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HomeMy WebLinkAbout1207 DONEGAL PL - Building Permitsi r � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1207 DONEGAL PL Suite: Vicinity: ROOF Parcel Number: 14104630 Zoning: R1 R1 Applicant: MAZZARELLA, MAUREEN Address: 1207 DONEGAL PL Phone: 714-435-0499 COSTA MESA, CA Zip: 92626-2750 Owner: MAZZARELLA, EDWARD J AND MAUREEN Address 1207 DONEGAL PL COSTA MESA, CA Contractor: OWNER -BUILDER Address: Zip: Arch : Address: Phone: 714-435-0499 Zip: 92626-2750 Phone: License: 000000 Eng Address ISSUED BY: Status: ISSUED Applied: 07/07/2003 Issued: 07/07/2003 Phone: Phone: Zip: License: License: SCOPE OF PERMIT 1 Total: $64.44 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 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days, or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and aft 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 2ue46 (600) FEE SUMMARY Plan Check: $25.19 Calc Valuation: $1,000.00 Permit: $38.75 Claim Valuation: 51,000.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $64.44 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 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days, or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and aft 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 2ue46 (600) DECLARATIONi WORKERS' COMPENSATION DE61LARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to sell -Insure for workers' compensatlon, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers compensation insurance, as required by section 3700 of the Labor Coda, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and polity number are: Carder: 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 it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with theserovlsions. Applicant Signature: /lit /1O/� ✓lam/C1 iZG ..L,l, Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Uc. 4 Class 4 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 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 Cade: 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.). ❑ 1, as owner of the property, am EXCLUSIVSLY 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 contractors) ,�p license pursuant to the Contractors License Laws.). 0' I am exam t er sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. Ves ❑ No Drivers License No. �� Expires: Vedficalion of Ownership by (type of docu a i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT C6RT1FICATION: ❑ 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 pernit, 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 CkRTIFICATION: 1 WIII the applicant or present or future building Occupant need to lila and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requlres, with some exceptions, that a Business Plan be filed with the Costs 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 slander temperature and pressure). ........................................................................................... _................I............._"................................................................................ ....... ............... ......................... ............ ........................ I .................... _............. _.............. _... . .......................... 2 Does or will the applicant or present or future building Occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................ _._._........................... .......... _.... ,............... _.._.... ._._................... _... __................ _....... ..................... .... ............................ ... .................................................................... ____.............. ......... _............... 3 Does or will the applicant or present or future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses whlcn are required to register acutely hazardous materials with the Fire Department. ........._— .......................___—__._._._._.______..............__..............._............................................................... ......................... _......____..._..__...._..� 4 It an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fumy complied with? ❑ Yes ❑ No ..............._.......___................_........_......_................,..._....._—_._......._.._................__...................._........................ _.................................................................................... ._............._............... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a $ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency! LJ Ves 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 WIII any part of the laclliry to be constmcted under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No (it "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............. ....... __.�........... ........ _................... ___..................... _.___........................ .............................................. __.... _._. 7 If appermit 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 applicatlon, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? []Yes ❑ 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: CERTWICATE 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 representetives of the City of Costa Mesa to enter upon the above-describetl ro for inspection purposes. I agree not to occupy allow occupancy of any building authorized by this permit unb final inspection. Signature Of Legal Qwner(s Dale And/Or Authorized Applicant Date CODE 1. INSPECTIONTYPE DAM INITTIELS CODE INSPECTION TYPE gI,IE RiTITAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Ro-Roof 210 Final Electrical 201 Final Block/Retaining Well 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 �-jf li Y.1-- NEw .I//l��oCEs oV62 ,� L/vrl s 30� FE�r G Lc-/GEz 2k� L 1 C.C. htt�,i f Vor - I loe s .. tv„n,,..., ��po5�'�°T/ �..G 90C)", j kat oalh.a 'Ks.�ican a5 , �I 'uocto'o� le\ay. I set of P of aketi'," . NOS be' , pidnar' bui,..nr C� osx.�Aesa r! r'rJG ��� �?eStamPm9olt �saYpsoatsans°yuYYe`ry°t aUB�gomedlw'P"n\cJdaY5otlssoan \\ 1tn`.daUon 3031 C� � '• of the v\olaGoand Bann spa\1��La,�ebactiNe Pe � 1 fide FDPs ommeoced and � \ . wo no i 1 I g iz.rz. oma. !N S,//, I Pf N v s 28 H�NGE.e AV. A-3S x l 0 1 FE- ca /vta. L IJ r/Z `^/,2 x `� �AGs�wrt.rr' i1,5 M 01 CIT OO BCOSTA MESA QTY ),VISIONE p p.PPiR V ob at all limes and.x is untBuddm9 !!!lt nhom"urnsi mykeany d>argea,,, _ hemtopennnV,,,,-- OT state andSale%CdYofOoslaHeSa xa'iwzgl{ALLN07be oS It Pmn tswol any CM of Costa Mesa 0nura'1 void If ha building of Tne stamp n9 of issuance. of the violation of an shall expire by llmdation auBC 4 dl wi* t8o days These plans and perm, and meintaxted active Per wodrls not comn (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 1207 DONEGAL PL Suite No Vicinity: Parcel Nunmber: 14104630 Applicant: MAZZARELLA, MAUREEN Address: 1207 DONEGAL PL Phone: 714-435-0499 COSTA MESA, CA Zip: 92626-2750 Owner: MAZZARELLA, EDWARD J AND MAUREEN Address 1207 DONEGAL PL COSTA MESA, CA Contractor: OWNER -BUILDER Address: Phone: 714-435-0499 Zip: 92626-2750 Phone: Zip: License: 000000 SCOPE OF PERMIT ADD 9 LIGHT FIXTURES TO EXISTING S.F.D. LOCATED IN FAMILY ROOM. Status: ISSUED Applied: 07/31/2003 Issued: 07/31/2003 ISSUED BY: �C.J 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 2"6.46(6100) FEE SUMMARY Quantity Quantity ISSUE FSE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 It $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool / Spa $0.00 0 ................up to 10 kva/kw $0.00 0 Lighting Fixts $9.90 9 .................up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 .................up to 100 kva/kw $0.00 0 Switches $0.00 0 ..................over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus (meth ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 1 00h $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS; In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2"6.46(6100) I WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to salt-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued atone hundred dollars ($f 00) or less.) 1 certify that in the performance of the work for which this permit is issuetl. 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. / A/j ',, / �n///7 Is 1I rr\\ Applicant Signature: )A A44 iY&12�(� Data: �5 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 (S10(L000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M 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. x Class q Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a pernit 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. ll, 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` der sec. new and Professions Code for this reason: Inature: Date: -71 wnar 10 vented by tlrivers license. Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type at docL i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth Into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title S, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight o1 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .............................................................................................................................. .............................................................. _........................... _.................................... ... _........ ..._...__...................... _.................................. __.............. _._._..... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...................................................... .................. .......... ................................................ ..... ................................................................. .... ..................... _................................................................................... ............... _.................... _................ _............ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ....._...................................__._..............r'e.'q................_............................................___.._.........................._........................__..........................___......................'iif..........................._.._...............__....... .............. ......................... _..... . 4 If an RMPP is presently requireQ has Section 25534 of the California Health end Safety Code been fully complietl with? ❑Yes ❑ No ......................................................plic......................................................... ildi............................................................................................................................................................................................................................................difi............... 5 Does or will the applicant or present or future building occupant require for the work which is the subage of this a plication epermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes S No (Section 65850.2 of the California Government Code requires that the requested infornation be furnished on applications for non-residential building permits). .._..___..............._............. .__._................................__.........................._...._.__..._.........._..........___..._........___..._..........._.._.._......._........................................................_.............._....—.._..........._..... ... ...... 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (It yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ...................__......................____.._............._......_...................................... _.____..._..............__....................__._._.................._.__................._.__...._.__.__..____...__ ........... __...... _.... __.._.. 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or 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 stale laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described pr for inspecaon pu es. I agree not t upy or allow occupancy of any building authorized by this permit until final in coon. ��1z'G- 7 7 f 3i�3 Signature Of Legal Owners) Date And/Or Authorized Applicant Date CODE t. INSPECTION TYPE PATE ItIIIDAL9 CODE# INSPECTION TYPE 2ATE IKTTML9 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing—�//��—/z� v� 200 Final Re-Root 210 Final Electrical / C/ 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1207 DONEGAL PL Suite No Vicinity: Parcel Number: 14104630 Applicant: MAZZARELLA, MAUREEN Address: 1207 DONEGAL PrL MECHANICAL PERMIT Phone: 714-435-0499 COSTA MESA, CA Zip: 92626-2750 Owner: `'MAZZARELLA, EDWARD J AND MAUREEN Address: 1207 DONEGAL PL Phone: 714-435-0499 COSTA MESA, CA Zip: 92626-2750 Contractor: OWNER -BUILDER Address: Phone: Zip: License: 000000 Status: ISSUED Applied: 07/07/2003 Issued: 07/07/2003 NEEMEMM10e SCOPE OF PERMIT REPLACE EXISTING MASONRY FIREPLACE WITHPRE-MANUFACTURED FIREPLACE, MAJESTIC, #ER -5677 LOCATED IN LIVING ROOM OF'S.F.D. --, FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 _ Repair/ Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $0.00_ 0 - 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 Hlr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys <100 k BTU - $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys >100 k BTU $0.00 0 _ -Compressors / Absorption Systems Gas Piping $0.00 0 'Up to 3 hp/100k BTU $0.00 0 FactoryAreplace " , $10.65 1 - 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 1-0 30 To 50 hp 11,756 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 $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 - 0 15 to 30 hp ' $0.00 0 Air Handlers < 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers > 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 ,. Reinspection Fee - $0.00 TOTAL CALCULATED FEES $34.15 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) WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and policy number are: 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 provisi9ns � Applicant Signature: AO ��L�Li Date: / 7 I f2 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 0106 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # Class Al Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: 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).): r{y 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. V 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of properly 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 havetheburden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, 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 conlractor(s) 11 license pursuant to the Contractors License Laws.). (f7�1 am exempt un er sec. Busin s and Professions Code for this reason: Signature: Date: 0 Owner ID verified by dnvers lDriver's L�'� icense. Yes ❑ No Drivicense No. Expires: � Verification of Ownership by (type of docurilk Le. - 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) teat high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, The 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...............................................................................................................................................................................................................................................................................................................................-.......................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feat of compressed gas at standard temperature and pressure). ................................................................................................................ .................................................................................................................................................................I.. .......................plica. . 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. ...................... ........... ................................................ ....................................... ............. ............................................................................................................ ................................................. ............. ...................................................... I................. .... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ll 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). ..........................................................cili............................................................................................ithi..................................................................................................................El ........................................................................................... fi Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................................................................................................................................................................................................................................................................................................................................................ 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is 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 stale laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-describep p party for inspection pu oses. I agree not lgoccupy or allow occupancy of any building authorized by this�rtyt u-nitil nOnsp inspection. �1.�(lt r l��G 2 Tia //^ I f Signature Of Legal Owners) Date And/Or Authorized Applicant Date CODE t. INSPECTION TYPE PACE INTIMAUS CODE. INSPECTION TYPE 24M INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical I - 15 - AF'i 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Well 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 OWNER GRUBISICH. JACK DATE12-28- JOB ADDRESS ,?n7 rr,,.Pma, r,;,. BUILDING PERMIT NO. 472nl GENERAL CONTRACTOR n n ,, DESCRIPTION_ ofWORKn + ti,ark ont-nines in Fire 1p_nrp_ o Na.1I,,_�I,ti_,A LOT TRACT FIRE ZONE VALUE $ goo no PECTIONS Si nature Date ITYPE tr GROUP ZONE R_ 'SOIL SUBCONTR4CTOR PERMITS ISSUED :PAS Date Number S. nature WATER Plembin ROUGH PLUMBING _ � _ ', gROP. SWR. LINE ❑ HOUSE CON. Li SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ❑ ROUGH WIRING H..tinQ and Y.M. TRENCHES FORMS 0 STEEL REINF. FLOOR SYSTEM BOND BEAM F-1 STEEL REINFORCE (-1 SHEATHING FRAME AND FLASHING LATHING — IN n OUT PLASTER. BROWN COAT -TURAL, FINAL H AG, VENT.. REFRIG. AND P.C.. FINAL PLUMBING. FINAL AND GAS TEST ELECTRIC, FINAL BUILDING. FINAL -' i� y 'i 1720 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 1124 12/28/78 5.5p0� TL APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEj /G DATE RECEIVED DATE ISS D 2 J BUILDING I Z07 Q����L \� ADDRESS ' C PERMIT NO. OWNER 4A (� !S A.P. NO. MAIL ADDRESS (� I i4j L=, IAL- ADILDING DRE S /-Zo L. CITV V (4� �`�l(� NOL TRACT LOT BLOCK CONSTRUCTION NEW ADD ALTER P LENDER Oil/ BRANCH s� �J OWNER 4 ADDRESS A211 VALUE S S ARCHITECT TEL. OR ENGINEER FIRE ADDRESS ZONE TYPE GROUP APPROVED041� ,�I CONTRACTOR �LL/ W BV DATE ADDRESS TEL. ZONE NO. OF USE OF NEW CITY NO. PLANS BUILDING STATE CITY P YARDSA VED YARDS APPROVED LIC. NO. LIC. NO. MAIN BU DIRONG ACCESSORY BUILDING SIZE NO. OF BLOCS (FROM C/LST ET) OF LOT NOW ON LOT FRONT F FT. USE OF EXISTING BLDG. R. SIDET FT Separate permits are required for L. SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. AIN & MAIN BLDGS. ACC BLDGS. VAR.+ DATE C.U.P.9W APPROVE L��/CC /X/ C APPROVED BY I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. 1 hereby certify that I am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the tate of California Business VALUATION PERMIT FEE $ and Professions Code, Divi Ion 3, C p r 9, PLAN CHECK $ 00 Signature of TAX $ G Permittee S 409 Authoriz Agent TOTAL PAID $ ,n VwNkat t tUj11v11, LAIZ JOB ADDRESS 1207 Donegal Place BUMDING PERMIT NO. 23543 GENERAL CONTRACTOR Owner-Bldr. DESCRIPTION OF WORK Add Fam.Rm. to res. AP No l lel 014( l H LOT TRACT FIRE ZONE VALUE $ 4 8o0 00 INSPECTIONS Signature Date GROUP I TYPE V ZONE _ - +t SUBCONTRACTOR I PERMITS ISSUED Date I Number I Signature Water I Plumbing Rough Plumbing Prop. Swr. Line 0 House Con. ,0 Sprinkling System Miscellaneous Rough Heating and Air Conditioning Temporary Service or Pole Underground 0 Power 0 Rou h Winn , 3- - Heating and Vent. Trenches Forms Steel Reinf. ❑ ,' a ie 5— Moor System 6S Bond Beam 0 Steel Reinforce ❑ Sheathing 3 <"- Frame and Flashing G Lathing — In (rq, Out I P. - Plaster, Brown Coat / 6f Structural, Final El e tris , Heating, Vent., Refrig. and A.C., Final T bing, Final and Gas Test 0 F..—t ic, Final( - Building, Final2/- Special Requirements COSTA MEA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA, CALIFORNIA For Applicant to Fill In Completely �J TYPE OR PRINT ADDRESS lc D Q A.G 1 COSTA MESA, CALIFORNIA ■ ARCHITECT FIRE LEGAL SEE RECENLU FEB 9 1965 C�FINfA11FFNCrE����TTDEPT. APRIiYATfOf�99k PERMIT BUILDING For Office Use Only NO. OF PLANS CITY DISTANCE BET. NOE STATE TEL '0"T TO SOIDE aVE REAR Pt LIG. NO. NO, MAIN BLDG4. SIZEEAVES/Q� ACCESS. BLOCS. /nV rvo. ow BLooB. ALLOWED OFLOT N /Iy NOW ON LAT YARDS APPROVED USE OF 10- r. A .... _ `- MAIN BUILDING SETBACK LINE FROM /, /J / - ^jQ / CENTER OP STREET V ('f REAR YARD J // 7/ SIDE YARD LEFT (O I RI HT DESCRIPTION OF WORK �( NEW II ALTERATION I I ADDITION I /\ USE OF NEW BUILDING Is,TR. a6 SHALL BE LESS THAN YARDSAPPROVED ACCESSORY BUILDING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PLY WITH ALL CITY ORDINANCE& AND STATE LAWS REGULATING BUILDING CONSTRUCTION. SAUTHORIZED AGENT al/&�i, & 4e so. FT. THE AMOUNT SHOWN UNDER VALUATION IB FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION PERMIT FEE O �- i goo PLAN CHECK $ ^l� // TOTAL FEE S Z/ DISTANCE BET. BET. MAIN B I I I I MAIN BLDG4. ACCESS. BLOCS. REPAIR MOVING DEMOLISH / q�/ DING /6 / R. 9 DATE S ZIE q" / ROOMS STORIES RIES CAU. P. $C APPROVED EXTERIOR WALL (p+ ROOF APP ED S COVERING �/% CCO COVERING %N - D BY - DATE USEOF UILDI NO AND WORK TO BE PERFORMED erA11AY ReoAM /ann 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PLY WITH ALL CITY ORDINANCE& AND STATE LAWS REGULATING BUILDING CONSTRUCTION. SAUTHORIZED AGENT al/&�i, & 4e so. FT. THE AMOUNT SHOWN UNDER VALUATION IB FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION PERMIT FEE O �- i goo PLAN CHECK $ ^l� // TOTAL FEE S Z/ OWNER g0LLE)GE-MESA COMPANY DATE 10-11-56 JOBADDRESS 1207 Donegal Place BUILDING PERMIT NO. #3835 GENERAL CONTRACTOR Tbe Hale CO, VALUE $ 10,880.00 --) 179 BLOCK TRACT 2671 Single dwelling watt,�. GROUP I R J TYPE O ZONE R)t FIRE DISTRICT 3865 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Footing Trench Foundation Forms and Grade to Garage Rough Framing ` Plumbing, Rough to Slab .,,_�_< .L•r✓I/1^ • /d '.3 0 `,S �a 91 i Plumbing, Rough Complete_ jyj is f2— TemporaryPole Wiring, Rough 2f//f Heating, Rough �'{��^ S �G-iC--.-�J -/j- sz n / /`.a,/ -.ti 5� .31:-5 ✓ tj atin Final g. S S '�' 7 / / i /7- / - ewer, House d Sewer, St. M/�"C i`-�.5-'".S% 5 %/� (r,%76 6 Septic Tank //or Cesspool Lathing, InT Duty ` r errng T 2 - -S 7 % Plumbing, Final, Fixtures Complete MHS 5 -2$ -SJ Plumbing, Final Gas Test/ S-- 41ffs Wiring, Final MSV9 Occuoancv M t/- C i Costa Mesa Building Department APPLICATION FOR PERMIT P. O. Box 317 ,2RIN5 BUILDING [COSTA MESA, CALIFORNIA ' FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY Receipt No. Permit No. A3S� Building Address 1207 Donegal Place Costa Mesa, California Received by Date Recd.// O—/O -JG Date Issued XD— Nearest Cross St. Loren Lane Building Address Owner College Mesa Company Costa Mesa, California Mail Address 1777 W. Lincoln Avenue Nearest Cross St. Tel. City Anaheim No. KEY 3-3161 Zone I No. of Plans I Type Grou Architect or Lic. Engineer Davis & Quigley ryo, C-1790 Approved by Date Address 43 Malaga Cove Plaza Palos Verde CORRECTIONS City Lic. Contractor The Hale Company No. 3422 Address 1777 W. Lincoln Ave., Anaheim Legal I Description Lot I I No. 179 Block I Tract 2671 (Attach Metes and Bounds) No. of Bldgs Size of Lot 66 x 110 Now on Lot None Use of No. of Existing Bldg. I Families No. of I Rooms D S — Setback Line from Rear Yard 3II Center of Street 60 Side Yard 6/7 D DESCRIPTION OF WORK r, New I X I Alteration I Addition Repair I I Moving I Demolish Building 1260 No. of 6 1 Size Rooms Stories ExterCoverior ingWaii Stucco Roof I Covering Shake APPROVALS Use of New Building Single family dwelling with Foundation Location Forms, Materials, Under -Pinning Inspector Date Frame: Fire Stops, Bracing, Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply with all City Ordinances and State Laws regulating building construction. Signature of THE HALE COMP Permittee Authorized Agt. Lath. Int. Lath. Ext. Plaster, Int. Plaster, Ext. Valuation $ 10,$$0.00$ TTotalChFee$ 26.00 $ 13 . 00 Masonry Reinforced Bond Beam 39.00 FINAL FORM 209 1015 O. P. S S. t it PLOT PLAN Show location and distances from property line and between buildings. d e J � o. J 0 d a 0 a Street PLOT PLAN Show location and distances from property line and between buildings.