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HomeMy WebLinkAbout1960 ANAHEIM AVE - Building Permits . CITY OF COSTA MESA , 4 BUILDING DIVISION o,i �.... F i w ,4. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 OK PERMIT E03-00728 se (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1960 ANAHEIM AV Status: ISSUED Suite No Applied: 08/12/2003 Vicinity: Issued: 08/12/2003 Parcel Nunmber: 42214132 • Applicant: RIGAS, JOHN ISSUED BY: Address: 1918 S MAIN ST - Phone: (714)545-8289 SANTA ANA,CA: , Zip: 92707 Owner /BERGER,,KEITH C_ " , - Address 1960'ANAHEIMAVE. - - Phone: COSTA MESA,CA' Zip: 92627-2603 Contractor: DICKSONS INCORPORATED • Address: 1918 S MAIN ST -- - ' Phone: (714)545-8289 • SANTA ANA,CA •, '• ' Zip: 92707 ' License: 401327 - SCOPE OF PERMIT INSTALL NEW FAU AND A/C'FORAN EXISTING SFR.SCOPE OF WORK TO INCLUDE: 1 LIGHT FIXTURE, 1 OUTLET,I MOTOR TOI0 HP,'1 FAU<100K BTU::GAS PIPING AND 1 COMPRESSOR ' FOR NC.DUCT WORK TO BE INSTALLED ALSO. - - - 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 . ' $1'.10 1 up to 50 kva/kw $0.00 0 Y Recept Outlets $1.10 -- 1 : 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 . 1. Res Appl - $0.00 0,. Low Volt Wiring System/Ckt $0.00 0 Service to 200a - $0.00 0' Misc.Conduit $18.20 1 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 $12.30 1 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 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 Milan 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 ' ork for which this permit is issued. I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number ere: 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 performa _ •f the • ,,,for which this permit is issoe4,I shall not employ any person in any manner so as o become subject to the workers' compensationlywith these laws of - omia and f that If :.d become subje2t toworkers'compensation provisions of Sect 3700 of he ode,I shall forthwith comply ti In law p + Isions. I1r of he c -Applicant Signature: 4 -A . !9/I Date: 0-5 WARNING:FAILURE TO SECU-- ORKERS'COMPENSATION COVERAGE IS if AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,•••,IN ADDITION TO THE COST OF COMPENSATI• DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. - LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under prov ons of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professi s Code,and my license Is in full force end effect.Lic.4 A Class It (C Contractor's Signatur. a• .rE� - _A i_ — Date: C' 17, 13 CONSTRUCTION LENDI c 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 Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: ' Owner ID verified by 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 and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or 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 greeter 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)? T ❑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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 13 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 com•I 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-descri•,: • •• or in 'on purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig r- ..f Le.. a• rte s), i' j,y=/ Iii„ ate yf U Or Authorized Applican 1 1 e CODE L PST=ON TYPE ' ' PATE ItffiIAL$ - LODE( INSPECTION TYPE DAIF• MAL4 1616 Fixed System Final Fire Prevention - 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing n i • 200 Final Re-Roof 210 Final Electrical lEa (O 'C 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 , CITY OF COSTA MESA 4 BUILDING DIVISION Fes,Avael DEVELOPMENT SERVICES DEPARTMENT PERM NUMBER J PERMIT 4%PoRgrris se ,. M03-00395 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1960 ANAHEIM AV Status: ISSUED Suite No Applied: 08/12/2003 Issued: 08/12/2003 Vicinity: Parcel Number: 42214132 ISSUED BY: Applicant: RIGAS, JOHN ' " Address: 1918 S MAIN ST:,- ' Phone: (714)545-8289 SANTA ANA,CA . Zip: 92707 Owner BERGER, KEITH _ - _ - - Address: . 1960 ANAHEIM AVE Phone: COSTA MESA,CA Zip: 92627-2603 ' Contractor DICKSONS INCORPORATED Address: 1918 S MAIN ST Phone: (714)545-8289 . SANTA ANA,CA 'Zip: 92707 License:401327 ' SCOPE OF PERMIT INSTALL NEW FAU AND NC FOR AN EXISTING SFR.SCOPE OF WORK TO INCLUDE: 1 LIGHT FIXTURE, 1 OUTLET„1 FAU< 100K BTU,GAS PIPING AND 1 COMPRESSOR. FEE SUMMARY Quantity Quantity ISSUE:FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1. - - - Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 • Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 • Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 _ Compressors/Absorption Systems ' Gas Piping $6.15 1 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 - 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 . Boilers Fire Dampers , $0.00 0 Up to 3 hp $14.70 1 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm -$0.00 0 - 30 to 50 hp - '• $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $59.15 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. ave 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 numbberr are: Carrier: Policy Number: - (This section need not be completed if the permit is valued et one hundred dollars.($100)orrkiss.)mpss.) ❑ 1 certify that In the performance of thew.• for which this permit is Issued,I shall not eloy any person in any manner so a to become subject to the workers' compensation laws of - and •• _-that if I sho •become subject to the workers'compensation provisions of Sectlpn 3700 oylhe Labor Code,I shall forthwith comply with the : . . •. -•• `L/XJ{z (I 2/ ,.Applicant Signet - s.J 1 at ` - Date: s- er - r.WARNING:FAILURE TO SEC KERS COMPENSATION COVERAGE IS UN - L AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(51.•,...),IN ADDITION TO THE COST OF COMPENSATION • `GES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARA • \ I hereby affirm that I em license. . • pr. of C ••t: 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 till Class a --- i- . �� SII -Contractor's-Signator:: cif • .;TI Date: CONSTRUCTION LEND 'G 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 em exempt under sec. Business and 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)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 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 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 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? 10 Yes A No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Wit 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 (II Nee,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). Management District _ equed for the work _..._ 7 Ita a permit from—the South Coast res Quality bygement is Healtheal or and Sr airpollution controlion district3been agency is required the work which is the subject of this application,have all of the disclosures prescribed by California Safety Coda Section 42303 made? ❑Yes 0 Na 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 stat: :ws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pr r In ! 2icanHQ4 poses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. N. j/Z'(. • / ;ODE I INSPEC PE PAM- JNTMALS- ' CODE! INSPECTIONTYPE • 1616 Fixed System Final Fire Prevention 206 Final Mechanical • . ..t 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/Occupendy . Jan 11 05 '12: 29p Vp 'tox, Inc. 71 - 979-7863 p. 2 CITY OF COSTA MEsA.jBuILDING.sAFrY DIVISION . ' POST IN CONSPICUOUS.:PLACE ON THE JOB . NOTICE: ,;:. . Schedule inspection one workday in advance T{o stlledule inspections;call(714)754.5626.:Provide the following Information: 1)Permit number,2)Job address,3)IIn/s�pection Item number 4)Day 8r4 Ante y}}ou,need the•inspection. Bung REdrw:ly(Q `f'[[I QI.I NII: Owis ___j� 1 �(� . . Bating Pernik ry���fj cEbclrkal Paml �� Contrictlr Ir ` .J ,r��'�(,✓�'YL Q--(�f�'�a Mechanical Perritt . .0347`--CO .J.Iambinr nYY n;r 1.' - Joo bptigip I . .An I I `� r t Tr... \! A t St GnuP: Q (!3 r/..7) Pen Oath No Issue Dab: p j1>it'' �< NEW PEn / REPAIR MDVMG DEMOLISH ��AS� y _ — • //lJ PERMITS EXPIRE 980 DAYS'(6 MONTHS).FROM ISSUE._OR LAST INSPECTION CONSTRUCTION APPROVALS tame STRUCTURAL Dau'. -'Inspector, 'Ibmt.' ".3,eC';; POOL&SPA Data Inspector 4 Footings :.. B4. -:Pool 8 Equipment Location • 6 Slab eel.Steel Reinforcement ' B SWtWral Floor ; - :100: Electric Barking 11 Pre-Inspect Roof ., • .'102 Rdugh Plumb&Pressure Test 12 Roof Sheathing • • '!_ , 1 'AR; Approval to Cover-Gunhe 14 T•Bar Ceiling-Structural • r 1106 Elec Conduil-Underground 16 Shear Pend _ 4'1' 108: Gas Rpe/Underground Test 18 Frame 8 Flashing i -:'110 BaiiiwashLples,P-7rap, 20 Lathing 8 Siding ., I :j: Underground, r_, 22 Insulation -. 1172..`Appiovel to DadC'��'44• ,:er: .. • 24 Drywall Nailing I '47:116 ,hgol RWmhfog,aystea dial? i , 26 Plaster Brown Coat • - •1:: 1B . Cel°, ',,S,K,, . . . . 30 Pre-Grout e j ''+'-122.'6161716(147741e7148'6;40704a1 `.• , 33 Disabled Access ' r Y/'+: , :::,124 "AppfpvaL(Ii 14.41 ling>(w ,•:,;r: .. :i, w ''er: ' 126 PoolSpa Sygt9rnp Flnel -:e:r.z'fi. ;,, .:, FIRE DEPARTMENT APPROVAL _�..e, I �.___. 1:.;. . aJB,. _` :;I, * 1610 'Oyamd Hydra'(Mrhd Rough ,' f 11- 1612 Ory Chemical ELECTRICAL I ti/ y11 .cr 38 :Ufer.Ground • p,rayo,�"�f th sroti� "•' '_.,.38:: •E1@c Conduit-Underground . .- FINAL INSPECTIONS `-''.44 .Rough Sec-VJidng ' Cal(714)7545626 for the following: ort. . Inapetlm • '46.-Rough Elec.Conduit 200 Final Re-Roof 48 Dec 7-Bar Cetirg 201 Final Black/Retaining Wal 50 Elec Power Final _ 203 Final Sign •. 51 Temp Power Final • _ 204 Final Demolition ,,/ //� 206 Final Mechanical ,ay2((,�{ 208 Final Plumbing =I- Y" • 4 '• 210 Final Bedrkal PLUMBING 8 MECHANICAL . . Call(7,141,322-7400 for the following: oat. Inspector 52 Sol Mpe-Underground- .j • -212,•Final Fire Prevention . ' ' 54 Water Pipe-Underground l Call(714)7545335 for the following: Oats bspeetar 55 Underground Gas - j . 214oatTransportation Svs.. 62 Rough Plumbing ' r Call(714)7545671 for the following: • Dat. Inspector 64 Rough Mechanical . 216':Final Engineering Approval 66 Rough•Factory Fireplace I Call(714)754-5307 for the following: '- Data Inspector 68 Sewer System ) 218 Final CMSO Approval • 72 Gas Pipe•Rough Test j .Call(714)754-5245 for the following: • Dy. Impactor 90 Gas Pipe Test-Final / 220 Final Planning Approval 92. Water,Service-Final j Call(714)754-5626 for the following: Date Inspector . 222 Final Site . NOTES: SEE REVERSE 250 Final Building/Occupancy .. .;raf'n : . If ` 71Jr • CITY OF COSTA MESA 4 BUILDING DIVISION • °,411.110-' •.;,r. , PERMIT NUMB R 1 DEVELOPMENT SERVICES DEPARTMENT II .....�.. I _ 4. 001C.� 754-5273PERMIT E03-007 (714) `5 o0m• Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1960 ANAHEIM AV Status: ISSUED • Suite No - Applied: 08/06/2003 Vicinity: Issued: 08/06/2003 • Parcel Nunmber: 42214132 - Applicant: RICH BOOMGARDEN - - . - ISSUED BY: Se:\ Address: - Phone: 714-840-2828 ` Zip: j _ , Owner: BERGER;KEITH , 'r Add ess'�1960 ANAHEIM,AVE,- � ����, / i C / A 'j - ' Phone: �� � COSTA MESA,CA Zip: 92627-2603 ;-�_� / .. 7/ _ .V'� • ,. Contractor. SUNBURST ELECTRIC `i Address: .5267,WARNER AVE •SUITE 125 Phone: (714)840-7828 HUNTINGTON BEACH,CAr, 2 Zip: 92649 - -'� License: 722125 i ,. .A � / • - = - SCOPE OF PERMIT , r c + `' UPGRADE EXISTING SERVICE TO,100AMP - ' V- .. . ,,, FEE SUMMARY r , - , ,Quenhty-" - - Quantity - -j ISSUE FEE $23.50 - - Temp Dist System/Lighting $0.00 0 ' Temp,ser'vice test . , $0.00 Busway/100 ft. " $0.00 0 • ' r 4 H. .Res,a/c package - $0.00 • Standing Section . _$0.00 0 ' - - , . New Res(1-2 units), i\\,;\ '' $0.00 0 Misc Electrical-Equipment $0.00 0 ' i ' New Res'(3+units)' -.\., .,4 , $0.00 0 Transformers up to 1 kva/kw $0.00 <0' , <j / •' Pool/Spay, '.k`,. > '\ .\,A, , $0.00 0 : • . up to 10kva/kw $0.00 ';0/ ' Lighting Fixts _ =.`-, $0.00 , ' 0 .I - up to 50 kva/kw $0.00 ,,', 0 ,'', Recept Outlets - ��e.$0:00 0 )�'E.• - ._ up to.100 kva/kw $0.00 '-`0 1, Switches\/\ A$0000 , over 100 kva/kw , ,$0.00', 0 ' / •/ Non Res Appl $0.00, 0" - Low Voltage Equipment - $0.00'' 0 , Res Appl V`';', , � $0.00> 0 Low Volt Wiring System/Ckt�. $0.00 - ' 0 /1 ' Service to 200ac N < //$30.50 •: H I Misc.Conduit _ •; $0.00 0 /`, Service to 1000a' ' 1 - '' 7 $0.00 , - 0_ _ Misc.Conductor - $0.00 k /0 'i is Service over 1000a\N; $0.00 0 , -.- - ' Circus(gen or ride)- $0.00 0 Motors to 1hp V-„,.\-. $0.00 / ,-, 0 - - Circus(mach ride or lights) ' , '$0.00- " -0, j • Motors to 10hp N, --: $0.00' ,70 . N Christmas Tree Stand . -$0.00 ' . 0 Motors to 50hp $0.00 " 1 0 -, / - -_ Fireworks Stand - - " . ' $0.00 /0 Motors to 100hp N-$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 --.- - 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(6100) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: '0 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 penult is issued. My workers'compensation Insurance carrier and policy number are: Cartier. Policy Number. l (This section need not be completed if the permit Is valued at one hundred dollars($1 )or less.) Tp I certify that In the performan • • the work for who•this permit i ued,I shall not employ any person in any manner so as to me s bject to the workers' compensation laws of Callfaml: and agree that 'should e ubject to the workers'compensation provisions of Section 00 tilt Lebo e,I shall forthwith comply with(hese provis• Applicant Signature: 'A_ a_ / Date: D WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED T1OI/SAND DOUARE($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 em Tic under prod itp5�_of Chap r 9(comm cing with Section )of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Uc.# • 2-Z1_� '/>^1I °//7000 Class# G (0 Contractors Signature: I 1 �� �Cr Date: 0/4,!U '3 CONSTRUCTION LENDING AGENCY: 666 ❑ 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 Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the 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 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 wit have the burden of proving that he or she did not build or Improve for purpose of sale.). • ❑ I,as owner of the properly,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 under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes ❑No Divers Ucense 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 e 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_aermit 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 0 No (Section 65850.2 of the California Government Code requires that the requested Information be fumished on applications for non-residential building permits). B Will any part of ihe facility to be constructed under this peel*within 1000 feet from the outer boundaries of a school? CI Vas 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). a.._e _.._ .___...__._.i�ution _sti... .._i_. ._.._.._..._i._ _ _.__.. 7 ifa a Aaron from the South Coast-Air reQuality Management Californiaeat or and Sr epollution c4l 303 been agency Is required for the work which Is the aubJect of this application,have all of the disclosures prescnbed by Callloe Health Safety Code Section 42303 made? 0 Yes 0 No ____l_ on...._n . ___._ _._._._.__—__._....—_......._...`._ 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 pro for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit u 1 final inspection. / Sig 01 ga Owner(s) And/Or Authorized Applicant ate CODE I INSPECTION TYPE DAff. I110ALS COOEI INSPECT1ONTYPE DATE RIOAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final PlumbingIv 200 ' Final Re-Roof - 210 Final Electrical I n I C -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 ! ! -.,:6 amparcment 1 \ APPLICATION FOR PERMIT " COSTA MESA, CALIFORNIA 1 111 EAST 20th STREET • 4976 L D ,� N G �.._ FOR APPLICANT FILL IN FOR OFFICE USE ONLY and 1 61 Permit No. Building ��f/o` Address Cot Mesa, California Received by Date Rec'd. I i S Date Issued Nearest 1u., vi -' r/ Cross St. ,4,� Building • / 1 Address Owner /110 Costa Mesa, California MAAddre/sss�sXi: ( 0--1� 0.t'"" Nearest City ect ,ye ,. No. Ll V/0.‘ DP'- , Zone I PNo.of lans Type \/ I Group 7 Architect or Lie. Y e: 1 Engineer No. Approved� n / Date7, 1,--4••- Address 4- Address '� CORRECTIONS w ,qI� City Lic. Contracto 0"W- C r No. ,-1 I Address II 7 3 !- ' . a..."1. Legal I Cote I Description No. B► ` act (Attach Metes and Bounds) //� Z/ —+.d( j!dI•'� 1 7T� No.of Bldgs. Size of Lot 5.6— Now on Lot 11-In UExisting Bldg.of I Fam lies I No.ofAUG 2 3 1ii Setback Line from i Rear Yard ;Si.— Z Center of Street 50 n"""' t. Side Yard q - DESCRIPTION OF WORK OW fel'. 0)1., A , ; r New I //I Alteration I I Addition I . - • Repair I I Moving I I Demolish I • Building 3/ No.of C Size ..25_ ' b Rooms ) Stories 4 • Exterior Wall / Roof - Covering OF_ Covering APPROVALS Use of New Buildin. - 1 •„ At-A- Foundation Location Inspector Date i -.[� Forms,Materials, /r� QA' i P Under-Pinning Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application Lath. Int.and state that the above is correct and agree to comply Lath.Ext with all City Ordinan nd Stat Laws regulating building const on Signature of Plaster,Int Permittee Plaster, Ext. Authorized Agt. Masonry Reinforced I Valuation Permit Fee 5 a.3 © r� Plan Check $ 3. 0 d Bond Beam �1 ,,! $ L_30 FeeTotal $ 7 C d g FINAL Ca '&( ^.7 Mit `vr� FORM 204 0-H 2M 0-54 • ,„. - 9. --.• 1. 00. a. I- 0. • • • ' . _ • • 1 '711 4 • e 4 ' , • • ., - • fa Street • . _ :P 'O • Show location and distances from . - • property line and between buildings. . • • • a . a 3642 SEP 20-71 ''10 3 00 589 cit. ":10 cc COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECEIV D BY DATE RECEIVED DATE ISSUED BUILDING /J ,t .. -�� ADDRESS may/96' 74fit,"�/.i/ rn^L. r'/f n . c ? �,�'r���I{�p� OWNER ///'M /4 L. • / / // A.P. NO. Il&32A-1i R Tage.2 MAIL / -( BUILDING 1960 Rnah�'m AV ADDRESS , / a el S A . a a ADDRESS z . ��] cert. 07 S Lu w /� �/�/A/ //�' TEL ('S FdIYgleftiA Y' MS LOT BLOCK 0.Z CITY/ �E�.S ///Poia ,/ a NO.k7 VC9IZG Z C CONSTRUCTION NEW ADD ALTER REPAIR MOVING f1FMf1LISH O N LENDER o. co J D BRANCH //��v���/t ...I(0 OWNER a.X.61eJ L . Ilk < LU ADDRESS VALUE /17 mJpy / ro J CO ARCHITECT TEL f� USE - S ! Q OR ENGINEER 0CLI h Pr NO.Or,�7?oZL V Q p I FIRE w Q ADDRESS ( 1 6 Q A-vt& Y1O s sM AVP ZONE TYPE GROUP a W APPROVED ////��J, J O CONTRACTOR Ow -e y-• BY / DATE1 t/ mZ L cc ADDRESS W WTEL. ZONE �Z ' OA.POF Z USE OOIFN ^^ aA\3 Cr Z CITY NO. COL,.0Y, —O STATE CITY YARDS APPROVED YARDS APPROVED Li co CC LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING D O (FROM9/LSTREET • SIZEINa OF OF LOT NOW ON LOT FRON � yf(/tri/."OAn M FT. USE OF //,, (� EXISTING BLDG. R SIDE SC/ FT. FT. I— SIZE OF NO.OF a ( 2 NEW BLDG. ROOMS STORIES L.SIDE I FT. FT. C.3EXTERIOR WALL I ROOF C{�I _ COVERING COVERING REAR V 1 FT. FT. < J USE OF BUILDING AND WORK TO BE PERFORMED 1 DISTANCE BET. /�Ia BET.MAIN&d MAIN BLDGS. r I ACCESS. BLDGS. QL VAR.# DATE O Leic 't i -e, ?ot'O Cover C.U.P.# APPROVED tam I � 1-ZQ -� IC) --ELY DATE Z 0 I— C.) I hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ I— any person in violation of the workman's compensation laws of Hm[he State of California. m Z I hereby certify that I am properly licensed as a contractor under SO. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5 Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a am exempt from the provisions of the State of California Business Q VALUATION m and Professions Code,Division 3,Chapter 9. PERMIT FEE $ a a'e N o O Signature of 6{f m G Permittee J. e' $ h it—V �_-7 PLAN CHECK $ E /l sTV o Authorized Agent u TOTAL FEE $ �./�/�,