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HomeMy WebLinkAbout1903 RAYMOND AVE - Building Permits w9 CITY OF COSTA MESA 4 BUILDING DIVISION - > • 4r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER Ft _÷..... .1. + PERMIT Rano B01-00398 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1903 RAYMOND AV Status: ISSUED Suite: Applied: 03/28/2001 Vicinity: Issued: 03/28/2001 Parcel Number: 42629323 Zoning: Applicant: FANS JAMES D., JR ISSUED BY: i Address: 1903 RAYMOND AV - ._. ..- „/„_/-1,115,-G 12 -Phone - 949-650-4457' - COSTA MESA,-CA'= - ' Zip: 92627 , • �--- Owner: FAHS''JAMES D� JR-V - �, Address 1903 RAYMOND AV r �%_ _ --- L /��� 'Phone. 949-650-145'i''',:::1.'-':.1--: �.�! �, COSTA MESA CA - Zip: 92627 �- V 1)� //� \\ i� �' ,' '.iii\���_ r 0 , 7 1 �` Contractor: O�•0 i �" v`CA\A �- i Address:j ii , `! \ 7 ,',� //T1 f!/ Phone: \.e;`, ;�,S '/i? K/ c ' ` �v i 'Ah ,,� rc / Y ,( , - rEng:,, v`}1\\� �� - \ '„ I Address: } r'( ' -. /. _ - Address: \ \�)‘, -\ i f k\\ f- / r 1 + i� , Phone: ,/ Phone. -� \ i ;1 r::::),1 � / � V-‘).7- � 4 h l + I \A _ - ' License: N N License: �'t P ri ci: ` Y;;,11' 4, ,..r 1\ i SCOPE OF-PERMIT ..,^1-7.: '; LO:' ` \l 1 ct CONSTRUCT A 13'HIGH, 14'BY 14,++.OPEN SIDED GAZEBO BEHIND ANEXISITING RESIDENCE. INCLUDES A 6'i) HIGH FRAMED FIREPLACE,WITH A 15'HIGH CHIMNEY.SEE MM-01-07 AND MM-01.08 % - r--- ' �l \ C v \ {) l z./:-65\-`4.::: FEE SUMMARY y I+ I ) /� •A ' P,lan-Check\ �\(1 ;$63.21 ',::-T7-.' _ , � Calc Valuation: C$3;, s9 52/ ���� SPe`rmit: \A\ ,$97.25 j;,/,, ' Claim Valuation: 1)1 $o:oo �i //.16:::::ifyi \SMIPCori \\\N\-H SMIPtiCom:v i'\$0.00'�Othera \$0.00 Ihspec'tlon -" $0 00 _-_,..7.7),: w . �% \t\ '.i'-$1�96\\may j:-:,-., y . ' `-,) i4, no ,:^ t 3 �,}'r `� /0 � v :-V � r �. 4`� >' / it C/o, // '44C-:,.` r=° o`�PLANNING.&ZONING _C n0" SETBACKS \� %�� c`c� ���,,__ —/ ( O��. MAIN STRUCTURE-,Frontes 0=0� ! Rear 0-0•:_ - _ left-__-�0=0-- RightA !0-0% /� ACCESSORY Front` 6-6 thTT `, ' Left0444-0L� 1 \ Riter 5 ,2 r + - 1 - PARKING Existino �=,R : 0-_ + !\\',Proposed: --0 ....---/-",-/-/„..--- . �-�"/'/ NOTES: c-— - ..mac;---.:1<-1- _, � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration.of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.48(6+00) DECLARATIONS U (' _J WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrion Policy Number: is ction need not.. ..mpleted if the permit is valued at one hundred dollars($100)or less.) I certify that in the perk) an :of the work for which this p•^•it i ued,I shall not employ any person in any manner so as to become subject to the workers' compensation la •- of C-111• la,and agree the • •�1•ec.• e subject to the workers'compensation provisions of Se lion 3700 of the Labor Code,I shall forthwith ply comwith these.ovis r. - Q1 CApplicanLSlgnature:" / ( / ' Date: 3 7`✓ 1 Q WARNING:FAILURE T• ECUR PRICERS'COMPENSA11ON COVE-- S UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAR- $103,O03 IN ADDITION TO THE COST OF COM' t ATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CO TRAC •RS DECLARATION: I hereby affirm tha 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# 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: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I' 7 •ter I hereby affirm that under.penalty.dt,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 whlch.requiresta 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 ortshe 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.IL 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 owne • the •roperty,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:Th• contrac •rs 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 p.rsuant to he ontractors License Laws. ❑ I am exe pt under : ItS S Business and Professions Code for this reason: nC'NSta a urte: Ir. x - ,/ JIW!1a � ate Owner ID verifi:. by• :es license. C Yes Y if Drivers License No. l i1" - Expires: Verification• Owners p by(type of document,I.e.-pro fly tax bill or deed): DIVISIO OF IND•STRIAL SAFETY PERMIT CERTIFICATION: ❑ I he edify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2.Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes L I No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: C-" RCA OF COMPLIANCE AND AUTHORIZATION.OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is co ect. I agre 'to ply with all state laws •d ci : dinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the a..,e-desc'•:d r•'es."in e o-, . agr:- not t.occupy or allow occupancy of any building authoriz d y this permit ntil final inspection. - -!/,/-/ 3� .2-g�OI L Signature of Leg. 0 r(s) ' Date And/Or Authorized .,•licant Date .. I, •, •. PEE• INTITIAL$ CODE I INSPECTION TYPE PALE INTRIAL$ 1. • Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval . _ 203 Final Sign 222 Final Site 204 Final Demolition 250' Final Building/Occupancy 6 9 CITY OF COSTA MESA • BUILDING DIVISION Yt•<<,a ,i ; DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t• l I..�.s� l _ 4. rill - PERMIT E01-00217 -°oa•namo te . (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1903 RAYMOND AV Status: ISSUED Suite No Applied: 03/20/2001 Vicinity: BACK YARD Issued: 03/20/2001 Parcel Nunmber: 42629323 Applicant: FANS JAMES D., JR ISSUED BY: / Address: 1903 RAYMOND AV- - - - Phone: 949-650-1457 COSTA MESA,CA Zip: 92627 , Owner: "FANS JAMES D., JR ��. Address 1903 RAYMOND AV Phone: 949-650-1457 COSTA MESA,CA Zip: 92627 . Contractor - - Address \ � \'‘•_• - Phone: -\ � ,.1 , . Zip: • ' License: - - - ' / " -' ' SCOPE OF PERMIT ' -- ---, ' '.1, . ,'' ! . • INSTALL ELECTRICAL CONDUIT FOR-OUTDOOR LIGHTING'17 LIGHT FIXTS.,2 OUTLETS, 1 MOTOR I } I ' , !FOR FOUNTAIN UP TO 10HP. - - - - 'i'' --._i i -- - FEE SUMMARY - /Fr,/I �) r Quantity 7' Quantity Ica/ - 1 n ISSUEFEE $23.50 Temp Dist System/Lighting $0.00 0// / ,-/:-z-._..% !'l�J((/ Temp service test $0.00 Busway/100.T• - $0.00 0'2�r ,� Th /it Res:'a/c package, $0.00 Standing'Sectlon - $0.00 0//f : H hf// New Res(1-2 units) • $0.00 0 _ .Misc.Electrical Equipment $0.00 7)0// /)c,-;,.. /4i New Res(3+units) -., ' $0.00 0 'Transformers up to 1 kva/kw $0.00 >`f0 V /i1 Pool/Spa',,, -$0.00 0 • -up to.).0 kva/kw $0.00 �/'0 '-' , Lighting Fixts\V ' • $18.70 17 up to 50•kva/kw $0.064/' 0 . 1 / Recept Outlets - $2.20 t 2., 'up to 100kva/kw -: $0 00 0 L.,> / , / Switches V•• $0.00 0-" - - over 100 kva/kw "$0.00 � 0 i Non Res Appl , //' $0.00 0 -Low Voltage Equipment ---_,22"/$0'.00��0 ��1 Res Appl \''\A N' $0100 �>•v 0 > . - 'L'ow Volt Wring System/Ckt' $0.00 ✓40% /!J Service to 200a ,N " $0.00.�> 0��, ��, _ =Misc Conduit" ,: .-$0.60;A�'o 4.0 2 Service to 1000a $0.00 , . 0 _ _ Misc.Conductor-> �'� -' $0.00 02 Service over 1000a ,` ,$0.00 • 0' Circus(gen or ride) Y.\ $0.00 %0>. Motors to 1 hp - $0.00 0 _ Circus(mech ride or lights) \ • $6.00-2;„''�,0" Motors to 10hp '`$24.60... -. '2 Christmas Tree Stand\ ` $0.00--;' 0 Motors to 50hp $0.00= 0' ' Fireworks Stand '' - " .•!-,;,,$6.60' 0 Motors to 100hp $0.00' -. - `' 0 - - Other,Electrical Fee 1��/ $0.00 Motors over 100hp $0.00 0• _ • -. - '� Communication drops $0.00 0 ' __ ! ." __.Investigation-Fee $0.00 Sub panel to 200a $0.00 0 - - Plan-0heck'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 $69.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration.of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS , (Thi WORKERS'COMPENSATION DECLARATION: . I hereby affirm under penalty of perjury one of the following declarations: • . ❑ I'have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit Is valued at 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 SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND MI I ARE(S100,000),IN ADDRICN 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.Lie.# 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: 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 selects 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 o• •f the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Cod:.The c• tractors 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) lice se pursu.nt the Contractors LiCens- ) ❑ I a exempt ',/4. •i aSta_ Business and Professions Code for this reason: Signature: i Date: 3/490/Cr Owner ID erifieel •y driver's license. ❑Ye- a No Driver's License No. Expires: Verificati•n of 0 nership by(type of document,i = •roperty tax bill or deed): DIVISI• •' INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety.as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑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 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air 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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIF CATE O' COMPLIANCE AND AUTHORIZATION.OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree is co •ly with all state law and '• •rdin. •.5 rel. ing to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-•'scribed•r• or in�•e "V ••-'- 'a. • not t"occ •y or allow occupancy of any building authorized by this permit until final inspection. 1. Signature•fL gal 0.ner(sz3/ /�/ Date -90 An&Or Authorized Applic- 1 Date CODE G •e I•, •' ' T ' 1NTITIAL4 CODE I INSPECTION TYPE DATE INTfTIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing --•-���•--+-,-,— 200 Final Re-Roof 210 Final Electrical 4 � , e�Y y.� 201 Final Block/Retaining Wall 212 Final Fire Prevention / ,-(-/r 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition • 250 Final Building/Occupancy ` CITY OF COSTA MESA 4 BUILDING DIVISION > i 4ili . . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F r4. . PERMIT 4441.,,, 40 P01-00158 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1903 RAYMOND AV Status: ISSUED Suite No Applied: 03/20/2001 Issued: 03/20/2001 Vicinity: BACK YARD Parcel Nunmber: 42629323 ISSUED BY: Applicant: FAHS JAMES D., JR- Address: 1903 RAYMOND AV Phone: 949-650-1457 , COSTA MESA,CA - Zip: 92627 Owner: FAHS JAMES D., JR Address 1903 RAYMOND AV ?tett) Phone: 949-650-1457 r COSTA MESA,CA Zip: 92627 ` �� ��' ��� � • 5 -1 `y is A Contractor: " _ ',,, -\ ,.1., i Address: • - - °\ 1 Phone: - � ' ' Zip: License: • Arch / Eng: , ,- . _ _ - _. .l': ` ��_ _ � 1 t Address: y' 0 ) v . Phone: > r� t i r l " � _ ;f .Zip: --,1/rf �, l• License_ ' _ ir� • l -';=---J It / t . . SCOPE OF PERMIT- y/7;)/ r'.,� ) / `, INSTALL GAS LINE AND TWO OUTLETS FOR BBQ AND OUTDOOR FIREPLACE. S %/ / .. _ ' // < ' ', /' / ` .• ' :FEE SUMMARY . _ y / /(/ AMT S QTY AMT" ,.,QTY4/ ' r ',�AMT QTY ISSUE FEE. $23.50 --Laundry Tub/Washer $0.00 0 Sump Pump ` � 41 i$0.00 0 Backflow irrigation ,$0.00 0 Landscape Irrigation -- ,..$0.00 .0 .-'Swimming,Pool /20 $0.00 0 Backflow Preventer 1V <,$0.00,> 0 $ 'P Trap - , $0.00 0 Trap Pruner/4 , 50.00 0 Bathtub \y\ $0.00/7/7"- 0 --.-Pressure Regulator , , $0 00 0-,-,`"?.;--7",..--- Urin' V --' $0.00 0 Clarifier System N H- ,$0.00 / 0 1 Process-Piping(per 10 ft): $0.00- `-'o :i /Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc)\�;$0.00 ..- ,0'/ _Receptors - - $0.00- 0' \Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00, 0,-" Septic Tank - - $0.00 0 v,.Wash Basin, ,- $0.00 0 Dishwasher $0.00' - .0 ' Sewer Cap for Demo. : $0.00 0 ,`,, ' Wash Ba'sin,Set $0.00 0 Drain, Floor $0.00. -0> Sewer Connect ' $0.00 0Waste and Vent System $0.00 0 Drain, Rainwater $0.00 -0- - . , Sewer Private Line , $0.00, .0 :> Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0f" Shower '$0.00 0 - Water Heater/vent $0.00 0 Drinking Fountain $0.00 " 0 Sink;bar , $0.00. ';-0" Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial ' - '1$0.00- 0- Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $6.15 1 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $29.65 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS fl {' WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at 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 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.a Class 4 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 s bjec he 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 andProfessions 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:orthrougli 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 coropIeetionttie owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as•wne •f the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Cod':The••ntrractors License Law doees'mdt apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) lice -e purl ant to the Contractors.Lice���� ❑ I am 'kerne, r^: .• / s•rSOS t .e = siness and Professions Code for this reason: T -Signature: j Or /• II Date: /O) Owner •verifies by driver's license. ❑Yes VA o Drivers License No. Expires: Verifi'.tion of• nership by(type of document,i.e.- • •perty tax bill or deed): DI ISION • INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 'reby 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,Gry 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the 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 en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U 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). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'ryes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERT ATE • COMPLIANCE AND AUTHORIZATION.OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct I agree .• co• sly with all state -w an ci 11rces rola'ng to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above •escribed•ry.- se/ rp e; grl • •occ •,),,or allow occupancy of any building authorized by this permit unti final inspection. / Signature Of Legal Owner 3//J•�yv1 Date And/Or Authorized Applic- t Date 1•• •'_ PEE' IUTITIAL$ CODE. JNSPECTIONTYP[ PATE INTrt1AL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final - 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall - 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition _ 250. Final Building/Occupancy PUBLIC RECORDS REQUES SO THAT THE CITY CAN ENSURE THAT A PROPER RESPONSE TO YOUR REQUEST IS PRODUCED, IT IS PREFERRED, BUT NOT MANDATORY THAT YOU PROVIDE IN THE SPACE BELOW THE NAME OF THE DOCUMENT OR DOCUMENTS YOU ARE REQUESTING. EVERY EFFORT WILL BE MADE TO PROVIDE THE DOCUMENTS REQUESTED N A REASONABLE TIME. HOWEVER PLEASE BE AWARE THAT UNDER CALIFORNIA GOVERNMENT CODE §6250 ET SEQ., THE CRY HAS TEN (10) DAYS AFTER YOU SUBMIT THIS FORM TO DETERMINE WHETHER THE RECORD(S) YOU HAVE REQUESTED IS SUBJECT TO DISCLOSURE UNDER THE PUBLIC RECORDS ACT. AFTER THE CITY HAS MADE THIS DETERMINATION, YOU WILL BE IMMEDIATELY NOTIFIED OF THE DETERMINATION AND THE REASONS THEREFORE. IF THE CITY DETERMINES THAT THE DOCUMENTS YOU HAVE ' QUESTED ARE SUBJECT TO DISCLOSURE, THEY WILL BE PRODUCED WITHIN A REASONABLE T r E THEREAF 1 tR. PLE.ISE,VOTE: YOU WILL BE CHARGED .10 CEN S PER PAGE FOR THOSE RECORDS YOU REQUEST TO BCOPIED. DESCRIPTION OF THE REQUESTED DOCUMENT(S): 7E0/ -0oZ(7 �r PDl-QO/C �r t4 ( 01- o03 ✓ SiKn.'ur• Dare Print , ame IC 'v(l(/&t2 S en7 , WILL PICK UP EV Addres 5/ 0 — 2 C PLEASE MAIL Phone - THIS FORM SHOULD BE SUBMITTED TO THE CITY CLERK OR APPROPRIATE DEPARTMENT FOR OFFICE USE ONLY p /ice , DATE RECEIVED: 0123/7 DATE NOTIFIED: kik3/ 2 r d� ✓v SANsr44,, '' Final Sign-Off OCCUPANCY RELEASE ° mo° ° :tic, at I Job Address: 1901 & 1903 Raymond ‘1 \c�-PORA S,/ Project Number S-98-225 A.P. Number: TPN980-103 & 104 FEES PAID AMOUNT DATE PAID RECEIPT NUMBER O.C.S.D. $ N/A INSP. And P.C. $ 320.00 1-28-99 000251 FIXTURE FEES $ • 97.50 2-3-99 13791 97.50 2-3-99 13790 SEWER PERMIT $ 55.00 3-16-99 2966 & 2967 ORD. #16 --------- $ ADD. INSP. - $ FIELD CHECK: YES DATE: 8-2-99 COMPUTER CHANGED: NO DATE: FINAL APPROVAL DATE SENT TO BUILDING DEPARTMENT: 8-2-99 APPROVED BY: Dawn Schmeisser . lig.. ,L i ® Residential Number of UNITS - 2 New Units ❑ Commercial Square FOOTAGE - (jam\\�(�✓/� ❑ Industrial Square FOOTAGE - ❑ Industrial Square FOOTAGE - ❑ Other Square FOOTAGE - • NOTES: This is for 1901 & 1903 Raymond. Two separate lots with 1 unit each on them. 2406-68 ON-LINE A. '\ —UI w - CITY OF COSTA MESA - }4y ,\ BUILDING DIVISION PERMIT NUM ER ° _ ' DEVELOPMENT SERVICES DEPARTMENT yam� �; PERMIT m B9 -00827 / (714)754-5273 • Fax(714)754-4856 . 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1903 RAYMOND AV Status: ISSUED Suite: Applied: 06/08/1999 Vicinity: N.SIDEYARD&REAR OF PROP. Issued: 06/08/1999 Parcel Nunmber: TPN980104 Zoning: f �J ISSUED BY: �/J>j'J_ Applicant: YOUNG, STEVE - Address: PO BOX 10757 , - - Phone: 949 515 7416 COSTA MESA,CA Zip: 92627 Owner: JMS RAYMOND STREET, LLC Address;r PO BOX 10757 Phone: 949 515 7416 COSTA MESA,CA Zip: 92627 - - Contractor: - " 1,LAddress: - - Phone: , ,Zip: License: • Arch : ' • - - • Eng: . ' Address: Address: , Phone: ,'''Phone: • L ' 'Zip License: Zip: , License: / SCOPE OF PERMIT • • CONSTRUCT 140 LF,6'HIGH BLOCK WALL ON THE REAR AND A PORTION OF THE RIGHT SIDE PROPERTY LINES FOR AN SFD , • FEE SUMMARY Plan Check: $0.00Calc Valuation: $2,800.00 ' Permit: $74.75 Claim Valuation:• $2,80o.00 SMTP Res: • • $0.00 SMIP Corn: $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 22-0 Rear 0-0 Left 0-0 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 end 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 f1 cm a • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ' ,,• ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My 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.) . ❑ 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 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.# Class# 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: 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,Busi.-- a • 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• erself.r 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 wi hin one .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.). VI, as o .:r o A', property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: Th: tractors 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) licenset to the Contr: tors L' :nse Laws.). CI ,I am ex: sec. Business and Professions Code for this reason: (Q '411 Signature: •. a_ Date: Owner ID verifies •y tlrivers lice. e. ■ 'e- 0 No Drivers License No. Expires: Verification of Ownership by( ,e of doc '•ent,i.e -property tax bill or deed): DIVISION OF INDUSTRIAL S TY CER FICATION: ❑ I hereby certify that no excava (5)or ore feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,end that no building structure, . •ling,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑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 an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? p 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 aaermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? lip Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Wit 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 at of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No - 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials end Emissions. Signatu Date: CE- FICA • ••MPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is corre I a• o comply with all s •: laws a • - ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-.:•.,. property for spec puss••ses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Ipprto.o- 99 e 0 egal Owner(s) Date - • • ' thori •.Applicant Date CODE I INSPECTION TYPE QATF INTRIALS CODES INSPECTION TYPE pm INTIALS 1616 Fixed System Fina - —- anion 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall RPlgs 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 • I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California He• d Safety Code and have completed the above information to the best of my personal knowledge, i compli• ce with this State law. C� Signed: i • S r �- Date: (P • `II Name: T'uaS A-ek ✓ d) 111irli? C.D.1.#OR S.S. # • mor For more information call City of Costa Mesa Building Division at(714)754-5273. 104246 (REV.9/98) I N ADDITIONS, DELETIONS, OR CORtii i i:.:1 SIM I BE APPROVED BY THE PL/.i: : :IS (.1 V :h TY) •THIS SKETCH IS FOR INFORMATIONAL PURPOSES •SOLID WALLS/FENCES BETWEEN 2'-6'&6'IN HEIGHT SHALL ONLY. APPLICANT IS RESPONSIBLE FOR PROVIDING BE SETBACK AT LEAST 10' FROM FRONT PROPERTY LINE. AN ACCURATE REPRESENTATION OF THEIR PROPERTY IN CASE THE SHAPE AND SRIF DO NOT CORRESPOND •SOLID WAILS/FENCES SHALL NOT EXCEED 2'6'IN HEIGHT • WITH THE INFORMATION PROVIDED ON THIS SHEET. WITHIN 10'OF THE FRONT PROPERTY LINE(NOT CURB LINE). bell - 0032-5 - }ALO LPA.W CW cut- /c/0/ •VERIFY DISTANCE FROM CURB TO PROPERTY LINE /onc - CO gZ7 - ,�jrpc,(,� 1A-VCA-4 cc f /°/c13 AND SHOW ON PLAN. VERIFICATION FROM THECITYS r ENGINEERING DIVISION IS REQUIRED. CALL(714)754,5347 FOR INFORMATION. APPROVED CITY OFCra>TA MESA PLANNING. DIV. SLBJECT *O LD43. DEPT. REG. 1.19 BY J C__ ;DATE -- -- -- � aaaNa PESCDCE g tai 2 arI I 1 I� � I LaH a Ig 1 g g 1 gI a RESIDENCE RESIDENCE REsEENCE RESIDENCEI 1 . 0034 I 11 1 W ` B .1101 piaci( R/{{ STi BAER //// I `nw 6 ,vto _ F f STREET • BLOCK WALL LAYOUT FOR BUILDING PERMIT PLANNING DIVISION 1/4. J .1,1:ll �, • / • TYPICAL 611 CONCRETE BLOCK FENCE • Cement Coping With Optional ii MI =MI �,j1 GENERAL- NOTES Channel Block With 1.3/80 Horizontal Top of all Fences H. '111.1 MI 11111. MORTAR: One Port Plastic Cement, and Three 'Parts Sand • Id GROUT: One Part Cement Three and For Fences 5'or Less { I i ,� �, • Vcn.Bars 3/8"¢at 4' 0"O.C. d One Half Ports Stand n° _ - - - - COPING: One Port Cement, Three • For Fences Higher Than 5' a a u ,I -, �- Ports Sand Vert. Ban 3/8"¢ at 32" O.C. r W --- - -- - CONCRETE: Well Mixed 1:2-1/2: 3-I/2 I . a " ��-1 Max of 7- 1/2 Gol;cns of Fill Cells Solid With Croute 1 > ' Water Per Sack of Cement Where Steel Occurs - s - - - - - - ReInlnrcin Steel Shall 11��a 2 GROUT MAY BE POURED FROM THE TOP Reinforcing '�� ��. OF THE FENCE IN CELLS WHERE STEEL Conform to Sec.A-15-39 , w O OCCURS. A.S.T.M. jllI _' �, CELLS AND AREASOF HORIZONTAL REIN Z All Steel to be Lapped ' I W '� - -- "-'- -' --- - FREE OF ALL FORCEMENT SMORTAR DEBRIS,ETC.CLEANHALL BE CLEAR, & 24"or to Code =1 LL I IIM MI NATURAL GRADE ill II III --- o .s a TWO 316"0 BAR • S ** Mfi. , • o CONTINUOUS TOP &BOTTOM I I I--.1—WIDTH III 10 16' 0 C MAX il . SEE CHART NO117-STEEL MUST BE TIED IN BELOW DEPTH CF EARTHTCOTH PLACE AT TIME OF TRENCH I/3 THE HE IGTH OF FENCE INSPECTION. -BELOW 801 BOTTOM OF POGTING ;4 10' J 2.. SCALE: 1/2 z I' FOOTING REQUIREMENTS CHART I WALL HEIGHT 6 ' S 4' 3' WIDTH . . . . 14" . . 14" 12". . 12" THICKNESS .10" 10" . . 8" 8 " DEPTH OF EARTHTOOTH 24" 20" . . . . . 16" 12" SPACING OF EARTHTOOTH. 12' . 14' . 16' 16' L M („ BUILDING DIVISION (-Fe) ra) J Lic. # 496841 ALL1CD 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: QQSIA.MESA ORANGE City County 19Q.1r,1.9A3: RAXMQNQ.AVE, Street No.(if available) Street Lot Number Tract No. DESCRIPTION OF INSTALLATION CEILINGS: Type of Material Fiberglass Manufacturer G.ertatinteed.... Thickness ..1..112".. R-Value** .R-3Q..... EXTERIOR WALLS: Type of Material Fiberglass Manufacturer ....QeA'tainteeJlt... Thickness ...Liz R-Value'* .R-1.3 FLOORS: Type of Material Fiberglass Manufacturer ....Q.extainte.ed.... Thickness R-Value"' TM Mars) Sq. Ft. Covered ....AIL. Sub Contractor(Insulation Applicator) ALLIED INSULATION INC. Licence number 496841 wu s.m a..n.u oww.l uvwa By ('r...S.LI.Y.a Title ...........Manager Date 4/.Z/.8.9................... (*California Administrative Code,Energy Insulation EXCERPT from Sec. 19875 of the Health and Safety Code of Standards,declares: "Compliance Upon completion of the the State of California: Installation of insulation,a card certifying that the insulation has been installed in conformance with the requirements of "No certificate of occupancy or similar certification that a these regulations shall be completed and executed by the newly constructed hotel,morel,apartment house,home of insulation applicator and by the builder. This isnulation other residential dwelling is habitable shall be issued by such a compliance card shall be posted at a conspicuous location building department unless the structure at least satisfies the within the dwelling.") minimum energy insulation standards established pursuant to this chapter." (**R Value is the measure of the resistance of a material of building component to the passage of heat. The resistance value(I?)of mass type insulations shall not include any value for reflective facing.) -lasulation Certificate few Number and Street City Vl�ftt��� County Subdivision Lot Number Description of Installation ROOF Material Th7 errnS Brand NameQIiePasr> ' CoeAt"3 Thickness(inches) 9t/e% Thermal Resistance(R-Value) 9.•�p CEILING Baa or Blanket Type VberZe s Pent't•5 Brand Name OWe.tiy. Coe rJINp Thickness(inches) (p" Thermal Resistance(R-Value) R•t� Loose Fill Type Brand Name Contractor's minimum installed weight/ft` lb Minimum thickness inches Manufacturer's installed weight per square foot to acheive Thermal Resistance(R-Value) R•Iq EXTERIOR WALL Material esetuot,t5i, Pon-5 Brand Name QWw 4 • C.ov4tt35 Thickness(inches) 3t/1`1 Thermal Resistance(R-Value) R• 15 RAISED FLOOR Material Brand Name Thickness(inches) Thermal Resistance(R-Value) SLAB FLOOR Material Brand Name Thickness(inches) Thermal Resistance(R-Value) Width(inches) FOUNDATION WALL Material Brand Name Thickness(inches) Thermal Resistance(R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Buildine Energy Efficiency Standards for new residential buildings contained in Tide 24 of the California Administrative Code. r• 1 _a General naactor(Budder) License Number Ml - se Par's a' • 15 '4\q Signature and Tide Date Atl.'3P M!. . _L 1yq(eb41 ntractor(lnsulation taller) License Number / i . as Signature and Tide Date Compliance Forms January 1, 1995 -u_Ct�• aCITY OF COSTA MESA ,`y' '4, BUILDING DIVISION • DEVELOPMENT SERVICES DEPARTMENT *# PERMIT PERMIT MBER/ E99- 0103 ✓ (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1903 RAYMOND AV Status: ISSUED Suite No Applied: 02/17/1999 Vicinity: Issued: 02/17/1999 Parcel Nunmber: TPN980104 Applicant: NORTON, KIRK Address: Phone: 714-997-2242 - , Zip: / t/2,; Owner: SMITH TONT Address 2961,INDUSTRIAL RD#54- ^- _ ;> N kms. / . �-. • �-.. Phone: �� ., /. Zip: 89109 % ' `,�'/�"./ . ,• A Contractor:," BUILDERS'POWER INCORPORAT �„ \� 'Address ' P 0130)67/ 'A% V-"- \\ 'vSA _% /'2 Phone:,996-2660 p= ,��t"\ �.,' � ORANGE CA ; • Zip' 92666 / , r v ;•' 1�" �\ _ License' -246046 ''. SCOPE OF PERMIT -TEMP POWER FOR 1903& 1901 RAYMOND:2 NEW SFD ON A LOT. N N�, 'REFERENCE 898-01943 - r, P`� / ‘,. FEE SUMMARY -^:f ,, y , t Quantity - -:\ -f- 1,1;, /./ ', Quantity; , ., ;'1' ISSUE FEE r - $22.00 - =Temp Dist System%Lighting'', $0.00 0 f r ,„,! Temp seivice test ..$0.00 - Busway/100'ft/t " -" $0.00 0 H r - � ,' Res,a/c package , $0.00 Standing Section $0.00 0 New Res'(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 "',';� New Res,(3+units) : $0.00 0 Transformers up.to 1 kva/kw ' $0.00 '<0 '-C'' /1-( Pool/Spa, ' `.0 $0.00 0 up to 10 kva/kw $0.00 „ 0' ' ,;1; ' Lighting Fitts - - A''$0.00 0 up to 50 kva/kw - ' $0.0021/. t;�t,-' Recept Outlets ' $0.00 0 - up to 100 kva/kw $0.00-AN 0 ' /-r. / Switches v'. '-$0;00 0 - s 'over 100 kva/kw '$0:00-/ 0 / _ Non Res Appl -, $0.00, 0 � Low-Voltage Equipment ,.$0.00 0 , , � Res Appl $0.00c .,-0 ' ."Low Volt Wiring System/Ckf: $0.00 0 ,=r i,= Service to 200a ', '$0.00 „0 , -' Misc.Conduit: 1 - /, $0.00'2 0 �, Service to 1000a - $0.00 ' -0 'Mist.Conductor $0.00 / 0 /� Service over 1000a _ . ,$0.00 -0 • , ' `Circus(gen or ride) - $0.00 off'// Motors to 1hp . $0.00 - _ 0 • ,Circus•(mech ride or lights) - '$0.00' ,/,:0YMotors to 10hp . $0.00 '' 0 Christmas Tree Stand $0.00 . - 0 Motors to 50hp $0.00 _ , .0 Fireworks Stand-' , . $0.00' 0 Motors to 100hp $0.00" 0 Other Electrical Fee $0:00 ' Motors over 100hp $0.00 - 0 Communication drops $0.00 ' ' 0 Investigation Fee '$0.o0 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 $22.00 1 TOTAL CALCULATED FEES $44.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora 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 n n WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My 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.) ❑ 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 y�/pr��I Applicant Signature: /�"- Date: •VJ9 1 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(S100,C00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am 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.k ' Class# � Contractors Signature: � Date: /" /l/1r 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 civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: • Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑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? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application appermit 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? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Snre al Owner(s) Date i6 ' -0/99 r Aulrazed Applicant cant Date 000E I. INAPFCTION TYPF PAlE REALS QQDEA INSPEClioN TYPE DATE REAlS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical —/" 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 244846 B CITY OF COSTA MESA • ,`y A. BUILDING DIVISION �� 6 DEVELOPMENT SERVICES DEPARTMENT Vcit •999 " PERMIT PE ITN BER . i 41% "OPo�'rF 9 00076 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1903 RAYMOND AV Status: ISSUED Suite No ' Applied: 02/03/1999 Issued: 02/03/1999 Vicinity: Parcel Nunmber: TPN980103 . Applicant: YOUNG, STEVE Address: Phone: Zip: Owner: JMS RAYMOND ST LLC Address P O BOX 17057 - ' Phone: , COSTA MESA,CA.. Zip: 92626 . Contractor: - Address: - _ - Phone: , Zip: .. . . _ - - License: Arch/Eng: . • Address: . Phone: Zip: . License: • • SCOPE OF PERMIT • NEW SFD: - ':898-0194 2 BATHTUBS, 1 D/W, 1 LAUNDRY TUB,2 SHOWERS, 1 KIT SINK,.1 • ' SINK,2 W• , BASIN SET 3 TOILETS, 1 W/S, 1 GAS PIPINGOUTLES(5), 1 GAS SERVICE, 1 DISPOSAL, 1 • • r TER, 1 SEWER CON.,2 HOSE BIBS. FEE SUMMARY +AMT QTY AMT QTY AMT QTY ISSUE FEE $22.00- Laundry Tub/Washer ' $8.75 1 Sump Pump ' $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool , $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 .0 .Trap Primer $0.00 0 Bathtub $17.50 2 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) ; $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 . Receptors ' $0.00 0 - Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $8.75 1 Dishwasher $8.75 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $17.50 2 Drain, Floor $0.00 0 Sewer Connect $22.00 1 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $26.25 3 Drain, Roof - $0.00 0 Shower $17.50 2 - Water Heater/vent $11.00 1 Drinking Fountain $0.00 0 Sink, bar $0.00 0 - • Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 - - Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service' $8.75 1 Gas(1-4 outlets) $5.50 1 Sink,kitchen $8.75 1 Water Softener $0.00 0 Gas(Over 4 outlets) $1.00 1 Sink,service/mop $0.00 0 OTHER $8.75 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $8.75 1 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 . REINSPECTION . $0.00 0 Interceptors(Sand Auto) $0.00 0 . • TOTAL CALCULATED FEES: $201.50 COMMENTS(SPECIAL CONDITIONS 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 ( ) l r WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the Following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My 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.) ❑ 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 SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am 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 ft 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 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 wi •' on. 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 o er o the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:Th: •r . tors 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) licensepur t to the Contractors License Laws.). ❑ I am exp .:r sec. Aik_ Business and Professions Code for this reason: �+ Signature: AW Date: �• 3 •• 1l Owner ID ye ':d b • er's li V P. Yes 0 No Driver's License No. Expires: 'I ro7_, Verification of Ownership by t,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL � •k CERTIFICATION: ❑ I hereby certify that no excava • ye(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,fatsework,or demolition or dismantling thereof,will be more than thirty-six(36)Feet high.(Chap.3.2,Grp 2.All 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 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air(Duality 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 part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the 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 required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIF- • E • 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 regardi g Haza •ous Materials and Emissions. Signatu -: _ Date: CERTIFlCA - a F OMPLIANCE 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 'a r-e to c•• ply with all state laws and c' ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-de bed plop: for insp. •• a agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ' Sig .tura'e` egal• ner(s) Date A d1Or • • ed Ap dicant Date CODE F INSPECTIONTYPE DAZE I1®ALS CODE E INAPFCTION TYPF Deg =ALS 1616 Fixed System Final Fire • . . i. 206 Final Mechanical p 1266 Pool Spa Final _ 208 Final Plumbing `1-9 —9 9 5lI 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 2446-46 �F CITY OF COSTA MESA gat. BUILDING DIVISION ,I � . ,. ' DEVELOPMENT SERVICES DEPARTMENT 4. '" PERMIT P NUMBER - 0 9-00038 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1903 RAYMOND AV Status: ISSUED Suite NoApplied: 02/03/1999 Issued: 02/03/1999 Vicinity: Parcel Nunmber: TPN980103 Applicant: YOUNG, STEVE Address: . Phone: Zip: • Owner: JMS RAYMOND ST LLC . Address: Pb BOX 17057 - - • Phone: , ' COSTA MESA,CA Zip: 92626 ' Contractor: Address: - Phone: Zip: License: • - - - • Arch/Eng: , Address: • - - Phone: - Zip: . License: • SCOPE OF PERMIT NEW SFD:ref:b98-01943-1 furn., 1 a/c,2 f/p, 1 hood, 1 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 Ventillation.System $0.00 0 Repair/Alt Cooling/Heat , $0.00 0 Evaporative Cooler . $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator • $0.00 0 Refrig Sys<100 k BTU $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/Mech 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 Reinspection Fee $0.00 - TOTAL CALCULATED FEES _ $83.50 • COMMENTS/SPECIAL CONDITIONS ' • 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: ❑ 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 carrier 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 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 Califomia,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 CAVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S106A00),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: 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 end 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 t./'"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.). . pp /I, as o.4ifit the . operty,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions (`-' Code: actors 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 p . t to the Contractors License Laws.). ❑ I am- TT1,der sec. - Business and Professions Code for this reason: �7 • . Signature: M. _ .A. Date: `• 11 Owner ID ve 7driver's lice• ant n t?s 0 No Driver's License No. \ Expires: 2C`�'z, Verification of Ownership by(ty.: ,i.e. •roperty tax bill or deed): DIVISION OF INDUSTRIAL SAFE• IT CERT (CATION: ❑ I hereby certify that no excavation - : more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,TItle 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature:• Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the 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 0 No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the f: ' • ust meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit f •m the -outh 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,ha,, all • the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach ce .f:to.1 compliance from the appropriate air pollution control officer). CERTIFICATE •• q•MPLIANCE:I certify that u .. .enalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Ha paterials and • iss s Signature: S Date: _2,Z3_.L._1_, Jr CERTIFICATE OF COMPLIANCE • OR r • • OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all s flaws laws and • dinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspe. n purposes. .. :a not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signatu"�• .: •. er(s) Date And/Or Authorized Applicant Date CODE I INSPECTIONTYPE OATS MALL COOS I IIISPFCTNIN TYPE DATE (,��AL5 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical ‘.1 / ' lo -99 L]1 y 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 " Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy ___ 2446-46 44,' CITY OF COSTA MESA /, BUILDING DIVISION /076 DEVELOPMENT SERVICES DEPARTMENT • J• • PERMIT PE IT qtb"osno (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1903 RAYMOND AV Status: ISSUED Suite No Applied: 02/03/1999 Vicinity: Issued: 02/03/1999 Parcel Nunmber: TPN980103 Applicant: YOUNG, STEVE Address: Phone: Zip: Owner: JMS'RAYMOND ST LLC Address P O 80X'10757 Phone: - - - COSTA MESA,CA Zip: 92626 - Contractor: - Address: - Phone: , Zip: License: - SCOPE OF PERMIT NEW SFD: REF:898-01943, 1 OUTLETS, 1 FIXTURE,&1 SWITCHES AND 2475 SQ FT TOTAL. • 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 - StandingSection - $0.00 0 ' New Res(1-2 units) $123.75 2475 Misc Electrical Equipment $0.00 0 New Res(34-units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 -up to 10 kva/kw $0.00 . 0 Lighting Fixts $2.00 2 up t650 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 AppI $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 1hp $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 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee ' $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $150.75 Intermed Pole $0.00 0 COMMENTS I SPECIAL CONDITIONS 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 fl WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - _ ❑ I have and will maintain a certificate of consent to sell-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ 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: Cartier: Policy Number: (This section need not be completed if the permit is valued at 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 es 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 CAVIL 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 ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.4 Class 4 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).): ❑ 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 hers: • hrough his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is Igosold within o e year,f 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 • th:. •roperty, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code:The co •ctor -:nse 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 pursua;,0.c1 e Contractors License Laws.). ❑ I am exam ` c. ► Business and Professions Code for this reason: Signature: _a Date: 2- 3 '99 Owner ID verified b 's license. pg/ ' a Driver's License No. Expires: 7 OQ�/ Verification of Ownership by(type of d••• rty tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PER' TION: ❑ I hereby certify that no excavation five(5 • •• , 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,Califomia Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to tile and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or,200 cubic feet of compressed gas at standard temperature 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 Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑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 required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 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 Hazard aterials and Emissions. • Signature: Date: ir CERTIFICATE OF C• -LI'• 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 co ••.. 'th 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. ...rt or inspection•urpo I agree not to occupy or allow occupancy of any building authorized by this� permit until final inspection. r / / ' ignatur • er(s) Date And/r r Auth• ••nt Date CODE I. INSPECTION TYPE • • ..1 MODALS COnF' tNSPECTIONTYPF Dell 2(0119LS 1616 Fixed System Final Fire Prey'- • 206 Final Mechanical _ 1266 Pool Spa Final 208 Final Plumbing 'I .jr 200 Final Re-Roof 210 Final Electrical 7 - 1'I _l'(y� W •J' 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 1/-01943;y •, BUILDING DIVISIONi "�'rr�'� ' DEVELOPMENT SERVICES DEPARTMENT�'' - PERMIT 4"�(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,CO UILDING PERMIT • Job •'dress: 1903 RAYMOND AV Status: ISSUED Suite: Applied: 10/27/1998 "cinity: Issued: 02/03/1999 Parcel Nunmber: TPN980104 Zoning: . Applicant: JMS RAYMOND ST LLC Address: PO BOX 10757 • Phone: 949 650-1457 COSTA MESA, CA Zip: 92627 Owner: SMITH, TONI Address 2961 INDUSTRIAL RD#54 Phone: . LAS VEGAS, NV Zip: 89109 - ' Contractor: , Address: " Phone: • Zip: License: Arch : ' ' Eng: OPTION ONE. Address: . Address: 20311 acacia ste240 • Phone: Phone: 714-553-1916 NEWPORT BEACH,CA Zip: License: 92660 - License: S3855 SCOPE OF PERMIT CONSTRUCT A NEW 2475 SF SFD(1277SF 1ST FL, 1198SF 2ND FL)WITH ATTACHED 638SF GARAGE, 137SF PORCH. ' SEE PARCEL MAP PM-98-225. • FEE SUMMARY Plan Check: $960.21 . ' , _ Calc Valuation: $217,637.94 Permit: $1,477.25 Claim Valuation: - $0.00 SMIP Res: $21.76 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • Total: $2,459.22 • PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 20-0 Rear 29-0 Left 7-0 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. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS (Th (1 ., , a WORKERS'COMPENSATION DECLARATION: 41 •• t I hereby affirm under penalty of perjury one of the following declarations: O 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. O 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: Cartier: Policy Number: (This section need not be completed if the permit is valued at 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 Califomia,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 CML FINES UP TO ONE HUNDRED THOUSAND On I ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am 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.R Class 4 • 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).): ❑ 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 h= for 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 o'"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.). (]01, as owner of •roperty, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions C'� Code:The contra • 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 pursuan o t ,Contractors License Laws.). ❑ I am exempt ender sec. Business and Professions Code for this reason: Q� Signature: � Expire : 2 -- Verification of Ownership by(type of do .-pro•erry tax bill or deed): lir DIVISION OF INDUSTRIAL SAFETY ' -TIFIC•TION: ❑ I hereby certify that no excavation or mo . 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,s -,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: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the 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 bapartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application epeNmit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U 10 (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 es 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signaturev Date: CERTIFICATE •' O. ••" 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 agre I. o -•ly with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desc'•-.prope t for inspection p m•'_ gree of to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature o Len: (s) ate And/Or •utho _ • ,Plica t Date CODE I INSPFT.TION TYPE .cI 21/DIALS CODE t INSPFCTIONTYPF DATE IBIlD•ALS 1616 Fixed System Final Fire Pre anti. 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site .204 Final Demolition 250 Final Building/Occupancy 8©e I 2446-46 • 2843 • ' NEWPORT-MESA UNIFIED SCHOOL DISTRICT CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 G �j06�� To: (X) City of Costa Mesa District Receipt No.01 O7/ ( ) City of Newport Beach ( ) County ^offOrang(e� I �� � I / Plan Check No.a1e) • f 43 Applicant: /��r V` / KfY (�N� i/ ,��t I LLt. Address: I'. o . 1 O)( 1x157 A M t @A . el 2- C614--Telephone Number: 9461 • 51,G •—1y I Co Tract/Parcel and Lot Number(s):� /�, ,,q— j I 1 D /� Location of Project: I 'L -7117-eg l-� JMhr1d Au&. / cm/ A'(610 Ave v-1 Number of Square Feet of: 2415 PJ.� 01914 C/i Vd 1 Residential Space l l °LP 1 x $1.84 Total 1957 . 7‘o 10(04 Residential/ Sr. Citizen Space x $ .30 Total Commercial and Industrial Space x $ .30 Total Eta) 1311 Commercial/Industrial Project is: (Check One) Warehouse Motel _ Preschool R & D Bank Auto Repair Movie Theater _ Neighborhood Shops Hospital • Mini-storage Racquet/Health Large Office Heavy Industrial Hotel Office Bldg. Regional Shops Medical Office Restaurant Light Industrial Office Park Fast Food This project is exempt because 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: ....."4, • Authorized Representative The above representation as to square footage is true. Applicant .: . that if it is-later determined that such representations are not true,then this certificate shall automatically terminate and the apI i i is - ity/County shall be notified. • pq � Date: I . 2 q t • f. 1 . Applied: From : PACIFIC CREST DEVELOPERS PHONE No. : 714 498 1420 Jul. 14 1999 5:31PM P01 FINAL CItOING CERTIFICATION Project Address: 1901 RAYMOND AVENUE COSTA MESA Lot Number: PARCEL 2 PARCEL MAP 98-225 Permit Number: seta ' coo t4 1 By Civil Engineer: I certify to thesatisfactory completion of grading in accordance with the approved plans, Specifications, local and state codes. All drainage devices required by the grading permit, grading plan and grading ordinance have been installed. Adequate provisions have been made for drainage of surface water from each building site, The minimums are: 2% Fall from structures within 5 feet from exterior walls. 1% Fall for asphalt surfaces and landscaped areas. • 0.5% Fall for concrete surfaces to approved disposal areas. The final monuments as shown on the recorded tract map were set. All final grading eleva- tions are within f 1/10 of the designed elevations. Supervising Civil Engineer .._ /!���`' . Reg. No, 2.25-47Z. °nature) Age. Date 7-7/5 JJ QRpf ESS/044,e1 Met Cp 0 3 No.22502 x Exp. 12.31-01 OF CAO'''' CAGE STRAP and ST ZI leve+c From : PACIFIC CREST DEVELOPERS PHONE No. : 714 498 1420 - Ju1. 14 1999 5:31PM P01 FINAL GRALIING CERTIFICATION Project Address: 1901 RAYMOND AVENUE COSTA MESA Lot Number: PARCEL 2 PARCEL MAP 98-225 Permll Number: (et • DOQ L4-) By Civil Engineer: I certify to the satisfactory completion of grading in accordance with the approved plans, Specifications, local and state codes. All drainage devices required by the grading permit, grading plan and grading ordinance have been installed, Adequate provisions have been made for drainage of surface water from each building site, The minimums are: 2% Fall from structures within 5 feet from exterior walls. 1% Fall for asphalt surfaces and landscaped areas. • 0.5% Fall for concrete surfaces to approved disposal areas. The final monuments as shown on the recorded tract map were set. All final grading eleva- tions are within ± 1/10 of the designed Cleve ions.%�/ Supervising Civil Engineer ../,, ,. _ Reg. No. 2Z51vZ . e ignawrc) / Date 7-15-'102 Ce„. IO,yq�G. '02 A i:1111-G',U% STAMP and SIGN