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Home My WebLink About134 MONTE VISTA AVE - Building Permits st'r`�t� CITY OF COSTA MESA y' �� BUILDING DIVISION 0 ,I DEVELOPMENT SERVICES DEPARTMENT " B98-00739 PERMIT PERMIT NUMBER (714)754-5273 • Fax(714)754-4856 BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 926262nV Job Address: 134 MONTE VISTA AV Status: ISSUED 1)P Suite: B Applied: 04/15/1998 Vicinity: Issued: 06/24/1998 Parcel Nunmber: TPN98054 Zoning: Applicant: CERNICH, ERIC Address: Phone: Zip: Owner MONTE VISTA PROPERTIES Address 3535 E COAST HWY`. - - 155 i,/ " Phone: 949-722-8120 '. G.D.M:i , -,' Zip: 92625 - / .. - Contractor: /DAVID L. ARNESON,% - Address: ,Cc5530-SAN JUAN DR ' -%= - ,/iii_- Phone: /l ./ ,.i/- i;. 7',' .- �'. ,t. / ORANGE,CA>:'> Zip: 92869 / 717 y License: C13354 Arch/BEng: /DAVID;L.ARNESON Address: 5530SAN JUAN DR � • : Phone: . -. ' ORANGE,CA —"-Zip:' 92869 j - I ', , '', -j-- ,License: C13354 i , /� - - - - SCOPE OF PERMIT p NEW SFR WITH ATTACHED GARAGE. REF PC/0425-98A. 1752 SQ FT LIVING SPACE.420 SQ FT GARAGE. ONE DU OF A 5-DU COMMON INTEREST DEVELOPMENT. WBK. - - TRIP FEES PAID UNDER ACTIVITY 71-98-05 - - PARK FEES PAID UNDER ACTIVITY PK-98-03 I --- _- - , 14\ , , FEE SUMMARY, Plan-Check: .$186.43 - - Calc Valuation: 151,818.00 .Permit: $1;147.25 . - Claimed Valuation: Moo, SMTP Res: $15.18 SMIP Com: $0.00 Other: $0.00 ' Inspection: $0.00 ,` - ' . Total: $1,348.86 - , PLANNING &ZONING ' SETBACKS - MAIN STRUCTURE Front 174-0 - - Rear 10-8 , Left 5-0 Right 5-0 ACCESSORY Front 0-0 Rear 0-0 Left . 0-0 " Right 0-0 PARKING Existinq: 16 Required: 16 Proposed: 0 NOTES: • 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 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 end will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number. (This section need not be completed/f the• milt is valued at one hund dollars($100)or less.) I certify that in the performa. of t • work for which this / it is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of Cal •mla, : • egr:: at If I should eAubject to the workers'compensation provisions of Section 3700 of the Labor e,I shall forthwith comply with these pr. ons. PAIA�t t' q USX/ �,apllcant Signature: /(N ' Date: �/iVT / / WARMNG:FAILURE TO SECURE •r•: • •• • . ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES N CML FINES UP TO ONE HUNDRED THOUSAND DOLIARE($10BODD),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LRCENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.4 Class 4 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lender's Name: 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 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 fore 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 . 'petty, am EXCLUSIV." CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The co :co s License Law doe 't apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license purs .nt to e • tractors Lic: Laws.). \/ t am axe.-.1 un.: sec I Business and Professions Code for this reason: Signature: 42,1'42,1' Date: ��a 49,??aL/ ner ID ve • .y drN: -:nse. .s (4 No Driver's License No. Expi s: Verification of Ownership by(type of docu. ant,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding alsework,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,Califoml: 'd Inlstrative Code). As owner-bull.: ,I will .of ern! .y anyone ' do work which would require a permit from the DMsion of Industrial Safety,as noted above,unless such has a permit to d• uch wo from a division. `L Ignature: /� h/,./ Date: rel/a TI q Division of Industrial Safety Permit Number: N ,A 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 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 ❑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 end 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 materiels)? ❑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 apereit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ❑No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be fumished 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 Alr Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above Is correct.I agree to comply with all state laws and Gy ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFIC - OF •'• , • CE AND1 ORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that a Information given is correct. gree • ely with all st - aws and di ordinances relating to building construction,and authorize representatives of the Cly of Costa esa to enter upon the e••v. descd.:.pp•'my for in> n purposes. .. ee not to occupy or allow occupancy of any building authorized by thi rryil until finAl n. '" • lure Of •.a •, er(s) / G/`]tTLDIh/le / Aar /A.4. '{(//y C And/Or Auto zed Applica , /4d 1 f m j t�,,1 � — L(. Date J CODE F INSPECTION TYPF DATE INTCAL5 COOS• INSPECTIONTYPE DATE ItalIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final - 208 Final Plumbing • 200 Final Re-Roof 210 Anal Electrical 201 Final Biock/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign 222 Anal Site � 204 Final Demolition 250 Anal Building/Occupancy / •5' 2446-46 Insulation Certificat, Number and Street _ City 0/1-ain I(�Q-- ( 5 6 SS Col ty Subdivision Lot Number Description of Installation ROOFMaterial F 51 4jS / 34.t.\B rand Name f rood Thickness(inches) CI k2 t` Thermal Resistance(R-Value) 3 0� CEILING Batt or Blanket Type c3Att. Brand Name b LA-4.4 5 Cii\vt-t%m Thickness(inches) Thermal Resistance(R-Value) jz- 3a Loose Fill Type Brand Name Contractor's minimum installed weight/ft- lb Minimum thickness inches Manufacturer's installed weight per square foot to acheive Thermal Resistance(R-Value) EXTERIOR WALL` Material r 7M 5(4S5 rt44-lc,ht (ed/y03randName buii+n5CXYLYId'v� Thickness(inches) 3 k? r' Thermal Resistance(R-Value) '2- 13 RAISED FLOOR ''II Material cA 4 4 ss tsti��,A (f9 )3randName DstA 3 [ (41 Thickness(inches) (.,k It Thermal Resistance(R-Value) � I9 • SLAB FLOOR Material Brand Name Thickness(inches) Thermal Resistance(R-Value) Width(inches) FOUNDATION WALL Material Brand Name • Thickness(inches) Thermal Resistance(R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the California Administrative Code. �IA`k(1)_I OP, tettavA); /5 th— v2-4e11% (is , —7 /9463 Ge. ral actor deL) License Number Sig rure and Title Date Subcontractor ulationlnstaller) License Number r. • (2- 14- 9F5 Signature and T- Dare Compliance Forms January 1,1995 • � ___ CITY OF COSTA MESA y' �>) BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT M48-00259 wPERMIT PERMIT NUMBER (714)7'54- � 5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626, MECHANICAL PERMIT Job Address: 134 MONTE VISTA AV Status: ISSUED Suite No e Applied: 06/23/1998 Issued: 06/24/1998 Vicinity: Parcel Nunmber: TPN98054 Applicant: CERNICH, ERIC Address: -Phone: r _ Zip: - Owner: MONTE VISTA PROPERTIES ,/,, Address: /T /G- '�' . - ' . %%,�'� ' Phone: " • - ., ' , . y/ ' v `,)/ - - Zip: '�- Contractor/ .N v,, ,/,,:b/i Address: ; -/ A /�. , i : Phone: ,. Zip: y / . .,�, .'; License: • I, , ; - '. Arch/Eng: . /.;, _ , .. - - - i - Address: v - : / -'% - ---Phone: - _ ,\ / Zip: - • ' " .License: - , v SCOPE OF PERMIT " 1 FAU,1 NC UNIT;1.FACTORY FIRE PLACE, 1 HOOD, 1 VENT FAN. .. .� , FEE SUMMARY . ,� • ,, Quantityvt r-‘`- - ."-----i_ • ,/./',.t, - Quantity ISSUE'FEE - $22.00 -,- -- -- -- - ' - - - .. Repair/Alt Absorbtion Unit $0.00 0 . t Inst FAU<100 k.BTU 4 $13.25 Repair,/Alt Refrigeration Unit $0.00 - '0 , Inst FAU,>100 k BTU ' 1 $0.00 Ventillation System $0.00 - 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler '$0.00 0 - . Inst/Rep.'Recess Wall Htr $0.00 0 Commercial-Incinerator $0.00- 0 Refrig Sys<100 k BTU ., ` ;,\ $13.25 1 . Domestic Incinerator ' $0.00 : DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: Is section need not be ampler— I t e permit Is vat one mired dollars($100)or less.) I certify that In the pe •rman , of the work • hich t ' permit Is ' tied. I shell not employ any person in any manner so as to become subject to the workers' compensation laws • alifo r and agree r•- If I o become su ct to the workers'compensation provisions of Section 3700 of the Labor ode,I shall forthwith comply with these pr'vision./ Applicant Signature: / /lA Date: /l 0t.( ii q WARNING:FAILURE TO- •-E WORKERS'COMPENSATION COVERAGE IS U WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P TIES AND CAVIL FINES UP TO ONE HUNDRED THOUSAND COUARE(S100000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class* Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: 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 -• pro.arty,am EX USIVELY C•NTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The • tractor- License L;. does not :•• - to an owner of properly who builds or Improves thereon, and who contracts for such project with a contractor(s) license p uant to e Contract.se License I am a -met and sec. usiness and Professions Code for this reason: ignature: / -49 Date: (Q//(�y/9( liv i Owner ID veri'ad • • vers en =. 1 es 0 No Driver's License No. (limy/ Verification of Ownership by(type of doc ent,Le.-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,lalsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gip 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 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 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 aaermit 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? ❑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 D 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: CERTIFICA t-OF CO •LIANCE AND -'t ORIZATIO OF ENTRY:I certify under penalty of perjury that I have read this application and state that th nformation given is correct.I ,gree to o ply with ail s- - laws and city rdinances reiatin to building construction,and authorize representatives of the Ciggty of Costa esa to enter upon the abpve-•ascribed .r•.:rry for 8o�ses.I me not to occu r allow occupancy of any building authorized by this per�jjm^it uniil�al il;s � n. ``X'/// / •eture lav r(s) ç441 , (/f/n a/jL ate fir 4 zdaAndAuthoeApplic /,y , ��1 Q ^,rye/'„ 4L L Date CODE L 1111�ECT1ON TYPETYPE DAIS/I MIMS CODE'' I_/IN'SPPEECTION TYPE DAIL ), 1616 Fixed System Final Fire Prevention 206 Final Mechanical la•,99 - 9 LA' Al 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 Place220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 , rJ. t CITY OF COSTA MESA ,4y' '►i BUILDING DIVISION 1. . ' DEVELOPMENT SERVICES DEPARTMENT o P98-00501 PERMIT PERMIT NUMBER (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT • Job Address: 134 MONTE VISTA AV Status: ISSUED Suite No B Applied: 06/23/1998 • Issued: 06/24/1998 • Vicinity: • Parcel Nunmber: TPN98054 Applicant: CERNICH, ERIC Address: Phone: i Zip: Owner MONTE VISTA PROPERTIES . • - /# / v !fi//'/ \ AAS / vHy. i,/ / ./7� ; Zip :,,\--;--,.-, V ; // / \ / / \ // // -'I- \`��\ / / j Contractor: //// „N s�/ %i!/ �.• \ ;Addes , . /1`% , /'/ Phone:'Y' I - _ ' /. r ",-•License: I' I � , / . A ' BArch l Eng: c1i'" I_ li"� • Address: " / - - ` ' / ,' Phone: , N ' - Zip: . License: SCOPE OF PERMIT i p PLUMBING FIXTS FO• R NEW SFR. 1 BATHTUB,-IJee ttAl4E t.. 1- - - I._&ntbR5¢L,()tSp054K • DISHWASHER, 1 GAS SYSTEM, 1 GAS SERVICE, 1WASHER, 1 /' - LANDSCAPE IRRIGATION SYS., 1 SEWER CONNECT,2 SHOWERS, 1' :- % i -- • / 1 KIT.SINK,2 WASH BASINS, 1 WASH BASIN SET,3 TOILETS, 1 , WATER;\ HEATER, 1 WATER SERVICE. SAN DIST. FEES PAID `- - / \.. • /. - FEE SUMMARY ‘,,, , - AMT I, QTYAMT QTY / AMT QTY ISSUE FEB \i\‘'‘ ..522.00i -,,, Laundry Tub/,Washer„_. ,$875 1 Sump Pump - $0.00 0 Backflow irrigation. • $0.00 Ni"'i0 Landscape Irrigation '/ $13.25.i 1 Swimming Pool i " $0.00 0 nt Backflow Preveer $0.00 N 0- P-Tra p ' '-• ,� . -,i, ,`'N "`` /,$0.00`' 0� • - -Trap Primer / $0.00 0 Bathtub _ $8 .75' 1;N;v' - Pressure Regulator , '� ,,$000., .0� ; ,Urinal %- ' / "1, $0.00 0 Clarifier System $0D0 v 0 - .\..„:,-.Process Piping'(per 10 ft)i.. $0.00 0 ." - --/Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) 58.75 /1' = 'Receptors $0.00 "0 :• - ' Vacuum[ThuBidlow(5+) $0.00 0 Dental Units $0.00 ' '0 _ ,, .Septic Tank. . . -$0.00 0 Wash Basin ./ $17.50 2 Dishwasher $8.75 ..1 - - - - Sewer Cap for Demo . $0.00 0 Wash Basin Set- $8.75 1 Drain,Floor $0.00 0 . i i, Sewer Connect $22.00 -1 ' Waste and Vent System $0.00 0 Drain,Rainwater $0.00 ' 0 Sewer Private Line - / -.$0.00 , 0• Water closet(Toilet) $26.25 3 Drain,Roof $0.00 - 0 'Shower , $17.50 -2 • Water Heater/vent $11.00 1 Drinking Fountain $0.00 0 .- Sink,bar . , , • .$0.00 0 '-Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 - Sink,commercial.. . .. .., $0.00. ,0- i Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor - - .. ,$0.00' 0 Water Service $8.75 1 Gas(1-4 outlets) $5.50 1 Sink,kitchen -$8.75 1 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 $8.75 1 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: $205.00 COMMENTS/SPECIAL CONDITIONS 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 DECLARATIONS I i WORKE S'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. ❑ 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: Carver: Policy Number, (This section need not he completed i7 •: .: It is valued at one h ••red dollars(5100)or less.) ❑ I certify that In the perfo• ance of t•: work for which tail- pe • s issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of •:Iifomla,/•agree that if I s •I . •..•m- subject the workers'compensation provisions of Section 700 of the Labor Code,I shall forthwith comply with these pro sions. , r 4/., Applicant Signature: _ 71/&r- Date: I11' / WARNING:FAILURE TO SECUR '•Al ERS'•• N ,TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Uc.4 Class k 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: 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 penally 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,end 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 t : • operty,am EXCLUS ELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code:The • re •rs License Law d••- not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license p uant •the Contractors U•.nse Laws.). I em a :mpt u �r ec. 41 4 Business and Professions Code for this reason: /,, !�`, n Signature: ,i Date: lX !�l T!l G/j G/ Owner ID erifi:.0.y dm- icense. it: Yes 0 No Drivers License No. / Expires: Verification o Ownership by(type of doc ent,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation fine(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 has the alifon9ai e HealthndeSafety a requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every any during reportedyear 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 end Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Flre 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? 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 epermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? PI 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 from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). -CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE •• •MPLIANCE .. D AUTHOR•. ON OF ENTRY:I certify under penalty of perjury that I have reed this application end state that the Information given Is correct. I a•-:e to amply with , state laws : • city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the e•ave-d:: ribe�opal' pection p -s.I spree Oql to occupy or allow occupancy of any building authorized by this peauntil f nal inypac]ipn. / al5N mwF'Tmatu Olof Owner( ) at )rr!_leith ,','-L-'uA• I//lam' AA 1/474 Andl Auorized plicant F `CC Date c0➢E_6 IN PFCTIeN TIPP DALE IDMS CQ U INSPECTION TYPE DMZ . ICALS 1616 Fixed System Final Flre Prevention 206 Final Mechanical la c (�,,/ • . 1266 Pool Spa Final • 208 Final Plumbing 'rX'9-9C1 f'i 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 2446-46 • I r P4-980- � " l'PN-q90- 54 l6.s' - rycIVATC YMm ARLA . I-StbRYArnesonE2t2'V1D( �tYR� I, 1 i I Associates I. - 1 `- twDluzm Lisv. Arduhrhae 1 b &� ;a l I.'i RBYfoWCC � Y • _— I. . 1i IIAnIDLGAPC ARtls• ;� I 1 I e�IEC to H -s I I _— er._ Cera% -stow) tYPu. ' ro -: if Ili b 6 ♦ t 'la' Tr-Ask ENCLOSURC PER CrrY SCFIDB.• re I /ail 10 B - � H I �-G�-53 N ,. . - o LM,DBOAPC AR44• nDu+Cr ,,,seat.-. ). .I 71SJ��i�! eD. is 4L;: - .'- IDDWE tuts. i' im:✓_ , v ._ " , i. ENl6LL4O (H,V111fi i:e,rn y _ - : _ ^: NMP. ,O% 4?Auer) .- tip' i � LL ss RS" . ..ice --.I H1FK1 3TA a�4 I I: 14.41 r el t 1 j awe Ai_ E �/ B ____ �+j Fy�PSr� rei .. !ilii �� EMBELLISHC�ARPl+ ��®�. .q./�/IPPYWQPct 9Q0-51 =' /AI.;at./ , t ... t .. Ii,l tli'i PRDPFrrY LD2C ttis .4.7-,_ 3 Neu Moir A9uPR -- - 1 1S.S. • per CC77 nuriROS Cul&est` r Cult C MONTE VISTA AWE— Ir • SITE, PLAN SCALE vd ho-i.3 /'-'?✓ — / 32- DH.wH DLA JOS NO 9S-IN Owner. Monte a Eta Properties.LLC 3535 E.Cant Hithw in, x IS5 /31t{,,-J— SHEET Canine Del Mar.CA 92625 (714)aex.-urs 1 Architect: DE.id L Arneson iLia v/t,5/C\. 5530 Ss laza Dm c O nate C.a.92869 5 —4 24 : 4•M -17/_57� of =nail