA 4 BUILDING DIVISION > y�,,. ,r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER Fr 111P14 PERMIT *fes�. P06-00275 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2550 ELDEN AV Status: ISSUED Suite No Applied: 04/18/2006 Issued: 04/18/2006 Vicinity: UNITE a Parcel Nunmber: 43916111 Applicant: SILER, HUGH ISSUED BY: Address: 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA Zip: 92627 Owner AGNES ENTS LLC Address 245 MESA DRIVE . - Phone: 949-646-6966 COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: -, Phone: • Zip: License: 000000 • SCOPE OF PERMIT REMODEL APT UNIT"E".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E) STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN . BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHER. REF#:806-00574 WORK TO INCLUDE: 1 BATHTUB, 1 DISHWASHER AND 1 SHOWER. FEE SUMMARY AMT QTY AMT QTY - AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer • $0.00 0 - P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 1 Pressure Regulator $0.00 0 Urinal - $0.00 0 Clarifier System '. $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors ` $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank ' $0.00 0 Wash Basin $0.00 0 Dishwasher $9.80 1 Sewef Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 -0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00• 0 ! - ' Sewer Private Line $0.00 0 ` ' - Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 ' 0 - Shower - $9.80 1 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 . ._ "Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0-' Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) .$0.00 0 Sink,kitchen $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) $0.00 - 0 _ - REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 • TOTAL CALCULATED FEES: $52.90 flf1MMCWTC /Corrifi RflMniTinIJC • 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,_ru twoIiC s suspended or abandoned far a period of 180 days. v' INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS, WORKERS'COMPENSATION DECLARATION: • 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 0 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 tion need not be completed it the permit is valued at one hundred dollars($100)or less.) Ldeitify 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' ( y 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 pr v"ori 'I � App Signature:— Dat 'T.� WARNING:FAILURE TO SECUR ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED 'THOUSAND DOLLARE($100.000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF 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# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). • Lender's Name: 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 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(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 DOn 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.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exem9tt un r sec. Business and Professions Code for this reason: Signature: r-Date:---14.'I6-0 b Ow'ner.ID.venfi by drivers license. Yes 0 No DTivers'License'No.--fig85637` L '"Ezjiires: 126 {)C Verification of Ownership by(type of doo merit,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,Scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health end Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare 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? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the wcrk 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? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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. I Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for i pea urposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Ign cure OfLegal Owner(s)> Dete`- And/Or Authorized Applicant Date CODE INSPECTION TYPF DATE INTRIAL$ CODE II INSPECTION TYPE PSE INTIALS 1616 FixedlSystem Final Fire Prevention 206 Final Mechanicalmbi5 1266 Pool Spa Final 208 Final Plumbing Uf a9/Ory 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 '0"Mt CITY OF COSTA MESA 4` BUILDING DIVISION • ). • «' 1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER b. r / PERMIT J% 0 E06-00330 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2550 ELDEN AV Status: ISSUED Suite No • Applied: 04/18/2006 Vicinity: UNITC Issued: 04/18/2006 Parcel Nunmber: 43916111 Applicant: SILER, HUGH Address: 245 MESA DRIVE ISSUED BY: 1p Phone: 949-646-6966 COSTA MESA,CAII^ ��`� • Zip 92627 - Owner: 4/.` �?-.6/11:1)- Address C41 ('U O/, /; 11 �l`/� 6f /�,__.I-� y J� /,� Phone0L(G}I�./to-Ile-(Pi"th Ll.-1-61/ -=i' _�1-` Zip: 0124:p/i7 Contractor: OWNER-BUILDER Address: , Phone: / Zip: ' License:000000 SCOPE OF PERMIT -REMODEL APT UNIT"C".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E) STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHER. , • REF#:B06-00572 WORK TO INCLUDE:1 LIGHT FIXTS AND 1 EL WIRING FOR DISHWASHER. 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 Res.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 $8.80 8 - up to 50 kva/kw $0.00 0 Recept Outlets ,$0.00 0 . - up to 100 kva/kw $0.00 0 Switches $0.00 0 • 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 . $0.00' 0 . Misc.Conduit $0.00 0 Service to 1000a . $0.00 ','v 0 Misc.Conductor $0.00 0 Service over 1000a / $0.00 0`. , - Circus(gen or ride) . $0.00 0 Motors to 1hp $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 $32.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§ 1, 12-21-92) �„- EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned* for a period of 180 days. /' INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754.5626 2446-46(6/00) DECLARATIONS' WORKERS'COMPENSATION DECLARATION: - - -- 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 perfomiance 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 end policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ertify.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 it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith P°o"r-'comply with these.provi i s. ``II ffA�pplicant Signature:•- -- 0 Date:—...'1_18-Ob Ld4 RN yi.:,___ THOUS GI FAILURE TE f SECURE DDITIO COMPENSATIONTCOSCOMPENSATION, IS UN,DWFULAMAG AND SHALLSUBJECTFOR I N EMPLSECTION TO FTHE LABOR CODE,INTEREST, CIVIL AND UP ONEHUNDRED. THOUSAND DOLLARE($100,0001,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3/06OF THE LABOR CODE, 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# 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 subj ats the applicant to a civil penalty of not more than five hundred dollars($500).): Cg.:-.Inas owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt der c. _ Business and Professions Code for this reason: ..--- Sig`nature: ElIN ��77 1."''`'oate: 4— 10-06Owner ID verified river's license. Yes No Driver's License No. A O(py 8.i8.3] EEzpires:-tJ_Z6r0t Verification of Ownership by(type of do menti.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFE PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). , ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: • HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 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 en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No , 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aPPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No • (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by 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. I Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for in ti�urposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. y-1g'a6 Si atur Of Legal Owrier(s) •Date And/Or Authorized Applicant Date CODE INSPECTION TYPE DATE INTITIALS CODE 1 INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing /►� 200 Final Re-Roof 210 Final Electrical i Py/ % 6/: 201 Final Block/Retaining Wall 212 Final Fire Prevention Pt 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 4` 9 CITY OF COSTA MESA Yom'_ _''�l BUILDING DIVISION 3 H •cn,� ,�I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT wog`' E06-00331 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2550 ELDEN AV Status: ISSUED Suite No Applied: 04/18/2006 Vicinity: UNI Issued: 04/18/2006 Parcel Nunmber: 43916111 Applicant: SILER, HUGH /1 Address: 245 MESA DRIVE ISSUED BY: 1 Phone: 949-646-6966 COSTA MESA,CA Zip 92627 Owner: eipA,rn1-fjy_tn F jt( 3 - Address p:(- . Ms"stQ/ Phone: C1L{4)(ecib ,Ali( ,� a3it.-tilt _(IPS- Zip: iZ1e27 Contractor: OWNER-BUILDER Address: Phone: • Zip: License:000000 SCOPEOF PERMIT ' - - -REMODEL APT UNIT"D".WORK TO INCLUDE: NEW FRAMING TO ENCLOSE A PORTION OF(E) ' STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHER. REF#:B06-00573 WORK TO INCLUDE:-1 LIGHT FIXTS AND 1 EL WIRING FOR DISHWASHER. ' 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 Res.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 $8.80 8 , - up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 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 _ $0.00 .- - 0 _ _ Misc.Conduit - ,$0.00 0 , Service to 1000a -% 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, • Ilhave'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. ',I I`w Myzw rkkers'compensation Insurance carrier and policy number are: , AGerrjge Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) • I certify that in the performance of the work for which this permit is issued,I shall not employ any 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 pro i 'ons Q� j�� Applicangtj�IgraturJl ecir .. —1^l(1 _(/� • WARNING:FAILURE TO SECUR ORKEAS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. I 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.Llc.# Class# 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 subje tot�applicant to a civil penalty et not more than five hundred dollars($500).): -as owner of the property,or my employees with wages as their sole compensation.WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt mil'se Business and Professions Code for this reason: Signetgre: q.oate:--K—W—•Ob x,t�-,_ a. pp Owner ID verdled by er's license. es 0 No (-rive:____rise No O .S3 7 Expire—c' -Og Verification of Ownership by(type of docu nt,i.e.-property tax bill or deed)a�= �_'" DIVISION OF INDUSTRIAL SAFETY P RMIT 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). I ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 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 De constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No I (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). , 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No • 8 (If"yes",attach certificate of Compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for i eeU purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final /�iinnspection. 14-1gI gnature Ot Legal.Owner(s) Date' " I Com,—__—_-'�`�. --'--- -.:st AndiOr Authorized Applicant Date CODE* INSPECTIONTYPE PEE INTRIALS CODE* INSPECTION TYPE PAIS WEALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical $k 9/i07 201 Final Block/Retaining Wall 212 Final Fire Prevention PP 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site ' 204 Final Demolition 250 Final Building/Occupancy 4`p09 Atte, CITY OF COSTA MESA BUILDING DIVISION F • r,,' ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER • PERMIT 0. 11110411 4ro� P06-00274 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mes PLUMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite No Applied: 04/18/2006 Issued: 04/18/2006 Vicinity: UNIT /� Parcel Nunmber: 43916111 J Applicant: SILER, HUGH ISSUED BY: Address: 245 MESA DRIVE - Phone:' 949-646-6966 COSTA MESA,CA Zip: 92627 • Owner AGNES ENTS LLC Address 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA - " " . Zip: 92627 Contractor OWNER-BUILDER Address: . Phone: Zip: License: 000000 SCOPE OF PERMIT REMODEL APT UNIT"D".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E) STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHER. , REF#:B06-00573 WORK TO INCLUDE: 1 BATHTUB, 1 DISHWASHER AND 1 SHOWER. ' FEE SUMMARY AMT QTY - -'-" _ --- -- ' - AMT QTY - AMT QTY ISSUE FEE $23.50 ; Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 " 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 1 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors - • : • $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $9.80 1 Sewer-0ap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 ' 0 Sewer Connect $0.00 "0 Waste and Vent System $0.00 0 Drain,Rainwater. $0.00 ,0 ,- ` '.' Sewer Private Line $0.00 0 - " Water Closet(Toilet) $0.00 0 Drain,Roof ,$0.00 ' 0; . Shower $9.80 1 Water Heater/vent $0.00 0 Drinking Fountain / $0.00 0 . 'Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank .$0.00 ', 0 "Sink,commercial , $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve- , $0.00 - 0- Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) ,$0.00 0 Sink,kitchen $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 ''$0.000 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 " ' 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 - 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $52.90 rf1MMCMTC I CDPI`IAt f:f\MfITIf1MC 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 fora period of 180 days. r; INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) . DECLARATIONS' WORKERS'COMPENSATION DECLARATION: 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: I Carrier: Policy Number - (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) WI 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' \.....r 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 j comply with these pro Ins �y Applica€t-Signatur_ C�tj9�p�p /Y' l �Dete: 4c IO WARNINO:`FAILURE TO SECURyY'/ORNeRS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOUARE($1x,x0).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# 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($500).): J12 C1,asownerof the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044'B6siness and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exepjI^nEqp/t_�ugdyr sec. Business and Professions Code for this reason: Signature:—itetlatq;. H=C$:rDb OWner'lDveri b river's license. Yes 0 No DriversLlcense-No.,— MI A'6337 Expires:_ (1-7Z& 03' Verification of Ownership by(type of do ment,i.e.-property tax bill or deed): 1 ""' 4 DIVISION OF INDUSTRIAL SAFETY ERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No ' 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? J 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? ❑Yes ❑No ' (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described propert r ins purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. lA �l—ik O6 flabOf.LegehOwner(s)� Date e And/Or Authorized Applicant Date CODE II INSPECTION TYPE PATE INTIAI S CODE INSPECTION TYPE DRE INTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical , 1266 Pool Spa Final 208 Final Plumbing 2?./&9/0 f 4- mc-r- 200 Final Re-Roof 210 Final Electrical G 201 Final BtocklRetaining 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 y` fl 44. CITY OF COSTA MESA Ilea BUILDING DIVISION w,,,,,,- ,�: DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER 1. 1 I prep!'•� . PERMIT +f roRmso 6" 06-00273 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us aUMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 PJob Address: 2550 ELDEN AV Status: ISSUED Suite No Applied: 04/18/2006 Issued: 04/18/2006 Vicinity: UNITC Parcel Nunmber: 43916111 Applicant: SILER, HUGH ISSUED BY: Address: 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA Zip: 92627 Owner: O, ywLS - • fnn s - Address ?�5 rn ' /�` ,r,^^ Phone: i((-{�l�tig-t`(' {067 ' iyt(7✓ 171.z6Jl�r�t't= Zip: Ojitoi7 Contractor: OWNER-BUILDER • Address: Phone: Zip: License: 000000 - SCOPE OF PERMIT REMODEL APT UNIT"C".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E) STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHER. REF#:806-0057 WORK TO INCLUDE: 1 BATHTUB, 1 DISHWASHER AND 1 SHOWER. FEE SUMMARY • AMT QTY -- -` - "---"- - AMT QTY - AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 • 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 1 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors _ $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank • $0.00 0 Wash Basin $0.00 0 Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0Sewer Sewer Connect $0.00 -0 Waste and Vent System , $0.00 0 Drain,Rainwater. $0.00 . . 0 ,' ' ' -.• Sewer Private Line $0.00 0• Water Closet(Toilet) $0.00 0 Drain,Roof ,$0.00 ,0, ' Shower $9.80 1 Water Heater/vent . $0.00 0 Drinking Fountain , $0.00 0, " Sink,bar $0.00 0 • Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 ', 0 - Sink,commercial , $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 .Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $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) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $52.90 (tf1MMCMTC /CDFrIAI lflMrlITlflPJC /--- • 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 s sL pend or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS, - WORKERS'COMPENSATION DECLARATION: 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 if the permit is valued at one hundred dollars($100)or less.) AK-certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' C. r compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith i ly_wlthh h se pro ail 1App LSignature: Oatl e;_ �1'1 . WARNING:FAILURE TO SE E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MD CML FINES UP TO ONE HUNDRED THOUSAND DOUARE($I00,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,MD 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.a Class d 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 city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant toe civil penalty of not more than five hundred dollars($500).): pAI,as,owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If.however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors Ucense Laws.). ❑ I am exempt,t�j ide ec. Business and Professions Code for this reason: Signature:— ._Dy r0"ate:_ 4�lA-ob 6 OwnerlD'varilied drivers license. Yes 0 No Drivers License.No."' Not BgSR37—� Expires:—Ci---"Vre? Verification of Ownership by(type of docu ant,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ' ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required.has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 apgermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California 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 California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enterupon the above-described prp y lgvgspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit C, final inspection. net Legal Owner(s)",':,. Datet And/Or Authorized Applicant Date CODE I INSPECTION TYPE PAIS REALS CODE. INSPECTION TYPE. PAIS fNTTTIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 37-2,1-06 Cr 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 yTp M CITY OF COSTA MESA aepee BUILDING DIVISION F �,,,•METEMi;",i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT E06-01485 ttboRDRatiost (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaEl€CTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite No A Applied: 12/15/2006 Vicinity: • Issued: 12/15/2006 Parcel Nunmber: 43916111 Applicant: SILER, HUGH • Address: 1835 NEWPORT BLVD UNIT A109-174 _ .. - Phone:-949-244-2880 - . ISSUEQ BY: COSTA MESA,CA „„-----,,;(-,,,/61-2::--•Zip`__ 92627 - - -. lr Owner AGNES ENTS LLC ---\ \ \ /- - ,�,A, • ,. <, Address 245ME/SA'DRIVE \ i' 1 k- ` - i✓7( `\� \ K Phon_e:" 949-646-6966-----:••:-.J.. e f` . COSTA MESA,.CA 1 �'�� Zip: 92626 �1111. �A • x Va /r ct W Contractor: ONER-BUILDER ontiect ss: ; • r// / Addre ;,/It//,1 0 //<// Phone:" � ' • ' '/ 7. i /' ,i Zip: • /!C / , License:000000, ,. • l '- f�''l/ ( ' /f. - ° i SCOPE OF PERMIT % - - :".ELECTRICAL PERMIT TO ADD 342SF,A 42SF FRONT ENTRY PORCH,A"42SF REAR PATIO AND ;0, ,•/UqN ERIORREMOD L. � ' - • 1 \ , j�1 /: /I,,REF#:B06-01928 , •` _ j . • I ' /.': _WORK TO INCLUDE:1 RES'A/C,PACKAGE,35:LIGHT,FIXTURES,:4-2 OUTLETS,47 SWITCHES,4 „ � SMOKE DETECTORS,5CEILING FANS 1•SERVICE,TO 200AE.1,SUB PANEL TO 200A. �` A FEE SUMMARY;i h • r : rQuill . ..�,.- / r�. -`�:- -• / / 5' _ Quantity _ . . 'ISSUE FEE ,• $23.50 - - - - i- Temp Dist System'I Lighting-'' $0.00 0 - cTempservice.test' C $0.00 --- • - " Busway/1008;',/ .. ---), $0.00 0 ),, , ' , ` Res.a/c package �, $54.50 Standing;Section $0.00 0,',. , New Res(1-2 units) 1,v' $0.00 J 0 Misc Electrical Equipment - $0.00 0.-/,'' ' -, • New Res(3+units) ,•\I . $0.00 , 0 Transformers up to 1 kva/kw Pool/Spa ' • y,`• $0.00 0 up to 10 kva/kw $0.00 0' - -. Lighting Fixts-� �, - $105.95 I 135 -1- =. up to 50 kva/kw Recept Outlets...i' \ -4. 38.06 42 ,.t�F ,'�', up to 100 kva/kw -$0.00,,�; 0 �'-� ' SwitchestV-�� N \�$18 70 17 .rw / over 100 kva/kw $0 00:// 0 Non Res Appl r- ( $0.00 0 _"N'-, .Low Voltage Equipment $0.00 0. - Res Appl \ \ -" ,� $000`,oi5. 0sc,vy > �/\ Low Volt Wiring System/Ckt 7 $0 00 0 ` - Sennce to 200a,�V ' $30 50„C' a 1 i Misc.Conduit $0.00 0 Service to 1000a; t'< 1$0.00' V 0 ' Misc.'Conductor - ' $0.00, '- 0 Service over t000a�\ '" /i i'$0.00-�'�.,�'0'���• ' -;\ Circus(gen or ride) • ."%�' $0.00 A'',0 �, Motors to 1hp - ' !$0.00), . -0,,- `. "Circus(mech.ride or lights)" $000 " 0 ' ," Motors to 10hp \.,•�.\ •$0.00 ^.� 0 ---,•:-:-__;. 1---:� " �Christmas Tree Stand $0.06 ' - 0.� Motors to 50hp c„-., $0 00 /r,0�, • - - -Fireworks Stand �, $0.007-7.,o,- Motors 0i Motors to 100hp • -'.$0.00\�1/ 0' 1 f N _ Other Electrical Fee' \ $9.90/ ' Motors over 100hp • $0.00 Lr\O, / J Jr,, l - - =, - ' ` Communication drops $0.00-x\0- -' , Investigation Fee,--., •$0.00 Sub panel to 200a $0.00-`�'- 0 � --�L, "6� - � .,,` �\Plan Check Fee- $0.00 Pole Light Pkg $0.00 -��0-'c-._ Reinspection.Fee /% �/� $0.00 Sign Circuits $0.00 0'---;' �C%_ --9�-j. Temp Pwr Pole $0.00 0 -- ---TOTAL CALCULATED FEES $281.11 Intermed Pole $0.00 0 -- 1 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes'ar nd 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 244646(600) • 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 willc maintain pnsworkers'compensation casaer a d policy u required retl 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: (Thi section need not be completed if the permit is valued at one hundred dollars($100)or less.) C 'fVfocI ceitify.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 t these pro ' ion Applicant signature: bete:. "1I L=I S'2n04 I A' WARNING:FAILURE TO SECUR ()FIXERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.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 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 Busines 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 subje 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 app '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 La .). 0 I am...exempt u er sec. Business and Professions Code for this reason: CSignature:1 --- Date:-.-12-159006 � `Owner ID vers d by driver's license. Yes 0 No Dr rsticense No. PIA tliSac7 - ExpiFar-07D D/ Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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.(Chep.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires.with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ora volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑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 California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application.have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: • CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws an city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection pu .I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sign u Of: Owner(§) Dat -— - , And/Or Authorized Applicant Date CODE r INSPECTION TYPE METE INTIMES CODE I INSPECTION TYPE DAIF ORALS 1616 Fixed System Final Fire Prevention - 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing p 200 Final Re-Roof 210 Final Electrical i[J' / i 7 i 2T.) 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 _ . 11116 - CITY OF COSTA MESA , 1l a 4 BUILDING DIVISION a 4`�a-%1 , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER - PERMIT4. P06-01051 %mows°It (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.FaL IMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite No A Applied: 12/15/2006 Issued: 12/15/2006 Vicinity: Parcel Nunmber: 43916111 Applicant SIL1835 NE HUGH ec175) Address: 1835 NEWPORT BLVD - ISSUED BY: _------1--/-:-/- Phone: 949-244-2880. UNIT A709-174 "� - COSTA MESA,.CA,-,“--1,-, , Zip: 92627 , \ Owner: AGNES ENTS LLC-- A ' 7 �_ ;A, Address 245 MESA�DRIVE\ (2_/ - . - - ( ` i \ //''/7\ \i I CI- -Phone: 949-646-6966 ,',.t.,-.. .,'-.:- / .�iCOSTA MESA,CAI%-�-- Zip: 92626 ._A' Oontraotp?: OWN�jBUI DER I. `S A3dressi� /Z•/ . . \��' , '- Ili - (yr �/ .,/,22/ Phone: , , yr i, 1r , ;o/ aZip: / V //62.-- - �� **License: 000000 ^� iii� i / Ly i -� 'U. /f' ' : - SCOPE OF PERMIT - - - , ,-\ i ov,,PLUMBING'PERMIT TO ADD 342SF,A 42SF FRONT ENTRY PORCH,A 42SFREAR PATIO AND , • , INTERIOR REMODEL, t, ' , i L' REF#:B06-01928' - - - ,- - _ - -i ,r-�---. .• ' A r;1 - r r WORK TO INCLjUDE:.t'BATHTUBS YDISHWAHSER, I GAS'(144°OUTLETS),1 LAUNDRY TUB, 1 ' s _; -. SEWER CONNECT,:1:KITCHEN:SINK,3 WASHBASINS,4-WASTE AND VENT SYST,2 WATER j, . _ - ' - i ' CLOSETS, 1 WATER HEATER, 1 WATER PIPING(INST OR REP)'AND 1 WATER SERVICE. �,' .� ,q , l 1 'FEE SUMMARY' - L - \1t�\ r AMT QTY•,---"t -_ ,_� ,,,,,t-AMT�/QTY j v / AMT' QTY ISSUE FEET .+ \.\'i, $23.50 1 Laundry Tub/Washer $980,7 1 , , Sump Pump $0.00 '0 Backflow irrigation \ \t' $0.00 0� Landscape Irrigation <$0.00/ 0 Swimming Pool ! .-$0.00 0 Backflow Preventer �' $0.00 0 P-Trap =„$0:00>70 Trap Primer .i , . . $0.00 ' 0 Bathtub', , '� -�' \A$19.60 2 Pressure Regulator $0.00 0 Urinal %'.-/ ', - $0.00, 0 Clarifier System- $0.00 01 Process Piping,(per,10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4). $0.00 0 Connect(Ice,Soda,etc) \$0.00 0, Receptors ter; $0,00 0 Vacuum Brkr Bkflow(5+) .$0.00 0 Dental Units $0.00 0 Septic Tank ' $0 00 0 Wash Basin ;$29.40 3 Dishwasher cti-) $9`lv� 1 - Sewer Cap for Demo ° $0.00'..-..",:.0 Wash Basin Set t ' $0.00 0 Drain,Floor . ./ ' $0 00'\b�`O,L-fi.." ,Sewer Connect ` $24.65 ;'1 z ' Waste and Vent System $39.20 4 Drain,Rainwater, $0 00 'OI\ Sewer P_ri'ate Line `� $0.00 '0 -Water Closet(Toilet) , ' $19.60 2 Drain,Roof \.... . /$0.00, `0 ,, :-Shower 0 / r $0.00 0 Water Heater/vent , - - $12.30 1 Drinking Fountain '/$0.00„//_,,,0'..":;,:.t•.,....,. --„Sink,\_ bar1. - $0 00 ' •0 'Water Piping(Inst or Rep.) $9.80 1 Expansion Tank \ $0.00 'N° ,Sink commercial $000 ;0 „Water Re-pipe .': _ $0.00 0 Gas Earthquake Valve'A$0.00 C 0 .,� -'1--Sink,-Floor->--- $0.00.-:=1;0--- .,(,Water Service %/' $9.80 1 Gas(1-4 outlets) $6.15`-J(Vi j-�Sink kitchen - $9 80' 1 \ \ Water Softenev' $0.00 0 Gas(Over4 outlets) ‘‘,1,.$0.00,„. 0 /.'�J !Sink,-service/mop $0,00 rO , ,'OTHER%0, $0.00 Gas Repipe $0.00O C!\ ;/Spa(private)\ -- -" ,$0:00 - .0 \ • ' VIOLATION $0.00 Gas Service $0.00-..„,-;c0;:-.....„ '-i(Spa(public) - - ' $0.00,,_..0:-' -- PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 -0 `- -- -- i,_, -- - - . , ' 'REINSPECTION $0.00 0 cc.LInterceptors(Sand Auto) $0.00 0��� z'• '- - -2'-�-- - \•-Tic- --- ;" - _ ,...,T,-.2 " `- TOTAL CALCULATED FEES: $223.40 MMMMMkITQ /QDC!•IAI r•AW111T1/141Q 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 wit '-II applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(&00) nitimmaimaramissamo WORKERS'COMPENSATION DECLARATION: I 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 wnich this permit is issued. • ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Cade,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: i (This section section need not be completed if the permit is valued at one hundred dollars($100)or less.) QJL='I&edify 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 Cade,I shall forthwith comply with these provi i s. A plicanhSignature: ,Date: 1 L- I S"J nob �F WARNING:FAILURE TOS UR ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF 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.II Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: 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 K ,,sub' cts the applicant to a civil penalty of not more than five hundred dollars($500).): 1 1,07'4‘11,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License La s.). ❑Iam exe t u:'er sec. Business and Professions Code for this reason: { tsignature: •4- I e•Pate:. (Z—IS'—Ob i Owner ID verifi 1 by driver's license. s ❑No Driver's License No. ,�I'j' '>g)7=.,�'t . Expires-7-07.0 g. Verification of Ownership by(type of document,i.e.-property tax bill or deed): r....-' DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: - I 0 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,Ail 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. I Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: ' I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section h of the California Health and Sefety Code requires,quant with some exceptions,mtthat a oinr Plan lad with the Mesa Fire volume of lions, businessrwhichhas o anyr one time duringt areported aa quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume 55o1gallons, 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? ❑Yes D No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes Q 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 end 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? Yes U 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 pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No I (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: _ Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described propertyf r ins ec'on purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. f 'SSI _lire ObbegatOwner(s) L.0,-; &". .• Date And/Or Authorized Applicant Date , CODE# JNSPECTION TYPE, DAIS 1MRIALE ;ODE# INSPECTION TYPE DATE INTtrIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical , �f 1266 Pool Spa Final 208 Final Plumbing SP d 9/9t //r yj 200 Final Re-Root 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 _ \ ) Its CITY OF COSTA MESA 4, t) BUILDING DIVISION ' :war. ►9 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER � ; PERMIT M06-00842 (714)754-5273 • Fax(714)754-4856 • www.ci:costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2550 ELDEN AV Status: ISSUED, Suite No A Applied: 12/15/2006 • Issued: 12/15/2006 Vicinity: . Parcel Number: 43916111 - �` V Applicant SILER, HUGH - . ,,(-' - - _ ISSUED BY: `)_ Address: 1835 NEWPORT BLVD ' ', - / i ' UNIT A109,174c" -r- .. Phone: 949-244-2880'. . - i / � / � COSTA MESA;CA' 1 Zip: 92627 - / it/, J-� v �,12/�� VA Owner AGNES ENTS LLCM i Address.'///�2/445 MESA DRIVE 1 �- i _ V/ / 7-:..<-;':-- _,` �, V 5i . Phone: 949-646 6966u - • - Iv 0 i /�-/ " i 7, COSTA MESA;CAS�ii Zip: 92626} 44: Tiro, --� , .‘,‘;• • - Contractor: OWNER.BUILDER lt '�.' - - Address: - c, /M' / Phone: , _ , , - Zip: - / - ; - "License:000000' '•' /il. f,--,l / , c5..\/` ‹, SCOPE OF PERMIT' ." - -7 /ELECTRICAL PERMIT TO ADD 342SF,A 42SF FRONT ENTRY PORCH,A 42SF REAR PATIO AND INTERIOR REMODEL.W _ - ` - REF#:BO6-01928'•; WORK WORK TO INCLUDE:.1 tNSTFAU<100 K BTU, 1 GAS PIPING,1 FACTORY FIREPLACE,4 -, _VENT FANS/SINGLE DUCT AND 1 COMPRESSOR UP TO 3 HP/100 kBTU. FEE SUMMARY - _ , A - -' . ! Quantity/ _,,, _ _ _ ,�' -�� r Quantity ISSUE FEE $23.50--j, ' _t, A'-. 'Repair/Alt Absorbtion Unit $0.00 0 ' Inst <100 k BTU,>„, $14.80.;,1 - 1. -r. _- - - Repair/.Alt Refrigeration Unit '$0.00 0 Inst FAU>100 k BTU' $0.00 0 Ventillation'System $0.00 -0 Repair/Alt-Cooling/Heat $0.00 0 Evaporative Cooler : / $0.00 0 Inst/,Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 • Refrig Sys<100 k.BTU`.�,\ $0.00 0 Domestic Incinerator $0.00 0 . Refrig Sys>1,00 k BTU = \ $0.00 0 Compressors/Absorption Systems /. , , Gas Piping • VA, ' $6.15 1 `, Upto3hp/100kBTU $14:70 " 1 Factory,Fireplace \., $10.65 1 ,, r?;V,J. ,., . 3 To 15 hp/500 k BTU �, -$0.00. . 0 Hood w/Mech Exhaust?r A . $0.00 0 15 To 30 hp/-1,000 k BTU - /,' / $0.00 0 VAVBox\ATV `:r.t kS`,$000 0, ' 30To50hp/1,750.k BTU. i '/ , $0.00 0 Vent Fan/Single Duct x$29 00 4 . . Over 50 hp/Over 1,750 BTU / $0.00; 0 Appliance N \-..---i\ '$000 0 _ i -„Boilers / - Fire Dampers ��` $0.00,, 0 '=-."o ,Up to 3'hp. , <%�/ /m`�/ ' '$0.00 0 Smoke Dampers\ ..\ l,./-7:$0.00--:„.-0 „.\\A-,,,,N0 ` ,` , 3 To 15 hp , v/ / z/ %'$0.00 0 Inst or Relocate Appl Vent, .,-/ $0 00, 0 <,, ' 15 to 30'hp:. i , /$0.00 0 Air Handlers< 10000cfm. \� $0.00 " 0_ - -30 to SPhp- - - / $0.00 0 Air Handlers> 10000cfrnv�/� $0.00//0�� •- --- -- -Over 50hp , . '- ,'' ;/ $0.00 0 Floor Furnace ��- 17,A$0.00 x$0.00 v 0 �/ / -_ , Other Mechanical Fee �/; Floor or Suspend Heater c$0 00 0�\ ! -' - • ' Investigation Fee $0.00 i _Plan Check Fee - $0.00 - / �% Reinspection Fee, 77 $0.00 <----I?/-c-i'- `TOTAL CALCULATED FEES $98.80 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) e` EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if wort-I,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 244646(6/00) ' WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This action need not be completed it the permit is valued at one hundred dollars($100)or less.) C .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 that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr visi e:. -Ap•plicant Signature: rDate: ) ?p5‘20496 ��•._ WARNING:FAILURE TO SECURE W KERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PLT AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DCLLARE($100,000),IN ADDITION TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.4 Class 4 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 of 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 DMsion 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 fora permit slits the applicant to a civil penalty of not more than five hundred dollars($500).): 4 I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt}under Business and Professions Code for this reason: (Signnaature: f 17 - Ic-zm o.._ Owner ID verified by driver's license. 0 s 0 No �Driver's.Liaense No. IV`)tt `j tExpire•s: tog 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)feel 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 appl ant 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? ❑❑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? ❑Yes 0 No ' (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the sublect of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ' 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. • Signature: _ Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described propertyfo inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. iinZ �..Z ure.OtLagal Owner(s) LDate-•,�_ i And/Or Authorized Applicant Date 16DE16 SOstem DEE IXTmAL$ 206 FinalINSPEMechanical / DA � , 1616 Fixed System Final Fire Prevention 206 Final Mechanical � O? 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 Y - 204 Final Demolition 250 ,Final Building/Occupancy / 'r�� . CITY OF COSTA MESA BUILDING DIVISION 0°tr>:` DEVELOPMENT SERVICES DEPARTMENT • PERMIT NUMBER 4, .J PERMIT ,gyp• E06-01203 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa fTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite No A Applied: 10/18/2006 Vicinity: Issued: 10/18/2006 Parcel Nunmber: 43916111 Applicant: HUGH SILER / �/, / Address: 245 MESA DRIVE l eF+'t- on -646-6966 ISSUED BY: �t COSTA MESA,--°44.P_ .'f,100 t ,fs ' 2626 - .. v. �J Owner: AGNES,EN :'LLC �� - Address 245 ESADRIVE� - \ " �/ - - /11/(7 \ ,Phone: 949646 6966 , ,r�COSTA.MESA,CAS �!,-:: "---Zip:-- • 92626 - _ , ,, " / \ '/i,,'-- / \ / •Z'i,/' Contract �-OWNER=BUILDER . Address: A ' /1" Phone:' • Zip: License:000000 / i - /✓/' _ I ( N - j_,; °N ! ' ` SCOPE OF PERMIT " • r, ,"DEMOLISH APPROXIMATELY 700 S.F.WORK INCLUDES:DEMOLISH EAST AND SOUTH EXTERIOR WALLS,INTERIOR-WALLS AND ROOF OF S.F.D.PORTIONS OF THE NORTHEAST WALL WILL REMAIN AND PORTION OF NORTHWEST WALL TO ENTRY DOOR WILL REMAIN FOR UNIT A.APPLICANT WILL INSTALL A FENCE IN FRONT OF PROPERTY. REF.:B06-01770 CAP ELECTRICAL AND SEWER.. . - . . FEE SUMMARY t\ �\• .t Quantity , , ' Quantity . ISSUE FEE $23.50 ,- .\ Temp Dist System/Lighting $0.00 0 Temp service test.- $0.00 - _ • - Busway/100 ft _ . $0.00 0 'Res.-a/c package $0.00 >' -Standing Section , $0.00 0 New Res(1-2 units) ' $0.00 t 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 , ,r, $0.00 ' 0 - up to 10 kva/kw $0.00 0 Lighting'Fixts $0.00 [ 0 up to 50 kva/kw $0.00 0 Recept Outlets . ‘- \\ $0.00 0 _ up to 100 kva/kw $0.00 0 Switches;, , $0.00 ' 0 -• ; ' over 100 kva/kw $0.00 • 0 . Non Res Appl i .$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 'x$0.00 •_ _ 0 ',, Misc.Conduit $0.00 0 Service to 1000e. $0.00 a '" `O -Misc.Conductor $0.00 0 Service over 1000a ,� $0.00\�A 0 - Circus(gen or ride) $0.00 0 Motors to 1hp . may, /1,:,:' $0 00 k-N p -_ - - 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 "O- ,` _ ' Fireworks Stand ' $0.00 0 •Motors to 100hp $0.00, `. . 0 - _ . Other Electrical-Fee $9.80 ' Motors over 100hp \ _$0.00 ; '' 0- Communication drops C$0.00 ----Ili' 01 . / - Investigation Fee ; $0.00 Sub panel to 200a Plan Check Fee $0.00 Pole Light Pkg $0.00----z.:::- 0 ' Reinspection Fee ' $0.00 Sign Circuits $0.00 .. :0-- _ - Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $33.30 Intermed Pole $0.00 0 - • - " 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)7545626 2446-48(6/00) 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: Cartier. Policy Number: (This section need not be completed if the permit is valued et one hundred dollars($100)or less.) , 111rI 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 Celifomi ,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 pr 'sion Applicant Signature: Date: 10//q2006 WARNING:FAILURE TO SE E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRI NAL FtNALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force end effect.Lie.4 Class It 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 Cale). 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).): • [V' 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 end Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am e t uya99er sec. Business and Professions Code for this reason: Signature: 4 ' C ].- ��I— Date: )G/JB/2LV% Owner ID ve by driver's license. ❑Yes 0 No Driver's License No. N9k€S837 Expires: CVO( Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety, as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑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 t]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,p,ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L i No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 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 AN 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 B (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify thct •er penalty of perjury the i • alien given above is cot: I agree to comply with all state laws and • ordinances regarding Hareq tlous Yel Is and Emissions. Signature: \ D= 6 MS.- - CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penally of perjury that I have read this application and state that the information given is 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 e-tlescri((("b///g'''Upro�rry for inspection purposes.I agree not to occupy or allow occupancy of any buil g euthorizgdd by tJ�is pertryt unti ipspection. Signature Of Legal Owner(s) // / g/2 Dates And/Or Authorized Applicant Date I CODE I INSPECTION TYPE PAN i LODE( INSPECTION TYPE OH PIMA 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing , 200 Final Re-Roof 210 Final Electrical 07 .8 P/IMM.r.r 201 Final Block/Retaining Wall 212 Final Fire Prevention o 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 'Final Building/Occupancy �; ' CITY OF COSTA MESA r� .�� BUILDING DIVISION F I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT ilb*Pomnot P06-00863 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2550 ELDEN AV Status: ISSUED Suite No A Applied: 10/18/2006 • Issued: 10/18/2006 Vicinity: Parcel Nunmber: 43916111 Applicant: HUGH SILER ISSUED BY: II /J Address: 245 MESA DRIVE _ - 7 .- i •' Phone: 949-646-6966 COSTA MESA:CA l `' - Zip: 92626 - 27 • Owner AGNES ENTS LLC"_ 2 Address/ ,2451MESA"/, ''',"/ DRIVE \ ' %d - - �i i V / ' P ne: 949fk 697/ ,-/ COSTA MESA,-CA--, Zip: 92626 "Contractor OWNER-BUILDER ' - Address:% % =" � �" ' 7. Phone: . - "� Zip: _ � - License: 000000 . - - ., SCOPE OF PERMIT ' DEMOLISH APPROXIMATELY 700 S.F.WORK INCLUDES:DEMOLISH EAST AND SOUTH EXTERIOR WALLS,INTERIOR WALLS AND ROOF OF S.F.D.PORTIONS OF THE NORTHEAST WALL WILL REMAIN i - -AND PORTION OF,NORTHWEST WALL TO ENTRY DOOR WILL REMAIN FOR UNIT A.APPLICANT WILL • INSTALL A FENCE IN.FRONT OF PROPERTY. REF.:B06-01770 CAP ELECTRICAL AND SEWER._ _-- - - •• ' - - ' ' " - • ' FEE SUMMARY AMT QTY. "-- -_ " = - - - SMT r AMT QTY ISSUE FEE ' , $23.50 Laundry Tub/Washer $0.00 0 • Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer , 50.00 0 P-Trap ,50.00 0 Trap Primer $0.00 0 Bathtub -- , $0.00 0-' Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) - -$0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) \,„$0.00 0 Receptors - $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units - $0.00 0' Septic Tank' =..''' H $0.00 0 Wash Basin $0.00 0 Dishwasher. - $0.00 0 Sewer Cap for Demo $9.80 1 Wash Basin Set $0.00 0 Drain,Floor- ' , $0100- 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater . $0.00-, 0 • • Sewer Private Line "- $0.00 .0 - Water Closet(Toilet) $0.00 0 Drain,Roof, C` - $0.00-',',:t.,‘0.L' '' Shower - - $0.00 0' Water Heater/vent $0.00 0 Drinking Fountain =$0.00 0 - �, Sink,bar „ $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank , $0.00 ) 0.::-/: ,' Sink,commercial $0.00 0 Water Re-pipe - $0.00 0 Gas EarthquakeValve .$0.00 ''0 1`� Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) A , $0.00- /'4,,,- '-Sink;kitchen _ - _ $0.00 _- 0 - -'Water Softener ' " / $0.00 0 Gas(Over 4 outlets) /--,'}1_, p ' V �-$0.00 �- 0 Sink,service%rano _ $0.00 0 OTHER $0.00 Gas Repipe -$0.00 " 'o',; - Spa_(private)- - $0.00 0 VIOLATION $0.00 Gas Service `$0.00 0 _. ,Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 [--.0. - / � ' - - REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0:-�`-.- -' _ N ' ` _ \. ' _ -- -•�• - TOTAL CALCULATED FEES: $33.30 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 2446.46(WOO) 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 Cale,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) _ VI 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 provision / Applicant Signature: Date: UZI f f 7 00 WARNING:FAILURE TO SECU WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CR NAL ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF 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.N Class N 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 live hundred dollars($500).): ize I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am axe. .t un.- sec. Business and Professions Code for this reason: Signature: PAa It a Date: I0/1tp.Q2rI Owner ID verifi:lb.y driver's license. 'lies 0 No Driver's License No. P Q 16g3 7 Expires: toe Verification of Ownership by(type of doc en,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: • Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires.with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Cale,with some exceptions,requires registration with the Costa Mesa Flre Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_Ler for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes umit (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 n 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 prescnbed 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 H. .rd. -Materials and Emissions. ql����1,,Qg,�� Signature: 'il.�r�1 OatE�1�0',!!N/W.'b� CERTiFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I havevread this application and state that the Information given is corre .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 abo -descri 4d�-prropy for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by thi ,]perrrpi{until final inspection. o (LV(t Signature Of Legal Owner(s) 03/16�l (li'0 Date And/Or Authorized Applicant Date CODE I INSPECTION TYPE PATE =ALI CODES INSPECTION TYPE PATE INTRIAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical ' 1266 Pool Spa Final • 208 Final Plumbing • glaT/O7 200 Final Re-Roof 210 Final Electrical QP 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 • • sta MF CITY OF COSTA MESA BUILDING DIVISION F 0-rr_ A1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT +� B06-00571 arerrtro (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.JtDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: - Applied: 04/18/2006 Vicinity: UNIT B Issued: 04/18/2006 Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH Address: 245 MESA DRIVE V - Phone: 949-646-6966 ISSUED BY: COSTA MESA,CA Zip: 92627 Owner AGNES ENTS LLC Address 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA, Zip: 92627 Contractor: OWNER-BUILDER • Address: Phone: Zip: License: 000000 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: • SCOPE OF PERMIT REMODEL APT UNIT"B".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E)STAIRCASE,CHANGE OUT(E)FLUORESCENT L TO FLUORESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHEI C — v FEE SUMMARY Plan Check: $0.00 • Calc Valuation: $3,000.00 Permit: $83.25 Claim Valuation: $3,000.00 SMIP Res: $0.50 SMIP Com: $0.00 Other $0.00 Inspection: $0.00 Total: $83.75 • PLANNING &ZONING SETBACKS MAIN STRUCTURE Front, 0-0 \ Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 07 0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,orjF tiik s suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(NW) DECLARATIONS* - WORKERS'COMPENSATION DECLARATION: I r 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 i/the permit is valued at one hundred dollars(5100)or less.) (.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 pray' ionp,1 �i -7 -Applicant Signature: 7 ,I ate:y.�If p /C Q(�(z 'WARNING::FAILURE TO SEC W ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMIWIL' PEN/ALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(5100.000).IN ADDITION TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.N 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).): Ir Iris 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 burdon 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 tot Contractors License Laws.). ❑ I am axe pt Rd c. Business and Professions Code for this reason: Signature:-- - ,1''� l�J�^ 7 Date: 4jw/2 OQ6 - Owner ID ve d by ' s license. Yes 0 No Driversticense No. IV I h X�. 3 / Expires: q,26'O7 Verification of Ownership by(type of docu ent i.e.-property tax bill or deed):k-------:-- DIVISION OF INDUSTRIAL SAFETY P RMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding.falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Gate: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health end Safety Code,with some exceptions.requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application ag$ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district Or agency? 0 Yes LJ No (Section 65850.2 of the California 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? ❑Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described propert f inypeppon purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. `.Sig re-04LegalOwner(s)_y I /O Date And/Or Authorised Applicant Date CODE 1 INSPECTION TYPE PATE lCA6$ CODE INSPECTION TYPE PEE INTITIAL4 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 $09/21 4`p4Tp MF 9 CITY OF COSTA MESA BUILDING DIVISION '}#1' ,l DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F r 1.4 PERMIT fro_a B06-00573 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa3jjILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 04/18/2006 Vicinity: UNIT D Issued: 04/18/2006 Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH ^ Address: 245 MESA DRIVE llA Phone: 949-646-6966 ISSUED BY: COSTA MESA,CA Zip: 92627 • Owner: - 'U s E7ft4.5 LlC_,. Address aq 5� ma,. Phone:114t' O0•'1 441 C6�P 6=iv Zip: v) Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: Address: - Address: Phone: Phone: Zip: - License: License: - SCOPE OF PERMIT REMODEL APT UNIT"D".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E)STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHER. ' FEE SUMMARY Plan Check: $0.00 Calc Valuation: $3,000.00 Permit: , $83.25 Claim Valuation: $3,000.00 SMIP Res`. $0.50 ' SMIP Com: $0.00 �. Other: ' $0.00 Inspection: $0.00 Total: $83.75 - -7 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0- ,Rear "0-0 Left 0-0 � Right 0,0 ACCESSORY ' Front '0-0 Rear 0-0 Left 0-0 Right - 0-0 , PARKING Existing: `0 • Required:_ 0 Proposed: 0 ,.: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and4 ated regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) • • L WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: El 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: (�Th�iss section need not be completed if the permit is valued at one hundred dollars($100)or less.) L8'�aLhderttlfy'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,an 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 provisio // � Applicant.Signature:' Dete: -L-,D Q WARNING:FAILURE TO SECURE W RICERS'COMPENSATION COVERAGE is UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF 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# 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).): IBC—fras.ownerof the property,or my employees with wages as their sole compensation,WILL DO-THE WORK,rand,the structure Is not intended or offered for sale(Sec. Lx-:--7044rBuslness 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 properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt1,[yy�Ljp��d ec. Business and Professions Code for this reason: Signature~ Ownew OD.verifoY tw '1ed drivels license. Yes 0 No Drivec's;License No. Aftl Expireir -ZG- Verification of Ownership by(type of docu ant,i.e.-property tax bill or deed): �w' "-^--•._ DIVISION OF INDUSTRIAL SAFETY ERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑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 lime 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 ❑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 en RMPP is presently required,has Section 25534 of the California 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes LI 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 ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for ins cti rooms.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 11-S-06 Situ _OtLegalOwner(a)�t aeLit And/Or Authorized Applicant Date CODE I INSPECTION TYPE PATE INTITIALS CODEI INSPECTION TYPE DATE INTRIAL$ 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 X O7 ICU. z�r fr LL/1 4`e WS 9 CITY OF COSTA MESA qe BUILDING,DIVISION F �„z ,I"$ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER b`, PERMIT zt• B06-00574 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesagDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 04/18/2006 Vicinity: UNITE a.- Issued: 04/1812006 Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH Address: 245 MESA DRIVE Phone: 949-646-6966 ISSUED BY: COSTA MESA,CA Zip: 92627 Owner: AGNES ENTS LLC . Address 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER . Address: . Phone: Zip: License: 000000 Arch : Eng: Address: - Address: Phone: Phone: Zip: License: • License: SCOPE OF PERMIT REMODEL APT UNIT"E".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E)STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHER. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $3,000.00 Permit: $83.25 Claim Valuation: $3,000.00 SMIP Res: $0.50 . _ SMIP Corn: $0.00 - _ -_ _ _ Other: $0.00 Inspection: $0.00 Total: $83.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 -. Reir 0-0 Left 0-0 ,. Right 0-0 ACCESSORY Front- '0-0 --,-< ,:. Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: ' 0 Required: 0 Proposed: 0 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 plicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the a piration of this permit. FOR INSPECTIONS CALL: (714)154-5626 244646(WOO) • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: r , ❑ 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 canter and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) 171 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' Ccompensation'.laws of California,end 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 provi ion Applicant Signature:- -f i `Date:: y .' 'I re26 (WARNING:FAILURETOrSECU WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(S100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: ' I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect,Lic.a Class x Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: 9 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(5500).): _LITJ.I'ae 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. 1 x•-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,em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exe t u der sec. Business and Professions Code for this reason: Signature: r-Date:y__'1 AC'Ob r Owner'1D vent y driver's license. Yes ❑No Drivers Ucense No.. ,�ft$S£�37 Expires:-R'Z6-U$ Verification of Ownership by(type of doc ent,i.e.-property tax bill or deed): -`'"`, DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ t hereby certify that no excavation live(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,Califomia 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? ❑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? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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? j�Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. -11-700,41 Signature Of Legal.Owner(s)• —Date--- And/Or Authorized Applicant Date ;ODE I INSPECTION TYPE QM )NTITIAI s BODE It INSPECTION TYPE PATE INRTIALS 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 Signm 222 Final Site • 204 Final Demolition 250 Final Building/Occupancy i a / /IH-f-uJ- FP • • 4`6"1 MFs9 CITY OF COSTA MESA BUILDING DIVISION l/.rnuu �, DEVELOpMENTSERVICES DEPARTMENT PERMIT NUMBER I: �• P-i : PERMIT �a e"�, B06-00575 stargo (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa•6aL�1DING PERMIT 77 FAIR DRIVE,COSTA MESA,Ci%-4626 Job Address: 2550 ELDEN AV C11Status: ISSUED Suite: Applied: 04/18/2006 Vicinity: UNIT F Issued: 04/18/2006 Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH Address: 245 MESA DRIVE Phone: 949-646-6966 ISSUED BY: COSTA MESA,CA Zip: 92627 Owner: AGNES ENTS LLC. Address 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA" Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: • Zip: License: 000000 Arch : Eng: Address: Address: Phone: Phone: Zip: License: • License: SCOPE OF PERMIT • REMODEL APT UNIT`gi WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E)STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FL RESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHER. • FEE SUMMARY Plan Check: $0.00 Calc Valuation: $3,000.00 Permit: $83.25 Claim Valuation: $3,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 _ Other $0.00 Inspection: $0.00 Total: $83.75 PLANNING &ZONING SETBACKS • MAIN STRUCTURE Front 0-0- . Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front; 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: "/0 Required: 0 Proposed: 0 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 ap able codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the ex tion of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) • DECLARATIONS' WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: A ❑ 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 if the permit is valued at one hundred dollars($100)or less.) Ur- I certify that,ln 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' cornpensadon.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 pr isi Appli`Signature:--det �Oate I O ` Q WARNNG,'FAICURE TO SEC E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND 00 LARE(S100,0:0),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. UCENSED 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 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 morn than five hundred dollars($500).): I as-owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for salel(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am ex m t der sec. Business and Professions Code for this reason: Signature: Date:--_H-1k-Ob r--�-. G -7 /Y rOwner,ID died by driver's license. Yes 0 No rUriverS Llcen`se No? .N QA eS 3-7 -'-- Expires:Q—Z46r-±0 -- �ication of Ownership by(type of doc ant,i.e.-property tax bill or deeds-"—J_ DIVISION OF INDUSTRIAL SAFE PERMIT CERTIFICATION: ❑ I hereby certify that no excave ion five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has an hand a quantity of acutely hazardous materials equal to or greeter then 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 en 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? 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 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 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection oses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SIJgal.Owner(s) LUate And/Or Authorized Applicant Date CODE t INSPECTION TYPE PALE 1NTmALS CON, )NSPECTIONTYPE PPT. INflIIALE 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 Finat Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign _ 222 Final Site G 204 Final Demolition _ _ 250 Final Building/Occupancy Y/ re `, IA Ws. CITY OF COSTA MESA BUILDING DIVISION •,,,•,' -,� - DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F 1 wrier]. PERMIT B06-00576 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaBUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 04/18/2006 Vicinity: UNIT G Issued: 04/18/2006 Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH Address: 245 MESA DRIVE �,,,^ Phone: 949-646-6966 ISSUED BY: /7Q COSTA MESA,CA Zip: 92627 Owner: AGNES ENTS LLC Address 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : - Eng: Address: Address: • Phone: - Phone: Zip: License:, License: SCOPE OF PERMIT REMODEL APT UNIT"0".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E)STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHER. - FEE SUMMARY Plan Check: $0.00 Calc Valuation: $3,000.00 Permit: $83.25 Claim Valuation: $3,000.00 SMIP Res: $0.50 ,SMIP Corn: $0.00 _ - Other: $0.00 Inspection: $0.00 Total: $83.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 - Rear .0-0 Left 0-0 Right 0-0 ACCESSORY ' Frbnt "'0-0 `� , Rear 0-0 Leff 0-0 Right 0-0 PARKING Existing: 0 . , Recuired: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No. 92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all-appli> ca�des, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the j'piration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(600) DECLARATIONS' WORKERS'COMPENSATION DECLARATION: Il r 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: Carder: Policy Number: (This section need not be completed i/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' ��'dcmpensatlon laws of California,end 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 pr�o.jyyy�i�sio s. Applicant Signature: // {�'.z L1BE Date: N—' —✓" b WARNINGrFAILURE.TO SEC WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a Class$ Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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). Lenders 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).): 9/—l;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. S-X7044;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.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt u er sec. Business and Professions Code for this reason: Signature: O ?pate:—N-1K 06 (OwneiID verified b drivers license. Yes 0 No Driver:s.License.No_JV et 8S5O) 7 Expires:^4_ZfOg Verification of Ownership by(type of docu ent,i.e.-property tax bill or deed): '------' DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety. as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires, with some exceptions. that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspeLyop purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. nature Of Date- y,\ And/Or Authorized Applicant Date CODE 0 INSPECTIONTYPE PRASE MURALS CODFf INSPECTION TYPE PATE INTITIAL$ 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 D p hail o r __ ___ r 11110 M i CITY OF COSTA MESA le � BUILDING DIVISION j J DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. re •• PERMIT B06-01928 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.c0. 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: A Applied: 11/16/2006 Vicinity: REAR OF HOUSE Issued: 12/15/2006 Primary Occ: R3 Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH Address: 1835 NEWPORT BLVD UNIT A109-174 Phone: 949-244-2880 COSTA MESA,CA - „i----- 'Zip: . 92627--- ISSUED BY: Owner: AGNES ENTS-LLCM.-3.-1. �. / Address 245 MESA DRIVE -- �,,12-- Phone: 949-646-6966 4 MES COSTA A,CA 1 Zip 92628: �+ 4t a . Contractor '-OWNER-BUILDER' P "y�'� ' , Address:/ A iii*- F" - - / ./1 72 r�1 Phone: i(;j' Zip'. / -V License: 000000 C: , i //> ,,,%/ - N /Arch :( MARCUS;KEMMERER Eng: .Address: KEMMERER DESIGN ARCHITURE i - Address: HUNTINGTON BEACH,CA Phone: 714-655-3139 - Phone: 228 CREST AV ,i ' Zip: --/92648/ i . > License:/ C29552 ' - License: . ,,,,` f / ,A<'- -- SCOPE OF PERMIT - ADD 342SF,A 42SF FRONT ENTRY PORCH,A 42SF REAR PATIO AND INTERIOR REMODEL.WORK TO INCLUDE:PORTION OF NEW FOUNDATI ' FRONT,SIDE AND REAR,INTERIOR REMODEL AND RELOCATION OF 2(E)BEDROOMS AND,1 (E)BATHROOM,RELOCATION KITCHEN AND AC „ FOOTAGE TOIEXTEND KITCHEN,ADDITION OF MASTER BEDROOM AND BATHROOM. N - ' " ` EXISTING 2 BEDROOM, 1 BATHROOM SFD;TO BE CONVERTED INTO-2 BEDROOM,2'BATHROOM SFD. , REF#:PA-06-55:,- 1 . 11, -, A Ir' �'1// ' '-_a ` FEE'SUMMARY/f - - Plan Check , $436.64 „ - ,_ — - ;1 ' Calc Valuation: 353,868.48 1 - Permit: $671.75 Claim Valuation: = so.00 /� \'�SMIP-Res: A;V`l $5.39 J --( � - - - 'SMIP Com: .\`' $0.00 - __. - /, y. Other: 10.00 - Inspection! 1$0:00 - �, Total: � , $1,1378 - \SETBACKy\ �/ '�A 6 , PLANNING'S,ZONING '/ ' f / '- /' MAIN STRUCTURE-Front./1&0�- Rear `17-9 ., ' " Left X10:o------ Right '21-'0 . % VA� '�v ,r-C'',. ------.-"=' - w. _ '- - - - C , / � /r ACCESSORY Front\0-0 C./ ,, ;Rear _ 0-0 - - - Left '0-0- - Right - .0-0 / N 3' 4 '' t -/( 1� f PARKING Existm 0. Rewired.- 0 Proposed• -01 2 c • 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 fora period of 180 days. V INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) mizziamigissainimetissimas 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 sell-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 wrier and policy number are: Cartier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) �,cI'certify.thatdn.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' j47.--compensatlon 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 pr sit AppliwnFSighe Date:, I Z /15/2 006WARNINGCFAILURE TOSE E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRUNAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),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). Lenders 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 andPfyfessions 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).): fI,-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. l 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.). 0 I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors license Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am examt under sec. Business and Professions Code for this reason: 'S_.--e:�.- tlb �r cc rate: -1Z'-(S 1(1��] Owner ID verifie y drivers license. 0 No Dri sLcanse No:" ' Ivq.Q(15g1"7 Expires: -C2/`OK Verification of Ownership by(type of document,I.e.•property tax bill or deed): / DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding.falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person hes a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic Leet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L-f 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). I 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 slate laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for i ecu purposes.I agree not to occupy or-allow occupancy of any building authorized by this permit until final inspection. r f __.. t'2-15_-2.0& ria a Of Legal Owner(s) 1-----Date__. • And/Or Authorized Applicant Date CODE I INSPECTION TYPE PALE !UMW CODE I INSPECTION TYPE OR PfTRIAL$ 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 , p 204 Final Demolition 250 Final Building/Occupancy d lag/OZEy-/,,--`n(�'r 1r V 4`,501 MF 9 CITY OF COSTA MESA r BUILDING DIVISION F• /,i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER sit PERMIT t). 011411� �. B06-00572 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.JtoING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 04/18/2006 Vicinity: UNIT C Issued: 04/18/2006 Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH Address: 245 MESA DRIVE Phone: 949-646-6966 ISSUED BY: L]./ COSTA MESA,CA Zip: - 92627 Owner: VA/R426 (;4171514.4„...• Address c9...(4- -5 mto r • Phone:��I ") ���� /late„ , or1/4- Zip: P24ez7 Contractor OWNER-BUILDER Address: Phone: • ' Zip: ' / - ” License: 000000 Arch : Eng: Address: Address: Phone: - Phone: • Zip: License: License: SCOPE OF PERMIT REMODEL APT UNIT"C".WORK TO INCLUDE:NEW FRAMING TO ENCLOSE A PORTION OF(E)STAIRCASE,CHANGE OUT(E)FLUORESCENT LIGHT TUBES TO FLUORESCENT CAN LIGHTS IN BATHROOM,KITCHEN AND HALLWAY;CHANGE OUT BATHTUB;SHOWER VALVES AND NEW DISHWASHER. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $3,000.00 Permit: $83.25 Claim Valuation: $3,000.00 SMIP Res: $0.50 • SMIP Com: $0.00 Other: $0.00 - Inspection: $0.00 Total: $83.75 • PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 �.: Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front- '0-0 ;, Rear 0-0, Left 0-0 Right / 0-0 PARKING Existing: 0 ' Required: 0 Proposed: 0 • 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 suspepSheftiCZned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS' WORKERS'COMPENSATION DECLARATION: • ' 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 if the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,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 pr Sig fJ n Applicant.Signature:,- 'Sc> Date: "I—a-06 GARNING'FAILURE TO SECU WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(3100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lie.a Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: I ❑ 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).): – owner of the pProrty,fen io s eloyhes wonth wages is their Loleaw compensation,snotply WILL DO THE WORK,and the structure is intendeder , offeredo for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am ex pt der sec. Business and Professions Code for this reason: _SLI y,� Signature: IDate:_ Owner-ID vier by driver's license. Yes 0 No Driver's.License.N-67.41 ggS837" Expires_q 26--Ory/i Verification of Ownership by(type of doc ment,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: ' 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No • (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which'at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Calif omia 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 end 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 L-I 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 California Health and Safety Code Section 42303 been made? 0 Yes 0 No I 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: • CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for insppcti9surposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ,TpVT)j,,,{N,1 y-t�-D� S' atur Of Legal Owner(s) /Date-----,.._. , �__ - fi -.. CI And/Or Authorized Applicant Date CODE E INSPECTION TYPE pia INTITIAL$ CODE0 INSPECTION TYPE, DAT INTITIALE 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 Signm 222 Final Site Q' 204 Final Demolition 250 Final Building/Occupancyc YIi U ell M CIT;OF COSTA MESA 4i BUILDING DIVISION >:l,, ,, ..4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER I. I .ir._.e��.ill'l Cll.k PERMIT 4 f • B06-00767 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BtJLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 05/19/2006 Vicinity: THROUGH OUT APT COMPLEX Issued: 05/19/2006 • Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: HUGH SILER Address: 245 MESA DRIVE Phone: 949-646-6966 ISSUED BY: COSTA MESA,CA _ Zip: 92627 Owner AGNES ENTS LLC Address 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA - .. Zip: 92627 Contractor: OWNER-BUILDER Address: • . Phone: • Zip: License: 000000 Arch : ' - ' !' Eng: Address: ,,, .,' Address: Phone: Phone: • Zip: Th.-License: - License: SCOPE OF PERMIT WINDOWS AND DOORS CHANGE'OUT FOR APARTMENT.WORK TO INCLUDE:CHANGE OUT 25 WINDOWS,6 PATIO DOORS LIKE FOR LIKE,C WINDOWS TO PATIO SLIDING DOORS'AND CHANGE OUT 6(E)ENTRY DOORS LIKE FOR LIKE.NO CHANGE IN HEADER.WINDOWS TO MEET- EGRESS - REQUIREMENTS. FEE SUMMARY Plan Check: $0.00 Calc Valuation: s1o,0oo.00 . Permit; , $181.25 __- , _ Claim Valuation: ' $10,000.00 ,`SMTP-Res: $1.00 - - -- - . .. -_. , , SMIP Corn: . $0.00 , • • Other $0.00 , Inspection:, $0.00 - ' Total: $182.25 - • N.\'': ,,: - PLANNING &ZONING • •. • SETBACKS 7 ` N '-'.....,S.,\. MAIN STRUCTURE Front 0-0 Rear - "0-0 Left 0-0 Right 0-0 - ACCESSORY7 Front'. 0-,0 - Rear_- _0-0. , Left 0-0 . _ Right 0-0 , PARKING Existing:- 0-- ' ,•Required: 0 Proposed: 0 ' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-48(WOO) 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 sect/on need not be completed if the permit is valued at one hundred dollars($100)or less.) jE—1'certify that In the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' ' L---compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these ow to pplicantSignature: DaDT •Siq-04 WARWNGI-FAILURE TO SE RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL MID SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($/00,0110).IN ADDMON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 31060E 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.Llc.ft Class ff 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). Lenders 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($500).): `❑_,..-I es owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Cale:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: ���c�, Date: -C= ^Ob Owner IDyerifietl by drivers license. Yes 0 No Driversse No: lVt11CiVC17 ‘.,.2__ ' Expires: '($?-0 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 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 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 I (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 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 Flre Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the California 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 appermit 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 ❑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 pert 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? ❑Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). I CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described props for s�,..on purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ' -- c-14-06 `•�tLueOYL"eget Owner(s) Date And/Or Authorized Applicant Date ' CODE 4 INSPECTION TYPE PATE INTRIAL6 CODE I INSPECTION TYPE PALE INIMAL5 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 , Wle ,a/.4.4...7‘.4.)-'` / W ' F gni @ COSTA MESA 4 9 BUILDING DIVISION ). N .,4. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER I. ' I_ICtre!� PERMIT ', 806-00879 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 06/062006 Vicinity: U �� Issued: 06/06/2006 Primary Occ: R Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH Address: 245 MESA DRIVE I Phone: 949-646-6966 ISSUED BY: CCCC COSTA MESA,CA Zip: 92626 Owner: AGNES ENTS LLC Address 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch - Eng: Address: Address: Phone: Phone: • Zip: 'License: r License: SCOPE OF PERMIT 32SF OPEN PATIO LATICE COVER OVER ENTRY WAY AND ROOF EXTENSION AT SIDE OF APT UNIT B. FEE SUMMARY Plan Check: $17.26 Calc Valuation: $515.84 Permit: $26.55 Claim Valuation: $0.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 -- --- - Total: $44.31 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-02 9 Rear 0-0 Left 0-0 " Right 0-0 PARKING Existinq: 0 Proposed: 0 • • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92.28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46 WOO) DECLARATIONS' G- , - 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 carrier and policy number are: Carrier: Policy Number: (This tion need not be completed if the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, gree that if I should become subject to the workers'compensation provisions of Section 370 of the Labor Code,I shall forthwith comply with these Dr isi°�/� Vg (J/,L` Applicant Signature: • ` Date: (� WARNING:FAILURE TO SE WORKERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PE TIES AND CML 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 E,INTEREST,ANDATTOf1NEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.4 Class 4 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 pormit 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 subjec the applicant to a civil penalty of not more than five hundred dollars(5500).): 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 ho or she did not build or Improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt undPyeec. Business and Professions Code for this reason: 6/1Signature: CJ�> ••rr 37 Date: / -i[ Owner ID verifie ri s license. 0 Yes 0 No Driver's &E License No. t Expires: CI-Lo'-C Verification of Ownership by(type of document.i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas et 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 en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied wiiiir 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 a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the 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 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 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described propertypinsp cti purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until nal inspection. i 6 g e Of Legal Owner(s) 6 //D ate And/Or Authorized Applicant Date 400E r, INSPECTION TYPE MEE 1MAiltS CODE0 INSPECTION TYPE PATE 11IIIDAL$ 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 7:74S.* 204 Final Demolition ' 250 Final Building/Occupancy /4...or e PG C 11W A CITY OF COSTA MESA BUILDING DIVISION F ,. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t. 11.141k PERMIT 806-00880 litt*Posiarso 41. (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaMAD ING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 06(0612006 Vicinity: UNIT C Issued: 06/06/2006 Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH Address: 245 MESA DRIVE V Phone: 949-646-6966 ISSUED BY: I/'IAV COSTA MESA,CA Zip: 92626 Owner: AGNES ENTS LLC Address 245 MESA DRIVE . - Phone: 949-646-6966 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: Address: .. Address: Phone: Phone: , Zip: License: License: SCOPE OF PERMIT 32SF OPEN PATIO LATICE COVER OVER ENTRY WAY FOR APT UNIT C. FEE SUMMARY Plan Check: $17.26 - . , - , , . Cale Valuation: $515.84 Permit: $26.55 Claim Valuation: $0.00 SMIP Res: $0.50 SMIP Com: $0.00 Other $0.00 ' Inspection: $0.00 Total: $44.31 PLANNING &ZONING SETBACKS ' MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front -0.0 . -. :.-, Rear- 0-0 - Left 0-0 ' Right 0-0 PARKING Existing: 0 . ,Repaired: 0 Proposed: 0 - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(WOO) I , , • A , 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 1 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 if the permit is valued at one hundred dollars($100)or less.) rIprTcertify thefin 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 vii ins )))) Applicant Signature: '•` fDate: bJ/O6 WARNING:FAILURE TO 6 RE w RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(SI ,OOO),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.p Class p 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: 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 the 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).): ,-ds 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. I X7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly 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 en owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am e e p der sec. Business and Professions Code for this reason: N Signature:"1�‘ — 4C� Date:—.6/1"14 Owner ID vetli,:d by driver's license. 0 Yes 0 No Ddver_s License,No-' Expires:'q 2.6— Verification of Ownership by(type of document,i.e.-property tax bill or deed): k...---__ 1 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2.Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant Or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on nand 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 feel of compressed gas al standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑NO (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this oP plication ajaPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the 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 all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penally of perjury that I have read this application and state that the information given is 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 prop°Ay jQ'Inpp-ectio p 1 agree not to occupy or allow occupancy of any building authorized by this permit until fin,iiaction, /V_-Stgghatur f Legal Owner(s)_I G/D e 1 vvv LTJ 'A ulhoriz Appli J — r goes r INSPECTION TYPE PATE INTIALS EOM 4 INSPECTION TYPE PATE INRRAV4 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 Signm 222 Final Site - -1 204 Final Demolition • 250 Final Building/Occupancy /a19/od B M6 CITY OF COSTA MESA t49 •0-r. . BUILDING DIVISION F 4,i, ,4,mm, ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �• PERMIT So•fre„arlo�+ B06-00881 (714)754-5273 • Fax(714)754-4856 • www.ci.cOsta-mesaDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 06/06/2006 Vicinity: UNIT D Issued: 06/06/2006 Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant SILER, HUGH Address: 245 MESA DRIVE /1 Phone: 949-646-6966 ISSUED BY: COSTA MESA,CA Zip: 92626 Owner AGNES ENTS LLC Address 245 MESA DRIVE " Phone: 949-646-6966 COSTA MESA,CA Zip: 92626 • Contractor: OWNER-BUILDER Address: Phone: Zip: - License: 000000 • Arch : - Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT 32SF OPEN PATIO LATICE COVER OVER ENTRY WAY FOR APT UNIT D. • FEE SUMMARY Plan Check: $17.26 Calc Valuation: $515.84 Permit: $26.55 Claim Valuation: so.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other $0.00 Inspection: $0.00 - - Total: $44.31 PLANNING & ZONING SETBACKS • MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY • Front 0-0 , - Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 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 244646(6/00) 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 if the permit is valued at one hundred dollars($100)or less.) [VI 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 e that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p vi Ion'�S.^ Applicant Signature: 04 Date: /6/� WARNING:FAILURE TO SECU WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRI/INALbENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($108000),IN ADDITION TO THE MGT OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: • I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# 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 subjectsT/ the applicant to a civil penalty of not more than five hundred dollars(5500).): W 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 properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exem.t u.•' sec. Business and Professions Code for this reason: Signature: ! 4 !s��-z Date: 6/6/06 �L,/p� Owner ID verit r•'�dver's license. ❑Yes 0 No Driver's License No. e... .'! Expires: !A vp Verification of Ownership by(type of document,i.e.-property tax bill or deed): . DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 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 en RMPP ib 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 akEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes-,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: _ Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for ins tion purposes.I agree not to occupy or allow occupancy of any building authorized by this permit unfilfinal inspection. attire Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE 1 INSPECTIONTYPF PAIS INTmALS CODES INSPECTIONTYPE PEE INTITIALS 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 Signm 222 Final Site 204 Final Demolition 250 Final Building/Occupancy W .( e/�yw J Mlc CITY OF COSTA MESA 49 BUILDING DIVISION f , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 11104 PERMIT B06-00882 ,y oRm 044 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesig0rLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 06/06/2006 Vicinity: UNITE Issued: 06/06/2006 primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH Address: 245 MESA DRIVE Phone: 949-646-6966 ISSUED BY: OP COSTA MESA,CA Zip: 92626 Owner: AGNES ENTS LLC Address 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip:_ License: 000000 Arch Eng: Address: Address: Phone: Phone: • Zip: iicense: License: SCOPE OF PERMIT 32SF OPEN PATIO LATICE COVER OVER ENTRY WAY FOR APT UNIT E. FEE SUMMARY Plan Check: $17.26 Calc Valuation: $515.84 Permit: $26.55 Claim Valuation: $0.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 • Inspection: $0.00 - • - Total: $44.31 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0.0 Right 0-0 ACCESSORY Front 0-0 ,- - Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 • • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6g0) DECLARATIONS' WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have end 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 ction need not be completed if the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calif o la,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 thesaDf si e� Applicant Signature: Date: yri/ WARNING:FAILURE TO S RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRI NAL TIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDriION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE R CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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). Lenders 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(5500).): ,fp,/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 end Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exewder sec. Business and Professions Code for this reason: Signature: 7 . Date: L/4/04 Owner ID ven ed by drivers license. 0 Yes 0 No Drivers License No. J/kj(('J7 Expires: 9-26 Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341.Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: . 1 W III 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 2s5.1.1 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 this a plication a_aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ut Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for ins �/@��ecc' p purposes.I agree not to occupy or allow occupancy of any building authorized by this permi unt final inspection. Sig Of Legal Owner(s) 6�D2f6 And/Or Authorized Applicant Date CODE 0 INSPECTION TYPE PASS INTITIALS GOOF. INSPFCTIONTYPE QAIE 1NTMAL6 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 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 1./9/06 RC PP ' 4I CITY OF COSTA MESA 44- ���99 BUILDING DIVISION > :j DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F1 riliZMTICEIA r i PERMIT . _- B06-00883 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaf3VL DING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN,AV GULStatus: ISSUED Suite: Applied: 06/06/2006 Vicinity: UNIT F Issued: 06/06/2006 Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH Address: 245 MESA DRIVE Phone: 949-646-6966 ISSUED BY: COSTA MESA,CA Zip: 92626 Owner AGNES ENTS LLC Address 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA Zip: 92626 Contractor OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch Eng: Address: Address: Phone: Phone: Zip: • License: License: SCOPE OF PERMIT 32SF OPEN PATIO LATICE COVER OVER ENTRY WAY FOR APT UNIT F. FEE SUMMARY Plan Check: $17.26 Calc Valuation: $515.84 Permit: $26.55 .. Claim Valuation: $0.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other $0.00 Inspection: $0.00 - - - - - - Total: $44.31 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 • ,.Required: 0 Proposed: 0 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 fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) 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 carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) 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 C ifomi 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 vi 6/ 4 Applicant Signature: Date: WARNING:FAILURE TO SE RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRI INAL ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF 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# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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 subje 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 es their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ tam exempt qpr sec. Business and Professions Code for this reason: `/`7,6 �,Jr Signature: yVL� N Date: tin Owner ID verifi by driver's license. ❑Yes 0 No Driver's License No. it{( 7 Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code.with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application 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? DI Yes 0 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 ❑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 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,end authorize representatives of the City of Costa Mesa to enter upon the above-described properctfor i pe ion purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. blbgSignature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE t INSPECTION TYPE PTE JNTITIALS CODE I INSPECTION TYPE all INTmAL5 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 �.1 204 Final Demolition . 250 Final Building/OCcupancy /2_,f etp,„7—• `001 tit CITY OF COSTA MESA 4 BUILDING DIVISION • r ggee > • DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 PERMIT BO6-00884 rosary (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa tDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 06/06/2006 Vicinity: UNIT G Issued: 06/06/2006 Primary Occ: MR Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: SILER, HUGH /� Address: 245 MESA DRIVEN 1 Phone: 949-646-6966 ISSUED BY: �/ COSTA MESA,CA Zip: 92626 Owner AGNES ENTS LLC Address 245 MESA DRIVE Phone: 949-646-6966 COSTA MESA,CA Zip: 92626 • Contractor: OWNER-BUILDER Address: .. Phone: 'Zip: i , License: 000000 Arch' : Eng: Address: Address: Phone: Phone: Zip: ; License: License: SCOPE OF PERMIT 32SF OPEN PATIO LATICE COVER OVER ENTRY WAY FOR APT UNIT G. FEE SUMMARY Plan Check: $17.26 •-• Calc Valuation: $515.64 Permit $26.55 Claim Valuation: $0.00 SMIP Res: $0.50 • SMIP Corn; $0.00 Other $0.00 Inspection: $0.00 --- --- - - — - - - Total: $44.31 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front . 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 - Rear 0-0 Left 0-0 Right 0-0 . PARKING Existing:- 0 "-Required: 0 . - Proposed: 0 ' • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS, WORKERS'COMPENSATION DECLARATION: 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 ofthe 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 ction need not be completed if the permit is valued at one hundred dollars($100)or less.) (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 t should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. 6/B/06 r /' '�p , Applicant Signature: Date: 6�/A/g"(/7// /V' WARNING:FAILURE TO SECURE FRS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI L P NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN DITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LA R 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 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 subjthe applicant to a civil penalty of not more than five hundred dollars($500).): leas owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of Completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exe u r sec. Business and Professions Code for this reason: ^' Signature: "& Date: 6 C4 Owner ID verifi by drivers license. 0 Yes 0 No Driver's License No. �t€, ti �/ Expires: 4 I6^kg- 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,Om 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 WIII 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 I (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 lime 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 ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required.has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No • (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all st8 s and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described props�1Q/ '''nnspe n pu ses.I agree not to occupy or allow occupancy of any building authorized by this pYrmit ynjil l inspection. Sig e 01 Legal Owner(s) 6{///6!///U ate And/Or Authorized Applicant Date 1 CODE 4 INSPECTION TYPE , DATE INITIALS cooall IYSPECT10N TYPE PAIL INTmALS 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 4 2/i/b6 PP • ill- -4-z";.•, . ' CITY OF COSTA MESA • 4 0 if BUILDING DIVISION - 0 ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER h a PERMIT B06-00886 %bounce. (714)754-5273 • Fax(714)754-4856 • www-cl.costa-mesa.ctgsJILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: Applied: 06/06/2006 Vicinity: 2ND STORY,UNIT G Issued: 07/19/2006 Primary Occ: R1 Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: MHUGH 245 Address: 245 MESA DRIVE Phone: 949-646-6966 ISSUED BY: • COSTA MESA,CA ,-- ---—Zip:- 92626 Owner AGNES ENTS-1,17b>( ;/'``- l / Address 245 MESA DRIVE,;) - -,:‘—' ' I i / - - - r>.---' ` - Phone: 949.646-6966 - COSTA MESA,CAS ,1 ` \ ‘-' L -: Zip ,92626/ , - '--.' - Contractor- (OWNER BUILDERS _ -- : > \ "/ Address //(' \\ �'/- -i vr� �- , ) , \ X---'. : _\_ % i%� Phone: �`•-. �•_ •_ • ,;; Zip: N. ✓, / License: 000000 \`\ ,�,\. 'Arch :7 ''MARCUS KEMMERER Eng: • Address:'•.KEMMERER DESIGN ARCHITURE Address: _ ' HUNTINGTON BEACH,CA Phone: 714-655-3139 . , . :�" - Phone: - ' 228 CREST AV "�' - , • - Zip: 92648,• _ License: C29552.C- - License: ,-� ... SCOPE OF PERMIT--- v`- /. • 2 NEW WINDOW OPENINGS ON SECOND FLOOR FRONT ELEVATION FOR UNIT B ONLY. - `-�'� ., S . '7, �' - \ C. FEE SUMMARY _ Plan Check:' .' $21.22 '.•„ - - _ - - _. Calc Valuation: $800.00 Permit , $32.65 : . __ I, LII,, a ,/--.- V, . : Claim Valuation: - $800.00 SMIP Res: . $0.50 - - SMIP Com: ' $0.00 ` ' . Other:. . $0.00 - ' - v`, -, Inspection:. $0.00 =��- " tr - _ - :%/.:..:r(= ,=j i 1/ 1, ( Total: <, $54.37 ' � �i PLANNING &ZONING /,' -SETBACKS. ' MAIN STRUCTURE Front 0-0 Rear . -0-.0 Left 0-0 . 1. ' Right 1 0-0' ACCESSORY ' Front 0-0 _r Rear .0-0 " Left 0-0 - Right,' ',/070 / ', PARKINGExisting: 0 ', Required; - 0 ' " --, Proposed: -0 '" . , • • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1,12-21-92) • EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: 'In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 ' 2446-48(8N0) '' '• DECLARATIONS ^ WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ' • ❑ I'have and will'malntain 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 end 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 if the permit/s valued at one hundred dollars($100)or less.) 1' I certifyytat in.the.perfonnance bathe work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' --compensatioalawsof California and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith -+ igco;these osl -Applicant Signature: ('OR9o`R,ld(€T Dae: 7-Ia-20-06 %_r WARNING:FAILURE TO SECU W RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),IN ADIXT ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of DMsion 3 of the Business and Professions Code,and my license Is in full force and effect.Uc.4 Class A 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,CMI Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects t>applicant to a civil penalty of not more than five hundred dollars($500).): /iq...I teas owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. ,-7044,Business and Professions Code:The Contractors Ucense Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.11,however,the building or Improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.), • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors Ucense Law does not apply to an owner of property who builds or Improves thereon,and who contracts Mor such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exemeR64n� Business and Professions Code for this reason: Signature% l�` yyLL--S�-- �i�' Mite: il141-�6 Ownerlb verifi rivers license. Yes 0 No Drive`UcenseNC Mkkg5R3�7 LE jiss;_09/0r Verification of Ownership by(type of d mens,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap,3.2,Grp 2,Art 2,Sec. 341,TItle 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: DMsion of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: ' I 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes _0 No �_ ^ (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .- 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? d 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 ap plicatlon appermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? I]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). _.— __.._ .._.-......__..._. �.._o_____. ._.._ _.._... . —..—__...._. 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 —nib (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 Ifa a permitn from tae South Coast s Quality ed by Californiaeal or other eeion control4district03ben Bade? Is required for the work which is the subject of this application,have all of the disclosures prescribed by Celfoia Health and Safety Code Section 42303 been made? ❑Vas 0 No ..._....___.p ____.. ._..._..__ ._.___._._ .._._,—_. 6 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPUANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described,prppert Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sgnr aNre Of Lagel.Owner(s) '4:-^^"-'•"._..•'_._" N _Latf ems.• And/Or Authorized Applicant Date CODE}, 22EG- m+TYPE PATE IIfIBULS CODF1 IysPECRON TYPE 26TE ItOMSLA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing • 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Flre Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition . . „ . 250 Final Building/Occupancy %!'SJ O.r 74✓ Pe � :1-1'( r • . CITY OFSTA MESA • 4 BUILDING DIVISION j: �t r..��i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER G Si' . • PERMIT B06-01144 4. (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.cEOBILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2550 ELDEN AV Status: ISSUED Suite: - Applied: 07/10/2006 Vicinity: UNIT G ._ Issued: 07/19/2006 Primary Occ: R1 Type of Construction: V-N Parcel Number: 43916111 Zoning: Applicant: AGNES ENTS LLC Address: 245 MESA DRIVE Phone: 949-646-6966 ISSUED BY: COSTA MESA,CA -- ---Zip: - 92626 "/-1:- - _,-_ - - - . ., Owner AGNES ENTS LLC - - - Address 245 MESA DRIVE- ' - - �‘ ,I , / _ ` .7. (-'27/ 1 \ y - / s Phone ',949 646-6966 --� COSTA MESA,CA" - V i 1 `-_-__ Zip: /r 92626 _ • Contractor ' ',OWNER-BUILDER `- �_ - v `� ;,, , ` V� \‘ � Address: / - ��-A � %c .?--;;-'5:2):,N/ Phone: . ; License: 000000 �` r„i'/ // . , -7< 'Arch (' " ;;/7 Eng: Address: - I - Address: Phone: _ - -' ' �'- - - 'Phone: �'. Zip: ' License: . ----- , k License: _ • ,s • ' .. -i - _ r . - - - N . . , SCOPE OF PERMIT- �- INSTALL 8SF, ,PATIO INFRONTOF-UNIT G - -y - , • FEE SUMMARY N. ' ' 1 • Plan Check:. I $15.28 '% -„ r-,.- - - Calc Valuation: $128.96. Permit $23.50 ' .� I..-1 ,' .•. ”( •, '\;Claim Valuation: $0.00, SMIP Res:, , $0.50 • SMIP Corn: ,, $0.00 '// I • -Other:, $0.00 - Inspection: ' $0.00 — 7/ , "` ,,� -Total: ,: $39.28 ./_ j • ,,/' _ _ ,, PLANNING &ZONING ''/ _ . -SETBACKS- ' MAINSTRUCTURE Front 0-0 Rear •40-6- ' • Left - 0-0„ Right 0.0 • D � ACCESSORY _ Front 0-,0: - Rear" 0-0 Left 0-0 - Right ' `-0=0 --/.7; - i PARKING Existing: 0 '- Required; - 0 ,Proposed: 0 , /,/ " N„,.1-".,.--„\., ',- (C // _ 7� • 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 244646(WOO) DECLARATIONS ( , ,.Th4 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: Cartier- Policy Number. (This section need not be completed 11 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' 7 +I —compensation laws of Califon! ,and agree that 81 should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these r sic ,06qpnt Signature'.re'. Dte:, J71q.-7..,04 W��o'rFNLURE TO SE WORKERS OOMPEISATKIN COVERAGE IS UN AWFLL MID SHALL SUBJECT AN EMPLOYER TO CRI/ANAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOUARE(5100.000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST.MID ATTONNEY"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.Uc.I Class I 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,CMI Code). Lenders 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 dull penalty of not more than five hundred dollars($500).): ? /I es 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. r 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 ere 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 WRIT LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt and sec. Business and Professions Code for this mason: -Signature:-- login(--- CrDale: - . el A towner.1D vedfl \u.Y.driver's license. Yes 0 No Drive'slIcense No"� L 9 n Or:AO'- Expires: Ann: Verification of Ownership by(type ofd ent,i.e.-property tax bill or deed): 1-''�'`��� DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Mt 2,Sec. 341,TItle B,California AdministratNe Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ti Ye--T-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 materlats 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 th❑e applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? 0 yesNO (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 en RMPP by businesses which aro 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 compiled with? O Yes fl 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_aermit for such construction or modification from the South Coast Alr Quality Management District or from any other air pollution control district or agency? ❑Yes J 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? ID Yes In-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 Alr Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). ----- -��--- CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Ls 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-des; p ry for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this rn t until n inspection. 7-��i-2 G� 6igoeaue-Ot4sget.ownar(s)—�'�- oats"--„ And/Or Authorized Applicant Date ;Oar I, tNSPECl1ON TYPF DM EMU gmQE( 91SPECIION TYPE RAZ DLII 1618 Fixed System Final Fire Prevention • 206 Final Mechanical 1268 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 o , 204 Final Demolition _ . .250 Final Bullding/Occupancy / /17o(o l e74$a- -r P ol CITY OF COSTA MESA 466 BUILDING DIVISION F , I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 0.141 PERMIT B01-01011 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2550 ELDEN AV - Status: ISSUED Suite: Applied: 06/29/2001 Vicinity: Issued: 06/29/2001 Parcel Number: 43916111 Zoning: Applicant: RAY,ROSS ISSUED BY: C/r 1 -- Address: 2192 AMERICAN AVE.#A Phone: (714)646-8694 COSTA MESA,CA Zip: 92626 Owner: RYAN, GERALD R TR Address 3902 RIVER AVE Phone: NEWPORT BEACH,CA Zip: 92663 Contractor: ALL WEATHER ROOFING Address: 2192 AMERICAN AVE.#A Phone: (714)646-8694 COSTA MESA,CA Zip: 92626 License: 739271 • Arch : • Eng: • Address: Address: Phone: Phone: Zip: License: License: • • SCOPE OF PERMIT. • . - TEAR OFF EXIST. ROCK INSTALL-2 LAYERS OF 15 LB FELT AND 25 YEAR COMP.SHINGLES. 35 SQUARES. , FEE SUMMARY Plan Check: $0.00 _ _ ___ -• .Calc Valuation: $4,500.00 Permit: $111.25 - . - Claim Valuation: $4,500.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: , $0.00 Inspection:, $0.00 • Total: $111.75 ,'.� �� ` ' PLANNING &ZONING - SETBACKS. MAIN STRUCTURE:Front' " 0-0 , , , Rear -0.0 Left 0-0 -- - Right 0-6, ACCESSORY Front . 0-0 Rear 0-0 Left 0-0 Right PARKING Existing: 0 - Required: 0 Proposed: 0 - NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: 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. �❑ II 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!!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 oroweIons. Applicant Signature: , "WARNING:FAILURE TO SECURE WORKERS'COMPENSATI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,0001,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 lam 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:k — class a_ '"(—31 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 for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec, 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,es 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 ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (if"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or-other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. II ^ re Of Legal Owner(s) Date p[� n. 4-29,01 �And/Or:A orized-Appl`cant -.Date I CODE I INSPECTION TYPE PIA E INTRIALE CODE! INSPECTIDNTYPE K QAII INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof ! - r 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 7— P A.ECT ADDRESS: UNIT: ma-ma2550 ELDEN AV CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 070937 ADDRESS: RYAN, GERALD R TR 3902 RIVER AVE PERMIT NO: 8 070937 PLAN CHECK NO: 00132-95 L GOVT: N SUPP : N NEWPORT BEACH,CA 92663 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE; ADD ARCM/ENGINEER: 714 ) 650-0500 RED.NO.: ADDRESS: UNIT: JOB DESCRIPTION : ENCLOSE 77SF PORCH & ADD 61SF TO FAMILY SQ FT: 138 PERMITTEE: CLAIM VALUE: 5, 000 . 00 CALC—VALUE: 10, 212 . 00 GROUP OCC : R-3 / ADDRESS: GERALD RYAN ( 714 ) 650-0500 3902 RIVER AV (., COMMENTS: ADD A TOTAL MOF 138SF TO FAMILY ROOM LICENSED CONTRACTOR.BCLARATION: InerebY affirm tnallam licensed undCrp .9n2o6L der 9lcommencinp with Section ******************************************************************************* 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. ZONING REQU IR EMEN TS CITY LIC.: STATE LIC.: CLASS: SETBACKS EXP ; pate: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: 25 FT IN REAR; FT IN FRNT; FT IN REAR : FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: 10 FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: � PARKING REQ• PROV: PARCEL: 43916111 ZNE: R2 REF NO: '7 Certified copy is hereby furnished. 0 Certified copy isfiled 'h the city B• in '•• n. PLANNING NOTES> ENCLOSE PORCH/EXPAND EX LIVING ROOM. NO DR B/C OK OS ( 79.20 _ i > SF REQ/7944 SF PROV) ; OK STBKS & ONLY 61 SF IN AREA. Applicant: o ******************************************************************************* MPTION FROM WORKERS'COMPENSATION OECLAM71 : need not be completed d this for one hundred($100)or less). D E V E L O P M E N T SERVICES REQUIREMENTS 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 10 become �/ subject to the Workers'Compensation Laws of California. ZONING APPROVED BY W IVC DATE: • i Date: Signature: , / �M NOTICE:II.after making this declaration.you should become subject to the to Compensation provisions of the Labor BUILD BUILDING APPROVED BY v V DATE: 4 EN 5 Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. • CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; ( DATE:which this permit is issued(Section 3097.Civ.C). ************************************** *�*********************** ** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT;Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for following reason BLDG PMT PLUMBING ELECTRIC MECHAN IC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or p ERM I T 126 . 00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed1 . 02 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the BusinessSMIP/NON—RES and Professions Code)on that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 81 . 90 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($5006 I S SUE FEE I. as owner of the property or my employees with wages as their sole compensation. will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sate(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 127 , 02 0 . 00 81 , 90 208 . 92 208 . 92 . 00 does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale,lf,however the building or improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED : 127. 02 OVER/SHORT: . 00 ' lorthe purposeol safe). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusivelycontracting with licensed contractors to construct the project(Section 7044,Business 126 . 00 1 . 02 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of prepe who builds or improves thereon and who contracts for such projects with acontractor(s)license pursuant to the Contractors' .te License Law).l am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. Tl I am exempt under Section:B P 7 0 4 4 B.s P.C. INDIVIDUAL F E E BREAKDOWN 1F' for this reason: OWN]ER—BUILDRE TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST 0 !r— 5/— •"-,s Owner t/41—� /�/L do hereby certify that I am aware of and understand the requirements:California Health and Safety Code : ions 25505,25533,and SFR 138 D W E—TYPE V—WOOD FRAME —GOOD 74 . 00 10, 212 , 00 25534 and that I on any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is : •ct.I agree to comply with all city and county ordinances and stale laws relating to building construction and hereby authorize represen ativ s of this city to enter upon the above-mentioned prorty for inspection purposes. Date _i — 3/— 9.S Signature' _/Li' A_ /// 01 00175805-00175806 TOT 127.02 Driver's License or Social Security a:R. n 4 q n 1 G DATE; 01/31/95 TIME: 08:42 1641.46 White—Building:Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING POOH SPA t APPROVALS Permit# I Date Inspector APPROVALS Permit # Date Inspector _t 1 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4: Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5, Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings i/3,6I 6/ 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line& House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater &Vent-Final 13. Roof Drains _ • 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning _ FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace . ,: - APPROVALS' Permit # 21. Ducts,in Structure - 70. Underground-Hydro 22. Ducts, Ventilating. - 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing • • . 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing • 74. Overhead Hydro - 26. T•Bar Ceiling (Structural) & MonoCoat 75. Dry Chemical • 27. Frame and Flashing _ X46-/ ap- 76. Dry Standpipe 28. Lathing& Siding • '1� • 77. FIXED SYSTEM FINAL 29. Insulation Ot1�Q7 vC . . 1aesr 78. FIRE PREV. FINAL 30. Drywall Nailing �J/"� HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUE 33. Final.Electric - Notes:Si �Qn G Ok- r> cafe 34. Final Heating& Air Conditioning - ¢ �/�,�. t• YYY/// 35, Final Gas Pipe-Tes (ems 36. Hood or Canopy - 37. Final Factory Fireplace • 38. Final Plumbing 39. Water'Service-Final 40. Gas Service-Final •• 41. Solar Domestic-Final .. 42. Backflow Preventer 43. Backflow Irrigation -- 44. Landscape Irrigation System - 45. Sound Attenuation • 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 5 '2/ r _ r 48. ANAL PLANNING V • 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY • No. Date PROAECTAODRESS: UNIT: OWN t% NAME: 2550 ELDEN AV CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 070938 J ADDRESS: RYAN, GERALD R TR 3902 RIVER AVE PERMIT NO: E 070938 PLAN CHECK NO: N GOVT: N SUPP : N NEWPORT BEACH, CA 92663 CONSTRUCTION TYPE: PERMIT TYPE; ELE PURPOSE: ADD ARCNIENGINEER: 714 ) 650-0500 REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : ENCLOSE 77SF PORCH 6 ADD 61SF TO FAMILY SQ FT: PERMITTEE: CLAIM VALUE; CALC—VALUE; GROUP OCC; R-3 / ADDRESS: GERALD RYAN ( 714 ) 650-0500 3902 RIVER AV COMMENTS : REF; B-70937 �,T pp (� *********Br***** ****+!*************F ***kr***Fr***err*************** *a6«> ** -*r+ES.a *** LICENSED CONTRACTOR DAARATION: I hereby allirm that I am kensed under o er 9(commencing with Section 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. Z ON ING R EQUIR EM EN TS S E T B A C K S CITY LIC.: STATE uCi: cuss: EXP : Dale: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV; PARCEL : 43916111 ZNE; REF NO; 7 Certified copy is hereby furnished. ❑ Certified copy is Med with the city Building Division. PLANNING NOTES> • > •. Date: Applicant: **********************************,**********************r********************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be co•0•to it the pernit is IW one hundred(5110)or less). I 7 I certify that in the penormance of the work for which this permit is issued.I shall not emp i a9y.pe�on in any manner so as to become D E L E L O P M E N T S E R L I C E S R E Q U I R E M E N T S su, ct to the Workers'Compensation) ws of California. /�/{/ q ZONING APPROVED BY DATE: e 5/' 9 S Signature: NOTICE:If.alter making this declaration.you sho . recome subject to the Workers'Comp cation provisions of the Labor BUILDING APPROVED BY : ' Code.you must forthwith comply with such pro .ions or this permit shall be deemed revoked. DATE CONSTRUCTION LENDING AGENCY: I hereby affirm roar there is a construction lending agency for the performance a1 the work for APPLICATION ISSUED B Y: DATE: which this permit is issued(Section 3097.Civ.Cl. LENDER: ADDRESS: ******************************************************************** ********** LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,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/she is licensed PERMIT 5 . 25 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 50% SMIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis or the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15 . 00 I. as owner of the property or my employees with wages as their sole compensation. will do the work, and the BUILD ING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTAL S----> 5 , 2S 15 . 00 0 , 00 20 . 25 20 , 25 , 00 does not apply to an owner 01 a property who builds or improves thereon,and who does such work himself/nersell or through his or her own employees, provided that such improvements are not intended or offered for sale.If,however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED: 20 . 25 OVER/SHORT: , 00 for the purpose of sate). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 20 . 25 ❑ antl Pmlesslons Code: The Contractors'Slate License Law does not apply to an owner of properrlryy who builds ar improves thereon and whUtofttheir oker's Cumpensathdnsurashbse eprovdedlme.Wnlldtlor5'smtl License L4WI.Idm aware ******************************************************************************* that proof of thecontracts Worker's projects with insurancecontrashould be provided tot m!. Di lam exempt underSection:BP7044 B.SP.C. IND I V IDUAL F E E BREAKDOWN n. for this reason: OWNER—BUILDRE TYPE QTY DESCR IP T TO N UNIT COST TOTAL COST 40 /— 1 – 9,S Owner _/L!� — ./ ao hereby cendy that lam aware of and understand the requirement d California Health and Safety Cade Sec Ions 25505.25533,and ELE 2 FIXTURES, LIGHTING 1 ST 20 EA, 75 1 50 25534 and that I or any fuiore building occupant wilwit not(circle one)need to comply with said state codes and the requirements for a ELE 3 R EC E P T/OUTLET 1 ST 20 EA, . 75 2 . 25 permit for construction or modification from the Air duality Management District.Residential construction applications are exempt from ELE 2 R EC EP T/SWITCH 1 ST 20 EA, . 75 1 , 50 mese provisions. END OF FEES Dale: Applicant: I hereby certify that I have read this application and state that the above information is co • t. agree to comply with all city and county Ordinances and state laws relating to budding construction and herebyout•'re representatives o his city to enter upon the above-mentioned property for inspection purposes. ate: (�37-9-Signature: =�/. - llif //i 0 TE:1 00101/31/9517 5307 TIME: 03 9 20.25 Driver's License or Social Security a: R 7 0 4 • a c 1641.46 white—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor POO, WA '?CONSTRUCTION AND PLANNING • APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector ^I. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit•Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13, Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS ' • Permit# 21. Ducts,in Structure • • - 70. Underground Hydro 22. Ducts, Ventilating , • 71. Product Piping 0 Gas G Oil 23. Gas Pipe-Rough & Test 72. Underground Flush • 24. Roof Framing' • 73. Undergrnd.Storage Tank 0 Gas 0 Oil • 25. Roof Sheathing 1 74. Overhead Hydro 26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe • 28. Lathing 2/Siding , 77. FIXED SYSTEM FINAL 29. Insulation • ' 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat - 79. FINAL INSPECTION 32. Electrical Power Meter•Final / / 80. FOOD CERTIFICATE ISSUED 33. Final.Electric _ 3/!0/ ' Notes: 34. Final Heating& Air Conditioning ((( ` 35. Final Gas Pipe-Test 36. Hood-or Canopy • 37. Final Factory fireplace 38. Final Plumbing - • 39. Water'Service-Final . ' 40. Gas Service•Final 41. Solar Domestic-Final 42. Backflow Preventer ' 43. Backflow Irrigation 44. Landscape Irrigation System ' ' 45. Sound Attenuation 46. Handicap Regulations • • 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING - 49. Electric Release to Edison _ 50. Gas Release to Southern California Gas Co . 51. CERTIFICATE OF OCCUPANCY • No. Date \I 19 I SbAR 5.6T�nure4 1 Site *****6.00 ' COSTAE MESA BUILDING-SAFETY DEPARTMENT • P.O:Box SI7 COSTA MESA,CALIFORNIA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING enILDING �Ajj � /Y / r�/ For Off ice Use Only ADDRESS {-.,j .�� 17'Is& /('Vy(y OF," RECEIPT NO. �B 8T,O� COSTA MESA, CALIFORNIA 1pVV LA /j +{� /t - //// Rear oY DST.RECEIVED DATE ISSUED OWNER M (/�.••1, lT jn�� /j/'•_ MAIL1.1-'3-'1) � ♦_ /,y�/��¢ BU ILtlINO ADDRESS 2,.i3 O £116'7j/r�� I¢eros . • F RERESS �O // CITY I.R 1 TE." ' y' ZONE " ..3t).. TYPE l( GRO P "•'" . ARCHITECT , TEL APPS t•,Ell it I :(401OR ENGINEER NO, `�I {�. .Iy DAT- JJJrIJ' y NING ADDRQ59 E R1_ NO,OPUSE OF NE/� �..(� ) /ry �fJ�y{ PLANS �IBUILDINGto CONTRACTOR r/,,,,v l 4, vA Ey/'Lt ' f�.{ ))))��11DESCRIPTION / 6J�, 3 / ., ADDRESS �54- 7}� }MSI�� i I f l O. f7 CITY \?$J9 ISL. A.P.NO. V ( O ' 06 STATENOC.N / / yy fff TE SI-ME^ 90'TO SIE: NODE V REAR PE H`NG SHALL BE LESS THAN VES Y OF LOT {�''x 3 0 / ' NO.or BLUGH. / ALLOWED (U.B.C.REQUIREMENT) /^ NOW Ox�.OT YARDS APPROVED YARDS APPROVED I USE OF EXISTING BLDG. /, (.f/Sr��jal� MAIN BUILDING ACCESSORY BUILDING (FROM C/L STR 3% qq SETBACK LINE FROM b _ r f DG! CENTER OP STREET y V REAR YARD +�L��,y// FRONT LLLBI�B""I ��Ij L P' SIDE YARDI LEFT �� r I RIGHT 24 it d r R.SIDE a3 FT. FT. DESCRIPTION. OF WORK L.SIDE /ie I 7.T' FT. NEW ALTERATION ADDITION (t REAR A.(� FT. Fr. DISTANCE B . BET.MAIN 8 REPAIR MOVING DEMOLISH MAIN SLOGS. ACCESS.BLOCS. VBUILDING / NO.OF J SIZE �Z ,/S ROOMS /ROOF /STORIES / CSU.P.# 7/� APPROVED EXTERIOR WA./(j CtV ( COVERING ('�(J/y APPROVED �1 I j 1 J h / COVERING J�{j 9Y I'..[`/'I`/TIil DATE Cj,3_`Y73 USE OP BUILDING AND WORK TO BE PERFOR D SFKY;ee ge i a--f d �'" 3 .sre)c c p 1pc,1/47p, _etc 727-1. i SQ.PT. to 10 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM• PURPOSE OP SSTASLISHING A PERMIT FEE ONLY, O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION / G' BUILDINGCONSTRUCTION. /.��._ $ (�J N {�� ,//I /�J PERMIT FEE S SIGNATURE OF j(I C/C/ --- t(G PERMITTEE $ E o A AUTHORIZED AGENT TOTAL FEE $ O hi 20392 I COSTA MESA BUILDING-SAFETY DEPARTMENT FEE RECEIVED P.O.BOX 317 COSTA MESA,CALIFORNIA AUGd 1989 For Applicant to Fill In Completely APPLICATION FOR PERMIT �1 TYPEI OR PRINT /r r�RFII PN,AAWI�G&D}l1B T. BUILDING ADDRESS (�� v j%•_( U�'l l" t%*eO�T7fB 9� �,/f�{1(�1j'+(f{lD..I S RECEIPT NO. LVV V2 COSTA MESA. CALIFORNIA 54214.1...44A J R[ Dy�7[�RCCygIv[9l gpAYE I UED r OWNER -./C2 • • !/ / '!9 J)) U �.�1/. MAIL ��1/l BUILDING �s �O / /7 // ADDRESS Z• ref) '�ZT`��T`�( ADDRESS �(p �L/Ojl�{/ �j�(�}G J�f�/ e ((,{rye FIRE / Ellam" ;ROL:3 - ZONE APPROVED GROUP CITY �7 Q /Q OR ENGINEERARCHITECT NO. BY • / DATE /J -- / --43 ZONING ADDRESS —1 �/� ZON6fJO:OP F NEW - © J/1. 1/1( LANG UILDI NO r $ CONTRACTOR ,. /' /✓S (delar I 3/� 1 •�� ,('7 ADDRESS .01-4.4.-1---- 01-4._ 1- ' LEGAL DESCRIPTION/�-O � J//{��1, /�/� . • CITY �1��(/ A.P.No.j N O / U. A ' NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE TEL. 5.-._ _ /� 30'TO SIDE&REAR P.L. LIC.NO. NO. !/[�+^�'� EAVE IZEOT O �� DO SI NO.or BLDG,. / NOW ON LOT ALLOWED f U.B.C.REQUIREMENT) F L YARDS APPROVED YARDS APPROVED USE OF EXISTING BLDG. Il--l=-=.� ,/..� IFRoA IN LBUIROIfiT;( ,tACCESSORY BUILDING • SETBACK LINE FROM 5 1 y= ' f REAR YARD0V ( - FRON J)/C.�G(/J'// FT. CENTER OP STREET /\ ��yy pp LJ� SIDE YARD I LEFT /0 is I RIGHT � ' R.SIDE )/FT. FT. DESCRIPTION OF WORK L.SIDE J FT. FT. NEW x _ ALTERATION _ ADDITION )( REAR.L b OFT. FT. DISTANCEYBET. BET.MAIN e REPAIR MOVING DEMOLISH MAIN BLDG'S. ACCESS.SLOGS. VAR.# DATE BUILDING / NO.OF SIZE (•� F� ROOMS STORIES / C.U.P.# APPROVED ^� EXTERIOR WALL ROOF �// a APPROVE' I f 171--q -Q —613 COVERING OA/ I COVERING f�Ll/6!{ BY I ' W 4 DATE o USE OBE UILDING AND WORK Sr COq 80.F7. B I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. G PLY WITH ALL CITY ORDINANCES AND STAT[ LAWS REGULATING VALUATION BUILDING CONSTRU / N PERMIT FEE $ Q SIGNATURE OF (,J'° D PERMITTEE .-J)�`/T YYYJJJ .rte V $ /�� PLAN CHECK $ �) O AUTHORIZED AGENT / / ✓ c ...;\ TOTAL FEE $ f� -.* . PATO 4 1�2 )EC 79-75-001132* ****37.17 .s COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APL A ON FOR STRUCTURAL PERMIT For Applicant to Fill in Completely— Use Ink Only roys ��0G?SEX/ Ate__ REC EO v DATE RECEIVED DA E ISSUED BUILDING �,/�/ i .27_3 ADDRESS �/J ��s Ern Y A 7 4E7,40asIC hi 1 S 0'70 ' CO ERMIT NO. BUILOWNER ` A.P.NO. �` ` ` AA (� ADDRE SNG a ) �-t_tE4J kJ MAIL /I�O �� ADDRESS r 'l �7 �p CITY &1 i,4 /�/ NO.TETRACT 37Co V COT.3I BLOCK CONSTRUCTION 25y �II/ C /�/[L6iP NEW ADD ALTER REPAIR MOVING OEMOI ISH LENDER /� J BRANCH F nC (t ADDRESS OWN �EJ ry-7 yJ /7 / �/-1- � ' ARCHITECT TEL. USED“/ I/ ar iaimc r y/ �$E a rn OR ENGINEER NOFIRE �JJ''/ /!! ADDRESS 'J ZONE T PE � GROUP Qil CONTRACTOR G. g /274, t/ ' APPROVED // I DATE a'`,?y ADDRESS / Z' NO.OF USE OF NEr CITY NO. TEL. I PLANS Z t.`-y BUILDING$ �V e. F STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING w S1ZE NO.OF BLOCS. (FROM C/L TREE I n1 . O, SI LOT NOW ON LOT FRONT I.-1;57T. •✓ SFT! bla et USE OF Cil EXISTING BLDG. R SIDE sFT. -% FT. cn Separate permits are required for / L.SIDE -®'FT. LI, welectric,plumbing and heating work. REAR 134=-FT. W FT.10E51-. E. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN 8i,_ aQ A/J/�/ i MAIN BLOCS. ACCESS.BLDG . ..l ���^ M,s-�'1 ✓�P C.U.P.VA � DATE 75 � APPROVED I-s-W. }a L / /I /J /�� 7 Q Girl v��4/ py ROVED�'AJ�II DATE L / .2.2(C. ce / HOLD FOR SkECIAL REQUIREMENT w o I hereby acknowledge that I have read this application and state N. CC that the above information is correct and agree to comply with -- CLI all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of (( Looe �lrs tl//7� �/ thereby of i ylthat le. / MSO. FT. i-.Llo'v� IN'y�, /o 5k ? O I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, HE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of State of California Business — y and Pr/ ision ,, Div3Ch ter 9. VALUATION PERMIT FEE $ n `w SignatPLAN CHECK $ 9 ,doPermiNIN TAX $ 7 � `7I-7L fla/lAutho TOTAL PAID $ • ms 444 0 24 _Dp ?7_7fcPAIUOQIOJS (1****56.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 A LIGATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely— Use Ink Only BUILDING /J — \ � " R V BY DATE RECEIVED DATE��/$%�I�J EQ%� ADDRESS 2ssa EL•OC+1/4) 41VE a-1 N co PERMIT NO. OWNER (t naaLo Es(*kJ A.P.NO. MAIL AS S 255° c r�av4 y, ADDRESS ADDDDRREES TEL. CITY NO. TRACT I LOT BLOCK CONSTRUCTION IR ADD ALTER REPAIR MOVING DFMOI ISH LENDER //`\ 'mss� BRANCH ^ ' ^ , OWNER /£ I L4O A ADDRESS _ VALUE_ a _ _ CL VALUE ARCHITECT TEL. USE C�F{�,pa� OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS TEL. ZONE NO.OF USE OF NEW PLANS BUILDING CITY NO. F STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING ILI SIZE INO.OF BLDGS. (FROM C/L STREET) 0. OF LOT NOW ON LOT FRONT FT. FT. 4 USE OF (15 EXISTING BLDG. &SIDE FL FT. CA 2 Separate permits are required for L,SIDE FT. FT. electric,plumbing and heating work. REAR FT. FT. k7 USE OF BUILDING AND WORK TO BE PERFORMED F DISTANCEBET. BET.MAIN& Q0 MAIN AINBLDBLD GS. ACCESS.BLOCS. VAR.# DATE C.U.P.# APPROVED a 7 APPROVED 0+ —AY DATE .1 a W 0. I hereby acknowledge that I have read this application and state n 04 that the above information is correct and agree to comply with m 0. all laws regulating building construction, and I shall not employ Z any parson In violation of the workman's compensation laws of m the State of California. .: 3 I hereby certify that I am properly licensed as a contractor under SQ. FT. IN the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter19, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEEONLY: n em exempt from the provisions of the State of California Business VALUATION r ? and Professions Code, Division 3,Chapter 9. PERMIT FEE E J n PLAN CHECK $ u. Signature of A)r/ 0 Permittee $ TAX S u.2 SU j V Authorized Agent TOTAL PAID $ / a��� w 41022 1Ef. 79-75�°5."001131* ***228.04 w COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink 0 y RE I D BY D•TE RECE V D DATE ISSUED BUILDING 2,rso L / L _ „y 4 , _ re ADDRESS R RYA ''') GEnt, AYA � A.P,NO.ILR`6 0_0(o PERMIT NO. OWNER /J� ���/f//�� MAIL BUILDING /)�^`�D(.y���1'(/b,r�'NV• 8�' r ADDRESS -7 a sacD1Ile eA ADDRESS oc I �p CITY CAI TA .*Ar4 NO` t 4210 9 TRACT 376 1t tOT 31 BLOCK CONSTRUCTION ENT UCTIOND 0� �iy9`� ^S.� �_p NEW ADD ALTER REPAIR MOVING DFMr]) ISH BRANCH 'f 2,0i/- ] ARRe 4, r A. H OWNER • ./ ADDRESS SA 4-7A Ae,A • • 'tom fsE J'� r ARCHITECT TEL. USh r /a.- ems"' .. /.• $/a70/r/ OR ENGINEER NO it?'• FIRE ADDRESS ZONE YPE ' GROUP 4 CONTRACTOR C s R s RyA ik APPROVED BY , el - DATE ie — - ADDRESS 3 2zit DA kOTA Z NO.OF USE OF NEW UNIT CITY CO JITA "4 sa TEL. O crt tzy ` '2, PLANS Z BUILDING , • F STATE ✓J CITY I YARDS APPROVED YARDS APPROVED LIC.NO.D'_ 2 Z 77 7 3 LIC.NO. MAIN BUILDING ACCESSORY BUILDING LTA SIZE NO.OF BLOGS (FROM C/L TREE7) 0. OF LOT et, V l e O I NOW ON LOT , _FRONT I FT. i FT. y USE OF et, /J��r t, EXISTING BLDG. R E1 i firer 7'Ai R.SIDE 2Zt t 0 FT, rA SF Separate permits are required for L.SIDE 'OFT. FT. G electric,plumbing and heating work. REAR 2SFT. FT. [s7 USE OF BUILDING AND WORK TO BE PERFORMED F DISTANCE BET. BET.MAIN& 40 /`� D MAIN BLDGS. ACCESS. BLOCS. •''�/ 74 Q J 'X / T (/Ni t s C.UP..9W2`nDATE 7SlrAPPROVED/— S 7(o >. RES t• D C...7-At APPROVE J� Oy2..."2-7--)6, —� _—)6, . HOLD FOR S ECIAi KC�JutxEK1L- YS w O. I hereby acknowledge that I have read this application and state n O m pg that the above information is correct and agree to comply with m 0. all laws regulating building construction, end I shall not employ .Z any person In violation of the workman's compensation laws of e o the State of California. //�/ I hereby certify that I am properly licensed as a contractor under ( a SO. FT. 5 the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m 4.3 Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a rl am exempt from the provisions of t tate of California Business VALUATION PERMIT FEE $ v and Professions Code, Division 3,Ch er 9. Signature of ? PLAN CHECK $ /Xfs 73 o C� Perm lttee S/ J oo TAX S ii, 73 3/ U ki Author d Agent . TOTAL PAID $ 27R.o4_ tr ØJc22 CFR 27-76PAILIOO1094 *336.50 COSTA MESA BUILDING-SAFETY DEPARTMENT . P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 P (CATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only ,y R E E BY DATE RECEIVED DATE ISSUED AB UD Na3�i' cc Dom.. / ve a 6_ 'E P-11- PER �f ADDRESS 0( V GIVil/ v N ` NO. OWNER A.P. NO. MAIL BUILDING ADDRESS (�(•// (�rpav ' orR i ADDRESS TEL. CITY NO. TRACT ` LOT BLOCK CONSTRUCTIONADD ALTER (REPAIR (MOVING ftFmoi ISH LENDER /� BRANCH N�/V OWNER $4--g4 to / / ADDRESS VALUE-- ARCHITECT TEL. USE /kWh°r Is s $ OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROUP APPROVED . CONTRACTOR BY DATE ADDRESS ZONE NO.OF USE OF NEW TEL, CITY ND. PLANS BUILDING F STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. (LIC.NO. MAIN BUILDING ACCESSORY BUILDING W SIZE INO.OFBLDGS. (FROM C/L STREET) 0., OF LOT I NOW ON LOT FRONT FT. FT. G USE OF 4, EXISTING BLDG. R.SIDE FT. FT, rn Separate permits are required for L.SIDE FT. FT. electric,plumbing and heating work . G - REAR FT. FT. W USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& QMAIN BLOCS. ACCFSS,BLDGS. VAR.# DATE QC. U.P:# APPROVED 7 APPROVED } --BY DATE 'U w C. I hereby acknowledge that I have read this application and state N N CL that the above Information is correct and agree to comply with m S ell laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of o S the State of California. I hereby certify that I am properly licensed as a contractor under SO. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: — us am exempt from the provisions of the State of California Business VALUATION ' PERMIT and Professions Code, Division 3,Chapter 9. PERMIT FEE $�33/ !teeSIP) m PLAN CHECK $ t(/ co a Signature of Permittee $ TAX S. f Authorized Agent TOTAL PAID $J.3 Y �U