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Home My WebLink About335 PRINCETON DR - Building PermitsPERMIT TYPE � CITY OF COSTA MESA � BYILDIN�s DIV►SION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.costa-mesa.ra.us FOR INSPECTIONS CALL: (714) 754-5626 � ) � o - PERMIT NUMBER. B07-01040 , JOB ADDRESS Vicinity: ROOF Squares: 2300 �'�I..i�� B_ROOF2 335 PRINCETON DR CM �STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: Valuation: ISSUED 12I10I2007 SOK $5,200.00 SCOPE OF WORK: TEAR OFF EXISTINGROOF. WSTALL 2 LAYERS OF 15# FELT, 3:12 PITCH, CIASS A, COMPOSITION, 30 YEAR SHINGLES FOR 23 SQUARES OF S.F.D. OWNER: FERRARA, YENA Address: 306 MORNING CANYON Unit: PHONE: - City/State/Zip: CORONA DEL MAR, CA APPLICANT: MIKE ROGERS � PHONE: 949-546-1645 '� -' CONTRACTOR: PETRONELLA ROOFING Address: 2626 NEWPORT BLUnit: CitylState2ip: COSTA MESA, CA 92627 ARCHITECT: ENGINEER: FEE SUMMARY Reroof Plan Check: Reroof Permit Fee: Reinspection Fee: TOTAL FEES $o.00 $125.25 $0.00 $125.25 Address: 2626 NEWPORT BL City/State/Zip: COSTA MESA, CA License No. License No. PHONE: License No. 460707 949-548-1645 CELL: � PHONE: PHONE:, Unit: : u NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Cali(ornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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 fnal approval will result in the expiration of this permit. CODE t. INSPECTION TYPE DRT INT111AL f� INSPEC710N ME QAjE iHnnu 1816 Fized System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa final n�J 208 Final Plumbing 200 FinalRe-Roof /2`Z 'D� G_� 210 FinalElecirical 201 Final BIocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition � 25o Pinal 9uilding/Occupancy 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 Ihe Labor Code, for the perfor ce o( the work lor which this permit is issuetl. f have and vrill maintain workers' canpensation insurance, as requiretl by Csectbn 3700 of the Labor Code, fw the peAortnance of the wurk for which Ihis permit is issued. My vrorkers' compensation Insurance tarner and policy number a/re: ' c�— �I �arrier 7.t�-� 'r�:'V (T�is seqion neetl iwf be cwndefeOA Me peimAa'val�e0 at one h�rMretlOaNars (5100) w less ) Policy�Number. ii2l7�57�� I ❑ I certify Ihat in the pertormance of Ihe work for which this permit is issued, I shall not employ any person in any manner so as [o become subject to Ihe workers' compensation laws of Califomia, and agree that if I should become subject to lhe workers' compensation provisions of Section 3700 of the Lab Cotle, shall hwilh comply with these provisions. lZ l0 07 Applic fs5i Wre Da C_ _ _ ' . . . . �_� . .. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE L480R CODE, INTEREST, AND AiTORNEY'S FEES. LICENSED CONTRACTORS DECIARATION: I hereby aKrtn 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 eflect. �ia u �/ 6b7o 7 r c�ass s- -G� 3 q /��• �.�� Conlr nors ' alure `__�ate l _ -- CONSTRUCTION LENDING AGENCY: ❑ I hereby affirtn that there is a constiuctbn lentling agency (or the peAormance of the v.ork fa wfiich this permit is issued. (Sec. 3097, Civil Code�. Lender's Name: Lentler's Atltlress: �ate OW NER-BUILDER DECLARATIONS: I hereby aKrm thal under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for lhe (ollowing reason (Sec. 7031.5, Business and Professions Cotle: Any city or county which requires a permit to construct, alter, improve. tlemolish, or repair any siructure, pnor lo its issuance, also requires the aOGlicant for such permit to fle a signed statement Ihat he or she is licensetl pursuant to lhe provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of �he Business and Professions Code) or Ihat 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 ro a civil penally of not more than fve hundred dollars (5500).): ❑ I, as owner o! the property, or my employees vnth wages as their sole compensation, WILL DO THE WORK, and the stmcture is not intended or oBeretl for sale (Sec. 7044, Business and Professions Code: The Contractors Licanse Law does not apply to an owner of pmperry who builds or improves thereon, and who does such vrork himself or herself or through his or her own employees, provided that such improvements are not intended or oflered for sale. If, however, t�e building or improvement is sold within one year o/ completion, the owner-huilder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CON7RAC70RS to construcl the project (Sec. 7044, Business and Pro(essbns Code: The contractors License Law dces not appty to an ovmer of property who builds or improves lhereon, and vfio contracts for such project v.ith a cmtraclor(s) license pursuant ro Ihe Contrac[ors License Laws.). ❑ I am exempt untler sec. Business antl Professions Code tor this reason: SignaWre ]051-<6�0I0]) Ovmer ID verifed by drive� ❑ Yes ❑ No Oriver,'s License No. Ezpires: Venfication of Ownership 6y (lype of document, i.e. - properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation frve (5) or mwe fee[ in deplh inlo vfiich a person is required to descend, vnll be made in connection wilh work authorized by this pertnit, and that no building strucwre, scaffdtling, falsev.ork, a demolitbn or dismantling thereof. vrill be more Ihan Ihitly-siz (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomia Atlministrative Code). ❑ As owner-huiltler, I will not employ anyone to tlo work which wvuld require a permit from the Division of Industrial Safe�y, as noied above, unless such person has a permit to do such vrork from lhe division. Applirant§ SgnaWre Dale Division of Industnal Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 7. Will the applicant or present or fuWre building ocwpant neetl to fle and certify a Business Plan for emergency response to release or threatened release o( a hazardous matenal? ❑ Yes ❑ No (Sedion 25505 0( the Califomia Heal�h and Safety Code requires, with some exceptions, iha[ a Business Plan be filed with the Costa Mesa Fire Department by every business which has al any one time Ouring a reported year a quantity of hazardous matedals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at stantlartl temperaNre and pressure). 2. Does or will Ihe applicant or present or future building occupant need to file a registration form for acutely hazartlous materials7 ❑ Yes ❑ No (Section 25533 of the Cali(omia Health anC Safery Code, with some exceptions, requires registrelion with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous matenals 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 win me applicant or present or future builtling cecupant need to prepare an RMPP (Risk Management antl Prevenlion Program for acutely hazar0ous matenals)? ❑ Yes ❑ No (Seclion 25534 0( the California Health and Safety Cotle provides ihat the Costa Mesa Fire DepaAment may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials vrith the Fire Department. 4. If an RMPP is presently required, has Section 25534 0( the California Health and Safely Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for �he work which is the subject of this application a permit for such construclion or modification from the Soulh Coasl Air Quality Management District or from any other air polWtion control tlistrict or agency? ❑ Yes ❑ No (Section 658502 0( ihe Calitomia Govemment Cotle requires ihat the requested infortnation be fumished on applications ta nornresitlential building pertnits). 6. Will any part o( the taciliry to be consWcted under this permit be within 1000 (ee[ from [he outer bountlanes of a school? � Yes ❑ No pf 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safery Code). 7. I( a pertnit (rom the South Coast Air Qualiry Management Disinct or other air pollution contml 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 Safe[y Code Section 42303 been matle? ❑ Ves ❑ No 8. Qf "yes", attach certificate of compliance from the appropriate air pollution control OKcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty o( perjury lhe information given above is correct I agree to comply with all state laws and ciry ordinances regarding Hazardous Materials and Emissions. Signawre Dale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penalty of perjury that I have read this application and state that t�e in(ortnalion given is wrrett I agree ro compty with all 5tate lav5 and ciry ordinances relating to building construction, and authorize representatives of Ihe City of Costa Mesa lo enter upon the above-tlescnbed property for inspection purposes. 1 agree not to occupy or allow occupancy of any builtling authorized by [�is permit until final inspection. Signature oi L I Ovmer�s) Dat _.�iu '� �1�/ Z � � AnClorAUNonzeEApO- nt � a� , * .�,usaem�oun: 335 PRINCETON DR ;! °w"Eas"""E'°'a°`''": FERRARA, YENA "°o"Ess 335 PRINCETON DR COSTA MESA,CA 92626 �va�. muimo �oonrss: 760-1241 � J x APCNffECTOfl FNCdlEEN: CONfPACTOP'S W11�: CONfXACTOR3 WJIPIG ADOPESS uHt: uc. ra.: urr: lIC NO.: uru: LICENSED COMp�CTON4 DECIAR�TION: I MieEy eflim uMx pendy d pee�iry Net I em Ikenmd uMx pwmons d Cheqs 9 (m�m�enen0 wEh Sectian ]000) d Oivuu� ] d tlro Bunroa entl PMmriaw�u COCe. W mY 4mns u in fu0 faro ud dled. cmuc.No.: uc.cuss: uc.no.: EXP: oma: comreco.: OWNEP BUILDEN OEClAN1T10N: I hreby elfum uMr pauly tl perjsy ihet I em e�emq Imn IM Comreeon liroma lew iu tM IdbwnO romon (Setlbn'lW1.5 Bus�ret� enE Pdeaebne GoEe: �nY cYy a munN xfiidi reVuim e Da�� lo mmlNcl. ellx.'pnWaro. demdnh, a repei vry aVucWre, pia b ea eaarce, deo �puires Ne appimM la euch pe�mu to fib e agind sretemefu thei he w ehe q liroreed punueN lo IM powians M Ne CoMradps Licenas Lew (CMqa� 9(mmmenieq wdh Setlqn ]000) d D'erveon 3 d iM Burr�ev ard Prdses"vu Coda� w ihm he a ehe ie exemp ihselrum vM iM bsda la IM elbpeE nrempion. My vidmion ot Setlion ]03t.5 W enY WW�N br e permY wbjetla Ihe epd� lo e dvY perolry d mi mws �hen frve hwdred tlotlan �i50p�. � I. n oxmr d iM popeM a my empb�eee wIh weyee m tAei eob oompenaeiion, xill do IM xwk. eM Ne st�ucture b ml iMaMeE w dlereE la eeb �SeUion )W�. Bwimo vd Prdmebna Cotls: TM CaMrenon Licerue lew daee mt eppyta en axnerd pmpeity who buide a inyo.�a� themm. enE v.fio Eom autli wak limeetl a huve� a �hraph he a herpwn empb�me. pewdeE thm ach �] I, n owiw d iM popny. em exNni.ely conVr Pmiaaeiona COEe: The Convodon Licenae Lew mnlrun 1« wd� prqop� wiih e mmreaoHs) Ic � 1 am exemq unEer Soniort, oda: I Ao Mreby ceNry NN I em awere d erd uMwei 0 25551.eMihella envlutun Wikim ocawM xil � rw�Duik w'un Wm�e M eelel. � renas m cmarw tM qqac 1�� . Baimee eM lo en o�merd propeny who WiNs wimpravxiheraon eM xho � �o Ihe Convmon Limma Lew�. , cannrudion epPYcetipm an examq fmm Ihme ome: aooirN�: WORKEN'9 COMPENS�TION DECLAPATION: I Mraby alfirtn uMer panMy W peijury one d Ns IOAowiiq dadaratbp: � I haw uM wll meimdn epnXi�ata d mneenl to saX�ineuro b worken' compenWbn, n w�� a Ey Sopian �)00 d iM lebor Coda. la �M p�lmnvice d Ne wark lar w1Yc� �hn prmX n heueE. � I haw uM wil meiniein worksrt mmpemeiion IneurerKa, m requirad by 8«fim 3100 d ihe Labor Coda, la Ihe q�lormenw d iM wak la Miich Nu pxmN u iausd. MY wpken' mmpametbn inw�vws urt4r ud poW.y number ars: c.m«: Pdicy Numbr: �I(T�his asUion mM m� b rompHM / iM pxmf is M ons huMisO dd/an /5100 e�.) `y ��A' � in IM pMpmanca d IM wark lor whkh �hu pam�il i uatl. I MeA M ampby ury perron N erry menror eo n to Mcmie wE�ea io tM whan' canperoetion levn W C s. end ep�ree Np tl I 4nuk becoma wbjq b tM xwken' <p COf11Vs11Y�U11 G�oUM OI SMU11'J)W OI IM1O LBEd CO . OII MhWll�l OJIII�' 1Mh �IM! PIWI8IMl. Dma: ' Wemlip: F�llun ro��cun workwi rompxwtlon �rp� Is unNwN, Gih/l �WNcf �n x�vlqx ro cNMiW p.n�lflu �M c/Hl flnss tp ro an� �inCnJ NouunE Co/Yn (Sl OOOA M M�Itlon N cwi oI compru�(bM1 Wm�p� u proHtlM br In 5xtlon �IOB ol M� Lebor Cotlr, Intwut. �nd �ttom� '� fw. CONSTIiUCiION LENDINO �OENCY: I MreW etfiem wAx �hel ihen u a wnA�utlion bMvip q�ercy 1or Ne peAormuim d �M waM lu MfiirA �hu qrmi n esuetl (Sepian �OBI. C'v. C�. LENDEN'S NiUIE: LENDEN'S ADDNES4: � I ceniN tAa I Aeva rud N' wion W pW �he� Ns ebw� iNomulion b cortetl.l e0ne to comdY xith eY aly enE aoumyad"uwicea eM�t�e Mel' iMiqconaupioneMherebywllwrizarW��etivaeMthur'nYwm�eruD�tMebwe.memiwado�roM �� 'JOAN P WI�LIAMS Dtle: (5�51s8.WP) WNIs-9uikiq 8 Selery: �rsamFle: Cenery-�ppiwn: Rnk-Revenua: GalCenraE-Aveeav ,,`1 CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 076627 PERMIT NO: E 076627 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: OTH JOH DESCRIPTION : METER REPLACEMENT SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS; METER CLEARANCE FOR EDISON iE iE iE IE IE 1E IE iE 1E fE 3E 1E iE jf' iE iE iE IE IE IE IE iE if 1E iE 1E �IE aE iE i! iE if iE �F iF 1E')E 1E af if iE iE 1E IE 1E 1E iE iE IE 1E iF 1ElE iE IE IE if IE 1E 1E 1f 1E 1E 1E if if 1E iE 1f 1E 18 iE'lE 1ElE 1f i� iE IE Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 14138411 ZNE: REF NO: PLANNING NOTES> i " fE 1E fE fE fE 1E fE 1E 1E iE 1E 1F 1E 1E iE iE iE 1ElE 1E 1E 1F iElE iE 1E 1E 1! iE 1E,1E 1E 1E 1E 1E 1E iF 1E 1E k 1E jf iElE 1E iE 1E iE 1f 1E iE 1E 1E ik iE iE iE if fE iF iE iE k 1E 1E iE 1E k 1f iE 1E iE 1E 7E 1E 1E ik i! iE D E V E L O P M E N T S!E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY � ' DATE: BUILDING APPROVED BY : �� APPLICATION ISSUED BY: *��****�x�*�r�**rt**�*�*��F LEGALIZATION:N F BLDG PMT PLUMBING PERMIT PLAN ISSUE FEE BUILDING—DIV—> PERMIT ISSUE TOTALS----> 18.50 15.00 E E S U M M A A Y ELECTRIC MECHANIC 18502 15.�� PLAN—CHECK 0.00 L�t:l�l DATE: DATE: L+G�'9� *+�*�r*+�� '��** STRUCTURAL SEGMENT:N SMIP/RES GRADING SMIP/NON—RES TOTAL PAID DUE 33.50 33.50 .00 REVENUE DIVISION TOTALS--> COLLECTED: 33,50 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 33.50 iE iklE 1E if iE i%if 1E fE 1E 1E 1E fE iE iE i%ih ih iE 1E iF 1h i(' ih 1E i%iI")h iE ih fElE iE 1E iE 1E iE 1E fE iE 1E fE'lE IE iI' 1E fE 1f if i[-iE if II' 1E 1k ih iI' iE ih iE iI' ff ih iE'IE if 4 iE 1E 1E iE if if 1E if 1f iE 1f I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 1 SERVICES BELOW 600 V& HELOW 201 AMP 18,50 END OF FEES � 1 J: . _• , . - . . - .�_ ^4 '' ._ ' , . ..� 18.50 �� . CONSTRUCTION AND PLANNING . P001- & SPA •� APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspeccor 1. Temporary Electrical Service or Pole 52. Poot & Equipme�t Location � • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit UtilitV-Undr9rnd. 54. Forms 4. E�ectrical Conduit-Undrgrnd. 55. Eleciricai Bonding 5: $teel Reinforcement 56. Rough Plumbing & Pressure Test . fi. Etectrital UFEft Grnd. 57. APPROVAL70 COVER�GUN�TE "7. Footings 58. Electrical ConduirUndrgrnd. - ' 6, Foundation . 59. Gas Pipe, O Undr9rnd., Test - -. 9. Water Pipe-Undrgrnd. ' �-60. Backwash lines, P-Trap, � Undrgmd.� � 70. Strucmral Floor System • 61. APPROVAL TO DECK - 7 7. Property 5ewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing Sys2em - Final 14. Rough Plumbing ` 65. Electrical�Final 75. Rough Electriw6Conduit 66. Sotas System-Finat 76. Rough Elactric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rou9h Electrical�T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating.& Air Conditionjng . - FI�RE DEPT. REQU�REMENT 20. Rough Pactory Fireplace � � � .�APPROVAtS - Permit # YV 27. Ducts, in Structure � . - - .�70. �Underground Hydro ,22. Dvtts, Ventilating �• � 71. Product Piping O Gas � Oil , 23. Oas Pipe�Rough & Test ' ' ' � - ' 72. Undergroyqd Flush � ti 24. fioof Framing - 73. Undergrnd. Storage Tank O Gas ❑ Oii 25. floof Sheathing ' � " - 74: Overhead Hydro . 26. 7-Bar,Ceil�ng (Structural) & f�ionocoat - > 75.: Dry Chemicai " c _ 27. Erame and Flashing- � " � - " ' � 76. Dry Standpipe � . , 28. Lathing & Siding -' �. ' 77. FIXED SYSTEM PINAL -� � 29. Insulation 78. F�RE PREV. FINAL �30. Drywall Nailing �. . #iEALTFI DEPT�. REQUIREMENT " 37. Plaster Brown Coat • � 79. PINAL INSPECTION 32. Electrical Power Meter�Final 80. FOOD CERTIFICAiE �SSUED 33. Final Efettric' �= - ^� �� ' � ' ' - ' . Note;: ,� •. 34. Final�Heating & Air Conditioning' ' ' , � ' " : � � " " - 35. Final Gas Pipe•Test '� � - - � " , � ' ' _ 36. yood or Canopy - . ' � � .� � - • , � -37. Final Faciory Fireplace � � � ` , 38. Final�Plumbing ' , ,�, ' - "39. Water�Ser��ce�Final r � � � � . ' :� 40. Gas Service-Final ' ' _ � '' '' � - - - 41. Solar pomestirFinal, , . •� � 42. Backf{ow Pteventer , "• " ' _ 43. Backflow Irrigation � � - - + . 44. �andscape�IrriAation'System � � '� - _ " � 45. Sound Atienu2tion � �. . � �� - � - 46. Handicap Regulations _ - - � 47. FINAL STRUCTUfiE & BUILDING � 48. FINAL PLANNING _ .`. ` 49. Efectrje Retease to Edison , • 50. Gas Release to Southem California Gas Co 55. CERTiF1CATE OF OCCUPANCY No. Date J !'� 1 DECLARATION OF .UTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS ��5 ��'�, Straet Address Bldg. Permit N This Permit # '�', %%D%��% AP Number 1. I(we), /��C�� l�`��'�'� �'�'Q'4'f'�'`� , declare that I am the Owner of Title oi the above reterenced real property, and that 1(we) hereby authorize: . �C�J�-� �w-� %6 m - /� �/ ' � Name Telephone No. �0 6 �i.�-�,�._. ;� �,c� �� -�- , � up to obtain permits in my behalf, as owner/builder, for LZ�/�� "`-'�" `"—� at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I(we) shall im- mediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers 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 the foregoing is true and correct. Executed this � day 19�, ari -��alifornia. �l�-�� C��1 �-��✓�c�.�. �- a�'- S� rintetl Na� � Date NOTE: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. NOTARIZATION REQUIRED OT/9�46 (He¢ 7/9p ► Apv��ant to fill in all spaces exttpt l�ose witnin neavy Ooreer Ilnes ana si9n all appropriate tleclaratians. ."� CiTv oF coSTa MESA C�NS.T.RUCTION PERMIT ��T�°i°+'a -+ r= TRACT NO. LOT NO. UNIT NO. . Project Address � t h Applicant's Mailing A{1d ess Owner's Name y�,� Phone�� ( ' Address �.�✓l-Q � ` � � Arch/Eng. License No. Address Contractor's Nam ^ p Phone . Address (ma �'�� ry�� (AL`Q� City LicensP No � � ' / '•� � LICENSED CONTRACTOR DECLARATION ' ' ' i hereby alfirm tnat I am IiCenSetl untler provl5ions ot CM1arter 9(commencin9 with section 7000) ot Division 3 0( tha Business antl ProteSzions Cotle, antl my Ilcense is in fu r e ana eftecl. �Licen I z_ li n e Dale� Si9na[ure WORKEqS' COMPENSATION DECLARATION � 1 here�y affirm [nat I have a terti(i<ate of mnsent to self-insure or a certificate �f Workers' Compensation Insurance, or a certifletl copy [hereof (Section � 3800, lab.�n11�� Company �� xrii PalicY No. ,�=r� �ertifietl cOPY i5 blletlbwithrthenc aY Q� Itl,i�/�s��! o%/ �J/ �J /� Da[e ��' �'�� Appllcant (,�L/L(f�'[rZ/a w� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thizsection neetl not be complet¢tl If th¢ permit is for one nuntlred ($300) or ' less). I ccrtify lhat In the perto�mance o� th¢ wOrk fOr which this�pe�mit is issuetl, I shall not employ any pOrion In any manne� so as to become subject to thE ' Workers' Compensa[ion l.aws of CaIlPornia. , � Date ' Signa[ure , NOTICE: If, atter making tnis tleUaration, you shoultl become subject to the Worke�s' Compensation provi5ions of the Labo� Cotle, you must torthwith' comply with such provisions or this permit 5hall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I nereby affirm tha[ there Is a constructlOn lentlin9 aqency for the performance of the work for wnich this permit is issuetl (Section 309� Civ. C.) Lentler's Nama Lentler's AOOress � � OWNER BUILDER �ECLARATION I hereby attirm that I am exampt trom tbe ConVactor'S License Law for the following rea5on (Soction 7031.5 Buziness antl Pro/essional Cotle: Any city or munry which rGq Wres a p¢rmit to cons(ruGt, alte�, ImOrove, tlemolish o� repair any 5tructme, prbr to its issuance, alzo requires the applicant for such permit [o file a signetl Stalement that he/She IS Iicensetl pursuant lo lne provi5ion5 ot tne Cw[ractor'S License Law (Chapter 9.(commencing with Section 7000) of 'Jivisian 3 of tne Business antl Protessions Cotle) or that he/zhe is exempt ierefrom antl lhe basis tor tne allegetl ezemption. Any violation of Section J31.5 by any applicant for a permit subjecfs tne applicant to a civil �nalty ot not more tnan tive huntlretl tlollars (E500). . LJ I, as owner ot tne oroperty or my employees with wa9es as their sole coTp¢nsation, will tlo th0 wotk, antl the st�ucture i5 nOt intentletl O� otfe�etl (o/ wle ($ectiOn 7044, Buslne55 antl P�OfG55iOnal Cotle: The Contractor'S LicenSe l., w Uoes not apply to an owner ot a prop¢rty who builtls or improves ther¢On, dntl who tloes such wark M1imsulf/hersetl or throu9h his o� her own employees, provitletl that such improvements are not lntentlea or oiteretl tor saie. It, however, the bulltling or ImO�ovament is Soltl within one y¢ar ot com- ple[IOn, the owner will have the burtlen of Oroving h¢/She tlitl nol Duiltl or im- prove for the purpos¢ of sale). ❑ I, as owner of the property, am exclusively contractin9 with Iicensetl con- tractors to conitruct tne prOject (5¢ctiOn 7044, BuSiness antl Protessions Cotle: Tha Contractor's License Law does not apply to an owner ot property who builtls or Improves thermn, antl who contracts for sucn orojects with a con- t�ac[or(5 1¢ense pursuanl to tne ContraCtoYs License Law). I am awa�e tha[ proof o� tneir Wo�ker'S CompanSallon Insu�ance Shoultl be p�ovl0etl to me. ❑ 1 am ezempt untler Section B. & P. C. for this reason Date 1 hereby certHy tnat information is corroct antl state laws relatin sentatives of tnis cit inspectlon p � se . Signature Driver5' License or 55 CMF 0865-46, rev. 10/84 _ Owner I hdve reatl Inis appllcatlon antl I agr¢e [o cOmply wi[h all tlty a to bulltling ConSIruCHon, antl N � l0 ente� upon lhe above-me� TYPE OF CONSTRUCTION LI NEW LJ ADD LI ALTERATION L�YREPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P # DESCRIPTION OF WORK/USE OF BLOG. � - ' $ Main Buildi E TVPEOFPERMIT GRADIrvG�/ FOUrvDATIOrv STIiUCTURAL � T Front ❑ TENANT ❑ ELECTRICAL IQ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PRQIECT DESCRIPTION Sa. FT. oCCVParvCV C Right K Left CONSTRUCTIONTVPE - VALUATIONS $ ZONE GRADINGGU.VDS. ACRES p�ng.Ref.�# Remarks: , Planning Notes: Sink <tlow Preventer Kflow Irrigation Drinking Fountains Floor Orains Floor Sinks Gas Service Outlels Interceptors Kitchen Sink . Lavacories P—Trap Roof Orains Reinspeclion Fee � $15 Duct� Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0.100,000 BTU 0100,000 BT I � Reinspection Fee I $15 White - Bulltling; Canary - Applicant: Pink - Accouniing; Goltlen�otl - A55essor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimmin9 Pool w/Spa Urinal Water Closet Water Heater � Water Service - � Auto�Wash • Issue Fee Hood or Type I ❑ Canopy Ty{ie I I ❑ Refrigeration System ❑4100,OOOBTU ❑100,OOOBT System Repair/Alteration Fire Dampers Fiegisters Issue Fea $ 3 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit D ishwasher Dryers'OGas ❑Eleci Fan F.A.U. Fixture5 Device Boxes Outlets Switches - Garbage Disposal Generator �65 KW [ 0 Fee 6041 10/27/B6 Zone Accessory Building: ELECTRICAL . Transformer ❑ 15-50 KW "� 50+KW � Meter �up to 100 amps Meter �over100amps , Sub Panel ' , Momrs00�7 HP 01X-8 Inc.Solar �9-75 HP �16-1 Microwave Pole Li9ht Range Standing Sections 5�15 KW Trash Compactor $15 Issue Fee � 5.00 TL FEES i $ 3 Z O N 1 N G R E � M T S DEVELOPMENT SERVICES RE�UIREMENTS: � 2oning Appmved By -- Date � Buildine %�PP�oved By Z'� Dat�� Application luued By y� Dat SUMMARV OF FEES . � � BUILDING PERMIT $- SMIP � . $ � PLAN CHECK $ �d�SSUANCE - $ � PLUMBING � � $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL� $ GRADING $ � PLAN CHECK 50% $ MICROFILM $ /� MECHANICAL $ TOTALFEE $ ��vU � PLAN CHECK 25% $ � � CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector ,qppROVALS Permit �h Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrnd. � 54. Forms � � 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding � �'�;' 5. Steel Reinforcement . 56. Rough Plumbing & Pressure Test �� 6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNI7E � 7. Footings 58. Electrical Conduit-Undrgrnd. "t7 8. Foundation 59. Gas Pipe, O Undrgrnd., Test.:t'i 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. � 10. Structural Floor System 61. APPROVAL TO DECK � 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains � 64. Plumbing System - Final 14. fiough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 76. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT�REQUIREMENT 20. fiough Factory Fireplace APPROVALS Permit # 27. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Robf Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing � 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL � 29. Insulation 76. FIRE PREV. FINAL � 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 37. Plaster Brown Coat � 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 6�$ �Z Gq/1(LG. 'Ad I�rQ �O$ U��L• I.16U 34. Final Heating & Air Conditioning , 35. Final Gas Pipe-Test ' 36. Hood or Canopy � 37. Final Factory Fireplace , 38. Final Plumbing � 39. Water Service-Final 40. Gas Service-Final . 41. Solar pomestic-Final . 42. Backflow Preventer - . - 43. Backflow Irrigation � 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations • 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed ; 49. Electric Release to Edison , 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date OWNER (!nI.tFY;F. PARK DATE ��_r,(� JOBADDRESS 935 Pa'inceton DI'j.V2 BUILDINGPERMITNO. �� G�"ERALCONTRACTORHai'jJO;' CORSt.�Q_�_ VAWE a u�2OO.00 LOT 5g BLOCK TRACT 27 6 R w�det. gar. GROUP I& J TVPE V ZONE +u.� FIRE DISTRICT �91 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE I NUMBER Footing Trench �/�} S/ Foundation Forms and Grade to Garage Rough Framing —% J Plumbing, Rough to Slab — �' " Plum6ina. Rouah Comnlete M ��F C _/— r) °7�� //Seweq House GZ(.< Sewe Se Tank or Cesspool Lat�..ng, In Out Plastering Plumbing, Final, Fixtures Coi Plumbing, Final Gas Test �e5 Wiring, Final Occupancy � �O FONM 310 3M 10�'JS ��o'sta Mesa Bnilding Department :�PPLICATION FOR PERMIT ,-- . • P.O.Boz3�� d�+4�- BUILDING � •, COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY FOR'APPLICANT TO I�'ILL IN Receipt No. Permit No. a��d��a 5�i 5� Address PR I NCETON DR I VE Costa Mesa, ri��OTIIIa Received by Date Rec'd. Date Issued rvearest . /�—o'I ]—S6 1 �'37'.�� CrossSt. �iARBOR BLVO. Building Address Owner (�, L L E G E P A R K N O 2 Costa Mesa, California Mall Address 2� 16 $O. iV�A I N `$T, Nearest Tel. Cross St. City SANTA ANA, L'nLIF. No.1(� 55577 Zone�„ I No.of I Type �/ Group� Address CIty LI� ontractor HARBOR CONST,CONo. Address S�ME Legal Lot � Description No. �a Block � Ti (Attaeh Met and Bou ds) No. of Bldga Size oi Lot ('7 X 9 � Now on Lot 45e of No. ot Exfstlna Blda. I Famillen X � Alteration � � Atltlitton IMoving I � Demolish No. ot Rooms Stories IRoof Coverfng RESIDENCE c�[ DETACHED I hereby acknowledge that I have read this Applicatlon and state that the abwe ts correct and agree to rnmply with all Clty Ordinances and State Laws regulating building construction. Signaturaof Perm�ttee HARBOR CONSTBUCT,ION C0. Valuation Permlt Fee $ 0?8 -- � Plan Check $ / i� � S I I �200, Total Fee a- � NAL CORRECTIONS APPROVALS n Location Inspector Naterials, 'inning re Stops, i �t ExL Date -O � _� _Z D -r L LVl 1 LAl� Show locatlon and distances Trom a ��: properly Iine antl between buildlnpa � Y r:. N G C� I ii - � �