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Home My WebLink About515 PIERPONT DR - Building Permits(714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 515 PIERPONT DR Suite: Vicinity: ADDITION BATHROOM AND FAMILY ROOM Parcel Number: 41803404 Applicant: WOLF, JOSEPH A Address: 515 PIERPONT DR COSTA MESA, CA Owner: WOLF, JOSEPH A Address 515 PIERPONT DR COSTA MESA, CA Contractor: OWNER-BUILDER Address: Zip: Arch : Address: Zoning: R1 R1 Phone: 714-979-4519 Zip: 926263708 Phone: Zip: 92626-3108 Phone: License: 000000 Eng: Address: ISSUED BY: Stalus: ISSUED Applied: 09/20/2002 Issued: 09/20/2002 Phone: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 579 SF FAMILY ROOM.CREATE A NEW BATHROOM. INCLUDES A WET BAR — SMALL BAR SINK ONLY OK. WIDE OPENING CONNECTS DEN TO HOUSE (NOT JUST A MAN DOOR). Plan Check: $436.64 Permit: $671.75 SMIP Res: $5.35 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,113.74 SETBACKS MAIN STRUCTURE Fron[ 20- 0 ACCESSORY Front 0- 0 PARKING Existinq: a NOTES: Rear 0- 0 Rear 0- 0 Reouired: 4 FEE SUMMARY PLANNING R ZONING Left 5- 0 Left 0- 0 Proposed: 4 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 $53,499.60 so.00 NOTICE: The work authorizad by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlrad Inspections end final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 � C / 246&681fl/00) V � WORKERS' COMPENSATION DECLARATION: I hereby effirm under penalry of perjury one of lhe following tleclarations: ❑ I heve end will melnlain a certificata of conseni to sell-Insure for workers' compensetlon, es provided for by sectlon 3700 of the Lebor Code, tor the peAormence of the work lor whith thi5 pertnil is issued. ❑ I heve antl will malntain workers' compensetion Insurance, es requiratl by sectlon 3700 0l the Labor Code, br the petlortnance ot ihe work tor whlch this permit is issuetl. My workers' compensatlon Insurance cerder and policy number ere: Carner. Policy Numbar: (Tbls sectlan need nat be comp/efed i! fhe permif is velued ef one hundred dollers ($ f00) or less.) ❑ I certity Ihet in Ihe peAortnance ol �he work lor which this permit is issued, I shall not employ eny person in any mflnner so es to hecome subject to Ihe workers' compensatlon laws of Calitomia, entl egree that II I should become subjeU lo lhe workers' compensation provisians of Sectlon 3700 of the Lflbor Catle, I shell forihwith complY with Ihese provisions. Applicam Signature: Date: WARNING: FNWRE TO SECURE WOHKERS' COMPENSATION COVERAGE IS UNLpW FUL AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FlNES UP TO ONE HUNORED T1iIX1SAND OOl1ARE (5100,000), IN AODfTIIXJ TO THE W5T OF GY)MPENSATION, DAMAGES AS PROVIOED WR IN SECTION 3108 OF THE LABOR COOE, IMEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm thet I em licensed under provislons of Chepter 9(commencing with Sectlon 7000) of Division 3 of the Business antl Professions Cotle, antl my license is in full torca and eHecL Lic. k Class q ContractoYs Signature: Date: CONSTRUCTION LENDING AGENCW. ' ❑ I hereby eflirm ihat there is e construction lentling agenty for ihe peAortnance ot t�a work tor which Ihis pertnit is Issuetl, (Sac. 3097, Civil Code). � Lentlers Name: Lendefs Atltlress: Signature: Date: OWNER•BUILDER DECLARATIONS: 1 hereby eNirm ihat untler penalry of perjury thet I em E%EMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions Cotla: Any ciry or counry which requires e Dermit to consWct, alter, improve, demolis�, or repair eny shucture, pnor to its issuence, elso requires the epplicant for such pertnit to tile a signed statement Ihat he or she Is IlcenseA pursuent to Ihe provislons of Ihe Contrectors License Law (Chapter 9(commendng with Section 7000) oi Divislon 3 ot ihe Business end Professions Code) or thet he or she is axempt Ihereirom end the basis lor the elleged examptian. Any violation ol Section 7031.5 by eny applicenl for e pertnit suDjects the epplicent lo e civil penalry of not more than flve hundred dollars ($500).): [� I, as owner oi Ihe properry, or my employees with wegas as their sole wmpensatlon, WILL DO THE WORK, end ihe structure is not intentletl or offered for sale (Sec. 7044, Business and Professions Cotle: The Coniractors Ucense Law does not epply to an owner of properry who Duilds or improves ihereon, antl who does such work �imself or hersetl or through his or her own employees, D�ovided thet such Improvements are not intentled or oXered for sele. II, hawever, Ihe builtling or ImD�ovemem is sold within one year ol completion, Ihe ownerbuil0er will have the burtlen ot pmving that he or sha did not 6uiltl or improve for purpose of saleJ. ❑ I, as owner of tha property, am E%CWSNELY CONTRACTING WITH LICENSED CONTRACTORS to construct ihe projact (Sec. 7044, Business antl Prolesslons Cotla: The contraaors License Law does not apply lo an owner ol propeny who bulltls or Improves thareon, and who comracls lor such project with a contracror(s) license pursuant to tl�a Contrectors License Lews.�. ❑ I em ex pt ur Signawre: Owner ID veriti by ❑ Vas ❑ No Bu5ine55 end Prolessions Code tor Ihis reason: oa�e: m9 P� n� Driver'S License No. Expires: Venlication oi OWnership by�rype oi tlocumem, i.e. - properry tax bill or tlaetl): DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATION: ❑ I hereby certify ihat no excavation five (5) or more feet in depih into which a person Is required lo descend, will be mede in connection with work euthorized by Ihis pertnit, end that no building structure, scefloltling, falsework, or tlemolition or tlismantlinq thereoi, will be more than �hirry-sia (38) feet high. (Chep. 32, Grp 2, Art 2, Sec. 3a1, Title B, Califomla AAminisiretive Cotle). ❑ As owner-builder, I will not employ enyone to tlo work which would require e permit trom the Division of Industnel Sefety, es noted above, unless such person hes e permlt lo do such work from Ihe division. Signature: Date: Division of Intlustrial Sefery Partnit Number: CER71FlCA7E OF COMPLIANCE D AUIHORVJITION OF ENiAY: I certity under penalty of perjury that I have read this epplice�ion and state thai Ihe infortnation given is correct. I egree to compty wit� el Iaie I e, d ciry ortlinances relating ta building consiruction, and authorize represeniatives oi ihe Ciry oi Coste Mesa to enter upon the aDove-described propeny for insp tion s. I eqree not to occupy or allow occupency of any building authonzad by this permit until final inspey ion. 09/zolvz_ Signet re OI Leg Owner(s) Date AnNOr AUVwnzed ApPliCent Date GODE �, INSPECTIONTYPE QAiE 1616 Fixetl System Final Fire Preventlon 7266 200 201 202 203 Pool Spa Finel Final (ie-Rooi Flnel Block/Ralaininq Well Final Factory Fire Placa Finel Sign 204 Final Demolition �$ �Qp�d INSPEGTIONTYVE 206 finel Mechanicel 200 Finfll PlumDing 210 Finel Eleciricel 212 220 Flnel Fire Preventlon Final Planning Approval 222 Finfll Site 250 Finel Building/Occupency � 3� 1N�L5 To: NEWPORT-MESA UNIFIED SCHOOL DISTRICT CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 (x) City of Costa Mesa ( ) Cily of Newport Beach ( ) County of Orange Applicant: Address: I� TelephoneNumber. ��4 l� l� 1�� TracUParcel and Lot ti��R+ha�r�r Locadon of Project: N° 4046 District Receipt No. Plan Check Np8 07 Q�iS� Number of Square Feet of: Residential Space Commercial and Industrial Space CommerciaUlndustrial Projed is: (Check One) Warehouse R8D Movie Theater Mini-storage Heavy Industrial Regional Shaps Light Industrial _ This project is exempl because s-79 x 51.84 x S .30 _ Motel Bank _ Neighborhood Shops _ RacqueUHealth _ Hotel Medical Office Office Park To�� ,��,� s : .� Total Preschool Auto Repair Hospital Large O(fice O1flce Bldg. Restaurant Fest Food This certifies that the above-named Developer/Applicant has paid school faatity fees in comp6ance with Government Code sections 53080 and 65995. The Buikling Pemiils for this square footage in Mis proposed development may now be issued by your jurisdictlon. Checks are to be matle payable to Newport-Mesa Unified School Dishid. AtAhoriiad RepreseMafive The above representation as W square footage is We. AppBcant agrees that if R is later determined that such representadons are not true, then this certificate shall automatically terminate and the appro riate Ciry/Counry shall be r80tfi@BI28B2/3:59 Rti/f ib6�.35 RLRT�:81-d182337 122312 Date: O9I ZD�U-2 _ �vv��+ (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT JobAddress: 515 PIERPONTDR Suite No Vicinity: FAMILY ROOM Parcel Nunmber: 41803404 Applicant: WOLF, JOSEPH A Address: 515 PIERPONT DR COSTA MESA; CA Owner: WOLF, JOSEPH A Address 575 PIERPONT DR , COSTA MESA,.CA Contractor: OW N ER-BU I LD ER Address: Phone: 714-979-4519 Zip: 92626-3108 � Phone: Zip: 92626-3108 'Phone: Zip: " License: 000000 ISSUED BY: Status: ISSUED Applied: 09/20/2002 Issued: 11/20/2002 ; SCOPE OF PERMIT • CONSTRUCT 590 SF FAMILY ROOM. CREATE A NEW�BATHROOM. REF-B02-01526. 'I6 LIGHT � FIXTURES, 12 OUTLETS, 6 SWITCHES � � � ,� �� " � ' REF: 802-01526 � � - . ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) . New Res (3+units) � � Pool / Spa Lighting Fixts � . Recept Outlets Switches Non Res Appl � , Res Appl Service to 200a Service to t000a �� - - Service over 1000a Motors to 7 hp ' Motors to 10hp Molors ta 50hp Motors to t00hp Motors over 100hp Communication drops Sub panel to 200a $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $17.60 $1320 $6.60. $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 � __.16 12 6 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY _ ' Temp Dist System / Llghting Busway N00 fl . , Standing Section � � ' Misc:Electrical Equipment ��• ~�� Transformers up to 1 kva/kw �.• � , , ' .............:..up to�10 kva/kw ..:.::...........up to 50 kva/kw,. �.; . .................up to 100 kva/kw - ..................over 100 kva/kw � � Low Volta9e Equipment � Low Volt Wiring System / Ckf� Misa Conduit � Misa Conductor � ' Circus ( gen ar ride) � Cirws (mech ride or lights) Christmas Tree Stand � Fireworks Stand Other Electrical Fee , � � . Investigation Fee Plan Check Fee Quantity, $0.00 0 $0.00 0 $0.00 - 0". -� $0.00 =-. 0' $0.00 -� : 0 $0.00 ; .� 0 $0.00 0 $0.00 0 $0.00 . � 0 $0.00 ; - 0 � - $0.00 : 0 .' � $0:00 0 � $0.00" - � 0 , $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 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 au�horized 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 parmit. FOR INSPECTIONS CALL: (714) 7545626 / 24d&d8 (6/00) WORKERS' COMPENSATION DECLARATION: I hereby eRirm U�tler penalry oi perjury ona of the following declarations: ❑ I have end wlll maintein a ceniticate of consent to self-Insure Por workers' compensetlon, es provided for by section 3700 of the Labor Code, for ihe performance of the work for which ihis permit is issuetl. ❑ I have antl will meintain workers' compensa�ion insurance, es requiretl by saction 3700 oi the LaOor Code, for ihe peAortnance of ihe work tor whlch this pertnit is issued. My worka�s' compensation Insurence carrier and policy number ere: Carner: Policy Number: (This secNon need not be completed il fhe permif is valued ef one hundred dollars ($100J or less.) ❑ I certity thA� in tha peAormence of the work for which ihis permit is issued, I shall not amploy eny person in any mannar so as to become subject to the workers' compensallon lews oi Celifornla, end a9ree that if I should become sublect to Ihe workers' compensation provisions of Sectlon 3700 of ihe Labor Code, I shall forthwith comply with these provisions. Applicant SigneWre: Date: WARNING: FAILUpE TO SECURE WORKERS' WMPENSFTION COVERAGE IS UNL4WFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIE$ ANO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (E100.000�, IN ADDITION TO TME COST OF COMPENSATION. DAMAGES AS PROVIOED FOR IN SECTIdJ 3]OB OF THE LABOF CADE, IMEREST, AND AT70RNEY'S FEES. LICENSED CONTRACTORS DECLARATON: I hereby aHirtn tl+at I em licensed under provisions of Chapter 9(commencinq with Section 7000) ot Division 3 oi ihe Business and Professlons Code, and my license is in full force an0 effea. Lic. q qass a Contrectofs Signature: Oate: CONSTRUC710N LENDING AGENCY: ❑ I hereby aHirm ihat ihere is a consiruction lending agency for ihe perlormanca of ihe work for which this permit is issued. (Sec. 3097, Civil Cotle). Lender's Name�. . Lender's Atltlress�. Signature: OWNER-BUILDEA DECLARA710NS: Date: I hereby ettirm that untler penelty of perjury Ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which raquires a peRnit to construct, elter, improve, demolish, or repair any stmcture, prior to Its issuance, also requires the applicant for such permit to tile e slgned s�atement Ihet he or she is licensed pursuem to the provislons of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professlons Code) or that he or she is exempt therelrom antl the besis tor the alleged exemption. Any vloletlon of Section 7031.5 by any applicant for a pertnit subjecis ihe appl�cant to e civil penalry af not more ihan fiva huntlretl dollars ($500).): �I, as ownaf ot the property, a my employees with wages as 1helr sole canpensailon, W IlL DO 7HE WORK, antl the structure Is not intentled or oHeretl tor sale (Sec. 7044, Business and ProFessions Code: The Coniractors License Lew does not apply to an owner of property who builds or improves ihereon, and who dces such work himseN or hersetl ar ihrough his or her own employees, Provided that such Improvemenis are not intended or oHerad for sale. If, however, iha building or improvament is sold within one year oi wmpletion, the owner-builder will have ihe burden of proving ihat he or she did not builtl or improve lor purpose of sele.). - ❑ I, es owner o� the property, am EXCLUSIVE�V CONTRAC7ING WITH LICENSED CONTRAC70RS to construct Ihe project (SecJ044, Business and Professions Code: The contrectors L' ense Lew tloes no� apply to an owner ol property who builds or improves ihereon, antl who coniracts tor such project with a contrector(s) license pursKent to thp �jniractors License Laws.). ❑ I am exemp tler sec Signature: Owner ID venfied by riveYs Verlticetion of OWne hip by ❑ Ves ❑ No BuSiness and Profe55ions Code tor ihis reason: Date: �a �Z- Driver's License No. Eapires: r4 f' ��—!�S of tlocument, i.e. - properry tax blll or tleetl): DIVISION OF INPUSTRIAL SAFETY PERMI7CERTIFICATION: ❑ I hereby ceh��y ihat no excavation five (5) or more feet In dep�h Into which a person is required to descend, will be mede In connaction wilh work authodzad by this permit, and ihat no building s�ruqure, scattolding, felsework, or demoli�ion or dismamling ihereof, will ba more than �hirty-six (36) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Tttle B, Calitornie Adminisirative Code). ❑ As owner-builtler, I will not employ anyona to do work which would require a pertnit from ihe Division of Industrial Sefety, es no�etl ebove, unless Such person has e permit to d0 such work from tha division. Signature: Date: Divisian of Intlusinal Sefaty Pertnit Number: CERTIFICATE OF COMPLIANCE AND AUTHORIZATON OF ENTRV: I certify undar penalty of periury that I have read this epplication and state that the information given is correct. I egree to comply with all s @@@te laws d ity ordinances relating to builtling constmction, and authorize representatives oi the City of Costa Mesa [o enter upon the above-tlescribetl property tor inspec i�n pur os s egree not to occupy or allow occupancy of any building authorized by Ihis permit until tinal inspection. �b� �i�Z�—c�7_ Signatur Of Legal mer(s) Da�e AnNOr Authorized Applicant Date COQE t. ItlSPiGD4k-C�E Pd7E �NTRIRLS 1616 Fixetl Sysiem Final Fire Prevention 1266 Paol Spa Final 200 Final Re-Rooi 201 Flnal BIOCk�Retaining Wall 202 Final FaG1ory Fire Place 203 Final Sign 204 Final Demolition CO�E� INSPECTIONTYPE 206 final Mechanical 208 Final Plumbing 270 Final Electrical 212 Final Fire Preven�ion 220 Final Planning Approval 222 Final Site 250 FinalBuiltling/Occupency o�re 1[ffIDaL4 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 1ob Address: 515 PIERPONT DR Suite No Vicinity: BATHROOM, FAMILY ROOM Parcel Nunmber: 41803404 Applicant: WOLF, JOSEPH A Address: 515 PIERPONT DR WSTA MESA, CA Owner: WOLF, JOSEPH A Address 515 PIERPONT DR COSTA MESA, CA Contractor: O W N E R-B U I L D E R Address: Arch / Eng : Address: PLUMBING PERMIT Status: ISSUED Applied: 09/20/2002 Issued: 09/20/2002 ISSUED BY: Phone: 714-979-4519 Zip: 92626-3108 Phone: Zip: 9262G3108 Phone: Zip: License: 000000 Phone: Zip: License: SCOPE OF PERMIT CONSTRUCT 579 SF ADDITION OF A BATHROOM AND FAMILY ROOM TO AN EXISTING SFD. 1 BAR SINK, 1 SHOWER, 1 WASH BASIN, 1 WATER CLOSET. REF: 802-01526 ISSUE FEE BackFlow irrigation Backflow Preventer Bathtub Clanfier System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 ou0ets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 30.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 So.00 $0.00 $0.00 $0.00 So.00 Qn FEE SUMMARY AMT Laundry Tub I Washer 30.00 Landscape Irtigation $0.00 P-Trap $0.00 Pressure Regulator 50.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap (or Demo $0.00 Sewer Connect $0.00 Sewer Pnva[e Line $0.00 Shower $9.80 Sink, bar §9.80 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (pnvate) $0.00 Spa (public) $0.00 �N 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-0) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Waler Closet (Toilet) Water Heater / vent Water Piping pnst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 So.00 $9.80 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: 562.70 an 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 C7 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 o� abandoned for a penod of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlretl Inapettlons and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiretion of this pertnit. FOR INSPECTIONS CALL: (714) 7545626 / zaas-ee (aao) // C WORKERS' COMPENSA710N DECLARA710N: I hereby aXirm under penalry of Derjury one of the tollowing declaratlons: ❑ I hava antl will malntain a cenificata ol consent to seN-Insure tor workers' compensation, es provided lor by section 3700 0l t�e Labor Code, for the padormence oi the work tor whlch Ihis permit is issued. ❑ I heve entl wlll maintain workers' compensetlon Insurance, as requiretl hy sectlon 3700 of the Lebor Code, for the pertortnance of the work tor which this permit Ig Igsuea. My workers' compenseNon Insurence carder and policy number are: Cerrier: Poliry Num�er: (This sectlon neetl nof be camp/efed i/ the permit is ve/ued af one hundred tlolleis (5/00) or less.) ❑ I certity that in the performance of the wark for w�ich Ihis permit is issued, I shall not employ any pereon in eny menner so es to become subject to the workers' compenSallon lews ot Califomia, entl egree Ihet il I shoultl become su6�ect lo the workars' compensatlon pmvlsions oi SecOon 3700 of ihe Labor Code, I shall fotlhwith comply with ihese D�ahsions. Applicant Signeture: Date: WARNINO: FAILURE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNLAWFUL AND SHAIL SUBJECT Ml EMPLOYER TO CRIMINN. PENALTIES AND GVIL FlNES UP TOONE HUNDRED THOUSANO �04.AHE (5100,0OO�.IN ADDITION TO THE COST Of COMPENSATION, DMMGES AS PFOVIDED FO{i IN SECTION 31080F TME LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CON7RACTORS DECLARATION: I hereby aRirm that I am licansed under provlsions of Chapter 9(commencing wit� Section 7000) of Divlsion 3 of the Business end Professlons Code, antl my license is in tull force end eXect. Lic. q Cless x ComrecmYs Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby a%irm that ihere is e consiruction lending agency tor Ihe peAormanca of tha work for which ihis pertnit is issued. (Sec. 3097, Civil Code). Lendels Name: Lendels Atltlress: Signature: Date: OWNER-BUILDER DECLARATONS: I hereby eNirm thel under penelry ot perjury thet I am EXEMPT PROM THE CONTRACTORS LICENSE LAW tor ihe following reeson (Sec. 7031.5, Buslness enC Protessions Cotle: Any city or counry which requires a permit to construct, alter, improve, tlomolish, or repair any structure, pnor to its issuance, also requires the eppllcant for such permit to file e signad statement that he ar she Is Iicensed pursuent ta the pmvisions ol the Contrectors License Law (Chepter e(commencing with Section 7000) of Dlvislon 3 ot t�e Business end Professions Code) or ihal he or she is eaampt therefrom and the basis for the alleged exemption. Any violation oi Sectlon 7031.5 by eny epplicant for e pertnit subjects the applicent to e ciNl penalry of nol more Ihen five hundred dollars ($500).): j� I, es owner ol the property, or my employees wl�h weges as Iheir sole compensation, WILL DO 7HE WORK, end ihe struciure is not intended or ottered for sale (Sec. 7044, Business and Proteuions COUe: The Contractors Licensa Law does not apply to an owner oi property who builds or improves thereon, and who does such work himself or herself or thmugh �is or her own employees, provided that such Improvements ere not intended or oflered tor sale. If, however, the building or impmvemant is sold within ona year ot completion, the owner-builder will have ihe burden ol proving ihet he or she did not build or improve lor purpose of sale.). ❑ I, es owner of t�e property, am EXCLUSIVELV CONTRACi1NG WITH LICENSED CONTRACTORS to con5lruct Ihe pro�ect (Sec. 7044, Busine5s and Prolessions COCe: The conirectors License law does not epply ta en awner at pmpeny w�o huilds or improves thereon, entl who wnirects for such project wlih e crontractor(s) license pur�suent to the Contractors License Lews.). ❑ I am exem und r e Signeturo: Owner ID venfietl tlnvels ❑ Yes ❑ No Business and Professions Code for this reason: � Date: � �2. Ddvels License No. Expires: �'� Venficatlon ol OwnArship by (rype ot tlocument, i.e. - property ta: bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICA710N: ❑ I hereby cenity thet no excavetion tive (5) or more leet in depth into whicli e person Is required to descend, wlll be made In connection with work euthonzed by Ihls pertnit, end that no building sirucWre, scaHOlCing, telsework, or tlemolitlon or tlismantling thereol, will be more Ihan thirty-siz (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Celifomia Administrative Code). ❑ As owner-builder, I will not employ enyane to tlo work which woultl require a permit Irom the Division ol Indusirial Selery, as notetl ahove, unless such person hes e permit to do such work from the tlivision. Signeture: Deto: Division ot Industrial Safery Pertnit Number: CERTIFlCA7E OF COMPLIANCE M� AUT}IORIZA710N OF ENTRV: 1 ceniy under penalry ot perjury that I have read this epplicetion and state that the infortnallon given is correct. I egree lo camply with ell ; e law� i ciry ordinances releting to builtling constmction, and euthorize representatives of the Gry of Coste Mesa to enter upon ihe above-descdbed properry for inspe li n p ryo I agree not ro occupy or ailow occupency of eny building authorized by this permit�il tir�� s�e� n. 9/ / Signatur OI egel ner(s) Date � And/Or Authorizetl Applicant Date CODE�. INSPECTIONTYPE Qd� INiRIALg 1616 Fizetl System Final Fire Prevantion 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Well 202 Final Fectory Fire Plece 203 204 Finel Sign Final Demolition COUE� INSPECTIONTYPE 206 Final MeCheniCal 20B Finel Plumbing 210 Final Eleciricel 212 Flnel Fire Preventlon 220 Finel Planning Approval 222 Final Site 250 Final Building/Oaupancy �g �� • �S-` UWNtK �os no DATE AP No. LOT !�q TRACT 5698 FIRE ZONE VALUE II '.CTIONS Sianotoro Dote GROUP T . T TYPE 54._ r Z � $u'o�vri i rtni. i V It GAS _ _ _ ._. . _ _If Y�I W Ai ER ROUGH PLUMBING PROP. SWR. LINE —HOU$�E fO—N�. SPRINKLING SYSTEm pc(,�,��(�/� MISCELLANEOUS ROUGH NEATING AND AIR CONOITIONIh TEMPORARY SERVI�E OR POLE UNOERGROUND � POWER � POIIGH WIPING TRENCHES � FORMS � STEELI FLOOR SYSTEM BOND BEAM n STEEL REINFORCE SMEATHING FRAME AND FLASHING LATHING — IN +� OUT [�] PLASTER, BROWN GOAT ST'�-TURAL, FINAL N� G, VENT., REFRIG. AND A.C., f PLl1MBING. FINAL AND GAS TEST � � COSTA AAESA BUILDINCrSAFETY DEPARTMEM' P.O. BOX 721�9 COSTA MESA� CALIFORNIA 9712! For Applieam ro FIII In Complofdy TYPE OR PRINT ;R� S I S �1 �c� �r� COSTA MESA, GALIFORNIA 1� r 01 BCTBACK LIN6 /ROY �� S R�o� DESCRIPTION OF WORK � Uii OF � � 1 H[R60Y ACIf}IO iD� ANO BTAT6 TXAT [, PLY WITH ALL CI OR eu�to�xo eox < H16NATUR! OP PHRMITTB wurnoRizco �aerR AP�LIGTON i[6 M COM. n�ouunxo ��8--�°AiD00 655+ ****85.5Q ArPLICATION FOR PERMR BUILDING FOr Offln Us� Only RtC�lIiNO. ^(�1 �� 0 ZONING [ MO.OP Y�[OIN� � / IU1ND � OUILGINO NOTB: NO EAV! YAXD6 MPROVlD MAIN BUILDINO D16iANCR B6T. MAIN BLDOB. VAR. �j 3��84 TMC AYOUM �URPoB[ OI BMALL EE LL'BS THAN YAR09APPROV60 ACCHSSORY BUILOINO BET. MAIN a AGGE59. BLI OATB iATQ .L � � .� W � /D�p� `� � vwLu�noH �e roa n�e � A P6RMIT /8[ ONLY. � w �T Fee s. 5� 7�— e LHRCIL �� w°