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HomeMy WebLinkAbout1901 RAYMOND AVE - Building Permits" u CITY OF COSTA MESA h . BUILDIMG DIVISION F DEVELOPMENT SERVICES DEPARTMENT PERMIT i. , PE IT NUMBER, . 898'01942 (714) 754-5273 Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 926 BUILDING PERMIT Job Address: 1901 RAYMONDAV Suite: Vicinity: Parcel Nunmber: TPN980103 Zoning: Applicant: JMS RAYMOND ST LLC/STEVE YOUNG Address: PO BOX 10757 Phone: 949 233-1420 COSTA MESA, CA Zip: 92627 Owner: SMITH, TON] Address 2961 INDUSTRIAL RD #54 Phone: LAS VEGAS, NV Zip: 89109 Contractor: Address: Phone: Zip: License: Status: ISSUED Applied: 10/27/1998 Issued: 02/03/1999 Arch : Eng: OPTION ONE Address: Address: - Phone: Phone: Zip: License: _ License: S3855 SCOPE OF PERMIT CONSTRUCT A NEW SFD 1277SF 1ST FL, 1022SF 2ND FL, 638SF GARAGE, 203SF PORCH. SEE PARCEL MAP PM -98-225 FEE SUMMARY Plan Check: $917.96 Calc Valuation: $204,351.86 Permit: $1,412.25 Claim Valuation: 80.00 SMIP Res: $20.44 SMIP Com:. $0.00 Other: $0.00 Inspection: $0.00 Total: $2,350.65 PLANNING R ZONING SETBACKS MAIN STRUCTURE Front 23- 0 Rear 22-0 Left 13-0 Right 5-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 2 Proposed: 2 NOTES: 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. j FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIONS WORKE�S' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance 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 laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37W OF THE LABOR CODE, 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 Cade, and my license is in full force and effect. Lic. ii Class M Contractor's 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). 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 fallowing reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, altar, 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 Cade) 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).): ❑ 1, 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. It, however, the building or Improvement is (� sold WS ar of completion, the owner -builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). b' Vas property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions N� 'Codectors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) licenso the Contractors License Laws.).I em r sec. Business and Processions Cotle for this reason:Signature: Oars:Owner ID vver's licenK ❑ No Drivers License No. Expires: 2C��7 Verification of Ownership by (typ of ocproperty tax bill or deed): DIVISION OF INDUSTRIAL SAF PER rr C TIFICATION: ❑ 1 hereby certify that no excavatio 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 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? ❑ 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 teat 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 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 It an RMPP is presently required, has Section 25534 of the California Health and Safety Code 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 a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ 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 ❑ 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 ❑ No 8 .........................................................................from th....."th.e....appropriate.................a......pollu..t..............o..ffice........). .................................. .......... ...................................................................................... (It yes", adach certificate of compliance ir ..io..n control....r CERTIFICATE OF COMPLIANCE: I certiy 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 CE 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 agreeto c ) 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 r inspection pure es. I a as not to occupy or allow occupancy of any building authorized by this permit until final inspection. z 3 S9 ignatur Ot L aI O er(s) 13ate An2LJ AUtV0rzeJ Appli nt Date WM•. INSPECTION TYPE De1F Iiia CODE# INSPECTION TYPE DATE IIS 1616 Fixed System Final Fire Pre 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electriosl 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 2"6 -46 2842 NEWPU.,f-MESA UNIFIED SCHOOL DISTr,.,oT ` '% CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 To: ( ) City of Costa Mesa City of Newport Beach ( ) County of Orange Address: Telephone Number: R I Tract/Parcel and Lot Number(s): Location of Project: M Number of Square Feet of: ZZCIq Residential Space Residential/ Sr. Citizen Space Commercial and Industrial Space 8120•'Ar f�VJ x $1.84 Commercial/Industrial Project is: (Check One) Warehouse R&D Movie Theater Mini -storage Heavy Industrial Regional Shops Light Industrial This project is exempt because x$.30 x $ .30 Motel Bank Neighborhood Shops Racquet/Health Hotel Medical Office Office Park District Receipt No. d� Jf% Plan Check No. 8.19 42 Total Total Tota I Preschool Auto Repair Hospital Large Office Office Bldg. Restaurant Fast Food This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport -Mesa Unified School District. By: The above representation as to square footage is true. Applicant true, then this certificate shall automatically terminate and the al Date: l - 2(� ' �q if it is later determined that such representations are not ity/County shall be notified. (714) 754-5273 • Fax (714) 754-4856 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT GRADING PERMIT Job Address: 1901 RAYMOND AV Suite: Vicinity: RAYMOND AV AND 19TH ST CORNER Parcel Nunmber: TPN980103 Zoning: Applicant FANS, JIM Address; Phone: 714-393-1457 Zip: Owner; JMS RAYMOND STREET, LLC Address P O BOX' 10757 " Phone: 714-393-1457 COSTA MESA, CA Zip: 92627 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 10/27/1998 Issued: 12/08/1998 Contractor, Address; Phone: Zip; License: Eng W.J. MCKEEVER Address; Phone: Zip; License: C22502 SCOPE OF PERMIT CUBIC YARDS GRADING FOR 2 NEW SINGLE FAMILY RESIDENCES INCLUDING 1903 RAYMONDAV. RE:898-01942 & B98-01943. 250 PLANNING & ZONING NOTES: 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 FEE SUMMARY . Plan Check; $33.00 Calc Valuation: $3,0'00.00 $0.00 Permit; $64.00 Other; $0.00 $0.00 Inspection: $0.00 $0.00 Total: $97.00 PLANNING & ZONING NOTES: 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 DECLARATIOMS WORKERS' COMPENSATION DECLARATION: I hereby affirn 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 workers' compensation Insurance Cartier and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued et one hundred dollars ($100) or less.) ❑ I certify that in the performance 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 laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), 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: 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. # Class # Contractor's 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). 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 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 civ,l 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: a ontractors 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) licen a puts ant to the Contractors U nse s.). ❑ Is axe t U Busin rotessions Cade for this reason: Signature: Date: r Owner ID erifie by drivers license. ❑ V ❑ No Driver's License No. Expires, Verifica n of nership by (type of docume i.e. - property tax bill or deed): DIVISkN,0 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? ❑ 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 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 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 en RMPP Is presently required, has Section 25534 of the California Health and Safety Code 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 a plication a8armit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No (Section 65850.2 of the California Govomment Code requires that the requested information be furnished on applications for non-residential building permits). ................................................................................................................................................................................................................................................................ ................... 6 WIII any pert of the facility to be constructed untler this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 reqGuired 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? ❑Vas ❑ No ....................................... ............................................................................................................................................................................................................................................. B (II 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. net re: Date: C RTIFlCA OF COMPLIANCE AND AUTHOR oN OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is _act. I ag ee to comply with all at 4 a i ci ordiryry ces relating to bu'lding construction, and authorize representatives of the City of Costa Mesa to enter upon the A ove-desc ibe r, I . I gra h t t occupypr occupanty of any building authorized by this permit) final iryspecticn. 77 Signa ure Of al vner(s) Date And/Or Authorize iApplicant Date INSPECTION TYPE VDeg ISIS CODE E INSPECTION TYPE gs¢ Ifs 161 Fixed System Final Fire Preventioh 206 Final Mechanical 66 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval pp • O 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2"6-46 t 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 , CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J •�; PERMIT 9-00825 (714) 754.5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1901 RAYMONDAV Status: ISSUED Suite: Applied: 06/08/1999 Vicinity: N. SIDEYARD & REAR OF PROP Issued: 06/08/1999 Parcel Nunmber: TPN980103 Zoning: ISSUED BY: Applicant: YOUNG, STEVE Address: PO BOX 10757 Phone: 949 515-7416 COSTA MESA, CA Zip: 92627 Owner: JMS"PROPERTY Address 'PO BOX 10757 Phone: 949 515 7416 COSTA MESA, CA Zip: 92627 -- , Contractor: '.Address: - Phone: Zip: License: Arch Eng:- - ' Address: Address: Phone: Phone: - ` . 'Zip License: Zip: ti License: SCOPE OF PERMIT ,. CONSTRUCT 118 LF, 6' HIGH BLOCK WALL ON PORTIONS OF THE RIGHT SIDE AND REAR PROPERTY LINES FOR ' SFD. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,360.00 : Permit: $74.75 Claim Valuation: $2,3so.00 SMIP Res: $0.00 SMIP Com:. $0.00 Other: $0.00 Inspection: $0.00 Total: $74.75 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 25-0 Rear 0-0 Left 25-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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 , DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 1 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 workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($161) or less.) ❑ 1 certify that in the performance 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 laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), 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: 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. N Class N Contractor's 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). 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 Sectlon 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 withi Mle y r 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 ow r he property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: Th ontr s License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license p to the Contractors License Laws.). ❑ I ama pt or sec. Business and Professions Code for this reason: Signature: Date: Owner ID verifl b slice a Yes ❑ No Driver's License No. Expires: Verification of Ownership by ( 1 d u ent, i.e. -property tax bill or deed): DIVISION OF INDUSTRIALER IT CERTIFICATION: ify ❑ I hereby carthat no w ti we (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 at 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? ❑ 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 cuing 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 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 ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a Ppermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U 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 feel from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 It 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 ❑ 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 CE 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 c I with all state laws and city ordI ances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described ope r Inspection to E . I g e not to occupy or allow occupancy of any building authorized by this permit ntil nal inspection. (0.9-q Signature L IOw ds) Date And/Or jtrizo!Xppliant Date CODE t, INSPECTION TYPE IAL CODE INSPECTION TYPE 2AM jam$ 1616 Fixed System Final Fire Preva gA¢, 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Relaming 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 3 244636 ADDITIONS, DELETiO , BE A'r'ROVED S.-.. i' .:.:.... • T2 -IIS SKETCH IS FOR INFORMATIONAL PURPOSES ONLY. APPLICANT IS RESPONSIBLE FOR PROVIDING AN ACCURATE REPRESE'NT'ATION OF THEIR PROPERTY IN CASE THE SHAPE AND SU:E DO NOT CORRESPOND WITH THE INFORMATION PROVIDED ON THIS SHF.EI'. i0 / . VERIFY DISTANCE FROM CURB TO PROPERTY LINE / c/ Q3 AND SHOW ON PLAN. VERIFICATION FROM THE CITYS ENGINEERING DIVISION IS REQUIRED. CALL (714) 754S343 FOR INFORMATION. C;7 ; OF MESA DIV. SJEC'i TO k I -D.-. DEPT. REG. RESIDENCE • SOLID WALLS/FENCES BETWEEN 2'6• k 6' IN HEIGHT SHALL BE SETBACK AT LEAST 10' FROM FRONT PROPERTY LINE • SOLID WAITS/FENCES SHALL NOT EXCEED 2' 6' IN HEIGHT WITHIN 17 OF THE FRONT PROPERTY LINE (NOT CURB LINE). RE90ERQ 1 1 I 1 2 C py6 O g RE90ERCF RESIDENCE RESIDENCE 1 I I 0'MOL LOCX ..L4 SET BAOt.._._.._...-- ..... i �2Gl,Lf)'L,uc,�Y A STREET BLOCK WALL LAYOUT FOR BUILDING PERMIT PLANNING DIVISION r A 4�, q CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT J PERMIT (714) 754-5273 • Fax (714) 754-4856 Job Address: 1901 RAYMOND AV Suite No Vicinity: Parcel Nunmber: TPN980103 Applicant: YOUNG, STEVE Address: Owner: JMS'RAYMOND ST LC Address PO BOX 10757 Contractor: Address: C.M. CA ELECTRICAL PERMIT Phone: 949-650-1457 _ Zip: Phone: 949-650-1457 Zip: 92626 Phone: Zip: License: 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 02/03/1999 Issued: 02/03/1999 Q SCOPE OF PERMIT NEW SFD: a I I��i 1� 2-� iPiV �l (� Z Sohl%i thel d - 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 FEE SUMMARY Quantity Quantity . ISSUE FEE $22.00 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) $114.95 2299 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool / Spa $0.00 0 ................ upto-10 kva/kw $0.00 -0 Lighting Fixts $2.00 2 .................up to 50 kva/kw $0.00 0 Recept Outlets $1.00 1 .................up to 100 kva/kw $0.00 0 Switches $2.00 2 ..................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) $0.00 0 Motors to 10hp - $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 - Fireworks Stand $0.00 0 Motors to 1 00h $0.00 0 Other Electrical Fee $0.00 Motors over 1 00h $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 $141.95 Intermed Pole $0.00 0 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 DECLARATIONS WORKERS' COMPENSATION DECLARATION. I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 workers' compensation Insurance carder and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ I cartity that in the performance 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 laws of California, and agree that it I should became subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUWECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), 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: 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. Lk. M Class If Contractor's 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). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjurythat 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 civ,l penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property. or my employees with wages as their sale 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 If 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 wit one ear 1. completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of safe.). es or of the operty, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions ode: o aorta 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 purs the Contractors License Law ). ❑ I am ex( t u 00. Business and Professions Code for this reason: Signature: Date: %• 3 • �� Owner ID verifi y driver's license. ❑ No Driver's License No. Expires: Son -1, Verification of Ownership by (type of doc .e. - roparty tax bill or deed): DIVISION OF INDUSTRIAL SAFETkMI E IFICATION: ❑ 1 hereby certify that no excavation fl 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be tiled 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 forth 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 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 at compressed gas at standard temperature and pressure). ...........&1t;.................................'r.lpr.............................l'd'ln.... C. C.u...................................................(Ris.......................................enti.......rogr...............utel.......................aerials .... 3 Does or will the applicant or present or future building occupant neetl 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 ❑ No .................................................................................................................................................................................................................................................................................. 5 Does or will the applicant..or present Or future building occupant require for the work which is the subject of this apple tion a6rMit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LE LL-J1No (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 pan of the facility to be constructed untler this permit be within 1000 feet from the outer boundaries of a school? [I 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 ❑ 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 MP ANCE 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 agre ply with all st to laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above.descr' pr rty for inspec!n p ses gree not to occupy or allow occupancy of any building authorized by this permit uj final inspection. Signet a egal nor(s) Date An r Authori d Aplplicant Date CODE r INSPECTIONTYPE Q&u INTITAL4 CODE l INSPECTIONTYPE DAM INTITIALS 1616 Fixed System Final Fire Preven I 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �1 p 200 Final Re -Raaf 210 Final Electrical -1 J V AP ­ 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 2446-46 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT J PERMIT (714) 754-5273 • Fax (714) 754-4856 MECHANICAL PERMIT Job Address: 1901 RAYMOND AV Suite No Vicinity: Parcel Nunmber. TPN980103 Applicant: YOUNG, STEVE Address: Phone: Zip: Owner: JMS RAYMOND 1ST LLC Address: P BOX 10757 7 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 02/03/1999 Issued: 02/03/1999 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 Phone: 949-650-1457 ' C.M. Zip: 92686 Contractor: Address: Phone: Zip: License: - Arch/Eng: • Address: - Phone: Zip: License: SCOPE OF PERMIT NEW SFD: REF B98-1942, 1 FAU, 1 A/C. 2 FIREPLACES, 1 HOOD 8 1 VENT. FAN CONNECT. TO ' - A SINGLE DUCT. , FEE SUMMARY ' Quantity - Quantity ISSUE FEE $22.00 Repair / Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $13.25 Repair / Alt Refrigeration Unit $0.00 0 Inst FAU >100 k BTU $0.00 Venlillation 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 $13.25 1 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 -- $19.00 2 3 To 15 hp / 500 k BTU $0.00 0 Hood w/Meth Exhaust $9.50 1 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 $6.50 1 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 Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 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 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 1 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 workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be Completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certity that in the performance 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 laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: 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 DOLLARE ($100,000). 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: 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. N Class a 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 civd 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.). �0I, as ow f the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: a nlractors License Law does not apply to an owner of properly who builds or Improves thereon, and who contracts for such project with a contractor(s) license rs to the Contractors License Laws.). ❑ 1 am 20Wnemh:1pby er sec. Business and Professions Code for this reason: Signature:/ Date: Owner ID v:(ty an Ent, ❑ No Drivers License No. (�� (�� Expires: 2�Z Veniicalion of tl - property tax bill or deed): DIVISION OF INDUSTRIAL SA TVP MR G RTIFICA710N: ❑ 1 hereby certify that no excavation five' ) or more feet in depth into which a person is required to descend, will be made In connection with work authonzed 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 pernit 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 ANO 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? ❑ 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 o1 compressed gas at standard temperature and pressure). .................................................................................................................................................................................................. .............. ............. ...................................... 2 Does or will the ap.plicant or present or future building occupant need to file a registration form for acutely hazardous materials? Dyes ❑ 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 antl 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. ..................................................................................................................................................................................................................................................... presently q ry y p ❑ Yes ❑ No 4 If en RMPP is resenll required, has Section 25534 of the California Health and Safe Code been full complied with? ........................................................................'u'tu.........'d'in.....................quir.................................................ject..fthi.....2plj...tton........rmit...................nstr.ctio........... modification 5 Does or will the applicant u present or future building occupant require for the work which is the subject c this U Yes ion apermit for such construction or motlificalion 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 Government Code requires that the requested information be furnished on applications for non-residential building permits). ................................................................................................................................................................................................................................................................................. 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? []Yes ❑ No (It 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 agent 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 ❑ No .W ............................................................................................................................................................................................................................................. B (11 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 Co4ell.10114CE 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 top will 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 roperty inspection purposes. I ogre of to occupy or allow occupancy of any building authorized by this per it until final inspection. Signature ( ga O mer ! -D_ate And/or Ihonze A licant I Date CODE I. INSPECTION TYPE I8ID1AL6 CODES INSPECTION TYPE DATF� 1616 Fixed System Final Fire Preva 206 Final Mechanical MAV 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final BIock/Retalning 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 Buildmg/Occupancy 2"6-46 r F CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT °•� PERMIT PEReME. (714) 754-5273 Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 1901 RAYMOND AV Status: ISSUED Suite No Applied: 02/03/1999 Issued: 02/03/1999 Vicinity: Parcel Nunmber: TPN980103 Applicant: YOUNG, STEVE Address: Phone: •0 Zip: Owner: JMS RAYMOND ST LLC Address PO BOX 10757 Contractor: Address: Arch l Eng: Address: Phone: 949-650-1457 C.M. CA Zip: 92686 Phone: Zip: License: Phone: Zip: License: SCOPE OF PERMIT NEW SFD: REF B98-1942, 2 TUBS, 1 DISHWASHER, 5 GAS OUTLETS, 1 GAS SERVICE 2 HOSE BTPS, 1 GARBAGE DISPOSAL, 1 LAUNDRY, 2 SHOWERS, 1 KITCHEN SINK, 1 WASH BASIN, 2 WSAH BASINS (SET) & 3TOILETS. CITY AMT FEE SUMMARY 1 AMT QTY 0 AMT ISSUE FEE $22.00 0 Laundry Tub / Washer $8.75 Backflow irrigation - $0.00 0 Landscape Irrigation - $0.00 Backflow Preventer $0.00 0 P -Trap $0.00 Bathtub $17.50 2 Pressure Regulator $0.00 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 Connect(Ice,Soda,etc) $0.00. 0 Receptors $0.00 Dental Units $0.00 0 Septic Tank $0.00 Dishwasher $8.75 - 1 Sewer Cap for Demo $0.00 Drain, Floor $0.00 0 Sewer Connect $22.00 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 Drain, Roof $0.00 0 Shower $17.50 Drinking Fountain $0.00 0 Sink, bar $0.00 Expansion Tank $0.00 0 Sink, commercial $0.00 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 Gas (1-4 outlets) $5.50 1 Sink, kitchen $8.75 Gas (Over 4 outlets) $1.00 1 Sink, service/mop $0.00 CITY AMT CITY 1 Sump Pump $0.00, 0 0 Swimming Pool - $0.00 0 0 Trap Primer $0.00 0 0 Urinal $0.00 0 0_ Vacuum Brkr Bkflow(1-4) $0.00 0 0 - Vacuum Brkr Bkflow(5+) $0.00 0 0 Wash Basin $8.75 1 o Wash Basin Set $17.50 2 1 Waste and Vent System $0.00 0 0 Water Closet (Toilet) $26.25 3 2 Water Heater / vent $11.00 1 0 Water Piping (Inst or Rep.) $0.00 0 0 Water Re -pipe $0.00 0 0 Water Service $0.00 0 1 Water Softener $0.00 0 0 OTHER $26.25 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 DECLARATIONS U WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 1 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 workers' compensation Insurance carder and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance 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 laws of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply With these provisions. Applicant Signature: Date: 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 DOLLARE ($100,000), 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: 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. It Class W Contractor's 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 ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure I$ not intended or offered for sale (Sec. 7044, Business and Profs 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 lhr gh his her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is ryry&1<�161 Id within one year of co talion, 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, CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions i' \1iCode: The contractors Lic w does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) cense pursuant to the C nrrec Licen a Laws.). ❑iharrFgxempt under Sec. Business and Professions Code for this reason: �rgnatur Owner�ID verified by drivers license. e ❑ o e s License o. Exoir 02--. Verification of Ownership by (type of do ume i.e. - ops tax bill or deetl): DIVISION OF INDUSTRIAL SAFETY P M EAT ICA N: ❑ I hereby certify that no excavation fl set 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, Titie 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? ❑ Yes [I 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 teat 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? j] 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 marshals)? ❑ 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 ❑ No .................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisapplication aermit 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 6 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 ❑ No (if 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ...................... .............................................................................................................................................................................................................................................................. 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is repulred 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? ❑ 9as ❑ No .................................................................................................................................................................................................................................................................................... 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certity that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding H doua Materials and Emissions. Sign re: _ Date: CERTIFICAMPLIANCE AND AUTHORIZATION OF ENTRY: 1 certify under penalty of perjury that I have read this application and state that the information given is correct. I eg e t omply with all tate laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the ON bed Orly for i sp on purp a s. I agree not to occupy or allow occupancy of any building authorized by this permit N I inspection. ,gnat � Le nets Date An Or Au on d Ap icant Date QQgFLL INSPECTIONTYPEpA1E INTMAlS CODEC INSPECTION TYPE DATE IIID11ALS 1616 Fixed System Final Fire vent, n 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final Block/Retdining 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 24x6-46 %02;10/99 µ'Ell 11:16 FAX UiW. J. McKeever Inc. Civil Engineering FAX COVER SHEET FAX - (909) 341-3740 TO: Tc ✓E. %0V N(,ri FAX: 04�) SIT' --7430 ATTN: FROM: DATE: Zllolq% RE: Ga5 i,q Comments: TOTAL NO. OF PAGES Z (Including this cover We are sending: Per your request Copy of letter Drawing Comments Information Approval Other: If you do not receive all pages, please call us as soon as possible at (909) 341-3700. Z001/002 647 North Main Street - Suite 2A - Riverside, California 92501 - M (909) 341.3700 - Fax (909) 341-3740 . y 02:30!00 WED 11:16 FAX Z002/002 W. J. McKeever Inc. Civil Engineering February 10, 1999 City of Costa Mesa Building Official 77 Pair Drivc Costa Mesa, CA 92628 Re: Foundation Location Verification Parcel Map No. 98-2,25, Parcels I & 2 Dear Gentlemen: Based upon a field survey, the location of the foundation forms upon the above referenced lots were found to be in conformance with the approved Precise Grade Plan. W,iM/lv cc: JMS Properties Yours truly, 647 North Main Street — Suite 2A — Riverside, California 92501 — Ph. (909) 341.3700 — Fan (9091341-1740 Lie. # 496841 ALL-iED INSULATION, INC. Telephone.# 2614 159th St. (310) 214-9136 Redondo Beach, CA 90278 (714) 960-1211 INSULATION CERTIFICATION This is to certify that, in conformance with the current energy regulations (California administrative Code, Title 25, State of California') and approved plans, insulation has been installed in the building located at: ............. .................................. P.QSTA.M95A.............................................. ....................................................01M. QF;..................................................... City County .............1.O.O.A-1.9Q3....................................... RAXMT> U.M.I.C.AIM ........................... ................................. ............. I ............ , Street No.(if available) Street Lot Number Tract No. DESCRIPTION OF INSTALLATION CEILINGS: Type of Material ....... —...,,,,,_,,,Eitheir91. ...... ............... Manufacturer ....G.ertiXiateed.... Thickness ..1.0..1!2::.. R -Value" ......&3.Q........ P.., EXTERIOR WALLS: Type of Material ...................... giberg);nfl............... ....... Manufacturer ....(.rerlainteed.... Thickness ...,3..j/. '... R -Value. ......&1.3......., FLOORS: Type of Material .............. ........ F.ibergim...................... Manufacturer ....Conal! ate.ed.... Thickness ..................... R -Value" Sq. Ft. Covered ....AIL.... Sub Contractor (Insulation Applicator) ALLIED INSULATION INC. Licence number 496841 By....................................Cr....S.H.Y.a.................................. Title ........... Manalge[........... Date .....................41.7.1.99................... (• California Administrative Code, Energy Insulation Standards, declares: "Compliance Upon completion of the Installation of insulation, a card certifying that the insulation has been installed in conformance with the requirements of these regulations shall be completed and executed by the insulation applicator and by the builder. This isnulation compliance card shall be posted at a conspicuous location within the dwelling. ") (** R value is the measure of the resistance of a material of building component to the passage of heat. The resistance value (R) of mass type insulations shall not include any value for reflective facing.) EXCERPT from Sec 19875 of the Health and Safety Code of the State of Cafifornia: "No certificate of occupancy or similar certification that a newly constructed hotel, morel, apartment house, home of other residential dwelling is habitable shall be issued by such a building department unless the structure at least satisfies the minimum energy insulation standards established pursuant to this chapter. " -Insulation Certificat[ yl �,►I���J�. �°�st� f,AFha Number and Sveet City ounry Subdivision Lot Number Description of Installation ROOF Material &3F c.-Aeer a—BeEF!�= Thickness (inches) $qe CEILING Batt or•Blanket Type;' Thickness (inches) Loose Fill Type Brand Name __U�J1j • (pp�.lill(p Thermal Resistance (R -Value) Q • 30 Brand Name DWDsjS -CpQNINQ* Thermal Resistance (R -Value) tL Brand Name Contractor's minimum installed weight/ft Ib bfinimum thickness inches Nanufacturer's installed weight per square foot to acheive Thermal Resistance (R -Value) 12-19 EXTERIOR WALL Material 6'f�2 Thickness (inches) 2)-5 RAISED FLOOR Material Thickness (inches) SLAB FLOOR Material Thickness (inches) Width (inches) FOUNDATION WALL Material Thickness (inches) Declaration Brand Name owraA6-_tog-jitJ Thermal Resistance (R -Value) 94% Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the Calik Fiia Administrative Code. zral Coac[or (Builder) License Number Amara l lS 9`1 i azure and Tide Date ,') TrJC,. bF�i 11 Iva tor(InsulationInv er) License Number ignanue and Tide Date Compliance Forms January 1, 1995 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ccaUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1901 RAYMOND AV Suite: Vicinity: Parcel Number: �TPN980103 Applicant: STEVE BROOKS Address: Owner: JMS PROPERTY Address Contractor: STEVE BROOKS Address: 22875 WING ELM Cl WILDOMAR Zip: 92595 Arch : Address: Zoning: Phone: 714-235-1468 Zip: Phone: Zip: Phone: 714-235-1468 License: 296636 Eng: Address: Phone: I Status: ISSUED Applied: 08/18/2000 Issued: 08/24/2000 ISSUED BY: (:� A— Phone: Zip: License: License: SCOPE OF PERMIT 41 LF OF 6' HIGH BLOCK WALL ALONG THE REAR PROPERTY LINE AND LEFT SIDE_. AND 187SF OPEN TRELLIS PATIO COVER. Plan Check: $63.21 Permit: $97.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $160.96 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 NOTES: FEE SUMMARY Calc Valuation: Claim Valuation: PLANNING & ZONING Rear 0-0 Left 0-0 -Right Rear 0-0 Left 0-0 Right Required: 0 Proposed: 0 $3,834.44 $o:a0 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 alt applicable codes, and all required inspectlons and final approval must be obtained, Failure to obtain inspections and final approval will result in the expiration of this permit, IFOR INSPECTIONS CALL: (714) 754-5626 2446.46(6/00) 0-0 0-0 $3,834.44 $o:a0 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 alt applicable codes, and all required inspectlons and final approval must be obtained, Failure to obtain inspections and final approval will result in the expiration of this permit, IFOR INSPECTIONS CALL: (714) 754-5626 2446.46(6/00) 70 DECLARATIONS WORKERS'"COMP&SATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - ❑ 1 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 workers' compensation Insurance carder and policy number are: Carder: / Policy Number: (This section need not be completed if the permit is valued atone hundred dollars ($100) Or less.) ❑ 1 certify that in the performance 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' compensatlon laws of Calilo nd agree that hould become subject to the we ars' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these rows s. /� Applicant Signature' -�+ Data: ©C� i WARNING: FAILURE TO iEGtlUM& OORKERS' COIAPENSATICN COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION W06OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section) of Division 3 of the Business and Professions Code, and my license is in ful force and effect. Lia a / - Class #L'T 2S—j Contractor's Signatur Date: 'CONSTRUCTION LENDING AGENCY: ❑ 1 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ 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: ❑ 1 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 e 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? ❑ 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 5DO 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 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). .................................................... ......................................... ........... ... ................................................ ................................................................................................ ................... ................................. ............................................ ........ I ........... ............ 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 registei acutely hazardous materials with the Fire Department. ...................................................................................................................................................................................._........_..............................................................I........................ ....................... ............................................ ......... .._.......... - 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Cade been fully complied with? ❑Yes ❑ No 5 Does or will the applicant Ai rt u present or future building occupant require for the work which is the subject c this a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Byes LJ Na (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 pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ........ .................................................................-._.......................................................................................................................................... ....................... ........................................................... -.............................. ......................................... ........ 7 It a Permit from the South Coast Air Quality Management District or other air pollution control district or agency is requiretl 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 ❑ No ................................ .............. ._...... .................................................... ............. ............................................. ..........................................................................._.................................................................................I................ 6 (If'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certity that under penalty of perjury the information given above is correct. I agree t0 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 giJthhe 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 up above-described property for inspection purposes. I agree not to occupy or allow Occupancy of any building authorized by this permit until final inspection. nature Of al Owner(s) / Date / -214_ m0 And/Or Authorized Applicant Date CODE I. INSPECTION TYPE Qd1E IxmuLs CODES INSPECTION TYPE gel$ 1NTITAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -. 200 Final Re -Root 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