HomeMy WebLinkAbout1203 HAZEL PL - Building Permits4 CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT E98-00517
�• PERMIT PERMIT NUMBER
(714) 754-5273 • Fax (714) 754-4856 ELECTRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 1203 HAZEL PL
Suite No
Vicinity: LOT 34
Parcel Nunmber: TPN98049
Applicant: FLYNN, DAN
Address:
Phone:
Zip
Owner: W. LYONS HOMES
Address
Phone:
Zip:
Contractor: WILLIAM LYON HOLMES
Address: 4490 VON KARMAN
Phone:.714-476-1361
C.M. CA Zip: 92660
License: 661158
Status: ISSUED
Applied: 06/05/1998
Issued: 06/15/1998
SCOPE OF PERMIT
FIXTURE FEES FOR PLAN 2A, LOT 34: 1 OUTLET, 1 FIX., 1 SW., 1 PANEL, 8 1997 SQ FT OF RES BLDG FEES.
Quantity
ISSUE FEE
$22.00
Temp service test
$0.00
Res. a/c package
$0.00
0
New Res (1-2 units)
$99.85
1997
New Res (3+units)
$0.00
0
Pool / Spa
$0.00
0
.Lighting Fixts
$1.00
1
Recept Outlets
$1.00
1
Switches
$1.00
1
Non Res Appl
$0.00
0
Res Appl
$0.00
0
Service to 200a
S27.25
1
Service to 1000a
$0.00
0
Service over 1000a
$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
0
Motors over 100hp
$0.00
0
Communication drops
$0.00
0
Sub panel to 200a
$0.00
0
Pole Light Pkg
$0.00
0
Sign Circuits
$0.00
0
Temp Pwr Pole
$0.00
0
Intermed Pole
$0.00
0
FEE SUMMARY
Quantity
Temp Dist System / Lighting
$0.00
0
Busway /100 It
$0.00
0
Standing Section
$0.00
0
- Misc Electrical Equipment
$0.00
0
Transformers up to 1 kva/kw
$0.00
0
................up to 10 kva/kw
$0.00
0
.................up to 50 kvalkw
$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 I 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
$0.00
Reinspection Fee
$0.00
TOTAL CALCULATED FEES
$152.10
COMMENTS / SPECIAL CONDITIONS
0
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result In the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is Issued.
❑ I have 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 it the permit Is valued at one hundred dollars ($100) or less.)
❑ I certify that In the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Callfornla, end ee that If shoultl become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisio
(+ Q
Applicant Signature: - � Date: tD
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 11706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES,
LICENSED CONTRACTORS DECLARATION:
1 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. If Class I
Conlramors Signature: o Date:
CONSTRUCTION LENDING AGENCY: v
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lenders Address:
Signature: - Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of 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 two hundred dollars ($5DO).):
❑ 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 awn employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivel's License No. Expires:
Verification of Ownership by (type o1 document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby cartity, 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. (Chep. 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
pernil 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 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).
................................................................................................................................................................................................................................. I..................................................
2 Does or will the applicant or present or future building occupant need to file a registration farm 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 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 application apernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
....................................................................................................................................................................................................................................................................................
6 Will any part of the facility to be constructed untler This permit be within 1000 feet from the outer boundaries of a school? ❑ Yss ' ❑ No
(If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
....................................................................................................................................................................................................................................................................................
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
....................................................................................................................................................................................................................................................................................
8 (If yes', Brach certificate of compllenca from the appropriate air pollution contrd officaQ.
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is cored. I agree to comply with al 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
abov"escribed property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
atur
AndtOr Authorized Applicant (O �Date
GOD" INSPECTION TYPgm INTMALS COD111 INSPECTIONTYPE 2M It{®AIS
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 BlocWRetalning Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-46
t
. t
1 PETRA
COSTA MESA • SAN DIEGO • TEMECULA • LOS ANGELES
June 24, 1998
J.N. 492-97
WILLIAM LYON HOMES, INC.
4490 Von Karman Avenue
Newport Beach, CA 92660-3600
Attention: Mr. Gary Haddy
Subject: Footing Observations, Lot 34, Tract No. 15570, City of Costa Mesa,
Orange County, California./ 2 0 3 14 (G 2 Y—P / /0 ,
References: See Attached References.
Dear Mr. Haddy:
Footing excavations for the proposed residence within the subject lot have been carried
into firm, competent bearing soils and are considered geotechnically suitable for
concrete placement.
If you require any additional information, please feel free to call.
Respectfully submitted,
PETRA GEOTECHNICAL, INC.
Ray�lenkamp
Supervls)ng Soils Technician
RM/mel
cc: 1998\400\492-97.34
PETRA GEOTECHNICAL INC.
3185-A Almay Avenue
Costa Mesa, CA 92626
Tel: (714) 549-8921
Fax: (714) 549-1438
petracm@ibm.net
REFERENCES
1) Geotechnical Investigation, Proposed Residential Development, Tentative Tract No. 15570, Northwest Comer
of Fairview Road and Adams Avenue, City of Costa Mesa, Orange County, California; a report by Petra
Geotechnical, Inc., dated December 29, 1997.
2) Geotechnical Report of Rough Gradings, Lots 1 through 34 and Lot "E", Tract No. 15570, City of Costa Mesa,
Orange County, California; report by Petra Geotechnical, Inc., dated April 6, 1998.
3) Geotechnical Recommendations for design of Post -Tensioned Foundations in Accordance with Design
Specifications of the Post -Tensioning Institute, Tract No. 15570, City of Costa Mesa, Orange County, California;
letter by Petra Geotechnical, Inc., dated April 14, 1998.
PETRA GEOTECHNICAL, INC.
J.N. 492-97
PARDUE, CORNWELL & ASSOCIATES, INC.
PIANNINCI • ENC{INEERINC{ • SURVEy1NC1
June 23, 1998
City of Costa Mesa
77 Fair Dr.
Costa Mesa, CA 92628
Re.: Tract 15570, Lot 34
Dear Sirs:
The engineer of record inspected the building forms for Lot 34 for the above referenced tract on
June 23, 1998. Upon inspection, the finish Floor elevation on Lot 34 of Tract 15570 located in
the City of Costa Mesa, CA. is within ± 0.1' of the elevation specified on the approved Precise
Grading plan.
If you have any questions or comments, please do not hesitate to call.
Sincerely,
PARDUE, CORNWELL & ASSOCIATES, INC.
Fred Cornwell, P.E. ��4� ��0 vOt��Vl��l\\
Principal
L' No. 45591 r
`I Exp.`p
cr�y� CIVIL
AV
1 5 1 Knlmus Da., SUITE G230. • Coss Mesa, CA 92626 • PNoNE (7 14) 2413400 • FAx (7 14) 241.3432
S.
insulation Certificate
a -V ?j H a,:-z.�e�l �(�cE `�..Q �( yye sC ,.
Numb,, and Svicet city
Cowry 0 Sub mston tF�\�iunbcr
Descrlption of Installation
ROOF
Maut<al
Mckncu (Laches)
Brand Name
The:mtat Resisunre (R -Value)
CEILING
Batt or Blanket Type P� Bri�d Namei\\%1
Tttiekress (inches) Thermal Resisunc: (R•Vzue)
Loose Fill Type Brand Name
Conseactor's minimum insulted weight W ib Minimum thick-ess _ iKhcs
Manufacttuet's instilled weight per square foot to aeheive Thcmal Resis�ance (R -Value)
EXTERIOR WALL n^ 1
Metrial Brand Name
Thickness (inches) ThcrmalRcsisunce(R-Vaiva).' 1��i
RAISED FLOOR
Material Brand None
Thickness (inches) The -mat Resis'ance (R -Value)
SLAB FLOOR
Material Brand Name _
Thickness (inches) Thenal Resistance (R•'Jalue)
Width (inches)
FOUNDATION WALL
Material
Thickness !inches)
Declaration
Brand Name
Thermal Re515tanCe (iiVice)
1 hereby certify that the above 'insulation was installed in the building at the above location in conformance vriG!
the current Building Energy Efficiency Standards for new msldencial bulldirtgs contained in Tile 24 of the
California Administrative Code.
Ccaoril Coaoactor(Builder) ~-- 1.ct.s41`lumber
kk ins « 1-L �� TOO_.
tib Cantr tor( ulation ta(iet'rn y int ernew Tj I ��
Clr l�/^I!. 1 I l
Signature and Title De
Cnrepuaacr than,
J.ovary 1, legs
r CITY OF COSTA MESA
BUILDING DIWSION
� DEVELOPMENT SERVICES DEPARTMENT
� ._. R98-00669
PERMIT PERMIT NUMBER
(714) 754-5273 • Fax (714) 7544856 BUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 1203 HAZEL PL Status: ISSUED
Suite: Applied: 02/18/1998
Vicinity: Issued: 06/1511998
Parcel Nunmber: TPN98049 Zoning:
Applicant: FLYNN, DAN
5-0
-.Right
Address:
Left
0- 0
Right
Phone:
- Zip:, , -...
owner: W. LYONS HOMES "—
Address-
Phone: -
%�• i _ �, A
Contractor AW LLIAM-LYON HOLMES
Address. ,4490 VON KARMAN. --
Phone: 714-476-1361
//t/, C.M,CA/
Zip: 92660VJ�V-�
��
License:,661158
^`
Arch/'Eng/A
'si A'ddre
ss:
-_
Licenser—
JVUI t Ut- 1 tKNll I 7 NEW 1997SF2-STORY-SFD AND 426SF GARAGE: REF_: PLAN CHECK NO. 00689-98A. PLAN TYPE 2A. \1 POWDER ROOM.
3 REQUIRED
PARKING SPACES PROVIDED ON THE SITE. GUESY.PARKING.ON PRIVATE STREETS. - -
.,1 ` .if .
SEE DR -97-0
'HOLD FOR SPECIAL REO��N17
Plan_Check
,,Permit:
SMIP,Res:
SMIP,Com:
FEE SUMMARY/
$202.68 Calc Valuation`, 171;914.50 '
$1;247.25 Claimed Valuation ,so.00
y,
$17:19
$0.00\,
$0.00,?� . ,
,\
Inspection_ $0.00
Total: $1,467.12 -/,.-
SETBACKS
ACCESSORY
Front 15- 0 - Rear 20- 0
Front 0-0 Rear 0-0
PLANNING & ZONING
Left
5-0
-.Right
5-0
Left
0- 0
Right
0-0
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) 7546626
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 prorAded for by section 3700 of the Labor Code, for the performance of the
work for which this permit Is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carder and policy number are:
Cartier: Policy Number.
(This section need not be completed /f the permit Is valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 o1 the Labor Code, I shall forthwith
comply with these p ^ /J^
Applicant Signature: rovl � e // � Date: " (� I f0 �7 X
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Uc .4 Class p
i
Contractors Sig�ure: 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: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Coda: 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 La 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 compensatlon, 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 contractors)
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 drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, Le. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certlty 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, Calitomla 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
pernit 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 Tile and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
....................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future DullOing ocwpant need to file a registration form for acutely hazardous metedels? ❑ Ves ❑ 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 WIII the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
aection 25534 of the California Health and Safety Code provides that the Costa Mese Fire Department may require the preparation, certification and filing with the Fire
partment 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 Doan or will the applicant or present or future building occupant require for the work which is the subject of this a plication a permit for such construction or modification
from the South Coast Air QualityManagement District or from any other air pollution control district or agency? Yes ❑ 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 part of the facility to ba 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 apermit from the South Coast Air Quality Management District or other air pollution control district or agency Is reywired 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 certlty 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 Emiss ons.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Si tura Of Legal Owners) /q Date
And/Or uthorized'Applicant Date
00ILL INSPECTION Ty? gATE II®ALS CODE INSPECTION TYPE 2A¢ ILLS
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 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 6-
2446.46
•yam.,
4
(714) 754-5273 • Fax (714) 754-4856
Job Address: 1203 HAZEL PL
Suite No
Vicinity:
Parcel Nunmber. TPN98049
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
Applicant
FLYNN, DAN
Address:
Phone:
Zip:
License:
-
Owner:
W.'LYONS HOMES,, ,
Address:
!��'. �,•�
a -
FIREPLACE AND 4 VENT FANS -
Contractors.
WILLIAM,LYON HOLMES
FEE SUMMARY-,,,
.Address:.
4490 VON KARMAN
C: M.,
Arch/Eng:
Address:
i
Quantity
MECHANICAL PERMIT
Phone:
Zip:
Phone:
Zip:
Phone:' 714476-1361
Zip:- 92660 :I: •
License` 661158
PERMIT NPMBER
M98-00224
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 06/05/1998
Issued: 08/0411998
i
Phone:
Zip:
License:
-
SCOPE OF PERMIT
'
FIXTURE FEES FOR PLAN 2A, LOT 34: REF B98-00669 INST 1 FAU UNDER 100K BTU, 1
a -
FIREPLACE AND 4 VENT FANS -
FEE SUMMARY-,,,
Quantity
i
Quantity
ISSUE FEE
$22.00
Repair/Alt Absorbtion Unit
$0.00
0
Inst FAU <100 k BTU
$13.25
Repair/ Alt Refrigeration Unit
$0.00
0
Inst FAU >106 k BTU
$0.00
Ventillation System
$0.00
0
Repair I Ah Cooling/Heat
$0.00
0
Evaporative Cooler
$0.00
0
Inst I Rep. Recess Wall Htr
$0.00
0
Commercial Incinerator
$0.00
0
Refrig Sys <100 k BTU -
$0.00
x$0.00
0
Domestic Incinerator
$0.00
0
Refrig Sys >100 k BTU
0
Compressors / Absorption Systems
Gas Piping
x:$0.00
0
Up to 3 hp / 100 k BTU
$0.00
0
_
Factory Fireplace -_
, . $9.50,11
3 To 15 hp / 500 k BTU.
$0.00
0
Hood w/Mech Exhaust
$0.00
0
15 To 30 hp 11,000 k BTU
$0.00
0
VAV Box
$0.00
0 -
• 30 To 50 hp 11,750 k BTU
$0.00
0
Vent Fan / Single Duct
$26.00
4
Over 50 hp / Over 1,750 BTU
$0.00
0
Appliance
- $0.00
0
Boilers
Fire Dampers
$0.00
0
Up to 3 hp
$0.00
0
Smoke Dampers
$0.00.0
3 To 15 hp
$0.00
0
Inst or Relocate Appl Vent
$0.00
0
15 to 30 hp
$0.00
0
Air Handlers < 10000cfm
$0.00
0
30 to 50 hp
$0.00
0
Air Handlers > 10000cfm
$0.00
0
Over 50 hp
$0.00
0
Floor Furnace
$0.00
0
Other Mechanical Fee
Floor or Suspend Heater
$0.00
0
Investigation Fee
$0.00
Plan Check Fee
$0.00
Reinspection Fee
$0.00
TOTAL CALCULATED FEES
$70.75
COMMENTS I SPECIAL CONDITIONS
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance terrier and policy number are:
Cartier: Polity Number:
(This section need not be completed it the permit is valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith
comply with these prows t� Q
Applicant Signature: Date: '3—
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS (5100,000), 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 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 N
Contractor's Signature: Date: `
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Coda).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her awn employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement Is
sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose or sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet In depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 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 reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
....................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
....................................................................................................................................................................................................................................................................................
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and tiling 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 requiretl, has Section 25534 of the Califomia Health end Safety Gode been fully complied with? ❑Yes ❑ No
...............................................................................................................'e'qu............................hich.................ject.. f thi.....2pll................. rmit...................nstructi ........... modification n
5 Does or will the applicant u present or future building occupant require for the work which is the subject c this a plication epermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes ❑ No
(Section 65850.2 of the 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 reGulred 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? ❑Ves ❑ No
....................................................................................................................................................................................................................................................................................
B (If yes ,attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Legal Owners) qt / And/Or Authorized Applicant Dates
gQgE_L INSPECTIONTYPE DATE INTIRAlS COOEI INSPECTION TYPE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root 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
24 646
07
(714) 754-5273 • Fax (714) 754-4856
Job Address: 1203 HAZEL PL
Suite No
VicinityLOT 34
Parcel Nunmber: N98049
Applicant: FLYNN, DAN
Address:
Owner: W. LYONS HOMES
Address
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
Contractor. WILLIAM LYON HOLMES
Address: 4490 VON KARMAN
Arch/Eng:
Address:
PLUMBING PERMIT
Phone:
Zip:
Phone:
Zip:
Phone:' 714-476-1361
C.M, CA Zip: - 92660
License: 661158
Phone:
Zip:
License:
P98-00452
PERMIT NUMBER
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 06/05/1998
Issued: 06/15/1998
SCOPE OF PERMIT
FIXTURE FEES FOR PLAN 2A, LOT 34:2 TUBS, 1 DM, 1 GAS 1-4, -
1 GAS OVER 4, 1 LNDRYTUB, 1 SEWER CON. 1 SHOWER, 1 KIT
SINK, 4 WASH BASINS, 3 TOILETS, 1 W/H, & 1 WATER SERVICE
FEE SUMMARY
AMT
QTY
AMT
QTY
AMT
QTY
ISSUE FEE
$22.00
Laundry Tub / Washer
$8.75
1
Sump Pump
$0.00
0
Backflow irrigation
$0.00
0
Landscape Irrigation
$0.00
0
Swimming Pool
$0.00
0
Backflow Preventer
$0.00
0
P -Trap
$0.00
0
Trap Primer
$0.00
0
Bathtub
$17.50
2
Pressure Regulator.
$0.00
0
Urinal
$0.00
0
Clarifier System
$0.00
0
Process Piping (per 10 ft)
$0.00
0
Vacuum Brkr Bkflow(1-4)
$0.00
0
Conned (Ice,Soda,etc)
$0.00
0
Receptors
$0.00
0
Vacuum Brkr Bkflow(5+)
$0.00
0
Dental Units
$0.00
0
Septic Tank
,$0.00
0 _
Wash Basin
$35.00
4
Dishwasher
$8.75
1
Sewer Cap for Demo
$0.00
0
Wash Basin Set
$0.00
0
Drain, Floor
$0.00
0
Sewer Conned
$22.00
1
Waste and Vent System
$0.00
0
Drain, Rainwater
$0.00
0
Sewer Private Line
$0.00
0
Water Closet (Toilet)
$26.25
3
Drain, Roof
$0.00
0
Shower
$8.75
1
Water Heater/vent
$11.00
1
Drinking Fountain
$0.00
0
Sink, bar
$0.00
0
Water Piping (Inst or Rep.)
$0.00
0
Expansion Tank
$0.00
0
Sink, commercial
$0.00
0
Water Re -pipe
$0.00
0
Gas Earthquake Valve
$0.00
0
Sink, Floor
$0.00
0
Water Service
$8.75
1
Gas (1-4 outlets)
$5.50
1
Sink, kitchen
$8.75
1
Water Softener
$0.00
0
Gas (Over 4 outlets)
$1.00
1
Sink, servicelmop
$0.00
0
OTHER
$0.00
Gas Repipe
$0.00
0
Spa (private)
$0.00
0
VIOLATION
$0.00
Gas Service
$8.75
1
Spa (public)
$0.00
0
PLAN CHECK
$0.00
Interceptors (Grease, Oil)
$0.00
0
REINSPECTION
$0.00
0
Interceptors (Sand Auto )
$0.00
0
TOTAL CALCULATED FEES:
$192.75
_
COMMENTS / SPECIAL CONDITIONS
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
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 pernil Is Issued.
❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carrier and policy number are:
Carder: Policy Number:
(This section need not be completed it the permit Is valued atone hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisl
Applicant Sign ture:— Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHAUL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLIRE ($100.000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR OODE. INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full
force and effect. LIC. q Class4
_
Contractor's Signature: 09 Dole: tl _
r
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 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of properly who builds or Improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such Improvements are not Intended Or offered for sale. If, however, the building or Improvement Is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or Improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license.. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify, that no excavation five (5) or more feet In depth Into which a person is required to descend, will be made In connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high, (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Pernit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
....................................................................................................................................................................................................................................................................................
2 Does or will iha applicant or present or future building occupant neetl 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 Mese 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).
...........................................................s,',an......tviu...............................................r'e.pa'r'e..................(Ris.......................................enti.......rogr...............utel.......................aterials ?
3 Does or will the applicant or present or future building occupant need to prepare en RMPP (Risk Management and Prevention Program for acutely hazardous materiels)?
❑ Yes ❑ No
(Section 25534 of the Califomla Health and Safety Code provides that the Costa Mesa Fire Department m7 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 Fre 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 e2pplication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applicatlons for non-residential building permits).
....................................................................................................................................................................................................................................................................................
6 Will any pan of the lecility 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 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is requlred for the work which is the subject Of this
appllca0on, have all of the disclosures prescribed by California Health and Safety Cade Section 42303 been made? ❑ Yes ❑ No
....................................................................................................................................................................................................................................................................................
e (It yes', attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to Occupy or allow Occupancy of any building authorized by this permit until final inspection.
nllllwnrsge Owner(s) / Oatq.�
And/Or'Authodzed Applicant Datey
CODE R. INSPECTION TYPE Qeg Itf®A65 CODE • INSPECTIONTYPE JIM INITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical /9/ps
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final BIOcklRetaining 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
244648