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HomeMy WebLinkAbout175 DEL MAR AVE - Building Permits t r F S • CITY OF COSTA MESA BUILDING DIVISION 4 F r.,,r .► DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4, PC.st PERMIT /B03-01029 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa,ca.paLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUIJob Address: 175 DEL MAR AV Status: ISSUED Suite: Applied: 06/17/2003 Vicinity: Issued: 06/17/2003 Parcel Number: 43916125 Zoning: CIF( Applicant: ASHARI, MOHAMMAD ISSUED BY: C�/ L 1n . Address: Phone: Zip: Owner: DEL VENTURE PART • ' 'N Address /JESSEE,DAVID . � " VISTA,CA - . I ' - Phone: - , .3442 HOLLYBERRY DR Zip: 92084 Contractor: X L IMPROVEMENT Address: 3419 VIA LIDO - ' Phone: 714-420-6986 ' NEWPORT BEACH,CA Zip: 92663 • License: 766881 - Arch : Eng: - - Address: - .. Address: Phone: N / . Phone: - , Zip: License: License: -- SCOPE OF PERMIT - ABATE ILLEGAL DUPLEX.RESTORE TO.ORIGINAL SINGLE FAMILY.DWELLING--A SEPARATE PERMIT WILL BE OBTAINED-FOR THE GARAGE EXPANSION ON THE LEFT SIDE OF THE BUILDING. THIS UNIT(175 DEL MAR)EXISTS ON THE SAME PROPERTY AS 173 DEL MAR. 173 IS AT THE FRONT OF THE PROPERTY;THIS UNIT IS AT THE REAR. - - REPLACE EXIST.WINDOWS WITH DOUBLE GLAZE,VINYL WINDOWS THROUGHOUT UNITS TO COMPLY WITH 1997 U.B.C.EGRESS REQUIREMENTS. 11/14/03:2 EXISTING SHOWER WILL BE CHANGED OUT TO TILE SHOWERS. - _ • . - ' -FEE'SUMMARY ' Plan Check: $1.17.81 Calc Valuation: $10,000.00 Permit: $181,25 ., .. Claim Valuation: ;$10,600.00 SMIP Res: $1.00 ., SMIP Com: $0.00 - Other: $0.00 Inspection: - $0.00 ' - Total: $300.06 - ' - PLANNING &ZONING SETBACKS - 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(Vaa) DECLARATIONS c fl ('1 y 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: . � I T 1 a 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# 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 end 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).): O 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 ...,,,,,,ttt!!! ,)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.). • y1 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 appy 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.). O I am exempt under sec. , Business and Professions Code for this reason: Signature: .Y� Date: n Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. - Expires: ) Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greeter 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 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? Yes IP No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.!agree not to occupy or allow occupancy of any building authorized by this permit until fin inspec on. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE# INSPECTION TYPE PATE PARTIALS CODE! INSPFCmON TYPE PAIS IIfNM& 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 1-2-11-or CITY OF COSTA MESA BUILDING DIVISION F ( ,;,, 111. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT B03-01029 rp,,,„0 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cBuILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • Job Address: 175 DEL MAR AV Status: ISSUED Suite: Applied: 06/17/2003 Vicinity: Issued: 06/17/2003 Parcel Number: 43916125 • Zoning: • • , a Applicant: ASHARI, MOHAMMAD ISSUED BY: r" Address: Phone: Zip: Owner: DEL VENTURE PART ' Address JESSEE,DAVID VISTA,CA . Phone: 3442 HOLLYBERRY DR - • Zip: 92084 Contractor: X L IMPROVEMENT Address: 3419 VIA LIDO Phone: 714-420-6986 NEWPORT BEACH,CA Zip: 92663 License: 766881 Arch : - Eng: • Address: - Address: Phone: Phone: Zip: License: License: • SCOPE OF PERMIT ABATE ILLEGAL DUPLEX. RESTORE TO ORIGINALSINGLE FAMILY DWELING. REPLACE EXIST.WINDOWS WITH DOUBLE GLAZE,VINYL WINDOWS THROUGHOUT UNITS TO COMPLY WITH 1997 U.B.C.EGRESS REQUIREMENTS. -FEE SUMMARY Plan Check: $117.81 Calc Valuation: $10,000.00 Permit: $181.25 Claim Valuation: $10,000.00 SMIP Res: $1.00 SMTP Corn: $0.00 Other: $0.00 • Inspection: $0.00 Total: $300.06 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 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. 4 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. r f i (Th _ . 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. axe 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 rkers'compensation Insurance carrier and policy number are: �///�''' rn Po6ty Num er: is sect/on 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 shalinot employ any person in any manner so as to become subject to the workers' corn lion 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 m wi these provisions. � / f nt S' ure: _ � s 7[11 J V 3 W :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 ADDmON 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 here '.afl' hat,I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3PL1ha-Business and Professions Code,and my license Is In full fr kUc.# l ' I.ij% 'CIS a3 a Con �Ijure: at v -� 3 1 I 0 3 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 ciWI 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 Cyde: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) I//�����ccccense pursuant to the Contractors License Laws.). r� exempt u r sec. Business and Professions Code for this reason: O''''))rrmer ID ved ted by driver ❑No r Driver 4icense No. - Expires: VeT; egoo of Ownership by(type of document,i.e.-property tax bill or dee C/ DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 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 Califomia 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 a plication aernit 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 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? ❑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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signa f Legal Owners) - T dT tr.'. —z 131 0 And/OrAtf IS6i t r (zed Appl' Date T,ODE f INSPECTION TYPE pA�FT INTImALS - • 'CODE I 'INSPECTiON TYPE UTZ INRTULS 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. q /�//>�7 7' q 1; k- • i ,`far! y CITY OF COSTA MESA • BUILDING DIVISION ). • «it ,i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t p •PERMIT . • r /Bo3-o1310 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.03,0aDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUIJob Address: 175 DEL MAR AV Status: ISSUED Suite: Applied: 08/01/2003 Vicinity: Issued: 08/29/2003 Parcel Number 43916125 Zoning: Applicant: ALLEN ASHARI ISSUED BY: r n Address: 3419 VIA LIDO � '� I f // ' �- ,'•i , Phone. 714-420:6986 NEWPORT BEACH,CA - Zip: 92663 , Owner DELMAR-PART. - N Address ,3419 VIA-LIDO - y `-- �� 1/2 Phone -714-420=6986,,- - .� " /_ ,\ 'NEWPORT BEACH CA Zip: 92663 � - , ,/. ///- ���� //( ( , -, r \—N \ C j)\\' Contractor: '-,X L IMPROVEMENT 'Address:, 3419 VIA'LIDO" �'��,/ \,'N \ Phone:' 714-420-6986 ' " ,; " W ' I ' NEWPORT BEACH,CA \ , . i \\\l` • Zip: 92663. License:r 766881 ' . Arch-, r. ._1 ' . Eng: • - ' Address: , Address:', . _ . ,,, Phone:_ - . % Phone: - _ 1 / , Zip: - \ License: License: � , ' : SCOPE OF PERMIT_, r_r,-y ` EXTEND EXIST GARAGE BY 11 X18FT "^. . , 7 - " :. " f ,: - i .SEE MINOR MODIFICATION MM-03=,FOR LEFT SIDE SETBACK ENCROACHMENT. ,-- .i ' - 5 _ i _ FEE.SUM_MARY_% Plan Check:, • • $18.08 .. _ •Calc Valuation '' $4,i81-1.4 0 1 0 "Permit: ',', v$111.25 • Claim Valuation: ,, : Woe • _ : J i .' 1 \SMTP Res: .\<<';$0.50 ` ' b;.// ' ;`_ i i,SMIP,Com ,$0.00 -- �/r / - , Other . V'$o00 t : - . /i/ Inspection. $0 00 - ,,r? -,� 1. '" J /07 Total: �� '$129.83' - '-`'� ' . . 77 N -PLANNING &ZONING - SETBACKS ti‘•, C MAIN STRUCTURE•Frdnt 7'1-'0 -' Rear 7-0 _ Left 2 8' Right "0 0 // ACCESSORY Front`- 02-0' - Rear , -0-0, ./,, - Left 0-0 , Right ;D-.0 ,Z PARKING Existing: 0--"-.- Required: 0 - -'`.-Proposed: 0 ,/ ' i5 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Californiautes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) E%PIRATION: 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. is 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 the.expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 / 2446-46(6/00) iY"�r. DECLARATIONS (- 1 (--j WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - r ❑ 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: r 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 DOLURE($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.tic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that Under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a 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.). - ❑.�.- . empt under sec. • Business and Professions Code for this reason: _ — cat) Owner ID verified by drivers license. C� 0 No river's Lic se No. r .ires: - 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 e 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 ❑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 greeter than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ._.._..._ r will t 'app._ present re — —_...r_ _ _ __ W. _ .._. 3 Does or will the plicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 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 ermlt 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 i�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). __ apermit theh_.__ ..isreq__ _. 7 a a n tram the South isclst res Qualityi ed Management District or other airpollution control district3 or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by CaliforniaCelifoHealth and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this pe It until final inspection. Signature a = • er(s) Date And/Or Authorized Applicant - Date ;ODE! INSPECTION TYPE PATE =al BODE t INSPECTIONTYPE UTE KIIIAL6 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• �({ ,,rte ',/ 204 Final Demolition 250 Final Building/Occupancy Z'-- `fir 4�"ry e� C "b' 7/1e44 Euu'du>9 DcucQiaa I � �; ' OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Properly Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No buildin& permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed properly improvement. ❑ Yes ❑ No I (have/have not) AL1,€1.3 PiSOPttlasigned an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone ( ) Contractor's Lic. No. 4. ' I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name XL lr'1Peta vGMCur 3 Address 3'4t Y\R L cc City p •Q. Phone (-IN4 ) 4 ta— ti`%8-- Co Contractor's Lic. No. 1 b 6 WI 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work 1012-46 (REV_9(9B) • I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State' , of California Health and Safety Code and have completed the above information to the best of my personal knowledge, in compliance with this State law. Signed: 5-- --> 1 Date: rIa'dd6 3 /Name: A tic.J Qs i44 —Z– (Printed or Typed) JC.D.L. tt OR S.S.tt For more information call City of Costa Mesa Building Division at(714)754-5273. 1042-46 (REV.WB(1) r • r r T CITY OF COSTA MESA i 4 � BUILDING DIVISION F I ,.T. I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. ;ft PERMIT B03-01310 w (714)754-5273 • Fax(714)754-4856 •www.ci.costa-mesa.o.a UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 175 DEL MAR AV tl Status: ISSUED Suite: Applied: 08/01/2003 Vicinity: Issued: 08/29/2003 Parcel Number 43916125 Zoning: Applicant: ALLEN ASHARI - . - - . _ ISSUED BY: Address: 3419 VIA LIDO 2 - — - Phone: 714-420-6986 NEWPORT BEACH;CA/-- Zip: 92663 .% - / \ Owner DEL�MAR=PART. ' /14,2, -, / ' �� , " '-Phone - 714•420=698B,--,- ' � ' ' ,7/NEWPORT BEACH,CA;` " Zip: 92663 - / N �. / ;v - ice' � - N- // / N,‘%!•,\ Contractor: `X L IMPROVEMENT =.N-'> ;Address:, 3419 VIA LIDO -.; '`-�', A�' J �� , t,�/ /�, Phone,, 714-420-6986 V',,��� ��� NEWPORT BEACH,CA 7 Zip: 92663 License: • 766881 - ' i. /,/! ' I - Eng. - - - , , / Arch: -�.. ' t .Address:- - - Address: p / - 1 Phone: '` Phone: ''‘Zip: • , License: "'License: ' � ' / � - r SCOPE OF PERMIT . _ __ EXTEND EXIST GARAGE BY 11 X18FT-' ' ' i' ' — / - 'I h SEE MINOR MODIFICATION MM-03-FOR LEFT SIDE SETBACK ENCROACHMENT. . - et ,;, FEE SUMMARY,' "1 , _' • 1 ' 'Plan Check: $18.08 Calc Valuation :; ' i - $4,811:40 i�v i Permit:'•'; v$111.25 // Claim Valuation: `,'// ' , so'.00 �SMIP Res: ,V;$0.50 .. f.- '— xp / i �. ,,, vSMIPCom,�� \‘‘\,,$0.00 - S f ; \t, Other V vx`$0. 00 • ; ; ` / Inspection $0;00 '''/ \V -.' _ - /-/ ./ / � n�/ / _Total: , '$129.83�<- c. ;, ,�A -" -/��, ., PLANNING & ZONING , - , SETBACKS\\c,,,'-.‘„ / • MAIN STRUCTURE'-Front, 71-0 . - Rear 7-0 - Left ' 2-6 Right '- 0-0 / . .. 'j17 ACCESSORY Front"-, 0-0 - -'Rear 0-0 - Left 0-0 Right 0.,0 PARKING Existing: 0 "Required: '0 - '-- , -Proposed: - 0 i,' ' • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and/related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned 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 2448-46(WOO) DECLARATIONS �) } « ' WORKERS'COMPENSATION DECLARATION: Y 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. ❑ 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(5100)or less.) o 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 MD SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARE(51OO,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 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.tic.N Class 0 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 Cade). • • 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 dull penalty of not more than five hundred dollars($500).): ❑ I,es owner of the property,of 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 LI,d 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, las 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.). . ❑ _ • exempt under sec. Business and Professions Code for this reason: f /03 - ee: 'y, er ID verified by driver's license. 0 No D' : o. Expires: , Verification of Ownership by(type of document,i.e.-property tax bill or deed): �7 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 e 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 Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during 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). ........_...._.es or_.....t_.appnt nt or fu f.._......f_.__ _ _ _ 2 Does or will the applicant or present or future building occupant need to file a registration forth 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 er 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. ....__..._._ _ presently_._......._._ _ fully complied If an RMPP is required,has Section 25534 of the California Health and SafetyCode been corn lied 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? Li Yes U No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _e..___._. _...—_ Dist__..t_.__ pollution .._._._._.__..__f.or the._...___._.hich is __..__..... 7 a icpaetiotram the South Coast s Quality Management Direct or anddSr airtpollution control district03ben agencyeis required for the work which is Ne subject of[his application,have all of the disclosures prescribed by California Health 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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by his it until final inspection. Signature saga. -- av, ds) And/Or Authorized Applicant Date coDE F, INSPECTION TYPE PATE IAL4 =El INSPECTION TYPE PAIL jam$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 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 L 27r'Gri ai of &aft 7ile.44 ta440- Vtsuidtda v tiattat4 OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion 'and'require the retum of, an owner-builder verification. Attention Property Owner: An `owner-builder building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I. I personally plan to provide the major labor and materials for construction of the proposed property improvement. ❑ Yes ❑ No I (have/have not) At-veo PS 3 4t..Tsigned an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone( ) Contractor's Lic. No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name )( 4 1M1PnovG s eh-'c,l Address 3`41`l Y\Pt Lye r3 City ,.1 .4. Phone (l"4 ) y to— is k Co Contractor's Lic. No. 1 b 6 it) 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work 1042.46 (REV.9/98) I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and hale completed the above information to the best of my personal knowledge, in compliance with this State law. i ell 2 :'Signed: Date: /Name: AtwJ QsRPti.--- (Printed or Typed) C.D.G. #OR S.S.# For more information call City of Costa Mesa Building Division at(714)754-5273. 1042-46 (REV.9178) • CITY OF COSTA MESA BUILDING DIVISION ROOF COVERING CERTIFICATION Permit No. V 03 -I) / 3 /2) _. Property Address / 7 S c Occ �// ^— e-ten • DEL EL fr-11 - 're-f,1 I Contractor y C 1 rat Prt,4 vc°M LA t, State Contractor License Number .1 c rr f Classification 3 I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the above address in conformance with Chapter 15, and Appendix 15 of the latest adopted edition of the Uniform Building Code, and the installation instructions of the manufacturer. I further certify that I am the owner of the property. (Owner-Builder permittee only). ❑ I further certify that I am: ❑ Owner of sole proprietorship company ❑ Full partner of the company O Limited partner of the company ❑ Officer of the corporation I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this certification, which shall be binding on all successors or assigns of the company or corporation. I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building Division for acceptance. Cady oCorporate Name Address Received by Building Division By: Y / ac/ o3 Signature Date w . - 9_ 2,0 403 Initial Date Printed or Typed Name 0990-46 MW 6/00 White-Building Div.;Canary-Contractor,Pink-Owner ! CITY OF COSTA MESA ,/ BUILDING DIVISION x F ,I DEVELOPMENT SERVICES DEPARTMENT P/?_RMIT NUMBER t w.fi • PERMIT / E03-00779 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 175 DEL MAR AV Status: ISSUED Suite No • Applied: 08/29/2003 Vicinity: Issued: 08/29/2003 Parcel Nunmber: 43916125 Applicant: DEL MAR PART. - . - - ISSUED BY: V Address: 3419 VIA LIDO ,,.ter" -- _ - -- . ", Phone: 714420-6986 - % i - NEWPORT BEACH,-CA. . Zip: 92663 , / - �, - '-..,„; i • Owner. DEL MARPART _ - - "' `, �. �. V� Address/} 419 VIA LIDO r"" - t..\\,- ,�� . %, ,� � /' / C '�> Phone: 714420-6986 N ,� v /, r NEWPORT-BEACH,CA Zip: 92663 V�- �� ' vVA\ `, /1? .,A\ ' - \ „'l/ ,//G' / , ',o - / �-A ',,.W. 'Contractor .,• OWNER-BUILDER -'g/ -. _ - , a' . ._A , 7 Address: -- u > . ,� ', , _ 'r • . ,"Phone: - ', t� t License: 000000 - ';,, v t - „A i r ' SCOPE OF PERMIT _, . •` I•REDF B03-01310`7,LIGHTS,3 OUTLETS, 1 SWITCH AND 1 RESD.MOTOR UP TO 1 HP. ., , � ' . - . - . liG - •�- --..- -�... „ ' FEE SUMMARY ""s I ' , Quantity Quantity ' - , 1i ' ISSUE FEE , $23.50System/ . . . - ., , -Temp Dist Lighting $0.00 0 ;,; ' " - _ t Temp service test $0.00 • • Busway/100 ft,-' 1/1$0.00 0 -/ _ 'I ti / • 'Rea a/c package A , J., $0.00 Standing,,Section -$0.00 0!,// -- .,((4i/ Nev Res(1-2 units), ,/ , $0.00 0 Misc Electrical Equipment $0.00 0 // , - /' i 1 / New Res 3+units \ $0.00 - 0 Transformers un to 1 kva/kw $0.00 !0' ' /n Pool hSpa, ; $0.00 • 0 -,...---:.;.-*--- .1,- up to 10 kva/kw $0.00 00�� ' 1 Lighting Fixts ‘',._ A',`'i$7.70 7 -=:�''>' _ -up to 50 kva/kw $0.00 ,7%0 Recept Outlets ,$3.30 3 '')� - r, tip to 100 kva/kw $0.00,;77/0 .19/ ;� �� Switches\, -,, "' " $1;10 1 .. - - • '- ' 'over 100.kya/kw;:,kva/kw?-„$0a0%$000%/ 0 ' - /� Non Res Appl ,� "' '$(5.06 ; 0:".:, - .Low Voltage Equipment '" :5'.''''',$6.00' 0 ., `' �/,,;)/ Res Appl \ ./' $4.757 ' 1 , ," Low Volt Wiring System/Ckt---/"$0.00„, '0 ' - Service to 200a ` - ,� $0.00 .` 0 , ,Misc:conduit, Service to 1000a ." - $0.00 '•0- Misc,Conductor - $0.00- /0. 'j Service over 1000a"�N $0.00 .� 0' ' `_ - Circus(gen or ride) ,$0.00-% / 0/, , Motors to 1 hp "�� "$0.00 / ^ •. 0 t _ - ` 'Circus(meth ride or lights) ' -$0.00'" "-0. Motors to 10hp N.$0.00 0,-. _ - Christmas Tree Stand • Motors to 50hp N $0.00 ' �.�/, a ' ) , - Fireworks Stam. . - $0.00,72,,'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 - -i.'---",----$0.00 Sub panel to 200a $0.00 - -0 _ • '. ,, -Plan Check-Feet / - $0.00 , Pole Light Pkg $0.00 0 - - .. " _ -- Rein_spection.Fee - $0.00 Sign Circuits $0.00 _ 0 . • • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord,No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is susp nded or abandoned for a period of 180 days. (/ INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspection('and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 t t 2446-46(6/00) DECLARATIONS rThn WORKER$'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following dedarellons: ° ' ❑ 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: t 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 MD SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MD 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.Uc.X Class p 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: • 1 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(commenting 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 Profession -for this reason: g`wnatercn _ the' 0 O�nerl verified by driver's license. Vs ❑No gL1L]Af•r+:r•�- •o. /✓ � —"-- Ex➢ices: - Verification of Ownership by(type of docume i.e.-properly tax bill or deed): V 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: 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 Ei 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 art 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 a mit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 8eNo (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 lithe subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No B (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above Is correct.I agree to comply with all state laws and city ordinances • regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this pe it until final inspection. • 4111111111111011.•• P/aoi � c S'- ature Of Legal...: { - J/o An zed licant Date cQQE f, INSPECTION TYT& PATE CODE( INSPECTION TYPF. LIAIL EMI 1616 Fixed System Final Fire Prevention 206 Final Mechanical 128 1008 Pool Spa Final • 208 Final Plumbing V—'— 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 guy D( ' . 4e s„ ILL ; ' `� OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I. I personally plan to provide the major labor and materials for construction of the proposed property improvement. ❑ Yes ❑ No I (have/have not) ALtze. AS 4Ml.Isigned an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone( ) Contractor's Lic. No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name )( L I M P IloVG r- ce j 3 Address 3_`11•t_VtR l.\t00 City pa .4- Phone(7'4 ) *Lb 69 k Co Contractor's Lic. No. 'l b b tri 5. 1 will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work 104246 (REV.9/98) I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my personal knowledge, in compliance with this State law. Signed: P. Date: ria--S6 3 Name: AciJ5 as 44L_1— (Printed or Typed) .D.L. #ORS.S.# ° For more information call City of Costa Mesa Building Division at(714)754-5273. 1042-46 (REV.9/98) ' MR CITY OF COSTA MESA BUILDING DIVISION F • ,,,, , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ri PERMIT \ E03-00530 se (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT • Job Address: 175 DEL MAR AV Status: ISSUED Suite No Applied: 06/19/2003 Vicinity: Issued: 06/20/2003 Parcel Nunmber: 43916125 Applicant: ASHARI, ALLEN ISSUED BY: Address: 3419 VIA LIDO Phone: 714-420-6986 NEWPORT BEACH,CA Zip: 92663 • Owner: DEL VENTURE PART. • Address ;173 E DEL MAR,r' VISTA,CA; . . Phone: 714-420-6986 C.M Zip: 92627 • Contractor: X L IMPROVEMENT Address: 3419 VIA LIDO -Phone: 714-420-6986 NEWPORT BEACH,CA Zip: 92663 License: 766881 • SCOPE OF PERMIT LEGALIZE WORK BEING COMPLETED THROUGHOUT THIS UNIT(FORMERLY 173 DEL MAR UNIT B). REPLACE EXISTING WINDOWS WITH DOUBLE GLAZE VINYL WINDOWS THROUGHOUT UNITS TO COMPLY WITH 1997 U.B.C.EGRESS REQUIREMENTS. REPLACE INTERIOR,NON-LOAD BEARING WALLS AND • EXTERIOR STUDS DUE TO WATER AND TERMITE DAMAGE. ELECTRICAL TO INCLUDE:31 OUTLETS AND 17 SWITCHES. 7/31/03:AMENDED ELEC PERMIT TO INCLUDE 25 LIGHT FIXTURES,28 OUTLETS,9 SWITCHES,2 RES APPL, 1 SERVICE TO 200A, 1 MOTOR TO 10 HP(FOR NC PKG UNIT). FEE SUMMARY Quantity - Quantity ISSUE FEE \$23.50 ' - Temp Dist System-/Lighting- $0.00 0 Temp service test / $0.00: t-- - -. Busway/100 ft $0.00 0 Res.a/c package ,..$0.00 r „, Standing Section $0.00 0 New Res(1-2 units) . $0.00 0 - Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 . • 0 -- Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 . 0 up to 10 kva/kw - $0.00 0 Lighting Fixts $30.03 " 31 up to 50 kva/kw $0.00 0 Recept Outlets $27.84 28 • up to 100 kva/kw $0.00 0 Switches $9.90 9 over 100 kva/kw . $0.00 0 Non Res Appl $0.00 - 0 Low Voltage Equipment $0.00 0 Res Appl $9.50 ' 2 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $30.50 - 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 - Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 • 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: t ❑ 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. gle 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: 1 Policy Number: S P 4". " .3 GI (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. /) g it 0 3 Applicant Signature: 7� 'Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($l00,000),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.f1= 1 4 4II gr' Class a a Contractor's Signature: 'R Date: "7//C 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: f Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 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 drivers 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.TIIIe 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 file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during 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 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 a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency'? 0 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"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) �/ / Date 2- • i/6 And/Or Authorized Applicant Date NODE r INSPECTIONTYPE Deg INrTIALS CODE• INSPECTION TYPE peg MALI • 1618 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 CITY OF COSTA MESA r ' BUILDING DIVISION ). . r.;,r.j ,r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER .4 11Pfrill PERMIT E03-00530 '°ooequrco - r (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 175 DEL MAR AV Status: ISSUED Suite No Applied: 06/19/2003 Vicinity: Issued: 06/20/2003 Parcel Nunmber: 43916125 ___,-.,f‘s.. Applicant: ASHARI, ALLEN ISSUED BY: Address: 3419 VIA LIDO . Phone: 714-420-6986 NEWPORT BEACH,CA Zip: 92663 Owner:' DEL VENTURE PART. Address 173 E DEL MAR VISTA,CA;/ -.-' Phone: 714-420-6986 C.M - Zip: 92627 ' Contractor: ' X L IMPROVEMENT Address: 3419 VIA LIDO • -Phone: 714-420-6986 NEWPORT BEACH,CA i Zip: 92663 License: 766881 . _ - SCOPE OF PERMIT LEGALIZE WORK BEING COMPLETED THROUGHOUT THIS UNIT(FORMERLY 173 DEL MAR UNIT B). REPLACE EXISTING-WINDOWS WITH DOUBLE GLAZE VINYL WINDOWS THROUGHOUT UNITS TO COMPLY WITH 1997 U.B.C. EGRESS REQUIREMENTS. REPLACE INTERIOR,NON-LOAD BEARING WALLS AND EXTERIOR STUDS DUE TO WATER AND TERMITE DAMAGE. • ELECTRICAL TO INCLUDE:52 OUTLETS AND 17 SWITCHES. 7/31/03:AMENDED.ELEC PERMIT TO INCLUDE 25 LIGHT FIXTURES,28 OUTLETS,9 SWITCHES,2 RES APPL, 1 SERVICE TO 200A, 1 MOTOR TO 10 HP(FOR NC PKG UNIT). FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft . $0.00 0 Res.a/c package • $0.00 . Standing Sectio .:• . - $0.00 0 New Res(1-2 units) $0.00' " 0', • Misc Electrical Equipment $0.00 0 New Res(3+units), /, $0.00 ': „ 0 , Transformers up to 1 kva/kw $0.00 0 Pool/Spa ",/ $0.00 - 0 - - up to 10 kva/kw $0.00 0 Lighting Fists $25.65 25 . up to 50 kva/kw $0.00 0 Recept Outlets . $27.84 28 • up to 100 kva/kw $0.00 0 Switches $9.90 9 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $9.50 2 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $30.50 1 Misc.Conduit $0.00 0 Service to 10002 $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 $12.30 1 ' Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 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 (Th WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the _ '9 ork for which this permit is issued. 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: .Carder: - a 4 T \ra Policy Number' I'art_-7 6 (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 it 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: Q. • -Date: ' ? 1 311 0 2 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE($100.000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.N 4 110 ') L Cr I Class s 0 - -Contractors Signature: fL ` Date: o , 'Y I) 0 3 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 properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,end who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: o I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Calif omia 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 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 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 Li 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?? Yes U No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the 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 Califomia 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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) ate • —�fit 43 And/Or Authorized Applicant Date ' CODE I ill$PECTION TYPE PILL 1NTIALS CODE II INSPECTIONTYPE PAIS LMIN4S 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing /� 200 Final Re-Roof 210 Final Electrical 2 a/ 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 ' ` CITY OF COSTA MESA ' BUILDING DIVISION F e �I . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 411141 PERMIT E03-00530 e 4pRPpypry0'89 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT • Job Address: 173 DEL MAR AV Status: ISSUED Suite No Applied: 06/19/2003 Vicinity: UNITS B AND C Issued: 06/20/2003 Parcel Nunmber: 43916125 . . Applicant: ASHARI, ALLEN - - .- ISSUED BY: Address: 3419 VIA LIDO Phone: 714-420-6986 _ - NEWPORT BEACH,CA " Zip: 92663 . . . Owner/ ,DEL VENTURE PART: - • - - . , ' Addres;/173EDEL:MAR - " VISTA,CA/ r_ ,' Phone: 714-420-6986 \ , ' ./ C.M -/< Zip: 92627 :A \.,' = \ /77. '/: i .'Convactor. X L%IMPROVEMENT • - , Address: 3419 VIA LIDO - ' . - - ' . -, • -Phone: 714-420-6986 , - , NEWPORT BEACH,CA vx/ ` Zip: 92663 , _ - . License: 766881 ' - N - 1 , SCOPE OF PERMIT LEGALIZE WORK BEING COMPLETED THROUGHOUT UNITS B AND C: • REPLACE EXISTING WINDOWS WITH DOUBLE GLAZEr VINYL WINDOWS•THROUGHOUT UNITS TO COMPLY WITH 1997 U.B.C. EGRESS REQUIREMENTS.REPLACE INTERIOR, NON-LOAD BEARING WALLS AND ' EXTERIOR STUDS DUE TO WATER AND TERMITE DAMAGE. - . - ELECTRICAL TO INCLUDE:52 OUTLETS AND 17 SWITCHES. ./ ' , . FEE SUMMARY ' ' C • "Quantity - ,. : Quantity, ISSUE FEE ` ��'- ` $23.50 Temp Dist System/Lighting ,$0.00 '0' :' ' Temp service test \ '-, $0.00 .+.,:_•" Busway/100 ft .$0.00 _:'",,,0/ _ ' Res.a/c package \N-C7.,$0.00 - '" ' Standing Section $0.00/„,/.7,0 x .. r-`'' �3i New Res(1-2 units) `,Z�$0.00 0 Misc Electrical Equipment $0.00 0 ' New Res(3+units) $0.00 0 .... 'Transformers up toll.kva/kw- ,, $0.00 ' 0' Pool/Spa-,'. - $0.00';:,,,1--;-”-07' - '- up to 10 kva/kiv• : $0.00' 0'' . , it Lighting Fixts "'"' /i $0.00` - 0 up to 50 kva%kw ' $0.00 7 ' 0 ' Recept Outletsv" ,- ,7 $45.3fi N. 52 up to 100 kva/kw ' $0.00/ ' 0 Switches VN . $18.70 -17 ' over 100 kva/kw $0.00 0 : /'� Non Res Appl N. v . „.$0.00 _ '' 0: - Low Voltage Equipment Res Appl \ ,� $0.00 ' : - ` ,0 - -Low Volt Wiring System/Ckt - $0.00-/ 7 0,',/ Service to 200a " '' .$0.00' ', 0• N , Misc.Conduit -$0.00 7, 07/ Service to 1000a 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 / 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 2446-4616/00) DECLARATIONS fl 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. f W/ 1 have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carder and policy number are: .Carrier: ST.A-Jr- e.#"'')Pe-isrnn J Policy Number: 7A'A-720 (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) 51( 1 certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Sectiggqn 3700 of the Labor Code,I shall forthwith comply with these prow pns. 0/a 2 ApplicanPSimature: K Date:. )..o 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 COLLARE($106,000),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: 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and ProfessionslCode,and my license is in full force and effect.Lic.# f 6 6 t-C I Class# Contractors Signature: 3 ,Date: CI / 03 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 l am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document.i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: __ _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Calif omia 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 ❑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 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 agermil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LI No (Section 65850.2 of the Califomia 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? ❑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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) �, I Date • J And/Or Authorized Applicant .. -Date COOS I INSPECTION TYPE 2AI€ INTMALS POE INSPECTION TYPE g9IE INII116LS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 sine actio 201 Anal Block/Retaining Wall , 2 Or in j - • ev-V+•;� 202 Final Factory Fire Place /22f Final Planning anning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy `� CITY OF COSTA MESA •a BUILDING DIVISION > • "� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ,, wnew/� I PERMIT M03-00276 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • MECHANICAL PERMIT • Job Address: 175 DEL MAR AV Status: ISSUED Suite No Applied: 06/19/2003 Issued: 06/20/2003 Vicinity: UNITS B AND C Parcel Number: 43916125 ISSUED BY: /\ i Applicant: ASHARI, ALLEN Address: 3419 VIA LIDO Phone: 714-420-6986 NEWPORT BEACH,CA - • Zip: 92663 Owner: DEL VENTURE PARTNERS Address: 173 E DEL MAR AV- Phone: 714-420-6986 COSTA MESA" Zip: 92627 Contractor: X L IMPROVEMENT • Address: 3419 VIA LIDO --Phone: 714-420-6986 •NEWPORT BEACH,CA '6' / Zip: 92663 License:766881 SCOPE OF PERMIT LEGALIZE WORK BEING COMPLETED THROUGHOUT UNITS(FORMERLY 173 DEL MAR UNIT B). REPLACE EXISTING WINDOWS WITH.DOUBLE GLAZE,VINYL WINDOWS THROUGHOUT UNITS TO COMPLY WITH 1997 U.B.C.EGRESS REQUIREMENTS. REPLACE INTERIOR,NON-LOAD BEARING WALLS AND EXTERIOR STUDS DUE TO WATER AND TERMITE DAMAGE.REF: B03-01029. NOTE:5 FOOT SETBACK FOR EXTERIOR UNIT PER PLANNING. • MECHANICAL TO INCLUDE:2 FAU'S AND 2 NC UNITS. -7/31/01: 1 INST FAU<100K BTU, 1 COMPRESSOR UP TO 3 HP/100K BTU(NC PACKAGE UNIT). FEE SUMMARY Quantity - - - Quantity ISSUE FEE • $23.50 �; Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU , $29.60 2 - Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00_ .0_ Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 •' Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr/ • $0:00 0 ., - Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU - $0.00 .0Domestic Incinerator $0.00 0 Refrig Sys>100 kBTU $0.00 0 ' Compressors/Absorption Systems Gas Piping • $0.00 0 Up to 3.hp/100 k BTU $0.00 0 Factory Fireplace • '$0.00" 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box `$0.00 0 - 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $29.40 2 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 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 24464616/00) DECLARATIONS n WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 0 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. "l;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: 'd 7',,r tat8J il\e•4 Policy Number:7 S PAA— 11 O is ' (This section need not be completed if the permit 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: ' /11/15 7 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 DOt1.ARE($100,000),IN ADDfTION 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.# 9 "� 6 V S f 1 Class Contractors Signature: - C- Dater ' 1 '3 916 3 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.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 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? 01 Yes O No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Dat • a� And/Or Authorized Applicant � ' Date y BODE I MUM= IAL pumas CODE I INSPECTION TYPE MEL =ttr 1616 Fixed System Final Fire Prevention 206 Final Mechanical a'J,-o'( •t 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 44p F 9 CITY OF COSTA MESA - - BUILDING DIVISION I) >0 „ 1DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4rPERMIT Stztoowrsoft M03-00276 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 173 DEL MAR AV Status: ISSUED Suite No Applied: 06/19/2003 Issued: 06/20/2003 Vicinity: UNITS B AND C Parcel Number 43916125 - - - _ _ - ISSUED BY: Applicant ASHARI, ALLEN- .i>'-' '- Address: 3419 VIA LIDO. 7 ,— - - 1 `/ - Phone: 714420-6986 NEWPORT BEACH,CA - Zip: ' 92663 :- - x j: Owne( 1 DEL'VENTURE PARTNERS f Address: '7'17'3 E DEL MAR AV - - ','' > / vy' i:f N \/; //jrr.; Phone: 714420-6986 � � l ., •• COSTA MESA' Zip: 92627 Z .Contractor: ' X.L.IMPROVEMENT • Address: 3419 VIA LIDO - - - - . " , ,_ - - ,,,� - - - . ` . Phone: 714420-6986 -• r.'NEWPORT BEACH,-CA •7' " , -- Zip:- - 92663 . -� " -- License:766881 -� - SCOPE OF PERMIT N �,' ,/ 0 , LEGALIZE WORK BEING COMPLETED THROUGHOUT UNITS B AND C. v - ' ' REPLACE EXISTING WINDOWS WITH DOUBLE,GLAZE,-VINYL WINDOWS THROUGHOUT UNITS TO .% - COMPLY WITH 1997 U.B.C. EGRESS REQUIREMENTS.REPLACE'INTERIOR;NON-LOAD BEARING . -' WALLS AND EXTERIOR STUDS DUE TO.WATER AND TERMITE DAMAGE.REF: B03-01029. MECHANICAL TO INCLUDE:2 FAU'S AND 2 NC UNITS. FEE SUMMARY - — \ J ` - - -'Quantity - - - / Quantity ISSUE FEE •' ' `,. $23.50 Repair/Ali Absorbtion Unit % ` $0.00. 0 Inst FAO<100 k BTU` `I, $29.60 2 Repair,/Att Refrigeration Unit -' $0.00 .0 -' 1 Inst'FAU>100 k BTU ,�:.> $0.00 0 Ventillation System r Repair/Alt Cooling/Heat,? $0.00 0 Evaporative Cooler x ,x$0.00, 0," / 7: ,Kx+ Inst/Rep. Recess Wall Htr ,:igy $0.00 0 i4pr,'_�-.'�-'.Commercial Incinerator ,iyj $0:00 -0; i- Refrig Sys<100-k-BTU -' $0.00 0 ,,5".2,„` : Domestic Incinerator /moi`, $0.00 f,0, Refrig Sys>100 k BTU, $0.00 0 Compressors/Absorption Systems - - / Gas Piping tir', - y ,'$0.00. 0 - - % Up to 3 hp/100:k BTU`.-' • // . ., $0.00-.',0 Factory Fireplace, -• N. $0 00 0 &k irk To 15 hp/ rk-BTU' ''-g,-' • $0.00' / 0 Hood w/Mech'Exhaust / /,'., -$0.00.< 0 - - 15 To 30 hp/1,000 k BTU; ' $0.00 0 VAVBox v -,- ' '- ' $0.00, . 0, - 30 To 50 hp/1,750 k BTU , ' . ,$0.00 0 Vent Fan/Single Duct' - - - -$0.00` 0 - • - --Over 50 hp/Over 1,750 BTU, - : $0.00 0 Appliance ti�,v $0 00 ti 0 - Boilers- - - - Fire Dampers �. ':::..:\\ -$0.00-, 0 , ` ' - - - Up to 3 hp Smoke Dampers `,�-' ''v $0.00'x;07*t-- 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-:C0' _.. , • _ Other Mechanical Fee;,-- Floor or Suspend Heater $0.00 0 - - • Investigation Fee-'' $0.00 ., __ Plan Check Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work 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) • NS 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 p� work for which this permit is issued. eW 1 have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: _Carrier:- SPSI Policy:Number: SPQR. ISO / -(This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ,I2C I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. eApplicahCSigneture:" ¢. — -C -Date:-- CIA 0/6 3 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($l06,ODU),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 effectrLic# 1 (o O it I Class# p ContractorsSignature: ¢ Date: B 4/).6/e CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,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 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 Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑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 California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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? ❑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 ell 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: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date isA•6 And/Or Authorized Applicant Date CODE r INSPECTION TYPt DAZE 1NTITIAL$ CODE 1/ INSPECTION TYPE DATE IdIIDALi 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 s9 CITY OF COSTA MESA 4 BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER J ra . PERMIT ItbkPosarre019 _ • , . . - P03-00386 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT - Job Address: 175 DEL MAR AV Status: ISSUED Suite No Applied: 06/19/2003 Issued: 06/20/2003 Vicinity: Parcel Nunmber: 43916125 ISSUED BY: �� Applicant: ASHARI,ALLEN Address: 3419 VIA LIDO Phone: 714-420-6986 NB Zip: - 92633 • Owner: /DEDL MAR PART Address 173 DEL MAR' Phone: 714-420-6986 VISTA,CA Zip: 92084 Contractor: X L IMPROVEMENT - Address: 3419 VIA LIDO Phone: 714-420-6986 NEWPORT BEACH,CA Zip: 92663 License: 766881 - Arch / Eng: Address: Phone: Zip: . License: . SCOPE OF PERMIT LEGALIZE WORK BEING COMPLETED THROUGHOUT UNITS(FORMERLY 173 DEL MAR UNIT B). REPLACE EXISTING WINDOWS WITHDOUBLEGLAZE,VINYL WINDOWS THROUGHOUT UNITS TO COMPLY WITH 1997 U.B.C. EGRESS REQUIREMENTS. REPLACE INTERIOR, NON-LOAD BEARING WALLS AND EXTERIOR STUDS DUE TO WATER AND TERMITE DAMAGE.REF:B03-01029. - .PLUMBING TO INCLUDE:2 SHOWERS,2 KITCHEN SINKS,2 WASH • BASINS. 7/31/03:AMENDED.ENTIRE PLUMBING PERMIT TO INCLUDE 2 SHOWERS, 1 KITCHEN SINK,2 WASH BASINS,2 WATER CLOSETS, 1 WATER PIPING(INST/REP), 1 WATER REPIPE. FEE SUMMARY AMT QTY - - AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 - P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 . NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSZTION 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 ork for which this permit is issued. V 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 ST1gTc 14)oLgeua (. i -uait ^3 Policy Number: S Number: s. "1361 (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) 0 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: e " Date:1 c/3 1 i 0 3 WARMNO: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 37060F 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.kh "? la 9q ST 1 Class 1) a Contractor's Signature:1 — R Date: o fl 1 1 0 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,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 haverthe burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,This 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 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? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air 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: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date t 62 And/Or Authorized Applicant _ - Date CODE 0 INSPECTION TYPE Qr jE INTIALE CODES JNSPECTION TYPE PAM JNTRIAIS 1616 Fixed System Final Fire Prevention 206 Final Mechanical y (� 1266 Pool Spa Final 208 Final Plumbing •^/�`19—O ` 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 4L 9 CITY OF COSTA MESA , - • , BUILDING DIVISION F �' ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT Ja'c*., l+,; P03-00386 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 173 DEL MAR AV Status: ISSUED Suite No Applied: 06/19/2003 Issued: 06/20/2003 Vicinity: UNITS B AND C Parcel Nunmber: 4391612$ - ISSUED BY: Applicant: ASHARI,ALLEN ,,-', Address: 3419 VIA LIDO, - . ' - Phone: 714-420-6986 �\ _ A Zip: 92633 i /Ki /, • /-'/Pi"\ rte; VIt!t1.. !� -1''-T: Owner:' , = —/ \:: Address 'v JESSE€-OAWD j j ye/ r1''' i " -ViSTArGA-�" . " V171A UP Phone: , y ,�.' , , , 442-HOLLYBEMRY DR ( -M Zip: 92084 Contractor: X.L•IMPROVEMENT •• r . -Address: '.-3419 VIA LIDO - ,, • - Phone: 714-420-6986 • - NEWPORT<BEACH,CA Zip: 92663 - License: 766881 r N Arch / EnB : - .,. ... ., ._ — _. . Address: . .•�._ - - - - - - . . , Phone: - , ,, Zip'. - - - , SCOPE OF PERMIT J/ ;'\ LEGALIZE WORK BEING COMPLETED THROUGHOUT-UNITS-El AND C. -".',, REPLACE EXISTING WINDOWS WITH DOUBLE GLAZE,VINYL WINDOWS THROUGHOUT UNITS TO COMPLY -. V, ,, WITH 1997 U.B.C.EGRESS REQUIREMENTS?REPLACE INTERIOR,NON-LOAD BEARING WALLS'AND.. ' '•�- _ - EXTERIOR STUDS DUE TO WATER AND TERMITE DAMAGE.REF:B03-01029. `,,, , \\ „, „PLUMBING TO INCLUDE:2 SHOWERS,2 KITCHEN SINKS,2 WASH BASINS. , \ LV" ij, 'FEE SUMMARY / -- AMT - QTY'> . AMT QTY ' ' ' AMT QTY ISSUE FEE $23.50 -Laundry Tub/Washer $0.00 0 - Sump.Pump. ,' $0.00 0 Backflow irrigation',,\ $0.00,• 0 Landscape Irrigation $0.00 - 0 - Swimming Pool , $0.00 0 Backflow Preventer `, \;$0.00. 0 , P-Trap - $0.00 .0 Trap-Primer- - $0.00 0 Bathtub `. $0.00 - 0 _ Pressure Regulator $0.00 0 • • Urinal $0.00 0 Clarifier System $0.00 - 0 Process Piping(per 10ft) . $0.00 -0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00." 0- _ ' . Receptors ' ' •$0.00 -0 Vacuurn-Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 ' 0Septic Tank- - $0.00 0 ' Wash Basin $19.60 2 Dishwasher $0.00 0 -- - Sewer Cap for Demo' $0.00 0 .„, " Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 . 0 --- Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer-Private Line -"so:oo - 0 Water Closet(Toilet) $0.00 0 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 i "N C: ; 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. o My workers'compensation Insurance carrier and policy number are: Carder: S /,re aa,..19CJA ATI4 •-1 Policy,Number: tgP4& 13 Q (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: a Date: 604-6/t3 3 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 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�ld Professions Code,and my license is in full force and effect.Lk.t4 'l I.,p et Class x LS /5 Contractors Signature: w • a Date: `/}-d d Z CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have.the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the properly,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.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 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 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 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 California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws end city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) GA-61-62 ate And/Or Authorized Applicant p Date CODE/ INSPECTION TYPE 2AIE INTmALS CODES INSPECTION TYPE D!!TE INTRIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 F" al Plu ' [ 200 Final Re-Roof • • y E &at 201 Final BlocngWell _ ./ % IFi/ 203 Final Sign 222 Final Site • 204 Final Demolition 250 Final Building/Occupancy ,<Ciar-LCITY OF COSTA MESA • , 4 BUILDING DIVISION FtJ `)� DEVELOPMENT SERVICES DEPARTMENT PER NUMBER J a • • PERMIT StWoommo 44' • P03-00560 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 175 DEL MAR AV Status: ISSUED Suite No Applied: 08/29/2003 • Issued: 08/29/2003 Vicinity: fL • Parcel Nunmber: 43916125 . _-- ISSUED BY: ---- Applicant: DEL MAR PARTo.- - Address: 3419 VIA LIDO' `-' . ' , \ � . - . ". mo-i. • Pho. n,e:, 714-420 .. /986 <I'; A NEWPORT BEACH;-CA-: , _ - Zip 92663 ' ' i -, , 1 yam`-=N. Owner'//DEL MAR PART r.. - ' \ H \ /', �•' v ,/ 7v-`,\ Address 3419 VIA LIDO,- - / - - •, ', Phone: 714-420-6986 . ,, ;-A I 1,r r.1 : NEWPORT BEACH,CA Zip: 92663 , �A �� t . , . •� - `\ ,,, •-) - , , VA '+Contractor: /"OWNER-BUILDER � Address ' - _ ', ,,', .1 �' ,, v - Phone: I r/, . , ; � Zip: , / '•�l , , -/ ` ' License: 000000 `� ` t i - , I 'Arch / Eng:" - /' - r � i_- . . . - _. . - - .-•. t "' Address: - - H. Phone: - i . License.' :: r r \ l `t t\t ,� L\. , SCOPE OF PERMIT _'--• /j'/ ` - .'",/ ',�., , . \ REDF B03-01310. _ - //it / ( - .',".1'�:.. -ID:. /7�a./: / ' 1' ' - \ �- 1 RELOCATE LAUNDRY/TUB AND 1 WATER HAETER AND 1 GAS. .,/,/,/ v r ,,✓ / . FEE SUMMARY` /-i,:(7,/ ,// \.\-;\ AMT \NQTY - ' - -AMT QTY - - ,,- - , „ /AMT QTY ISSUE FEE v �� $23.50 Laundry Tub/Washer ; $9.80 •1 Sump Pump , / $0.00 0 Backflow irrigation', 1-'$0.00 'i0 - '' Landscape Irrigation - $0.00 0 Swimming Pool $0.00 0 Backflow Preventer, $0.00 ;70- P-Trap -$0.00„ ; 0 Trap Primer Bathtub c-,'; $0:00- 0 Pressure,Regulator; . -.... -$0.00_ �0 - ; „Trap ,-/-C-',/ $0 .00 0 Clarifier System �.,\$0.00 �`.0 , • -,Process Piping,(per 10 fQ- .$0.00 • 0 Vacuum Brkr Bkflow(1-4) . $0.00 0 Connect(Ice,Soda,etc) \$0.00- 0 , r -')Receptors - $0.00.- _- 0' ,Vacuum'Brkr,Bkflow(5+) $0.00 0 Dental Units - $0:00 :" a - ' , 1 Septic Tank . ' -$0.00 0 Wash Basin' $0.00 0 Dishwasher $0.00"--. 0 '- Sewer Cap for Demo _ $0.00 ' 0 'Wash Basin Set $0.00 0 Drain, Floor $0.00 -`0:..::- -.,Sewer Connect( ,`. \I. , .$0.00 0 _ _' Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 - Sewer PrivateLine $0.00- 0,!� -- Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 -Sh'ower ' __ _ __ -,'$0.00`` 0 ' Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar" -- -- • $0.00- 0 Water Piping(Inst or Rep.) $0.00 0 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 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 2448.48(WOO) DECLARATIONS /Th (--`r WORKERS'OOMPENSATION 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.) ❑ 1 nervy 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 MD SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOUARE($100,603),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E 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.Uc.N Class e 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.My violation of Section 7031.5 by any applicant tore 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 /gold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). exempt under sec. Business and Professions Code for this reason: urs: 4--� Dwe� r/,416 � Owner ID verified by drivers license. iN s 0 No Drive e No: � car s; 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: 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? ❑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 Celifomia Health and Safety Code been fully complied with? CI 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&permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this . application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes-,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by is pe it until final inspection. - a i Yr ISign ee) -- r A-_ k ate And/Or.-APZ':: t Date I. INSPECTION TYP LODE E �� QM URAL$ LODE If INSPECTION TYPE PATE II{TmALS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical D-11 -09 1266 Pool Spa Final 208 Final Plumbing -, Ow 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 BuiidingtOccupancy • _ .i., ..e,z5i a met �7' 124" E a OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I. I personally plan to provide the major labor and materials for construction of the proposed property improvement. ❑ Yes ❑ No I (have/have not) At.A.R0 ASOPtilIsigned an application for a building permit for the proposed work. 3. I have contracted with the following person(firm) to provide the proposed construction: Name Address City Phone ( ) Contractor's Lic. No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name yL 1r1Pito v'd euVA Address 3,11' YNPt Lea City a4(. Phone (1'J ) 4 — "SS- (o Contractor's Lic. No. -1 b 4 tri 5. I will provide some of the work but 1 have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work 1012.46 (REV.998) ' r I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code'and have completed the above information to the best of my personal knowledge, in compliance with this State law. , Signed: Q I Date: 0?-6/6 6 3 /Name: A(Az.J as 1-1/41-1-- (Printed or Typed) C.D.L. #ORS.S.# For more information call City of Costa Mesa Building Division at(714)754-5273. 1042-46 (REV.9/98) "ORANGE COUNTY BUILDING DEPARTMENT •APPLICATION FOR PERMIT I + • ' 636 North • } SANTA ANA; CALIFORNIALIFOR FOR APPLICANT TO FILL INFOR OFFICE USE ONLY _.-_ yy RECEIPT NO., PERMIT NO. BUILDING (n/ /1 � / , �f s4T 1�_ ADDRESS Y/(I �V 44 1/ ✓ J I , VA SCHOOL DIS . _ cyan- 'Q�I4a_ q .L `. . RECEIVE• BY DATE • APPL. DA ISSUE I NEAREOR TOWN �j//�A („G1I Yr{�Cr/I/�(pY^pnV^+•/�/� _� �,,T ///�/♦ v‘.5.3.- CROSS ST.v/LJW/Jl�ly�A-/V/�LI�/02__ • 'Ie�I' cit...t hes- ✓ f: �''"'�!/ ��at �jl� BUILDING OWNER )/'• h1 `/�I1IY/t��j��Z[-a.i1!,a..� ( 449Cr ADDRESS ,4 y '����^`ev✓ •/ I ADDRESS / �I(/V.Q/{,/��♦�O"'i%(•{/y OR• HTOWN OOL IST: f'�/j'�'} �1'Cl _ -i e � �F�'i NO. 1% NEAREST �1(/_i�: /J(iC•ti / r`�R/rr�� CITY CROSS ST, ARCHITECT OR �- n w NO. O TEL. ZONESr-,4 ) ,PLANS I TYPE .-11.-.) ��( ENGINEER Y•!A/ ADDRESS SETBACK LINE F OM, ENTER OF ST. 7. •i " �,,, �_ e _ TEL. REAR,'YARD yaw, SIDE YARD -d. VEL CONTRACTOR /Wim NO. APPROVED1REClOSX + �J BVADDRESS LEGAL DESCRIPTION I LOT NO. I BLOCK (ATTACH METES & BOUNDS) { to n/4! '4(_. D. TRACT • SIZE OF LOT e..5)( / / ® I NOW ON LOT 7..... V EXISTING BLDG. /W4/ I FAUSE OFDMILIIES /I ROOMS V DESCRIPTION OF WORK • ' NEW I I ALTERATION I I ADDITION I iir M O REPAIR I I MOVING I I DEMOLISH Iy SIZE BUILDING),). �v�/}9 •�+- NO. OF/R,000MS STORIESdemi, )f� r OV ER I N GA,.Q..Y7e�IWZI.I COVERING dem 1 ilv r .f " USE ODI NEW / Cr /�./,<n�ecf, , .�T UILDING �,�5e�' APPROVALS FOUNDATION: LOCATION INSPECTOR I DATE I HE E K WL E TOI HAVE READ THIS FORMS, MATERIALS, UNDER-PINNING APPLICA I N AT HAT T OVE IS CORRECT FRAME: FIRE STOPS. AND AG O PLV WI LL COUNTY ORDINANCES BRACING, BOLTS AND STA L S REG INC BUILDING CONSTRUCTION. t„/Jf�v3 �J //�j LATH. INT. SIGNATU OF ri J'w f� / 4.4"ars. LATH. EXT, �X ' /(4 b PERMITTEE ��CC slN as�./�`'i ,r\-/( �/, , :VL 1. „ PLASTER. INT. /wI1X AUTHORIZED ACT. F PLASTER. EXT. $ /©©©`•' P. C. S�/�/� MASONRY REINFORCED FEE Z B0 , 5 6 BOND BEAM m Cr"VALUATION O ilt\! an FEE `�� FINAL \� / S/