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HomeMy WebLinkAbout1851 PAROS CIR - Building Permits Y l • . %OP ' CITY OF CdS1'A MESA 4 BUILDING DIVISION a PE IT NUMBER F t jam DEVELOPMENT SERVICES DEPARTMENT I PERMIT B07-00444 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BWLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1851 PAROS CI Status: ISSUED Suite: Applied: 04/11/2007 Vicinity: Issued: 04/11/2007 Primary Occ: R3 Type of Construction: V-N Parcel Number: 13942122 Zoning: R1 Applicant: LIZA ZOSCACK Address: 24512 BRIDGER RD Phone: 949-338-4189 ISSUED BY: �. LAKE FOREST,CA Zip: 92630 Owner: COOK, EUGENE F Address 1851 PAROS CIR Phone: 714-546-2615 COSTA MESA,CA Zip: 92626 Contractor: SWAN POOLS OF SOUTHERN CALIFORNIA Address: 24512 BRIDGER RD Phone: 949-859-8466 LAKE FOREST,CA Zip: 92630 License: 440333 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: • SCOPE OF PERMIT INGROUND GUNITE POOL AND SPA. FEE SUMMARY Plan Check: $300.59 Calc Valuation: $32,000.00 Permit: $462.45 Claim Valuation: $32,000.00 SMIP Res: $3.20 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 . Total: $766.24 PLANNING &ZONING 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 r'. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) DECLARATIONS 1 'k-) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My w c s'compenSati n Insuran 1 carder any \y number are: Cartier: C.) 1,N Policy Number: 'bD C>310-2-0( (This section need n e completed if the permit Is valued at one hundred dollars($100)or less.) O I certify that in the pert. once of the work for !eh this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation la s of V, Ilfomla,and agree that f I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the : p .f^ ID Applicant Signature: j b Lfi . Date: L4 41-D7 WARNING:FAILURE TO S:• RE A••KE 'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLL ARE($lO0.000),IP,•ORION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am li :n.:• -,a ' ••n5Chapter 9(commencing with Section 7000)of DMsion 3 of the Busi rofessions Code,and my license is In full force and effect.tic.N 4 - Class it Contractors Signature: �ai l Date: CONSTRUCTION LENDING AG.- CY: • ❑ 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). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than 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.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous ' material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ... t file a registration 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? 0 Yes LI No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes• 0 No 6 (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 COMPUANCE 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-desc ed property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by/this/permit until final inspection. itSIgnati et 1.0 •, nor s) �y �f'I aQaf� a6/ An.s.• zed App can I ( /(,Datee IP COPE r INSPECTIONTYPE PATE j(fimAL$ CODE INSPECTION TYPE 2AIF EMUS 1616 Fixed System Final Fire Prevention T_ 206 Final Mechanical 7- l 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Flre Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 03/27/07 14:51 FAX 714 708 1919 CDFA/RIFA • COSTA MESA 0001/001 Mar. 22 . 2007 3 : 52PM S' POOLS No.4147 P. 1 ceope• nbve Red Imported Fire An P} -Fie_ Z � , yr3 Cf C2r _Until?:7Qr of enM to ove Soil from orrf tiri tQ'ia arztize - kre S ; rrO zge, Riverside; s A and Longeles Counties • .. .. >„ rte pt,--„,_,_ 4.91F11 eraser- l :ate - . .=_neo _r°iT 3 a' f" F _f ' ) _��` L -- _ - / f# . `1 , _rte:_ pi-741=7Z . ... _.w...... c a • • a:-e T?a^ ni Cly p-,-rnfi-nwi rr UGil!,5; Ci-L - - VW '>`r I rib'T 7 tw SO-_. f .moi. J .i •-Tti.t,�.z�:Jy^i D_�r AND The:. a T^' l 'e v — ren •t - t. 1-, _ +._•-, ..giro- ” . i 3/97/9 03/22/07 TRU 14;31 [T%/R% NO 8785] ,411 CITY OF COSTA MESA BUILDING DIVISION >2k•.,,,, r• DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER `e. ' PERMIT IPA N M07-00186 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1851 PAROS CI Status: ISSUED Suite No Applied: 04/11/2007 Issued: 04/11/2007 Vicinity: Parcel Number: 13942122 ISSUED BY: Applicant LIZA ZOSCACK Address: 24512 BRIDGER RD Phone: 949-338-4189 LAKE FOREST,CA Zip: 92630 Owner: COOK, EUGENE F Address: 1851 PAROS CR Phone: 714-546-2615 COSTA MESA,CA Zip: 92626 Contractor: SWAN POOLS OF SOUTHERN CALIFORNIA Address: 24512 BRIDGER RD Phone: 949-859-8466 LAKE FOREST,CA Zip: 92630 License:440333 SCOPE OF PERMIT INGROUND GUNITE POOL AND SPA. REF B07-00044 - - ' 1 HEATER>100K BTU FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 . Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $18.20 1 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 • Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 -0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/.1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 - . Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp- $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00- 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000dm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 • TOTAL CALCULATED FEES $41.70 COMMENTS/SPECIAL CONDITIONS / NOTICE: The work authorized by this permit shall comply with all applicable handicap access'requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended.or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 '2446-48(WOO) . A WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: C. I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the \— work for which this permit Is issued. 9 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. tl My w em'compen tion Instance card a d policy number are: /� �7.,QO Carrier: C� y f�j Policy Number:l ,,DO 7 D✓0 I (This section need be••mpleted d he permit Is valued at one hundred dollars($100)or less.) 0 I certify that in I e pc,'ormance 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 Is A.alifomia, :nd =gr..th=t if I should become subject to the workers'compensation provisions of Sectio 3700 of the Labor Code,I shall forthwith comply with then ,TI ' / ` I ! �I/I' A 7 Applicant Signature: ! I/ ( i Date: 1_A1 ' v WARNING:FAILURE TO CUR: `•RKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000 ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am tic n u t{ vis n f Char7pter 9(commencing with Section 7000)of Division 3 of the Busines Bions Code,and my license Is in full force and effect.Us.atu N lJ `f Class M –� Contractors Signature: ,vl� p _?. Date: • CONSTRUCTION LEN NG NCV: �/ ❑ I hereby affirm that there' a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Lew(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: • HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to filo and certify a Business Plan for emergency response to release or threatened release of a hazardous materiel? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ _ _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑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 hes on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes A No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descri ed property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 7M Si na OVeg Ow ens), 4/1 to An uthodze App ant Date CODE I INSPECTION TYPE all IITmALS CODE 1 INSPECTION TYPE . 1616 Fixed System Final Fire Prevention 206 Final Mechanical T� M 1266 Pool Spa Final 208 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 9 CITY OF COSTA MESA BUILDING DIVISION F �C.„�, ,3�,� / DEVELOPMENT SERVICES DEPARTMENT PE NUMBER PERMIT P07-00218 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaP UMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1851 PAROS CI Status: ISSUED Suite No Applied: 04/11/2007 Issued: 04/11/2007 Vicinity: Parcel Nunmber: 13942122 Applicant LIZA ZOSCACK • Address: 24512 BRIDGER RD ISSUED BY: Phone: 949-338-4189 LAKE FOREST,CA Zip: 92630 Owner: COOK, EUGENE F Address 1851 PAROS CIR Phone: 714-546-2615 COSTA MESA,CA Zip: 92626 Contractor: SWAN POOLS OF SOUTHERN CALIFORNIA • Address: 24512 BRIDGER RD Phone: 949-859-8466 LAKE FOREST,CA Zip: 92630 License: 440333 SCOPE OF PERMIT INGROUND GUNITE POOL AND SPA. REF B07-00044 1 SPA AND 1 POOL FEE SUMMARY AMT QTY • AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $60.75 1 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0. Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo , $0.00 -0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 • Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar • $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0- - • Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $30.25 1 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $114.50 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections 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 2448-46(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My wricr'co`mOpensat n Insuran a carder an Iicy number are: (1 1\6-103C _ 2 a C mer: I' \IAM/8tLc i 1 MS Polity Number. `'�v�10J D o� (This section need rJgObe completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the pa rnance 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 I ws o lifomia,and agree t t If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the e 51 /"'I �w/ //� Applicant Signature: 4"_� / Date: U 4)- (/7 WARNING:FAILURE TO CUR ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100, ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COOE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.4 Class 0 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). 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 county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a-permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her 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,em 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 propeny who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 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,talsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safely Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). _ __ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No _ (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time hes on hand a quantity of acutely hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 or will thebuilding applicant or present or future 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 Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No . (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 47) ' Signet/ur•Of Legal i ner(s) i //�Jga1Jq/ An• /�Ih 1' -• . t II Dale CODE It INSPECTION TYPE PATE IHTmAL$ COPE! INSPECTION TYPE PATE P1TUAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical /� x-14 1266 Pool Spa Final 208 Final Plumbing M[9 7' 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • 'S CITY OF COSTA MESA 4 a BUILDING DIVISION >:<<,,,z'' , DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER F I Ka Itx PERMIT 11s` E07-00305 .),,,„ se (714) (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesad TRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1851 PAROS CI Status: ISSUED Suite No Applied: 04/11/2007 Vicinity: Issued: 04/11/2007 Parcel Nunmber: 13942122 Applicant:ddressLI512 ZOSCACKGERR Address: 24512 BRIDGER RD Phone: 949-338-4189 ISSUED BY: LAKE FOREST,CA Zip 92630 Owner COOK, EUGENE F , Address 1851 PAROS CIR 'Phone: 714-546-2615 COSTA MESA,CA Zip: 92626 Contractor: SWAN POOLS OF SOUTHERN CALIFORNIA' Address: 24512 BRIDGER RD Phone: 949-859-8466 LAKE FOREST,CA Zip: - 92630 License:440333 . - SCOPE OF PERMIT . INGROUND GUNITE POOL AND SPA. B07-00044 FEE SUMMARY Quantity - - - Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 • • ' Transformers up to 1 kva/kw $0.00 0 Pool/Spa $49.50 1 - - - up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 ' 0 up to 50 kva/kw $0.00 0 Recept Outlets - $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 • Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 - 0 Service to 200a $0.00 0 .- :Misc.Conduit $0.00 0 Service to 1000a $0.00 0 - - Misc.Conductor $0.00 ' 0 _ Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $000 0 Motors to 10hp $0.00 t. 0 . Christmas Tree Stand . •• -, $0.00 0 Motors to 50hp $0.00 0' Fireworks Stand $0.00 0 Motors to 100hp $0.00 - 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 - Investigation Fee $0.00 Sub panel to 200a $0.00 0 . Plan Check Fee ' $0.00 Pole Light Pkg $0.00 0 - Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $73.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 7:I NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related .regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance the work for which t is permit is issued. • #.6 My c/`orlmp s to Insurancvirdar an polity numb �0-3 ,\ I r: �.'WCi are: oli umber: (� 000 V (This section need not be complet If t e permit is toed at one hundred dollars($100)or less.) ❑ I certify that in the .ed., ance of the work for Ich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation la . of •alifomia,and agree the i I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith mpy 'th rhes:pr•`' to licanf Wm •' //i L - ate: 1 --I I L/� WARNING:FAILURE TO S"UR •RKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000,1 ADDITION TOME COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I I hereb - - Ilene• n.e •r• 's'••S of Chapter 9(commencing with Section 7000)of Division 3 of Ih: rofessions Code,and my license is in full f. cean• a A - Y • factorsSignature: r�'� / Date: •--�� i I' n CONSTRUCTION LENDING AG-e Y: ❑ 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). 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 county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her 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 properly who builds or Improves thereon,end who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code), ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person hes a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia 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 it reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2—Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0 N (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the Califomia Health and Safety Cale 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? 0 Yes 0 No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (if'yes",attach certificate of compliance front 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,end authorize representatives of the City of Costa Mesa to enter upon the above-despribed property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. AklCid' y y! SI, LODal'sf e ne LI I 1,7 i6 CODE t INSPECTION TYPE WI INTRIALS coast INSPECTIONTYPE -------- � WEE INTmALs 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ' 9 CITY OF COSTA MESA BUILDING DIVISION F �' DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER PERMIT J M01-00603 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1851 PAROS CI Status: ISSUED Suite No Applied: 12/14/2001 Issued: 12/14/2001 Vicinity: /� Parcel Number: 13942122 ISSUED BY: V '%- Applicant: BROWN,BARBARA Address: 1401 BAXTER ST - . - . Phone: 310-253-5229 - ANA;CA ' - • Zip: 92806 Owner: COOK, EUGENE F , Address: 1851 PAROS CIR - . Phone: COSTA MESA,/CA Zip: 92626 . . Contractor: ALASKA AIR • Address: 1401 BAXTER ST - Phone: 310-253-5229 - ANA,CA . . Zip: 92806 , License: - • SCOPE OF PERMIT C/O 1 FAU< 100K BTU. - - FEE SUMMARY ' Quantity Quantity ISSUE FEE $23.50 _ , - Repair/Alt Absorbtion Unit . . $0.00 0 Inst FAU<100 k BTU $14.80 1 _ _ Repair/Alt Refrigeration'Unit $0.00 0 InstFAU>100 k BTU $0.00" 0 - Ventillation System - $0.00 0 Repair/Alt Cooling/Heat $0.00 0 • Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Ref rig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 . Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 •. -3 To 15 hp/500 k BTU , $0.00 0 Hood w/Mech Exhaust $0.00 0 • 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 - 30 To 50 hp./.1,750 k BTU $0.00 ' 0 Vent Fan/Single Duct $0.00.: 0 ' Over 50 hp/Over.1,750 BTU , " - $0.00 0 Appliance . $0.00 0 Boilers - , Fire Dampers $0.00, 0 Up to 3 hp $0.00 0 • Smoke Dampers - $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent - $0.00 0 15 to 30 hp - , $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp , $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee - 'i Floor or Suspend Heater $0.00 . 0 Investigation Fee $0.00 . Plan Check Fee $0.00 - . . Reinspection Fee - - . $0.00 , . , '' TOTAL CALCULATED FEES $38.30 • COMMENTS/SPECIAL CONDITIONS // NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. / INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to sell-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. L.-I have and will m intain 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 worker's pen nlnsu c)carrier,7antl policy number are: ��/�• � �`�_Q/ Carrier: S/// // Policy Number: (This section need no be completed ll the permit is valued at one hundred dollars($100)or less.) O I certify that in the performa c.of the work for which this per it is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califor and agree that if I should becbme subject to the workers''_-:. .• .ovisions of Section 3 00 of the abor Code,I shall forthwith • compl w' • ese prov ., _ _isioy r , "" / Aii Date: 'tsp. '- • - •SECU" WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT •` - • -IMINAL-•NALTIES ND CIVIL FINES UP TO ONE HUNDRED THO AND DOLLARE($1Kapok IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: e rT'LL s:nsed under.rovisions of Chap'r• (comme cing col Section 700• • the Business and Professions Code,and my license is in full GJnn. \ %111A CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,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.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 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,Gm 2,Art 2,Sec. 341,Title 8,Califomia 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: I Will the applicant or preset or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to tile a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application 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 Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air 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? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. j� .7Sigrl&t�Of Legal O ner(s) 2 Date I / `a- CODE t INSPECTION TYPE QaIE 1NIr1ALS CODE( INSPECTION TYPE 1 PAIS J.NTITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical cz r'[.".]7 LL 1266 Pool Spa Final 208 Final Plumbing -. 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place - 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy s ( 8242 . COSTA MESA BUILDING-SAFETY DEPARTMENT "^V 21-67 PkelMA C782 **** •Sfl P. O. BOX 917 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING AUDRDJ 85 / 03N n c . 7/ LL ,h / COSTA MESA. CALIFORNIA For Office Use Only S �G� l RECEIPT NO. I PERMITMINO. OWNER Iri?4ZMAILJ/ RE D BY /EIV/ED A E BADDRESS J( C3 Af'V07etry _ �C� I, 7/'�}�2-I NOV 2. 3 1 b2 //JJ ��/// TEL. p / BUILDING CITY (7e.--s-77,- SEC,* NO /(6996 _ ADDRESS ARCHITECT ' TEL. COSTA MESA. CALIFORNIA I OR ENGINEER 1/(ate 4/ffYENtiee,IN02�1-330/ )� J ADDRESS XiAr'c /-en > : . //%9Men.-H ZONE TYPE 1' GROUPVY CONTRACTOR,SZyV ST. C APPROVEDBY /DATE 3 i , ADDRESS/65 'vnC/� y'-1�. ZONING I II'/ /J {��5� ZO NO.OF USE OF NEW./)4t`I /.' �/1 CITY `✓. ?rw--Y �//'/ /,['/D p • rL-V J I I PLANS T j H BUILDING (I/v IIINNNq42 BTC.NO. /// I/ 3 NO. / I/ /O5/ L DESCRIPTION /O/ 3 "7( �J ,/AAAIII/ SIZE � // NO. OF BLDG°. __. /y�- OF LOT !J D /I/o ` NOW ON LOT A.P.NO. ^^ USE OF YARDS ` ! ��'VVV VV EVES EXISTING BLDG. APPROVED ALLOWED SETBACK LINE FROM _ (CENTER LINE ST.) L CENTER OF STREET '` REAR YARD FRONT ,J [9FT. IN. SIDE YARD I LEFT I RIGHT r} R.SIDE J FT. IN. DESCRIPTION OF WORK L.SIDE �FT. IN. X y� NEW I / II ALTERATION I II ADDITION REAR 0 FT. IN. q REPAIR I II MOVING II DEMOLISH I APPROVED' , l_ /� TE /I'" y'"-�.' v BUILDING 2 NO. OF �J IVI_/ ll a/f/I SIZE /6" / ROOMS / STORIES / EXTERIOR WALL(`•�} ROOF �I -�<_ COVERING `+JF-lt C.? COVERING USE OF BUILDING AND WORK TO BE PERFORMED ,E-C-4..<„-Ctz. ilk /9 C 9-414.—/ itfr J /y52 °'J1 - 41ey.D I HEREBY ACKNOWLEDGE THAT I 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 ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. �j) VALUATION /a SIGNATURE OF l y�7f // PERMIT FEE $ ( PERMITTEE �-111///�/�'�(�?/�ST LN �^ w $/t1,3/— PLAN CHECK $ ,J/i 52 lh AUTHORIZED AGENT TOTAL FEE $ 9/,s-e E