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HomeMy WebLinkAbout2450 ELDEN AVE - Building Permits f 5785 FEE RECEIVED 9 - r3 _ C 7 ✓ tc. COSTA MESA BUILDING DEPARTMENT FINANCE O. BOX 317 DEPT. COSTA MESA. CALIFORNIA CITY OF COSTA MESA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING ?A- 00 ELDER BUILDING 'ADDRESS • COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. PERMIT NO. OWNER �n NtQEuv4nv £ KESJSNDLI ..I S6 9S_ MAIL p RECEIVED BY /DAATE RECEIVED /,DATE ISSUED ADDRESS 316_ C-Cpt ..8 S �,- y --3 -J77 -/ 3-S, CITY S A.1.)T RA t.)n TNO. �1 3— ?S/SADDREISSG / I ORCHGECE LIC. OR ENGINEER C. COSTA MESA. CALIFORNIA FIRE ADDRL ZONE '' CITY LIC. ZONE NO.OF TYPE GROUP �1 LANS CONTRACTOR OwKIE R NO. r/ TEL. APPROVED ADDRESS NO. BY DATE LEGAL LOT $ 300 CORRECTIONS DESCRIPTION NNO. O �B¢LO�CCK /] TRACT}A A.P.NO. _ -11/ / / O. I(7 f/ J SIZE /./ )/ 3 05 ' NO.OF SLOGS. , OF LOT ' /` ,NOW ON LOT USE OF Imo\%0 ••-_, S- ifJ EXISTING BLDG. LI'LI,I' SETBACK LINE FROM - • - CENTER OF STREET REAR YARD •SIDE YARD RIGHT LEFT DESCRIPTION OF WORK NEW ALTERATION ADDITION REPAIt, MOVING DEMOLISH BUILDING NO.OF • SIZE ROOMS STORIES EXTERIOR WA - ROOF F _COVERING COVERING �( USE OF W h O L-1 $ M (T O M BUILDI G I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. VALUATION 0 SIGNATURE OFD • PERMIT FEE S _--- PERMITTEE ---PERMITTEE / 1'�'L^C�..^.-"_0./wi 4/21/1 � B S— � A� n ' PLAN CHECK S = /E / L.p YL-•� TOTAL FEE S g, OO •41` AUTHORIZED AGENT 13700 FEE RECEIVED JAN 1 COSTA MESA BUILDING-SAFETY DEPARTMENT DEPT. P. O. BOX 317 COSTA MESA. CALIFORNIA FINANCE DDE CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING 9 j1 i, ADDRESS IX YO V L h Ok N n COSTA MESA. CALIFORNIA For Office Use Only /� A j_9 / RECEIPT NO. I i�1 PERMIT.,NO. OWNER BRCLtl /_ t' RO6�C C / 0-0 ` MAIL �T RECEIVED BY DATE REC/4- F ED DATE ISSUED ADDRESS / 711 7 �/Q4Amic On (/L'°i /��j/// t/I i—.2 7-' ''7 TEL.3t BUILDING ./• y� /�/ //��` CITY �.}N/.i4O/9. �/J(, P NO. ,)4 �_ BUILDING ff� {C .GryC///ij ARCHITECT --- TEL. COSTA MESA. CALIFORNIA OR E"^INEER NO. FIRE ADOL. .3 ZONE TYPEVGROUP CONTRACTOR (OWJVC Yt APPROVED `` 2 / ,�II BY /r ADDRESS ( .4 DATE - `1 / d OV i.: ZONING ZONE/{-�-� II NO.OF USE OF NEW CITY _ / \ I PLANS I BUILDING STATE TEL. LEGAL • LIC.NO. NO. �a... �Gj 1 7�,3 (S Q DESCRIPTION -- SIZE SIZE // 'f Q NO. OF EIDOB. 0 /� OF LOT (F X J `� NOW ON LOT A.P.NO. I / % /1S Co O 0 7 USE OF YARDS EVES EXISTING BLDG. APPROVED ALLOWED SETBACK LINE FROM / -/ (CENTER LINE ST.) CENTER OF STREET LS'-O REAR YARD ..2 ks FRONT U DFT. IN. SIDE YARD I LEFT 'J 1 ( RIGHT 'S i R.SIDE SFT. IN. DESCRIPTION OF WORK L.SIDE / FT. IN. NEW I kr. II ALTERATION I II ADDITION I REAR /p/, /FT. �4 • �] IN. // REP., _ I II MOVING I II DEMOLISH APPROVEDYte y ///I DATE /y0�3—�/ BUILDING 1 X/ J V ANO. OF /�� YA U//1,1j�/ SIZE / 0 Sy IF ROOMS / STORIES / / EXTERIOR WALL ) y- ROOF R , COVERING 'f�p31/v COVERING 1}B[ USE OfB IILDING ArWOR( O BE P IFi RMMD /l llt C Ir °tltti1^d I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOU T SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORD NANCES AND STA WS REGULATING BUILDING CONSTRUCT VALUATION SIGNATURE OF D�'/�� { 7i� PERMIT FEE $ L'� N - PERMITTEF f/irfJ /i St .y I � j �� $ PLAN CHECK $ / P — `- AUTHORIZED AGENT 0o TOTAL FEE 5 0 P 13701 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT C- JAN 1 81961 P. O. BOX 817 COSTA MESA. CALIFORNIA - F!Ntili cE DEPT. For Applicant to Fill In Completely ri `' APPLICATION' FOR f ERMINE9A TYPE OR PRINT „ II BUILDING BUILDING r ADDRESS .2 y 0_0 (�4 Ilae 3 COSTA MESA. CALIFORNIA For Office Use Only ,{�! .s(� I RECEIPT NO. I 1 moor OWNER -4:14/2 OAD �% 4JC� IZOS Ct � Y`A'f MAILAA,y'�'� n,L RBLeIy�ED'BY O/� IVPP I pAT�1.71; / ADDRESS /% F/ C /` //1 (l' /). TEL. BUILDING CITY 13. ,o., CT NO. .it,p,41 ADDRESS 7/7 v�Ii(' (du /.6\i ARCHITECT TEL. COSTA MESA. CALIFORNIA OR E•'-INFER NO. - FIRE / ADD.. .S ZONE /TYPE V .1 GROUP l�/^ Y CONTRACTOR CJGVIYK • APPROVED I /1 (y/DATE/ ---2.1/ /4. ADDRESS 0 deL-{ ZONING ZONE NO.OF USE OF NEW - CITY fl l/ I PLANS I BUILDING 4. n STATE TEL. LEWL 1 `Y� � / I p e4- '��-4-fr LIC.NO. NO. DESCRIPTION A f Y/ .-c, TK• 30-(J SIZE // X O S ' I NNOW ON LOTS OF LOT NV `7 A.P.NO. 1 � '-- d CO a — of USE OF YARDS EVES EXISTING BLDG. APPROVED ALLOWED SETBACK LINE FROM / J (CENTER UNE ST.) / /� CENTER OF STREET U REAR YARD aL. FRONT /(j] FT. /a.-P/f.. • IN. SIDE YARD I LEFT II RIGHT Lc R.SIDE SFT. IN. DESCRIPTION OF WORK L.SIDE �FT. IN.�j NEW I fr- ALTERATION I II ADDITION I REAR //I 5 FT. /a #4 1 IN./� REP..... I II MOVING II DEMOLISH I APPROVED /(, y� / / DATE /-,5—IL/ BUILDING NO. OF (� /1' bt / » SIZE ••• 7 $ 3 ROOMS STORIES / / 1- EXTERIOR WALL e/ + ROOF `. / COVERING d� (COVERING �'�� f--, / USE OF BUILDING AND WORK TO DE PERFORMED • ;21' E ,,C .' ._ .%u , 1� w . .>. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT - OWN UNDER VALUATION IS POR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. PLY WITH ALL CITY DINANCES AND ATE LAWS REGULATING BUILDING CONSTRU ON. VALUATION . 1 et/— /SIGNSIGNATURE ATURE Oy(/ yq�/� B PERMIT FEE S PERMITTED s/ R ( /Y/ _ .LGtP�2Z: /`/�/ ) e Cy/ $ f CJ / PLAN CHECK $ /T AUTHORIZED AGENT Y �I TOTAL FEE 3 I , 13 02 . II L.L. A.:. ..>1-'... . . COSTA MESA BUILDING-SAFETY DEPARTMENT �' JAN 181581 - P. O. BOX SIT COSTA MESA. CALIFORNIA 1, CFINANCE DEPT. For Applicant to Fill in Completely APPLICATION EOR;P,ERMITIESA TYPE OR PRINT BUILDING BUILDING � Yo C Sok/Y I,C If ADDRESS ,+� L. COSTA MESA. CALIFORNIA For Office Use Only ��)) ��AA RECEIPT NO. A pm�aitly2 OWNER A??.rCCnp /%. /1A7NRCTf G A .7 I I 11 a} /�.l,G MAIL //,�11 //)� RECEIV SY Din_R}�g1V6�j' O TE ISSU ADDRESS /741 ) /�//4.Fikr, J//Z_ �./�,-'-/ //!�7//-/�`(r'JI / 2Y-4/ CITY a> doe I S NO.,,EL G! 1 ADOREib:, ,s—D �yli/(/it "elk ARCHITECT �. TEL. COSTA MESA. CALIFORNIA OR ¶ INEER NO. ,ys� FIRE ADCStTtLS ZONE TYPE GROUP CONTRACTOR' inCLl6YC✓ BY "lel/ APPROVED DATE I -'2V ADDRESS ..6. ✓r , NING Pe. i°Ne Rill NO.OF USE OF N6WFl"0. /s CITY `'� PLANS BUILDINOs _' OLJ 7',�"'p�i STATEIC.NO. TEL. LEGAL �. Q '� I 7/ -.-v 3 0 U LIC. NO. ESCRIPTIOHS ],.-�/U T/w� !ezt4- 666!((nPPC7I , OF LOT o.6 x 3 G'J I NOW ON tor rw. OP B �' A.P.NO, f i '7 0 ler 0^ ©/ USE OF YARDS EVES EXISTING 8/./22, / / APPROVED ALLOWED SETBACK LINE FROM (CENTER UNE ST.) ./7 (//� CENTER OF STREET '/ C REAR YARD 1R.i FRONT A FT. }�_-RA i IN. SIDE YARD LEFT �r I RIGHT Y R SIDE TFT IN. DESCRIPTION� �+ OF WORK L.SIDE FT. IN. b,NEI" I�- IIYALTERATION I II ADDITION I - REAR p/,/S� FT. Q,�__e..4 1 p IN. REF.../ I MOVING I II DEMOLISH I 0PPROVED10 y�l / /.. DATE /2J `cs BUILDING NO OF �/ j //(/ /` O/ / SIZE .Z 7 X 3a ROOMS / /�STORIIE_S I ��/ _• COVERING EXTERIOR WALL,/LWfes I ROOF'COVERING "OO✓ 1 / / / US OP 6UILDIN �D WOR O SE PEERFORMED. i / ; ,/r Y'�Ply( d /114t ..a.Inc 4e p 0 . . 1 ,l 1 / / `l I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMO N SHOW UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF EST =I ISHING A PERMIT PEE ONLY. PLY WITH ALL CITY ORDI ANCES AND STATE S REGULATING BUILDING CONSTRU VALUATION/ PERMAITTEE OF 1 ' 1 It�r./5/1/111 PERMIT FEE $ 2 La 7 N et? $ / PLAN CHECK S // i S. AUTHORIZED AGENTE TOTAL FEE $ .J= — y - . x-37®3 -JAN 1 81961 _ COSTA MESA BUILDING-SAFETY DEPARTMENT `i IS; . • .. 13704 C5-� JAN 181331 1 COSTA MESA BUILDING-SAFETY DEPARTMENT '2, , ' - I};. ;. - P. O. BOX 917 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT Ir BUDRESS l! L . I- BUILDING BUILDING yU Q /moi! /P% I /J/COSTA MESA. CALIFORNIA FOlFor Office Use Only OWNER A r7Q QL/J LA MAIL //�]��.q. azr 7/1 OS{.l y I RECEIPT NO. I / MIT O. l ADDRESS ) 7y 7 /t )Ve.o.ac- pa RHCE)l eD BY I 7E- Jr�///I/YE�///�7�7 gUED-oj fJ // /1 / TEL. BUILDENG�A/"` /G� //'Y•C k/4/� 1i:ai& cu� ''I CITY /5-jj02 ) ( 4A( .�C4 ADDRESS �Y]U ARCHITECT TEL. COSTA MESA. CALIFORNIA -1 OR - "GINEER NO. ADL..ESS FIRE /J/ t//��� ZONE TYPE (/ GROUPOCONTRAOR L/Cz//! e L/ APPROVED rfil7ri-BYDATE/ 2 . ADDRESS .7460 v e . ONING CITY ZONE A 1; I PLANS I BNO.OF UILDITIW..E OF NEW'I(J�`j A STATE TEL. LEGAL Y ��� �( � (�/44�7j/ n LIC.NO. NO. DESCRIPTIONS( -6 / -fit+ �" ( k7-1 GLe SIZE O. / 5/' 3 ea— NO. OP BLDG; - / / C OF LOT L( (f 7� NOW ON LOT A.P.NO. `�2.- G �/n l / USE OF YARDS EVES EXISTING BLDG. / i APPROVED ALLOWED SETBACK LINE PROM (CENTER LINE ST.) CENTER OF STREET REAR YARD ZC FRONT / 7 FT. IN. SIDE YARD I LEFT ‘S I RIGHT R.SIDE 740 FT. IN. DESCRIPTION OF WORK L.SIDE ) FT. N. I , ALTERATION I II ADDITION I REAR 5 FT. IN.//-- I II MOVING I II DEMOLISH I APPROVED /� 9. DATE /- �'J-1o/ RerAIR ////����"' SIZE ING 7 X Y D ROOMS csr STORIES / y/� D/ 0 7�/ EXTERIOR WALL j2/rs � ROOF /7 l V G�/ ` COVERING COVERING DO T _J/ f J Q USE p% ILD ft „A'NDiORK Te. fr,E IERF?RL11Fy ( /�// C/GP //�f' /// I aafril I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT T OWCe I N UNDER VALUATION ALUATIO IS FOR THE AND STATE THAT THE BOVE IS CORRECT AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT PEE ONLY. PLY WITH ALL CITY O INANCES AND A LAWS REGULATING BUILDING CONSTRU ON. VALUATION SIGNATURE OFAL4 ^ / / 7 �� �/ PERMIT PERMTTEF P PLANCHECK $ ��$ / AUTHORIZED AGENT 1 - TOTAL FEE S r•.? _E ELDES AVENUE, 2450 Al `cru 5785 - 12-26-57 d n. res. $ 00.1 13700 - 4-27-61 rasidence 7,776.; 13701 - 4-27-61 - .s ;.,/att Ear 9,096. 13702 - 4-27-61 r a, a, gar 8,434.. 13703 4-27-61 r?.5 w/att 8,4344 13704 - 4-27-61 - .s :r,/att sar 11,138. - 64657 - 12-4-73 . NC0..H . • 67864 - 9-22-75 P 5g. N.C. (W.H.) r • • • i I 4 . 1 1 CITY OF COSTA MESA • �@ BUILDING DIVISION :l,,,,, %•�p$ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4: 'B PERMIT barow`4. 01-0 01 39 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2450 ELDEN AV Status: ISSUED Suite No A Applied: 03/20/2001 Issued: 03/23/2001 Vicinity: ¢�{j—�-►'� Parcel Number: 43929105 - ISSUED BY: Applicant RENZ, RUSS �w/-- ' , 1 Address: i/'/ ; r :: . . . 77 ` ', Phone 714-577-0771 i // ; Owner:.-/ INFINITY'HOMES CMI;LLC A \ Address: 10945 SOUTH ST#301 ? �V., / //i i. /, Phone: / -::: \ /, . //i �T,n .� �\ /- i / //ri CERR`OS,CA Zip: ,90703 \N ' /, i/ te' - / Contractor s,/SENTRY MECHANICAL, INC. vv` \-S----"- .\ e/ -/ �� '_ Address: r 540 S JEFFERSON `/ / ,-� / /,..'-- / y-' - i Ati�' 'N�-\ / / / CA, 7 Phone. 714-577-0771_ , - �� �� `- / ,lPIACENTIA,CA, - - Zip: 92870 . _ -�N •- , / " _ - 1 ) 1 , ,Y( e-e - /� License: 631049 A� Arch/Eng / - :„/ \�'� / �\ vLi A I I (/Address /� �- - - - - - i' I In'i 1 it 's Phone ,l v, , ,N, I (_ A' ‘.il! -' L \_✓ e ---' __ -(4 _ a ..v / Zp. - / Ill i 'i)('. - License: " •— • ,'A I \ S `' l • SCOPE OF-PERMIT V / % '=�/ 1l `i INSTALL HVAC UNITJNNEW SFR CONTRACTOR DOING HEATING AND AIR'CONDITIONING ° / tl , c. ONLY PER PAT WILLIAMS.REF.B00-00956" '-- ,,../,/ ,, III /I .-----) 7J • �� FEE SUMMARY" ,A� I/ / �.�\ -- V Quantity �� �Qyaniity ISSUE FEE � � - / � � � / �;\\ $23.50 .� ;?-� � �''RepaglAlt Absorbtion Unit � i, $0.00/ OI/ Inst FAU700 k BTU $14.80 1 ?-- Repair/Alt Refrigeration Unit .(77 $0.00 0 Inst FAU 1100 k BTU ,'` /�� $0.00 0 ° Ventiilation'System . /2 $0.000 Repair/AItACooling/Heats k$0.oO- o.,.;,',� _/'Evaporable Cooler•i2 7 //i ‘.../1, $0.00y 0 Inst/Rep. Recess"Wall Htr $0.00 0 ' 6 , c ° J ,-' Commercial Incinerator i $0.000 Refrig Sys<100,k-BTU � \ $0.00\0 c-, o," `'' ° �' 'Domestic Incinerator ���c2 $0.00 0 Refrig Sys>100 k-BTU i $0.00"-0�' a o .,-O ° ° ' Compressors•/Absorption.Systems �C//) Gas Piping $000 0��)- ` °_�' °Up.to 3 hp.!_100Ik t3TU� `�� V$0.00 0 Factory Fireplace ($01-00l:::,.0\� o -�<—_3-To_1514-500k'BTUn O `6/ $0.00 0 Hood w/Mach Exhaust $01.00 / 0'\ - -- _"_15 To 30 hp 11,000 k BTU G(7 $0.00 0 VAV Box C.."--:-.,,,.-- $0.00:j 0 ',y 30 To 50 hpJi1,750 k Btu $0.00 0 Vent Fan/Single Duct x,$0.00 (0` l/-. ' nl Over 50Mp l0vei,t•,750 BTU 0 $0.00 0 Appliance `$0.000 v-✓ ) L , �, Boilers t \/ Fire Dampers $oon->0;�, '-i: 1N�, upto3hp- $0.00 0 Smoke Dampers $0.00-----0,.."----)C. --- 3 To 15 hp���j.--0 ' $27.15 1 Inst or Relocate Appl Vent $0.00 0 --�..„.> _ .to'30 hp_.— $0.00 0 Air Handlers< 10000cfm $0.00 0 -!' — 30to'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 $65.45 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration.of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: • • t hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work.for which this permit is issued. heve end will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. �My workers'compensation Insurance carter and policy number are: Cartier: Policy Number: (This section need not be completed 1/the permit is valued et one hundred dollars($I00)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 la.s of California,and agree t at If I should become subject to the workers'compensation provisions of S ion 37 of the Labor Code,I shall forthwith complyir � visions. 3 2330 I cent Signature: � Date: WARNING:FAILURE TO SECURE WORKERS'COM NSATION IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRAM PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOL ARE(3100,001,IN ADDmON TO THE COST OF COMPENSATION,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 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.# Class 4 \Coniractors.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). ..:.. Lentler's Name: _ Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPTcROM 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 DIvlslon 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'es their sole compensation,WELL 00 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 driver's license. 0 Yes 0 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,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 Flre 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 then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .._ p._. __.. .�,_. __..._. _ 3 O yes sesr 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 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 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 Ppi No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). str.._._d._.nde_..t .._.rmit be.with__ da.ri..__.00l.......... ..._ 6 Will any pert 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). the Souh_...__.__ ...__— ._o_.d.._..r._._ _ %T _o ___ 7 application,a permit from the South Coast-Air Quality Management Healthal or and Sr airpollution control 3i 3 been aadecy is required for the work which is the subject 01 This have all of the disclosures prescribed by Californiaia 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 COMPUANCE AND AUfHORIZATION.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 ell 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 inspection purposes.I agree not to occupy or allow occupancy of any building authorized by)))this permit until final inspection. (�(� egrQ t Legal Owners) 3 /z 3 r'0 Date rAuthoriz pplicent j Date CODE I INBPECTON TYPE g&TE' ANI AU ODE( INSPECTIONTYPE © ^PETE 1616 Fixed System Final Fire Prevention 208 Final Mechanical 8- at —of L 1I V 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 2t0 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 CITY OF COSTA MESA . a BUILDING DIVISION f i I DEVELOPMENT SERVICES DEPARTMENT PERM! NUMBER ..t• pica PERMIT itb4Posrmu tie 00-00641 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2450 ELDEN AV Status: ISSUED 'Suite No A Applied: 11/20/2000 Issued: 11/20/2000 Vicinity: UNIT A Parcel Nunmber: 43929105 ISSUED BY: Applicant: TAYLOR, WAYNE Address: 1247 NORTH BATAVIA Phone: (714)997-9991 ORANGE,CA Zip: 92667 Owner: INFINITY HOMES CM I, LLC Address 10945 SOUTH ST#301 Phone: CERRITOS,CA Zip: 90703 Contractor: GOLDEN WEST PLUMBING INC Address: 1247 NORTH BATAVIA Phone: (714)997-9991 ORANGE,CA Zip: 92667 License: 317026 Arch/ Eng: Address: . Phone: Zip: • License: SCOPE OF PERMIT PLUMBING PERMIT FOR NEW SINGLE FAMILY RESIDENCE FOR"INFINITY HOMES"(UNIT A)., INSTALL 2 BATHTUBS, 1 DISHWASHER, 1 EXPANSION TANKS GAS OUTLETS, 1 WASHER, 1 PRESSURE REGULATOR, 1 SHOWER, 1 KITCHEN SINK, 1 PRIVATE SEWER LINE, UP TO 4 VACUUM BREAKERS,4 WASH BASINS,3 WATER CLOSETS,& 1 WATER HEATER. REF: B00-00956 FEE SUMMARY AMT OTY AMT OTY AMT OTY ISSUE FEE $23.50 Laundry Tub I Washer $9.80 1 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 $19.60 2 Pressure Regulator $9.80 1 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $12.30 1 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 $39.20 4 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 Sewer Private Line $24.65 1 Water Closet(Toilet) $29.40 3 Drain,Roof $0.00 0 Shower $9.80 1 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 $9.80 1 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) $6.15 1 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $1.10 1 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: $227.00 NOTICE: The work authorized by this permit WEOMMErJi'i&laIBRICuilhle C MD*Td@NS 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 I required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of thismit /per FOR INSPECTIONS CALL: (714)754-5626 // 2448-48(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 r I.haveT4nd 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: Car 5r'`—A7'LE Policy Number—OP Ft cc (This section need not be completed i/the permit is valued at one hundred dollars($100)or less.) L --1 ❑ 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 thea should become subject to the workers'compensation provisions of S cti 700 of the Labor Code,I shall forthwith comply with thesepj ons. // Applicant Signature:. j i.o.• ._ • LT3amL_- -i/- oo WARNING:FAILURE TO SECU RKER.S'••- ND IONSATION COVERAGE IS UNLAWFUL ASHALL SUBJECT AN EMPLOYER TO ENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,... ADDITION E COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that,am.Ncensed 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..Y 3-i'7 02— - ( Class x — -ContractorsSignatue:— .—at,.i• J.i_.- Date:— s ®/• _._ I CONSTRUCTION LENDING AG Y: / ❑ 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).): ❑ 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 exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 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 feel 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: 7 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 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,codification 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 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 ❑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 Duality 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 inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. rJ , II SI.n:,. . . :gal Ow r(s) J Date (d 'nab ,-' t.. --+ ncant . .- , /� al Dam _.. 600E/, g15PECRON TYPE/ ( PATE =MA LODE/ gf$PECT70NTYPE PATI RQIDAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical AA 1266 Pool Spa Final 208 Final Plumbing R-r x�li I - of /�P2 ^y 200 Final Re-Roof 210 Final Electrical r 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 _ _ I-• CITY OF COSTA MESA BUILDING DIVISION >f ,'� i. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT /E03-00390 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT • Job Address: 2450 ELDEN AV Status: ISSUED Suite No A Applied: 05/20/2003 Vicinity: Issued: 05/20/2003 Parcel Nunmber: 43929105 ��y�� Applicant: SWOR, JAMES _ "- - - - - ISSUED BY: L�JK��i'�---- Address: 2450 ELDEN AV '-,,.:', -- ` i ', UNIT A 1%„ ,/ ;: _ . - Phone: 949-514-0365 f - - - 0011111111. COSTA MESA;-CA " Zip: 92626 ' 1 Owner o'SWOR, JAMES AND;KIMBERLY - - ; Address�j2450 ELDEN AV,:, ..\ - ; - \ A �: . - UNIT A//2iii y Phone: 949-514-0365 - ��\ ,� `.7 „ COSTA MESA,"CA Zip: 92626 / Contractor:,,' OWNER-BUILDER - , • Address: , .7 --- ,\ .. . , _ !Phone: - , _ - - /" I ' ,y_ License: 000000 _ , i , \/ A , ',--. SCOPE OF PERMIT , - - ELECTRICAL TO INCLUDE: 1 EXTER_IOR_'LIGH_TIN_G FIXTURE,3 OUTLETS; 1 LOW VOLT WIRING ' SYSTEM,AND 1 MISC.CONDUIT ' FOR NEW LANDSCAPING. . .. !,- - , .,, - -. -- -FEE SUMMARY ' , - . - - + Quantity /�' i Quantity; ' - • ISSUE FEE - $23.50 Temp Dist System/Lighting ' "$0.00 0 ., - - Temp service test $0.00 Busway/100 ft "-- "$0.00 0 " - - , ' Resa/c'packageA, ' -, $0.00 Standing Section x$0.00 -0 .' New Res(172 units) J '`., $0.00 0 ....,..t.'\•:"17" Misc Electrical Equipment $0.00 - 0" - New Res`(3+units)' ' $0.00 0 ,,,,-7;f->. , -. Transformers up to 1 kva/kw $0.00/',^.0 Pool/Spa''-v \ $0.00 0 up tc'.10 kva/kw , $0.00;, ' 0. Lighting Fixts-,A ; A$1.10 - ._1„ up to50.kva/kw 7.. --$000 0, Recept Outlets $3.30 3� - up to 100 kva/kw'' '$0.00 0 Switches , \l,;v /7„,/, '$0.00 ,' 0 - -- over 100 kva/kw - $0.00 0 Non Res Appl ' \ 7$0.00 -0- - Low Voltage Equipment $0.00 . 0 Res Appl $0.00 - 0 e Low Volt Wiring System/Ckt $25.00 - 1 - /' Service to 200a \ \ ' "$0.00 -,70----: - - - Misc.Conduit - ' $18.20 1 Service to 1000a A -.A $0.00! ; i 0 - - _ Misc.Conductor $0.00 0 Service over 1000a Circus(gen or-ride) $0.00 - 0 Motors to 1hp '- $0:00., 1`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. j. $0.00 Motors over 100hp $0.00 . " _ - Communication drops $0.00 0 - - - -- Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check 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 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(sroo) • DECLARATIONS -- " i J . WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (Thisissection need not be completed it the permit is valued at one hundred dollars($100)or less.) ly' 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 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 ions. Applicant Signature A-4 Asa.-----,- Date: ' S 2a> 2003 WARNING:FAILURE T SECURE W RKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED LL THOUSAND DOLLARS ,000),I DDITION 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.Lk.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). Lenders Name: Lender's Address: Signature: '� Date: OWNER-BUILDER DECLARATIONS: i I hereby affirm that under penalt°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 permsto 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 mote than five hundred dollars($500).): ❑ 7 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 EV, 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.). • pd I,as owner of the property,am EXCLdSIVELY 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 ours ant to the Contractors License Laws.). ❑ I am exempt'(ler sec. Business and Professions Code for this reason: Signature: �� _...4....-----------•._...4....-----------•. c./.24:4Z.003c./.24:4Z.003Datec./.24:4Z.003Owner ID ve . •I vers license. Yes 0 No Drivers License / Expires: IC-27-01/ Verification of• • • ship by(type of doc t,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 a_pPernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ 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 Celifomia 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 c ply 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 proper for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this per it until final inspection.b S/L ,200.3 Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE t IlSPECTION TYPE QAIE MEN& CODE( INSPECTION TYPE PATE MAIS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing j 200 Final Re-Roof 210 Final Electrical ;-3 9 201 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 _O CITY OF COSTA MESA 4BUILDING DIVISION :4J J-. , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 11111141 • PERMIT JP03-00314 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2450 ELDEN AV Status: ISSUED Suite No A Applied: 05/20/2003 Issued: 05/20/2003 Vicinity: Parcel Nunmber: 43929105 ISSUED BY: _ Applicant: SWOR, JAMES- Address: 2450 ELDEN AV UNIT A Phone: 949-514-0365 COSTA MESA,CA Zip: 92626 Owner: SWOR, JAMES AND KIMBERLY Address 2450 ELDEN AV, UNIT A Phone: 949-514-0365 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER - Address: Phone: Zip: License: 000000 Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT PLUMBING TO INCLUDE: 1 GAS(1-4)OUTLETS, 1 GAS REPIPE,AND 1 LANDSCAPE IRRIGATION FOR NEW LANDSCAPING. 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 - $14.80 1 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 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 $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 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 . Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 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 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: Cartier: Policy Number: (This section need not be completed i/the permit is valued at one hundred dollars($100)or less.) 12 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• 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.' ions. Applicant Signature: . Date: Z G 3 WARNING:FAILURE T.•SECURE ••KERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRI PENAL T ES AND CIVIL FiNES UP TO ONE HUNDRED THOUSAND DOLLARE(S <•••• '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 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: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I ajy 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 issuanco,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 civilpenalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employels 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 appy 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.), (3" 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,end who contracts for such project with a contractor(s) license pu ant to the Contractors License Laws.). ❑ I am exempt der sec. Business and Professions Code for this reason: Signature: 4.4�� Date: S Z '42 b 03 Owner ID 'fled by dr ars license. Yes 0 No Driver's License No. Expires: 10 '27-b f 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 the 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 Safely 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 tile 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 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject o/this a plicetion a ermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? j�Yes U No (Section 65850.2 of the Califomia Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 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 (If yes',the fedlity must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ___.___...._...._......anageme _._ 7 Ifa a permit from the South Coast res Duality ed by Californiaal or other airpollution ooncontrol district3 or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Callfoia Health and Safety Code Section 42303 been made? 0 Yes 0 No e appropriate 8 (If yes',attach certificate o1 compliance from the apprpriaair 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 c ply 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 y for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this per it until final inspection. s20)ZtO3 Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE f VISPECTION TYPE DAIS maks CODE' INSPECTIONTYPE • PATE INTTTIALs 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 7-3-o3 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 CITY OF COSTA MESA 4 BUILDING DIVISION >:J' �1i 8 DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER 4, rit r8C PERMIT MO1-00140 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2450 ELDEN AV Status: ISSUED Suite No B Applied: 03/20/2001 Issued: 03/23/2001 Vicinity: \/ / Parcel Number: 43929105 _ - ISSUED BY: '�/�(� ✓ - Applicant: RENZ, RUSS- //`' ! _=i 7- i,,-,�.-"--C--- .--1 ( 1 Address: - /gc/A 'V Ph_,e: 1714-577t9,77,1_,/,:' � (, A7 V \, Owner:,V INFINITYrHOMES-CM--I,LLC �. - ;,- �� //IV/ A �'//ii/ A Addre s V945 SOUTH ST#301' " ,N , �. iN 1V Phone: v:` _ / 'N 1,�7 ,f CERRI�OS SCA Zip:y 90703 N\''.\\:\: '\ /�\ ///�l „�. '.y ���� cii:�Contractor.�.]SENTRY MECHANICAL, INC. (•• ' t y \v ' Advi dress / 540-S JEFFERSON! '" ° ` } / ) t !'i /i( �CA _ ,---T) 1 v a Phone. 714-577-0771, - 4 �'�\ 1 �'� � f //j PLACENTIA, CA if::-.e.„-y.o I - Zip: 92870 - -- � 1' »� � , j" � :1.,...:',!.: �� ��, �.-�:: % 1 t�' ,��'/ 111 i -�`��r� License: 631049 'i'`" \ t .�- yi ( Aoh/Eng II it Ire` / �./ ��� v ‘--, )�1 Address ,)�/f l _ . - - _ - _ . �'1I 17 It_ / errVZ ..-r �, �L(��. J a. �, 11 - = License ' - - - -- t \-\ i t, - SCOPE OF-PERMIT. %, 4 ��/( ,c-,__,) 1 `INSTALL HVAC UNIT IN'NEW SFR.CONTRACTOR DOING'HEATING-AND AIR`CONDITIONING , yONLY PER PAT WILLIAMS. REF B00-00960 `-- -> 'l ii f/� C.� ) � � c..---:_3_ �_�.`, /li/�� 111 v Vk.I., FEE SUMMARYer?:%L 1 1(F �� �-J ) Quantity /� Quantity ISSUEFEE\ \ / A�t� $23.50 :,,, t,'',>,-Repas/Alt Absorbtion Unit , C.$0.00 OU Inst FAU 100 k BTU \ A $14.80 1 ^�5 s: Re air/Alt Refrl eration Unit /2 I \ p g $0:00 �0 Inst FAU>100 k BTU �� V,.-$0.00 0 .0'4.••[...c,'',,:�'� , .r•'r,,,Ventillahon;System.. .. $0.00 0 Repair/Alt"Cooling/Heat �'N80.00 sc 0 , x�`° 0, p z,�„ �%'✓�-" 2�?$0.000 ..� mss,{ - p ,�� ,-, Eva orahve';Cooler Inst/Rep. Recess.Wall Htr N$0:00 0 '�'- , .. v b'r C'Commercial Incinerator $0.00/0 Refng Sys<100 kEBTU 0 $0:66%0 -' rb c.. ..%, o o °Domestic}Incinerator �i C/ $0'00 0 Refrig Sys>100 k•BTU , $0.00.*0 --- o n�� o " a Compressors/Absorption.Systems a/ Gas Piping $0:00 0 l'" oUp.to 3 lip.//t00 k:BTI.V ` 0$0.00 0 � o Factory Fireplace K$0.00----.0 ----...,,c --.,,_-°,3 To:15:h Y500JKBTU 0 V $0.00 0 Hood w/Meth Exhaust �� $0:00 / 0� - �. __ - _15`-Tb.30'hp/1,000 k BTU AV $0.00 0 VAV Box �$0:00�0 L� 30 To SQhp./(1.750 k BTU / d- $0.00 0 Vent Fan/Single Duct -$0.00 LO ��rs^�)U 5)r"OGei5501hp Over,f,,750 BTU /9 $0.00 0 Appliance c.$6:60-,,,,0 ', ! 1 l_Boiler's 1, �L% „� Fire Dampers $O:Oo-oz �-_„. ;\cL Up td.3 hp !�i? $0.00 0 Smoke Dampers $0.00"-0 3 To 15.hp--;T2 l' $27.15 1 - Inst or Relocate Appl Vent $0.00 0 �'='r -��,; c S:to 30:hp�- $0.00 0 Air Handlers< 10000cfm $0.00 0 30to-50hp $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 $65.45 COMMENTS I 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 it 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. --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 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 withrovisions. �7 T -Apptlgant:S�tu0Y Date: '/3) [ 7 WARNING:FAILURE TO EC _�URE WORKERS'COM NSA ION COVE E 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 37060E 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 a r Class#i—lIY(/Con S'Sgnaure- - K� Date: 4n , QQ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 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,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 Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the 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 en 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 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? 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). ....nag m..t. t i.t. other o 7 a icatiofromn the South Coast s Qualityci ed Management District or Sr airpollution control 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 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. �� Si. it.Of Legal Owner(s) 31z 3/a/Date I r / 4/ •hd/•.AuttioilzeQ r•Ildarits Date CODE I INSPECTION TYPE gaff.' INrmA46 CODEI INSPECTIONTYPE [� 2101 A 1616 Fixed System Final Fire Prevention 206 Final Mechanical ZS"X.1-01 n( 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 1 250 Final Building/Occupancy j L CITY OF COSTA MESA 4 BUILDING DIVISION >:f_,.,,, ,1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t IPERMIT J%,,wl. P00-00642 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2450 ELDEN AV Status: ISSUED Suite No B Applied: 11/20/2000 Issued: 11/20/2000 Vicinity: UNIT B Parcel Nunmber: 43929105 ISSUED BY: Applicant: TAYLOR, WAYNE Address: 1247 NORTH BATAVIA Phone: (714)997-9991 ORANGE,CA Zip: 92667 Owner: INFINITY HOMES CM I, LLC Address 10945 SOUTH ST#301 . Phone: CERRITOS, CA Zip: 90703 Contractor: GOLDEN WEST PLUMBING INC Address: 1247 NORTH BATAVIA Phone: (714)997-9991 ORANGE,CA Zip: 92667 License: 317026 Arch / Eng: Address: • Phone: Zip: License: SCOPE OF PERMIT - PLUMBING PERMIT FOR NEW SINGLE FAMILY RESIDENCE FOR"INFINITY HOMES"(UNIT B). INSTALL 2 BATHTUBS, 1 DISHWASHER, 1'EXPANSION TANK,5 GAS OUTLETS, 1 WASHER, 1 PRESSURE REGULATOR, 1 SHOWER, 1 KITCHEN SINK, 1 PRIVATE SEWER LINE, UP TO 4 VACUUM BREAKERS,4 WASH BASINS,3 WATER CLOSETS,&1 WATER HEATER. REF: B00-00960 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 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 $19.60 2 Pressure Regulator $9.80 1 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $12.30 1 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 $39.20 4 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 Sewer Private Line $24.65 1 Water Closet(Toilet) $29.40 3 Drain,Root $0.00 0 Shower $9.80 1 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Ins(or Rep.) $0.00 0 Expansion Tank $9.80 1 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) $6.15 1 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $1.10 1 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: $227.00 NOTICE: The work authorized by this permit slope 7i®Aspiny*6 8AT40/43 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 it. FOR INSPECTIONS CALL: (714)754-5626 (/ 24464E(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. EQ I havt 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: //�� Carder D6•40-Fl L (15 Toy Number:Old-FY C..e_ (This section need not be completed ll 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 should become subject to the workers'compensation provisions of ctlo 3700 of the Labor Code,I shall forthwith comply with these•ro -ions. Applicen(Signature:_ .. S1-MSS ..._ .i CDate:!�_ Oil WARNING:FAILURE TO SECURE RKERS'Art SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TOC MI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000)•ADDITION T• E 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 nder 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. CntraaorsSignattura:— -/ ' - � re /Date: / CONSTRUCTION LENDING_`eCY: 7-! ❑ 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: 4' ' 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 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.). ❑ I em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑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 feel 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 wit 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? DI 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? ❑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 properly for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. . eOf /'gal Owner(s) Date • A ••• ihorizetl CODE I hI•i. •' RAIE RO6$ CODE INSPECTION TYPE PATE AMU 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ©©"A 1''01S'u 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 p F - CITY OF COSTA MESA • BUILDING DIVISION : t ,' DEVELOPMENT SERVICES DEPARTMENT PERM! NUMBER � . PERMIT 41114PoRmso 41" 00-00288 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-FIRE SUPRESSION PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2450 ELDEN AV Status: ISSUED • " Suite: C Applied: 11/02/2000 Vicinity: UNIT C Issued: 03/29/2001 Parcel Number: 43929105 Zoning: ISSUED BY: Applicant: MARTINEZ, MONA-LISA'- :"---, (_ i ' Address: 1787 POMONA-RD,,..---, -'''\\- , ` SUITES D 8-E% i ; Phone:- (800)915-3473/, CORONA2CA'h\ \ tv Zip: : 91720 .- �� i ����_�v cam/ C�\ ,J Owner: /INFINITY HOMES CM I,LLC - -- N �t : Address r/l 109`45 SOUTH ST#301� - A ' �('/ / \ %/jl %/ Phone: /\ \,\ / ,1/ CERRITOS,,CA'r.�7 Zip: 90703 ' / - //�"i/ CoritractoC/)FIRE"SPRINKLER SYSTEMS �' �- �' \\\.\ / . .-r i ✓ r i.--i A ' 7" — A i /Address: v,1787 POMONA RD 'y 1/�)1 �N7..1 SUITES D&E r Phone _;(800)915-3473 ., �- `j .�y r 'U \ ()in), CORONA,,-CA -"Zip:, - 91720 ' _ '�� t V CO = �,I r License 684600 , - ‘, 1 ���?� `�� \ kJ •� ,FIRE SPRINKLER PERMIT FOR NEW SINGLE FAMILY RESIDENCE&GARAGE FOR`INFINITY\HOMES \vv 1` (UNIT C). INSTALL 25 FIRE SPRINKLER HEADS. \., r I - ' } ; I ' it/r--. i' \ � i . ' � ` u REF: B00�00961� _ . �l )� ,r-5/ -t y "-s r /v6rl ! � ' / � '�l�l � Z� z/ l =t / _. �ul� it/ 1 i:'_', ! , �� H1' I t .. I)i " \ FEE SUMMARY ` i `U yPlan_Check di1$35.10 � ,- �- /' Calc Valuation /i$1,500.010 i \Permit 6'1.,$54.00 r-y \ ` ,_ .Claimed Valuation:" $1,500 00 \ \ ` Other v $0.00 �,73 ��i �' ) / / ----j /ro) `' 1 \ �/l \..,�Total:, `� .$89.10 , i cc---) .5,,,y , , „,„.2 _,,, / ,_,, 0, N , ....„:„.„,,,0_,0 _,„,_ . , \,), €0,,,,,:„.,,,,, ,,,, . 0 , 0 ,. 04„ 7 do� c, o o if &,. 0 .,„ cocc.„„ , r), r.„.„ 00..c..:0_,„, ,,.„.„0„.„±:,_0,0„0_,, , ,,,,, 7, ______ ,0., <„, (0:.,, , .,, _ ,, NT, \ J �J, n,�i i-- T .-r --\�i. )} ( 1 , 1GA_ cam __ �_: t\c ,, u, ',----d _.--:.-;.:5,2.- - - ..jc-''--: -. .. . _ - -_ ,'fir'/-- �� 'moi,-.: �i✓�%J���' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration.of this permit.. ` FOR INSPECTIONS CALL: (714)754-5626 ,// 244646(6/00) U DECLARATIONS f1 WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: O 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. T.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 worker?'compensation Insurance carriercaand policy number are: I ��,_,,--��7 Carder:_ -le? 9T('Yl(� CPolicy.Number:C(7 0C�(l (.11,11T ou.c qq `(This sect/on need not be completed It the ppe it is valued at one hundred dollars($100)or less.) ❑ 1 certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Sect on 3700 of he Labor Code,I shall forthwith comply with these Fjrov;ions. N� 2 //�) APPII�ni Slgnetu7e:�rY a�G( �.. // ([�✓v� CDe1e:---G' '�/ WARNING:FAILURE TO SECU E W RS'COMPENSATION COVE- S UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN DITION TO THE COST OF COW ION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm than t I am licensed u �•visions_pf Chapter 9(commencing with Section 7000)of Division 3 ofthhe.Buslnes d Prete '.ns Code,and my license is in full force and effect.Licit. -� 0 ♦ �XJ/� Cless e- Con ac gneture:_ r /� `Q9 D r Date:. -; .�� .ii 8/ //(J f CONSTRUCTION LENDING AGENCY: l ❑ 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: ,y` I hereby affirm that under penalty of perjury that 1 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 0 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,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 en 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? Ull Yes IJ 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 1 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. Signature Of Legal Owner(s) Date And/Or Authorized'Applicant (__Date__ CODE 1 INSPECTION TYPE DAM' .. 9L6 MODE. INSPECTION TYPE PAMLNTrfALS 1616 Fixed System Final Fire Prevention Ce:1'0) 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical a /�,1, 201 Final Block/Retaining Wall 212 Final Fire Prevention 07'x) NO 202 Final Factory Fire Place ' 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition • - 250 Final Building/Occupancy I.*9 CITY OF COSTA MESA BUILDING DIVISION ` P t i„�. ,r ; DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4, 11r.4 I PERMIT gkob.0 `sr" 01-00141 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2450 ELDEN AV Status: ISSUED Suite No C Applied: 03/20/2001 Issued: 03/23/2001 Vicinity: ili Parcel Number: 43929105 - - - . - - _ ISSUED BY: Applicant: RENZ, RUSS/(2-)(2,,---------- 1 Address: i - - _ • �6) ' V\ "� A Phone 714-577.0771 % • - � =z,p- �'� yc'>,v Owner:,gINFINITY/H MES CM:1,=LLC ' �� /n'/// A `_S%012- 3- . �"-`A // j�VA�� Address: 10945,SOUTH ST#301 ', - ��//"---7jPhone: \.;� /0//7 CERR�TOS CA Zip: .90703 �. / ,t\��� �contractor:�SENTRY MECHANICAL, INC. ; \�'� /Addrreess / 540 5 JEFFERSON' • ��' , v1�C h C / j CA �/ , V/ , .Phhone 714-577 0771 , ‘,\\:\ \.0 / / �_/ �PLACENTIA CA( " �r , - Zip: 92870 - - .� �� i' 1 1' \ - . r, /,/ ,/ � �� Eco - Iw I\ 9 /1.72...71 /j;.�\ License: 631049 � . \ ,(� Arch/En r \ \ ', \I (/ �� `� �� �' /Address f n( ; - A / I! (-- Vc / S ���) _ /�*=r: A/ 'rPhone /�/^ �^-. •v",v '.A '' I . I{ pI I I A 1 wit :� ll ,1/_Zip 1 -‘1....U21 - w r L I �J� _ License - - - - - -- t (, E- 1 1 \-i- •()///n=� �°SCOPE OF PERMIT = ��j"., ; , ., /%/ '�-J c \ INSTALL HVAC UNIT:IN'NEW SFR=CONTRACTOR DOING.HE TING_-AND AIR:CONDITIONING '(///1 "�� ,� \\\ ONLY PER PAT WILLIAMS. REF:B00-00961 - , ,l , \ 1\ V I �' _ /// �7 C i ` FEE SUMMARY- -- . -,, , \'�v ��y Quantity �( Qyantit l ty ISSUE FEE,A� \�� $23.50 .r;,;�,r, ',i tu"Repay/Alt Absorbtion Unit 1 O/��$0.00 Oji Inst FAU\ 100 k BTU 1 $14.80 1 a�'�4 Repair/Alt Refrigeration Unit l' $0:00 01 Inst FAU>100'k BTU<,r \„$0.00 04.-)4,4,,,,',. - ' .)-,'• Ventillation'System, ✓' $0.000 Repair/Alt\Cooling/Heat `$0.00; 0,34,? b nq �( c .�Evaporative Ccoler,j'r;'r?'�� '$0.000 Inst/Rep. Recess-Wall Htr //J� $0:00 0 . 0, o f( ' ,. Commercial Incinerator o $0.00/0 Refrig Sys<100.k-BTU /� $0.00 0� c, o a 6 q r `'Domestic Incinerator ,112 7/. $of.00 0 Refrig Sys>100 k•BTU $0.00 0 C� Ca' Cc,,_ a °Compressors 7 Absorption.Systems VllI /,Jv Gas Piping $0:00 0"� ' '/> Upto,3 fipJ�t00,k:BTU' �\CCC/// fgr/$0.00 0 Face $0.00�0 �_ s%`. .c_3 To=15.h /500.KBTU 7 /l 50.00 0 ry �- - --_ -_ p n� (/ Hood w/Meth Exhaust �$0.'00> 0"" _ _ _75_To30hp/1,000 k BTU !=J /$0.00 0 VAV Box $0:00 0 `��-i� 30 To 50.hp/1,750 k BTU 7)/ $0.00 0 VenteFan/Single Duct C>$0.0 (0� t �� 1 -'\F riOver 50 hp/-Over 750 BTU /�' $0.00 0 V i Appliance $0.00 _0 ' �' ` 1 ; Boilers I L.1,) Fire Dampers $0:00=%0; Q-__--).'1 "\C 1 •=Up'td.3 hp-' J $0.00 0 Smoke Dampers $0.00'^0 %C,�_ 3 To 15.hp-0,---<. �J $27.15 1 • Inst or Relocate Appl Vent $0.00 0.---- --' '-7/1.. ��j_15:to:30.h --- $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to"50lip $0.00 0 Air Handlers> 10000dm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $65.45 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(6/00) • r WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O 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 .c/work for which this permit Is issued. .INS 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. t� My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This sect/on 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 Sectippn 3700 0(the Labor Code,I shall forthwith comply with the Ions. 3 9�_ /Q i a t:Signature- AM Date: II :'[// WARNING:FAILURE TO SECURE WORKERS'COM SATION COVEISC 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 COMP SATION,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 .Lc..e Class a aLifectOrs-Sig_e:- Dale: jj/ ?j 0 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a consr lmctlon lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: -tt+ Lender's Address: Signature: n 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 then 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. ❑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: 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 Safely 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 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). 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 end Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification end 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? 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 am Permit for such construction ormodification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ 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 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(Duality 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 inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �A M Er%nor(s Date • licant Date CODE c IHSPEC1ION TYPE RAM INIEIALE CODE T INSPECTION TYPE (� �1 PDI{ I 1616 Fixed System Final Fire Prevention 206 Final Mechanical (l'.,L i -01 ", 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 ":y-ir CITY OF COSTA MESA t -@ BUILDING DIVISION F ;..41 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J PERMIT ' ,,oms41' P00-00643 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2450 ELDEN AV Status: ISSUED Suite No C Applied: 11/20/2000 Issued: 11/20/2000 Vicinity: UNIT C . Parcel Nunmber: 43929105 ISSUED BY: Applicant: TAYLOR, WAYNE Address: 1247 NORTH BATAVIA Phone: (714)997-9991 ORANGE,CA Zip: 92667 Owner: INFINITY HOMES CM I, LLC 1111111. Address 10945 SOUTH ST#301 • Phone: CERRITOS,CA Zip: 90703 Contractor: GOLDEN WEST PLUMBING INC Address: 1247 NORTH BATAVIA ' Phone: (714)997-9991 • ORANGE,CA Zip: 92667 License: 317026 Arch / Eng: - Address: Phone: Zip: License: • SCOPE OF PERMIT - - -. ,PLUMBING PERMIT FOR NEW SINGLE FAMILY RESIDENCE FOR"INFINITY HOMES"(UNIT C)... 'INSTALL 2 BATHTUBS, 1 DISHWASHER, 1 EXPANSION TANK,5 GAS OUTLETS, 1 WASHER, 1 PRESSURE REGULATOR, 1 SHOWER, 1 KITCHEN SINK, 1 PRIVATE SEWER LINE, UP TO 4 VACUUM BREAKERS,4 WASH BASINS,3 WATER CLOSETS,&1 WATER HEATER. REF: 000-00961 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 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 $19.60 2 Pressure Regulator $9.80 1 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $12.30 1 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 $39.20 4 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 Sewer Private Line $24.65 1 Water Closet(Toilet) $29.40 3 Drain, Roof $0.00 0 Shower $9.80 1 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 $9.80 1 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) $6.15 1 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $1.10 1 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: $227.00 NOTICE: The work authorized by this permit sOOMMENTS laSPECIAle GONIMT401441 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 7 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 2448-48(8/00) 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,es provided for by section 3700 of the Labor Code,for the performance of the ----work for which this permit is issued. L :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: _ _Garner"—QPJF1 L_ Policy Number:(SK) P7Lb (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 :• ,' at i should become subject to the workers'compensation provisions of ectlon 700 of the Labor Code,I shall forthwith comply with these pr• is•ns. _ h V -AppiicantSignature:—LLeheA a1 .ei Date: /i Zl w WARNING:FAILURE TO SECURE/ SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO C MI ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE f$1o0,000 'ADDITION T• 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 th�ness and Professions Code,and my license is In full force and a Sign t o - i Cal p--rL Contredtor� s Si . ./!rars/.7 re �I L_Date:. Or CONSTRUCTION LENDING AG-- CY: ❑ 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: v OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPS 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 constnic(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 properly,or my employees with4wages 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. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,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(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 tile 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? 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 ppermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? t�Yes LJ No (Section 65850.2 of the Calitomia 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 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. Sign: r:Of Le•,/Owner(s) Date A / .4/11.&I /V-:/4 - „ff/ —A'• i`F"-orized'•pplicant "' I—Date-----__ CODE I -S, a'. / PATE INITIALS CODE! INSPECTION TYPE PATE .lNTTT L$ r 1616 Fixed System Final Fire Prevention 206 Final Mechanical �� 1266 Pool Spa Final 208 Final Plumbing R`/�n!-o I 4�r/ 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 CITY OF COSTA MESA 4BUILDING DIVISION :f i l.•t DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER 0.1 12 4 . • PERMIT ro 00-00289 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-FIRE SUPRESSION PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2450 ELDEN AV Status: ISSUED Suite: D Applied: 11/02/2000 Vicinity: UNIT D Issued: 11/02/2000 Parcel Number: 43929105 _Zoning: - - __ ISSUED BY: Applicant: MARTINEZ, MONA-LISA-C- -1 1 I" �:` - - ' Address: 1787 POMONA RD !`-- 3�--\ � �, • i . / SUITES-D,&'E'='' r \ _---1 \ vv Phone:-, (800)9153473; CORONA,-CA .=\ ` 1 ,fZip 91720 ,/, �1 `\ Owner /IiN/FIN'ITY HOMES CM.I LLC - - " \ : , \�/ V�, Address l 10945 SOUTH ST#301,-,-:,/,,,,,--- /,,,l/ 301 ,i �(/ V N / -1/,./7"`-%i� Phone: / �\ �//CERRITOS;CA'� Zip: 90703 \, Contractor it FIRE/SPRINKLER SYSTEMS , .e , 7-z \; //,,Address: 1787 POMONA RD '��`� ' S bi/ �� Oci ��SUITES D&E Phone. -,(800)915 3473 J - ��\ c 0/ CORONA" CA "I'Zip:,-, „_91720 ,t �o/ /�� �� / Lic ne se. 684600 �t,' v i ,v - . <<� r ,,� —, , , �� ///1.;� r - — SCOPE OF PERMIT �--, � , iir � • i �\ i I vRE SPRINKLER PERMIT FOR NEW SINGLE FAMILY RESIDENCE&GARAGE FOR"INFINITY HOMES F (UNIT bp.INSTALL 23 FIRESPRINKLER HEADS r > V'A I. 't 1 , _ Vu L REF: B00:00957/�'-) I'' I r/ ^S i y � -� I ,l I I:0 r-1 ,i /V1....tc _ y .2. ! ! l .l` �(/ a t ji• \\ t \, ICJ I I, rt 1 I,__-- V Of VU j i FEE SUMMARY , I I VPlan.Check: 6\.$35.10 � f,,_N �+..� ;': ; �__. Calc Valuation: f• iid$1,5�oo j Permit j`U`I$54.00 - --~ -u ---Claimed Valuatlon i $1,00.00 :, c \\ _--_7___j,)0I Total. \$89.10 \off „/6,.._• .4, \\...„ • ..... .......tis„,../, , ,, ,i.• .:.„ „: „..,......„ , .„ .. ,,_ • , ,i . 7,7,7 0( y \‘,H•4. 11•;•tb...-4.4'y•--i., , (;).) '44- -' c-. (4 „ :),..-> ;Al::•„.±:),...1!'.‘•37 N--t:,-„__.--, Q/6,(:::Jr t------) - .-,-0 � C-i-/', ;\\} •'—ti U --2.) ---; 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 expirationof this permit. / FOR INSPECTIONS CALL: (714)754-5626 2448-413(6/00) V 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. have a - I. nd 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' ompe sat on Insurance carrier nd policy number are: •Carder:--' O -1'1TI •—Policy NumberDOU n I*OctZKiRQ "(Thisssection Knee not be completed if the permit is valued at one hundred dollars($100)or less.) --- r-.g O 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 f the Labor Code,I shall forthwith comply with these•rovisions. ` /.-�/� Q (APPl =� cant Signature: /%///�%.40, to• �/ mt : Ovn Date WARNING:FAILURE TO SECURE W;E'S'COM-ENSATION COVE-•r E 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 • gj.•TION,DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that am•licensed u d rov' i s of r 9(commencing with Section 7000)of Division 3 of the.Business d Pr a cions Code,and my license is in full force and effect..Licrtt / � _. Glassx� Conttaolors•Slgnature: ,p(� ir7,0 \( Date:--"C3l Q CONSTRUCTION'LENDING AGENCY: //�1J'�' ❑ 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: u I hereby affirm that under penalty of perjury that I em 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 toe 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`lo 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 driver's license. 0 Yes 0 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: 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: 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 en 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 thisapplication 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? 0 Yes j�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? ❑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 approprtate 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. �? ignature Qt{,pgy`OLw1(s 45/a1245/0 j`An r-Authorized A cant - (jDate.. ODE t INSPECTION TYPE MAO CODE• INSPECTION TYPO ))h 9 T Z.-iv/A, �, 11ALS 1616 Fixed System Final Fire Prevention .-iv/ , Nip 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical ^� a� 201 Final Block/Retaining Wall 212 Final Fire Prevention 2"/SCI) 14 202 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 F ti I;.,„ %i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER `1• % • PERMIT 01-00142 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2450 ELDEN AV Status: ISSUED . Suite No D Applied: 03/20/2001 Issued: 03/23/2001 Vicinity: / / Parcel Number: 43929105 , - - ISSUED BY: V ��� c. - � Applicant: RENZ, RUSS/ G�i�= _ _. I �-�S�- -_ - � - - - 1 -V i • Address: �/ i - � -, - \ Phone: _714-5770771 / _; DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: " O 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. c -QQ�I.havb 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 ll 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 It I should become subject to the workers'compensation provisions of S ction 37 of the Labor Code,I shall forthwith comply with thecd;T1n' Isio♦ns�.� p ,( \v^�*J O� -WARNIaG:FAILUREature: REWO • "�9A Date: WARNING: TO SECURE WORKERS'COMPEN TION COVERAGE I 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 3708 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. Des Conlr�ignature:_ Datate: 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: -•A Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I apt 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).): 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 ha 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 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,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous materiel? 0 Yes 0 No (Section 25505 of the California Health 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 al 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 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? j�Yes LI No (Section 65850.2 of the California Government Coda 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. 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. Ig rtu : eget Owner(s) Date . ' SAA.7r.A'OozedApplIe Date tri POPE I INSPECTION TYPE PAIS' Itim915 COPE INSPECT10N tyPE p_9IE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 9'23'0( N ia 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 r' tr CITY OF COSTA MESA t BUILDING DIVISION :e-tii .,1• DEVELOPMENT SERVICES DEPARTMENT PERM! NUMBER F l 4 PERMIT 4%4, ,++� • P00-00644 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2450 ELDEN AV Status: ISSUED '.Suite No D Applied: 11/20/2000 Issued: 11/20/2000 Vicinity: UNIT D • Parcel Nunmber: 43929105 ISSUED BY: Applicant: TAYLOR, WAYNE Address: 1247 NORTH BATAVIA Phone: (714)997-9991 ORANGE,CA Zip: 92667 Owner: INFINITY HOMES CM I, LLC 1111.161.11. Address 10945 SOUTH ST#301 Phone: CERRITOS,CA Zip: 90703 Contractor: GOLDEN WEST PLUMBING INC Address: 1247 NORTH BATAVIA Phone: (714)997-9991 ORANGE, CA Zip: 92667 License: 317026 Arch / Eng: Address: • . Phone: Zip: License: SCOPE OF PERMIT . PLUMBING PERMIT FOR NEW SINGLE FAMILY RESIDENCE FOR"INFINITY HOMES"(UNIT D). , •INSTALL 2BATHTUBS, 1 DISHWASHER, 1 EXPANSION TANK,-5 GAS OUTLETS, 1 WASHER;V PRESSURE REGULATOR, 1 SHOWER, 1 KITCHEN SINK, 1 PRIVATE SEWER LINE,UP TO 4 VACUUM BREAKERS,4 WASH BASINS,3 WATER CLOSETS,&1 WATER HEATER. REF: B00-00957 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 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 $19.60 2 Pressure Regulator $9.80 1 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $12.30 1 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 $39.20 4 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 Sewer Private Line $24.65 1 Water Closet(Toilet) $29.40 3 Drain, Roof $0.00 0 Shower $9.80 1 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 $9.80 1 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) $6.15 1 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $1.10 1 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: $227.00 NOTICE: The work authorized by this permit 5COMMENT$NISR CI74t GONWINsa 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, an 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 (v/ 2448-48(8/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O 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.fowhich this permit Is issued. 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: /3 Carrier e440 FTC=6— 1%�''Policy Number.-et0-0€7C- ' 1(Thls sectlon need not be completed li 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 ould become subject to the workers'compensation provisions of S tion 700 of the Labor Code,I shall forthwith comply with these• •vi-• s. JT� r. —ApplicantSignature:� `✓/ A Date: WARNING:FAILURE TO SECURE RKERS'COM TION COVERAGE IS UNLAWFUL AND SHALL SUaiECT AN EMPLOYER O CRI NAL ENALT1ES AND CML FINES UP TO ONE HUNDRED LLA THOUSAND DORE(5100,0001 ADDMON TO COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that tam.lict•-:• 0 provisions of Chapter 9(commencing with Section 7000)of Division 3 of4he'Buslness and Professions Code,and my license is in full force and effect.ud.:tt.- • er Contractor's . ✓. A Dar te: 'MAP CONSTRUCTION LENDING A"E CY: ❑ 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: a•- Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: �7 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.My 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 properly who builds or Improves thereon,end 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 exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes ❑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 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? ❑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 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 0 N (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 ao_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]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 lobe 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? ❑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 purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sit 3au.AA meas) --- Date An,rt ' •zed Applicant 1100E 1 m•. r.'T, gdIF IN:mLS ;ODE f INSPECTION TYPE RAIL — 02:01464 1616 Fixed System Final Fire Prevention 206 Final Mechanical r� 1268 Pool Spa Final 208 Final Plumbing g(1".Q 3 'O( RPJ 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 CITY OF COSTA MESA 4 ►Y BUILDING DIVISION >. DEVELOPMENT SERVICES DEPARTMENT PERM NUMBER � . �s PERMIT 0-00290 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-FIRE SUPRESSION PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2450 ELDEN AV Status: ISSUED • Suite: E Applied: 11/02/2000 Vicinity: UNIT E Issued: 03/29/2001 Parcel Number: 43929105 Zoning: ISSUED BY: Applicant: MARTINEZ, MONA•LISA l \r r Address: 1787 POMONA.RD ;— I • ' i•-• :7 - SUITES-D&'Ei ( C — 1 Phone:-- (600)915-3473-, / ' �" - CORONA(CA �\, , Zip r 91720 /,' // / �1 , Owner: INFINITY HOMES CM I, LLC � cam, A. C';''. Address y 710945 SOUTH ST#301A�/ 7/".--c; mac/ \ 2 2 \ \\ �/ v / /��� Phone: �:.Al .� �,A / CERRITOS,CAr.-/ Zip: 90703 �� \A Contractor:',, FIRE/SPRINKLER SYSTEMS o.' `c /;A , ✓7 ,/, ,-, CSA, � � �� � //. ,Address �,1787,POMONA RD / �1fSUITES D&E Phone =(800)915-3473 r - ' , // / CORONA CA>- 11 " 'Zip 91720 ---.1,\ • ,' - -,-,:---- / �� ���� ; ,, `f License. 684600 \ �V� %' � P.,1 SCOPE OF PERMIT -_ • ; '` ' : v , j \( • � ^\ xFIRE SPRINKLER PERMIT FOR NEW SINGLE FAMILY RESIDENCE&GARAGEFOR"INFINITY HOMES ' (UNIT E):INSTALL 25 FIRE SPRINKLER HEADS ( 1, \ ` uli/ i �� L2 �l REF: B007 -00962 i. / /'1 v1 �.^� s rc� A i i 1 i l___ ''(UIt. FEE SUMMARY ' -1 t, 0U Plan_Checkt`i'tti�k.$35.10 ,moi J.., - /': v_,�' Calc Valuation: f,,$1,soo oo 1Permit\10 $54.00 --- R - -=Claimed Valuation' $1,50000 I Other ,$0.00 I -., . , - ; // i Ul r \���T;tal� It11 10 ir `c :: / P A \ n. A\vV : r 7,-7.7 " 7/.1.7 \ t:1/--.0 % 0 : 0 i' (, ' ,s., - ' 0' „,- ' "1 , ' --f' // -I \ r 00 0 --CC: A Ci 1 /U - - moi% 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) U I 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. 1 have and will maintain workers'compensation Insurance,as required bysection 3700 of the Labor Code,for theperformance of the work for which this P q permit is issued. My wo comp nation�loJsur�ance mer and policy number are: 1 ..,.n -Carder:- � TU 1�)r Cl?olicy.Number.�OCir- ) u tit T 00htiO r ' -(This section need not be completed i/the pe it is valued et one hundred dollars($100)or less) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. / '2/ / Applicant Signature:- n'? �C +�.f�7�J``f �/lnC, Date:--C� ��l/Q/ WARNING:'FAILURE TO SECURE W Ft&COMPENSATION COVERAGE IS U AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND OOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATI GES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that.tam licensay un r plc visions oLLirChapter 9(commencing with Section 7000)of Division 3 of the.Business an Prof sgions Code,and my license is In full force and effect.Llcrq—� /! ./l CClasstt'J /yq.7-1r/fes CootractoY�s;Slgnatur -/�!Li�.- �/ �-Dete:—�=Lc1 /9.,c;(0 / 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: f OWNER-BUILDER DECLARATIONS: -,W 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 owns-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 driver's 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? ❑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 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? 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. Sign ur f Legal Ow r(s to AndtOr'Authodz licant- ---- .- - - COPE t I[ISPECTIONTYPE PAW INTITIALS CODEC INSPECTION TYPE DATE 1111316Ls 1616 Fixed System Final Fire Prevention (S r 1)1 ) 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 %'7 -01 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • '(c CITY OF COSTA MESA 4 BUILDING DIVISION >lei n. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t I PERMIT v 01115 -"Pa et 01-00143 (714)7545273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,C STA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2450 ELDEN AV Status: ISSUED Suite No E Applied: 03/20/2001 Issued: 03/23/2001 Vicinity: Parcel Number: 43929105 • - ISSUED BY: a l/ Applicant: RENZ, RUSS ---//21--; i - Address: 4(2i „ V t Phone: . 714-5770771 / i � ' \ /` - Zip: -.\ , _\ owner y> INFINITY°HOMEECM I;LLC v Address: 10945 SOUTH ST#301 - AA �/ ,.moi. �� Phone: v , / VSA :/ CERRITOS,CA Zip:y 90703 �� �� 1,,,' A /,;',-(7/ V >A /Contractor -/SENTRY MECHANICAL, INC A •,- %Address I 540 SIJEFFERSON! '• - :, _ ; �. �\ i �� ;CAS -�� �P_hone: 714-577-0771 �, `,�`. . , I i :`i A J /PLACENTIA CA/7- , - - Zip: 92870 • - c-V < , / - . i i',' I/ - -;yam License: 631049 - Arch/Eng:, % " ./ "-� '\ /' `' i Address _ _ _ � - C 1/ /. i /' , , - / Phone . ;y)'l •��'v �� I , j i� 1 ' .....2/ ,_ d , ; Zip . ./... .. ., A . / 't\ License. , ' \ '�'I � SCOPE OF PERMIT , / �� _l, I f • �'� �t�`ONLY PER PAT'INSTALL HVAC WIT IN NEW SFR.LLIAMS.LIAMS REF:00-0gT6R2AOTOR DOING TING AND AIR CONDITIONING Q�,// �-- '� I n\ y\ .,. /% // 4e1 :,------ -_ _;) nil ��� (\ \ FEE SUMMARY_ /1 �' 1,1 Quantity _ y. • ,.. //�/ /1/Quantity ISSUE FEE�v � Vv $23.50 - ••` "Repair/Alt Absorbtion Unit 2/ x$0.00 o i� Inst FAUV<100 k BTU N,; $14.80 1 Repair/Alt Refrigeration Unit !�" $0.00 /o Inst FAU>100 k BTU '7 A .$0.00 0 . o Ventillation System •- r $0.00/60 Repair/Alt ACooling/Heat- �$0.00< 0 '-2,,,-- �, a 'Evaporative;Cooler i 7, 7 . woof) 0 Inst/Rep.Recess-Wall Htr .$0.00- _ 0 "' �., " C, '`Commercial Incinerator `"i>`� $0.00 0 Refrig Sys<10QkBTU $0.00'k0 2 �' o ' �^ Domestic Incinerator " ojA $0:000 o o. 0 ()",/ Refrig Sys>100 k.BTU , I $0.000) o�o )`" 'Compressors/Absorption:Systems Gas Piping 1 / $0.000 -0J �Up.to 3 hp/_100 k,BT,U� x$0.00 0 FactoryFireplace Q_ $0.00A0��� p A'��o����-,.:_-.3 To.i5hp 1�500kBTU n�O $0.00 0 Hood w/Mech Exhaust �- '$0.00 i O^- --- _- _ _15 To 30 hp/1,000 k BTU, L/$0.00 0 VAV Box ��$O.00/O �i'�, 30 To 50-hp;1,1,750 k BTU\k �/° $0.00 0 Vent Fan/Single Duct C-_-,,.$0.06 (o �/ c 7j/--,A,( ,I,')(=04ei 50'hp hOJer'i7;750 BTS-0 $0.00 0 Appliance $0.000 .f ' �I I? `- Boilers �\ \_/ Fire Dampers $0:000, �-/L 1.K.i-UP to 3 hp� �� $0.00 0 Smoke Dampers $0.000"-U' 3T 15_hp��_)-,:2 69 $27.15 1 . Inst or Relocate Appl Vent $0.00 0�'-- O' -�,�� ,---__,,,,15 to 3ahp� $0.00 0 Air Handlers< 10000cfm $0.00 0 _--------30 to'S0 lip $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 $65.45 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 expirationof this permit. FOR INSPECTIONS CALL: (714)754-5626 2449-49(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. c _ 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: Canter. Policy Number: (This section need not be completed i/the permit is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers compensation laws of California,and agree that it I should become subject to the workers'compensation provisions of g$action700 of the Labor Code,I shall forthwith comp with the " ions. (�(�1/4 ^ I�)D I WARNING:FAILURE TO SE RE WORKERS'COMP SAllON COVERA IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRI :Applicant Signature:' `\/ EOM � Date: /,)rll`GRIMPENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOLMAND DOLLARE(5100,003),W ADDMON 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.Uc.NClass a / !� DVaclor:s Signeluref A �. .1/V -31 1r,E . Dale: ✓I ZA/ "f Th< CONSTRUCTION LENDING AGENCY: 111 ❑ 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: A I hereby affirm that under penalty of perjury that I am E%EITPT 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 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 Ucense Law does not apply to an ownor 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. ❑Yes ❑No Driver's 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(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous 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 builtling occupant need to prepare an RMPP(Risk Management and Prevention Program lar 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 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? Yes L]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). _._ Maage..._.._..__ _ _ _ _. 7 Ifa a potion from the South Coast res esby Califo District o other et gold tioncton control district3bor 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 MD 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. c MA Q9 Si QOff Legal Owner(s) 3123/ 0) I^3I D 1 Date \V�✓s7^, X,( N r ellitzed plicannf L 1 J Date CODE I INSPECTIONTYPE PATE' ILLS CODE. INSPECTIONTYPE PATE 1618 Fixed System Final Fire Prevention 208 Final Mechanical —a3'o� I( 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 204 Final Demolition 250 Final Building/Occupancy 4I 9 CITY OF COSTA MESA 4 BUILDING DIVISION f • ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER J PERMIT • ' „a,atill#4. 00-00645 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2450 ELDEN AV Status: ISSUED Suite No E Applied: 11/20/2000 Issued: 11/20/2000 Vicinity: UNITE • - Parcel Nunmber: 43929105 ISSUED BY: ., Applicant: TAYLOR, WAYNEIII Address: 1247 NORTH BATAVIA Phone: (714)997-9991 ORANGE, CA Zip: 92667 Owner: INFINITY HOMES CM I, LLC Vs. Address 10945 SOUTH ST#301 Phone: CERRITOS, CA Zip: 90703 Contractor: GOLDEN WEST PLUMBING INC Address: 1247 NORTH BATAVIA • Phone: (714)997-9991 ORANGE,CA Zip: 92667 License: 317026 Arch / Eng: Address: . Phone: Zip: License: SCOPE OF PERMIT - ' PLUMBING PERMIT FOR NEW SINGLE FAMILY RESIDENCE FOR"INFINITY HOMES"(UNITE) INSTALL 2 BATHTUBS, 1 DISHWASHER, 1 EXPANSION TANK,5 GAS OUTLETS, 1 WASHER, 1 PRESSURE REGULATOR, 1 SHOWER, 1 KITCHEN SINK, 1 PRIVATE SEWER LINE, UP TO 4 VACUUM BREAKERS,4 WASH BASINS,3 WATER CLOSETS,& 1 WATER HEATER. REF:B00-00962 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 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 $19.60 2 Pressure Regulator $9.80 1 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $12.30 1 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 $39.20 4 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 Sewer Private Line $24.65 1 Water Closet(Toilet) $29.40 3 Drain, Roof $0.00 0 Shower $9.80 1 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 $9.80 1 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) $6.15 1 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $1.10 1 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: $227.00 NOTICE: The work authorized by this permit sCOMNIgisMiS ABBE k4L Ciettal0014S 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 V 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. ` T l 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:. (�N/"1 Lt-----Th. Policy Number: a`z'F1(--t_ ` '(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,end agree that if I should become subject to the workers'compensation provisions of Se Ion 37 of the Labor Code,I shall forthwith comply with these•ro 'sions. / _ T Apphcant.Signature:- Ant- /4.J 01 rDate/� W a O iWARNING:FAILURE.TO SECUR 4rRKERS'CO SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRI NALP TIES AND OVIL FINES UP TO ONE HUNDRED -Th sr JD DOLLARE(5100,.• ADDMON Ta E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that.Iam licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the'Buslness-and,Professions Code,and my license is in full force and effect.Sig atu e.-_ 'Date,N Contractors Signature:— '-/ •� -�1 Date:.--- I ele. // 7/ O( ff CONSTRUCTION LENDING Arf NCY: ' ❑ 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: r 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 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 exempt under sec. + Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑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(38)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 ❑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 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 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 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 a plication aQQermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ul 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 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 prescnbed 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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. ner(s) Signa_. . r• f - Date / , at -.. /- SAn• ••r'-Ur••% ed Applicant .> (,Date CODE E INSPECTION yT PAIL l LEaka SODFit I/ISPECBON TYPE PAIL IMMLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical L� 1266 Pool Spa Final 208 Final Plumbing R-2S-0I t N 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`0 M`9 CITY OF COSTA MESA \ BUILDING DIVISION r{. • DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER F ( aup i y�ir�ssf PERMIT -`"M4.iamn`m�1"f`• F00-00291 (714)754-5273 • Fax(714)754-4856 • w.ci.costa- FlREa.us SUPRESSION PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: _2450 ELDEN AV Status: ISSUED • /Suite: F Applied: 11/02/2000 Vicinity: UNIT F Issued: 03/29/2001 Parcel Number: 43929105 Zoning: . ISSUED BY: Applicant: MARTINEZ, MONA-LISA -`> I Address: 1787 POMONA-RD..—- \t- \ A i SUITES'D&"El%' / r�.� 1 Phone: (800)915-3473/ // " - , CORONA CA \ —t , Zip:- ' 91720 /t/ ` � Owner (INF,INITY HOMES CM.I=LLC �\N. Address;12/10945 SOUTH ST#30,1 �� •" - �yN�' //7'( � t A /,�;/ Phone: 1�A \� J CERRITOS,,CA ,/ Zip: 90703 " \\\ cont-actor/:/ FIRE/SPRINKLER SYSTEMS \ / �\ Address '- 1787 POMONA RD -' \ , ` \ /i/ /SUITES D&E ' Phone 4(800)915 3473 -� �� "�� . / I f 1 CORONA,CA > -'Zip -- 91720 - �,� /r"-.. 1 .l�//' -� � ! � .-License. 684600 _ " ' \4y� %� `� t / „i ' SCOPE OF PERMIT Nt.,:// 11 t ;N i.j,,FIRE SPRINKLER PERMIT FOR NEW SINGLE FAMILY RESIDENCE&GARAGE FOR"INFINITYNHOMES"HOMES' , \ i (UNIT F) INSTALL 25 FIRESPRINKLER HEADS \ --I n ' REF: BOO-00963/ I ' ' (-/ ' I 'U 1 1M I� S-./(' i._ .i J... r ii --ut4 U/ i th , A_-- in i ` \ � '�� �� FEE SUMMARY - / '7 U I t< Plan Checks\V-1$35.10 -v,- - - (:•:,,, ;'2/,:'"A, Calc Valuation '$1,5 0 0>0 �V �� �� ,',',J, $54.00 __ _ —= .. _ /f L, , -Claimed Valuation:/ $1 5oo:oo> Permit 1f 1 \ �� Other. AA- „$0.00 _. � f7I j/-- ‘, ,%\ Totals \$89101 ...... ..,,ty:st.,..... \ /.„,. /.(---) , n, Ior J- 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(6/00) v • 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. [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, t_r"---My workers'c pens ion Insylaace carded policy number are: I Carrier:-- 1t..1 lIIcy.Number�YL� - 2z_ LLrll1TW,W . .9 -(This section need not be comp eted If the permit is lued 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 agr 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 ss}ons. ��/J (--� /Q �/� / Applicant Signature: -/•Y! / /'(QI��G CDala:_ . v/[/`-7-1 a/ WARNING FAILURE TO SECURE WORK 'COMPENSATION COVERAGE I WFt1L 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 COMPENS ON AMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm tl]al I am kens§§d�trader visions o}Chapter 9(commencing with Section 7000)of Division 3 of the,Business a f Pro ions Code,and my license Is in full force and effeclnLic.e-/�(� CC-.../ ^ lass 4---/ ConlredorsSigneWie:. l��t.'-7 /i"fC'✓ (Dater- cg 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: r 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 shp 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. ❑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? 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 Safely 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? 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 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. Ignatur�r Off gal Owner W,24:(—D074_,7 ni2nra7u And/OrAuthedd Appli - aate=-._ CODE 1 INSPECTIONTYPF C p� BAR' RamL5 CODE( INSPECTION TYPE PAIS ISL$ 1616 Fixed System Final Fire Prevention C-7 "CI/ 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 Z" 'O/ a9.-- 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition • 250 • Final Building/OcCupancy ,y1 ' , CITY OF COSTA MESA BUILDING DIVISION j•'-'�r• DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER qtybonne r PERMIT M01-00144 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2450 ELDEN AV Status: ISSUED ' Suite No F Applied: 0312012001 • Issued: 03/2312001 Vicinity: Parcel Number: 43929105 - - - ISSUED BY: Applicant: RENZ, RUSSi �C. -- .,_ Address: ��% � ;�� \� i, )��-,\ , � . '%�� \! \ V `� Phone: 714-577:2771 i/ !- � ��7�� - zip ! � Owner: %.INF,INITYIHOMES.CM I,-LLC \ . , /,'' 7 ' ii2 -� :; �, ., /vVN2' 7 Address:,10945 SOUTH-ST.#301 .7v 7- \\� //f?/> [ i j/ / /� Phone: - . - / / -� „�, CERRITOS;CA Zip. 90703 A /Contractdr�/SENTRY MECHANICAL, INC. 1 / r1/47 i Address 540 S JEFFERSONr °•° - \\, `�� / (� CA( / I 1 ,/ _ .-Phone 714-5770771_.- , \I , \;'\ \ • -� \�\ 'i \-� /� r/.PLACENTIA,CA/',_-1 , ' _ _- Zip: 92870 - f _ , A ‘ \K ,;-,1 ��' License: 631049 -_,; \ / Arch/Eng U ' 1/ /v /N N vA� .' I� Ai 1 , Address $r ' _ _ - - --Th 1 /- it i •r i7 i Phone / rL _)) nryv `VA j1 , ‘r✓21 it .- L�! Zip: i 1'Lt-�_ii 1. L X L [ii \ -1 •- �� � �� - - - License: -• - . - - - . -- i L 00 ' \ ,r/ (' L I/2 ,---I'`� NSCOPE OF PERMIT '7/ ^,, -- %;' ! - -� �� ^ , u \`� INSTALL HVAC UNIT IN:NEW SFR CONTRACTOR DOING"HEATING AND-AIR CONDITIONING 'Pit' L_ n 71V \ONLY PER PAT WILLIAMS:REF:BOO-00956-' - ,-- S i I - l7 _ ) Q l/l� r�_� r� ' �. FEE SUMMARY . ; � '-. �i �� ��, Quantity �- u// // Quantity ISSUE FE ,,�� �\ $23.50 `"`'V -Repair/Alt Absorbtion Unit i `$0.00/ 014 Inst FAU10 k BTU �' \ $14.80 1 -,i;- . • Repair,/Alt Refrigeration Unit /� W:00 /0 Inst FAU>100 k BTU 17 �\ $0.00 0 %�- 7 Ventillation•System % .c $0.00/7,0 Repair/AI�Coolmg/Heat l $0;00:-/0,_,4;-*-,.,-- . %Evaporative Coolerta 1�.! -)/7 ) '$0.00r 0 " q - 0• i , Cv /i -V Inst/Rep. Recess.Wall Htr $0.06- 0 c/ c' i„ Commercial Incinerator / $0.00/0 Refrig Sys<100 k BTU $0.00 10 0 _� Domestic Incinerator �f,/ 6'N $0:00 0 Refrig Sys>100 k.BTU , -/�$0.000VO\� o�'o -/2_O ° " °Compressors/Absorption'Systemis �7) (/ Gas Piping \� I //$0.00 0�` ° o" \1'3 Utzto 3 hp/-100,X13TU� iii �/Th Q" ,9$0.00 0 Factory Fireplace \N \/ $0 00' 0 ��'-`c--„;-,-G---. °,3 To 15-hp1500'k1BTU,,,�\�� $0.00 0 - Hood w/Meth Exhaust \, \-,S0.00-‘) 0^ - - 15 To30hp%1,000 k BTU �/$0.00 0 VAV Box $0:00�0 O�/� 30 To 50_hp/y1;750 k BTU\�� $0.00 0 Vent Fan/Single Duct x$0.00 t0' �/ C-i ` /- _ _Ovei50h /Over 1,750 BTU $0.00 0 Appliance '$000 0 V [ 1 , 't,\ - r p V / i�� pp C/`J� Boilers `/ 0 Fire Dampers $0:00--S0--_,_ '-_J; /\/�. rUp td.3 hp- $0.00 0 Smoke Dampers $0.000-c _ 3 To 15 hp.-�,�� $27.15 1 Inst or Relocate Appl Vent $0.00 O�l�o.�5-� Ge15 toi30:hp - $0.00 0 Air Handlers< 10000cfm $0.00 0 t-x_.._30 6.50 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 $65.45 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 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. lahave 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 recited. 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, g if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the Bions. A_ `WARNING: FAILURE T If Date: E� `WARNIAG:FNLURE TO 5���'''���"'G```lREWORKERS' TION WVERAG S UNLAWFUL AND SHALL SUBJEOf AN EMPLOYER TO CRIMINAL PE TIES D CML FINES UP TO ONE HUNDRED THOUSAND DOL ARE($100,000),IN ADDMON 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.LN.a Class a _Contrectoraslgnafure7��ur�"""�tC. �'� p� / Date: Zh O 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 1 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(commenting 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 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 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 feel 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? ❑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 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 Califomla 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 penally 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 inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Aar (l(1 Si. e Legal11/ Owners - 12-J.7 /o (Date `A l • ..thomed'Ap IcantThs Date CODE I INSPECDON TYPE RATE' UELB CODE! INSPECTION Mt PAU 1616 Fixed System Final Fire Prevention 208 Final Mechanical F1'ei 3—o 1 Alet 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 • CITY OF COSTA MESA _ ►9@@@ BUILDING DIVISION >•f '. DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER t• ""e".-14. PERMIT 4t w Rana +�' 00-00646 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2450 ELDEN AV Status: ISSUED Suite No F Applied: 11/20/2000 Issued: 11/20/2000 Vicinity: UNIT F • Parcel Nunmber: 43929105 ISSUED BY: Applicant: TAYLOR, WAYNE Address: 1247 NORTH BATAVIA Phone: (714)997-9991 ORANGE,CA Zip: 92667 Owner: INFINITY HOMES CM I, LLC Address 10945 SOUTH ST#301 . Phone: 11111111. CERRITOS,CA Zip: 90703 Contractor: GOLDEN WEST PLUMBING INC ' Address: 1247 NORTH BATAVIA Phone: (714)997-9991 ORANGE,CA Zip: 92667 License: 317026 Arch / Eng: • Address: Phone: Zip: License: SCOPE OF PERMIT . PLUMBING PERMIT FOR NEW SINGLE FAMILY RESIDENCE FOR"INFINITY HOMES"(UNIT F).,, -INSTALL 2 BATHTUBS, 1 DISHWASHER, 1 EXPANSION TANK;5 GAS OUTLETS, 1 WASHER, 1 PRESSURE REGULATOR, 1 SHOWER, 1 KITCHEN SINK, 1 PRIVATE SEWER LINE, UP TO 4 VACUUM BREAKERS,4 WASH BASINS,3 WATER CLOSETS,8 1 WATER HEATER. REF:B00-00963 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 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 $19.60 2 Pressure Regulator $9.80 1 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $12.30 1 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 $39.20 4 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 Sewer Private Line $24.65 1 Water Closet(Toilet) $29.40 3 Drain, Roof $0.00 0 Shower $9.80 1 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 $9.80 1 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) $6.15 1 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $1.10 1 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: $227.00 , NOTICE: The work authorized by this permit slCOMppgµ f)AISpiattAt oOttUrnowS 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) C--v, DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O 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 avecwork.tor which this permit is issued. e- 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 number are: / reenter: at/ACP- Pvrcy� Number: pwl-Elc.e l _((hissecdon need not be completed 11 the permit is valued at one hundred dollars($100)or less.) (�--�---r ❑ 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,end agree th If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these•. .vi i.ns. Applicant Signature:.:�is r a r Date: -06 WARNING:FAILURE TO SECUR' �•ORKE0.S'gr'ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE($100,0x,. N ADDITI• F.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 thattam.li 5#44in er 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 effecl.,Lib.B. . - {-Classic-- - Contractor/Signature: r. Date: / -/1741 CONSTRUCTION LENDING AG CV: ❑ 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).): ❑ 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.). in I am exempt under sec. - Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 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 n0 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). D 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 ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a2ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _...._...._ _ _ __ -w...__ — _...___ 7 -if a permit from the South iscast Air prescribed ed Management CaliforniaDistrict or other airpollution tioncontrol district03 or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by CelfoHealth 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.1 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. . .ener(s) / Date A .i artA IAY- :Arid/.Oi 'ded Applicant------________ (Date - - .. CODE, . '.m L2AIE II{ I8LS CODEt INSPECTION TYPE PATE MALI 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing $'"^a-01 " {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 P OS" CITY CITY OF COSTA MESA -- aBUILDING DIVISION )' i� 1, s , DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER 1. I _-_ - 1- PERMIT 4. ' E02-00330 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2450 ELDEN AV Status: ISSUED Suite No F Applied: 04/23/2002 Vicinity: Issued: 04/23/2002 Parcel Nunmber: 43929105 Applicant: DEANS, CRAIG . ._ - - ISSUED BY: I Address: 3535E COAST HWY -- ,c2 ,/-' � - , SUITE 174 /-2. „- ,„�l •Phone: 949-675-99-72 t - ---- CORONA DEL4AAR= , • Zip: 92625 . A /• \ ) -) . /l r / �A Owner/ CALDWELL"JEFF AND-DANA- N ', A.;-\ Address /2450 ELDEN A\t//..-------,-.<;.-_-:---- �' \ - �\ ,. �� t� � X // / N / ,,/ �UNIT,F�/7�7 ,� Phone: 714-548-2669 �� i < `vv' N ' % COSTA MESA;CA Zip: 92626 ��'YA/% , '/ \`,�_� /ii/ ...\; ',, i ., .rte; 1\ Contractor,,,,'JIM DEANS LANDSCAPE i i •' . Address: -8535 E PACIFIC COAST HWY s , -.___ �! 'N _ _ �. ' ,STE 174. -Phone: 949-675-9972 . - • ' .CORONA DEL MAR CA '7 i " . _ ., Zip: 92625 , - - _ � - License: 302013 - - /, � / .\ i ,- -\ .. V A' - . ' Z. SCOPE OF PERMIT . t ` '\ / ,,.n..> > . I } 1/ . -ELECTRICAL LINE FOR'COUNTER TOPHIGHBBQ.LOCATED'AT,A'SIINGLE FAMILY RESIDENCE. . ' wL ._.. s:✓./ _ i:.-,L.- 1;.,L- IL A.✓ N - .- - - - f 4 -. , A `1::i i ,r J 1 , 1 .- N FEE SUMMARY , Quantity.. - 7 'v _ /,jam Quantity ' tip ISSUE FEE • '• $23.50 ... - .- _- -Temp Dist System/lighting $0.00 0 . Temp servicedest . $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 10.00 New'Res(3+units)- , - I ' $0.00 0 Transformers up to 1 kva/kw ;$0.00 -0 / Pool/Spa / , $0.00 0 -• up to 10 kva/kw $0.00 �,oY' Lighting Fixts , �`N _$0.00 0 `'`�1. �r -_ -up to 50 kva/kw • $0.00 ;'.•2 0 Recept Outlets v;.$1.10 1 % .-•up to.100 kva/kw $0 00'/ 0 Switches\ \\, / \$110 - 1 • - % over 100 kva/kw_ $000 / 0�% / Non Res Apply,. j $0,‘66-.)„..1.;-c"-"b-07f5 - Low Voltage Equipment 10.00/ 0 ,. i/ Res Appl �/, '-,-„,,\ ,/'',/,50.00, $0 00\ 0 ' , ` Low Volt Wiring System/Ckt, -$0.00/ 0 // , Service to 200a.- v N/' $0,00 A-0 - - Misc.�Conduit Service to 10004�v. C/ ' - ----,,,,:"..$184-2„)1;$00 - ' o / /,/ $0.00 0.� ) v Misc.Conductor . $0 00 (,0 ./ Service over 10004 N-�: ,$0.00I''', 0 'N` _, " Circus(gen or ride) /1,50.00.) 0/i ' Motors to 1hp A v� $0.00 0 -_Circus(mech ride or lights)SN. "'$0:00•' 10, Motors to 10hp `>�$0.00/7_r/,' 0_ ' - Christmas Tree Standv $0:00 '/ 0 Motors to 50h '-$0.00 'i -0 /,' e-, ` I' �:" p l -� . _ Fireworks, Sta"nd ( \, - $0.00%l/0 Motors to 100hp '-•$0.06-:-, -' 0, / ` _- Other Electrical Fee.; ' , ,10.00/ Motors over 100hp $0.00` _0 '� -� • i%', Communication drops $0.00 ---,:z---0->---- _ - ' ' ''• Investigation Fee ---„,/:(12<-„,.- '$0.00 Sub panel to 200a $0.00 "0- _ , - Plan Check Fee. $0.00 Pole Light Pkg $0.00 0 - --" 'Reins_p_e_ction.Fee' $0.00 Sign Circuits $0.00 0 . Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $43.90 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)754-5626 2446-66(6ro0) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • O I have and willmaintain 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. have and will maintai workers' pensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'comp tion I suran carrier an Ilcy number are: CO [ 1? %� Carrier: Policy Number: I l(y 0'4 1 3 w (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) O 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 Celifomi d a r eYtfTshould become subject to the workers'compensation provisions of Section 3700 o the Labor Code,I shall forthwith comply with these provision 12,E /a Applicant Signature: Date: (/ WARNING:FAILURE TO 5 URE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed un r ' 5pf 9hrlPter 9(commencing with Section 7000)of Division 3 of the Business and Professi s Code,and my license is in full force and effect.Lie.# (� - Class# 7 Contractors Signature: Date: { 2_ 4) 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: 4> Lender's Address: Signature: - - � Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under chr of iresjury thaterm I amEICEMPT FROM THE CONTRACTORS Lany SE LAW for the following reason a(ore.7031.5,Businesslicaand suh Professionse Code:Any cityed or ctemen which a or he a permit to,purs antt,alter,improve,provisions demolish,or repair any nsecLu ,prior to its issuance,also with Section the 7000)oDivi ionh of thtoe fiue a stand statement that or she Is Ito r is exempt t tothe and of the forContractorslLed exe Law(Chapter oof e0 5tbyaof Division 3 e mit subjects Business andpficantProfessionsto Code)or that or she is five therefrom 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 mc�e 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 awn 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 EXCLIihIVELY 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 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,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). 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)?❑ 0 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 a plication appernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? al Yes C]No (Section 65850.2 of the Celifomia 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 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 for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. _Signature `�/T�/- horized Applicant / / Date CODE L INSPECTIONTYPE PATE &MAIa ;ODEt INSPECIIONTYPE PAIS IIal16L$ 1616 FixedSystem Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -. 200 Final Re-Roof 210 Final Electrical y-ti•03 te 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 fra - ' I. 9 CITY OF COSTA MESA .. BUILDING DIVISION F • •,,,1 ; 1I DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER 4• f • PERMIT *ro6. Rump P02-00254 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2450 ELDEN AV Status: ISSUED Suite No F Applied: 04/23/2002 Issued: 04/23/2002 Vicinity: Parcel Nunmber: 43929105 _ - - - ISSUED BY: Applicant: DEANS, CRAIG 2( ' Address: 3535 E COAST_HWY ", SUITE,174.- V',, , Phone: 949-675-9972 ' / `", . ; -. ; CORONA DEL MAR - "\ Zip: 92625 / i / - Owner. �CALDWELL,-JEFF;AND DANA /� \� '� Address 2450 ELDEN AV 17' '> vv r %" UNIT F,/ / Phone: 714-548-2669 \ o\k;\ / , i ' �' COSTA MESA,CA Zip(y 92626 �\;' - /deli. ,- - - _ ' Contractor: JIM DEANS LANDSCAPE v � .... - ' .A Address: 8535E PACIFIC COAST HWY .= -•- , _ - , - , - - , i STE 174 - - Phone: 949-675-9972 , ` N.,- 7/ o ' - CORONA-DEL MAR,CA Zip: 92625 / � . - ' , 1 License: 302013 \ /, - - . • j /r'' ' ✓,7' / /rN r 7 "' 7_ ,- Aroh / Eng: . � .,' _ ✓.: ,�- _ l..J, t �_' Address: . . ' Phone: /- , r - License: ; ij _ . // . - ' . _ • SCOPE OF PERMIT - Y GAS LINE FOR COUNTER TOP HIGH BBQ AT A SINGLE FAMILY RESIDENCE. , ' 'FEE SUMMARY ,. AMT. A QTY ., -= AMT- , QTY _ 7/// c AMT QTY ISSUE FEE'` / ' $2350-.�> i'=r...--LaundryTub/Washer ' $0.00 ' 0- ""SumpPump $0.00 0 Backflow irrigation $0.00 �y'Q ' Landscape Irrigation: $0.00- 0 _ Swimming Pool $0.00 0 Backflow PreventerA /$0.00 „ '0` -P-Trap 2 "= $0.00 0 ;Trap pruner / y�/$0.00 0 Bathtub ,V�\\"/$0 00// 0 �,,,,Pressure Regulator ' ' $0.00 0 ''Unna)% '7 i r $0.00 0 Clarifier System N $0 00,' -0' Process Piping(per 10 ft)' $0.00 0 Vacuurn.Brkr Bkflo(1-4) $0.00 0 Connect(Ice,Soda,etc) v-$0.00 0 - Receptors -- $0.00 0 Vacuum Brkr Bktow(5+) $0.00 0 Dental Units ' $0.00 0r 'I//' - Septic Tank $0.00 " 0 ',`\Wash Basin e ' $0.00 0 Dishwasher x$0.00 0 '„ - 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'-C 0 -'Sewer Private Line , $0.00 0 / -'Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower' -'. .'N ',, . . . $0.00 0 ,C-' ,Water Heater/vent $0.00 0 DrinkingFountain $0.00 0 --�; 'Sink,bar - . $0.00 - .0 -- Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 'Sink-,dommercial '$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) $6.15 1 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: $29.65 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 245.46(WOO) . DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ' tyhave 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. have and w' i am w ers'.aef 1pensation ins r nce,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. workers ura�nce rp'er and icy number are: 2 Carrier: w/\ Policy Number: + Len-Pig -110 ) (This section need not be completed if the permit is value at one hundred dollars($100)or less.) O I certify that in the performance of the rk 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, at if I should become subject to the workers'compensation provisions of Section 370 of the L,ror Code,I shall forthwith comply with these provisions � T 1 Applicant Signature: c/Date: � u WARNING:FAILURE TO SE RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND D'x I ARE($10O000),IN ADDITION TO ISE TMST 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 license der ro ' io qi,9(commencing with Section 7000)of Division 3 of the Business and Professi ns Code,and my license is in full force and effect.Lic.# Class 4 Contractor's Signature: 4' Date: V/�/0 1 _ • CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). 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 Lew 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 driver's license. 0 Yes 0 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,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: t 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? ❑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 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 inspection purposes.I agree not to occupy or allow occupancy of any building authorized by thisispermit until final inspection. Signature c//`J/O !e r uthorized Applicant Date COOLY. INSPECTION TYPE RAIL INTRIALS SON I INSPECTION TYPE PATE MAO 1616 Fixed System Final Fire Prevention 206 Final Mechanical �� 1266 Pool Spa Final 208 Final Plumbing -. £j')'8-03 UIV 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 9 CITY OF COSTA MESA 4 BUILDING DIVISION F• r,,,,,; hii 8. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J IPAia •,I PERMIT R'`�4%,cissrss le 00-00292 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-FIRE SUPRESSION PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • Job Address: 2450 ELDEN AV Status: ISSUED • Suite: G Applied: 11/02/2000 Vicinity: UNIT G Issued: 03/29/2001 Parcel Number: 43929105 Zoning: ISSUED BY: Applicant: MARTINEZ, MONA"LISA \. _ Address: 1787 POMONA RD'. - - / ' SUITES-DB"ESI- ' Phone: - (800)915.3473 / CORONA,CA \ , ,Zip: 91720 -- - _ Owner ,INFINITY HOMES CM:I;LLC', - '� . '7 Address x'/10945 SOUTH ST#301 -, /�� 'N /��i% /"���/ Phone: \ \' ' / j\\\� / CERRITOS,CA'/ Zip: 90703 \�\ \ 'V /K 7/ N '� _ A� Corb'actor:/)FIR&SPRINKLER SYSTEMS •,‘, 7 'v /if 1787�POMONA RD ^ - \\ \ j / ��SUITES D 8 E . Phone: (800)915-3473 ;; - ' "\ � / ir/ (7' CORONA;CA—? Zip - - 91720 \ `" / , ; 1 ,� r //HI - :..-License: 684600 ' ' v�,. '.- 1 i , , C. t '7i / / 3. \ SCOPE OF PERMIT- - - ' v t AFIRE SPRINKLER PERMIT FOR NEW SINGLE FAMILY RESIDENCE 8 GARAGE FOR'"INFINITY HOMES" (UNIT G):INSTALL 25 FIRE/SPRINKLER HEADS." ' `V ---' ) N -\ �, iA REF:B00-00964 - - V B00-00964 �� 7 rr/ ../ - . . _. • V ' I,6I \ FEE SUMMARY ' ';/ I ,! I ) PIan.Check.l '�'v$35.10 �, .v Calc Valuation sisoo.00j yI Permit:\i\' ,$54.00 -- /N Claimed Valuation Valuation:" ti I Other:�1\ $0.00 / /� �� I \\`'\ Total•.•� \x$89.10 7//// �/ v :�A A / ‘`."�) •� %/ V / i' o ;�/ �0 ��� vvj� Ji,-- _Th3-1- ,-i `=- -2 ,720 .-3 ---_ \--:_ ',. ,\S".1;- . ! __--) _<,;,::),(2 • 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 expiratlon.of this permit. ‘,..C1 FOR INSPECTIONS CALL: (714)754-5626 '� 2446.46(6/00) V 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 ``_JJ work for which this permit is Issued. J�-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; °�mpensatlonIns rier and policy number are: G7 .,�- -Carrier—'�7T 1(,('^ —SJ JVIcPoli--Ncy er:e,OS'C� -hi-i— 2' _(This'sebflon need not completed if the permit/s re ued at one hundred dollars($700)or less.) umb ' O 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 S ctlon 3700 of the Labor Code,I shall forthwith comply with these r sions. '7 �pllcant Signature:_ !�/ .. _Date:-V rr`7 lift WARNING:FAILURE TO SECURE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRI NAL PENALTIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF E TION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm thattam am Ilce9sed updtryjovisions of Chapter 9(commencing with Section 7000)of Division 3 of.the Business a94 Prof s�55ions Code,and my license is In full force and effect.Llc..• flirt 7- o r)7.4„, l7. l 1Tr1 IClasra-- ; Coltractors'Slg f` t 04 Date: 3 2C? 0/ 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,CM!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 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 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.). O 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 exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's 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: 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)? ❑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 wit 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? LJ Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit fromn the South Coast As prescriffity ed Management Californiaal or odhSrerr pollution control district3 or—agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Celifoia Health and Safety Code Section 42303 been made? ❑Ves 0 No 6 (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. Signature Of Legal Ow s Date �ii� ��Ioc J - - � 6/2410 / And/Or Aulhodzetl A Date- - ;or F, INSPECTION TYPE PAIL' \MALS SODS( INSPECTION TYPE I IF g1IIIIALS 1616 Fixed System Final Fire Prevention g-1"O1 i' ' 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical Q, 201 Final Block/Retaining Wall 212 Final Fire PreVenlion ❑`7-01 U)� 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • r CITY OF COSTA MESA 4 ►'➢ -- BUILDING DIVISION >:j __ .t/ DEVELOPMENT SERVICES DEPARTMENT PER NUMBER a I F 1 _ _a t PERMIT J'w bkrof:11 op 6% 00-00293 (714)754-5273 • Fax(714)754-4856 • www.cl.costa- FIRE.us SUPRESSION PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2450 ELDEN AV Status: ISSUED • Suite: H Applied: 11/02/2000 Vicinity: UNIT H Issued: 03/29/2001 Parcel Number: 43929105 _Zoning: -- ISSUED BY: Applicant: MARTINEZ, MONA LISA , .. - Address: 1787 POMONA RDi i- i- . ' I �_ - SUITES:D KE--- ' 1 Phone:- (800)915-3473, --N i ,/moi � � \ i � � CORONA;CAS 1\ V \ Zip 91720 / ` ::>.:K, .\N., Owner F,INITY HOMES CM VLLC - --\� < \ ‘::::\? VT Address. 10945 SOUTH ST#301, l.,-:•.:- V� ����� Address / .�� � Phone: _ ,:'. i j \\, \ A/ CERRITOS CA Y Zip: 90703 ;` 'i / v, \ // �1 �� //e7r ,. , Contractor'' FIRE-SPRINKLER SYSTEMS \'-�\\ � ;Address: �1787�POMONA RD -N ,°1 Nt/SUITES D&E : Phone: '0(800)915-3473 i — v �v :, CORONA,CA i, 1'Zip - 91720 / .,� �� 11' 1 �)i' ,/; ` license: 684600 ‘.. p� . ' > lA i AI, SCOPE OF PERMIT - !. ,v, _ ,, " • " } ", 1:FIRE SPRINKLER PERMIT FOR NEW SINGLE FAMILY RESIDENCE&GARAGE FOR"INFINITY,HOMES" \ ' (UNIT Hp,INSTALL 23 FIRE SPRINKLER HEADSCTh A - "' � I� iVy 2 /./� �� � - - I REF:B00 009581— ' '> � / r --) �� 1?, /s1 rrir; .r T`/ `-:Thr -v :7)''''''‘,7 `\ /; - IN I t-C I �- - - L�1 �� FEE SUMMARY / • U ' A Plan-Check \\,n).\-$35.10 ! _•r✓ -v ''-�_i •_/,. _ Calc Valuation: ,/-S7 Soo.Oo) i iP �Permd \,'-$54.00 •,`. -- -- t. /; ° ' : -Claimed Valuation: 51 500:00) li ;``\\ rOther \`\: $0.00 % i/ f/ 7 -c---1 )I ^ 7 / -C,-,-.ii il/ � C - \ Total:\ $89.10 :»-- i -/ i,i N1 r~t/ \ � � , - \ if-, -`. ' ::,,,,x., •�°o �Zr� ties 0�� �C _ l U & 0' GJ p � Jrid/e)� 40 J NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration.of this permit. FOR INSPECTIONS CALL: (714)754-5626 / 2446-46(6/00) v 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. ( 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' pensation I urance carter and policy number are: ,.,,�,..�.-,,�yL Carrier _^- ') lkiro LPolicy.Number. O '(X� Ulf li'L-L-A--L�-7"r'f C -(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 . • ;Mons. 400/ 'rApplicantSignature:- _I J//2JI G! irehr .Date:_ (g/?Q/0/ M IWARNG:'FAILURE TO SECURE WO- /RS'COMPENSATION COVE 45''UNL AND S WFUL HALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED n TH 'SAND DOLLARE(SI00,000),IN ADDITION TO THE CO ST OF COM TION,DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em.liceneedypo� der provisions of Chapter 9(commencing with Section 7000)of Division 3 of the.BusA sinesnd Professions Code,and my license is in lull force end effect.Lic.N t !Ze� t O( gess#, Contract�gnature:- Def_ �•—�-�`�f^o 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: sr-• 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 end 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 DMslon 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 Ucense 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.). ❑ 1,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 contractors) 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(38)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 Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutelyhazardous 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 feel of compressed gas at standard temperature and pressure). _.__.__ in ._...__ _ __._..__._._._._.._or___._ 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 en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No ___ ___ _..h_ _.._..__..j .._.._ _.._ 5 Does or will the ap stcAir Du present a emen buildingsoccupant at any other for the work ontch is the sor age of this Op estion a ermit for such construction or modification from the South Coast Air(Duality Management District or from other air pollution control district or agency? L]Yes �No (Section 65850.2 of the Califomia 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 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 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 inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ^nl _ Signature Of Legal a s) Date ' Andy `••t • .nt--- • --Dfite— ;ODE 0 INSPECTION TYPE (� '7p_STE 1�� CODE! INSPECTION TYPE PATE ILLS 1616 Fixed System Final Fire Prevention d - ' 0 1 r'V^" 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 $-7-pi 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition • 250 Final Building/Occupancy `p .�9 CITY OF COSTA MESA 44111111111,... - BUILDING DIVISION • .,rz ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER •4. ! ! I PERMIT IPPIC. /7600-01526 , l (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.thys. DING PERMIT 77 FAIR DRIVE,COSTA MESA, CA 92626 Job Address: 2450 ELDEN AV CULL Status: ISSUED Suite: Applied: 09/27/2000 Vicinity: Issued: 09/27/2000 Parcel Number: 43929105 Zoning: [//t Applicant: JONES, CLIFF ISSUED BY: .Vl Address: 10945 SOUTH ST#301 Phone: CERRITOS,CA Zip: 90703 Owner: INFINITY HOMES CM I, LLC Address 10945 SOUTH ST#301 FPhone: CERRITOS,CA Zip: 90703 , • Contractor: INTREPID HOMES INC Address: 10945 SOUTH ST . . UNIT 301 Phone:, (562)924-4491 CERRITOS,CA Zip: 90703 License: . 779066 Arch : Eng: Address: Address: Phone: Phone: 'Zip: License: License: ' v SCOPE OF PERMIT CONSTRUCT 6'TO 9'HIGH BLOCK WALL AROUND PERIMETER OF NEW COMMON INTEREST DEVELOPMENT. , CONSTRUCT 732 FT BLOCK WALL&432 FT RETAINING WALL UP TO 4 FT 8 IN. - - FEE SUMMARY Plan Check: $359.68 - _: Calc Valuation: • . 340,560.00 'Permit: $553.35 Claim Valuation: 30.00 SMIP Res: • $4.06 SMIP Corn: $0.00 Other $0.00 - Inspection: $0.00 Total: $917.09 - , PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 . ' i ACCESSORY Front '0-0 - ' Rear 0-0 Left 0-0 ' Right` " 0-0/- "' 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 /j 2446-46(6/00) C--"'. / 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. 1 ❑ I have and wit 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 w ers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This ton need not be•• ..': :,.if -,permit is valued at one hundred dollars(5100)or less.) I certify that in the•--orm •ce•f th: 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 law •i Cal�.t -,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?hes- cm;,, . -f (], Pppllcant.Sig�ure: I' Ic�2'., -Date: 7-� .-c WARMNOfFAILURE TO SE• RE W• �'COMPENSATION COVERAGEFUM IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CL RNES UP TOONE HUNDRED THOUSAND DOLLARE($100,•••I IN y..•117 ON TO THE COST OF COMPENSATION,DAANGES AS PROVIDED FOR IN SECTION 3718 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisi•- .• er 9(commencing with Section 7000)of Division 3 of the Busineand Professions Code,and my license is In full force and effect.Lie.4 77 gr En 6- / glir Class A /} � dt6i Si nature: ,4/.4Date:- 9-77--CU I_.._• CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,CMI Code). Lender's Name: Lenders Address: Signature: Date: K. OWNER-BUILDER DECLARATIONS: . ;9 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 the 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).): ❑ I,as owner o1 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,end 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. ❑Yes ❑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 et any one time hes 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 ❑filo (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification end 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 modificationfrom the South Coast Alr Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be fumished 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 Safely Code). 7 If D.-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 penally 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 COMP •• • •r D AUTHORMATION 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•,. ith all; :Ia laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described • 4" or ins•f tion purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / �. ',a.e•al Owner(s) 2 7-atco flo ‘And/Or Authonzed7lpplicant (-Date \ CODE 1, .tre 2611 18ID1eL5 ;ODE E INSPEc00N TYPE DAM I l'l AL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1286 Pool Spa Final 208 Final Plumbing - 200 Final Re-Roof �• 0( '. / 210 Final Electrical _f ' 201 Final Block/Retaining Wall 1 4 w�/ 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 F •,„, on;.�I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 1 •: PERMIT E00-01140 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2450 ELDEN AV Status: ISSUED Suite No L Applied: 11/30/2000 Vicinity: Issued: 11/30/2000 Parcel Nunmber: 43929105 Q Applicant: LYLE COOTER ISSUED BY: "t- Address: Phone: 800-863-2525-SHAWN Zip: Owner: INFINITY HOMES CM I, LLC Address CLIFTON JONES III CERRITOS,CA Phone: 562 924 4491 10945 SOUTH STREET.#301 Zip: 90703 , F" Contractor SR BRAY CORP/DBAPOWER PLUS TEMP UTILITY SERVICES Address: 1372 VALENCIA AV Phone: (800)863-2525 TUSTIN,CA Zip: 92660 License: 523596 - - - SCOPE OF PERMIT (TEMP POWER POLE AND 6SUBPOLES. • 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 $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 $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 $23.50 1 TOTAL CALCULATED FEES $120.80 Intermed Pole $73.80 6 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 2446-48(8/00) 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 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 Ls issued. Er 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 carrier and policy number are: Cartier: �T F IAN Policy Number: / S 55 (This section nee not be Completed I!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. /• / aQ ? 00 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(5100,000),IN ADDrTION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3708 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)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lk.a S z5C Class it c— r y Contractor's Signature: 6�"' Date: // —a 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%m 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 and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 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: In 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 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 flied 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 f en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No • _..t.__.._...___ _ _- 5 Does or So the oast or Duality or future building occupant at requirer for the work which is the subject of this a estion aUPertnit for such construction or modification tram the South Coast Air Oualiry 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). 8 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 Califomia 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 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 inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. • Signature Of Legal Ow r(s // Date -74 n -eJO And/Or Authorized Dlicant LN /d Y,_�� !/ Date LODE L INSPECTION TYPE PATE J MAO LODE( INSPECTION TYPE DAIF. !MALI 1816 Fixed System Final Fire Prevention 208 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing L� J 200 Final Re-Roof 210 Final Electrical /411/ 7r ;rit 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 , pSTp MFCITY OF COSTA MESA 4 BUILDING DIVISION F• 4 4i DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER f .: 'aria. i MINI PERMIT J'4,� ,4° P00-00489 wnso (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2450 ELDEN AV Status: ISSUED Suite No Applied: 09/06/2000 Issued: 09/06/2000 Vicinity: FRONT OF LOT _ Parcel Nunmber: 43929105 ISSUED BY: 1G/ Applicant: JONES, CLIFTON -, Address: 10945 SOUTH ST , UNIT 301, • Phone: (562)924-4491 - . CERRITOS,CA Zip: 90703 Owner: INFINITY HOMES CM I, LLC Address ,10945 SOUTH ST#301 - - Phone: - - - - CERRITOS, CA Zip: 90703 • . . ' Contractor: INTREPID HOMES INC \ Address: 10945 SOUTH ST UNIT 301Phone: (562)924-4491 ` CERRITOS,CA- ' ' Zip: 90703 / License: 779066 ' Arch / Eng : - ._ - J - , Address: • i, _.. . . / . Phone: - Zip: License: / • •' SCOPE OF PERMIT •' • CAP OFF EXISTING SEWER LINE FOR DEMOLITION OF 5 SINGLE FAMILY RESIDENCE. 2 • . - REF: B00-01375 THRU B00-01379 ' 'I.=FEE SUMMARY= . • AMT ' ,QTY - AMT =QTY ;4; -. AMT QTY ISSUE FEE r $23.50 - :r Laundry Tub/Washer - $0.00 0 :,, ,a.- Sump Pump . „ i . $0.00 0 Backflow irrigation , $0.00 0 . Landscape Irrigation $0.00 0 _ Swimming Pool Backflow Preventer.. /$0.00 - 0 ' v P-Trap $0.00 0 - Trap Primer H- / : $0.00 0 Bathtub ,,, '$0.00 , 0 Pressure Regulator ' $0.00 0 ---"Urinal': ;i' / / $0.00 0 Clarifier System $0.00 0 - _Process Piping(per 10 ft)' $0.00 0 Vacuum&kr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 , 0 , , Receptors ' ' ' $0.00 •0 ' .,Vacuum Brkr-Bkfow(54-) $0.00 0 Dental Units ' . $0.00 0 Septic Tank $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 $0.00' 0 . Sewer Connect • -$0.00 .0 Waste andVent 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' , - $0.00' 0 , '/,Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 - Sink,bar $0.00 ,0 ' Water Piping(Ins(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: $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 1/ 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: (Thiss Ion need not be completed if f It is valued at one hundred dollars($100)or less.) 't certify that in the performan ark 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 ofA. . .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 p . -AppllcaicSignalurei_ ...,2; _ Date:1 &) ...WARNING:FAILURE TO SEC •E WO-•' S'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL-PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,•.. '••DITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION aiCe OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I r I hereby affirm that I am licensednder pr�corps of , encing with Section 7000)of Division 3 of t�w and Professions Code,and my license Is In full force and effect.LIC.A . 9. z/0 •Class e, Contractor's Signature:-- .. /i > Date:96-0`"- ) F CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction I: - .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: - _.f 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).): Asi_ O I,as owner of the properly,or my employees with wages'estbey 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 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 properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). i ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 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,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 _ c _ _ _.._ a._..__._ _ _ 5 Does or willo the CoasttcAir or present or emen building occupant at y other for the work which isi the subject this application apeNnit for such construction art modification from the South 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 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 thedisclosures 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 ' I-t-,,- •ON 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 st: : and cl" • dinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspe- % • I :5.I.• ::not to occupy or allow occupancy of any building authorized by this permit until final inspection. Ignatu - • Date e. AhnWOLAuth' S. ' : - .._ _ - _- ( Date - A CODE t INSPECTIONTYPE PAIS IOU CODEC INSPECTION TYPE PAM MALI 1616 Fixed System Final Fir: : entlon 206 Final Mechanical Q 1266 Pool Spa Final 208 Final Plumbing t 1 I it—CO E W 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