The URL can be used to link to this page

Home My WebLink About2470 NAPOLI WAY - Building Permitsp�4) 754-5273 • Fex (714) 75a-4856 • wv+w.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 2470 NAPOLI WY 43914146 Applicant: RIGHTEMYER, DON Address: 2470 NAPOLI WY ' � COSTA MESA, CA Owner:- SOO, RAELENE M Address 2470 NAPOLI WY� � - COSTA MESA, CA Con tra c tor: O W N E R-B U I L D E R Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 unifs) New Res (3+unils) Pool / Spa Lighting Fixts Recept Outlets Switches Nan Res Appl , Res Appl Service to 200a � Service to 1000a Service over 1000a Motors to thp Motors to 10hp Motors to 50hp Mators to 100hp Mators over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pale Phone: Zip: 92627-1480 Phone: Zip: 92627-1480 Phone: Zip: License: 0 Status: ISSU ED Applied: 04/24/2002 Issued: 04/24/2002 ISSUED BY: - .- SCORE OF"PERMIT ELECTRICAL TO INCLUDE: 30 LIGHTING FIXTURES, 15 RECEPT OUTLETS, 10 SWITCHES, 1 SERVICE TO 200A AND 1 SUB PANEL TO 200A REF: B02-00227 $23.50 50.00 $0.00 $0.00 $0.00 ao.00 $29.30 $16.50 $11.00 $0.00 $0.00 $30.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $30.50 $0.00 $0.00 $0.00 $0.00 Quantity � 0 0 0 30 . 15 10 0 0 1 0 0 0 0 0 0 0_-, 0. 1 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway I100 ft SWnding Section Misc Electncal Equipment Transfortners up to 1 kva/kw ...............:up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 700 kva/kw � Low Voltage Equipment Low Volt Wiring System / Ckt . Misa Conduit Misc. Conductor Circus ( gen or ride) . Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Invesfigation,Fee � Plan Check Fee Reinspection Fee Quantiry $0.00 0 50.00 0 50.00 0 50.00 0 $0.00 , . 0 $0.00 0 $0.00 0 $0.00 0 $0.00 ' 0' $0.00 0 50.00 , 0 $0.00 ' 0 S0.00 0 30.00 0 $0.00 0 $0.00 � -'�0 $0.00 0 $0:00 $0.00 50.00 $0.00 TOTAL CALCULATED FEES $141.30 COMMENTS / SPECIAL CONDITIONS ;"' � 0 NOTICE: The work authorized by this permit shall wmply with all applirable handicap access requirements under Calilornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-g2) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. � INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapectiona and final approvel must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this pertnit. FOR INSPECTIONS CqLL: (714) 754-5626 � zaae+e (aroo) . . . . WORKERS'COMPENSAnON DECLARATON: �' �' I hereby aHirtn untler penalry tl� perJury one of ihe tollowing tlecleretlons: ' ❑ I have end wlll maintein a certlficate af consent to self-Insure far workers' compensetion, ea provided tor hy sectlon 3700 oi ihe Lebor Cotle, for ihe peAormence of the Work for whlch this perm�� Is issuetl. ❑ I heve entl wlll melntain Workera' compensetion insurence, es redulred by section 3700 of Ihe Lebor Code, for t�e pertormance ot the work for whiCh thls pertnit Is IssueO. My workers' compensatlon Insurence cartler antl policy number ere: CaMer. not one or/ess.) Policy Number I ceritly ihat in ihe pertart�ence ol the work for which this permit Is issued, I shall no� employ eny person in eny manner so es to become sublecl �a �he workers' compensation laws af Cd��omi C ree t' I shou d.become sub�act to Ihe workers' compenseilon provlslons at Sectlon 3700 attttpppe lebor Code, I shall lorlhwlt� comply wiih ihese Drovisi�iisr�� n �� `� a TYIOUSAND DOILARE (E100,000), IN -� �% f2�1 g 2 De�e: COVEMGE IS UNLAW FUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALPES AND CML FlNES UP TO ONE HUNDRED ° COMPENSATION, DAA4IGES AS PROVIDED FOH IN SECTION 31W OF THE UBOR CADE, IMEREST, M1D FTTORNEPS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aXirm that I am Ilcensed under praWsions oi Chapter B(commencing with Section 7000) ol Dlvlslon 3 of Ihe Business enA Professions Code, end my Iicense Is in tull force and eflect. Llc. q Cless M ContreCtOls Signelure: Dete: CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirm that ihere Is e consiructlon lentling egency for Ihe performance of iha wark for which this permit is issued. (Sec. 3097, Civil Code). Lentlers Neme: Lander's Address: Signature: � Date: OWNER-BUILUER DECLARAnONS: I hereby eXirm that untler penelry ot perjury Ihet I em EXEMPT FROM TME CONTFiACTORS IICENSE LAW for the followinp reason (Sec. 7031.5, 8usiness end Professions Code: Any ciry or counry which reQuires e pertnit to construct, alter, improve, demolish, or repair eny strudure, O�ar to ils issuance, elso requires the applicent tor such pertnit to lile a slgned stetement thet he or she is Ilcensed pursuent ta t�e provlslons at the Contrectors LJcense Lew (Chaptar 9(commendng with Secllon 7000) of DhAslon 3 of Ne Business entl Professions Code) or thet he o� she Is exempt ihereirom end Ihe 6asis for ihe allegetl exemption. Any vlolatlon of Sadion 7031.5 by eny appllcant for e pertnit sub�ects tha epplicant to e civil penalry ot not more ihen five huntlretl tlollers ($500).): ❑ I, es owner oi ihe property, or my employees with weges as ihelr sole compensetlon, WILL DO THE WORK, and the structure is not Intentletl or ofleretl lor sele (Sec. 7044, Business and Protesslons Code: The Conirac�ors License Lew does not epply �o an owner oi property who builds or improves ihereon, flnd who does such work hlmself or herselt or through his or har own employees, provided that such improvemenis are nat intended or oNered lor sale. If, however, the bulltling or Improvement is soltl within one year of rAmpletion, the owner-Duilder will have the burden of proving that he or she tlid not build or improve for purpose oi sele.). ❑ I, as owner of the property. em EXCLUSIVELV CON7RACTING WITH LICENSED CONTFiACTORS to cansiruct the proleci (Sec. 7044, Business flnd Professions Code: The contrectors LlGense Law tloes nol apply b an owner ol property wtro bulVds w Imp�oves tlreraon, antl wtro contrects for such projea wNh e contractor(s) Iicenee'pureuant to the CAntracbra Licensa Laws.). am exempt Owner ID vedfied by tlrivefs IICem. Vediicetlon of Ownership Dy (type Professions Cada tor lNs reeson: is ❑ No D'nvels.Cicense.No. i.e. - property tav blll or tleed): DIVISION OF INDUS7RIAL SAFETY PERMR CERTFICA710N: � I hereby certlfy thet no excave0on five (5) or more ieel in depth Into which e person Is requireG to descend, will be metle In connedlon wi�h work eu�hoAzeG by Ihis pertnit, and tha� no buildip9 slruIXure, scaflolding, falsework, or demolitlon or dismantling �hereaf, wlll ba more than thlrty-sL� (38j tee� high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, CelHomia Adminlsiretive CoOe). ❑ As owner-�ulltler, I will not employ enyone to do work whic� would require e pertnit Irom the DiNsion o1 Indusirifll Sefery, es noted ebove, unless such pereon hes e permit to do such work IrPm the division. Signature: _ . . Date: Divlsion ot Industnel Safery PeR�lt Numbar: CEKfIFlCATE OF COMPLIANGE AND AVIHORPA710N OF EHTAY: I certity under penalry ot per�ury thet I have reed this epplication antl state that ihe Inlormatlon given is correct. I agree to comply with ell stete lews entl ciry ortlinances releting to bulltling constructlon, entl euthorize representetives o1 the Ciry af Costa Mesa to enter upon the flbove-descdbed pmperry for In9pectlon purywes. I egree not to occupy or allow occupency of eny Euilding euthonzed by Ihis permlt until flnal inspection. 181fi 1268 200 201 202 203 264 Fixed System Finel Fire Prevention Pool Spa Final Finel Re-Roof Finel BIocWReteining Well Finel Feclory Flre Plece Finel Sign Final DemWiuon �� WOE/ ixsveerroxrne 208 Final Mechanical 20B Finel Plumbing 210 Final ElectdCal 212 Flnel Fire Preventlon 220 Flnel Plenning P.pprovel 222 Finel Site 250 Finel BuildinglOccupflncy _k7 l�JNI,'i r (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2470 NAPOLI WY Suite No Vicinity: Parcel Nunmber: 43914146 Applicant: JANET SCOTT Address: Owner: SOO, RAELENE M Address 2470 NAPOLI WY COSTA MESA, CA Contractor: CULLIGAN WATER Address: ' 502 S LYON ST Arch / Eng ; Address: ISSUE FEE BackFlow irtigalion BackFlow Preventer Bathtub Clarifer System Connect (Ice,Soda.etc) Dental UniLs Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve SANTA ANA, CA WATERSOFTENER AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 PLUMBING PERMIT Phone: 714-953-6300 Zip: Phone: Zip: 92627-1480 Phone: 714-750-2233 Zip: 92701 License: 663091 Phone: Zip: License: SCOPE OF PERMIT FEE SUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landscape Irrigation $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 k) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 0 Shower $0.00 0 �Sink, bar $0.00 0 Sink, commercial $0.00 0 Sink, Floor $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Status: ISSUED Applied: 12/05/2003 Issued: 12/OS/2003 �� ISSUED BY: � �� Q a� � 94'� SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Waler Closet (Toilet) Water Hea(er / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. g2-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become voitl if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under this pe�mit to be considered legal, such work must comply with all applicable codes, and all required Inspeetions and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this parmit. FOR INSPECTION$ CALL: (774) 7545626 2946d8 (8�00) WORKERS' COMVENSAT��N DECLARATION: I hereby ettirm untler penalry of perjury one of Ihe following declaretions: � ❑ I heve and will meinteln a certificate af consem to seli-Insure tor workers' compensation, as pmvitled br by section 3700 of Ihe Labor Cotle, �or the pertormence of the work for whlch ihis permit is issued. � I �ave entl will maintain woMere' compensation Insurance, as required by section 3700 ot ihe Lehor CoOe, for the pertormence of Ihe work lor which this pertnit is issued. My workers' compensation Insurenca carner end policy numDer are: I ,�¢�n ppr�` carrier: 2 U�- I C I�' A-/Vl P� i e A nl .iNs Ci d F�L Policy Number: V`i.� K"1 a a!�o O CJ (This section need not be complefed I/ the permit is valued af one huntlred dollars ($100) or less.) ❑ I certify ihet in ihe per�ormence oi the work for which t�is permit is issued, I shall not employ any person in any manner so as to become sublect to the workers' compensaUon laws at Caliiomia, and agrae t�at If 1 shoultl becom subject to the woAcess' compensalion provisbns ot Sectlon 3700 ot the Lebor Cade, f sha11 tonfiwith comply with these p'slons. I / Applicant SignaWre: � Date: � o�— � / � � WARNING FAI�URE TO SECU ORKERS' C/JMPENSNTION CAVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED T/1IXISAND OOWRE (5100,000). IN ADDITIdJ TO THE WST OF CAMPENSATIIXJ, DAMAGES AS PROVIOED FOR IN SECTION 31O80F THE IABOq CODE, IMEREST, AND ATTORNE`fS FEES. LICENSED CONTRACTOFS DECLARATION: I here6y aHirm ihat I am licensed ntler wvlsic force and aflecL LIC. M Q 9 ComreaorsSlgnature: CU LL� a n.n of Chapter 9(commencing with Section 7000) ot Divlsion 3 of ihe B i . / s . CI855 a Code, end my license is in full LONSTRUCTION LENDING AGENCY: ❑ I hereby ettirtn that th0�e Is a construction lentling agenty for Ihe peAortnance of ihe work for which Ihis permil is issued. (Sec. 3097, Civil Code). Lentlefs Neme: SiqnaNre: _ Lentler's Adtlress: Date: OWNEH-BUILDER DECLARAnONS: I hereby ettirtn ihat under pBnalry of perjury Ihat I am EXEMPT FROM THE CON7RACTORS LICENSE LAW lor Ihe following reason (Sec. 7031.5, Business end Professions Cotle: Any ciry or counry wMch requires e permit to construct, alter, improve, demolish, or repair any sWcture, prior to its issuance, also requires the appliwnt for such pertnit to file a signed statement the� he or she I5 Iicensetl pursuent to the provisions of the Contrectors License Lew (Chapter 9(commencing with SecUan 7000) oi DlNsion 3 ot the Business entl Professions Gode) or that he or she is e:empt therefrom and ihe basis for the elleqetl exemption. Any violatlon of Section 7031.5 by eny epplicant for e partnit subjects the applicant to a clvll penatly of not more ihan fiva hundred dollars ($500).): ❑ I, as owner oi Ihe properry, or my amployees with weges as iheir sole compensation, WILL DO 7HE WORK, and the slructure Is not Intentled or oflered for sale (Sec. 7044, Business and Plofessions Code: The Contractors License Law does not apply to an owner ot propeny who builAs or improves Ihareon, end who does such work himsetl or herselt or Ih�ough his or her own employees, provided that suc� improvemenis are not Intended or oHered for sele. If, however, t�e builtling or improvement Is sold withln one year oi complePion, Ihe owner-buitder wili have ihe burden ol proving Ihat �e or she did not build or improve tor purpose of sele.). ' ❑ I, es owner oi ihe pmperty, am EXCLUSIVELV CONTRACTNG WITH LICENSED CON7RAC70RS to wnstruct the prolect (SecJ044, eusiness end Profassions Cotle: The contrectow Llcense Lew tloes not epply to an owner ol pmperty who bullds or improves theraon, end who comrects lor 5uth projeci wilh e con�rador(s) license pursueni to t�B Contrectors License Lews.). ❑ I em exempt untler seG. Signe�ure: Ownar ID venfied by tlrivefs license. ❑ Yes ❑ No Business antl Protessions Code for Ihis reason: Venficetion of Ownership by (�ype of tlocument, i.e. - property taz 6ill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Drivefs License No. Date: Expires: ❑ I �ereby certity ihat no exceve�ion five (5) or more leat in tlepth into which e person is required Io descend, will be metle in connection with work authonzed by this pertnit, antl that no buPding stmcture, scalloltling, falsework, or demolitlon ot dismamling thereof, will be more ihan thirty-six (36) feet high. (Chep. 3.2, Grp 2, Atl 2, Sec. 341, Title B, Celibmle Atlm4nistretive Coda). ❑ As owner-bulltler, I wi�l not employ enyone to tlo work which would require a permit Irom the Oivision ol Industnal Sefery, es noted above, unless such person has e permit to do such worN ��om ihe Eivislon. Signature: Dete: Division ot Indusirial Salery Pertnii Number: ICER7IFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity untler penalty oF perjury that 1 heve read this epplication end stale that the infortnation given is I correct. I egree to comply with all stete lews antl ciry ordinances relating to buildinq cons�ruction, antl authodze representelives of �he City of Costa Mesa to enter upon Ihe above-described property fo! inspection puryoses. I agree not to occupy or allow occupancy of eny buildinq euthorizetl 6y this Oermit un61 finel inspection. COOE �. 1616 1266 FIxBC System Final Fire Prevention Pool Spe Final 200 Finel Re-Rool 201 Final Blak/Retainin8 Well 202 Final Factory Fire Place 203 Flnal Sign 204 Final Demofilion � _I7��CimL149 J� /8 D��e � Date EQQf,j INSPE TIONTYPE 20fi Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Finel Fire Prevention 220 Final Planninp ApOroval 222 Finel Site 250 Final Building�Occupancy pAg Iti�lL,4 (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job /+ddress: 2470 NAPOLI WY Suite: Vicinity: Parcel Number: -43914146 Applicant: RIGHTMYER, DON Address: owner: SOO, RAELENE M , _.. Address ,2470 NAPOLI WY _ i, � � � � COSTA MESA, CA� � Contractor: Address: r Zoning: " � Phone: 949-650-2120 Zip: � " Phone: - -� . - � Zip: 92627-1480 Phone: Sfatus: ISSUED Apptied: 02/15/2002 Issued: 04/24/2002 � ISSUED BY: Zip: , . License: - � " - ' � . Arch : ' Eng: STEPHEN K AHUNA Address: � , - , � . ` - � ' _ _ Address:� 25101VIAPORTOLA� - - - . . � '� Phone: � - , , Phone: 949�953214 , LAGUNA NIGUEL, CA � � - Zip: � .� License: 92677 License: 34264 �,-, _ SCOPE OF PERMIT . . '� CONSTRUCT 251 SF ADDITION WHICH INCLUDES EXPANSION OF"AN EXISTING MASTER BEDROOM AND ENCLOSURE OF AN ATRIUM-COURTYARD AREA AND WALKWAY AT THE FRONT OF AN EXISTINGCONDO. WORK TO�ALSO INCLUDE ' REMODEL OF THE EXISTING AREAS: REMOVING INTERIOR WALLS, CHANGING THE INTERIOR CEILING CONFIGURATION. , � - -- --- . . - F.EE SUMMARY Plan Check: $366.24 ' • � � � Calc Valuation: ' ga�,aso.5o Permit: ' $563.45 Claim Valuation: So.00 SMIP Res: $4.15 � � SMIP Com: $0.00 Other: $0.00 , . � .. � Inspection: $0.00 TotaL• � 5933.84 �� = i_.._. .'�' • , ._ . -_ ,,. , � � � � PLANNING�&ZONING . � � � � �,� SETBACKS �, , � � � � . . , MAIN STRUCTURE Front 0- 0," " Rear 0- 0 Left 0- 0 Right ��-0- 0-" ' ACCESSORY Fronl 0-0 ' PARKING Ezis[inq: 0 � NOTES: Rear ., -, Required: � i 0 Left 0- 0 -` Proposed: .0 Right 0- 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. - . INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapeetlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration�of this permit. FOR INSPECTIONS CALL: (714) 7545626 - 244fi-46(6/00) WORKERS' COhiPENSATION DECLANATION: �' ' � � � I �ereby aXirm untler penelry of perjury O�e of the following tleclaretions: _ ❑ I have enG wlll meintain e certificate af consenl lo sell�lnsure for warkers' compensatian, es provided for Dy sectlan 3700 of Ihe Lebor Code, lor Me peAortnence of iha work for which ihis permit is issued. ❑ I �ave end wlll maintaln workere' ca�pensation insurance, es requlred by secclon 3700 of Ne Lebor Cotle, for the pertortnanca of the work for which NIs pertnit Is Issued. My workera' compensatlon Insurfl�e certier entl pollcy number ere: - Certler. (m/s se Policy Number: � 1 catllfy ihat In ihe paAormance of the work for which this pertnit is issuetl, I shell not employ eny person in eny manner eo es to become subjact to ihe warkera' compensetlon laws of Celifomla, entl e e thb I should ecome sub�ecl to the workers' compensatlon provlslons of Section 3700 of the Lebor Cotle, I shell Porthwith comply with these provisions. // //� /' ApplicantSignature: � / � Date: �`�/��%/�~' 0 WARNING: FAILURE TO SECURE WORKERS' �PEN�9 TIIXJ COVEMGE IS UNUWFUL qND SMALL SUBJECT AN EMPLOYER TO CRIMINA� PENALTIES AND GVIL FlNES UP TOONE MUNDRED THOUSAND DOLLARE (5100.000�, IN ADDITIOf� TO TH� COST OF COMPENSATION, DMNGES /S PROVIDED FOR IN SECf10N 3]OB OF THE IABOR COOE, IMERE5i, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATON: I hereDy ettirtn ihat I em licensad under p�ovisions of Chepter 9(commencing with Section 7000) of Division 3 ot the Business and Pratessions Code, end my Ilcense is In full lorce end eflect. LJc. p Class M Contrectors Signewre: Date: CONSTRUCTON LENDING AGENCV: ❑ I hereby eHirm thet there is e cons��uctlon lentling eqency for the peAormance af ihe work for whlch this permit is Issued. (Sec. 3097, Civil Cotle). Lentler's Neme: LentleYs Address: Signature: � Date: OWNER•BUILDER DECLARATIONS: I hereby effirm Ihat untler penelry of per�ury ihet I am E%EMPT FROM TME CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business entl Professions Cotle: My ciry or counry which reQuires e pertnit to construct, elter, improve, tlemolish, or repair any strucMe, pdor to ita iswance, also requlres the applicant lor wch pemdt lo file e signetl stetement that he or she �s Ilcensetl pursuam to Ihe pmdslons oi Ihe Contractors Llcense Lew (Cheptar B(commendng wlth Sectlon 7000) ot DlNslon 3 oi Ihe Business antl Professions Code) or that he or she is exempt therefrom and Ihe basis for the alleped examptlon. Any vloletion oi Sectlon 7031.5 by any epplicant for a pertnit sub�ects the epplicent to e cMl penalry o� �ot more then tNe hundretl tlollars ($500).): � I, es owner ol the property, or my employees wlth weges es thelr sole compensation, WILL DO THE WORK, enOlhe siructure is not IntendeG or otteretl for sele (Sec. 7044, Business antl Profeuions Code: The Contrectors License Lew tloes not apply lo an owner ol proparry who 6uilds or impraves thereon, and who tloes such work himselt or hersetl or Ihrough his or her own employees, providetl that such impravements ere not Intended ar otteretl for sale. If, however, ihe building or Improvement Is sald within one yeer of complation, the owner-builder will have ihe burden oi proving that he or she did not builtl or Improve far purpose of sale.). ❑ I, es owner oi Ihe Droperty, em EXCLUSIVELV CONTRAC7ING WITH LICENSED CONTRACTORS to construcl lhe prolect (Sec. 7044, Business end Pratessions Cada: ntrectors License Lew tloes not appty to en owner ol propehy who builds or Improves �hereon, end w�o conirecis for such project with e contrector(s) sa pursuent to t�e Contractors Licensa Lews.). 'p I am exempt un SigneNre: �,� Owner ID verlfled by tlrivels Veriticallon of Ownership by Business and Professions Code tor Ihis reason: � -Date: U 2�% (,�— ❑ Yes ❑ No Drivefs License No. Expires: _� /1 �% nent, i.e. - property tev blll or tleed): DIVISION OF INDUSTRIAL SAFETY PBAMR CERTFICATION: ❑ I hereby certify ihat no excavation O�a (5) ar more feel in depth into which e persan is requlred to descand, wlll be mflde in connectlon wlth wodc authodze0 Cy lhis permil, antl Ihat no building slruMure, scaXolding, felsework, or demolition or dismantling thereoi, will be more then Ihirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title B, CalNomla Atlmini5lretive Cotle). ❑ As owner-bullder, I will not employ anyone to do work which would requlre a pertnil from t�e Division o� Industrial Satery, as noted above, unless such person hes e permit to do such work irom Ihe dihsion. Signature: Date: Divislon oi Industnel Safery Pertnit Num6er: CERTIFlCATE OF COMPLUWCE AND AIJTHOR¢ATION OF EMFiY: I ceM1ify under penalry of per�ury t�et I heve reeA this applicatlon end stele that ihe Informatlon given is wrrecl 1 egree to comply with flll s;ate lews end dy artlinances relating to builtling construcNon, end authodze representaWes of the Ciry ot Costa Mese to enter upon the ebove-descn�etl praperry for inspedion purpases. I agree not lo occupy or ellow occupancy of eny building euthonzed by Ihis pertnit until finel inspectian. COOE �. INSiECTIONT'PE 1616 FI:eC System Flnal Fire Preventlon 1286 Paol Spe Finel 200 Finel Re-Root 201 Flnfll BIxWRetelning Wall 202 203 204 Finel Faaory Fire Placa Final Sign Finel Demalitian pAg U�E64 �' y%�il/v Dete CODE� INSPECTONTYPE 206 Finel Mechanical 20B Finel PlumDinp 210 Final Electdcel 212 Final Fira Prevention 220 Flnal Planning Apprwal 222 Final Sita 250 Finel BuilGing�Occupency � �� \ �� o� �� 7?2eda �'uii'c�i y Dirsidio�' OWNER-BUILDER VERIFICATtON A city or county, which is reyuired ro give notice pursuant to Section 19830, shall attach ro such notice, and, as a condition precedent to issuing a building permit, require the comple[ion and require the retum of, an owner-builder verification. Attention Property Owner. An bwnervbuilder' building permit has been applied for in your name and bearing your signamre. Please complete and retum this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No buildine oermit will be issued until this verification is received. 1 personally plan to provid e major labor and materials for construction of the proposed property improvemenL Yes ❑ No 2. 1(have/have noQ _ the proposed work. signed an application for a building permit for 3. 1 have contracted with the following person (firm) [o provide the proposed conswction: IVamc . Address Phone ( ) City — Contractor's Lic. No. 4. I plan to provide portions of the work, but 1 have hired the following person to coordinate, supervise and provide the major work: Name Address _ Phone ( ) City _ Contractor's Lic. No. 5. 1 will provide some of the work bu[ I have con[rac[ed (hired) the following persons to provide the work indicated; Name t0a246 IPEV. 95B) Address Phone Type of Work 1 . . DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS Street Address: � (� G . Bldg. Permit # V _JL i � This Permil # AP Number: 1. I(we), 110.r�('—�'� +�i�� , declare lhat I am the Owner of Title of lhe above referenced real property, and that I(we) hereby authorize: � � /� \ � ✓Name: '`�J �b��M�j�� TelephoneNumber. GI�'�� v�� 1�u Streel Address: Ciry: CU�� 'MC �� State: �` Zip: a� v2 � to obtain pertnits in my behalf, as ownedbuilder, for at the above reterenced property. 2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Wor4ers Compensation Insurance coverage and cause a certificate ot that coverage to be filed with the Building Division of the Ciry of Costa Mesa, as required by State of California laws. ' 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. , 4. I agree to indemnify and hold the Ciry of Costa Mesa and its employees or o�cers harmless from any claim resulting in damage or personal injury to myseif or any other parties as a result of work authorized by the permits from the City of Costa Mesa. � 5. I declare under the p;�nalty of perjury lhat the foregoing is true and wrrecL ' Executedthis�'� dayof �I /G��_/"� 20��,at LJ(�hGF ��r��' ,California. 6 W79-a6lrev.NNO) (7 I ' ^p Print Name: LiC�G7�:— c)d � Lf� 7i•jvPrS UC�r � Il� \��- Signature: �L�-�' � ��a�' Date: `� / �i I c � Note: This authorization does not grant auUrorization to perfortn the work as owner, d solely provides for limited power of attomey to secure this pertnit in any behalF. DEPUTY 1 INSP SERVICE INC. 25121 DE SALLE ST, LAGUNA HILLS, CA 92653 1- 800 - DEPUTY 1= 1- 800 - 337 - 8891 DEPT. OF BLDG. & SAFETY CITY OF �o��7t�t-✓�� COUNTY OF SPECIAL INSPECTION REPORT Building Permit No. ��2'� pb2'�-7 Job. No. Date �'-� �U L Jobind�ntification/Address 2�GttT7Y1F�l�L �trzs :,, 2��Zb 1.lrf�v�-t ��h{, (�,,y�, General Contractor/Address �'^�^�'��-- �3iD/2� � Sub - Contractor / Address £�� ~'+��c 25 Structural Engineer / Address �'%� V�n[ Y�'N-w�F� Arch. REINFORCED CONCRETE MASONRY HI-TENSILE BQLTING CHEMICAL PRES7RESSED CONCRETE WELDING GYPSUM CONCRETE OTHER DA7EOFINSPECTION DESCRIPTION OF WORK INSPECTED ?-/-U� Ceu�u�r s".�- T�f+�9n, .�05 �3�¢cd� W�F S'i/�;q� w%�Ll- S'�C�ale-�nCI ._-- Tb�`�f� i�f_5 /�i�75 . [-f- �Tc � c�u �✓.Fc��v c FvK Ps �� '7"��- uE R�-@ t DATE Reg. 'Z -/ -t� Z. OT I Time In I Time Out' I Grout I Mortar I Concrete I Block I pensity All inspections based on e minimum oi 4 hours & over 4 hours - 8 hours minimum. Any inspection extentling past the noon hour will be billed as 8 hour minimum. tn addition, any inspection axtending past an 8 hour pe- riod, or Saturdey inspeetion will be billetl at time and a helf. ATTORNEY'S FEES - If any action at law or in equity is brought to enforce or interupt the terms of this Contract, the prevailing party shall be entitled to reasonable attorney's fees, costs and necessary disbursements in addition to any other relief to which such party maybe entitled. /;��;c� � SPECIAL INSPECTION REPORT Inspector's Name: � "''f�""'�"— Inspector's Signature: I.D. No. _ �� has been filed and it states that ihe above work to the besl /her nowledge complies with the provisions of the Unitorm Building Code and meets approved plans and specifications. ){� espectfully Sub �''�tted�, Approved by: �/� t�� " � gy: ��G — Project Superintendent • larry Certer (714) 754-5273 • Fax (714) �54-4856 • www.ci.cosla-mesa.ca.u5 77 FAIF DRIVE, GOSTA MESA, GA 92626 Job Address: 247� NAPOLI WY Suite No Vicinity: Parcel Number: 43914146 Appliwnt: RIGHTEMYER, DON- Address: 2470 NAPOLI WY . COSTA MESA, CA � - � Owner SOO, RAELENE M ; Address: 2470 NAPOLI WY COSTA MESA, CA C o n tra cto r: O W N E R- B U i L D E R Address: MECHANICAL PERMIT Phone: Zip: 92627-1480 Phone: Zip: 92627-1480 � Phone: Zip: _. License: 0 Status: ISSUED Applied: 04/24/2002 Issued: 04/24/2002 ISSUED BY: i � i` , SCOPE OF PERMIT MECHANICAL TO INCLUDE: 1 INST FAU< t00K BTU, 1 COOLING/HEAT, 1 GAS PIPING, 1 HOOD W/MECH EXHAUST; AND;1 COMPRESSOR UP TO 3HPI100�K BTU. REF: B02-00227 ISSUE FEE Insl FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refng Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Ezhaust , VAV Box ' Vent Fan / Single Duct Appliance � � Fire Dampers . , � Smoke Dampers � Inst or Relocate Appl Vent � Air Handlers < t0000cfm � � Air Handlers > 10000cfm � Floor Fumace Floor or Suspend Heater Quantity $23.50 $14.80 1- � - $0.00 0 $13.70 1 $0.00 0 $0.00 0 $0.00 0 $6.15 7 $0.00 0 ` $10.65 1 �� $0.00'_ �0 :: � � $0.00 0 $0.00 0 $0.00 0 - .50.00 � 0 . - $0.00 0 $0.00 0 , $0.00 0 . $0.00 � 0 �, $0.00 0 FEE SUMMARY . � Repair/AltAbsorbtionUnit Repair / Alt Refngeration Unit ' Ventillation System Evaporetive Cooler Com me rcial I ncinerator Domestic Incinerator , Compressors / Absorption Svstems � Upto3hp/100kBTU � 3To�15hp/SOOkBTU � 15 To 30 hp�/ 1,000 k BTU ' 30 To 50 hp7:1,750'k BTU . ' Over 50 hp / Over 1 750 BTU ,�.� Boilere " � � . � Upto3hp . . ' ' 3To15hp 15 l0 30 hp � , . " 30 to 50 hp - - Over 50 hp � ' � � � Other Mechanical Fee Investlgatlon Fee � � Plan Check Fee - Reinspection Fee . Quantity 50.00 0 30.00 0 ' $0.00 0 $0.00 0 $0.00 0 $0.00 0 $1470 1 $0.00 0 $0.00 0 $0.00 0 $0.00 . 0 � � $0.00 0 ' " $0.00 0 $0.00 0 � %i� $0.00 0 j �" $0.00 0 50.00 30.00 $0.00 TOTAL CALCULATED FEES $83.50 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 9248, § i, 12-21-92) � � '�. EXPIRATION: �This permit shall automatically expire and become voitl if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspectiona and tinal 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 zsawe�ano� WORKERS'COMPENSAnON DECLARAnON: � � I hereby aftirm under penelry of perjury one of the following tleGaretlons: ❑ I have end will meintaln a cenlficete of consent to selhlnsure tor warkera' compensetlan, es Orovidetl for Ey seaion 3700 of ihe Lebor CaCe, for Ihe peAortnence o1 Ihe work iar whlc� IN9 OBrmit Is Issued. ❑ I have and wlll mainWin workers' campensafion insu2nce, es requiretl by secUon 3700 of Ihe Lebor Code, tw Ihe pertortnance of Ne work tw w�kh Nls permit is issued. My workers' compensetlon Insurence cerner and policy numher are: . Cartier. Policy Number. (rnis s need �o� be compieree u rne pertnn is Vawed er a,e nunered daiers (aioo) or �ess.) 1 certity that In the pertormance of the work or which ihis permit is issued, I ahell nol employ eny person in any manne� so as to become subjact to the workers' compensetlon laws of Callfomia, iCegre hat' houl b ' ct to t�e workers' compensatlon prodslons of Sectlon 3700 of the Lebor Cotla, I shell forthwit� comply with Ihese provislons. ApplicantSigneture: Date: ��—��%/Z WARNINO: FAILURE TO SECl1RE WOH ERS' COMPENS�. I COVERAGE IS UNLAWFUT AND SHALL SUBIEGT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED TFKKISANO OOLLAFE (5100,00p), IN ADDITION i0 THE OF COMPENSATION, DAMAGES AS GROVIDED f-0R IN SECTION 3]OB OF iME LABOR CODE, IfJ�EREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eflirm �het I am Ilcensed under pmvisions of Chapter 9(commencing with Sectlon 7000) of DiNsion 3 of ihe Business and Professlons CoAe, end my Ilcense Is in tull force end eMect. Lic. N_ Cless a Contractofs SigneWre: Date: i CONSTRUCTION LENDING AGENCV: I ❑ I hereby eHirtn thet ihere Is a consiruction lending egency for the peAormance ot the work for w�ich ihis pertnit is issuetl. (Sec. 3097, Civil Code). Lentlers Name: Lendefs Adtlre53: Signature: � Date: OWNER-BUILOER DECLARATONS: I hereby ettirtn that under penelry at perjury t�et I am EXEMPT FHOM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business end Professions Cotle: Any ciry or counry which repuires a pertnit ro conswct, elter, improve, demolish, ar repair any structure, pnor to its Issuance, elso requires the epplicant for such pertnit to file a signetl statement �het he or she Is Ilcensed pursuent to the prodslans of Ihe Contrectors License Law (Chepter 9(cammencing with Sectlan 7000) of Dlvisian 3 of Ne Business end Professions Code) or thet he ar she is exempt therefrom end the besls for t�e ellaged exempilon. Any violation at Sedlan 7031.5 by eny epplicent for a pertnit sublects Ihe eDPlicant to e civil penelry ol not more than five hundretl dollers ($500).): ❑ I, as owner of the property, or my emplayees with wages es thelr sole compensatlon, WILL DO T}IE WORK, entl the structure Is nat intendetl or oflered far sale (Sec. 7044, Business entl Protessions Code: The Conirectors License Lew does not apply to en owner oi propeM1y who builds or improves therean, en0 who does such work hlmselt or hersell or ihrough his or her awn employees, provitletl ihet such Improvements are not Intended or otteretl for sale. It, hawever, the bulltling or improvement is sold within one year ol complation, the owner-builder will have t�e burden of proving that he or she did not build or improve tor purpose oi sale,). ❑ 1, as owner ol the property, em E%CLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Prafeulons Cotle: The contrectore Llcense Lew does not eppy to an owner ol property who bullds or Improves therean, entl who contrects lor such pro�ect with e conirador(s) licen5e pursuent to the Conirectors License Laws.). ��exempt u d ,s . Business end Protessions Cotla for this reason: SignaNre: � � Date: y %� �/� L -r Owner ID vedfie y ddvers Iic ❑ Ves ❑ No Ddvers License No. �� Explres: rt" / O� Verlllcetion of Ownership by (t e ot document, i.e. - praperty ten bill or deed): ___ DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATION: ❑ I hereby cetlify Ihei no excaveilon five (5) or more leet in tlepth into which e pereon Is requlred to descenq will be mede In connectlon wllh work euthodzetl by this pertnit, and that no building siructure, scaHoltling, falsework, or demolitlon or dismentlinp thereof, will be more ihan �hirty-six (38) feet high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, Title B, Celitomia Administrative Cotle). ❑ As owner-builder, I will not employ enyane to tlo work which would require e pertnit trom the Division oi Intlustnal Satery, es natetl above, unless suc� person hes e permit Io do 5uch woAc Irom Ihe OiWSion. Signature: Date: Division o1 Indusirial Selety Pertnit Number: XAZARDOUS MATERIALS AND EMISSIONS CERTIFICATON: 1 WIII the epplicent or present or future �ulltling wcupant need to file end certly e Busineas Plen far emergency response to release or Ihreatenetl releese of e herartlous mBterlel7 ❑ Ye9 ❑ No (Sedian 25505 oi ihe Celifornla Healih end Sefery Code requires, with some excaptions, ihat a Business Plan be liled with ihe Cas�a Mesa Flre Deperlment by every business which hes et eny one time during e reported year e quantlry oi hezardous materlals eQual to or greater than e weight of 500 pounds, or e volume of 55 gellons, or 200 cu61c feet of compressed ges at standard temperelure and pressure). 2 Does or will the eD011cant or present or tuture building occupent need to file e registratlon form for ecutely hezerdous meteriels9 ❑ Ves [] No (Sectlon 25533 of ihe CalNornls Heelth antl Setery Code, with some exca�tions, requlres registretion with the Costa Mesa Flre Depanment hy each business which et eny one time hes on hend e Quentlry of acutaly hazardous meteriels eque to or greeter Ihen e welght o1 500 pounds, or e volume ot 55 gellons, or 200 cubic feet of compressed ges et stendard tempereture anG pressure). ....................................................................................................................................................................................................................................................................................................................................................................................... 3 Does or will the epplicant or presenl or tuture building occupant neetl to preDere en RMPP (Risk Management end Prevention Progrflm for ecutely hazardous matedals)? (SecHon 25534 of Ihe Califomle Health end Safery Cade pmvides that the Coste Mesa Flre Depariment may requlr DeDertment of en RMPP 6y businesses which ere requlred to register ecutely hezardous metedels wit� the Fire Dep� .........._ ..............................................................__................__.._.................................................................................................................................................... It en RMPP Is presently required, hes Seciion 25534 oi the Celifomie Heelth entl Sefery Cotle been lully complied wi� ..................................._......................................_..._..._......_.............................................._................................................................._....................................... Doas or wlll ihe epplicant or present or luture building occupent require for Ihe wark whiCh Is Ihe sub�ad ot �his e p trom Ihe Soulh COBS� Alr Ouallry Management DisMct or Irom any otner eir polutlon control tlistdct or egan�? �` (Secllon 658502 01 the Calitomla Govemmem Cotle requlres t�et the reQuestetl Intormetion be fumished on apDlical ....._._.._ ...............__.............................'_'_'..."'........_........................._..—._............."—._.................__._—__'................. W III any pan of t�e Iaciliry to Oe construcled under this pertnit he within 1000 �eet trom the outer boundaries ot e schc (If yes , Ihe feciliry must meel the requirement ot Seclions 25534 entl 42303 of Ihe CalHamla HeeIN entl Safery Cotl ............._.................'_""............._.....""'._....._................_.......__.._............'_'......._......._ _..."'............. I� e permll �mm Ihe Sout� Coast Alr Queli�y Menagement Dl9tdct or other eir polWtion conlrol tlisttict or egency eoolicatlon, have ell of the disdosures orescnbe0 bv Califomla Health end SaleN Code Sectlon 42303 been mede7 the preparation, certitiwtlon enC fillnp with the Fire Iment. .................................................. _.................................................. _........ 7 ❑ Ye9 ❑ NO ......................................................................................................... _.... :8�10l1 8 ermit tor such wnstructlon or motlNicetlon �s � No �ns tor nomresidentiel builtlinq oermits). � CERTIFICATE Of COMPLIANCE: I certity ihat under Denalry of per�ury Ihe Iniormatlon given ebove is wrrect. I agree to comply with ell slate laws end Gy ordinances regarding Hazardous Materials an0 Emissions. SlgneNre: Data: CERTIFlCATE OF COMPLIANCE AND AUfHORVA'I10N OF ENTAY: I cerlify under penelry ot perjury �he� I heve read this applicetion end state thet the Intormetion given is corract. I agree to comply with ell stete lews and ciry ordinances releting to bullding consWctlon, end authodze representatives oi the Ciry ot Coste Mese to enter upon the ebove-described property tor Inspection purposes. I egree not to occupy or ellow occupency of eny building euthorized by this permit until finel insDectlon. eooe �. 1616 1266 200 FIxeA System Final Fire Prevention Pool Spe Finel Finel Re-Root 201 Flnel Block/Releininp Well 202 Finel Factory Fire Place 203 Final Sign 204 Finel Demolition eeiF �$ �� INSPECl10NTYPE 20fi Final Mechanical 20B Finel PlumDing 210 Final Eleclncal 212 Flnal Fire Preventlon 220 finel Planning Approval 222 FinalSite 250 Finel Builtling�Occupancy ��/A �— Da�e 2\� ISutl.\!: • �� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2470 NAPOLI WY Suite No Vicinity: Parcel Nunmber: 43974146 Applicant: RIGHTEMYER, DON" Address: 2470 NAPOLI WY � COSTA MESq, CA Owner: SOO, RAELENE M Address 2470 NAPOLI WY COSTA MESq, CA Contractor: OWN ER-BUILDER Address: Arch / Eng : Address: PLUMBING PERMIT Phone: Zip: 92627-1480 Phone: Zip: 92627-1480 Phone: Zip: License: 0 Status: ISSUED Applied: 04/24/2002 Issued: 04/24/2002 � ISSUED BY: Phone: � ��P� � � . � - --- . _ 'License: � _ _ .. , : ,. SCOPE OF PERMIT • PLUMBING TO INCLUDE: 1 GAS (1-4 OUTLETS), 1 SHOWER, t KITCHEN SINK, 1 LAUNDRY TUB/WASHER, 2 WATER CLOSETS, 1 WATER HEATER, AND 1 WATER RE-PIPE. REF: 602-00227 � ISSUE FEE Backflow irtigalion � BackFlow Preventer Bathtub Clarifier System Connect Qce,Soda,etc) Dental UniGs Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Dnnking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT, $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $6.15 $0.00 $0.00 $0.00 $0.00 so.00 QTY- 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 FEE SUMMARY AMT Laundry Tub / Washer $9.80 Landscape Irrigation " $0.00 .. � p-Trap , $0.00 Pressure Regulator � $0.00 Process Piping (per 10 ft) $0.00 � Receptors $0.00 Septic Tank $0.00 � Sewer Cap for Demo $0.00 Sewer Connecl $0.00 Sewer Privale Line $0.00 Shower $9.80 � Sink,.bar - , - $0.00" Sink, wmmercial $0.00 Sink, Floor $0.00 Sink, kitchen $9.80 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTY 1 0 0 0 - 0 0 0 -0 0 0 � 0- 0 0 1 0 0 0 . AMT Sump Pump . �$0.00 Swimming Pool , $0.00 � Trep Biimer , $0.00 Urinal . � � - $0.00 Vacuum Brkr Bkflow(1-4) $0.00 Vacuum Brkr Bkflow(5+) $0.00 Wash Basin � $0.00 Wash Basin Set $0.00 Waste and Vent System 30.00 WaterClosel(Toileq $19.60 Water Heater / vent $12.30 Water Piping pnst or Rep.) $0.00 Water Re-pipe $9.80 ' Water Service $0.00 Water Sokener $0.00 OTHER $0.00 VIOLATION $0.00 PLAN CHECK $0.00 REINSPECTION $0.00 TOTAL CALCULATED FEES: E100.75 QTY 0 0 0 0 0 0 0 0 0 2 1 0 1 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) � EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1B0 days, or if work is suspended or abandoned tor a period of 180 days. . INSPECTIONS: In order for ihe work authorized under this permit to ba considered legal, such work must comply with all applicable cotles, and all requlred inepeetione and final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 750.5626 � � � � zae-�e (a'ool . . WORKERS'COMPENSArON DECLAiiAnON: � � I hereby ettirtn untler penalry o1 perjury one of iha tollowing tleclereUons: � , � ❑ I heve end wlll malnteln a certiticele of consani to sell-Insure for workere' compensation, es provltled tor by sedlan 3700 at the Lebor Code, tor the pertortnance of the work for which this pertnit Is Is5ue0. ❑ I have en0 wlll mainteln workers' compensaGon Insurence, es requiretl Dy section 3700 oi Ne LeEor Cotle, for Ne perfortnance of I�e work for whkh NLv pertnit is IssueO. My workers' campensetlon Insurence carrier enC pollcy number ere: Cartler: Policy Number: ' (Thls�feoNon neetl not be canpleted!/ the permiNs velued at one hundred dol/ere ($f 00) or less.) / ❑ I certily thet In the pertormence of the ark tor which ihis ertnit Is Issued, I shall not employ eny person in eny mennar ao es to become subject to tha workers' compensetlon lews af CelNor �e,en �ree 11�0� If I oi d beco e suG�ect to the workere' compensetion pmvlslons of Sactl� 3j0� �he �boS r Catle, I shall ionhwlth comply with Ihese provisions 1 � /' Appllcent SlgneNre: Dete: � � WARNING: FAILURE TO SECURE ORKERS' COM TION COVERAOE IS UNIAWFUL AND SMALL SU81ECi AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE MUNDRED TIIOUSANDDIXIFRE(E100,000),INADDITIIXJTO COSTOFWMPENSATION,DAM4GESASPROVI�EDF-0RINSECTION37060FTHElABORCADE,INTEREST,ANDATTORNEI^SFEES. LICENSED CONTRACTORS DECLARATION: I hereby aMirtn that I am Ilcensetl unCer provisions af Chapter 9(commencinp wlth Sectlan 7000) of Divislan 3 of the Business end Prolessions Code, antl my Ilcense Is in full fome entl eflect. LJa a_ Cless N CONrectors SigneWre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereGy eNirtn Ihel ihere Is e construction lentling agency for I�e periortnance of ihe work for which Ihis permi� is Issuetl. (Sec. 3097, Civil Code). Lenders Neme: Lentlefs Atltlress: Signature: � Date: OWNER•BUILDER DECLARATIONS: I hereby effirm thet un0er penelry of per�ury thet 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the followinp reeeon (Sec. 7031.5, 8usiness end Professlons Code: Any ciry or counry whic� requlres e Dermit to construct, eltar, Improve, tlemolish, or repeir eny sirucNre, pdor lo Ita isauance, elso requlres ihe eppllcaN tor such pertnit lo flle e signed atetemenl thet he ar she is licensetl pursuent to Ihe provislons ol ihe Contrectors Llcense Lew (Chapter 8(commencing wit� Sectlan 7000) of DlWsion 3 0l the Business antl Prolesslons Gode) ar thet he or she Is ezempt therefrom and the besis far the alleped exemption. Any vlolatlon of Sectlon 7031.5 by any epplicent for e pertnN suh�ects the applicent to e ciNl penalry of not mare Ihan five huntlreA tlollers ($500).): ❑ I, es owner of the property, or my employees with weges es their sole compensalion, WILL DO 7HE WORK, entl t�e structure Is not Intendetl or oXered for sale (Sec. 704d, Business end Profeuions Code: The Contrectors Ucense Lew does not apply �o an owner of property who builds or Improves thereon, end who tloes such work himsetl or herself or ihrough his ar her own employees, proWdeO thet such impravements ere not Intended ar otteretl for sele. It, however, ihe Dullding or improvement is sold wit�in one year of wmpletion, the owner-builtler will have the burden of proving ihet he or she did not builG or improve tor purpose of sele.). ❑ I, as owner oi Ihe property, em El(CLUSIVELV CONTRACTING WITF1 LICENSED CON7AACTORS to construq the prolect (Sec. 7044, Business antl Professions Cotle: 'tantrectors License Lew does not eppty to en awner at pmperty who builEs or improves thereon, end who wntrecis for such pro�ect wlth a contractor(s) II e pursuenl Io �he ConlfactOrS License lew5 J. I am e:empt ur�w,fecp Business and Profeulons Cade tor this reeson: Siqnature:—, �.7�-��-�1� Date: �� 1FI 1 2� Owner ID vedtiedby ddvefs lice ❑ Yes � No Ddvefs License No. Expires: � D�/ Veriflcatlon ol Ownership by (type at tlocument, I.e. - properry tav DIII or deetl): DIVISION OF INDUSTRIAL SAFE7Y PERMI7 CERTIFICATION: ❑ I hereby certlly that no excevation five (5) or more feet In tlepth Into which e pereon is requiretl to tlescentl, wlll be mede In connectlon with work euthoAzed by this pertnit, end that no building strudure, scettolding, talsework, or tlemolitlon ar dismantling t�ereof, wlll be more then �hirty-six (38) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tille 8, Celifarnla Adminisirative Cotle). ❑ As awner-builder, I will not employ anyone to do work which would requlre e permit trom t�e DiNsion ot Industdal Setery, as noted ebove, unless such pereon hes e pertnit to do suc� work irom the division. Signature: Division of Industdfll Satery Permit Number. Date: XAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 W III the epplicent or present or future builAing occupent need to file and cenily e Busineu Plen for emergency response ro releese or threetened release of a hazartlous metedel7 ❑ Yes ❑ No (Section 25505 af the Calilamia Healih and Sefery Catle requires, with awne exceptions, thel e Business Plan ba fled with the Coste Mesa Fire DeDertment by every business which has et eny one time during e reported year e queniiry oi hezartlous me�enals equfll to or greater than e weight of 500 pountls, or a voluma of 55 gallons, or 200 cubic leet of compressetl gas at stanaard temperaWre end pressure). _' .................................._.__........_.................................._.._._._....................._._.__..................__............._.__._...................._"................................................_...__ ............._..... .....__........_.._........'_ 2 Does or will the epplicant or present or future building occupent need to lile e registration form for ecutety hazerdous materials7 ❑ Yes ❑ No (Sectlon 25533 of the Calitomia Health end Safery Coda, with some exceptlons, reQulres registretion with the Coste Mese Flre Depariment by each business which et eny ane Ilme �as on hentl e quentiry ot acutety hazardous meteriela equel to or greater than e welght oi 500 pountls, or e volume of 55 gellons, or 200 cubic feet of 3 Does or wlll the eppllcant or present or tuture bulltling occupant need to prepere en RMPP (Risk Manegement end Preventlan Pragram tor ecutely hazarUous meterials)7 ❑ Ves ❑ No (SeCtion 25534 of the Callfomla Health antl Safery Cotle provides that the Coste Mesa Fire Department may requlre �he preperation, certification and flling with the Fire bepertment o1 en RMPP by businesses which ere requlred ta register ecutely hezerdous mateAels wlth �he Flre Depertment. .................................................................................................................................................................................................................................................................................... .............................................................................................. 4 II en RMPP i9 presently required, hes Sectlon 25534 0l the Callfomle Healih and Safery Code been tully complietl wilhl ❑ Yes ❑ No ............................__...................................................._...._._....._'_................................"'........................_..........................._................................................................................._......................_..............._............................................ 5 Does or will the epDlicent or present or future bullding occupent require for the work which is the subJed of this e pllcation e ertnit for such construction or motllflcetlon from the Sou�� Coesl Alr Qualiry Menegement Dlstdct or irom any other eir pollutlon control tlisidd or agenc�? � Vea � No (Section 85850.2 of the Celifomia Govemment Code repulres that the requested Infortnetion be fumished an epplicatlons lor non-resiOentiel bullding permits). 8......VJili�eny pen�ot the feciiiry to�be const�uqed under�this �perrnli be�wlthin�1000 teet from �the�ouier bounCanes ot a school� �� Ves............[7..No ................._......................................... pf yes', Ihe leciliry must meet tha requirement at Sectlons 25534 antl 42303 ot tne Califomia Healin end Setery Code). 7 or epency Is requiretl lor Ihe wwk which is the 3n matle7 ❑ Yes ❑ No 8 Qf yes', attach certiiicete of wmpllance trom Ihe eppropriele air pollution control otticer). CERTIFICATE OF CO PLIAN rti th er nelry o1 per�ury t�e' � n'grven ebove Is conect. I epree to compty with all state laws and ciry ordinances regarding HazerOous el ' . \ � Signature: � Dete: � -�y(A Z i CEH7IFlCATE OF COMPLUWCE AND � OR¢ATON OF EMRY: I certity under penalry of per�ury that I have reatl t�is epplicatlan enC state that the infortnatlon given is correct. I egree to comply wlth ell siete lews and clry ordlnences relating to bulltling cons�ruction, end sutharize representellves af Ihe Ciry ol Caste Mesa to enter upon Ihe ebove-tlescrlDed properry far inspedion purposes. I egree not to occupy or ellow occupanry of eny building euthonzed by thls permit until tlnel inspeMion. CODE I, ixsveenoxrrve � pdg 1616 Fixetl System Final Fire Prevention 1268 Pool Spe Final 200 Finel Re-Root 201 Final BIocWReteining Well 202 Flnal Fectary Fire Place 203 Finel Sign 204 Final Demolition � �C�at ��— Data � �Qp[j INSVECTIONT'PE 206 Final Mec�enical 208 Final PlumDinp 210 Final Electrical 212 Final Fire Preventlon 220 Flnal Plenning Approvel 222 Finel Site 250 Finel Building/Occupancy PAff. IIi�llB DOYLE & SHIELDS Develop�ent Co.,Inc. DATE 6-3-63 GENERAL CONTRACTOR VALUE SUBCONTH.ACTOR N0. rt��ttt�t�vtU ! 9E'.�? JU N 3 1953 COSTA MESA BUILDING-SAFEIY DEPARTMENT INANCE DEPT. P.O. BOX 9f7 CO3TA MEBA, CALIFORNIA CIiY OF COSTA MESA For Appllcan► ►o Fill In Completely APPLICATION FOR PERMR TYPE OR PRINT BUILDING for OfflC@ US@ On�y BUILOINO '� l i,7 O � ADDRE53 � " flHCH1If NO. COSTA MESA. CALIFO IA � rt rvco r oere nceeivao onre ieeueo OWNER o ti .f� , �./fl �� S— -G � JUN 3 1963 MAIL .�f, B DINO �l� O �7 ADDRESS �. Q.hG ed I. �/ A R63S os / � � � FIRE CITY Q P/b� ry �� ZONE TYPE GROU ARCHITEGT T6L.6 / APPROVHD OR ENGINEER 0.. , NO.O i�� O BY DATE �7''� ONING ADORE63 I O O .�/ /H/h 0/7 (VC�� O NO.OP . UB80PN8 (�'��'� �' " �UN 9UIlO�NO CONTRACTOR J (/ �% �ea�� /6 -/r�� 37 3 ADDRE83 J l(,{�F C� oEccRirtlon O CITY � P� A. P. NO. // NOTE: NO EAVE OVERHAN6 SHALL BE LE59 THAN LICTNOJ`�/Z �� N� �iO 30'TOSIDE@REARP.L. SIZE � i/ J�7 � I NO.OFBLOOD/ ALLOWED fU.B.C.REQUIREMENT) OF LOT !� U NOW ON LOT � YARDSAPPROVEO YAR�SAPPROVED USE OF MAIN BUILDINO ACCESSORY BUILDIN6 EXISTING BLO6. . (FROM C/L�^TREET) SETBACK LINE FROM FRONT (f Fr. Fr. cenrex on erns¢i �� REAR YAR SIDEYARDI L6FT .� I RIOHT� R.SIDH O p7', F7. DESCRIPTION OF WORK L.61D8 Fr. Fr. J , NEW ALT6RATION � DEMOL SH REAR % Ff. Ff. � DI6TANCE BtT. BET. MAIN @ REPAIR MOVING MAIN BLDGS. ACCESS.BLO69. BUILDINO'/ � � fJO.OF VAR.�C DATE 512E y Y ROOMS STORIE9 / C.U.P. APPROVED % COVERINGWAi_J UctJOI COVOERINO S�/~�`r BYPROV �^ DATE '�" " �.• USE OF BUILDING AND WORK TO BE PfiRFORMED e.J'/ ( G'C. W cht� �pY. G '� ' � � 0 3 j i,r y 54. �. 3 � I HHqEBY ACKI�OWLHDOH TXAT � MAVB qBAO THI9 AppLICATION TNH AMOUNT 9 W IINOER VALUATION 19 POR THE _' ANO 9TTTE THAT TH8 A00V6 19 CORflECT AND AOqE[ TO COM� PUHP09H Op B T LIBHINO A PERMIT PE8 ONLY. � PLY WITH ALL CITY OHo�NANCBG ANO BTAT[ LAWB H[OULATINO yqLUAT10N � ry BWLOINO CONBTFUClION. � PERMIT FEE S S� j SIGNATUREO m PERMITTE '� � �' � C ' /' �1 .j �/ P71 E � . � ' S /� �6�J ' PLAN CHECK $ ✓ / o AUTHORIZEDAGHNT � , / �,� ,.� �. TOTALFEE Y