HomeMy WebLinkAbout2302 HALF MOON LN - Building PermitsSee 190 23rd St. for add'I
paperwork covering entire tract.
(714) 754-5273 • Fax (774) 754-4856 • www.ci.wsta-mesa.��LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2302 HALF MOON LN
Suite:
Vicinily: LOT 18
Primary Occ: R3 Dwellings/ Cong Res <10 Type of Conshuction: V-N
Parcel Number: TPN00515 2oning:
Applicant: CORTEZ, JEN
Address:
" .
Owner. SHEA NOMES LTD
Address 603 SOUTH VALENCIA AVE �
�
i -.BREA, CA � � � �-
Contraotor: ,OWNER-BUILDER
,Address: � = j ,-'�, .
� i,
'
-Z�p: ,'y,.;
Status: ISSUED
Applied: 01/24/2005
Issued: 04/04/2005
" ISSUED BY:
, - Phone:� 714-245-9760 X19 ,
Zip:
�'
�
� i' � � �
Phone: '.714;9851300 , � � , � �� � •
Zip: 92823 �� � � . ` / ' ��A� �
� � .���- �
�.
_•._�-,� , �
_ Phone: � � ti�- i � ,
� .
;License: 000000 ., - - � ' ` '��� �
.. ._ .. . '.;
Arch : WILLIAM HEZMAtHALCH � _ ; : , Eng: '
Address: _ ' WILLIAM HEZMALHALCH ARCHITECTS INCJ i �Address: .. , _ � �
� , SANTA ANA, CA , � Phone: 94&250-0607 - � Phone: �
� , 2650 REDHILCAV STE 200 � ' � - '�
� Zip: 92705-5543� License: . � ,License: � �
� ., , � � , � , .
SCOPE OF PERMIT
LOT 18 —. .- -� / , .� ' o . - ' . , . _
PLAN 16 -. , . ._, ' _ r- ;, d', , ' . �
CONSTRUCT 2257 SF 2-STORY SFD WITH 457 ATTACHED-GARAGE. FIRST FLOOR 1036 SF WITH 1221 SF SECOND STORY. A 126 SF �
COVERED PORCH WILL BE CONSTRUCT AT THE FRONT OF THE DWELLING. A FIREPLACE MODEL it4236 (ANSI, UL127) WILL BE INSTALLED
IN THE FAMILY ROOM; THERE � - � . ' � '
WILL BE A 2ND FLOOR LAUNORY ROOM. - � - � _ ` ' .:- " �'t �
�REF: G04-00010, PA-03-47/T-16600 � . �_ : " � � � . - ' .
- - � � _ �= - ' % ' , .
FEE SUMMARY
Plan Check: $279.79 ' Calc Valuation,:;` -� � Szzs,saz.5z
Permit: $1,72175 ClaimValuation:�- '"',, � '.�So.00
SMIP Res: $22.96 „r.' "w � �
%,;; ,. �.
SMIP'Com: $OA0 " ,?� / .�,
Other. $0.00� ,_ � � � - _ . i
Inspection: $0:00 � � � .. � � � � i � �
Total:. � $2,024.50, . � � � �� � �-� ��
� � PLANNING & �ZONING � , , � � ,%, ��
SETBACKS � � � � �'. � �
MAIN STRUCTURE Front 20- 0- �. Rear 8-0 �- Lek 44- 0�� RighG ��16- 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, 1241-92)
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
requlred Inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
�
24A6-46 (NW) L''��.�'.-n: j
WORKERS'COMPENSAnON DECLARATON:
I hereby aftirm under penelry oi perjury one of ihe following decleratlons:
❑ I heve end will mainlein e certifcete of consent to selbinsure for workers' compensetion, es providad br 6y section 3700 of the Ls6or Code, for the pertortnance of lhe
work for which this perrt�ii is issued.
❑ 1 have anC will maintein woAcers' compensetion insurence, as requiretl by section 3700 0l the Labor Code, lor the performance of the work for whic� this permit is issuatl.
My workers' crompense�ion Insurence cerner end policy number ere:
Certier. Polity Number:
(1�s sectlon need not be mmplated i/ the permit is valued af one hundred dallers ($100) or less.)
�] �..1 cetlify that in the peAo � ol t� r which ihis permil is issuetl, I shell not employ any person in any manner so as to become suDject to Ihe workers'
� compensetion laws elito i� end egree t et II I should become sub�ect to the workers' compensetlon pmvisions of Sec on 3700 of the Lahor Code, I shell torthwith
_. comply with Ihes ovisio %�,{// '�)c
Applicant Signature: Date: � 1/'�/� J
WARNING: FAII.URE TO RS' CIXdPENSATION G1�VERAQE IS UNLAWFUL AND SHALL SU6IECT AN EMPLOVER TO CFiIMI L P ALTIES FND CIVIL FlNE$ UP TOONE HUNDPED
T}KK15ANODOLL4RE(51 A ITIONTOTHECOSTOFCOMPENSATIIXJ,DAMAOESASPROVIDEDFORINSEC710N31060FTHELA00RCODE,IMEREST,ANDATTORNEI^SFEES.
LICENSED CON7RACTORS DECLARA710N: ',
I heraby alfirtn that I am licensed under pmvisions ol Chapter 9(commencing with Seclion 7000) ot Division 3 of the Business and Professions Code, and my license is in full
farce end eflecL Lic. M Glass M
Coniramor's SignaWre: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 herehy aflirtn that there is a construction lending agency br ihe pedormence of iha work for which this permit is issued. (Sec. 3097, Civil Coda).
Lentlers Name: Lantler's Adtlress:
Signature: Date:
OWNER•BUILDER DECLARATIONS:
I hereby effirtn thet under pe�alry of perjury thet I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the lollowing reason (Sec. 7031.5, Business antl Professions
COCe: Any ciry or counry w�iG� requires e pertnit to construct, elter, Improve, demolish, or repeir eny simcture, prior to its issuance, also requires the applicant for such permit
to tile e signed stetement tha� he or she Is Iicensetl pursuanl ro ihe provlslons ai the Contrectore License Law (Chapter 9(commencing with Section 7000) of Dlvision 3 of Ihe
Busin85s end Profe55ion5 COde) or Ihet he or 5he i9 exemp� Iherelrom and Ihe besls for Ihe elleged exemptlon. Any violation of Section 7031.5 by any epplicant for a Oermit
subjects the epplicant to e ciN� penalry oi not more then tive hundred dollers ($500).):
❑ I, as owner ol the prop9rty. ar my employees with weges as thelr sole compensation, WILL DO TME WORK, and Ihe sirucNre is not intentletl or oReretl tor sale (Sec.
7044, Business end PrO�essions Code: Tha Coniractors License Law does nol ap01y Io an owner of proDerry who builds or imOroves thereon, and who tloes such work
himseN or herself or through his or her own employees, provi4etl ihat such improvemenis ere not Intanded or ofieretl for saie. II, however, the 6uilding or improvement is
�sold within one year ot Completion, the owner-builder wi0 heve the burden ot proving Ihat he or she tlitl not build or improve for purpose ot sale.�.
I fas owner ot Ihe prope em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS Io constmct the D�olect (Sec. 7044, Business antl ProfesSions
Code: TTe contr� cen Law tloes not apply to en owner ol property who builtls or impmves thereon, and who wntracts for such project with a contracior(s)
license pytgllaRt o i CoNrec rs License Laws.).
❑ lem.�
Signeture:
Ownar ID �
Venticetion
BuSinesS and Prolessions Code for ihis reason:
�icen58. ❑ Ves ❑ No DriveYs LiCenSe No.
(type of tlocument, i.e. - property tax �ill or tleed):�
E:pire5:
DIVISION OF INDUSTAIAL SNFETY PERMIT CERTIFICATION:
❑ I here6y certily ihat no Bxcavation five (5) or more feet in depih into which a person is required to descend, will be made in connection with work authonzed by this
pertnit antl that no building swcture, scaftolding, talsework, or demolition or dismantling thereof, will be more ihan i�irty-six (3fi) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title 8, Calitomia Administrative Code).
❑ As owner-builder, I will noI employ anyone to do work which would require a permit trom the Division of Indusirial Safery, as notetl above, unless such person has a
pertnii to tlo such work ��am Ihe division.
Signeture: Date:
Division ot Intlustnal Safary Pertnit Number:
CERTIFlCA7E OF COMPLIAHCE AND AUTHORVA710N OF ENfRY: I certity untler penalty of perjury ihat I heve reatl Ihis application and state ihal the intormation given is
wrreci. I agree to wmply ith all state laws city ordinances releting to 6uilding conswclion, and aulhorize represenlatives of ihe City ot Costa Mesa to enter uDon the
above�tlescnbed propen for inspectio rp ses. I e e no� to occupy or allow occupancy of eny building euthorizad by Ihis permit until final inspection.
LODE / ItlSPf.iL4HIY�✓ �J
1616 Fizea System Final Fire Prevention
1288 Pool Spa Final
200 Finel Fie-Roof
201 Final BIxWRetaining Wall
�
203
Final Factory Fire Pla�e
Final Sign
204 Final Demolition
p� u
�I�y��S
Date a
COpE 1 INSPECTION TYPE
206 Finel Mechanical
20B Final Plumbing
210 Finel Electrical
212 Final Fire Prevention
220 final Planning Approval
222 Finel Si�e
250 Finel Building/Occupency
2,7E irmru�s
�
DECLARATION OF AUTHORITY Bldg. Permit#
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS This Permit #
Street Address:
AP Number:
1. I(we), .SFi.G� i{Dh/lES L-��� , declare that I am the Owner of Title of the above
referenced real property, and that I(we) hereby authorize:
Name� �1. � flJ-IC,C �//�V'��C��S TelephoneN m�f ber: 7��i- �C.`I�. �/��
�l� �77�Z / n Y 1n)iuA�MS
Street Ad � i�l l�. 1C7 '�717 !'1'U� � .�(�f l�,S
City: r �,�/'� ii4'1� � State: ,��'t Zip�
to obtain pertnits in my behalf, as owner/builder, for 'E{°��� �-+ �-A+.� T�G�- ( 4� U d
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Workefs
Compensation Insurance coverage and cause a ceRificate of that coverage to be filed with the Building Division of the City of Costa
Mesa, as required by State of Califomia laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the Cily of Costa Mesa and its employees or o�cers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that lhe foregoing is true and conect.
Executed this 3 day of ,qp/�� 20 d,T , at �2C''� , California.
Print Name:
Signature: S�N UhN✓E'Qi
Date: �� ���
Note: This auttrorization does not g2nt authorization to perform ihe work as owner,
it soley provides for limded power of attomey to secure this pertnit in any behaH.
0]'l9�46 (rev.11/00)
School Fces aJjuslcJ
Address
Ori�inal : 1.31 AS
R cv. N I: 2.3.05
Rcv. r2: 3.79�
Rec.q3: 331.05
Re�. #4:
Rcv.qS:
Rcv. qG:
�
� I���� Valua�ion-Planl: $225,194.22
Ji. s s o c� s� T E s Valuanon-PIan2: $245,582.40
.�*�,�.M....s �.AM�rs . ��o.,e�...�,..oE,.�„, Valuation - Plan 1: 5163173.00
.: �: ��t0 DE W 11AS'I'E R�
...... .... .....
Lot Plan Livable
�;.I S I 2.:
19 2 2,:
22 3 I,i
F�.
SHEA - HALF MOON LANE - PROJECT FEE BREAKDOIT%N
CITY RUII..DINC � PLA
SFA PLAN CHECK CITY PLAN CHECK PF,RDIIT FEES �1EP PERi111T OYLY FEES
P/an�Check Fee P(an Check Fee Permit/Shc(P Fees P[umbing l��bfeclmuica! I Elec[rica! F
$32S.d2 $279J9 $1,744.71
$833.05 530517 $1,90d31
$65920 $223.83 51.425.52 � �
tane�, I 2 2,560 $220.76 $305.27 $1,90431
Yane 2 I 2,312 $207.10 $286.15 $1,784.58
Lanep, 3 2 2,560 $220]6 $305.27 $1,90431
t e�. 4 I 2,276 $207.10 $281.61 $1,756.09
'Lane 5 2 2,560 $220J6 $305.27 $1,90431
Lane 6 I 2,257 $207.10 $279J9 $1,744.71
'Lane 7 2 2,560 $220.76 $}0527 $1,904.}�
�Lane= S I 2,312 $207.10 $133.05 $826.24
Lane 9 2 2,560 $220.76 $30527 $1,90431
Lane 10 I 2,276 $207.10 $281.61 $1,756.09
Lane 11 2 2,560 $220.76 $305.27 $1,90431
Lane 12 3 1,693 $164.81 $229J4 $1,431.16
Lane 13 2 2,560 $220J6 $305.27 $1,90431
Lane 14 2 2,560 $220.76 ' $30527 $1,90431
Cane IS 2 2,560 $220J6 $305.27 $1,90431
Lane 16 I 2,312 $207.10 $28433 $1,77314
Lane 17 2 2,560 $220J6 $305.27 $1,90431
e`t."'�- 20 2 2,560 $220J6 $305.27 $1,90431
er_>. 21 3 1,693 $164.81 $228.83 $1.425.52
enue+ 23 2 2,560 $220J6 $297.08 $1,853.01
enue. 24 3 1,693 $164.81 $228.83 $1,425.52
enue„ 25 3 1,693 $164.81 $228.83 $1,425.52
'g''� = TOTAL FEES : $6,921.63 $6,931J1 $38,149.09
Total # of Lo[s: 25
c<n�i <�
7'OiAL MODEL SQ. F7 G.510 Check #1 SFA PC(ees: �� pd.
70`��TI:PROD?SQ=FT St;277) Clieck #1 CiN PC(ees: $6,93�� pd.
Schoolfee $I-84
Mudel School Fec 511,978.40 �/ Check # 3 BP Fees 6lodels $5,074.54
ProJ School Fee 59a,276.08 '� ��%� . Check # 4 BP Fees Prod 538,149.09
¢L(T,T�G�SCHOOL:FEES=S1(16;ZS4:48�a� �
so.00
FEE
rrad Fces
$538.08
$538.08
$538.OS
$538.08
$538.08
$538.08
$538.08
$538.08
$538.08
$538.08
$538.08
$538.08
$538.08
$538.08
$538.08
5538.08
$538.OS
$538.08
$538.OS
' `:rt_•,: ":r,,,; =<» '.
.,� ,
SANITATION DIST. FE6
Sa�ti. D�st. Fees
$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
50.00
$0.00
$0.00
so.00 so.00 � st3,asz.00 � so.00 �
Check #S - Road Fecs: $13,452.00 �
Check # 5 -Sani[ation DisL Fees: $0.00
(Paid by Olson Company)
f
0
a
(714) 754-5273 • Fax (714) 754-0856 • www.ci.costa-mesa€�.�TRICAL PERMIT » FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
2302 HALF MOON LN
LOT 18
TPN00515
Stams: ISSUED
Applied: 04/06/2005
Issued: 04/27/2005
npplicant: WILLIAMS, GARY — ":'"_ '.'� *-_. �
.. ... , :,,. �....:�x, �,a-,_,�.v ISSUED BY:
Address: 1450 N. TUSTIN AVE, . .. �'i %� "� � � - - � � :�>;-- = -�
... ,..':t{ f j�^,C.� ; Phone: � ,j . ,� / � �'"�_`_ _ ..
i '
SANTA ANA, CA� ��' � - � '� �, Zip 92705 : ':, /� ` � "� ;��'��..`,
. �,
�rl'r .. �� .� . � .� /..1`f i� � � 4�`. -
� S i. .i V > i _ . _ . _.,%�'' ' � i \A C � �.
` �� / - _ _ . .^ � . �� � '
owner ' SHEAHOMESLTD 'i �-- " � ��.irv �� ,� � �'�`'
�.,,.tt; : t w.•�.�.,- r✓;i="-/ � `.���.. \l ���.�� .
� i
AddressJ 603;SOUTH'VALENCIA'AVE'" �' �`'=-�'*~' �' r r ^'
�-' ;.. .�e � "`A� .A � �� ����`\ .
,�� � _V -'=��j'�%'� Phone: 714-985-1300 � �1��,*���.� .- �'�.,
,� ,., i
. k . '� ti;, � � y ._ i
f -, .� BREA. CA� '_: ' Zip: 92823 �';,�V�, � �� � �
, A �
`- ,
,,. v\\..
, � � � � .
. f, � ,
���Contracror: 'OWNER-BUILDER i `� " �`'����` �. `�
�, � Address. 7i � . ., � � . `.,.. . ,. - � �' } � .
_
, , _ ,�,. {�. � , �
t �'"Phone� '
, r ,.� ._ . -• , � . _
' � r �, - ..-_ i !' -
. : � ���/� � , r. ����. - ��ZiP '-. ' � . _ _
-%r r' , . , � ; .
� License:000000 �� -
-� 1 , ` \ ;�,i `
,�
_ 4�1 ._ . � . . ' � .
�' ' �� ' Y+'� `_
� � ' � , ^�� � 1; •�;'r SCOPE OF�P-ERMIT� - ' . '° - f _ '
� , �LOT 18/PIAN 1�8 _ .. . , . ..' i: ':� �' � � ,�. '^' `. , , . .
l. . " ' - _ .,. _.. , .,.. _-..-. .- ...'-_ ' - - � . .
, ELECTRICAL PERMIT FOR NEW 2257 SF SINGLE FAMILY RESIDENGE FOR "SHEA HOMES". INSTALC �- �
, � • �, �B LIGHT FIXTURES, 5 RECEPTACLE OUTLETS, & 2 SWITCHES IN'GARAGE, & t RES A/C ` - ' � . � _, ,
� ' PACKAGE. •-�._�i�-_ - . - � - ' . . . �
' _ l
., _ - - - "�'^ � �,,,n� � " -'.i '.i.' -,
- ' .REF: BOS-00133 � , ` . .' ^- . . . ` � �"` ' ` - ' . ,
c f. . �
r. h �
ISSUE FEE � , �'
Temp seryice�test
Res. a/c package �
New Res (1-2 units) ,
New Res (3+units)
Pool / Spa :
Lighting Fixts �` `�J���
Recept OutleLs ` ,
Switches �
Non Res Appl
Res Appl '
Service to 200a
Service to 1000a
Service over 1000a
Mators to thp
Motors to tOhp
Motors to 50hp
FEESUMMARY •
Quantity
\; $23.50 ' �='� �-���Temp Dist System / Llghting
� ,$0.00 .. � Busway/100.ft
$54.50 . � � � Standing Sectiod;.:
5126:39,. ti 2257,yi .', Misc Electncal,Equipment'.�
-- $0 00:' '� 0'•' - � - �Tran'sfortners up�to�1'kva/kw
�f.
1.. V
� '� ail
' Quantity �� �
so.00 �p ; !'' <: :� ,� �.;; :
„
$0.00 i'%,0 �
$0.00' r 0 i.�' �
i:
$0:00'/ 0 � ; �;�' �,
i � . � ;..�� . ,� �.50.00� 0 ' �,-� /
/
;�/`$0.00`� ���0 � y � . � � up to'10 kva/kw"' .r $0 00 ' j�0 �%/1 J
�, $3,30 �,� _3� � " . . up to 50 kva/kw � $0 00�� �l/0 � �F3
� ' $5.50= , �� 5 -j��; ` ` ... .'..up�to t00.kva/kw-" .$0,00"� .A �'�: ',
-... . ' �..... -
' ,.' $0.0 � �' 2 ��';`? 'r.: . , ;" �, .............:.�.oyerv100'kva/kwr, �� $0.00� .� �„ ��,, .
$2.2
�� � 0 �� 0�� � - - -LowVoltage;Equipment ��� $000 /;0� .
,-$0.00 �` �� 0- s f Law Volt Wiring.System / Ckt ��y`$0 00 ;: !� 0'� '� �
�$0:00-.. �, 0 c" " : �'-` � Misc. Conduit C�`� � } SO OO;U� �0
$0.00�:-,`�.� 0��;,�'�� `" `=t�%'MisaConductor_:�,��.� -;$0:00�`� 0
$0.00 � ` 0 .. �- � �� �Circus ( gen a'r ride) %✓$0:00 0
$0.00 � -',_0 . Circus (mech ride�or.lights)' ��" $0.00 0
50.00 0 � � ~ ,�' . .. - Christmas Tree�Stznd �" � $0.00 0
$0.00 0 "' - � -=� Fireworks�Stand � $0.00 0
NOTICE: The work authorized by this permit shall comply with all applirable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27•92)
EXPIRATION: This permit shail automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned
for a penod of 180 days.
INSPECTIONS: In order for the work authorized under this permit to ba considered legal, such work must comply with all applicable codes, and all
requlred Inspeetiona and final approvel must be obtained. Failure to obtain inspeclions and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
2448-48(W00)
WORKERS' COMPENSATION DECLARATION: � ' � � ' '
I hereby ettirm under penalry of periury one ot ihe tollowing declarations:; ''. . ' ^� -" '. � .
❑ I �eve and will maintain e certificate ot consent to self-Insure for workers' compensation, as providetl tor by section 3700 of the Labor Code, for ihe pertortnence of Ihe
work tor w�ich�tfiis permit is issuetl. ' ' ' , '�
❑ I have and will Fnaintain workers' compensation insurance, as requiretl by section 3700 of the Labor Code, for the peAormance of the work for which this permit is issued.`
My workers' compensation Insurance carrier antl policy number are: ' .
Carrier: Policy Number: -
yyy(Th///is section need nof be comp/efed /l the permit is velued et one huntlred tlollars ($700) or less.)
t� I certiy Ihat in the pertormance oi ihe woAc for which t' pertnit is issuetl, I shall not employ eny person in any manner so as to become sublect to ihe workers' �
/` compensetlon laws of Calitomi , antl egree that If I IQbewme su ��ect to Ihe workers' compansalion provisions of S ion 37yyy��� of the Labor Code, I shell totlhwlth
comply wit� thesa provisi �� ��
.
Applicant Signeture: Date: 7 a
WARNINCa: FAIWRE TO CURE W ( ' COMPENSATION C �RAGE IS L4WFUL AND SHALL SU&IECT AN EMPLOVER TO CFIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNORED
TFi0U5ANDDOLI.ARE(51 0 ONTOTHECQSTOF PE ON,DANAGESASPROVIDEDFORINSECilON7/O60FTHELABORCODE,IMEREST,ANDATTORNEI"SFEES.
LICENSED CONTRACTORS DECLARATON:
I hereby attirtn that I em licensed under provisions of Chapter 9(commencing with Seciion 7000) of Division 3 of ihe Business and Professions Code, entl my license Is in full
force end ettect. Lia x Class p
ContrectoYs Signeture: Da[e:
CONSTRUCTION LENDING AGENCV: ,
❑ 1 hereby aHirtn Ihat there is a construction lendinq agency for �he pertormance of the work for which �his pertnit is issued. (Sec. 3097, Civil Code).
Lender's Neme: Lentlefs Address:
Signelura: Date:
OWNER-BUILDER DECLARATIONS:
I here6y eflirtn Ihat under penalry oi Derjury that I em EXEMPT FROM TME CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7037.5, Business end Pmtessions
Cotle: Any city or counry which requires a permit to construct, alter, improve, demolish, or repair any structure, Onor to its issuance, also requires ihe eppliwnt for such pertnit
lo file a signed statement thet he or she is licensed pursuan� to Ihe provisions oi ihe Contradors License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of the
Business end Professians Code) ar Ihet he or she is eaempt thereirom antl Ihe Desis for the elleged azempiion. Any violation of Sedion 7031.5 by any aDPlicant for e pertnit
sublects the applicent to e civil penalry of not more than tive hundred dollars ($500).):
❑ I, es owner ot �ha property, or my employees wlth wages as their sole compensation, WILL DO TME WORK, and the structure Is not intentletl or offered tor sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of properry who builds or improves thereon, antl who does such work
himselt or �erseli or ihrough his or her own employees, pravided ihat such improvemems are not intended or ottered br sele. tl, however, the building or improvement is
�wltl within ane year of completion, ihe owner-builder will have ihe burden of proving ihat he or she did nat build a improve far purpose of seleJ. �
I, as owner oi the property, am E%CLUSIVELY CON7RACTING WITH LICENSED CONTRACTORS to constmct ihe project (Sec. 7044, eusiness and Pwfessions
Code: The contractors License Lew tloes not apply to an owner of property who builds or Improves ihereon, and who contrects lor such prqect wiih a contrector(s)
license pursuant to ihe Coniractors Li Laws.).
❑ I em eaempt u er sec. Business and Protessions Code for this reason: � �
SignaWre: � •
Expires: �� ��
Verilicati ners p by (rype o1 docu� �.e. - pmperty tan bill or tleetl):
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depih into which a person is requiretl to descenQ will be matle in connection with work aut�onzeC by ihis
permit, and that no Duilding structure, scattolding, falsework, or demolition or dismantling thereof, will be more than thirry-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Ttla B, Califomla Atlministrative Gode).
❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Division of Intlustnal Safery. as noted flbove, unless such person has e
pertnit to do such work fram the division.
Signature:
Division of Indusinal Sefery Permit Number:
Date:
CERTIFlCA7E OF COMPLIANCE AND AIJfHORIZA710N OF ENTTiY: I certity under penalry oF peryury iha� 1 have read Ihis epplication and state Ihat the information given is
correct. I agree to comply wiih all state laws entl ci ordinances relating to building consiruction, antl authonze representa�ives oi the Ciry ot Costa Mesa to enter upon Ihe
ebove-descnbe roperty for inspection p rp s gree not ccupy or allow occupancy of eny 6uilding authorized by this rmit u il final inspection.
Signature Ot Legal O er�s) � �� Dat�
And/Or Authonzed A ant Date
COOE I, INSPECTION TYPE' ' ' ' '
1616 Fixed System Final Fire Prevention
1266 Pool Spa Finel
200 Finel Re-Roof ' '
201 Finel BIocWRetaining Wall _
202 Final Factory Fire Place � "
203 Final Sign _
204 Final Demoliiian _
�_l. �111..
'•^� � QQpg1 INSPECTIONTYPE - �
' 206 Final Mechanical.
20B Final Plumbing
� 210 Final Elacirical. � �
212 Final Fire Prevention
220 Final Planning Approval �
222 Final Site
250 FinalBuilding/Occupancy
�. 1 .1111.
T ,
C�� '
r
�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2302 HALF MOON LN
Suite No
Vicinity: LOT 18
Parcel Nunmber: TPN00515
Applicant: WILLIAMS, GARY
Address: 1450 N.TUSTIN AVE � .
SANTAANA,�CA .
Owner. SHEA HOMES LTD .
Address 603SOUTH�VALENCIAAVE
BREA, CA
�_ ,
Contractor. OWNER-BU ILDER
, �Address: ' .� _ . . .
PLUMBING PERMIT
ISSUED BY:
Status: ISSUED
Applied: 04/O6/2005
Issued: 04/22/2005
Phone: ,714-245-9760 -
Zip: 92705 � � � : � , - .
- . �\
� .
Phone: 714-985-1300
Zip:, 92823
o__ : '
Phone:
2ip: "
License: 000000
�
' SCOPE OF PERMIT'
LOT 18
PLAN 1B �
PLUMBING PERMIT FOR NEW SINGLE FAMILY RESIDENCE FOR "SHEA HOMES". INSTALL 2 � �
�' BATHTUBS, 1 DISHWASHER, 5 GAS OUTLETS, 1 WASHER, 1 PRESSURE REGULATOR, 1 SEWER -� -
CONNECTION, 2 SHOWERS, 1 KITCHEN SINK, 1'SERVICE SINK, UP TO 4 VACUUM BREAKERS, 1'
WASH BASIN, 2 WASH BASIN SETS, 1 WASTE & VENT.SYSTEM, 3 WATER CLOSETS, 1 WATER "
HEATER, t WATER PIPING, & 1 WATER SERVICE. ��- � �_ .
� �� - .J;' . �
REF:BOS-00133 __ - � '" ' � .
� ,� � � FEE SUMMARY"'";. . �=;'i � -
� AMT , ,QTY;--- - .. � - AMT � 'QTY �' _ _ � . � ��� � � AMT QTY
ISSUE FEE - � $23.50 ` � - Laundry Tub / Washer -$9.80 1 Surrip Pump-� , ,' $0.00 0
Backflow irrigatlon $0.00 0��-,..- „ Landscape Irrigalion� �. $0.00 0- .: Swimming Pool� ,� $0.00 0
BackFlow Preventer $0.00� -� 0 ,` -P-Trap � $0.00 0 - _ `�� Trap Primer � = , - $0.00 0
Bathtub �,$19.60 , 2 Pressure Regulator 59.80 1� Urinal �- � � $0.00 0
Clarifier System ��'$0.00 0, - Process Piping (per 10 ft) $0.00 _ 0 � Vacuum Brkr Bkflow(1-4) $12.30 1
Connect Qce,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 , $9.80 1
Dishwasher 59.80 � 1 Sewer Cap for Demo - $0.00 0 Wash�Basin Set $19.60 2
Drein, Floor $0.00 �, 0 , Sewer Connect $24.65 � 1�� � -' Waste and Vent System $9.80 1
Drain, Rainwater $0.00 0� � Sewer Private Line ��- $0.00 0 ' Wa[er Closet (Toilet) $29.40 3
Drain, Roof 50.00 0 ''� Shower $79.60 2-�' -` Water Heater / vent $12.30 1
Drinking Fountain $0.00 0 Sink, bar - - �$0.00 -� 0" Water Piping (Inst or Rep.) $9.80 1
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremanis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a penod of 780 days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inapactions and final approval must be obtained. Failure to obtain inspections and final approval will resufl in ihe expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
2406-4fi (fY00)
WORKERS'COMPENSAnON DECLARAnON: • �
I hereby ettirm under penelry ot perjury one of the tollowing declarations:
❑ I heve end will meintein e certificete of consent to sel4lnsure lor workers' compensation, as provided for by section 3700 of �he Labor Cotle, for �he pertortnance oi �he
work for which IM5 pertnit is issued.
❑ I have end will ma�ntain workers' compensetion insurence, es requlred 6y sectlon 3700 of the Lebor Cotle, for ihe pertormance of fhe work for which Ihis pertnit is issuetl.
My workers' compensation Insurence carrler end policy number ere:
Carner. Policy Number:
(This section n9ed nof be completed i! the pertnit is velued et one hundred dollare ($ f 00) or less.)
❑ I certity that in ihB Pertormance ot Ihe woik for which this pertnit is Issuetl, I shell not employ eny person in any manner so as to become 5ublect Io ihe workers'
compensation laws o� Califomie, entl egree Iha� If I should hecome subjecl Io iha workars' compensetion provisions ot Section 3700 of �he Le6or Cotle, I shall torthwl�h
comply with these provisians.
Applican� Signature: Dete:
WARNING' Fr11LURE TO SECUPE WORKERS' GYMIPENSATION COVEPAGE IS UNLAWFUL AND SHALL SUflIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
hKK15AND DOLURE (51�.�). IN ADDITION TO THE COST OF COMPENSATION, DAM/ GES AS PROVIDED FOR IN SECTION �O6 OF THE 1A80R COOE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTOFS DECLARA710N:
I here6y attirm that 1 arn licensed under provisions of Chapter 9(commencing with Seclion 7000) of Division 3 of tha Business and Professions Code, and my license is in full
torce and ettect. Lic. • Class a
COMractor s Slgnature: Data:
CONSTAUCTION LENDING AGENCY:
❑ I hereby attirm Ihat ihere i5 a COnS�ruction lending agency br ihe pedormance oi �ha work tor which �his permit is issuetl. (Set. 3097, Civil Cotla).
Lentler's Name: Lender's Adtlress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereDy aftirm that under penalry ol perjury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for iha following reason (Sec. 7031.5, Business and Professlons
Code: Any ciry or counry which requires e permit to construc6 eltar, improve, tlemolish, or repair any stmcture, prior to its issuance, also requires ihe applicant for such permit
lo tile a sig�ed slatem0nl that he or she is licensed pursuenl to the pmWsions ot the Conlraclors Ucense law (Chapiet 9(commencing with Section 7000) ot Div�sion 3 of ihe
Business and Professio�s Code) or Ihat he or she is exempt Iherefmm entl the basis for the alleged exemptlon. Any violetion of Section 7031.5 by any apPlicant for a pertnit
�s ts ihe epplicent to e civil penalty of not more Ihan five �untlred tlollers ($500).):
, as own ol the p�operty, or my employees with w Wkeiwole compensatlon, WILL DO TME WORK, antl Iha structure is not intentleC or offered for sala (Sec.
�' 7044, siness a tl Professio ontractors License Law does not appty to an owner of pmperty who builtls or improves Ihereon, antl who tices such woM
hims or is or her own amployeas, provided thel such impmvemenis ere not intended or oHereO for sale. If, however, the huiltling or improvement is
�soltl within one y�ar of completion, t�e owner-builtler will have tha burden ol proving that he or she tlitl not build or improve for purpose of sale.).
I, as owner of the Property, am EXCLUSNELV CONTRACTING WITH LICENSED LONTRACTORS to constmct the Oroject (SecJ044, Business and Pmfessions
Cotla: The contrectore License Lew does not epply to an owner of property who builtls or Improves Ihereon, antl who conifacis for such OrOleci with a contrettor(s)
license pursuani lo ihe Coniractors License Lews.).
❑ lam
by
� Business antl Professions Cotle �or �his reason:
� �-/ 2Z pS
5 ❑No � -�� ires �
i.e. - propeny tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certify Ihat no exwvation five (5) or more teet in tlepth into which a person is required to descen4 will be made in connedion with work authonzea by ihis
permit, antl �hat no builtling s�ructure, scaXoltling, falsework, or demolition or dismantling ihereoi, wiil be more than ihirty-siz (36) feat high. (Chap. 32, Gry 2, Art 2, Sec.
341, Ttle B. CalifP�nia Atlministraiive Code�.
❑ As owner-builder, � will not employ anyone to do work which woula require e permit from the Division of Industnal Salery. as notetl above, unless such person has a
pertni� to do such work from the division.
SignaWre: Date:
Division of lndustriaf 58�ery Permit Number.
CERTIFlCATE OF COMPLIANCE AND AUfHORIZA710N OF ENTRY: I cenify under penalty ol perjury �hat I �eve read this application antl state Ihat t�e information given is
wrrect. I agree to wmp�y with all stet lews end city ordinences rela�ing to building construclion, entl euthodze represenla�ives ol iha Ciry of Costa Mesa to enter upon �he
above-descnbe ropeliy lo insp �poses. I e e �o� �o occupy or ellow occupency of any building au�horized hy this permit unlil final inspection.
—s9�a-- s .. L b�w
n0f0 orized icant Date
CODE � IFSEELAONTYPE
7fi76 Fized System Final Fire Prevention
1266 Pool Spe Final
200 Final Re-Roof
201 Finel BIocWRe�aining Wall
202 Final Factory fire Place
203 Finel Slgn
204 Final Demoli�ion
Q��
�
INTRIALS
CODE� INSPECTIONTYPE
206 Final Mechenical
20B Final Plumbinq
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval'
222 Final Sila
250 Final BuilainyOccupancy
D�TE
�Z io
(714) 754•5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
2302 HALF MOON LN
LOT 18
MECHANICAL PERMIT
Status: ISSUED
Applied: 04/O6/2005
Issued: 04127/2005
. ._--- -�;��-:n�; ._, �
Parcel Numbec TPN00515 - "_ _',-"`���t,-';;= ^Y. i.'�-�� ISSUED BY:
Applicant CORTEZ, JEN . � �.� � � ( � ,� � t ��• �� A � ��� �.' �
, � r, , � , , ,
Address: J L HARE�.;. '-_ :�. _(_,� 1 . � ' '� / ! A�;�._�"
SANTA ANA; CA � i �. �1� `. , , � � , - / \ y ��� .: � .
� , �Phone 714-245 9760 i��� ,
� , .
,�1450 N TUSTIN AV, STE 105�; �'% _•Zip: . -� 92705 � _ ' `�- � � � i A �� z \�
f ,. A � %rv -'- ' _' � ; r .f . . .� , �
� - ,.l � i � � , rr.'. .�,� %�'� � � .;,r^.. <.t - � � .�`.
Owner' SHEA HOf41ES LTDr � �`,;t �,:%�` j ; � ` �'��
.,. � l. i / /°`"%i �'�`� . , �_ r ���"^��
Address� 603SOUTH,VALENCIAAVE � -�-`�i A ` �
',. / ' � ,,.�.`,\� .' i ; � �; � .
� - �' Phone: 774-985-1300 � � /
,°� , - ,
- �: ���' BREA. CA.:� Zip: r92823 -`-': ��� � � � � ,
i .
, �'� :� - � . _ . �. ` , � � .
� Contrecror OWNER-BUILDER - .. ,.. '
- ,r . � �. t ,y. ';� . �� � r .
- H Addf055 r �� � ' r� ji � d �� -" , �` . t ' . �.,�' ��' '
. ! rt. � , � . r �t�?a m� � Phone ` � . _ . . , . , � ,- t _
'.b ,. ,_ t ,,l , .z�`,f . - . _. , . .��, ' - , _ .
'�
. . �', �� ,.Zip:
� : .;
.�� �,,,� License:000000
r���, , �-"�
�
�'. h '
� 'i
,/ �
_ _ - - ` SCOPE OF-PERMIT- _ � ,
.{LOT�78/PLANIB�i _�7"��•T� '.4 .-���_ ��r � �—, � .
.. � ' � �il. '1 . .. - "� _ t i- �_.a ! :. . . . ,
` MECHANICAL PERMIT'FOR NEW 2257 SF SINGLE FAMILY RESIDENCE FOR�"SHEA HOMES". .+, '�
�-';;INSTALL 2 FAU'S, 1 DUCTWORK, 3 FACTORY FIREPLACE, 5 FENT FANS, 3 FIRE DAMPERS,-' `- o� ',,
��, .'& 2 A/C CONDENSORS.y. -. i.s , / , � � ; .
,., . �..,r' ,.-_.. ��--•� ._ i[ . - '�
` _. .. �. i "s'>- ' 1 r
�S REF: B05-00133 "' � ' -" � � "_ � � �=� � '
}� .. � � . . , �� _. _.. . if ..� "_�..,..� •
` 1 i�
,-
r
� �� , �.
�� � ��
' �� ' � �� FEE SUMMARY- ,° � � %� '� ,� „+� -
. • . Quantity . - � ` -. -�- , ,�. � " -� Quantity
ISSUEFEE � $23.50 ,.Repair/AltAbsorbtionUnit i�.��j ,�$0,00 ; 0',:i -
. '.�:: _
InstFAU<t�00�k.BTU'� �� $29.60 2 Y��_�'��,r�..iRepair/AltRefrigerationUnit� -'%�, �$0.00� 0;��.
Inst FAU >100 k BTU �� $0.00 0 ' Ventillatio�System � � °,� , $0.00 - 0
Repair/AltCooling/Heat� ��A'$1370 1 ` r:.Evaporatlye�Cooler . ��'/ \^$0.00�r0,�
Inst/Rep.RecessWall+Hfr ��`:$000;�",O�.:tiSt i� �rCommercial�Incinerator�,�;:,5-�.�/ l."'$OOO��r��0
Refrig Sys <100 k BTU �`$0 00 0 „�' - � ��Domestic Incinerator t� , �' ^�'-i/ / $0 00� � 0
Refrig Sys >100�k BTU � /� � $0 00 bQ� �`�> �Comoressors / Absorptiori.Svstems ; j - 1`"� `
Gas Piping �� �'� - -'�,$0 00 � 0 \ , °Up to 3 hp / 100 K�BTU��F ��y �-� ' j $0'00 0
Factory Fireplace . � � . , $31.95 �3 �� _ ; �3 To-15 hp /�500;k BTU' / �; � � , ` �� �% 50.00 0
Hood w/Mech Exhaust �. � � $0.00 . �0 �-�-�5 To'30,hp�/-1;000 k BTU.. �. i , � �, l,i /$0.00 0
VAV Box � �ti �`$0 00 � 0 , - - -�_30 To�50'hp % 1,750 k BTU -,y_. ii '.'� � $0.00 0.
VentFan7SingleDuct "��53625� rJS�' \� � Over501hp/aOver1,750BTU ; �� _���� $0.00 �0-
Appliance �`.$000 0 � '�,�� �� �� �, s "-Boilers' �1,`��� -'
Fire Dampers 4"$21 75 �� 3 �� � t; +�-Up to 3 hp,---�,�.. -�' -' r'� � $29.40 2
Smoke Dampers $0:00' �'0` � � �:. ', ,;: -3So 15 hp" ' '�''�'' $0.00 0
�--�:.; - �,.�
Inst or Relocate Appl Vent $0.00 '"0; � �'� — - - 75,to 30.hp��,, � � , $0.00 0
Air Handlers < 70000cfm $0.00 0 � - � _ - . ,�:30 to"SO�tip . `` � $0.00 0
Air Handlers > 10000cfm $0.00 0 "� � --0ver SO�hp $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiraments under Califomia statutes and related
regulations. (Ord. No. 92-28, §�1, 1241-92)
� EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or il work is suspended or abandoned
for a period of 1 H0 days. .
INSPECTIONS: In order for the work authorized under this permiLto be considered�legal, such wark must comply with all applicable codes, and all
required Inspeetlo�s and.ftnal epproval�must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545826
2C46C8 (W00)
WORKERS'COMPENSAnON DECLARAnON: — - � � � ' ' '
I hereby aflirm under penalry of perjury one ol the following declarations:,' �� , , •� .' �"' . '
❑ I have entl will maintain a certificete of consent to self-Insure for workers' compensetion, es provitletl for�by section 3700 of the Labor Code, for ihe pertortnence of lhe
work lor whlCh thi5 permit is issued. '' ' �' ' " ' ��
❑ I have antl will main�ain workers' compensation insurance, as required by section 3700 of the Lahor Code, for the peAortnance of Ihe work for which this�pertnit is issued.
My workers' compansation Insurance carder end policy number are: ' � � .
Carrier. Policy Number:
(This section neetl nof be complered il the permit is velued et one hundred dollars ($100) or less.)
�I certity thet in t�e pertortnence of the work tor wh' h his pertnit is issued, I shall not employ eny persori in any manner so as to become subject to ihe workers"
compensation laws of Calitomia, and agree tha ould bec me subject to ihe workers' compensation provisions of Section 700 of the Labor Code, I shall tonhwith
comply with Ihese pro 9 s. � � �
ApplicaM Signature�L� Date: Y� 7 O�
WAqNiNG: FAILURE T�SECURE RS' COMPENSATION GE IS UNLAWFUL AND SHALL SUflIECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDPED
Ti1011SANDDOLLRRE(6� DRIONTOTHECOSTOF PENSATION,DAMAGESASPROVIOEDFORMSECilON31060FiMELABOqCWE,IMEREST,FNDATTORNEI"SFEES.
LICENSED COMRACTORS DECLARATION:
I hereby ettirm Ihat I am licensed under provisions ot Chapter 9(commencinq with Section 7000) of Division 3 oi ihe Business and Professions Cotle, and my license Is In full
foroe antl eHect. Lic. x Class #
ConlrectoYs Signawre: Date:
CONSTRUC710N LENDING AGENCY: .
❑ I hereby ettirm that there is a wnstruction landing agency for ihe peAormance ol ihe work tor which ihis pertnit is issued. (Sec. 3097, Civil Gode).
Lendefs Neme: Lender's Adtlress:
Signeture: Date:
OWNER-BUILDER DECLARA710NS:
I hereby aRirm that under penalry ot perjury lhat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, 8usine55 end Protessions
Code: Any ciry or counry which requires A permit to construct, alter, improve, tlemolish, or repair any structure, pnor to its issuance, also requires Ihe applicant for such pertnit
�o file e signed stetement that he or she Is Iicensed pureuent to ihe provisions of ihe Contrectore License Law (Chapter 9(commencing with Section 7000) of Division 3 ot ihe
Business end Professions Cotle) or thet he or she is exempt therefrom and ihe besis for Ihe elleged exemption. Any violation oi Section 7031.5 by any epplicant for a parmit
subjects the apDlicant to a civil penelty of not more �han five huntlred dollars ($500).):
❑ I, es awner ol the property, or my employees wlth weges as thair sole compensetion, WILL DO THE WORK, end ihe sWcture Is not intentletl or oflered for sale (Sec.
7044, Business and Professions Code: The Coniractors License Law does not epply to en owner ot property who builds or improves t�ereon, and who does such work
himselt or herself or ihrouqh his or her own employees, provided that such improvements are not intended or oflered for sale. tl, however, the building or improvement Is
sold within one year of completion, the owner-builder will have ihe burden of proving ihat he or she did not build or improve for purpose of sale.). �
�I, as owner ot the property, am EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construcl lhe prolect (Sec. 7044, Business and Professions
Code: The contractors License Lew does noi gpplyto an owner of propeny who bullas or improves thereon. and who contwcls for such project with a contrector(s)
license oursuanLto ihe Coniractors License 14w9�'
❑ lem
Owner I�v
Venficetian
58C.
(rype af document, i.e.
lax 6ill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Pmfe55ion5 Code for this rea5on:
Driver's License No.
Expiras:
❑ I hereDy cetlity that no excavetion tive (5) or more teet in depth into which a person is required to descentl, will be matle in connec�ion wilh work auihonzed by this
permi6 end Ihat no building structure, scettolding, talsework, or demolition or dismantling ihereof, will be more than ihirry-six (36) fee� high. (Chap. 32, Gry 2, Art 2, Sec.
341, Ttle B, Celifomia Atlminisirative Code). ,
❑ As owner-builtler, I will not emplay anyone to do work which would require e permit from Ihe Division of Indusinal Sefery, es noted abova, unless such pereon hes e
permit to do such wark irom ihe division.
Signature: Date:
Division ot Industnal Safery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF EMRY: I certify under penalry of Derjury that I have read this application and state that the information given is
correci. I egree to wmply with all state la §q tl city ordinances relating to builtling cons�ruction, end authonze representaiives oi the Ciry of Costa Mesa to enter upon Iha
ebove-descn property for inspe ion dses. I agree to occupy or allow occupancy of any building authorized b%y �is perry M1 until finel inspection.
` S�/L" %/O �
ignature Of L, Own ) ��' Dete �
Antl/Or Aut Applicant Date
CODE 6 INSPECTIONTYVE " ' - -' � ' ^ � ' PdIE " "' INTIf11L5
1616 Fized System Final Fire Rrevention '
1266 Pool Spe Finfll
200 Finel Re-Rooi � � "' - �
201 Finel Block/Retaining Wall
202 Final Factory Fire Place '
203 Final Sign
204 Final Demolition
COOEI INSPECTIONTYPE' -
206 Final Mechanical
208 Final Plumbing
210 'Final ElecMc21 : �
212 Final Fire Prevemion
220 Final Planning Approval
222 Final Site �
250 Final Building/Occuparicy
. [2�2D/S
��