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HomeMy WebLinkAbout1792 HUMMINGBIRD DR - Building Permits CITY OF COSTA MESA 21- rt. BUILDING DIVISION ,� PER T NUMBER F , DEVELOPMENT SERVICES DEPARTMENT .% OM • , • PERMIT P99-00440 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1792 HUMMINGBIRD DR Status: ISSUED Suite No Applied: 07/30/1999 Issued: 07/30/1999 Vicinity: WHOLE HOUSE Parcel Nunmber: 13962122 ISSUED BY: l Applicant: THOMAS, GARY W. & KIM M. Address: 1792 HUMMINGBIRD DR CA Phone: (714)979-3386 COSTA MESA / Zip: 92626 Owner: • THOMAS, GARY W. & KIM M. Address - 1792 HUMMINGBIRD DR - - - - - Phone: (714)979-3386 - , ' COSTA MESA Zip: 92626 - �' ' Contractor: • Address: . Phone: " Zip: License: , Arch/Eng: Address: . Phone: Zip: - License: SCOPE OF PERMIT PLUMBING PERMIT FOR REMODEL OF SFR.INSTALL 1-LAUNDRY TUB 8 1-SHOWER. REF: B99-01007 FEE SUMMARY AMI 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 $0.00 0 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 Connect(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 $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $8.75 1 Water Heater/vent $0.00 0 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 $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 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: $39.50 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 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 end 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: ❑ 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. ❑ 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 carder and policy number are: Carder: Policy Number: (rhls section need not be completod d 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 it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($1 00,000), 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. Lic. a Clan » 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: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm first 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 andthe 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 (3500).): ❑ 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 Cada: 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 a ��_ ���t u��'nd��,er"""sec. Business and Professions Code for this reason: Signature: ( 7(� Date 7 (f / Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License NA Expires: O 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 6. 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? Q Yes ❑ No (Section 25505 of the California Health and Safety Coda roquires, with some exceptions, that a Business Plan be filed with the Costs 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 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 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 applicant or present or future building occupant require for the work which is the 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 65850.2 of the California Government Code requires that the requested information be furnished an 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 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 try Calllomia 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 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 AUTHORV-AT10N OF ENTRY: I cartity 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 abovy16a'scribed property pection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit uq�11 fine nspection. 36 Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date LODE 1, )y$PEcrighM9 gd¢, IT1fITAL5 CODE INSPECTION TYPE gd¢, INITRAL3 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -Q 200 Final Re -Roof 210 Final Electrical 201 Final BIock/Retalning 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 • 244&46 CITY OF COSTA MESA },a-.mom..., BUILDING DIVISION fr PER NUMBER �.-�, DEVELOPMENT SERVICES DEPARTMENT Ta. `".0; PERMIT g-00364 (714)754-5273" 7 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT • Job Address: 1792 HUMMINGBIRD DR Status: ISSUED Suite No - Applied: 07/30/1999 . 114 A"rrT C- Issued: 07)3011999 Vicinity: WIIDLEI IOkl5E Parcel Number: 13962122 ISSUED BY: _�'1/�"- Applicant: THOMAS, GARY W. & KIM M. - 11 Address: 1792 HUMMINGBIRD DR CA Phone: (714)979-3386 COSTA MESA , Zip: 92626 Owner: THOMAS, GARY W. & KIM M. Address:'.'1792 HUMMINGBIRD DR " CA' - Phone: (714)979-3386 ,', / 7 COSTA MESA 1 '' Zip: 92626 i/ Contractor: - ' Address:, . / Phone: Zip: ' ' ' - . License: Arch l Eng: Address: • ? - Phone: , • Zip: - • License: , / - 'SCOPE OF PERMIT MECHANICAL PERMIT FOR REMODEL FOR SFR.CHANGEOUT EXISTING MU&RELOCATE TO • ATTIC, 1 GAS-PIPING,&1-VENT FAN. i , REF:899-01007 --- • FEE SUMMARY Quantity • Quantity ISSUE FEE $22.00 Repair/Alt Absorbtion Unit - $0.00 0 Inst FAU-<1d0 k BTU $13.25 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System - $0.00 0 Repair]Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00' • 0 Compressors/Absorption Systems Gas Piping - .. $5.50 1 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace-, • $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box . " , $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct - $6.50 1 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 $47.25 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 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 end 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 carrier and policy number are: Carrier: Policy Number: (This section need not be completed/f the permit is valued at one hundred dollars($100)or less.) O 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 of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED THOUSAND DOI I ARE[S1C4000),IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.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 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 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).): O 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.). O I am exem under sec. /�}, Business and Professions Code for this reason: q Signature: Lea l Date: 213,) / , Owner ID verified bylicense. 0 Yes 0 No Driver's License No. / Expires: cid r Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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,1alsework,or demolition or dismantling thereof,will be more than thirty-six(36)Leet high.(Chap.3.2,Grp 2,An 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 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? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit 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 LJ No (Section 65850.2 of the Califomia GOvemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and 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-describ property for inspecitric ' purposes.I agree not to occupy or allow occupancy of any building authorized by this permit ntil fi I inspection. AYAt 7 Signature Legal Owner(s) Dat And/Or Authorized Applicant Date CODE/ INSPECTIONTYP4 PATE thaM6.1.8 CODE( INSPECTIONTYPE O INTRIIALLS 1616 Fixed System Final Fire Prevention 208 Final Mechanicalu�!9 61 FY 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 Anal Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 244636 t(�� CITY OF COSTA MESA - wsit- il�'` BUILDING DIVISION 0.I" 'j4 ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER • • PERMIT '%rc.am#. P99-00463 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1792 HUMMINGBIRD DR Status: ISSUED Suite No Applied: 08/11/1999 Issued: 08/11/1999 Vicinity: Parcel Nunmber: 13962122 ISSUED BY: Applicant THOMAS, GARY W. & KIM,M.' • Address: 1792 HUMMINGBIRD DR - CA - /'- . - Phone: (714)979-3386 "• COSTA MESA I Zip: 92626 Owner I'THOMASVGARY W'& KIMM. Address%1792 SHUMMINGBIRDDR . - - Phone: (714)979-3386/,l ' NCA_ /2/,,,,,,,,z,„,,,, COTA'MESAN Zip: 92626 ' ��7`✓ /' /;r,/ '._//;":, :l/- %// -/ V' _ ; ,Contractor-' -/:�/%%/ , ' Address: • i' - Zip:_ - i - - , 7 License: � . /' • i,.. • �Archl Eng:r, \ ^ jAddress:, - ' - N , " / - i / , Zip:. . . .. License: . _ .'SCOPE OF PERMIT ' / ' -:_ 8 N ',SUPPLEMENTAL PLUMBING PERMIT_1 NEW TUB 8 1 NEW'SHOER IN MASTER BATHROOM. ' _ i.. -REF:B99-01007 8 P99-00440 -- , - I , FEE SUMMARY AMT QTY r AMT QTY AMT QTY ISSUE FEE ` , $7.25 Laundry Tub/Washer . $0.00 0 •Sump Pump $0.00 0 Backflow irrigation $0.00 • 0 . Landscape Irrigation . - $0.00 0 Swimming Pool $0.00 0 Backflow Preyenter $0.00 \ - 0 ')r' P-Trap $0.00 0 -Trap Primer $0.00 0 Bathtub -'$9.80 1 . Pressure Regulator ' $0.00 0 Urinal $0.00 0 Clarifier Systern (/-$0.00' 0 •Process Piping(per 10 ft)" $0.00 0 'Vacuum Brkr Bkflow(1.4) $0.00 0 Connect(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 , - $0.00 0 Dishwasher ` $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor '\-$0.00 0 . Sewer Connect $0.00 0 - Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $9.80 1 • Water Heater/vent $0.00 0 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 $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen . $0.00" 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 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: $26.85 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 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: Carrier: Policy Number: (This section 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 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 provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE I5 UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.ft Class 4 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: El 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 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).): 142 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.). ❑ I am axe under sec. Business and Professions Code for this reason: Signature:!','/'//� _/�_t� Date: V/1/I 91 Owner ID verified by drivArs license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: El 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 end 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? El 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). 3Doe._.orhe_..pplicanopent o.r.fuildingo_ _.._ __..l._h.—_ 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? 0 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .....-o o.... boundaries school?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 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 Califomia 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 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 aqa - escribed propertyins oho urposes.I agree not to occupy or allow occupancy of any building authorized by this permit 4n it fpal nspection. CU//LL��ii��Si�ipp Signature Of Legal Owner(s) 2/Cy Date And/Or Authorized Applicant Date CODE I INSPECTION TYPE DATE INTRIALS CODE l/ WSPECTION TYPE DATE INTrtIALs 1616 Fixed System Final Fire Prevention 206 Final Mechanical C 1266 Pool Spa Final 208 Final Plumbing 1 5`c D 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 or T CITY OF COSTA MESA gral BUILDING DIVISION PERMIT NUMBER ,r t ^-"`^' ' DEVELOPMENT SERVICES DEPARTMENT / Ta. r; PERMIT E99-00715 V (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1792 HUMMINGBIRD DR Status: ISSUED Suite No Applied: 07/30/1999 Vicinity: WHOLE HOUSE Issued: 07/30/1999 Parcel Nunmber: 13962122 ISSUED BY: Applicant: THOMAS, GARY W. & KIM M. Address: 1792 HUMMINGBIRD DR " - - - CA , 'Phone: (714)979.3386 ^ COSTA MESA Zip: 92626 - Owner THOMAS;GARY W. & KIM M_ Address A792 HUMMINGBIRD DR:- - - / ,CA \, j _ Phone: (714)979-3386 v i - -N. COSTA MESA;�' Zip: 92626,,- - �% - �= .\ Contractor.' - - . _ Address: Phone: - , ' "Zip: -License: , / - . . - ' SCOPE OF PERMIT \ \ , ELECTRICAL'PERMIT FOR REMODEL OF EXISTING SFR.INSTALL 30 LIGHTS, 18 OUTLETS,,,8 • SWITCHES&20TORS UPTO 1 HP. i " - - • REF:B99-01007 • • • FEE SUMMARY Quantity / Quantity 1 ISSUE FEE $22.00 • Temp Dist System/Lighting ,$0.00 0 Temp service test $0.00 Busway/100ft- " - $0.00 0 Res.a/c package $0.00 Standing Section ! $0.00 0 New Res(1-2 units) $0.00 0 ,' Misc Electrical Equipment $0.00 : 0 New Res(3+units) , $0.00 ' 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 ." 0 Lighting Fixts $26.50 30 up to 50 kva/kw $0.00 0 Recept Outlets - $18.00 18 . - up to 100 kva/kw "$0.00 0 Switches $8.00^ • 8 over 100 kva/kw , $0.00 0 , Non Res Appl - $0.00 ^ 0 - Low Voltage Equipment $0.00 0 - Res Appl $0.00 - 0 Low Volt Wiring System/Ckt $0.00 ^ • 0 ' Service to 200a $0.00 , 0 Misc:Conduit $0.00 0. Service to 1000a $0:00 0 • . , Misc.Conductor $0.00 0 Service over 1000a ''�- $0.00 "0 Circus(gen or ride) $0.00 - / 0- Motors to 1 hp $8.50 2 Circus(mech ride or lights) $0.00 - 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 - . ' Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 -Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 • Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $83.00 Intermed Pole $0.00 0 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 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 carrier and policy number are: Carrier: Policy Number: (This section need not be completed U 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 Califomia,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 provisions. Applicant Signature: Date: 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(5104000),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.Llc.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: 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 then 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 �J[ 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.). Y' 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 exe pt under sec. Business and Professions Code for this reason: Signature: Date: 7/Tia l Owner ID verified by drives license. 0 Yes 0 No Driver's License No./ Expires: S 01/1 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? 0 Yes 0 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? 0 Yes 0 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 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 0 No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? pi Yes U. No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No ii B (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 end 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 prope{t%.fe/Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /�J�M,la ortesd _ Signature OI Legal Owner(s) 7/30 /99 Date And/Or Authorized Applicant Date CODE r INSPECTION TYPE Pill. INTnIALS CODE I INSPECTION TYPE 29.11 IBT1A45 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Final l 2Spa Final 1 8 Final Plumbing . . 200Fl Re-Roof 0 Final Electrical I J-L?-%9 1(04-4. 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 2448-46 a► 9 ` r- itie q CITY OF COSTA MESA BUILDING DIVISION 1- 1 PERMIT NUMBER DEVELOPMENT SERVICES DEPARTMENT �• ; PERMIT B99-01007 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1792 HUMMINGBIRD DR Status: ISSUED Suite: Applied: 06/29/1999 Vicinity: WHOLE HOUSE Issued: 07/30/1999 Parcel Nunmber: 13962122 Zoning: R1 R1 . Applicant: THOMAS, GARY ISSUED BY: {v Address: , r :-, i Phone: (714)964-5215 ` - ,_ Zip: Owner THOMAS;GARY' - - Address 1792.HUMMINGBIRDDR , _7/1 /'I76/A1 ' _ - Phone:- (714)979-3386 - - , N . COSTA MESA'„ Zip: 92626 Contractor: Address: ''',�;- ,//� Phone:. -,�t .- Zip: - License: I , , Arch : • , . i - Eng: , Address: ,,, - Address: , / ,,, . . e 'Phone: - Phone: V. License: - License: j SCOPE OF PERMIT , INTERIOR REMODEL OF SINGLE FAMILY RESIDENCE(NO ADDED SQ.FOOTAGE)-RAISE CEILINGS IN LIVING RM, DINING RM,&KITCHEN. ,• - - - . ,. - ' ` INCLUDING WINDOW CHANGEOUTS.ALL SLIDING GLASS DOORS TO BE TEMPERED. 520 ,� , ,� • SQ.FT.REAR YARD COVERAGE ALLOWED;49 SQ:FT.COVERAGE PROPOSED: .-:- / / - . - FEE SUMMARY! - Plan-Check: $256.59 - — Calc Valuation: : $3o,000.0o Permit '$394.75 -- Claim Valuation': $30,000.00 SMIP Res: ' $3.00 - SMIP Com:' ' $0.00 , , Other: - ,. $0.00 , .. - • , Inspection: ' , $0.00 . . I - . . ”- Total:.. $654.34 ' , ' • - PLANNING &ZONING c. SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 20-0 Right 13-6 ACCESSORY Front 0-0 .,Rear 0-0 Left - 0-0 - ' Right 0-0 PARKING Existing: 0 Required: 0 • Proposed: 0 NOTES: 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 • l I WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carder: Policy Number: (This section 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 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 provisions. Applicant Signature: Date: 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(5100,000),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 end Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: 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 t0 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 bubjects the applicant to a civil penalty of not more than five hundred dollars($500).): fy—'` 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 t0 the Contractors License Laws.). ❑ I am ex= it under sec. a Business and Professions Code for this reason: Signature: at, A. Zeta - 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 t0 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)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? 0 Yes 0 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? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature 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? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application 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? 0 Yes No (Section 85850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Cale Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and 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 aboveyescnbed property fin s ction purposes.I agree not to occupy or allow occupancy of any building authorized by this permit withfine'inspection. l/ ,l IevLegal Signature Of Legal Owner(s) ate And/Or Authorized Applicant Date CODE or INSPECTION rift PATE MALE CODE( INSPECTION TYPE GATE INTRIALS 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 f" S—00 "C&O 2446-46 CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT NO. 6. 7--C8 DATE 9//l/r/G� /91`72% LOT NO. 20 ADDRESS /79a ycJ. wlicJCS tO Opt The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (he-she (was or dC advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the City harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. / BY 4-4 4v '. -4 Purchaser BY kre- 0 Developer and/or authorized /representative BY G. pc FE.IJ.• ea... l/� . Lender U 33855 PA:: t.'OV 12-71E;,;.00 547` *** 159•,, COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 Q ? f1 , APPLICATION FOR BUILDING PERMIT Y .�YlDForApp/sceneroFill in Completely k] APPLICATION DATE RECEIVED sb�r S {�-(f pow �N(0�n _ k DATE ISSUED BUILDING /� ;! 4 ! ((��.' P - j 5 ADDRESS �/Q� /i �/J� / '% OWNER l �1,�/ rL..Ft A.P. NO. Cif 1p / •� 2 . . ( ^, d O /Y BUILDING '�./y MAIL / CJD (-" / ADDRESS / / O� '.'.'�.`-:__�se�- ' Z - ADDRESS se.„..4ZA / .y l/�I} /�, TEL (2-1&) TRACT(p / LOT 7• BLOCK 0 Z CITY no IA/l1 rib, 9 Oni/7 NO, e7..5 7;YI L Z C CONSTRUCTION VA n / NEW ADD ALTER REPAIR MOVING FM 1 ISH O w - LENDER Q\<WYY�K J C BRANCH ///` Vii--d ( �� �{'j r J to OWNER i �r Vii-- L�-�L ` CO J ADDRESS �/ /1 /{^/- , ��y// �,/.�- )VA E r Jm ARCHITECT } // rf� ATEL.p USE /�L(/.LD7 /l+ • e1 $.�� ;.,..110e der_ Q OR ENGINEERS'''. /`F /t L.NO. O7O-Si� / � Z N FIRE //1�. W a t2cl,/S p � _— . *� 4 ZONE TV E GROUPJV �[f ADDRESS^-^^ U aw _ APPROVED J O CONTRACTOR� ( ., OA BY DATE m Z Jr ADDRESS tic© ( 2,C KAt �j�(/111 p�T '/ "J/'4 / A W W 1 V - - Zr.... NO.OF USE OF NEW .i/ U.//-.( O= Lard TEL. PLANS y BUILDING ` ZI- CITY I-C ,, _� NO.S✓ 0-Q27)j W O STATE V""""' CITY YARDS APPROVED YARDS APPROVED NIL- LIC.NO. / to 42_3 LIC.ND,01085 MAIN BUILDING ACCESSORY BUILD( G D O ' (FROM C/L STREET) SIZE f NO.OF BLDGS. OF LOT �d x I NOW ON LOT O FRONT FT. FT. d' 5� USE OF `/ EXISTING BLDG. ,..f R SIDE /' FT. FT. I- SIZE OF // S i-t NO.OF ROOMS /� STORIES 1 L.SIDE 1 7 FT. — f/jam FT. Z NEW SLOG. h EXTERIOR WALLROOF ''11 rg U COVERING COVERING REAR /p. FT. FT. J USE OF�jUILDING AND WORK��TO• BEP/Ef RFORM DISTANCE BET. BET.MAIN& y / G • -to _ Q , V ,� O_?c_. MAIN BLDGS. ACCESS. BLOCS. Q oVAR.* DATE O C.0 P.qt APPROVED - . APPROVED t z ..---BY (a / DATE 1 I / O UI hereby acknowledge that I have road this application and state HOLD FOR SPECIAL REQUIREMENTS D that the above information is correct and agree to comply with cr all laws regulating building construction, and I shall not employ F any person in violation of the workmen's compensation laws of ^ the State of California. CO f2 /6 • FT, G C '9 '9 I hereby certify that I am properly licensed as a contractor under the State of California Business •-• 'rofessions Code, Division 3, THE AMOUNT SHOWN UNDER ALUATION IS FOR e Chapter 9, and that such liven .s are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt fr•• the provisio s of t•it State of•ifornia Business VALUATION ppt� m and Professi• ode, P ilio 3,C apter 9. PERMIT FEE $ /v 0 N Signature o I L`v m Permittee /t �# Lo $ e/4 5t r_ PLAN CHECK $ #5 3 Z� E 0/YYY/ CCC o Authors • • Agent ` a TOTAL FEE $ /5 7