HomeMy WebLinkAbout3196 CHEMIN DE FER WAY - Building Permits(714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa�DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
,lobAddress: 3196 CHEMIN DE FER WY
Suite:
Viciniry:
Primary Occ: R3 Type of Consiruction: V-N
Parcel Number: 41814512 Zoning: R2
Applicant: GLYCHER,ELIMOR
Address: 9056 SANTA MONICA BLVD
WEST HOLLYWOOD, CA
Owner: BERINGER, MICHAEL D
Address 3196 CHEMIN DE FERVJY
COSTA MESA, CA
Phone: 213-792-7899
Zip: 90069
Phone:
Zip: 92626
Contractor: ELITE REMODELING AND CONSTRUCTION INC
Address: 9056 SANTA MONICA BLVD
Arch :
Address:
Zip:
WEST HOLLYVJOOD, CA
Zip: 90069
Phone:
License:
Phone: 370-247-1995
License: 823311
Eng:
Address:
SCOPE OP PERMIT
MASTER BATHROOM AND KITCHEN REMODEL.
FEE SUMMARY
Plan Check: $108.71
Permit: $167.25
SMIP Res: $0.90
SMIP Com: $0.00
Other: $0.00
Inspectio�: $0.00
Total: $276.86
PLANNING 8 ZONING
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existina: o
Slalus: ISSUED
Applied: 0724R006
Issued: 07I242006
ISSUED BV: `/ � '
Phone:
License:
Calc Valuation: se,000.00
Claim Valuation: ss.000.00
Rear 0- 0 Left 0- 0 Right 0- 0
Rear 0. 0 Left 0- 0 Right 0- 0
Re uired: 0 Pr000sed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calilornia statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92) .
EXPIRATION: This permit shall automatically expire and become void il work Is not commenced within 180 days, or if work is �suspended or abandoned
for a penod of 180 days.
INSPEC710NS: In order tor the work authorized under ihis permit to be consitlered legal, such work must comply wlth all applicaDle codes, antl all
requlred Inapectlone and (inal epproval must be obtained. Fallura to obtain inspections end linal epproval will result in the ezpiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
24a&4B (fl�W)
WORKERS'COMPENSAnON DECLApAnON: _
I hereby eNirtn untler penalry ot perjury one ot t�e lollowing declara6ons:
p I have antl will maintain a certificate of consent to setl-Insure fOr workers' campenution, as providetl tor by section 3700 ot the Labor Code, lo� the pertormanca ot the
work for which t�is permit is issu80.
e end wlll maintain workers' compensatlon insurence, as requireA by sectlon 3700 of ihe Lebor Gode, for ihe pertortnance ot the work for whic� ihis permit is issued.
My orke�s' com ensaC n Insuren wrAer�d policy num r are: /��� �� ����
Certier �-� �fiU%%�• �!n � Ain/D icyNum6o.
secNon need nof crompleted i the permit is velUed a! one hundretl ollors (8 f00) or less.)
[] I ceni that in i�a peAormance of the work lor which t�is permit is issued, I s�ell not employ any person in any menner so es to become subject to the workere'
ense ' n laws of Califomia, and egree that II I s�qultl becane sub�ect to Ihe workers' compens n provisions of Soction 3700 ot Ihe Lebor Code, I shell forthwlth
om I wit t�ese ���' � / � 'J
A PII Slgn re: �.fD' y��q�� . �i �-+� c� �
I � ILUPE TO SECURE WORKERS' COMPENS ON COVERAGE IS WJlAWR1L ANO SMALL SU&IECT AN EMROVER TO CflIMIW�1 PENALTIES AND CML FlNES UP TOONE HUNDRED
TFKKISANDOOLLARE(5100.ODO�.INADOfTIIXJTOTME TOFCOAIPENSAiION,DMIAGE50.SPROVIDEDf-0RINSECTIIXJ3]080FTHEUBORCWE,IMEREST,ANDATTORNEYSFEES.
IICENSED
ACTORS DECLARA710N:
am Ilcense0 un er pmvl5ions 01 Chapter 9(commencing wll� Soctlon 7000) ol Divislon 3 o iness and rolessions Code, antl my Ilcense is In full
� Q 2 � Cless N �
re�� 4L. ^� � `�I.21J.0
CONSTRUCTON LENDING AGENCV:
❑ I hereby aflirtn t�at Ihere is a consWclion lentling egenry tor Ihe pertormance ot the work lor whic� t�is permit is Issuatl. (Sec. 3097, Civil Cotle1.
Le�tlers Name:
Signawre: _
OWNER•BUILDEH DECLAfiAT10NS:
Lentlers Adtlreu:
Date:
I hereby ettlrm tnet under penalry ot perjury lhet I em E%EMPT FROM 7HE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, 9usiness end Prolessions
Cotlo: Any clty or caunry which requires a pormtl to construc6 alter, impmve, demolls�, or repair any structure, prior m Its issuence, also requlres the applicant tor such permit
b file e signe0 statement ihat he or she is licensetl pursuant to the p�ovisions ol ihe Comrector5 License Law (Chepter 9(wmmencinp with Section 7000) of Dlvlsion 3 ot tha
Business entl Pmfessions Coda) or lhat ha or she is exempt thereirom end the besis tor the eliegetl e:emption. Any violatlon of Sectlon 7031.5 by 9ny applicflnt for e pertnit
subjects the epplicanl to e civil peneiry of not more than live �mWred tlollars (5500).):
❑ I, as owner of the property or my employees with wages as their sole compensalion, WILL DO THE WORK, antl the structure is not intended or oNeratl for sale (Sec.
7044, Business and Pwfessions Code: The Contraaors License Lew Ooes not eppty to an owner of property who bullds or improves lhereon, and who tloes such work
himsell or herselt ar through his or her own employees, proviAed Ihat such impmvemenLs ere not Intandetl or ottered tor sale. If, however, Ihe building or Impmvement is
sold within one year of complation, tne owner-builder will have the burden oi proving that he or she did not build or improve lor purpo:� oi sale.�. '
❑ I, as ownet of i�e properry• am EXLLUSIVELV CONTRACTING WI7N LICENSED CONTRACTORS to construct the O�o�ect (Sec. 7044, Business antl Pmtessions
Code: The coniractors U�ense Law does nat appty to an owner ol proDeny who huilds or impmves ihereon, and who contracts tor such project with a contractor(s)
licensa pursuant to ihe Conirectors �cense Laws.).
❑ I am exempt untler sec. Business antl Professions Code 1or this reason:
Signeture: Da�e:
OWner ID venfieG by dnvers license. ❑ Ves ❑ No Driver's License No.
Verificatlon ot Ownership by (type of dwument, i.e. � property �ez bill or deed):
DIV�SION OF INDUSTRIAL SAFETY PERMIT CERrIF{CAT10N:
Expires:
❑ I �ereby cenify that no excevation live (5) or more feel in depth into which e person Is required to tlescend, will be metla in connection with work euthodzetl by this
permit, and Ihat no building structure, scaNdtling, lalsework, or demolitlon or tlismantling thereoC will be more Ihan Inirty-sia (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle B, Califomia AdminislreUve Catla).
❑ As owner-buiker, I wlll fwt employ snyone to do wak wMch wouk requiie a pamrii lrom iha Division ot IntlusldeV Satory, as notee abova, unlass such person �as a
pertnil to Oo such work trom t�e tlivislon.
Sig�aturo: Date:
Div�sion oi Industdel Safety Permil NumDer:
CEpT1FlCATE OF COMPLIANCE AND AUfHORIZA710N OF EMAY: I certlty under penalry of pe�ury thet I have reatl this application antl state that Ihe inlortnaUon given is
correct I agree to compty vrith all state laws entl dry ordinances relatinp to bullding construction, and authodze representatives of the Ciry of Costa Mesa to enter upon Ne
ebove-tlescnbed property tor inspection purposes. I egree nat to occupy or allow occupancy of eny building authonzed by this permil until linel inspection.
f�g„/, INSPECTIONTYPE PSiE II�L$
1816 Fixed System Finel Fire Prevention
1268 Pool Spa Final
ppp Flnal Re-Rool
2p1 Final Block/Retaining Well
ppp Final Factory Fire Place
203 Finel Sign
204 Final Damolition
GODEt INSPECTIONTYPE
206 Finel Mochanicel
208 Final Plumbing
210 Finel Electdcal
212 Finel Fire Prevenllon
220 Final Pla��ing Apprwal
222 Final Site
250 Final Builtling/Occupancy
PdIE II�L4
: ��V
(774) 754•5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinily:
Parcel Nunmber.
Applicant:
Address:
Owner:
Address
3196 CHEMIN DE FER WY
41814512
GLYCHER,ELIMOR
9056 SANTA MONICA BLVD
WEST HOlLYW00D, CA
BERINGER, MICHAEL D
3196 CHEMIN DE FER WY
COSTA MESA, CA
Phone: 213-792-7899
Zip 90069
Phone:
Zip: 92626
Contractor: ELITE REMODELING AND CONSTRUCTION INC
Address: 9056 SANTA MONICA BLVD
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool I Spa
Lighting Fixts
Recept OuUets
Switthes .
Non Res Appl
Res Appl
Service to 200a
Service to 7000a
Service over 1000a
Motore to 1hp
Motors to 10hp
Molors to SOhp
Molors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
Phone: 310-247-1995
WEST HOLLYWOOD, CA Zip: 90069
License: 823311
SCOPE OF PERMIT
MASTER BATHROOM AND KITCHEN REMODEL.
16 LIGHTS 4 OUTLETS 1 SWITCH 1 RES APPLINCE
$23.50
$0.00
$0.00
50.00
$0.00
$0.00
$17.60
$4.40
$1.10
$0.00
$4.75
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
so.00
50.00
$0.00
50.00
$0.00
$0.00
So.00
�uantity
0
0
0
16
4
1
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway I100 ft
Standing Section
Misc Eleclrical Equipment
Transformers up to 1 kva/kw
................up l0 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring Syslem / Ckt
Misc. Conduit
Misc. Conductor
Cirws ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Status: ISSUED
Applied: 07/24/2006
Issued: 07/242006
C
ISSUED BY:
50.00
$0.00
$0.00
50.00
50.00
$0.00
$0.00
30.00
$0.00
50.00
50.00
50.00
$0.00
$0.00
$0.00
80.00
$0.00
50.00
50.00
50.00
50.00
TOTAL CAICULATED FEES E51.35
COMMENTS / SPECIAL CONDITIONS
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
r
NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 9248, § 1, 1241•92)
EXPIRA710N: 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 periotl ot 180 days.
INSPECTIONS: In order for the work authorized under this permN to be considered legal, such work must compty with all applicable codes, and all
requlred Inepeetiona end tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
zae+s �amo�
WORKERS'COMPENSAnON DECLARATON: � �
1 nereby aHifm under penalry ot pe�ury ona Di the tollowing declaratlons:
d heve end w�ll melntaln a certllicate of consent lo sell-Insure lor workers' campensetlon, es provitletl tor by section 3700 0l the Labor Cotle, tor the peRormance of ihe
work tor whlch this pertfiit is issuetl.
antl w�l meimein workere' compenSalion insurence, es required by socUon 3700 ot Na LeGor Code, for �he peAormance ot �he work for whkh Utl9 permit I5 issuetl.
My orke'ts'Lpo nsetlo su/re,�n'ce^ carder antl pdicy n� er ar9J'% ` I �
t 771im/.'�'�_ ✓✓//l� �i' ( (i( V oicy ber. / �.�'y��/ ' ���
(7�is sec0on neetl nof be conq�leted i/ t e pB�i Is va/ued a( ono hundr d OWlers (5100J or /oss.J
❑ I cenily Ihai In the peAormenco of Ihe wark lor which this permit Is issuod, I shell not emplq eny person in eny menner so es to becomo su0�ect to Ihe workers'
compen ' laws ot Cellto�ree Ihat il I s�ould becomo 5ubjec� co Ihe warkeB' compensa�ion pmvisions ol Settion 3700 ot the Lebor Catle. I shall torihwl�n
with �h 50 pro ' 'o /
Ap mSigne /!. �ete: � r �—����n .
W IURE TO SECURE WORKERS' COMPENS ON COVERAGE IS UNU�WFUL rWD SHA�L SU&IEGT AN EMPLOVER TO CRIMINAL PENALilES AND pVll FlNES UP TOONE HUNORED
D �OLLARE (5100,000), IN ADDRION TO THE COST OF GOMPENSATION, OAMAGES PS PPOVIOED FOR IN SECTION 3)OB OF THE LABOfl CODE, INTEREST, AND FTTORNEV'S FEES.
DECLARA710N:
qQ under rovisions of Chapler 9(commencing with Section 7000) sion 3 of iha Business and ofessions Coda, and my licanse is in full
(i2. ��� k /�
� bp'�/� '9 .' -.O. n
CONSTRUCTION LENDING AGENCY:
❑ I hereDy ettirtn that there Is a construction lentling egency lor iha pertormance of ihe work for which ihis pertnit is issued. (Sec. 3097, Civil Cotle).
Le�tlera Name: Lenders Address:
Slgnaiura:
Dei9:
pWNER-BUILDER DECLARATIONS:
I �ereby eflirtn Nat under penelry ol perjury that I em E%EMPT FROM TME CONTRAC70RS LICENSE LAW tor the Iollowing reason (Sec. 7031.5, Business antl Pmlesslons
Code: Any ciry or county which raqolres a permit to construct, afler, improve, demollsh, or repair eny 51mcWre, pdor lo ita Issuance, elso requires Ihe epplicant tor such pormit
to lile e signetl stalement thet he or she Is licensetl pureuant ta the pwvisions of the Contractors Llcense Lew (Chapter 9(wmmenGng with Sectlon 7000) oi Divlslon 3 ot fhe
Businoss end Pmfessions Gotle) or that he or she is axempt therefrom and the basis lor Ihe elleged exemptlon. Any violeNon ol Section 7037.5 by eny epplicant for e permit
subjects t�e epplicam m a civil ponelry of not more than live hundred tlollars (5500).):
❑ I, as owner of the properry, or my employees with weges es I�eir sole compensatlon, WILL DO THE WORK, antl the structure is not interWetl or otteretl for sale (Sec.
7044, Business and Pmfeuions Cotle: The Contractom License Law dces not appty to en awner ot pmperty who builtls or Impmves Nereon, entl who tloes such wodc
himselt or herseN or through his or her own employees, provltletl that such Imprwemems are noI IntenOed or oflered for sele. It, however, tne building or improvemeN is
soltl within one year of completlon, the owner-builtler will heve �he hurden ol pmving that he or she did not 6uild or improve }or purpose o} saleJ. '
❑ I, as owner of the property, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTAACTORS to conSWct the prqect (Sac. 7044, Business antl Pmlassions
Cotle: The contractors Llcense Lew tloes not appty to an owner of property who builtls or ImO�oves �hereon, entl who conirects for such pmject with a contracmr(s)
license pursuant to the Co�iractors Litense Laws.).
� I am exempt under sec.
Sig�ature:
pwner ID vanfieC by driveYs lice�so. ❑ Ves
Ved�kation ot Ownership by (rype ol document, i.e.
Business entl Profeuions Cotle tor lhis reason:
❑ No Dnvefs License No.
properry tax bill ar Aeed):
Date:
Expires:
OIV�SION OF IN�USTRIAL SAFETV PERMIT CER7IFICATION:
❑ I hareby cetlity that no excavetlon /ive (5) or more teet In dept� Into which a pereon Is required to descentl, will be made In connec�ion with work authodze0 by Ihis
permiL and Ihat no building structure, scaflolding, lalsework, or tlomolition or tlismentling thereol. will be more then ihirry-six (36) teel high. (C�ap. 3.2, Grp 2, Ar12, Sec.
341, Title fi, Califwnia Adml�ist�aUve Cotle).
❑ As owner-6uiltler, I will no� employ enyone to do work which wauld require e permit from the Division al Indusinal Safery, es nated ebove, unless such person hes e
pertnit to tlo such work tmm the tlivision.
Signature: Data:
Division of InAusirial Safery Pertnit Number:
CERTIFlCA7E OF COMPLIANCE AND AUTHORVA110N OF EMAY: I cenity untler penalty ol perjury that I heva reed this applica6on and state that fhe information given is
corract I agree to comply wiN a�l stete lews end city ordinances relating to builtling constructlon, end auNorize re0�esentatives ol the qry ot Costa Mesa to enter upon Ihe
ebove-tlescnDetl propeny tor inspeclion purposes. I agrea not to occupy or ellow occupancy ol any building euthonzod by lhis pertnil until tinel inspection.
CODE2, {NSPECTIONS�7E Qd¢, �4
1616 Fixetl System Final Fire Prevention
1266
200
201
202
203
204
Pool Spa Final
Final Re-Roof
Finel BIocWFeteining Well
Final Faciory Fire Place
Final Sign
Final Demolition
CQOE• MSPEGTIONTYPE
206 Final Mechanic2l
20B Final Plumbing
210 Final Elecincal
212 Final Flre Prevention
220 Final Planning Apprwal
222 Final Sile
250 Final BuildindOa�uPanc
�.:
�/_=-.
�ii'�
�.t d111.
� i . �:i
(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mes PLUMBING PERMIT �� FAIfl DRIVE, COSTA MESA, CA 92626
Job Address: 3196 CHEMIN DE FER WY
Suite No
Viciniry:
Parcel Nunmber: 41814512
Applicant:
Address:
Owner:
Address
GLYCHER,ELIMOR
9056 SANTA MONICA BLVD
WEST HOLLYWOOD, CA
BERINGER, MICHAEL D
3196 CHEMIN DE FER WY
COSTA MESA, CA,
Phone: 213-792-7899
2ip: 90069
Phone:
Zip: 92626
Contractor: ELITE REMODELING AND CONSTRUCTION INC
Address: 9056 SANTA MONICA BLVD
Phone: 310-247-1995
WEST HOLLYWOOD, CA Zip: 90069
License: 823311
SCOPE OF PERMIT
MASTER BATHROOM AND KITCHEN REMODEL.
REF B06-01232
1 BATHTUB 1 SHOWER 1 BAR SINK 1 TOILET 1 WATER PIPING
AND 1 KITCHEN SINK . _ _
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Orinking Fountain
Expansion Tank
Gas Earthquake Valve ,
Gas (1-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oip
Inlerceptors (Sand Auto )
AMT
$23.50
$0.00
$0.00
$9.80
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
FEE SUMMARY
QTY AMT
Laundry Tub / Washer $0.00
0 Landscape Irrigation $0.00
0 . P-Trap - $0.00
1 Pressure Regulalor $0.00
0 Pracess Piping (per 10 ft) $0.00
0 Receptors $0.00
0 Septic Tank $0.00
0 Sewer Cap tor Demo $0.00
0 SewerConned � � $0.00
0 Sewer Private Line $0.00
0 Shower � $9.80
0 Sink, bar $9.80
0 ` ' - Sink, commercial $0.00
0 , Sink, Floor . $0.00
0 Sink, kitchen $9.80
0 Sink, service/mop $0.00
0 Spa (private) $0.00
0 Spa (public) $0.00
sn
0
0
0
0
0
0
0
0
0
0
1
1
0
0
1
0
0
0
COMMENTS / SPECIAL CONDITIONS
Status: ISSUED
Applied: 07/24/2006
Issued: 07/24/2006
ISSUED BY:
SumpPump
Swimming Paol
Trap Primer
Urinal
Vacuum Brkr Bktlow(7�4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (ToileQ
Water Heater / vent
Water Piping (Inst or RepJ
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
TOTAL CALCULATED FEES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia
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 susj
for a period of 180 daya /
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.80
$0.00
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
582.30
Qrv
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
and related
orabandoned
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 Inapectiona and flnal epproval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2446-66(N00)
WORKERS'COMPENSAnON DECLARATION:
I hereby affirm Under penalry of perjury one of the following declarations:
❑ I have and wiil maintain a certifiwte of consent to self-Insure tor workers' compensatioq es provitled for by seclion 3700 of lhe Labor Code, for �he peAormance ot �he
ork tor Which Ihis permit is issuetl.
I have and will maintain workers' compensation insurance, as required 6y section 3700 oi ihe Labor Cotle, tor ihe pertortnance of ihe work tor which Ihis pertnit is issued.
worka!Lg' co pensa�ti4n Insurance carrier and policy number are: ���� �� � �^— �
Car' . .S`w�� i.ldlM✓i �L��� <HJ
is section need no! be complete il the permit is valued a one hun r'ed dollars ($100J or /ess.) --- ��
❑ I certi(y th8� in ihe performance oi the work for which ihis parmit is issued, I shall not employ any person in eny manner so es to become subject to the workers'
com e a�lon laws of California, antl a9rea that ii I should bacome subject to Ihe workers' compensation provisions of Section 3700 of ihe Labor Coda, I shall forthwith
ly wit these prJo �isAi ns. /, �/
A li antSig re: / y�L�ti ���i�%�I/` -- te: � r Zv1 .GY)
ARN : FAILUFE TO SEWRE WORKERS' CAMPEN3ATION CAVERAGE IS UNUWFUL ANp SHALL SUBJECT A�q 70 CRIMINAL PENALTIES AND CIVIL FWES UP TOONE HUNDRED
THOUSAND DOLLARE ($100,000�, IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE L4BOR CADE, INTEREST, AND ATTORNEV'S FEES.
DECLARATION:
lam
�
of Chapter 9(commencing with Section 7000) of �ivision 3 o iness and Pmfessions Code, and my license is in full
_ �„�` � ' . Z . o L
CONSTRUCTION LENOING AGENCV:
❑ I hereby aNirm that there is a constmction lending agency for the pertormance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Cotle).
Lentlefs Name: LendeYs Adtlress:
Signature:
OWNER•BUILDEA DECLARATIONS:
Date:
I hereby aHirtn tdat under penairy ot perjury �hat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Protessions
Code: Any city or counry which requires a permit to constmct, alter, improve, demolish, or repair any strucwre, prior ro its issuance, also requires the applicant tor such permit
to file a signed stetement that he or she is licensed pursuant to the provisions of Ihe Coniracrors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Coda) or that he or she is exempt iherefrom and t�e basis for the allegetl exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil panalty of noI more then tive hundred dollars ($500).):
❑ I, as owneY o� the property, or my employees with wagas as lhair sole compensation, WILL DO TI1E WORK, and the stmcture Is not intentletl o� oHeretl for sale (Sec.
7044, Busipess and Professions Code�. 7he Contractors License iaw dces not app{y to an owner of propeMy who huilds or imprwas ihereon, and who does such work
himselt or nerseN or through his or her own employees, provided that such improvaments are not Intended or oHered for sale. If, however, the builtling or improvament is
sold within one year of completion, ihe owner-builtler will have ihe burden of proving iha� he or she tlitl not build or improve tor purpose of sale.). '
❑ I, as owner ot ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Busines5 antl Professions
Code: Tha coniractors License Law does not apply to an owner of property who builds or improves thereon, antl who contracts for such project with a coniractor(s)
license pursuant m the Comracbrs License Laws.).
❑ I am exemp� under sec. Business and Professions Code tor ihis reason:
Signa�ure: Da�e:
Owner ID veritied by drivers license. ❑ Ves ❑ No Driver's License No. Expires:
Venticalion of OWnership by (type of documant, i.e. - propetly tax bill or deed):
DIVISION OF INPUSTRIAL SAFE7V PERMIT CER7IFICATION:
❑ I hereby certify ihat no excavation fiva (5) or more feet in tlepih into which a person is required �o tlescend, will be matle in connection with work authonzad by Ihis
permi�, and ihat no building stmcture, scaHoltling, falsework, or tlemolition or dismantling ihereot, will De more Ihan ihirty-sia (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, California Adminisirative Cotla).
❑ As owner-builder, I will not employ anyone to do work which woultl require a permit fmm the �ivision of Industriel Safety, as noted above, unless such person has a
permitto do such work trom the division.
SignaWre: oate:
Division of Industnal Safety Permit Number:
CERTIFICATE OK COMPLIANCE AND AUTHORVATION OP ENTFiY: I cenify under penalty of perjury that I have read this application and state that tha information qiven is
correct I agree to comply wi�h all state lews and city ordinances relating to building constmction, and authonze representatives of the Ciry ot Coste Mesa lo enter upon the
above-descnbed property foi inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
COpE t. IN PE TI T�'PE � QA7E �MRIALS
1616 Fiaetl System Final Fire Prevention
7266
200
201
202
203
Pool Spa Final
Final Re-Rooi
Final Block/Retaining Wall
Final FaCiory Fire Place
Final Sign
204 Final Demalifion
LOpE♦ INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Finai Fire Prevantion
220 Final Planning Approval
222 Final Site
250 Final Building/Occupency
Q� INfRIALS
�� 22700
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 91] COSTA MHHA. CALIFONNIA
For App►itan� ►o Fill In Completely
COSTA MESA. CALIFORNIA v
Harbor Hall of Fame Homes, Inc.
ARCHITECT
ORENGINEER
ADDRE33 4 2 V' a Q
CONTRACTOR Lifet
ADDRB98 P• O• DVX
�,Tv Santa Ana
6TATE 208676-
LIC. NO.
OFLOT ZO X VO
USE OF None
EXISTIN6 BLDO,
BETBACK LINB PROM
CENTEP OF BTRELM1 � C �
BUILDIN6� o0
6IZE 11
EXTERIOR WAL
e �.�n
NO. OP OLDOB.o
NOW ON LOT
DESCRIPTION OF WORK
�I H8R8BY ACKNQy�LH+08 ,HAT 1 XAV^RBAD TH�B AppL�CAT�ON
ANO BTATB THAT TH8 ABOVH 10 COPRBR ANO AOflHH TO COM.
PLY WITH ALL q'ry pqDINANC88 AND BTATB L�WB PBOYUTINO
euao�No conarp�crion.
SIGNATUR80F �'
� AUTHORIZHD
FEE RECEIVED
Lot No � Tl"'0��� E��
APPLICATION FOR PERMR
BUILDING
For Office Use Only
aece�rr Ho. rnnw
APPROVED U
BY DATB
�1 IONING (1 _ / _ (-;,. -�
1�!—U/( ` 5 U
EAVE OVERHAN6 SHALL BE LESS THAN
YARDBMPROVED I VARDSAPPROVED
MAIN BUIL�ING ACGESSORYBUILDII
REAR yV FT.� FT. ;
DISTAlICfi BFT. HE7. MAIN d F
MAIN BLDGb. AGCESS. BLDCB. W
VAR.JR '1 DATE �/(' �
C. U. P. APPR V ED �-� V LLI
,J a
MPROVS � � a
BY DATE
W
Q.'
�
<
/0� ea. F;�'h� 3 p� � w
= a
TM8 AMOYNT BNOWN IINOBH VALUATION 19 pOP TX8 =' �
PUftP00B OP 89TAOLI9HIN0 A PBNMIT F68 ONLY. �
VALUATION ' y// p �
PERMIiFEE $ / � j �
�% m Q
s /� � � A (J'^ ¢ .>
r.,r., �aG $ lv:? —
¢ S