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Home My WebLink About2300 HALF MOON LN - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2300 HALF MOON LN Suite: Vicinity: LOT 19 Pnmary Occ: R3 Dwellings/ Cong Res <10 Parcel Number: TPN00514 App�icant: CORTEZ, JEN Address: Type of Constructian: V-N Zoning: . , - Phone: 714-245-9760 X19 Zip: ISSUED BV: Status: ISSUED Applied: 01/24/2005 Issued: 04/04/2005 Owner. SHEA HOMES'LTD " � � ' � . , , A Address 603 SOUTH VALENCIA AVE . � � - . � ,� �' � � " � , . - --�. - - Phone:` 714-985-7300� �� '� .� . � - �_; BREA, CA , - � .. - - Zip: 92823 � �' . ` / � � .�:� i. Contractor: OWNER BUILDER \��` ` � \�'� �� / Address: - ',i,.� � = � � , � � . _ Phone: ` � � - , �' . Zip: � , yLicense: �000000 ' ' � � � � Arch : WILCIAM HEZMALHALCH « . ; Eng: ��. . , Address: � WILLIAM HEZMALHALCH ARCHITECTS INC ,�'~��• �, Address:� � � , �� - ' - SANTA ANA, CA � �Phone: 949-250-0607 -' � � ; , Phone: � � 2850 REDHILL AV;STE 200 ' � -� Zip: 92705-5543 . License: C12920 � �License: � SCOPE OF PERMIT � LOT'19 � -, . _ /. _- __ .. . . . -- _ .., .-. . PLAN2C -� _ . . _. _.. , •- � ._ _ti' � CONSTRUCT 2560 SF 2-STORY SFD WITH 449 SF ATTACFiED�GARAGE; A 72 SF ENTRY PORCH WILL ALSO BE CONSTRUCTED.�FIRST FLOOR WILL BE 1225 SF WITH 1335�SF SECOND FLOOR. A FIREPLACE MODEL #4236 (ANSI UL127) WILL BE INSTALCED IN THE FAMILY ROOM; THERE WILL BE A 2ND , . - " . � � " FLOOR LAUNDRY ROOM. � . _ � - . - ' i r � ' ' ' REF: G04-00010, PA-03-47li-166— " � - " - � - . � �' � ' . , . . - - . . . . - j � .. Plan Check: $305.27 Permit: $1,878.55 SMIP Res: $25.76 ,i„';� •� SMIB Cam: ;. $0.00 r Other: $0.00 . .�.;, : r. . Inspection: $0.00 ' � '� �.i� �. TotaL• ��$2,209,58, � � � - SETBACKS MAIN STRUCTURE Front 20- 0��.` , Rear - Calc Valuation:; ; . � g2s�,s�5.3a . Claim Valuation: � � � $o.00 , - ; ` - l�� i/ . � �` _. ,.��J: (l . �. �- % � �: '�, � � � � " �// ;�=. � . , � . �; i PLANNING & ZONING 20- 0 � . , . Left � 48- 0 ' � _ Right = ". 20- 0 �. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 780 days, or if work is suspended or abandoned for a period of 180 days. � INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred inspectiona and final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � 2d46d6(N00) WORKERS'COMPENSAnON DECLARAnON: . I hereby affirtn under penelry oF perjury one of lhe following declarations: ❑ I heve end will meintein e cenificete of consent to selbinsure for workers' compensation, as pmvided for by saction 3700 of the Labor Cotle, for the pertormance ot �he. work for which this pertnit is issued. ❑ I have end will meintein woBers' cnmpensetlon insurence, as required 6y section 3700 of the Labor Code, lor ihe pedormance of ihe work lor which this permit is issued. My workers' compensetion Insurence cerrler end policy number ere� Carrier. Policy Number: rs section need not be comp/ete0 d the permif is velued ef one hundrea aollers /$100J or less.) I certity that in the pedorman e work br ich Ihis permil Is Issued, I shall not employ any person in any manner so as to Decome subject to Ihe workars' compensation laws ol C' a, n egree Ihet I should become sublect to the workers' compensation provisions of Seaion 700 of tha Lebor Coda, 1 sha0 fonhwith crompry with these pro � i s. _. . Applicant Signature: -� Date: WARNING: FAIWRE TO SEC RE W PENSATION WVERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL NALT S AND qVIL FlNE$ UP TOONE HUNDRED THOUSAN�OOLURE(5100, ),INFDD OTNECOSTOFCOMPENSATION,DFMAGES/SPROVIOEDFOqINSECTIIXJ3)O60FTHELABORGODE,IMEREST,ANDATTOqNE1^SFEES. LICENSED CONTAACTORS DECLARATION: I hereby aHirtn that I am licensed under provisions of Chap�er 9(commencing wllh Seclion 7000) of Division 3 of ihe Business antl Protassions Code, and my license is in full force and effect Lic. N Class k Conirecior's Signature: Dete: CONSTRUCTION LENDING AGENCV: ❑ I hereby aflirtn that there is a consiruction lending egency for the pertormence of ihe work for whicb ihis permit is issuetl. (Sec. 3097, Givil COtla). Lender'S Nam¢: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I herehy aftirm ihat untler penelry of perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions , Cotle: Any ciry or counry which requires a permit to conslmct, eltar, improve, demolish, or repair any stmcWre, prior to its issuance, also raquires ihe applicant for such permit � ro file a signetl stetement ihet he or she is Ilcensed pursuenl lo Ihe provlslons of ihe Contractors License Law (Cheptar 9(commencing with Sectlon J000) of Division 3 of the Business end Pmfessions Cotle) or thet he or She 19 e:empt theralrom end Ihe be5i9 Por the elleged ecemplion. Any violation of Section 7031.5 Dy any applicant for a permit subjects the applicant to e civil penelty of not more Ihen live huntlretl tlollers ($500).): ❑ I, es owner of Ihe property, or my employees with weges es their sole compensetion, WILL DO THE WORK, and ihe structure is not intended or ofleretl for sale (Sec. 7044, Business end Professions Code: The Con�rectors License Law does not apO�Y �o an owner of property who builds or improves thereon, and who dces such work himself or �erself or through his or her own employees, provided Ihet such improvements are not intendetl or otteretl lor sale. If, however, t�e building or improvement is soltl wit�in one year of completion, the owner-builder will hava the 6urden of proving thal he or she tlia not build or impmve Por puryose of sale.). I, es owner of �he properry, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct ihe prolect (Sec. 7044, BuSiness antl ProfesSions Code: lTe crontract nse Law tloes not epply to en owner ot property who builtls or improves thereon, and who contracts lor suU project with a coniractor(s) license purf t e Co aCtors License Lews.�. _p_ .I am exe Siqnature: _ Owner ID ven Venficetion ot Business antl Professions Code for this reason: license. ❑ VBS ❑ No Dnvefs LicenSe No. (rype of dwumem, i.e. - pmperty tax bill or tleetl): Expires: DIVISION OF INDUSTRIAL SAFETV PERMIT CEFTIFICATION: ❑ I hereby cetlify thet no eacavetion five (5) or more leet in depth into which a person is required to descend, will be made in connection with work authonzed by t�is pertnit, and ihat no building structure, scaHolding, falsework, or demolition or dismantling thereof, will be more ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, Title 8, Califomia Administrative Code). ❑ As ownervbuiltler, I will not employ anyone to tlo work w�ich would require a permit fmm the Division of InduSMal Sefety, as notetl above, unleu such person has a pertnit to do such work from ihe division. Signature: Date: Division of Indusirial Safery Permit Number: CERTPICA7E OF COMPLIANCE AND AIffHOR2ATON OF ENTRY: I certify under penalry of perjury that I have read this epplication end slate ihat ihe information given is correct I agree to comply wlih all stete laws en ordinences releling to building consimction, and euthorize represenla�ives of Ihe City ot Costa Mesa to enter upon ihe above-described pmperty for inspection purp s. I a ee not to occupy or ellow occupancy ol any building aulhorized by Ihis permit until finel inspection. COpE 1, INSPECTIONTYPE 1676 Fizetl System Final FirB Pi 1266 Pool Spe Final 200 Final Re-Rool 201 Final BIxWReteining Well 202 Final Factory Fire Plece 203 Final Sign 204 Finel Demolition QAjE INIlILAL$ GQpEd INSYECTIONTYPE _ 206 Finel Mechanicel 208 Finel Plumbing 210 Finel Elecirical 212 Finel Fire Prevention 220 Final Planning Approval 222 Finel Si1e 250 Final9uilding/Occupancy QaIE INTRI�Lg � " y . � �_"� � . DECLARATIOIv OF AUTHORITY I BIdg.Permil# FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS This Permit # Street Address: AP Number: 1. I(we), .SF{C-� 'fiDF/\ES �-� jr� , declare that I am the Owner of Title of the above referenced real property, and that I(we) hereby authorize: Name: �/J`. � rl,��f"�C u l i ' I�%��, 7 Telephone Number: / r� ��C�i`? .� 7L �� ?L'' �f��'Z. �1 �c�'y��'y 6;J�LU��(5 StreetAddress /4�? !�: I[�`i�7Yl �1,��' IG'S Ciry: ��t �'1(;1 � State: r�� Zip: � �� to obtain permits in my behalf, as owner/builder, for �ti�� n.txY, �M.� T�G(- ( 4 � U� at the above referenced property. 2. Should any person become an employee engaged in ihe improvement of the property, I(we) shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage ro be filed with the Building Division of the City of Costa Mesa, as required by Stale of California laws. 3. As ownedbuilder in fact, I understand and accept lhal my responsibililies do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold lhe City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other paAies as a result ot work authorized by the permils from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correct. Executed this 3 day of �'j/�� 20 O.I- , at ��C-� , California. i Prinl Name: , °' �—� i _ V Signature: JOFIri D�FN✓Eei Date: � � ( �� Note: This authorization does not grant authorization to perform ihe work as owner, it solely provides for limited power of ariomey to secure ihis permit in any behaH. �]9936 �rev t I I00) Sdxwl Fces adjusicd vn^�nJl : R ev. q I : Re�. fi?: Rcv. Nl. Re�. NJ: Rev. N5: Rcv. pG: I.S I.UJ 23.05 3.7.05 { 331.OS ..1 ` 11 e Vslustia�-Planl: 5225,19412 Js> s s o c� s�. T E s Valuation - Plan 2: 5245.582.40 .„.�+�.M..... . ..,,..�.� . ,.,,o,.�. ....o...... Valuation - Plan 3: 81G3.278.00 SHEA - HALF' hfOON LANE - PROJECT FEE BREAKDO �i'N CITY BUILDING PLANNING ROAD SFA PL.4N CHECK CITY PLAN CHECK PERDIIT FEES p1EP PERM1IIT ONLI' FEBS FEE SANITATfON DIST. FEE ... .:r,. �lOU6Ll\IASTERS : � �. ..��:. �. , �.:. �.. ..-. . . . .. �. � '. : � ..��.... . : . : . ..:. .::,,.,, .;.. �: .. �... . Addre.rs Lol Plan Livable S. F�. Plm� Check Fee Plan Check Fee Periuit /SM/P Fees P/uwbing � Mechanica( I Eleclrica/ Road Fees Sani. Dist Fees .�;, ...._....�. ._ . ... �: Hal/M"oun-Laiuz� � 18 I 2.257 $825.42 $279.79 $IJ44.71 5538.08 50.00 ,.Z' _ Hnl/Mom�lnnr" 19 2 2,560 $SS3.05 �305.27 $1,904.31 $538.08 $0.00 '�`" s•2307OrangeAvenue 22 3 1,693 $65920 $225.83 $1,425.52 5538.08 $0.00 55,07454 :�.�:' PRODUCTIOIV ..230tHaHAbonlane 1 2 2.560 $22Q76 $3Q527 $19�431 $538.08 50.00 � a2303HaNMoonlane 2 1 2,312 $207.10 $256.15 51,784.58 5538.08 50.00 �.230.5h1a1(Moonlane 3 2 2,560 $220J6 $30527 $1,90431 $538.08 50.00 � G2Jb7�HA1oo"riCane 4 I 2Z76 $207.10 $281.61 $1,756.09 8538.08 $0.00 „.2308Hal/MoonLane 5 2 2,560 $220J6 $305.27 $1,90431 5538.08 $0.00 '231.1-H�17Moonlane 6 I 2.257 $207.10 $279.79 $1,744J1 $538.08 F0.00 �2913Hau�btoonLane 7 2 2,560 $220J6 $305.27 51,90431 $538.08 E0.00 ' :.`2375Ha7MoonLane 8 I 2,312 $207.10 $133.05 $826.24 $538.08 $0.00 23f7HaIlMoonLane 9 2 2.560 $220.76 $30527 $1,90431 $538.08 50.00 2319N2NMoonLane 10 1 2,276 $207.10 $281.61 $1,756.09 $538.08 $0.00 `"�7321'HanMoonLane 11 2 2.560 $220J6 $30517 $1,904.31 $538.08 $0.00 �2818tiallMoonLane 12 3 1,693 $164.81 S229J4 $1,431.16 $538.08 50.00 2372Hal1MoonLane 13 2 2,560 $220.76 $305.27 $1,90431 $538.08 50.00 "23fOHauMoonLane 14 2 2,560 $220J6 ' $305.27 $1,90431 $538.08 $0.00 ;230BNaNMoonlane IS 2 2,560 $220.76 $305.27 $1,904.31 5538.08 $0.00 '2306HaNn�oonLane 16 1 2.312 $207.10 $28433 $1,77324 8538.OR $0.00 �-2304-Ha!/MoonLane 17 2 2,560 $220.76 $305.27 $1,904.31 $538.08 $0.00 �1s623rosneer ' 20 2 2,560 8220J6 $305.27 $1,90431 3538.08 $0.00 ,ti78a23rO5rreel 21 3 1,693 $I64.81 $228.83 $1,425.52 5538.08 50.00 2303.Orange avenue 23 2 2,560 $220.76 $297.08 $1,853.01 5538.08 $0.00 2305.Ofanee Avenue 24 3 1,693 $164.81 $228.83 $1,425.52 $538.08 $0.00 . m233�Oraipe Avenue 25 3 1,693 8164.81 $228.83 $ I,425.52 5538.08 50.00 G"�`"'��` �A' TOTAL FEES : $6,921.63 56,931.71 $38,149.09 $0.00 $0.00 $0.00 $13,452.00 $0.00 /U�JI M VI LU6: LJ e<n�i �e TOTAL MODEL SQ. FI' 6,510 Check MI SFA PCfees: �, -.� pd. TOTAL PRODrSQ: Ff. e� ��' '� pd. �-"��¢�51237• Chetk #1 Cih� PC(ers: ao-�, - . Schoolfee bI.84 Dlodel School Fee SI1,978A0 � Check # 3 BP Fees Alodels $5,074.54 Prod Schoul Fce 59�,276.08 '� �%� jj Check fF 4 BP Fees Prod $38,149,Q9 Check #5 - Road Fees: 513,452.00 CFeck q 6-Sanitation Dist. Fees� $0.00 (Paid by Olson Company) (714) 754-5273 • Fax (774) 754-4856 • wv+w.ci.costa-mesa.ca.�TRICAL PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 tL Job Address: Suite No Viciniry: Parcel Nunmber: 2300 HALF MOON LN LOT 79 TPN00514 Applicant: WILLIAMS, GARY _ --;",; ;,: �': " ' � , - _ . 2 =-,-' <'-:7.-,�� ISSUED�BY: Address: 1450 N. TUSTIN AVE= ' ' "� `'- . . . i' . , �_: �i�-� ., __ __.. , _�-..i _ Status: ISSUED Applied: 04/27/2005 Issued: 04/27/2005 . _ � : '--. � .. _ � . �-.. ......., - �.�,: ��--��_ _Phone: � ' �t /.�_.��.�-� ��,. ti SANTAANA,CA ��`� !�; •� Zip 92705 ' � .+ �\`� �- � �r- . Ni/.'.' v.�, f �l � � _ . _ . ` 1 �/ l) f r+ �.�. ��'-�,'�.v �O � !` < <. � ' .f' r� ��.�Ai:.�` ' � '� � � �.% % A`. '- i owner SHEA FdOMES LTD '�i'' ` � - � � �.� n. �•.�� , �i�` �,�--' � _ ��`�� ; ;/ �� Address 603 SOUTH VALENCIA AVE � �� + �� , :.,� .. �-r�_ ,� .\� , ��i/ �� \`�-:,� j , / �� .��,"-- �;��,% Phone: 714-985-1300 �-, � , .,.,��q �j �A� , \^� � � ' , BREA,.CA-'�7/ Zip: 92823 � , -V �, �� '�,�`,�• � .' �i �t� \� ` \ . i � / ` .�, � y� . ��-��A "' Contrector: - O!NNER-BUILDER i ' - .. , �� Adtlress i `�i- ' . ' � . . . �� r l,` �"� _ J�. �`.. ` � '1 . .. � � , _ ..r � s �_> /p:,�. *'.Phone � � . ��..� . . , � � ' � * : ! � l - �'1 � 'r . .. � . .. ._ .?f ,:% .��i� _ ' �Zip: _ � � .' . -" • `1��_ i �" - License:000000 ��`�'��" .`�..' .° _� � . � . �+;, �i . _. ��''.t. ..- �i .. x .. x.�, . �\ _ � ' � . � � 'i' -'� •) �— � SCOPE OF PERMIT r � - . � .. � . ': LOT19/PLAN2C :L I, .,.. .. i_ ,_� /�.1 - . ,. �� :' � . ,_. ..�� ELECTRICAL PERMIT FOR NEW 2560 SF SINGLE FAMILY RESIDENCE. INSTALL 2 LIGHT FIXTURES�,` - � 3 RECEPTACLE OUTLETS, & 1 SWITCH IN GARAGE, AND p;RES A/C PACKAGE. , ' -� �,�� ', e i..�.�-��.r� r. �`"�iy � � �r��"y- . . '� � ,*�� t �: � .,REF: B05-00134 �; _ - ..- ..-i� _ r. "F� _ , -, . .. . i _ - _... - , " "_" . ��, ISSUE FEE �� Temp, service.test � Res. a/c package New Res (1-2'umts) 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 1hp Motors to tOhp Motors to SOhp Motors to t00hp FEE SUMMARY� Quantity � . _ _ `�� $23.50 ;,�zTemp Dist System / Lighting $0.00 t �"�� Busway/100k � ' $54.50 . ,��;;.... ,"� . Standing.: �$143.36 2560 MiscEleci , $0.00,� � O,ty �' Transform �� /� 9000� x f�' . `:.`.....: s,' r,iszzo. `.�z ;� � ''- .. _ $3.20 ��\3\, , ... . $1:10.�y ,1� � - ' ,_'-� ' $0:00 .% �, � 0�� `" -` �` � -. Lovuy_olta� _ �,''� $0.00;' ' . (:-0-., � � -- _ ' Low VoIC� ' �.--50.00��'f� 0✓i'�-�� MisaCon ��$0.00,,. ,.� 0 �`'Y '� .; L,��=.,'`� " r;�Misc: Con $0.00?�� 0 ' _ - ; ,� 1 ; "�--'.Circus'( gi 50.00^-�` �0. � -!,��,�Clras(mi $0.00 `_0 -.��17 -, Christmas $0.00 0�� : .- ;:=�Fireworics� 50.00 0 - � - � = Other Elec :� �� . � _ . �� i'. _.."� , „ �'., � �: __ / j �� . r � Quantity; ,' � �- ` $0.00 . FO%/� � r'i� �50.00 %l"0 � � �� / -�� $000'. �0 �. gwpment $OOOrj � 0 _� �' � ,, i i.to T kva/kw;.�� $0 00� 0 � % �� 10 kJalkw�'3%-j$0:00 0 ' '� � 50k`va/kwru,. � ,�$O.00�j��Q f /,' �� 700�kJa/kw� j $0.00- lif0� /l, ,� 100:kya/kw- _$0.00`� � �0 �/ � Sipment ��'L�$O;OO j 0',�1�� System / Ckt ' �-- $0.00 �0�' i � �� < CS0.00 �_<�0, . . �;�� ' $0:00%'�0 ide)_:iJ /�$0'.00' 0 le or lights) l�$0.00 0 Stand�",i�' � $0.00 0 "� " $0.00 0 Fee $0.00 NOTICE: -The work �authonzed.bythis�.permit.shall.comply.with all.applicable handicap access requirements.under Califomia�statutes and related regulations. (Ord.�No. 92-28, §�t,'12-21-92) 'EXPIRATION: This permitshall automatically expire and become void if work is nof commenced.within �1 BO�days,�or if work is suspended or.abandoned for a period of 1BO.days. MSPECTIONS: dn order for ihe workrautharized under.ihis�permit�.to.be considered1egal,-such work must�comply with all.applicable codes,�and all �requlred.inspeetiona end final�approval must be�obtainetl.-Failure to obtain.inspections and final�approval wilhresult in the expiration of�.this permit. '�FOR INSPECTIONS'CACL: ,(7/4)'7545626 .244WBIN00) WORKERS'COMPENSAnON UECLAHAnON: � �' � � I hereby ettirm under penalry ot Oerjury one ot the Following tleclarations:. �. ' , „ '` ' ❑ I heve anC will mainlain a ceniliwte of consent to selFinsure tor workers' compensetion, es provided lor by section 3700 0l ihe Le6or Cotle, for the peAortnence of the work for whlch this permit is issuetl. ' � .. ' ❑ I have and wlll mainWin workers' compensetion insurance, as required by section 3700 ot Ne Labor COCe, for ihe pertortnance ot the work for whicFi ihis pertnit is issuad. My workers' compensation Insurance carner and policy number ara: , � Carrier: Policy Number. J(T�his sectlwr need nof be comp/efetl/l the permi! is valued at wre hundred dollars ($100) or less.) � l�l I certily thet in the paAortnanca of the work for which this permit is issued, I shall not employ any person in any mannei so as to 6ecome 5ubjecYto ihe workers'� �� compensation laws ol Califomia, and epree that if ultl become su j ct ro ihe workers' compensetion provision�t Sec�ion 37Q0 of ihe Labor Cotle, I shell fotlhwith comply with Ihese proNsi s. . � L ApplicaniSignature: Date: �/L�7 O� S�- WARNINO: FAILURE T SECUFE O�1 RS' COMPENSATION ERA NLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIM NAL PI E14ALTIES AND CIVIL FlNES UP TOONE HUNDRED TVIOUSAND OOLLARE , N ICDDfTION TO THE COST OF ENSATION, OAMAGES AS PROVIDED FOR IN SECTIqJ 31O60F iHE UBOfl CODE, IMEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eNirtn that I am licensed under provislons oi Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle, and my license Is in full force end ettect. Llc. a Class a Contractofs Slgnature: Date: CONSTRUC710N LENDING AGENCY: ' . ' '�. ❑ I hereby aHirm that Ihere is a construction lending agency tor the pedormance of t�e work for which �his permit is issueC. (Sec. 3097, Civil Code). Lentlefs Name: Lentlels Atltlress: SignaNre: Date: OWNER-BUILDER UECLARATIONS: I hereDy aHirm thet under penalry oi perjury,that I em El(EMPT FROM TME CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or counry which requires a pertnit to construct, alter, impmve, demolish, or repair any structure, pnor to its issuance, also requires ihe appliwn� for such pertnit ro file a slgned sletement thet he or she is licensed pursuant ro t�e provisions ot ihe Contractors license Law (Chepter 9(commencing with SecUon 7000) of DiWsion 3 of the Business antl Prolessions Code) or that he or sha is exempt therelrom and �he basis tor the ellegetl axemption. Any violation of Section 7031.5 Dy any a00�icent fo� a permit subjecis Ihe applicant to e civll penalty of not more than five hundretl tlollars ($500).): ❑ I, as owner ot Ihe property, or my employees with wages as t�elr sole compensation, WILL DO THE WORK, end the siructure is not intended or otteretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of properry who builds or improves ihereon, antl who tloes such work himseN or herself or through his or her own employees, provitlatl that such improvements are not intended or ofle�ed tor sele. It, howevar, the building or improvement is sold within one year of completion, the owneo-builder will have the burden of proving ihat he or she ditl not builtl or improve for purpose ot saleJ. � �I, es owner oi the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to con5truct the projecl (Sec. 7044, Business and Professions Cotle: lTe comractors Llcense Lew tloes not apply to an owner oi pmpeny w�o builtls or Improves thereon, and who comraas lor such project with a conirador(s) license pursuent to ihe Contractors Licer�a�f L§ws.). ❑ I am ezempt u r sec. SignaNre' Owner I venfietl by 'v s license. Venficatio ership by (type of and Professions Code for this reason: tan bill or deed): DIVISION OF INDUSTHIAL SAFETV VERMIT CERTIFICATION: D te: "1'i � �/ _�� Drivers LiCense No. _ Expires: ❑ I hereby certify ihat no excavation tive (5) or more feet in tlepih into which a person is required to descend, will be matle in connection with work authorizetl by this permit, and thet no building siructure, scaflolding, lalsework, or demolition or tlisman�ling thereof, will be more �han thirty-six (36) teet hig�. (Chap. 32, Grp 2, Art 2, Sec. 341, Title e, Calitornia Adminisiretive Cada). , � ❑ As owner-builder, I will not employ anyone to do work which would raquire a pertnit from ihe Division oi Industnal Safery, es noted ebove, unless such person has e permit to tlo such wark irom ihe division. Signature: Date: Division ot Intlustrial Satery Permit Numbec CERTIFlCATE OF COMPLIANCE AND AIJTHORVA710N OF EMAV: I certity under penalry ot perjury that I have read this application and state that �he information given is correcL 1 agree to q ply with all state lews en i ortlinances relaling �o builtling consWction, and authorize representatives of the Ciry ot Costa Mesa to enter upon ihe ebove-dexribed (o rry tor inspe tion purp . agree not to occ or allow occupancy of any building authorizedUby Ih' perm/p until tinal inspection. / � l ZZ/ ��—� SignaWre f Le wner(s) �� Date And/Or Aulhonze ppliwnt Date COOE �' INSVEC710NTYPE ' " " i616 Fized System Final Fire Prevention 126fi 200 201 202 203 204 Pool Spe Final Final Re-Root Final BIocWRetaining Well Finel Factory Fire Place � Final Sign Final Demolition PAIE � . - MTRIALg �QQ�t INSPECTONTYPE ' 206 Final Mechanical 20B Final Plumbing � '210 Firial Electrical � 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy �� / (714) 754-5273 • Fax (714) 7543856 • www.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 2300 HALF MOON LN Suite No Vicinity: � LOT1Q Status: ISSUED Applied: 04/27/2005 Issued: 04/27/2005 s:y-��. Parcel Number TPN00514 _ " �i, - _ : _ _. _,. '�^' k: -�•- ISSUED BY: + r ��.v�j'- � _ . . . . _" -. �+"'�w. � .�`.,, Applicant: WILLIAMS,�GARY-�� , � ' � � � <'��_� . .�� - ; � . � � � ��.,;. � -� Address: 1450 N TUSTIN AVE 'i y r.� �� , . �.. il ( �� y� --'" '� ? � -� � \ � ,-^� ' ` l_ ; Ptione: - ��; � t� � , � ti ��. ' ", .> J .. � - - ' �. 1 ,"�� A� " SANTA ANA CA � £ �.-'� j =.Zip.. _��:92705 ; � � . t \ � . - f ' � 1 �•. 1 - �-i-�" _ ' l< � � , �'� ti �. . ' p` Ci '" '„� „ . .`�i ��":�'-'.r""' � � �.. � �.' �A \� � l� �._ , . . Ow er � �.SHEA HOMES LTD/ � `� �� /� �• ,�� ,� ' / i ; :.-/:�/ \� Addresa� 603�SOUTH.VALENCIAAVE ��::..�?,\`y�,.'`,' , j/� -�\��,; �•�.. .�,�:y' ...:;;,1-� , �\}� � � , i . � /'f Phone: 714-985-1300 ; i�, :��`V . -i.�'�i � , " BREA,�CA�' . Zlp: �.92823 �;`,�� , , .. `�.�� ' � . . . `a. i" . . . . ' � . , . `, � � . Contractor � ON/NER-BUILDER • . • . • , .�, : � ' < . , , � �� l � � v . - Address � I LL. t ... . � „r .- v � , ,. ' - '� � � - 4. .j 'ii` �" i ^'f �. �,. n 1 ii �' i i ' . . , �� .1.. . .. � � �' ;Ph'one . ; , � � ' � fA" yj „ . '.--- , _ -� � .. " . 'i �� : Zip: . . , . _ , � , , � � License:000000 1 � � , . . , .. �. . . � �.i �r .. - , _ � t � � � , - , SCOPE-OF PERMIT -- ; . . � � LOT 19/PLAN 2G ''�'�� i � " j 5 rqr �f :r //y� � ' . . - ' . � ' J. � _' .. ... ;� .'. i� �.. J (?!.. ._\ . . i . . . � MECHANICAL PERMIT�FOR�NEW 2560'SF�SINGLE�FAMILY�RESIDENCE. INSTALL 2 FAU'S, ALT �- - '.. ', c}.� 4�� , t;';,,1 DUCTN/ORK,�2-FACTORY FIREPLACES, 6 VENT FANS, 2 FIRE DAMPERS, &-2 A/C ,'�� ;, . ;`�. ' . � _ � l , CONDENSORS. - ,1�. t� � ;� , ' � �" -� � s - `.REF:805-00134 ' � — . .,- , - � - , �. . . , , - , y . _. " �. � --- _ __--� � � , FEESUMMARY . r,;�.` ` - ;,� � . Quantity , " - - - -- , - -Quantity . ; , ISSUEFEE �� --' $23.50 ---.:.Repair/AltAbsorbtionUnit �� ,,�,�� r'$0.00.' 0��>� � Inst FAU <100 k BTU' $29.60 2 -�,,,'?�� . ��, Repair / Alt Refrigeration Unit? %,r� � ��•$0.00` ; 0 Inst FAU >100 k BTU ,$0.00 0 Venhlla(ion Syslem %; $0.00 i 0- Repair/AIt�Cooling/Heat' � �,��$1370 1 ,'� . . �-'r„-,.Evaporativ'e�Cooler . �/i�;,� .s $000/��0 Inst/Rep.RecessWalbHtr V�;:$000-,�.,0.;�; , `, �� `�Commeraal_Incineratoi(yys�� i�'l -;�$000�, ;0 Refrig Sys <100 k BTU ' / � �'�50 00 �0 �; ",�Domeshc Incinerator � i� � ' � ' $0;00��` 0 Refrig Sys >100 k BTU t� f _ti $0 00�40 ;� `" Compressors / Absorption-Svstemstl: -, ;�/ ,� Gas Piping - ;�$0 00�0 ti\� ��, ,' �O Up to 3�hp./"100 k BT,U3� � ��! ��$0.00 0 Factory Fireplace � ' $21.30 2�_�� ;� � .,- , , `3 To>15�hpJ; 500 k�BTU �--��' �� /� �- $0.00 0 Hood w/Mech Exhaust � � ! $0.00. �,0 � '� - . -15To;30:Fip'/..1,000 k BTU !- �': �i . ` �, �i -' $0.00 0 VAVBox � ''� ,`$O.00�f/0�..�., _-.-.':.30'-To-50"fip/1,750kBT,U' � �;<�%,�f $0.00 0 Venl Fad/ Single Duct ",$43.50 %i6� ' -� Over 50 hp7 Over 1,750 BTU ��. �'i $0.00 -0 Appliance � ��:�30.00 ��0'.� _. - , ; �Boilersi':,�-,;`�'+�} �i�'��-�� FireDampers ��`$14.50��;2 � � ; �;., - '.,..Uplo3hp-^,`.--� �::/:-' $29.40 2 Smoke Dampers $0:00" "-0` � ` - • � . . _4 3 To�t5 hp � ' !"r% $0.00 0 Ins[ or Relocate Appl Vent $0.00�^ 0_ -'-,_ -.�., --_ 1_5 to 30 hp�,� ��-�"� $0.00 0 AirHandlers< 10000cfm $0.00 0 ' .�. . .:ir30�to�50tjp..--'" $0.00 0 Air Handlers > 10000cfm $0.00 0 � """ � � - �Over 50 hp $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.�(Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1B0 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 requlred Inspeetions�and final epproval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: � � - ' " I hereby ettirm.untler penalry ot perjury one ot the following declarations: � __ .;:�.;, �° � � . F . ❑ I have and will maintain a cenificate ot consent to selt-Insure for workers' compensation, es provitled tor�by section 3700 ot the Lebor Coee, for the pertormenca 6t Ihe work for which this pertnit is issuetl. � � � ' ' - ', ❑ I have and will maintain workers' compensa�ion insurance, as required by section 3700 of ihe Labor Code, for the perfortnanca oi the work for which this pertnit is issuetl. My workers' compensation Insurence cartier entl policy number ere: Certier: Policy Number: ' � (This sec(ion need not be comp/efe0 il the permlt is va/ued a( one hundred dollars ($100) ar /euJ �� I certify that in the peAormance of ihe work for which thi permit is issued, 1 shall not employ any person'in any manner so as to become sublect to Ihe�workere' ' compensation laws ol Califomie, and egree that if I dbecome sub'ect m the workers' wmpensation provisions of Se n 00 of t�e Labor Cotle, I shall forthwith comply with �hese provisions. Appliwnt Signature: Date: �� WARNING FAILURE TO S URE W KE COMPENSATION RAGE I LAWFUL AND SMALL SUBIECL AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED Tl10USAND DOIURE (51 ADDI ON TO TME WST OF P TION, DAAWGES AS PROVIDED FOR IN SECTIIXJ 3/060F THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I �ereby aHirm ihat I em Ilcensetl under provisions ot Chapter 9(commencing with Section 7000) of Division 3 of the Business and Pmtessions Code, and my license Is in full torce and eliect. Lic. # Class A Contractofs Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby ettirtn thet there is a consiruciion lending agency tor Ihe pedortnance ot the work for which this pertnit is issued. (Sec. 3097, Civil Code). Lentlefs Name: Lender's Atldress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby atflrm that untler penalty of perjury thet I em EXEMPT FROM TME CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5, Busineu antl Protessions Code: My ciry or counry which requires a permit to wnsWct, alter, improve, tlemolish, or repair any structure, prior to its issuance, elso requires the applicant for such pertnit to file a signed statement that he or she is IlcenseA pursuant to the pmvisions of the Contractors License Lew (Chapter 9(commendng with Section 7000) of Division 3 of ihe Business and Professions Code) or Ihat he or she is exemp� Ihereirom end the basis for ihe alleged exemption. Any violetion of Section 7031.5 by any eppliwnt for e pertnit sublecis ihe epplicant to e civil penelty of not more than ilve hundretl tloilers ($500).): ❑ I, as owner oi Ihe property, or my employees with wa9es as thelr sole compensation, WILL DO TT1E WORK, and Ihe structure Is not intended or oHeretl tor sale (Sec. 7044, Business end Professions Cotle: The Coniractors License Law does not apply to an owner of properry who builds or improves thereon, and who does such work himself or hereelt ar through his or her own employees, provitled that such impmvemenis are not intended or ottered for sale. It, however, tha builtling or improvement is sold within ona year of completion, the ov+ner-Duiltler will have the burden ot proving ihat he or she did not build or improve for Durpose ot sale.). � IS� I, as owner of the property, am E%CLUSIVELY CONTRACTING WITi LICENSED CONTRACTORS to consiruct ihe prolect (Sec. 7044, Business and Professions T Cotle: The comrecmrs Ucense Lew tloes not apply to an owner of property who builds or Improves ihereon, and w�o coniracts for such prolect with a contractor(s) license pursuant to the Comractors Licens�jL�wsJ. ❑ lam adtietl h tlri�s license. e5 of ership by (type ot d ment, i.e. DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: and Protessions Code for this reason: bill or deetl): Drivefs License No. •- _ ��c:l/ . ^ � � l I � �'. ❑ I hereby certify t�et no ezwvation five (5) or more feet in depth into which a person is required to descentl, will be matle in connection with work authorized by this pertnit, and ihat no Duiltling siructure, scaHolding, felsework, or demolition or tlismantling thereof, will be more Ihan thirty-si: (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, 71t1e B, Califomia Administretive Code). ❑ As owner-builder, I will not employ anyone to do work which woultl require a pertnit fram Ihe Division of Industrial Satety, as noted above, unless such person hes e permit to tlo such work irom Ihe division. SignaNre: Date: Division of InAustrial Sefery Pertnit Number: CERTIFlCATE OF COMPUANCE AND AUTHOR TION OF ENTAV: I certify under Denalry of perjury that I have read Ihis application and state Ihat the infortnation given is wrrect. I egree to comply with all stete lay+ iry ordinanc relating to building construction, and authonze represeNatives of Ihe Ciry of Costa Mesa to enter upon the ebove-described operry tor i pec' n G . I agree n � occupy or allow occupancy oi eny building authonzed b t�is p mit until final inspection. � yl.� Jos-- Signaiure O egal O s) �� Date AnNOr Authorized ADplicant Date GODE I. �NSPECTIONTYVE '� �� 1616 .Fised System Final Fire Prevention 1266 Pool Spa Final 200 � Finel Re-Rooi � . � � ' 201 Finel BIocWReteining Wall 202 ' Final Fecmry Fire Place 203 � FinalSign 204 Final Demolition �g. ' ' �$ COOEI INSVECTIONTYGE 206 � Final Mechanical 208 Final Plumbing � 210 Final ElecMcal � . . 212 Final Flre Praven�ion ' ' ' 220 Final Pl2nninq Approval � 222 Final Sita � 250 Final Building/Occupancy '� QR�. 12 �� v� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2300 HALF MOON LN Suite No Vicinity: LOT 19 Parcel Nunmber: TPN00514 Applicant: WILLIAMS,GARY-.' � Address: 1450 N. TUSTIN AVE � SANTA ANA, CA . � Owner: Address Contractor: .Address: SHEA HOMES LTD � 603 SOUTH�VALENCIA AVE ', BREA; CA - OWNER-BUILDER PLUMBING PERMIT Phone: . Zip:. 92705 � Phone: 714-985-1300 Zip: . 92823 Phone: Zip: License: 000000 Status: ISSUED Applied: 04/22/2005 Issued: 04122/2005 ISSUED BY: ' SCOPE OF PERMIT� -' LOT 19 _ PLAN 2C �PLUMBING PERMIT FOR NEW SINGLE FAMILY RESIDENCE FOR "SHEA HOMES". INSTALL 3 . �, BATHTUBS, 1 DISHWASHER, 7 GP,S OUTLETS, 1 WASHER, 1 PRESSURE REGULATOR, 1 SEWER - CONNECTION, 3 SHOWERS, 1 KITCHEN SINK, 1 SERVICE SINK, UP TO 4 VACUUM BREAKERS, 3 � , WASH BASINS, 1 WASH BASIN SET, 1 WASTE & VENT.SYSTEM, 4 WATER CLOSETS, 1 WATER , . HEATER, 1 WATER PIPING, & 1 WATER SERVICE. � ' , . , REF: 805-00134 _ _ . - - , � . � ".. " . �' FEE SUMMARY � ' AMT � �TY - '. . . . . . . AMT- � �QTY �' . ' . . , , . � AMT ISSUE FEE ' $23.50 � � � Laundry Tub / Washer �$9.80 1 � Sump Pump , . - $0.00 Backflow irrigation ��$0.00 . 0 � �, Landscape Irrigation $0.00 0 .�Swimming Pool � ; � $0.00 BackFlowPreventer � $0.00" �, 0 ��P-Trap $0.00 0 - � � TrapPrimer�� - $0.00 Bathtub , �,. $29.40 � 3 . � � Pressure Regulator ' $9.80 1 � Udnal - .- � ' . $0.00 Clarifier System �$0.00 Q Process Piping�(per 10 R) $0.00 0 ,� Vacuum BrkcBkOow(1-4) $72.30 Connect Qce,Soda,etc) � � � $0.00 � 0 � , � � Receptors - $0.00 0 � �� Vacuum Brkr Bkflow(5+� $0.00 Dental Units 'S0.00� � 0 - Septic Tank $0.00 � 0 ' � Wash Basin � $29.40 Dishwasher $9.80 � .1 �' Sewer Cap for Demo $0.00 0 Wash Basin Set $9.80 Drain, Floor $0.00 � 0 � Sewer Connect 524.65 1 � Waste and Vent System $9.80 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 � Water Closet (Toilet) $39.20 Drein, Roof 50.00 0 � Shower $29.40. �.3 � � . ' � WaterHeater/vent $12.30 Drinking Fountain $0.00 0 Sink, bar - -. �� $0.00 .. 0� Water Piping (Inst or Rep.) $9.80 QTY 0 0 0 0 1 0 3 1 1 4 7 1 NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requiremeMs 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 1 BO tlays. INSPECTIONS: In order for ihe work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectione and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 754-5626 246648(&00) WORKERS'COMPENSAnON DECLARAnON: I hereby effrtn untler penalty oi perjury one of ihe lollowing declarations: ❑ I heve entl will meinlein e certificete ot consent to self-Insure lor workers' compensatlon, es provitlatl for by section 3700 of the Labor Code, for the pertortnance ot the work tor which Ih�S pertnit i5 i55uetl. ' ❑ I heve end will mA�ntain workers' cnmpensetion insurence, as required by sec0on 3700 0l Ihe Labor Cotle, for the pedortnance of ihe work for which this pertnit is issued. My workers' compensetlon Insuranca carder entl policy number ere: Carrier Policy Number: {This secUon need not be crompleted il fhe permit is valuetl at one hundred dollere ($100/ or less. J ❑ I certify that in th¢ pertormance of the work for which Ihis permil Is issued, I shell not employ eny person in any manner so as to 6ecome subject to the workers' compensation IaWs oi Califomia, end egree that il I should become sub�ect to the workers' compansation provisions of Section 3700 of the LaDor Code, I shell fonhwith comply with ihes& Provisions. Applicant Signature: Date: WARNING: FAILURE TO SECUFE WORKERS' COMPENSAT1qJ COVERA�E IS UNL4WFUL ANO SHALlSUBJECt AN EMPLOVER 70 CRIMINAL PENALTIES AND CNIL FlNES UP TOONE MUNDRED hKK1SAND DOLLARE (5100.000). IN ADDITIqJ TO THE COST OF COMPENSATION, OAMAGES r1S PROVIDE� FOR IN SECTION 3]O6 OF THE LABOR CODE, IMEREST, ANO ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirtn Ihat I am litensed under provisions ol Chap�er 9(commencing with Section 7000) of Division 3 of ihe Business and Protessions Code, and my license is in full force ana eRecL Lic. M Class a Contractors Slgnature: Daie: CONSTRUCTON LENDING AGENLV: ❑ I herehy aRirm that there is a consiruction lending agency for ihe Oertormance of ihe work tor which ihis permit is issuetl. (Sec. 3097, Civil Cotle). Lentlers Name: Lender's Address: Signature: Date: OWNER-BUILDER D6CLARATIONS: I hereby attirtn Ihat under penelry ot perjury Ihat I am E7(EMPT FROM THE CONTRACTORS LICENSE LAW for iha tollowing reason (SecJ031.5, Business and Profeuions Code: Any ciry or coun�y which requires e permit to cons�mct, elter, improve, tlemolish, or repair eny stmcture, prior lo its issuance, also requires the applicant for suc� pertnit to file a sig�d ststem0�� that he w she is Ikensed Wrsuant lo the provisions ot the Gontractors l'+cense Lew (Chapter 9{comme�irg with Seclbn 7000) ot DMsion 3 ot the Business end Professi0ns Cotle) or thet ha or she is e�empt iherefrom end the basis for tha alleged eremption. Any violation of Section 7031.5 by any applicant for a permit subjects the ep0licant to e civil penelry ot not more than Nve hundred dollers ($500).): I, as owner ot the p�Weny. or my employees with weges es iheir sole compensation, WILL DO THE WORK, and Ihe sWcture is not intentled or oftered for sale (Sec. 'ness entl Professions Code: The Coniractors License Law tloes not apD�Y �o en owner of property who huilds or improves thereon, and who does such work hims o 4a-W�engRMisor-her own employees, provitletl that such improvements are not intendetl or oNered for sale. tl, however, the building or improvement is soltl wit in One y0er ot compleiion, the owner-builder will have the burden of proving ihat he or 5he did not build or improve tor Durpose of sale.). �I, as owner ot the P�oPerty, am EXCLUSIVELY CONTRACTING WIT}1 UCENSED CONTRACTORS to constmct ihe projett (SecJ04a, 9usinesg and Protessions Cotle: The conirectors License Lew tloes not apply to an owner of property who builds or impmves Ihereon, and who conVacts for such pmject wit� a contractor(s) license pursuan� to �he Con�rac�ors License Laws.). ❑ I e.m eze t untl6� sec. Business and Professions Code for ihis raason: Signature: Date: �'Z O $— Owner I v' by vers license. es � No Orivefs License No. Expires: � � P9 Venfiwtion of Ownership by (type ocument, i.e. - pmpeny tez bill or aaed): DIVISION OF INDUSTR�4�L SAFETV PERMIT CER7IFICATION: ❑ I �ereby cenify that no excavation tiva (5) or more feet in depth into which e person is required to descen4 will be made in conneaion with work authonzed 6y Ihis pertni6 and that no building swcWre, scattolding, falsework, or demolition or dismantling ihereof, will be more than ihirty-six (36) feet high. (Chap. 32. Grp 2, Art 2, Sec. 341, T�le B, Califomia Administrativa Code). ❑ As owner-builtler, I will not employ anyone to do work which would require e permit irom the Division of Industriel Safery, as notetl abova. unleu such person has a pertnit to do such work Irom the division. Signature: Date: Division of Intlustnal Sa�ery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AVTHORVJITON OF ENTRY: I cenify unaer penalry ol perjury ihat I have reatl ihis application antl sta�e that t�e inbrmation given is correcL I gree �o wmp�y with all siate laws en0 city ord�nances relating to Gullding constmction, and aulhonze represematives ol ihe City of Costa Mesa to eNer upon ihe ab cnbed propeRy b i n purposes. I ee not to occupy or allow occupency ot any huilding euthorized by ihis permit unf linal inspection. �6 '�_ Sig tur ner(s �Date Y Za/v< And/ ori Aoo ica � �` Date Pd7E INTITI�LS 1616 Fixed Sysiem Final Fire Preveniion 1266 Pool SOa Final 200 Final Re�Rool 201 Pinal BIocWRetaining wall 202 Final Factory Gire Place 203 Final Sign 204 Final Demoliti0n COpE� INSPECTIONTYPE 206 Final Mechanical 208 Finel Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 final Building/Occupancy �zn r�r:.�� (�/ � r