Loading...
HomeMy WebLinkAbout1798 HAWAII CIR - Building PermitsJob Address: 1798 HAWAII CI Suite: Vicinity: POOL AT REAR SFD Primary Occ: Type of Construction: Parcel Number: 13957207 Zoning: Applicant: SCHWERIN, SHERRY Address: Phone: 714.313-2819 Zip: Status: ISSUED Applied: 08/02/2006 Issued: 08/022006 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) .,. EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, oif-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 2"646 (6100) r_1 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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: (Thi action need not be completed if the permit is valued at one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo , and agree th it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisi Applicant Signature: Cate: WARNING: FAILURE TO SECURE WO COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (1100,000), IN DI TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. N Class M Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, eller, 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 bj the applicant to a civil penalty of not more than five hundred dollars ($500).): ,LcrI as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to he Contractors Lic nse Laws.). ❑ I am exempt un ec. Business and Professions Code for this reason: Signature: —✓ T -Date:— -Owner ID verifie by driver' a e. s ❑ No Drivor's License No. ---- " Expires: --- Verification of Ownership (type of document, i.e. • property tax bill or deed): (-- DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 0, 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 MAT9RIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). a applicant or.present_..r.fu_..r ...building Occupant need to file.g.registration... .......,..for..... ....................................................................................................................-.. ........... ........ .......... ..... 2 Does or will the pp p o future building pform for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Cade, 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 ❑ No .. ...._............................. ............__—__.__.... _......_.._............. ..........._..................................__....................._..............................._.....................__............—.....................__...................... .._._......._._............................................. _......... 5 Does or will the applicant or present or future building occupant require for the Work which is the subject of this a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li Yes LJ No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ............................ ........... _................................................. ..................... -............................. _............................................................_................._........................... ................................................__................................................................ -...... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely Code). .. .......................................................................... .......... ... ...................................................... ...................... ................................................................................................................................................... ..,.... ........................... ................................. 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ..........._._.._ .......... .................. __._._._............... .............. _.......................... __............. __............... __................. _................... _................. _............................... _...................................... _.-.._....................................... _.._......... B (11'yes"", attach Certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described properly 1 nspection rpo s. I ;gree not to occupy or allow occupancy of any building authorized by this permit until final inspection. _ LUa'/[ALN %^_-Z1 G7 lure Of Legal Owners) - Data _ And/Or Authorized Applicant Date CODE 1. INSPECTION TYPE PBiE 1NTFIAL$ CODES INSPECTION TYPE DATE ItQm�A ,j 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing n y n 200 �4'f 1 7 �l lrl. .t r'l r� � Inel Re� ( - ,� 1 `)210 Final Electrical - V: 201 Final Block/Relaiiing Well �� /' ,_ � 212 Final Fire Prevention i 202 Final Fact 1 rY.Fire Place 220 -Final _Planning Approval - -� - 203 LFinal Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy .■man POOL AND SPA REQUIREMENTS The following information is required in a clear and legible manner. All information shall be complete and on the plans. Three sets of plans showing all of the following with measurements shown from property lines, buildings, patio covers or other structures. 1. Name, address, phone number of owner. 2. Name, address, phone number, type of license of any contractors or subcontractors. 3. Pool and/or spa location. 4. Equipment location. 5. Gas and electrical meter locations. 6. Overhead service lines and serving pole location. 7. Type of gas and electrical conduits to be used. 8. Size of main electrical service (if less than 100 AMP, service is probably inadequate and will have to be upgraded to minimum City requirements.) 9. Rating (horsepower, voltage, amps) of all electrical equipment. 10. BTU rating of gas heater. 11. Distance and size of gas line. 12. All electrical outlets within 15 ft. of pool/spa. 13. Capacity of spa (spas only). 14. Handrails, ladders, slides and diving boards (if any). 15. Location and details of solar panels (if any). 16. Location of doors and windows within 5 ft. of pool/spa. 17. The type of construction—gunite, poured concrete, prefabricated fiberglass or other. 18. The pool dimensions, including the depth and adequate cross-sections drawn to scale. 19. Computations, stress diagrams and other data sufficient to show the correctness of plans; including reinforcing steel schedule and details. 20. A statement by the applicant concerning the anticipated nature of the soil under and around the pool structure (expansive, moderately expansive, non -expansive). (A soils report may be required by Building Division prior to permit issuance.) 21. The Engineer's wet ink signature is required on pool plans and calculations. 22. All semi -private pools and spas shall conform to California Administrative Code Title 24 handicapped requirements (hotels, motels, recreation areas for lease to public or publicly funded projects). 23. Where a permanently installed pool is constructed, at least one 120 volt receptacle shall be installed a minimum of 10 feet and not more than 15 feet from the'inside wall of the pool and shall be protected by a ground fault circuit interrupter. 24. Indoor installation of spas and hot tubs, receptacles shall not be closer than five (5) feet to spa/tub. 25. Receptacles located within twenty (20) feet of a spa or hot tub shall be G.F.C.I. 26. Receptacles for spa/hot tub motors shall be G.F.C.I. protected. 27. Comply with Costa Mesa City ordinance 93-12 requiring protective barriers, fencing and/or enclosures. 1009.46 (REV. 7186) GENERAL REQUIREMENTS 1. If capacity is 750 gal. Or more, backwash and P -Trap shall be installed. 2. All P -Traps shall tie in at lower terminus of house drain. 3. If permanent fill line is not installed, nearest hose bib shall have an anti -siphon valve. 4. All PVC shall be 18 inches underground. 5. PVC gas lines shall be tested at 60 P.S.I. 6. Pressure test required on entire system (35 P.S.I. air test or water fill) prior to back fill. TYPICAL SETBACK REQUIREMENTS Equipment; 4 ft. from property line 4 ft. from doors/windows 4 ft. from attic vents 18 inches from house/garage Pools/Spas; Above -ground pools and spas shall not be located in the required front yard setback from a public street and are subject to 5 -foot side and 10 -foot rear yard setbacks for main structures. Any deck that is raised higher than 6 inches above grade will also be subject to the 5 -foot side and 10 -foot rear yard setbacks for main structures. In -ground pools and spas shall be located 5 feet from any property line. Please consult with the Planning Division regarding any in -ground pool and/or spa that are proposed to be located in the front yard. All pools and spas shall be located 5 feet from any structure. 1. Overhead Edison drops shall be installed per NEC 680-8 (see attachment). 2. It shall be unlawful for any person to install, remove, alter, repair or replace any plumbing, gas or drainage piping or any fixture, swimming pool heater or treating equipment in a building or premises without first obtaining a permit to do such work from the City Building Division. 3. Clarification or additional information may be obtained by telephone: (714) 754-5273, between 8:00 a.m. and 4:30 p.m. FENCE AND GATE REQUIREMENTS (see attached) 103966 (REV. W90) CHAP. 31B, DIV. 11 31508 -41 CALIFORNIA BUILDING CODE 3150.18 Division ll—PRIVATE SWIMMING POOLS (STATEWIDE) NOTE: These regulationsaresubject to local government modification. The applicable local government requirementsat the timeofopplication for a building permit should be verified. NOTE: Thesestandards becomeapplicablecommeneingJanuam 1, 1998, ro o privare, single famiPo home for which a construction permit fora newswbnming pool has been issued on or after January 1, 1998. SECTION 3150B — DEFINITIONS As used in this division, the following terms have the following meanings: APPROVED SAFETY POOL COVER means a manually or power -operated safety pool cover that meets all of the perfor- mance standards of theAmerican Society for Testing and Materi- als (ASTM), in compliance with Standard F 1346-91. ENCLOSURE means a fence, wall or other barrier that iso- lates a swimming pool from access to the home. EXIT ALARMS means devices that make audible, continuous alarm sounds when any door or window that permits access from the residence to the pool area, that is without any intervening en- closure, is opened or is left ajar. Exit alarms may be battery oper- ated or may be connected to the electrical wiring of the building. PUBLIC SWIMMING POOL means a swimming pool oper- ated for the use of the general public with or without charge, or for the use of the members and guests of a private club. Public swim- ming pool does not include a swimming pool located on the grounds of a private single-family home. SWIMMING POOL or POOL means any structure intended for swimming or recreational bathing that contains water over 18 inches (457 mm) deep. "Swimming pool" includes in -ground and above -ground structures and includes, but is not limited to, hot tubs, spas, portable.spas and nonportable wading pools. Reference: Health and Safety Code Section 115921 Authority: Health and Safety Code Section 18942(b) AB 3305, Statutes 1996, C.925 SECTION 3151B — CONSTRUCTION PERMIT - SAFETY FEATURES REQUIRED Commencing January 1, 1998, except as provided in Section 3154B, whenever a construction permit is issued for construction of a new swimming pool at a private, single-family home, it shall be equipped with at least one of the following safety features: 1. Thepool shall beisolatedfromaccess toahome byanenclo- sure that meets the requirements of Section 3152B. 2. The pool shall be equipped with an approved safety pool cover. 3. The residence shall be equipped with exit alarms on those doors providing direct access to the pool. 4. All doorsproviding direct accessfrom the home to the swim- ming pool shall be equipped with a self-closing, self latching de- vice with a release mechanism placed no lower than 54 inches (1372 mm) above the floor. 5. Other means of protection, if the degree of protection af- forded is equal to or greater than that afforded by any of the de- vices set forth in Items 1-4, inclusive, as determined by the building official of the jurisdiction issuing the applicable building permit. Any ordinance governing child access to pools adopted by apolitical subdivision on or before January 1, 1997, is presumed 1-294.16 to afford protection that is equal to orgreater than that afforded by any of the devices set forth in Items 1-4, inclusive. Reference: Health and Safety Code Section 115922 Authority: Health and Safety Code Section 18942(b) AB 3305, Statutes 1996, C. 925 SECTION 3152B—ENCLOSURE; REQUIRED CHARACTERISTICS 3152B.1 An enclosure shall have all of thefollowing characteris- tics: 1. Any access gates through the enclosure open away from the swimming pool and are self-closing with a self -latching device placed no lower than 60 inches (1524 mm) above the ground. 2. A minimum height of 60 inches (1524 mm). 3. A maximum vertical clearancefrom the ground to the bottom of the enclosure of 2 inches (51 mm). 4. Gaps or voids, ifany, do not allowpassage ofa sphere equal to or greater than 4 inches (102 mm) in diameter. 5. An outside surface free of protrusions, cavities or other physical characteristics that would serve as handholds or foot- holds that could enable a child below the age of five years to climb over. Reference: Health and Safety Code Section 115923 Authority: Health and Safety Code Section 18942(b) AB 3305, Statures 1996, C. 925 SECTION 31538 —AGREEMENTS TO BUILD; NOTICE OF PROVISIONS Any person entering into an agreement to build a swimming pool shall give the consumer notice of the requirements of this article. Reference: Health and Safety Code Section 115924 Authority: Health and Safety Code Section 18942(b) AB 3305, Statutes 1996, C. 925 SECTION 3154B — EXEMPT FACILITIES 3154.111 The requirements of this article shall not apply to any of the following.• 1. Public swimming pools. 2. Hot tubs or spas with locking safety covers that comply with the American Society for Testing Materials—Emergency Perfor- mance Specification (ASLN-ES 13-89). 3. Any pool within the jurisdiction of any political subdivision that adopts an ordinance for swimming pool safety that includes requirements that are at least as stringent as this division. 4. An apartment complex or any residentialsetting other than single-family home. Reference: Health and Safety Code Section 115925 Authority: Health and Safety Code Section 18942(b) AB 3305, Statutes 1996, C.925 C A c A C A c A C A c A c A A c A c A c A c 2001 CALIFORNIA BUILDING CODs FIGURE 31 B-4—PERPENDICULAR FENCING DIMENSIONS ON SLOPING GROUND INSIDE OUTSIDE 5' deer FeWrq space .11 0 FIGURE 31 B-5—EFFECTIVE FENCING HEIGHT CHAP. 318, DIY. I FIGURE 31B-4 FIGURE 31B-5 1-294.15 I d tLa er R.C.E. F �GI5nc.�7p�^6ce . rUBLIC SERVICES UEPARTMEN-I FOR ID SITE ACCESS PERMIT NO. ❑ ADDITIONAL PERMITS REQUIRED FOR -OFF-SITE IMPROVEMENIli ❑ RIGHT OF WAY UNDERGROUND PERMIT NO. RIGHT OF WAY CONSTRUCTION PERMIT NO. C] APPROVED FOR CITY INFRASTRUCTURE AND/OR PUBLIC RJ ❑ PROVED FOR CONNECTION TO CITY DRAINAGE ACILITY ENGINEER: DATE: �� ! ❑ TRANSPORTATION: _ DATE: ON-SITE GRADING PERMIT MUST BE OBTAINED FROM THE BUILDING SAFETY DIVISION (2ND FLOOR) 'N- - t-. r v CITY OF Cl)SIAh9ESA (�P��j1VISION [r J B . DL -PT. EG. NR,: DIT ONS DELET NS, CTIONS SHAL . BE APED BY THE PLANNI, G DIV. BY: WAT E.RW O=R L,E- POOLS Po"g Designers Pc&s^ Builders -Creators of FUN phone ... (951)-894-6767 �liD.no. 831713� fax 951)-493-1988, ® - WATERVVORLD INDUSTRIES INC. No Slopes within Of Swimmino �i ti! -N.1` ,��_ 1(�0i�r� ��1 f Qi)3� f� 0 ,e a• fir'". IIt�o��.eEts�arf>iIl�tlt�t�E.l�l� ACCESS: SAW CUTS: HOME RUN: GC`✓ +10 a� Ili REMOTE: '"' RUN: �- POOL SIZE: ' D1W: 114 RD: DEPTH: 31 — �`•�. L F.: _---'' STEPS: © AR_ �,. HIH TYPE: L.F. DECK TYPE: SO. FT.:--""' COLOR- OLORNAT. O' pooK- J U5c s (mc 0,#n 6e 3 SWIMMING POOL SPECIFICATIONS f- �i ?^_ ACCESS: SAW CUTS: HOME RUN: GC`✓ +10 POOL LIGHT RUNG +5 WALLS: REMOVI REMOTE: '"' RUN: �- POOL SIZE: ' D1W: 114 RD: DEPTH: 31 — �`•�. L F.: _---'' STEPS: pIr ACCs jt I- W c 1 /0 = Owner has been made aware of the POOL/SPA equipment location. Any changes in the location by the owner will be an ADDITIONAL EXPENSE TO THE OWNER BENCH: — N NI— M. D.: .57V LIGHT: Cd 16 K L 'e- D FILL UNE: 7mo AUTO. I RUN: CHi-m-5 A% 6-6tJy� WASTE DISPOSAL:." CLEANER TYPE:A N /QAT0x RUN: h? O SPA RUN: ENGINEERING•. S! �' SURCHARGE:" ""- HOME RUN: GC`✓ +10 POOL LIGHT RUNG +5 SPA LIGHT RUN:-' +5 REMOTE: '"' RUN: �- WIL TILE: I D1W: 114 RD: TARGETS: -6j5!% N n Tl--- RAISED DfW: L F.: _---'' R.B.B: S": 12": 16": 24": HIH TYPE: L.F. DECK TYPE: SO. FT.:--""' COLOR- OLORNAT. NAT.CONC: -^'-" SQ. FT.: CANTILEVER D.O.D.: '-"-"-' COLOR: - SLEEVES: RISERS: TYPE: -" LF.: ,.---- STRIPIFINISH: _!- L.F. TURNDOWN: 6": 1Y": 16": 24": Co Ing Type: S1 G,RIP Color: INTERIOR FINISH: 1,el COLOR: W r7 J11-1_ CODE GATES BY: kWl /, WARON: -� UF: — DI WORK BY OTHERS: L • A / k c, (C_A`AJ Ylk/i I HEREBY APPROVE POOL AND EQUIPMENT LOCATI SIGN: M // NAME:, 1AAAE-(a'."i-1: "!f _Sr hl. G] AND DEP[Msel of plrs A4 •/afi: makean,,t, ,r- he,ab: and Safety C°v N C _ da Me The stampnq ,f Ihls Fan ark DATE: of the violation of ar. prov ,These plans and Perhil sha'. ADDRESS: / 7 '/` ,q; 4l•! j G L CITY: CoJ IV LA CROSS STREETS: A920 )t RES. PHONE: BUS. PHONE: DESIGNER: J rrfS / J y: BLDR/SUB. JOB #: OWN. BY: CHK'D BY: DRAFTS. SIGN.: CONTRACTOR: r WEIDENKELLER, MARY JAI, -- From: KENNERSON, SILVIA Sent: Tuesday, July 31, 2007 4:31 PM To: WEIDENKELLER, MARY JANE Subject: BO6-01314/1798 HAWAII Cl Attachments: Picture (Metafile) Hello, Just want to let you know the property owner came in today and withdrew all of the permits for this project. You had sent her a letter advising they will expire next week. Thanks! Silvia Kennerson Development Services Building Division City of Costa Mesa (7I4) 754-5652 Fax. 754.4856 a" n nerson CEDu costa -mesa. ca. us Cost MM "-"_` C) �F#d3obor3,���0600.1s, t 0600 Gia_ ' N 0.,,0, � C, �� Cos r q M is,q C// --;L-16 Job Address: 1795 HAWAII CI Status: ISSUED Suite No Applied: 08/02/2006 Vicinity: POOL AT REAR SFO Issued: 08/02/2006 Parcel Nunmber: Applicant: CHRIS RASTEDT Address: 40485 MURRIETA HOT SPRINGS RD SUITE 259 MURRIETA, CA Phone: 951-894-6767 Zip 92563 Owner: SCHWERIN, JAMES A AND SHERRY, Address 1798 HAWAII CIR COSTA MESA, CA - Contractor: OWNER -BUILDER Address: INSTALL 275 S.F. INGROUND ELECTRICAL TO INCLUDE: 1 Phone: 714-313-: Zip: 92626 Phone: Zip: REF.: 806-01314. COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under'California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or 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 2"646 (6W) Quantity Quantity ISSUE FEE $23.50 T p O' t System/ Lighting $0.00 0 Temp service test $0.00 swa /100 ft $0.00 0 Res. a/c package $0.00 Stan g Section $0.00 0 New Res (1-2 units) $0.00 0 lectrical Equipment $0.00 0 New Res (3+units) $0.00 Transformers up to 1 kva/kw $0.00 0 Pool / Spa $49.50 1 ...............up to 10 kva/kw $0.00 0 Lighting Forts $0.00 ...............:up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 .................up to 100 kva/kw $0.00 0 Switches $0.00 0 ..................over 100 kvalkw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0. Low Volt Wiring System / Ckt $0.00 0 Service to 200a $0 0 0 Misc. Conduit $0.00 0 Service to 1000a , "SO. Misc. Conductor $0.00 0 Service over 1000a . 0 0 Circus (gen or ride) $0.00 0 Motors to 1 hp , . $0.0 " 0 Circus (mech ride or lights) $0.00 0 Motors to 10hp 0 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.0 Fireworks Stand $0.00 0 Motors to 1 00h $ 0 0 Other Electrical Fee $0.00 Motors over 100hp 0.0 Communication drops 0 0 Investigation Fee $0.00 Sub panel to 200a $ . 0 Plan Check Fee $0.00 Pole Light Pkg 0 Reinspection Fee $0.00 Sign Circuits $ 0 Temp Pwr Pole 0.0 - TOTAL CALCULATED FEES $73.00 Intermed Pole .00. 0 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under'California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or 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 2"646 (6W) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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: (This se on need not be completed i/ the permit is valued at one hundred dollars ($100) or less.) i cdrfity that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Callfor/u� no agree that if I s Id become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisio p /Applicant Signature: �L� CDate: (WARNING: FAILURE TO SECURE WORK S' PE SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000). IN AD OTHE 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. I-c. a Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, Pr Or 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 subjec 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. It, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License L s.). ❑ 1 am exemptun CC. Business and Professions Code for this reason: Signature:_ - Owner ID veriti d by driver' Yes ❑ No Dii` vis License No. ✓ Expires: Verification of Owner shi y (type of tlocument, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ 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 reacted year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..............__.................._-.......................... ............... _............... _......... _...... __............ _................................. _........ _._... .............. __......... ......................... _................. _............... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ 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 th applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes j� No (Section 25534 of the California Health and Safety Code pro-Ades 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 It an RMPP is presently required. has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is me subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes � No (Section 658502 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? ❑ Ves ❑ No (If "yes", the facility must meet the requirement Of Sections 25534 and 42303 of the California Health and Safety Code). .......................................................................................................................................................................................................................................................................................................................................................................................... 7 11 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 atl of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ........................................................................................................................................................................................................................................................................................................................................................... B (If 'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penally of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to Comply with all s ata laws and cit ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for' s� tion purposes. a not to occupy or allow occupancy of any building authorized by this permit until final inspection. -- ,.3) —07 ,Slgnatu I L gal OwnedsTGDate _ - AM �Or Authorized Applicant Date CODE I, INSPECTION_i]pg Qdi& INRT�ALS CODED INSPECTION TYPE 2AN INTRA 1616 Fixed System Final Fire Prevention 206 Final Mechanical M 1266 Pool S a Final 208 _Final Plumbing �n 200 Final Re -Roof Final Electdoel� I ! ' �n1� 201 Final BIocWFTetaining Wall r //� ( 212 Final Fire Prevention's 202 Final Factory Fire Place�J^ `� ��(� 220 Final Planning Approval"'_ 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy Job Address: 1798 HAWAII CI Suite No Vicinity: POOL AT REAR SFD Parcel Nunmber: Applicant: CHRIS RASTEDT Address: 40485 MURRIETA HOT SPRINGS RD SUITE 259 MURRIETA, CA Phone: 951-894-6767 Zip: 92563 Owner: SCHWERIN, JAMES A AND SHERRY, Address 1798 HAWAII CIR 0.00 0- Sump Pump - Phone: 714-31 Swimming Pool COSTA MESA,. CA- - Zip: 92626 $0.00 0. - Urinal $0.00 Contractor: OWNER --BUILDER �) $0.00 ' Address:- $0.00 0 Wash Basin , 0 Phone: $0.00 0 Waste and Vent System Zip: ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System - Corinect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof. Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets)' Gas (Over 4 outlets) , Gas Repipe Gas Service Interceptors (Grease,-Oi Interceptors (Sand Autol SCCb INSTALL 275 S.F. INGROUND SWIMMING PLUMBING TO INCLUDE: 1 SWIM ING P( AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY r I r Sink, Sink, Status: ISSUED Applied: 08/02/2006 Issued: 08/022006 REF.: B06-01314. MMA Y % , MT - QTY 0.00 0- Sump Pump $0.00 0 Swimming Pool $0.00, 0 Trap Primer $0.00 0. - Urinal $0.00 0 - Vacuum Brkr Bkflow(1-4) �) $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Wash Basin $0.00 0 Wash Basin Set $0.00 0 Waste and Vent System $0.00 0 Water Closet(Toilet) $0.00 0 Water Heater / vent $0.00 0 Water Piping (Inst or Rep.) $0.00': 0 Water Re -pipe $0.00 0. Water Service $0.00 0 Water Softener $0.00 0 OTHER $0.00 0 VIOLATION $0.00 0 PLAN CHECK REINSPECTION TOTAL CALCULATED FEES: GUMMrN 1 S / SrtGIAL UUNUI I IUNb AMT $0.00 $60.75 $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 $0.00 $0.00 $0.00 $84.25 QTY 0 1 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. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180days, -or if work is suspended or abandoned for a period of 180 days. _V INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 244646 (&W) 6 DECLARATIONS WORKERSCOMPENSATION DECLARATION: I hereby affirm Under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work lot which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carder: Policy Number: J(Thi�s�saction need not be completed it the permit is valued of one hundred dollars ($100) or Iess.) ,7 I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the workers' i compensation laws of CBlifonj'ifand agree that djAhJUld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall fonhwith ___comply with these pravisio 'Applicant Signature: ` r-Daw: 41 WARNING: FAILURE TO SECURE WORKE ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100.000), IN ADD TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37W OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect, Lia N Class If Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I 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 Cade: 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 Winthe applicant to a civil penalty of not more than five hundred dollars (S500).): ,Xd,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. X7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws ). ❑ I am exemp der sec. Business and Professions Code for this reason: Signature's (Dale'- i Owner ID verifietl by is license. es ❑ No vers License No. _ _ - -- Expires:—1 Verification of Own ip by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 0, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safely, as noted above, unless such person has a permit to do such work from the division. Signature: Dale: Division of Industrial Safety Permit Number HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). the applicant p er ppresent.or future building Occupant to file a registration form for.ac .................................................................................-.................. ..................... .......... .... 2 Does or will a o o g p need go acutely hazardous materials? ❑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 and pressure). .........................................................................................._._............................................................................-................._.__............-_...............-.................-............................................................._......................_...............I.......................... 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 It an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No 5 Does or will the applicantsAiru present or future building occupant require for the work which is the subject c this a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes LJ No (Section 65050.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .................................................................................... ...._........ ........... -..................-..... ................... ... ...... ................................. ............................................................................... ............. ... ......................... ................ -.......... ......................... ......... 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ........................................................................................................................................................................................................................................................................................................................................................................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No -............................................................................... -..... -.................................. -............................................................................... -......................... .................. ................................................................ .................................................................. 6 (If yes-, attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree 10 c mply with all state aws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described arty for inspects p rpose;. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /y_ 67 Cbignature UT Legal Owner(s) And/Or Authorized Applicant Date copE P. iNspEcTiON TYPE 2AIE IMUTALS CODE INSPECTION TYPE DATE INTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical - 1266 Pool Spa Final 206 (Final Plumbing I Final Electrical 200 Fine Ro-Roo f , ((( 2011 in' al B� k�/Retelning �alh ��� I - 212 lFlnel Fire Prevention I J 202/ Final Feclory Fire Place I i ` v - 1� t 220Finel Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754.4856 • www.ci.costa-mesa.caBUILDING PERMIT 77 I-AiH UHrve, wa lA MMOA, l A U4040 Job Address: 1798 HAWAII Cl Status: ISSUED Suite: Applied: 08/022006 Vicinity: POOL AT REAR SFD Issued: 08/022006 Primary Occ: Type of Construction: Parcel Number: 13957207 Zoning: Applicant: CHRIS RASTEDT Address: 40485 MURRIETA HOT SPRINGS RD SUITE 259 Phone: 909-234-7747 ISSUED BY: MURRIETA, CA _ - „Zip:_ 92563 - Owner: SCHWERIN,.JAMES A Address 1798 HAWAII CIO-' Phone:- ��J A COSTA MESA, CA . , - Zip 92626 Contractorr WATERWORLD INDUSTRIES INC �\ Address /'40485 MURRIETA.HOT SPRINGS RD i � / SUITE 259 // �� Phone: 951 894787 �jj ',MURRIETA�CA Zip:92563 =,' License: 831713 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result In the explration of this permit. FOR INSPECTIONS CALL: (714) 7645626 lass (voo) _ L ,' A, 'Arch : o I II Eng: TODD L LACHER,� Address: Address: 1201 N TUSTIN AV - Phone: _ Phone: 714-630=6114 _ - ANAHEIM, CA - Zipi_ License: 92807 License: C67656 SCOPE OF PERMIT INSTALL 275 S.F, INGROUNO SWIMMING POOL 25' WIDE X 1 T DEEP - FEE SUMMARY Plan Check:, $287.46 ,, - - , ,Calc Valuation: $30,000.00' ' Permit: _ $442.25 `- _ / "- - 'Claim Valuation: $3o,0oo.00 SMIP Res:, $3.00 �. SMIPCom: $0.00 Other;, $0.00 Inspection: $0.00 - -- - - _Total: ,,, $732.71 - PLANNING & ZONING, - ;- SETBACKS .-- MAINSTRUCTURE Front 0-0 Rear -0-.0 � Left 0-0 ,- Right 0-0 , ACCESSORY Front 0- 0 — - . Rear 5-0 Left 10-0 ' -` . _ - Right '!G='O' PARKING" Ezistir : - 0Required: 0 Proposed: 0 � i NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result In the explration of this permit. FOR INSPECTIONS CALL: (714) 7645626 lass (voo) _ L DECLARATIONS .. ol 'ROW WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have end will maintain a certificate of consent to sell -Insure for workers' compensation, as provided for by section 3700 of the Labor Cade, 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 carder and policy number are: Carder: Policy Number: (This section need not be completed if the permit Is valued atone hundred dollars ($100) or less.) 0A I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' �✓ compensation laws of California, and agree that If I should become subject to the workers' compensation provisions o1 Section 3700 of the Labor Code, I shall forthwith comply with these pro%'sig •^ �icem�Sigrufe: �� WARNING -_FAILURE TO SECURE WORKERS• DOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLIARE ($100p001, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION Nos OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirn that I am titans d underpr�ovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and FClasI COntrfs.Slgnature: .vy— CONSTRUCTION LENDING AGENCY: ❑ 1 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). Lander's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: 1 hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a Civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yea ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight o1 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 forth for acutely hazardous materials? ❑ 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 and pressure). _—. ..............._............_.............................. .,_._...... ........................................._._.................................._........................._............................._.._..................................................................._..........._.........................................._...........__..... 3 O r will th❑a applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ...................................................................................................................................................................................................................................._............................................................................_..__...................._.._............._..........._. 4 If en RMPP la presently required, hes Section 25534 Of the California Health and Safety Code been fully compiled with? ❑ Yes ❑ No ......................................................................................... _......................................_..............................._...-.......................__...........................—_.............................................................................._.......__..............._............_.......... -_ 5 Does or will the applicant or present or future building Occupant require for the work which Is the subject of this a plication afarmit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes LU No (Section 65650.2 of the California Government 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? ❑ Yes ❑ No (it -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 Quell ty Management District or other air pollution control district or agency Is required for the work which is the subject of this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No .................. ...........I....................P...........................I..........................................................................._............................................................................................................_.................................................................. attach certificate of compliance from the appropriate air pollution control officer CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1 certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sigrlgture Of gal Owner(s) g Date O/ !!!! And/OrAutho zed Applicant DDate Lo CODE I. INSPECTIONTYPE INITIAL CODE r INSPECTION TYPE g9IE NITTA 1616 Fixed System Final Fire Prevention 206 Final Mechanical ,1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 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 . (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us ELECTRICAL PERMIT r r rAn1 unrvc, wo I A mcam, . ^ aceto Job Address: 1798 HAWAII Cl Suite No Vicinity: POOL AT REAR SFD Parcel Nunmber: 13957207 Applicant: CHRIS RASTEDT ISSUE FEE Address: 40485 MURRIETA HOT SPRINGS RD Temp service test $0.00 SUITE 259 Phone: 951-894-6767 $0.00 MURRIETA, CA -Zip 92563 , Owner, SCHWERIN, JAMES A New Res (3+units) Address 1798 HAWAII CIR $49.50 -- Phone: - _--1__. $0.00 COSTA MESA, CA Zip: - 92620 Contractor: ,WA\TERWORLD INDUSTRIES INC Address: 40485MUR11 RIETA HOT SPRINGS RD SUITE259/ Phone: -951-894-6767 ' MURRIETA, CA Zip: , 92563 License: 831713 Status: ISSUED Applied: 08/02/2006 Issued: 08/02/2006 ISSUED BY: SCOPE OF PERMIT INSTAL 275 S.F. INGROUND SWIMMING POOL 25' WIDE X 11' DEEP. REF.: B06-01314. TO INCLUDE: 1 SWIMMING POOL - - .Quantity ISSUE FEE $23.50 - - Temp service test $0.00 $0.00 Res. a/c package $0.00 $0.00 New Res (1-2 units) - $0.00 „0 New Res (3+units) $0.00 - 0 Pool'/ Spa $49.50 -- Lighting Fixts _--1__. $0.00 0 Recept Outlets - $0.00 0 Switches $0.00 0 Non Res Appl $0.00 0 Res Appl $0.00 0 Service to 200a' " , $0.00 0 Service to 1000a �� _$0.00 0 Service over t 000a� $0.00 _ 0 Motors to 1 hp', '$0.00 0 - Motors to 10hp ". $0.00 " - 0 Motors to 50hp\ -$0.00- �\ \ 0 " Motors to 1 00h - ` - $0.00 :. -< v 0 , Motors over 100hp $0.00, '$0.00 Communication drops . _ $0.00 - 0,_ Sub panel to 200a $000, 0 - Pole Light Pkg ` �. $0.00 %� 0 Sign Circuits $0.00 - .,0 Temp Pwr Pole -" $0.00- - 0 - Intermed Pale $0.00. 0 FEE SUMMARY. Quantity , -'' Temp Dist System I Lighting $0.00 0 _ Busway/10oft $0.00 0 Standing Section $0.00 0 Misc Electrical Equipment $0.00 0 , '- Transformers up to.1 kva/kv ' $0.00 0 I ___ _ ................up to 10 kva/kw $0.00 - 0 -- ..................up to 50 kva/kw $0.00 0 .................up to 100 kva/kw $0.00 0. ..................over 100 kva/kw $0.00 0" , Low Voltage Equipment $0.00 -0 - Low Volt Wiring System / Ckt $0.00 ,` 0; , _ -Misc. Conduit $0.00 % '0 -- Misc. Conductor $0.00, - 0 Circus ( gen or ride) $0.00 " 0 Circus (mech ride;or lights) _$0.00, 0 . - Christmas Tree Stand -$0.00 0 , ' Fireworks Stand .'$0.00. 0 Other Electrical Fee; '$0.00 Investigation Fee ,' $0.00 Plan Check Fee - ' Reinspection Fee - A " $0.00/ TOTAL CALCULATED FEES $73.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 160 days, or if work is suspended or abandoned for a period of 160 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446-46 (6/0a) DECLARATIOMS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 hive 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 carder and policy number are: Carder: Policy Number: (This section need not be completed 11 the permit is valued atone hundred dollars ($100) or less.) T)dl I certify that in the performance of the work for which this permit is Issued, I shall not employ any Damon In any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these prow 'on Applicant-SigiTyre WARNING-FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOUARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am Ilcense�i-u It or rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business nd Professions Code, and my license L5 in full force and effect. Uc.'R-i 7�.. J% /�J Class a Contractor's'Stgnat -- z 'A.'z D&I. CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions o1 the Contractors License Lew (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 %rotation of Section 7031.5 by any applicant for a permit subjects the appllcant to a civil penalty o1 not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ' ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. . ❑ Yes ❑ No Drivers License No. Expires: Vedticatlon of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet In depth Into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, faisework, or demolition or dismantling thereof, will be more than thirty-six (36) teat high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California AdminlstratNe 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 WIII the applicant or present or future building occupant need to file and certity a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mess 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). ................................................................................................................................................_,t—n,e...........file,.....__......................._....._..........................._........................................._....................._._..............._...............__........�._... 2 Does or will the applicant or present or future builtling occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the Califomia Health and Safety Code. with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................ ...................................................................................................................... _... _........................... .............................. _........................ __...................................... -.__................... _................ ___.............. _........ _... __. 3 Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ Nlo (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 [INo ...... .......................................................................................................................................................................................................................................................................................................................................................................... _.......... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication epemelt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 WIII any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). ..............._....__.........................._..._.........................................___..........................._...........................__........................_...__—__._._................. —_................... —_ ................. ___._......... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ... ........................__..............................__...................._...._.....................................__.........................__.........................._......................_..__...._.............._._.__._.__._._.................._........................_..................- 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cedity under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. Signaturg Legal(gyvner(s) Dat �l An - r AuthGri ed•Applicaht' t o CODE I. INSPECTION TYPE 26H IBimELS CODE,0 INSPECTION TYPE pe¢, get$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pod Spa Final 208 Final Plumbing 200 Final Re-Roof - 210 Final Electrical 201 Final BIocWRetaming 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.c3,tsUMBING PERMIT Job Address: 1798 HAWAII Cl -FEE SUMN Suite No AMT QTY • • - - Vicinity: POOL AT REAR SFD $23.50 Parcel Nunmber: 13957207 Backflow irrigation Applicant: CHRIS RASTEDT Landscape Irrigation Address: 40485 MURRIETA HOT SPRINGS RDSUITE 0 P, -Trap 259 - Phone: 951-894-6767 0 MURRIETA, CA- Zip: 92563 - $0.00 0 -- Process Piping (per 10 ft) Owner: SCHWERIN, JAMES A 0 Address /1798.HAWAII CIR,'- $0.00 0 ��i� Phone $0.00 COSTA MESA, -CA/ - Zip: 92626 Contractor. WATERWORLD INDUSTRIES INC Address:. 40485 MURRIETA HOT SPRINGS RD SUITE 259 Phone:. 951-894-6767 MURRIETA, CA Zip: -92563 License: :831713 - Status: ISSUED Applied: 08/02/2006 Issued: 08/02/2006 ISSUED BY: 0, V i N\ /N V," U" , SCOPE OF PERMIT INSTALL 275 S.F. INGROUND SWIMMING POOL 25' WIDE X 11' DEEP. REF.: 1306-01314. , PLUMBING TO•INCLUDE: 1 SWIMMING POOL , Interceptors (Sand Auto)", ,$0.00 0" - - - 4RY - -FEE SUMN AMT QTY • • - - _ _ ISSUE FEE $23.50 QTY Laundry Tub/Washer Backflow irrigation $0.00 0 • Landscape Irrigation Backflow Preventer ', _ $0.00 0 P, -Trap Bathtub $0.00 0 Pressure Regulator. Clarifier System $0.00 0 -- Process Piping (per 10 ft) Connect (Ice,Soda,etc) - $0.00 0 Receptors ' - Dental Units $0.00 0 Septic Tank Dishwasher $0.00 0 Sewer Cap for Demo Drain, Floor '' " • $o.00 0' Sewer Connect Drain, Rainwater . ,,,$0.00 01 Sewer Private Line Drain, Roof - `$0.00 0 Shower - Drinking Fountain .$0.00 0 Sink, bar, Expansion Tank $0.00 0 Sink, commercial Gas Earthquake Valve. $0.00, 0 Sink, Floor Gas (1-4 outlets) $0.00 0 Sink, kitchen Gas (Over 4 outlets) ,$0100 0; ` - Sink, service/mop' Gas Repipe ', "' $0.00;0 �I,� ,�� Spa (private); Gas Service x$0.00 i 0 �- Spa (public) - Interceptors(Grease Oip $000 -0' Water.Softener`-. Interceptors (Sand Auto)", ,$0.00 0" - - - 4RY - , _AMT" QTY AMT QTY $0.00 0; Sump Pump - $0.00 �0-, $0.00 -0' Swimming Pool - $60.75 .1, $0.00, '0' Trap Primer $0.00 �0 -$0.00 �.0 ,' <; Urinal -; '$0.00 I0 _$0.00" 0- Vacuum Brkr Bkflow(14)� $0.00 0 $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 $0.00 0 Wash Basin , $0.00 0 $0.00 0 Wash Basin Set $0.00 0 -$0.00 - 0 Waste and Vent System - . $0.00 i 0 $0.00 0 Water Closet (Toilet), $0.00/ 0 $0.00 0 Water Heater/vent $0.00 0 $0.00 0 Water Piping (Inst or Rep.) ; $0.00 0 $0.00- 0 Water Re -pipe /$0.00 0 $0.00 ,"0 _Water. Service ;, $0.00 0 $0.00'0`- Water.Softener`-. -,$0.00 0 • $0.00 0 -. OTHERi;`., /�i,/$0.00 $0.00 0 .- VIOLATION,` ' $0.00 $0.00 '0 PLANCHECK- ', $o00 REINSFECTION�l / $0.00 0 TOTAL CALCULATED'FEES: $84.25 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 1'/ DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby effimi 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 Cade, for the performance of the work for which this permit is Issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carder and policy number are: Cartier: Policy Number: (This section need not be completed If the permit is valued at one hundred dollars ($100) or lass.) certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that It I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these prpvi ns. APPllgant S� ignatura. gy `L1 WIP pate? WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 3100 OF THE LABOR OWE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that am licepSacteexovisions 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. Liq, a� X 5 // t',(gsq /,_� :5::5 L"• --_� Cofi�trectoYs'Signatura.,�-�AZA, .6�4- - z -/J4 CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, 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.). ' ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and cenify, a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .....................__._.............._......................................_._....__.._.___._...v.._...........................""'...................... _._._......................... -__.......................... _._..... _.................... - ...... _____...... -._............... _........ __......... ._ 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ 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 materiels 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 appplicant 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 II an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ._ ...................._..... ............ ....._.....................................__.—_.____................................__.......................... _._............................ __......................... ................................................................................ _.......... _ 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apeumil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65050.2 of the California Government Code requires that the requested information be furnished an applications for non-residential building permits). ...................._.._._.........................__..._......................_..................................................._..........................._........................_—.._......_...._._—_.-._.... ....................... _..............___.......... .... 8 Will any par of the facilfly to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ................................................................................................................................................................................................................................................................................................................................................................................... 7 W.W.If a permit from the South Coast Air Quality Management District or other air pollution control district or agency 19 reqquired 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? ❑Vas ❑ No ............................... ............... ................................................................... ...................................... .._.................................................................................................... ..... .._........ _..... _................................................................................ _................ 8 (If yes", attach cartificate of compliance from the appropriate air pollution control officar). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /g ure Of Legal,Owner 6 48je / i- �, tG' (:A O�Auth-Applicanl IDetto CODE t. INSPECTION TYPE RdIE I[iTTML CODE r INSPECTION TYPE 2&M 1KT1TIA 1615 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 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 A. Applicant to fill in all spaces except those within heavy border Iinef and sign all appropriate declarations. 3968 3/13/67 7.00 TL A F COSTA MES/Ay p'�CyONSTR UCTION PERMIT Projec duress / J 25 Ha LUa i / e �. P RMIT NO. 3 TRACT NO. LOT NO. UNIT NO. TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION Z REPAIR ❑ CONVERSION 1:1 DEMOLISH El OTHER ,.,.1 k AI.e � e.:. ter DESCRIPTION -2 ION OF WORK/USE OF BLDG. 'f -F 11 F_a v Applicant's Mailing Address y, Owner's Name 5/1ei�V �!/er1.l�Ir) Phone 7— Address Same A.P. # Zone S Main Building: Accessory Building: Arch/Eng. License No. Address TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL 1:1TENANT ❑ ELECTRICAL El PLUMBING OTHER �4v1ECHANICAL PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATIONS ZONE GRADING CU.YDS. ACRES - E T Front Z p B Rear N Contractor's Name Phone O.O./ Address(mailing)27 2'/C�•saminO Gap(5+rano-LQQvw t1e1 0`%%'/.�r� City License No. 7 Il LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full for a and effect. p �] p A C Right -- I S Left ".l`IG T G R 1 - Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: Q M T o License Class Lice a NP.3 93711 D Date �'a �� Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate PLUMBING FEES - Bar Sink Showers - ELECTRICAL FEES • of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) 1 Policy No, f•AQ I'1/ Company F � Certified copy is hereby furnished. Certified copy is filed with the city Builp ipg_Dlvisl Backflow Preventer Service Sink Automatic Washer ' Construction Pole Sub. Transformer ❑ 15-50 KW ❑50+KW ' Backflow Irrigation Sewer Ca P Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date ( '%-R) Applicant t&F EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for One hundred ($100) or less). 1 certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Clarifiers - Solar Collectors Dishwasher Meter Dover 100 amps Dish washer Solar Piping - Dryers ❑Gas ❑Electric Sub Panel lDrinking Fountains Solar Tank I Fan Motors 1:10-1 HP ❑1X-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP ❑18-15+ Date' Signature NOTICE: If, after making this declaration, you should become subject t0 the Workers' Compensation provisions Of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Floor Sinks Urinal Fixtures Microwave 'Gas Service Outlets Water Closet Device Boxes Pole Light 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 (Section 3097 Civ. C.) Lender's Name Interceptors Water Heater Outlets - Range Kitchen Sink Water Service Switches Sign ' ' Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division -3 of the Business and Professions Code) or that he/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 nnaltY of not more than five hundred dollars ($500). LJ I, as ,not of the property or my emiloyees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply t0 an owner Of a property who builds or Improves thereon, and who does such work himself/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 com- pletion, the owner will have the burden Of proving he/she did not build or im- far the purpose of sale). Ll 1, as owner of the property, am exclusively contracting with licensed con- a tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds Or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). 1 am aware thatExhaust proof of their Workers Compensation insurance should be provided t0 me. ❑ 1 am exempt under Section B. & P. C. for this reason - Lavatories - Auto -Wash Garbage Disposal 9 P Standing Sections P -Trap Laundry Trays y y Generator ❑0-5 KW ❑5.15 KW Trash Compactor ROOf Drains - - Reinspection Fee $15 - Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood Or Type I ❑ Canopy Type II ❑ DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By —Date Application Issued By Data — Duct - Under Ground Duct -Structural Refrigeration System ❑4100,000 BTU ❑100,000 BTU Duct - Ventilating SUMMARY OF FEES BUILDING PERMIT $ $MIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE S System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICSO # Fire Dampers Date owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and tate of tri rt�n to enter, poo the above-mentioned ropzu t for and state laws relating to bent cons n- hereby authorize yfor inspection purpo s Signature Date Drivers' License Or SS - Heating System &Ducting 00-100,000 BTU 0100,000BT Registers PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% $ $ $ S $ ENERGY P.C. $ GRADING $ MICROFILM. $ pp TOTAL FEE $ '-: �.et-t- CL�p Ii a^ Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # vote Inspector POOL 8 APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding o r., 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 1r� 6. Electrical LIFER Grnd. 57. APPROVALTO COVER-GUNITE ' 7. Footings 58. Electrical Conduit-Undrgrnd.'' 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P-Trap, 0 Undrgrnd.* 10. Structural Floor System 61. APPROVAL TO DECK ' 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping C] Gas 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑Gas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. .Final Factory Fireplace 38. Final Plumbing 39-� Water Service-Final ' 40. Gas Service-Final 41. Solar Domestic-Final ' 42. Backflow Preventer 43. Backflow Irrigation f 44. 'Landscape Irrigation System 45. Sound Attenuation - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed _ 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date UWNtK APOLLO DEVELOPMENT DATE 1-22-70 JOB ADDRESS 1798 Hawaii Circle BUILDING PERMIT NO. 31290 _ GFMFPAI rr)MTPAr Tr)P o___ nFC(RIPTInM..f Wf7P1C n-------- .,r. AP No. - LOT 24 TRACT 6694 FIRE ZONE VALUE $26 470.oO INSPECTIONS Signature Date GROUP I & j TYPE ZONE SOIL 1-3c - a SUBCONTRACTOR PERMITS ISSUED Date Number Si nature GAS d WATER % PI mbin ROUGH PLUMBING �- PROP. SWR. LINE 125OUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING O TEMPORARY SERVICE OR POLE UNDERGROUND YQ POWER F-1 r ROUGH WIRING i %GI%G Heatin TRENCHES KI FORMS KI STEEL REINF. I070 FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING O V--6 O LATHING — IN OUT rZ 4e. PLASTER, BROWN COAT 7 _ STRUCTURAL, FINAL HEATING, VENT., REFRIG. AND A.C., F - PLUMBING, FINAL AND GAS TEST O ELECTRIC, FINAL .gr BUILDING, FINAL a G yr iG Z . U.1 LU cL U I- Z Z_ < Orn am J � J to m J J m Q U N Za W M aW W Z J 0 CO J � W ly, Z Z_ H w0 N 70 F Z Q U J CL CL Q 0 F - (h Z 0 F_ U F- N N Z 312977 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 ���AN2F9C4-W0 731* ***141.00 A 7 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECE D DATE CE17VED /—" O GATE ISSUED BUILDING�} `(J--4L�fJ'i i -aa - ADDRESS PERM OWNER Apollo Development Corp. A.P. NO. �) MAIL 1104 E. 17th Street BUILDING ADDRESS / &A ADDRESS CITY Santa Ana NoL'547-9673 TRACT 6694 LOT 24 BLOCK CONSTRUCTION U. S. National Bank NEW ADD P LENDER R BRANCH Main Office OWNER Apollo Development Corp. 190 S. Broadway, San Diego USE DW 11- VALUE 16 000 ADDRESS ARCHITECT TEL Kermit DOrius 675-1164 OR ENGINEER N FIRE //�� ZONE TYPE GROUP.i"f� ADDRESS 3111 2nd Ave., Corona Del Mar APPROVED CONTRACTOR Apollo Develolment Corp. BY DATE ADDRESS 1104 E. 17th Street TEL. ZO(! NO, OF PLANS ;�— USE OF NEW"? / BUILDING CITY Santa Ana No.547-9673 V\.I STATE CITY 252549 1690 YARDS APPROVED YARDS APP OVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE 52 X 110 NO.OFBLDGS. (FROM C/L TRE OF LOT NOW ON LOT T. FRONT FT. FT. USE OF 10 EXISTING BLDG. R. SIDE FT. FT SIZE OF NOOF 1770 S.F. 7 1 U NEWBLDG. ROOMS STORIES L. SIDE FT. FT. EXTERIOR WALL er Plans ROOF Shingle COVERING COVERING REAR (IFT. 'V) FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN SLOGS. ACCESS. BLOCS. Construct new dwellin with g VAR.x C V— DATE C.U.P, ,�` APPROVED attached garage. APPROVED HOLD FOR SPE �F I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under / 70 SO. FT. 19p THE AMOUNTS OWN UNDER VALUATION IS FOR — the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m m am exempt from the provisions of the State of California Business VALUATION and Professions C e, D,vjslon 3, hapter 9. _,may PERMIT FEE $ � !/tom m Signature 0 aG, y7d Permittee �� - / s r✓��� $ PLAN CHECK 5 A)0 E 1 0 Authorized Agent LL �V d TOTAL FEE $