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Home My WebLink About1856 IOWA ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa9E9'CTRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1860 IOWA ST status: ISSUED Suite No Applied: 12/05/2006 Vicinity: Issued: 12/05/2006 Parcel Nunmber: Applicant: Address: 13904337 BART 3101 ENTERPISE STREET BREA, CA ISSUED B Phone: 800-503-2666 Zip 92821 Owner: MAGNUSON,DAVID WAND RUBY J Address 1860 IOWA ST Contractor: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to the Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole COSTA MESA, CA ECONO AIR 3101 ENTERPISE STREET BREA, CA Phone: 714-751=1217 Zip: 92626 Phone: 800-503-2666 Zip: 92821 1 U F License: 445220 SCOPE OF PERMIT ELECTRICAL PERMIT FOR THE INSTALLATION OF A NEW A/C UNIT TO BE LOCATED AT SIDEYARD OF A SFD. REF#: M06-00784 WORK TO INCLUDE: 1RES A/C PACKAGE $23.50 $0.00 $54.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 0 0 0 0 0, 0 0 0 0 0: 0 0.- 0 0 0,. 0 0; 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 fP , Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw .........:......up to 10 kva/kw .................up to 50 kva/kw ....:............up to 100 kva/kw ........:..........over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit . Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0" $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 ! 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 , $0.00 0 $0.00 $0.00 $0.00 Soon TOTAL CALCULATED FEES $78.00 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) i 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. 1� INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply witl'all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 2446-46IBM) 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 fork for which this permit Is issued. ❑/ I have and will maintain workers' oomponsation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is Issued. iMy workers' compensation Insurance carrier and policy number are: Cerrlem Polli:y Number. W s y / 6 / (e ,('�(/O (Th�secdon need not be comp/eyed? the.0.1t 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, I shall forthwith comply with these provisions. . Applicant Signature: (Date:/ "/ z — WARNING: TO SECURE WORKERS' COMPENSATION OOVERAGE IS UNLAWFUL AND SHALL SUWECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOU_ARE (S1O0.000), IN ADOMON TO THE OOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR OODE, INTEREST, AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby aHi4 that I am licensed and r provis' ns of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full IOroe'and enecl..Lic. a Ll � Corliract rsSignature: 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 LJoense Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL 00 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. IL 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. 704. 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 drivels 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 thlrty-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 appllcant 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 hes 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 feel of compressed gas at standard temperature and pressure). ..........._...................._.................................____....._....____.........._—__............._.._.................___........................................................................_......._....�.__._..- 2 Does or will the applicant or present or future building ocouparlt need to file a registration form for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health end 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 en RMPP is presently required, has Suction 25534 of the California Health and Safety Code been fully compiled with? ❑ Ves ❑ 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 ePermil 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 UNo (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 ❑ No (It 'yes', the fact try 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 Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUVORIZAT10N OF ENTRY: 1 cortify 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 Clry 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. net a Of Legal Owner(s) Date /L-S--dr.. And/Or-Au dzed Applicant - )-Date CODE P. INSPECTION TYPE - PATE INITIALS COOE1 INSPECTION TYPE QAIE ItTITIALs 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 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 Bullding/Occupency (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ,lob Address: 1860 IOWA ST Suite No Vicinity: CLOSET Parcel Number: 13904337 Applicant- BART IBANEZ Address: 3101 ENTERPISE STREET' BREA, CA MECHANICAL PERMIT Phone: 800-503-2666 Zip: 92821 Owner: , MAGNUSON,DAVID WAND RUBY J Address: 1860 IOWA ST COSTA MESA, CA Contractor: ECONO AIR Address: 3101 ENTERPISE STREET BREA, CA Phone: 714-751-1217 Zip: 92626 Status: ISSUED Applied: 12/05/2006 Issued: 12/05/2006 ISSUED BY: 7 Phone: 800-503-2666 Zip: 92821 License: 445220 SCOPE OF PERMIT MECHANICAL PERMIT FOR THE INSTALLATION OF A NEW A/C UNIT LOCATED AT THE SIDE YARD AND REPLACEMENT OF HEATING UNIT LOCATED IN CLOSET FOR A SFD. REF#: E06-01386 WORK TO INCLUDE: 1 INST FAU < 100 K BTU, 1 REPAIR/ALT COOLING/HEAT AND 1 COMPRESSOR UP TO 3HP/100 K BTU. FEE SUMMARY Quantity Repair/ Alt Absorbtion Unit $0.00 Quantity ISSUE FEE $23.50 0 Inst FAU <100 k BTU $14.80 1 Inst FAU >100 k BTU $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Inst /Rep. Recess Wall Htr $0.00 0 Refrig Sys <100 k BTU $0.00 0 Refrig Sys >100 k BTU $0.00 0 Gas Piping $0.00 0 Factory Fireplace $0.00 0 Hood w/Meth Exhaust $0.00 0 VAV Box $0.00 01 - Vent Fan / Single Duct $0.00 0 Appliance $0.00 0 Fire Dampers $0.00 0 Smoke Dampers $0.00 0, Inst or Relocate Appl Vcnt $0.00 0- -. Air Handlers < 10000cfm $0.00' 0_ Air Handlers > 10000cfm - $0.00 6 Floor Furnace $0.00 0 Floor or Suspend Heater $0.00 0, FEE SUMMARY Quantity Repair/ Alt Absorbtion Unit $0.00 0 Repair/ Alt Refrigeration Unit $0.00 0 Ventilation System $0.00 0 Evaporative Cooler - $0.00 0 Commercial Incinerator $0.00 0 Domestic Incinerator - $0.00 0 Compressors /Compressors / Absorption Systems Up to 3 hp / 100 k BTU $14.70 1 3 To 15 hp/500k BTU - $0.00. 0 15 To 30 hp / 1,000 k BTU $0.00 0 30 To 50 hp / 1,750 k BTU $0.00 0 Over 50 hp I Over 1,750 BTU, $0.00 0 Boilers Up to 3 hp - $0.00 0 3 To 15 hp $0.00 0 15 to 30 hp $0.00 0 30 to 50 hp $0.00 0 Over 50 hp $0.00 0 Other Mechanical Fee Investigation Fee $0.00 Plan Check Fee - $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $66.70 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.V-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 1=-1.1L12jI 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 sell -Insure for workers' compensation, as provided for by section 3700 o1 the Labor Code, for the performance of the �Nork for which this pertnit is Issued. C3! I have and wql maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the pertonnance of the work for which this permit is issued. j �My workers' compensati Insurance carrier antl policy number ere: �-r � Cartier. Policy Number; LUSQ2. /� � b J 7 cf0 (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, I shall forthwith comply with these provisions. ApplcantSignature: Date: t r Jam" Co WARNWG:FAILURE TO SECURE WORKE 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 N06 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 0l the Business and Professions Code, and my license is in full force and affect. Lic. If f' r_`? Class k _Coraractors Signature:Date:. CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuanco, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 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 B, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet Of compressed gas at standard temperature and pressure). .....ant or....resent or future tiuildin...........u..anit need to file a re istratioIt form for ......................... 2 Does ar will the appllc p g occ p g o acutely hazartlous materials? ❑Ves ❑ 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 atstandard 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 II an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ NO .............................................................................................._........................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this ,application a emit for such construction or modification IJ from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). . ..._....................................................................................................-................................................................................................................._........................................................ ............................................._........................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ................_...._..........._._.................................__.....................__.....................__......................__.............................._._.._.__..._................................._........._..__..._.............................. ....................._.__.................. P YSafety 7 application, a ication from the South Coast Air Duality Management District or other eir pollution control district or agency is required for the work which is the subject of this epplicatlon, have all of the disclosures prescribed b CaliforniaCelllomia Health and Safe Code Section 42303 been made? ❑Ves ❑ 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 AUTHORV-AT10N OF ENTRY: I certify under penalty of perjury that 1 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. Sin egal Owners Date ,A Or Authorized Appli --1 L_ Date -- — CODE I. INSPECTION TYPE gdIE INTMALS CODES INSPECTION TYP Aml 1616 Fixed System Final Fire Prevention 206 Final Mechanical !/ 1266 PONT Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final BlocidRetaining 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 iq r m a M fk6o T(pv�/f� APPR CITY OF C( SUBJECT TO B N(-YTE: STA MESA DIVISION )G. DEPT. REG. >, DELETIONS, JS SHALL 13E PLANNING DIV. DA7rE: (714) 754-5273 • Fax (714) 754.4856 • www.ci.costa-mesa.ca-usNG PERMIT 77 FAIR DHIVE, COSTA MhSA, CA 92626 ,lob Address: 1860 IOWA ST Suite: Vicinity: FRONT SFR & SOFFIT/FASCIA Parcel Number. 13904337 Applicant: SILVA, ANDREW Address: 10415 SLUSHER DR SANTA FE SPRINGS, CA Owner: MAGNUSON, DAVID W Address 1860 IOWA ST COSTA MESA, CA Zoning: Phone: (562)906-7773 Zip: 90670 Phone: Zip: 92626 Contractor: SEARS HOME IMPROVEMENT PRODUCTS INC Address: 10415 SLUSHER DR Arch : Address: Phone: (562)906-7773 SANTA FE SPRINGS, CA Zip: 90670 License: 721379 Phone: Eng: Address: Status: ISSUED Applied: 05/30/2001 Issued: 05/30/2001 ISSUED BY: Phone: Zip: License: License: SCOPE OF PERMIT APPLY 150 SF VINYL SIDING OVER EXISTING SOFFIT & FASCIA AND 200 SF SIDINGOVER FRONT OF A SINGLE FAMILY RESIDENCE. ICBG #ER1478 FEE SUMMARY Plan Check: $0.00 Calc Valuation: $11,262.00 Permit: $209.25 Claim Valuation: $11,262.00 SMIP Res: $1.13 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $210.38 PLANNING B ZONING sY- SETBACKS MAIN STRUCTURE Front '0- 0 �- Rear . 0-0 Left 0-0 Right., 0- 0 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 it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2"6-46 (6/00) 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. Q 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 wo co'm'pensation I ure co carrier and policy number are: Carrier: ,' W Policy Number: 1v M1I9�pg+Lj (This settlor need not be completed it in pemuf Is ed of one hundred dollars ($100) or less.) ❑ 1 certify that in the performaQoft we k for h this permit is Issued, I shall not employ any person In anymanner so s to bT-Of e subject to the workers' compensation laws of Califagr m II should become subject tome workers'compensation provisions ofSe Ion37the Labor Code, I snail forthwith comply with these provision30 Applicant Signature: Date: WARNING: FAILURE T RE WORK RS' COMPENSA ON COVE W E IS, r wrFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL ES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE (S1o0,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION Nos OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLAR ON: I hereby affirm that I am lice u ns C apter 9 (commencing with Section 7000) of Division 3 of the Bust and rofessions Code. and my license Is in full force and effect. Lic. a Class a Contractors Signature: Date: O A CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or oounty;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 hei or she Is licensed pursuant to the provisions of the Contractors Umnse 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 bl not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not appy 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 drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type Of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 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 then thirty-six (36) feet 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, 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 to cried 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 .......................... I.......__.........I....._...................... 2 Does or will the applicant or present or future building occupant need to file a registration torn 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 loot of compressed gas at standard temperature and pressure). .........._......_...._.................._..___...................._................................._.._._..........._..__............................._........................................................................................._...___..._......_............__..........__.._...__.._. 3 Does or will the applicant or present or Iulure building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ tdo (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 anRMPP 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 apermit 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 LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..................................................................................................................................................................................................................................................................................................................................................................................... 6 WIII any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes-, the facility must meet the requirement of Sections 25534 and 42303 of the 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 .......................................................................................................................................................................................................................................................................................................................................................................................... e (If yes-, attach cenilicate 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 urpos agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sign er(s)�� Date 9 And/Or AGthOrz0dJAppIIcanI I Dale CODE E. INSPECTION TYPE gA¢, INTMAL CODE INSPECTION TYPE UH gam$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy v mvCR •• `� ..I .ar+a "i UAIC 'JOB ADDRESS Iowa St. BUILDING PERMIT NO. 48827 VALUE V:2L I I II SUBCONTRACTOR I _ PERMITS ISSUED ROUGH PLUMBING PROP. SWR. LINE M HOUSE CON. ROUGH HEATING AND AIR CONDITIONING I 1 11 1 1 1 UNDERGROUND U POWER ROUGH WIRING BOND BEAM U STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING - IN n OUT PLASTER, BROWN COAT HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST 0 ELECTRIC, FINAI BUILDING, FINAL Z . aU HZ Z Q OCO am J M J N <W m J J m Q < Z CC Ly aW _I0 mZ J w Z_ Z_I.- 0 0 N0 �O F Z Q U J CL a Q O F Yn Z O_ F_ U F_ F H Z 38827 L COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 1nr, -7-7'00 528* ****10.50 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECEI V O - DATE RECEIVED D E ISSUED BUILDING • ADDRESS//�� PE,TANO. .lJ/s OWNER l� 6,6fz L. �j Nv s�(� Q /' A.P. NO. /'V MAIL p ADDRESS p G D v ti✓� � BUILDING ADDRESSS� CITY % Mridq NO.. 3 -yo -vie TRACT {� LOT 9 BLOCK CONSTRUCTION W ADD ALTER LENDER BRANCH ! / /� s OWNER N�6i�-�ss( ADDRESS VALUE �00 SE $ ARCHITECT TEL. OR ENGINEER FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR 0 WA1,jA V L 0 r7lt BY DATE ADDRESS TEL. ZONE�J NO.OF USE OF NEW CITY NO. PLz+NS Z BUILDING f P STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF SLOGS. IF ROM C/L STR EET) OF LOT NOW ON LOT ERONT FT.� �^ USE OF EXISTING BLDG. FT. F SIZE OF NO OF `FT. NkWBLDGJrX42 o ROOMS STORIES L. SIDE FT. y EXTERIOR WALL ROOF COVERING COVERING REAR FT. AO FT. USE OF BUILT' jG,AND ORK TO BE PERFORMED DISTANCE BET. BET. MAIN & C-( rJ r O C c? kW- MAIN SLOGS. ACCESS SLOGS. VAR.+ DATE C.U.P,# APPROVED p APPflOVED /"t'? (J / H C I hereby acknowledge that I have read this application and state Al thet the above information is correct and agree to comply with ((/ TAX all laws regulating building construction, and I shall not employ any Person In violation of the workman's compensation laws of /' G �Ov the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. U �j- THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION and Professions Code, Division 3, Chapter 9. 00 PERMIT FEE $ Signature of e'- _ Pefminee �r $ U PLAN CHECK $ f Authorized Agent �_ TOTAL FEE $ OWNER MAGNUSON, DAVID W. DATE 9_12_77 JOB ADDRESS 1860 Iowa Street BUILDING PERMIT NO. hIlAw GENERAL CONTRACTOR ()wT,pr_Ta,iia r DESCRIPTION of WORK Slockwa7T AP No. LOT TRACT FIRE ZONE VALUE f INSPECTIONS Signature I Date TYPE v GROUP J ZONE SOIL SUBCONTRACTOR GAS Data Num_bar Si nature WATER Plumbin ROUGH PLUMBING PROP; SWR. LINE 0 HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING' TEMPORARY SERVICE OR POLE UNOERGROUNO C] POWER E] ROUGH WIRING Heatina and Vent. TR EryC HES FORMS STEEL REINF. Ej FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN M OUT PLASTER. BROWN COAT Eli STRUCTURAL, FINAL Electric HEATING, VENT., REFRIG. AND A.C., FINA PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL BUILDING. FINAL 1 SEP 12-77PAIn00 455* ***** tf;sA 5.50 t COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 M APPLICATION FOR STRUCTURAL PERMIT • For Applicant to Fill in Completely — Use Ink Only RECEIVED BY I DATE RECEIVqEDSUED �i—/s BUILDING (J/ -� ADDRESS I /p QCIi 2r PERMIT NO. - oY3 -91-21 -_'MAIL OWNER /� % (J A.P. NO. ✓'I �+ / J U BUILDING �'1ADDRESS ADDRESS / /D 'TEL. TNo.ECONSTRUCTION qq TRACT36 LOCKCITV� W A PLENDERBRANCH nwf�`OWNER II/ � O�ADDRESS Wf i (�OR ARCHITECTIVA TEL. SE ENGINEER N TFIRE ADDRESS ZONE TYPE Ci CONTRACTOR 6 Q APPROVED BY DATE //0N ADDRESS S/�ryt�Y%� SST/r/L� TEL. �'/1 /y.0 CITY NO. cY�r•I�i ZONE NO. OF USE OF NEW w pLgNS BUILDING STATE CITY UC. NO. NA LIC. NO./ A YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING SIZE r NO. OF BLDGS. (FROM C/L STREET) OF LOT �QQ NOW ON LOT / T. FRONT FT.USEOF EXISTING BLDG. FS Dgg /L} L R. SIDEFT. C F� Separate permits are required for L. SIDE FT. C electric, plumbing and heating work. REAR FT. USE OelU LDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLOGS. ACCESS. BLOCS. NNS TR C TION 0 (� i C.U.P.DATE VAR.+ APPROVED y APPROVE -ff I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that 1 em properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from a provisions of the State of California Business VALUATION PERMIT FEE S antl Professions o e, D isI n 3, Chap br 9. sl PLAN CHECK $ Signature / TAX $ Permittee $ Authorized Agent TOTAL PAID - M g2ov COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT COSTA MESA. CALIFORNIA I dl' APPLICATION FOR PERMIT,I BUILDING For Office Use Only RECEIPT NO. PCRMIT NO. OWNER Y I I`y MAIL St. REC81 BY OATS C8 V D DATE 188UCD ED ADDRESS 419 E. 17th i%L�-L hq 4-111, BUILDING CITYrmstpMesaNOL• ADDRESS ARCHITECT Carlson & TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. ADDRESS rT., FIRE ZONE TYPE GROUP CONTRACTOR Dike & Coleerove, Inc.APPROVED BY DATE 419 E. 17th St. ZONING rADDRESS ('i05ta Mesa E Re 1 No. or I PLANS 2 I USE OF NEW/• BUILDINCO w sit gar NO. L — LEGAL Lot 2 D¢eCgIPTION TI'. V H SIZE 611 1001 I NO. OF SLDGB.Qne OF LOT X NOW ON LOT 1l A. P. NO. nOnP USE OF YARDS EVES EXISTING BLDG. i APPROVED ALLOWED SETBACK LINE FROM 1 (CENTER LINE BTJ I CENTER OF STREET 1 REAR YARD FRONT FT. N. SIDE YARD I LEFT 1 I ...... 1 R. SIDE T. IN. DESCRIPTION OF WORK L. SIDE T. IN. I A II ALTERATION I II ADDITION I REAR FT, IN. rREPAIRMOVING I II DEMOLISH I APPROVED GATE -1 -6O BUILDING 0 N OF 6 1 SQ.ft ROOMS STORIES EXTERIOR WALL (ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED Singlp F nttanhpd a I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF H8TA8U8HlN0 A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATS LAWS REGULATING VALUATION BUILDING CGNETq�u /rny/('+/�� SIGNATURE OP / PERMIT FEE $ 35- PERMITTEE $ 15,045. PLAN CHECK S 17.50 Dike Colegrove, Inc. AUTHORIZED AGENT 52.50 TOTAL FEE 5