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Home My WebLink About2441 ELDEN AVE - Building Permits (6)1ob Address: 2441 ELDEN AV Suite No A Vicinity: Parcel Nunmber: 43928137 Applicant; Address: Owner; Address Contractor, Address: Arch / Eng : Address: ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clanfier System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain. Rainwater Drain, Roof Drinking Fountain Expansion Tank DECINCES,IM 12 STRAWBERRY FARMS ROAD IRVINE, CA PLUMBING PERMIT Phone: 949.477.4280 Zip: 92612 DECINCES, DOUGLAS AND KRISTI 12 STRAWBERRY FARMS ROAD IRVINE. CA REF 804-00475. SEWER CAP. AMT $23.50 $0.00 50.00 50.00 50.00 50.00 S0.00 S0.00 $0.00 $0.00 50.00 30.00 $0.00 Phone: 949.417.4280 Zip: 92612 Phone: Zip: License: Phone: Zip: License: SCOPE OF PERMIT FEESUMMARY QTY AMT Laundry Tub / Washer 50.00 0 Landscape Irrigation 50.00 0 P-Trap 50.00 0 Pressure Regulator 50.00 0 Process Piping (per 10 tt) 50.00 0 Receptors $0.00 0 Septic Tank 50.00 0 Sewer Cap for Demo 39.80 0 Sewer Connecl $0.00 0 Sewer Privale Line $0.00 0 Shower $0.00 0 Sink, bar $0.00 0 Sink, commercial $0.00 QTY 0 0 0 0 0 0 0 1 0 0 0 0 0 Status: ISSUED Applied: 03/02/2004 Issued: 03/02I2004 ISSUED BY: SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum BrkrBkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping �1nst or Rep.) Water Re-pipe AMT 50.00 $0.00 30.00 50.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements undei California statutes and related regulatlons. (Ord. No, g2-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 780 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeetion8 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) 7545626 �•3 '..�if•:i:9] WOAKERS'COMPENSAnON DECLARATON: � I hereby ettirtn untler penalry of perjury one ot the following tlaclare�lons: � I have end will meimain e certificate ot consent to self-Insure lor workers' compensation, as Orovided br by section 3700 of the Wbor Code, for the pertortnence of Ihe work for whfch ihis permit is issued. ❑ I have end wlll maintain workers' compensation Insurance, es reQuired by section 3700 ot ihe Labor Code, tor the perfortnance oF Ihe work tor which this permit Is Issued. My workers' compensatlon Insurence carner antl policy number ere: Carner: Policy Numher: (This secflon need nof be complefed il the permit is velued et one hundred dollers ($100) or less.) i ❑ I certity thet in Ihe perfortnance of the work for which this permit Is issued, I shall not employ eny person in�eny manner so as to become subject to the workers' compensetion laws of Celifomia, entl aqree that It I should become subject to the workers' compensa�ion provislons ot Section 3700 ot Ihe Wbor Code, I shall forthwlth comply with Ihese provisions. Applicant Signeture: Date: WAHNING FAIWFE TO SECURE WORKERS' COMPENSATIIXJ COVERAOE IS UNUWFUL M'D SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENPLTIES M1D CIVIL FlNES UP TO ONE HUNDRED THOUSPIJO DOLL4RE (St W,OW). IN AODITION TO THE COST OF COMPENSATION, DMl4GE5 PS PROVIOED FOF IN SECTION 370fi OF THE LABOR WDE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I here6y ettirm ihat I am licensed under provisions of C�apter 9(commencing with Sectian 7000) oi Divisian 3 af the Business and Professions Code, end my license is in full torce entl eMecL Lic. N Class q Conirac�or's Signature: Data: CONSTRUCTION LENDING AGENCY: ❑ I hereby attirm that there is a consWction lending agency for ihe pedormance of the work for which ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lendar's Address: Signature: Date: OWNER-BUILDEH DECLAiiAT10NS: I hereby aHirm thet untler penalry of perjury that I am EXEMPT FROM THE CONTFiAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Protessions Cotle: Any ciry or counry whic� requires a permit to consiruct, elter, improva, tlemolish, or repair any structura, prior to its iuuance, also requiras the applicant tor such permit to tlle a signed sietement ihet he or she Is licensed pursuent to Ihe pravisions oi �he Contractors License Lew (Chepter 9(commencing with Sectlon 7000) of DlWsion 3 oi the 8usinass entl Professions Cotle) or that he or sha is exempt thorelrom and the basis for Ihe allegetl exemption. Any violation of Section 7031.5 by eny epplicent far e permit subjects Ihe epplicam to a civil penalry of not more than Ilve huntlred dollers ($500)J: ❑ I, es owner of Ihe Dmperry, or my employees wlth wages es their sole compensation, WILL DO THE WORK, and the strucWre is not intendetl or ottered tor sele (Sec. 7044, Business and Professions Cotle: The Conirectors Ucense Law does not appty to an ownar of properry who builds or improves Ihereon, and who does such work himselt or hersetl or t�rough his or �er own employees, provided Ihat such improvements are not Intended or oHered for sele. If, hawever, the builtling or improvement is �sold within one year of completion, ihe owneo-builder will have the burden of D�oving ihat he or she did not build or improve for purpose ot sale.). ' ❑ I, as owner oi the pmperty, am EXCLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business entl Prolesslons Cotle: The comractors License Law tloes not apply to en owner of propeny who builtls or improves thereon, entl who contracts for such projea with e contractor(s) license pursuant to the Contractors License Laws.). ❑ by ❑ NO Business and Protessions Code for �his reeson: Venfication of Ownership Gy (type of daument, i.e. - property taa bill or deetl): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CER7IFICATION: ❑ I hereby certify ihat no eawvation five (5) or more feet in depth into which a pereon is requiretl �o Oescen0, will be matle in connection with work euthonzetl by t�is permil, antl Ihat no 6uildinq swcture, scattoltling, telsework, or demolition or dismamling thereof, will be more than thirty-si: (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Celifomia AOministrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a pertnit trom the Division ot Indusirial Salery, es noted ebove, unless such person has e permit to tlo such work imm the division. Signalure: Data: Division oi Intlusirial Sefety Permit Num6er: CERTIFICATE OF COMPLIANCE AND AUTHORVA710N OF ENTAV: I certity under penalry of perjury thet I have read this application and state thel lhe iniormation given is wrrect. I egree to comply with all state laws end ciry ordinances relating to builtling conswction, end euthorize representatives oi the Ciry of Caste Mesa to enter upon ihe ebova-descdbed D�operry for inspection purpwses. I egree not to occupy or allow occupancy ot any Duiltling euthorized by this permit umil final inspection. COOE A, MSPECTIONTYPE �-� 1616 FixeO System Final Fire Prevention 12fi6 Pool Spe Finel 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Finel Slgn 204 Final Demotition f�¢� IN(RIALS �f� INSPELTIONTYPE \ 206 Final Mechanical 208 Final Plumbing 210 Finel Electricel 212 Finel Fire Prevention 220 Finel Planning Approval 222 250 Finel Site Finel Building/Occupancy PA7E It1�IdL5 (7ta) 754-5273 • Fax (77a) 754-ae56 • www.ci.costa-mesa.ca.us 77 FA�F DFNE, GOSTA MtSn, Gn s262e BUILDING PERMIT Jab Address: 2441 ELDEN AV �%'y Suite: Vicinity: Parcel Number: 43928137 Applicant: DECINCES,TIM Address: 12 STRAWBERRY FARMS ROAD Zoning: Phone: 949.417.4280 IRVWE, CA Zip: 92612 owner: DECINCES, DOUGLAS AND KRISTI Address 12 STRAWBERRY FARMS ROAD IRV W E, CA Convactor: O W N E R-B U I L D E R Address: Zip: Arch : Address: Phone: 949.417.4280 Zip: 92612 Phone: License: 000000 Eng: Address: Status: ISSUED Applied: 03/02/2004 Issued: 03/02/2004 ISSUED BY: � Phone: Phone: Zip: License: License: SCOPE OF PERMIT DEMOLISH EXIST. TWO HOMES . REAR UNIT HAS 1216SF AS PER OUR RECORDS THE FRONT WAS BUILT IN 1920. APPLIACNR WILL BRING IF FOUND A COPY FROM THE COUNTY . DEMILITION SHALL COMPLY WITH THE APPROVED WQMP/BMP GRADING PLAN. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total $90.51 $139.25 $o.00 $0.00 $0.00 $0.00 $229.76 SETBACKS MAIN STRUCTURE Fronl 0- 0 ACCESSORY Front 0-0 PARKING Existinq: 0 Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0-0 S�,000.00 s7,000.00 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 it work is not commenced within 1 BO days, or if work Is suspended or abandoned for a period of 1 BO 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 Inspectiona and f(nal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 75h5626 � WORKERS'COMPENSAnON DECLARATION: I herehy eHirm under penelty of perjury one ot Ihe tollowing tleclarations: ❑ I heve entl will malntain e certificate ot consent ro self-Insure for workers' compensetlon, as provided for by section 3700 of ihe Labor Code, for the pedormance of the work for which this pertnit is issuetl. ❑ I have end will maintain workers' compensation insurance, as requiretl by sectlon 3700 of Ne Lebor Code, br the peAortnance of the work for whlch Ihis pertnit is issued. My workers' compensation Insurance carner antl policy num6er ere: Carner. Policy Number. (This sec(ion need not be comp/eted il the permif is vslued af one hundred dallars (5100) or less.) ❑ I certily thet in the pertortnance of the work for which this permit is issued, I shall not employ eny person in any manner so as to become sub�ect to the warkers' compensatlon laws oi Celifomia, end egree thet II I should become subject to the workere' compensation provislons of Section 3700 oi the Labor Cotla, I shall forthwith comply wi�h these provisions. Applicam Signature: Dete: WARNING: FAILURE TO SECURE WORKERS' COMPENSNTIIXJ COVERAGE IS UNLAWFUL PNO SMALL SUBJEGT M' EMPLOVER TO CflIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED THOUSAND DOILARE (E100.000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 37080F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettlrm Ihat I am licensed undar provisions of Chepter 9(commencing with Section 7000) ot Dlvision 3 of ihe Businass and Professions Coda, antl my license is in full force antl eNect. LJc. a Class N Contractols Signature: Date: CONSTRUCTION LENDING AGENCY: I❑ 1 here6y aNirm that t�ere is a construction lending egency for the pedortnance ot t�e work for which this permit is issued. (Sec. 3097. Civil Code). li Lendels Name: Lentlers Address: ISignature: Date: OWNER-BUILDER DECLARA710N5: I hereby eMirm Ihet under penalry of perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions Code: Any city or counry which requires e permit to consiruct, alter, improve, demolish, or repair eny strucWre, prior to its issuance, elso requires the applicant for such permit to tile a signetl statement thet he or sha Is Ilcensetl pursuant to the provlsions ot the Contrectors Llcense Lew (Chapter 9(commencing with Sectlon 7000) of Dlvision 3 oi the Businoss end Professions Code) or Ihet he or she is exempt therefrom end the basis for ihe elleged e:emption. Any violetion of Sectlon 7031.5 by eny applicant for a pertnit subjects tne epplicant to e civil penalry of not more then tive hundred dollers ($500).): ❑ I, es owner of the propeM. ar my employees with weges as their sole compensation, WILL DO THE WORK, and ihe structure Is not intended or oflered lor sele (Sec. 7044, Business flntl Professions Code: The Contractors License Lew dces noI apply to an owner ot properry who builds or imD�oves thereon, entl who does such work himself or �erselt or through his or her own employees, pmvided that such impmvemems ere not Intended or oHered for sale. tl, however, �he bullding or Improvement is oltl within one year ot wmpletion, t�e owner-builder wiil heve ihe burden of proving that he or she did not build or improve for purpose ot sele.). ' �as owner ot the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business antl Protessions �� Cotle: The comracrors Llcense Law does not epply to en owner ot pmperry w�o builtls or impmves thereon, end who cromracts for such pmlect with e coniraaor(s) � license pursuant to the Contractors License Laws.). ' Business and Professions Cotle for this reason: �er ID venlied by Er(va�cense. R1Yes ❑ No �� \ Venficatlon ol Ownership by (type of dxument, i.e. - pmperty ta: 6111 or DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: No. ❑ I hereby certify ihet no axcavation live (5) or more feet in depih Into which e person is required to tlescenq will be made in connection with work authodzed by this permit, and that no building siructure, swflolding, falsework, or tlemolition or dismantling thereol, will be more ihan thirty-si: (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltle B, Californla Atlministrative Code). ❑ As owner-builder, I will not employ enyone to Ao work which would require a Oermit from the Division of Indusirial Safery, es noted above, unleu such parson has e permit to tlo such work irom the division. Siqnature: Date: Division oi Intlustrial Safery Pertnit Number: ICERTIFlCA7E OF COMPIIANCE AND AUTHORVATION OF EHTAV: I cenify under penalry of perjury that I have read this appliwtion and stale tha� ihe infortnation given is I correcl. I agree to comply with all stete laws and ciry ortlinances relating to builtling construction, and euihodze represenlatives ol the Ciry ot Casta Mesa to enter upon Ihe ebove-descnbed property for inspection purposes. I egree not to occupy or allow occupancy of eny building authorized by this permil until finel inspection. COOE I, INSPECTIONTYPE 1616 Fixed System Final Fire Prevention 1266 200 201 202 203 204 Pool Spa Final Final Re-Root Final BIaWRetaining Wall Final Faciory Fire Place Final Sign Final Demolition n� '� z �jg IA �f„( INSPECTIONTYPE 206 Final Mechaniwl 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning ApP�oval 222 Final Site - 250 FinelBuiltling/OccupanCy � '�2� ��;,,.��, . � �DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS Street Address: 1. I (we). referenced real property, and that �(we) hereby authorize: Bldg. Permit # This Permit # �� _ AP Number. declare that I am the Owner of Title of the above Name: ,/ �V6 , ' �Cl._, �Ne�S� TelephoneNumber. ` �� [ — ��o� l Z ^ Street Address: �1�l3/�-Y � Ciry: �- (�V � N�' State: ��- Zip: Z�o / z-- to obtain pertnits-in my behalt, as owner/builder, for o� y�I I E � C�GV� (_t)S� I� � G' SG�� „� �.�%.2 % at the above referenced property. 2. Should any person become an employee engaged in the improvemeni of the property, I(we) sha�l immediately provide Worker's Compehsation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Cosla Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. 1 declare under the penalty of perjury that the foregoing is true and correct. � Executed this day of Ii�GI.Y`C�/l.. 20 Q� , at T V� � � YL � , California. Note: This author¢ation does not grant authorization to perform the work as ovmer, it solely provides for limked power of attomey to secure this pertnit in any behaH. 0]]9-a6 (rp�.� �/00) (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 2441 ELD�N AV Suite: A Vicinity: Parcel Number: 43928137 Applicant: EDGARDO J. GELSANO Address: 20351 IRVINE AV SUITE 1C SANTA ANA, CA Zoning: Phone: 714-641-1505 Zip: 92707 Owner: DECINCES, DOUGLAS AND KRISTI Address 12 STRAWBERRY FARMS ROAD � IRVINE, CA Contractor. Address: Zip: Arch : Address: Phone: Phone: 949.417.4280 Zip: 92612 Phone: License: Eng: Address: Slatus: ISSUED Applied: 12/04/2003 Issued: 04/22/2004 ISSUED BY: � � v Phone: Zip: License: License: SCOPE OF PERMIT LOT 1 UNIT A PLAN 1A ' NEW 2,249 S.F. S.F.D. WITH 433 S.F. P,TTACHED GARAGE. WORK TO INCLUDE: 1 ST STORY (1,031 S.F.) AND 2ND STORY (1,218 S.F.), 3 BEDROOMS AND 3 BATHS. ALSO INCLUDES 101SF FRONT PORCH. REF.: 803-02094/2096/2097 AND G03-00021, PA-03-08, PM-03-243 Plan Check: $1,082.74 Permit: $1,665.75 SMIP Res: $22.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $2,770.49 SETBACKS MAINSTRUCTURE Front 33-0 ACCESSORY Front 0- 0 PARKING Existinq: p Rear 20- 0 Rear 0- 0 Re uired: 4 FEE SUMMARY Calc Valuation: Claim Valuation: PLANNING & ZONING Left S 0 Right Left 0- 0 Right Pr000sed: 4 5- 0 � $219.957.62 so.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitomia statutes and related regulalions. (Ord. No. 92-28, § 1, 12-21�92) • EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspectlona and final approvel must be obtained. Failure to obtain inspections and tinal approval will result in ihe expiration of this permit. FOR INSPECTIONS CAIL: (714) 7545626 144ti-96 (IV W � WORKERS' COMPENSATION DECLARA710N: I hereby ettirm under penalry oi pe�uaf.one M.the lollowing declaretions: �'' � ❑ I have and will meintain a ceniticate ol consent to sell-Insure for workers' compensetion, es providetl for by section 3700 0l Ihe Lebor Code, br t�e pertortnence of Ihe work for which this permit is issued. ❑ I have end wlll maintain workers' compensetion Insurence, as required by section 3700 of Ihe Lebor Code, Por the pertortnance ot ihe work for which this permit is Issued. My workers' compensaUon Insurance certler and pollcy number are: Carner. Poliry Number. (This socNon neeC not 6e comp/etetl it Ihe permlt !s velued af one hundred dollaro ($f 00J oi less.) ❑ I cenify Ihat in tha pertortnance of lha work tor w�ich this permi� is issued, I shall not employ eny person in any menner so es to become subject to ihe workers' compensation laws oi CaliFomla, erM egree thel if I shoultl become subject to the workers' compensation provisions ol Section 3700 of the Labor Code, I shall torthwith comply with these provisions. AppllcaN Signeture: Date: WAfiNINO: FAI�URE TO SEWRE WORKERS' COMPENSATION COVERAGE IS UNLAW FUL AND SHALL SU91ECi AN EMPIOVEP TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED TFIOUSAND OOLLARE (5100.OW). IN A�DITION TO TME COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3706 OF THE IABOR WDE, IMEREST. AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm Ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Professions Cotle, enC my license Is in full torce end eHect. Lic. W qess N ConireCloYs Signalure: Date: CONSTRUCTION LENDING AGENCY: � ❑ I hereby affirm that there is a construction lending agency for the peAormance of the work br which this permit is issued. (Sec. 3097, Civil Cotle). Lendefs Neme: Lendefs Address: Signature: Date: OWNER•BUILDER DECLARATIONS: I hereby aHirm t�et untler penalry of perjury Met I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business and Protesslons Cotle: Any city or counry w�ic� requires e permit m construct, alter, improve, demolish, or repair any simcture, prior to its issuance, elso requires the epplicant for such permit to file a signed siatement ihet ha or she Is Ilcensed pursuent ro the provislons ot Ihe Conirectors License Law (Chapter 9(commencing with Sectlon 7000) ot Divislon 3 ot the Businoss entl Pmfeuions Cotle) or t�et he or she is e:empt therelrom end the basis for the alleged axemption. Any violation oi Section 7031.5 by eny applicent tor e pertnit sublecis t�e epplicant m a civil penelty of nat more Ihan five hundretl tlollars ($500).): ❑ I, es owner oi tha property, or my employees with wages as their sole wmpensation, WILL DO THE WORK, and the s�ructure Is not inten0atl or oXaretl for sale (Sec. 7044, Business and Professions Code: The Coniractors License Law Ooes not appty to an owner of properry who builds or improves thereon, flntl who does such work himself or herseH ar through his or her own emplayaes, provitled i�at such Improvemems are not intended or oHered tor sale. II, however, ihe building or improvement is sold within one year of completion, the owner-builder will have the burden ol proving that he or she did not huiltl or Improve for purpose of sale.). � ��¢s owner oi �he property, am E%CLUSNELY CONTRACTING WITH LICENSED CONTRACTORS to wnstruci tha pryect (SBC. 7044, Busine55 end Protessions Code: The contrectors License Lew tloes not apply to en owner of property who bullds or improves Ihereon, and who conlracts for such pmject with a coniractor(s) license pursuant fo the Contractors License Lews.). ❑ lem Ow`ner ID vedfletl D�tln� licbrf5a. Verificetian ot Ownership by (Iype ol Business ena Prolessions Coda tor this reason: ��.. ❑ No Ddver's Liianse No. .__�— I.e. - property Iax hlll or Ceed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFIGATION: ❑ I hereby certify t�at no excavetion tive (5) or more feet in depth into which a person Is required to descenq will be made in connection with work euthodzetl by Ihis permit, end that na building sWcture, scaXolding, falsewark, or demolition or dismantling thereoi, will be more than thirty-six (36) leet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Ttle B, Galitomia Adminlsiretive CoUe). ❑ As owner-builtler, I will not employ enyone to do work which would requira e parmit trom Ihe Division ol Industrial Salery, as noted ebove, unless such person has a permi� to tlo such work Irom the division. Signeture: Dale: Divislon of Induslnal Safery Permit Numher: CERTIFlCA7E OF COMPLJANCE /WD AIITHORIZATION OF EMRV: I cenity under penalry of perjury ihat I have reaC this application and state thet ihe infortnation given is conect I egree to compty with all slate lews antl ciry ordinances relating Io bullding consWc�ion, and euthodze representa�ives of the Ciry of Costa Mesa to enter upon the ebova-descnbed properry tor i ection purpo 1 agree not to occupy or allow occupancy of eny building authonzed by this it until finel inspection. � 22 oy� � nr OI alOwrref(s) �� 'Date� � =:- �/zz/.6�; _ . ihorized�Aooliwnt �� Date CODE �. INSPECTIONTYPE 1818 Fixetl System Final Fire Preven�lon 1266 200 201 202 203 206 Pool Spa Final Finel Re-Root Final Block/Retaining Well Finel Faciory Fire Place Final Sign Final Demolition p�¢, ��S �Q�f,j INSPECTIONTYPE 206 Flnal MechaniCal 208 Final Plumbing 270 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Sl�e � 250 FinalBuiltlingiOccupency� Q�IF II�Lfl .�-: NEWPORT-MESA UNIFIED SCHOOL DISTRIC� `� N° _ 4995 CER7IFICATE OF COMPLIANCE OF OEVELOPMENT FEES PURSUANT TO AB 1600 ANO AB 181 To: (� Ciry of Costa Mesa ( ) Ciry o� Newport Beach ( ) County of Orange Applicant: �\ w� \ Address: Telephone TractlParcel and Lot Location of Project: Number of Square Feet of: Residential Space Commercial and Industrial Space CommerciaVlndustrial Projed is: (Check One) _ Warehouse _ R8D District Receipt No. Plan Check No. �3-�� g Movie Theater Mini-storage Heavy Industrial Regional Shops Light Industrial This project is exempt because �: a�.aa z S .30 Total � I �� `F� Total '��`�� , 1 APR 2120�1 Motel `{� Bank � ��' Neighbofiood Sho� O� RacqueVHealth Hotel Medical O(6ce Office Park Preschool Auto Repair Hospital Large Ofice Office Bldg. Restaurant Fest Food This certifies that the above-named Developer/Applicant has paid school facidty fees in comp6ance with Government Code sections 53080 and 65995. The Building pemiils for this square tootage in lhis proposed development may now be issued by your jurisdicBon. Checks are to be made payable to Newport-Mesa Unified School Disfid. AuMoriiad RapreseMateve The above represenhation as W square footege is We. AppHcant agrees that if it is later detetmned that such representa6ons are not true, then this certificate shall automaticaly temtinate and the appropriate City/County shall be notified. �i ZZ a`� �. - Date: � �l� A�plie�M (714) 754-5273 • Fa�c (714) 754-4056 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Viciniry: Parcel Nunmber: ApplicanC Address: Owner: Address 2441 ELDEN AV A 43928137 DECINCES,TIM 12 STRAWBERRY FARMS ROAD IRVtNE, CA ELECTRICAL PERMIT Status: ISSUED Applied: 08/23/2004 Issued: 08/23/2004 ISSUED BY: / Phone: 949.417.4280 Zip: 92612 DECINCES, DOUGLAS AND KRISTI 12 STRAWBERRY FARMS ROAD IRVINE, CA - Con tra c tor: O W N E R- B U I L D E R Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lightin9 Fixts Recept Outlets Svritches Nan Res Appl Res Appl Service to 200a - Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Phone: 949.417.4280 Zip: 92612 Phone: Zip: License: 000000 � SCOPE OF PERMIT ' EL�CTRICAL TO INCLUDE: 2249 S.F. NEW S.F.D., 6 LIGHT FIXTURES, 4 OUTLETS AND 2 SWITCHES. $23.50 $0.00 $0.00 $125.94 $0.00 $0.00 $6.60 $4.40 $220 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 , $0.00 j $0.00 I $0.00 ' $0.00 $0.00 Quantity 2249 0 0 6 4 2 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to SO.kva/kw .................up to 10o kvalkw ..................over 100 kva/kw Low Volfage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misc. Conductor " , Circus ( gen or ride) Circus (mech ride o� lighis) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantiry $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 30.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 � 50.00 0 $0.00 �. 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements untler Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned� for a period of 180 days. i r INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes and all required Inepeetions and final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of /th/{s permit. FOR INSPECTIONS CALL: (714) 7545626 v �'E� :�n:3F.'i:)] WORKERS'COMPENSATONDECLARATION: I hereby aftirm under penalry of Derjury one of ihe following declaratlons: ❑ I have end wlll meintaln e certificete of consent to selFlnsure for workers' campensetlon, es provided tor by section 3700 of Ihe Labor Code, 1or the peAortnence of the work ior whiCh IhiS permil I5 i55uBd. ❑ I have antl wlll melntain workers' compensaGon insurence, es requiretl by sectlon 3700 of Ne Lebor Code, tor Ne peAortnence oi the work for which Nis pertnit is issued. My workers' compensation Insurence cartier and policy number are: Certier. nof one Policy Number: or /ess.) I,certiy ihet In the pertormance ol tha work tor which thls pertnil is issuetl, I shall not employ eny person in eny manner so as to become subject to Ihe workers' ��-"'"compensetlon lews oi Celifornla, entl egree ihat If I should become sublect to the workers' compensetion p�ovlslons of Sectlon 3700 0l the Labor Cotle, I shell torihwlih camply with Ihese pr�o_�vis' nc� App��centsignawre: \a�� oa�e: '�/-23—n� WARl11N�rFA1LURE TO SECURE WORkERS' GYkAPENSAiION GUVERAGE IS UNLAWFUL AND SMALL SUflIECT AN EMPLOVER�iOCRIMINA� PENPLTIES AND CIVIL FlNES UP TOONE HUNDRED THOUSAND DOLLARE (5100.000), IN ADDITION TO iME COST OF COMPENSATION, DAMAGES AS PPOVIDED FOF IN SECTION 31O60F THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLAHATION: I hereby aMirtn that I am Ilcensed under provisions oi Chap�er 9(commencing wlih Section 7000) of Division 3 of the Business and Professlons Code, antl my licensa is in full torce and eftect. Lic. a Class a Contreqofs Signeture: Date: CONSTRUCTION LENDING AGENCY: ❑ I �ereby eHirtn that there is e construction lending agency for the peAormance ol the work br w�ich this permit is issued. (Sea 3097, Civil Cotle). Lenders Neme: Lentlers AtlOress: Signature: Date: OWNER-BUIIOER DECLARATIONS: I hereby ettirm ihel under penalty of per�ury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business end Protessions Coda: Any city or counry which requlres e permit to constmct, elter, improve, demolish, or repair eny stmcture, prior to its issuance, elso reqWres the epplicant for such permit to Illo e signeC statement that he or she Is licensed pursuent to Ihe provlslons al the Comrectors License Law (Ghapter 8(commencing with Sactlon 7000) of Dlvision 3 of the Business and Professions Code) or that he or she is ezempt therefrom and Ne besis for Ihe ellaged ezemption. Any vlolatlon of Sectlon 7031.5 by any epplicent for a pertnit sub�ects the applicent to e civil penelry of not more than five hundred dollars ($500).): ❑ I, es owner at the pmperty, or my employees with wages es their sole compenseUon, WILL DO THE WORK, antl the sWqure Is not intentletl or ottered tor sale (Sec. 7044, Business and Professlons Cotle: The Contractore License Lew does not apply to an owner ot properry who builds or improves Ihereon, and w�o tloes such work �imself ar herselt or Ihrough his or her own employees, provided thet such Improvements ere not intended or oHered tor sele. If, however, the huiltling or Improvement is sold within ono year oi completion, the ownerbuilder will heve the burden of proving that he or she ditl not build or improve tor purpose of sele.). • � I,-es owner of Ihe property, am El(CWSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, BuSiness entl Profession5 . Cotle: The comrectors License Law does not apply ta en owner of property who �ulltls or improves ihereon, end who contracts lor such pwject with e cnntractor(s) license pursuent to the Coniractors License Laws.). ❑ I em exampt unde�ec. Busineu and Professions Cotle for this reason: Sign`ature: '� " �E=pires: !.� �[- n5_ Vediication of Ownership by (rype oi dau ".e. - property tez bill or tleetl): � DIVISION OF INOUSTRIAL SAFETV ❑ I hereby cerilty ihat no excavation five (5) or more teet In tlapt� Into whlc� a peroon Is requiretl to descend, will be mede in connectlon wi�h work authorized by this permil, and Ihat no building sWdure, scaHoltling, telsework, or demolition or dismantling thereot, will be more ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltla 8, Cellfornla Atlminisiretive Code). ❑ As ownervbullder, I will not employ enyone to do work which would requlre e permit trom the Division of Industrial Setety, es notetl ebove, unless such person hes a permit to tlo such work from the division. Slgnature: Date: Division of Intlustriel Salery Permit Number: CERTFlCATE OF COMPLIANCE IWo AIITHORVATON OP ENTfiV: I certity under penalry ol perjury that I have reed this epplication entl state that the information given is correcL I egree to comply with ell st laws and ciry ortlinences relating to building consWction, and authotlze representatives of the Ciry of Costa Mesa to enter upon the ebove-descnbed prope � es. I egree not to occupy or allow occupancy ot any building authorized by �his permit until tinel inspection. � _ 9-z�s=.oy SigneWra,Of�L`egal Owner(s) , ; "t - Date_-... . � �;�.y._ =..�.-.._.. ... Antl/Or Authorized Applicant Data GOOE I, INSPEGTIONTYPE PAIE 1618 Flzed System Final Fire Preventlon 1266 Pool Spa Finel 200 Finel Ra-Rool 201 Final BIocWRetaining Wall 202 Final Fectory Fire Place 203 Final Slgn 204 Finel Demolition f[�¢ COpE� INSPECTIONTYPE 206 Final Mechanicel 208 Final Plumbing 270 Final Elecirical 212 Final Flre Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildinyOccupancy o"n IMR1�L5 -1 2Y-�s � Job Address: Suite No Vicinity: 2441 ELDEN AV A Parcel Number: 43928137 Appliwnt: DECINCES,TIM Address: 12 STRAWBERRY FARMS ROAD IRVINE, CA MECHANICAL PERMIT Phone: 949.417.4280 Zip: 92612 Owner: DECINCES, DOUGLAS AND KRISTI Address: 12 STRAWBERRY FARMS ROAD " � Phone: 949.417.4280 IRVINE, CA Co nt ra cto r: O W N E R-B U I L D E R Address: Zip: 92612 Phone: Zip: License: 000000 Status: ISSUED Applied: 08/23/2004 Issued: 08/23/2004 ISSUED BY: SCOPE OF PERMIT MECHANICAL TO INCLUDE: 1 INST FAU < 100K BTU, 1 REPAIR/ALT COOLING/HEAT, t FACTORY FIREPLACE, 1 HOOD W/MECH EXHAUST AND 3 VENT FANS. UNIT A REF.: B0302098 ISSUE FEE Inst FAU <100 k BTU . Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall HV Refrig Sys <100 k BTU Refrig Sys >100 k BTU . Gas Piping " Factory Fireplace Hood w/Mech Exhaust - VAV Box Vent Fan / Single Duct Appliance � Fire Dampers � Smoke Dampers � ' Inst or Relocate Appl Vent � Air Handlers < 10000cfm , Air Handlers > 10000cfm Floor Fumace Floor or Suspend Heater $23.50 $14.80 $0.00 $13.70 $0.00 $0.00 $0.00 $0.00 $10.65 $10.65 $0.00 $21.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 7 0 � 0 0 0 0 1 1 0 3 0 0 0 0 0 0 0 0 FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler . Com mercial I ncineretor Domestic Incinera[or Compressors / Absorption Systems . Upto3hp/100kBTU " . 3To15hp/500kBTU 15 To 30 hp /�1,OOO.k BTU , 30 To 50 hp % 1,750 k BTU � - Over 50 hp / Over 1,750 BTU � Boilers Up to 3 hp ,� �"i 3Tot5hp . � ._ 15to30hp � � . - 30 to 50 hp � � 'i Over 50 hp ;-� Other Mechanical Fee - , Investigation Fee . - � Plan Check Fee - Reinspection Fee � � TOTAL CALCULATED FEES Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 30.00 0 $0.00 0 � � 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $95.05 NOTICE: The work authorized by ihis 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 ezpire and become void if work is not commenced within 180 days, or if work is suspended or abandoned tor a period of 180 days. ��, INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable cotles, and all required Inspectiona 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) 7545628 // 2aasas (vao� WORKERS' COMPENSATION D�CLARATION: � I here6y affirm under penalry of perjury one ot ihe following declaretions: ❑ I heve and will mainteln a certificate ot consent to selbinsure for workers' compensation, es provided for by section 3700 of the Labor Code, lor the paAormance of the wark tor which Ihis permii is issued. ❑ I have antl wlll mainiain work9rs' compensalion insurance, as required by section 3700 of the La6or Code, tor ihe performance of the work for whlch this pertnit is Issued. My workers' compensation Ihsurence carrier end policy numbei are: Carrier: Policy Number: (Tliis section need nof be completed i! the permif is velued et one hundred dollars ($100) or less.) ,� I certity ihat in the pedortnance oi ihe work for which this pertnit is issuetl, I shall not employ any person in eny manner so es to become sub�ect to Ihe workers' compensation laws oi Calitornie, end egree t�et it I should becoma subject b the workers' compensation provisions of Section 3700 of the Labor Cotle, I shall torthwllh comply with these provisions, /� � ' a Applicant SigneNre: �r� f�—� oa�a: 9— Z3_ n�-� WAPNINO: FAILURE TO SECURE WOqKERS' MP ATION CqVERAGE IS UNLIWFUL AND SHALL SU6IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND �OLLARE ($100,000�, IN nqDITION TO THE COST OF COMPENSATION, DNMAGES AS PROVIDED FOR IN SECTION 31W OF THE LABOP CA�E, INTEREST, AND ATTORNEY'S FEES. UCENSED CONTRACTORS DECLARATION: I hereby aflirm that I am licensetl under provisions of Chapter 9(commencing wiN Section 7000) of Division 3 of the Business and Professions Coaa, and my licanse is in tull torce and eRect Lic. q Cless # Contracbr's Signeture: Dete: CONSTRUC710N LENDING AGHNCY: ❑ I hereby attirm that ihere is a construction lending aqency for tha pertormance of the work for which ihis pertnit is issued. (Sec. 3097, Civil Code). , Lendar's Name: Lender's Address: Slqnature: Dafe: OWNER-BUILOER DECLARA7IQNS: I hereby ettirm that under panalry ot perjury that I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for Ihe following reeson (Sec. 7031.5, Business entl Protesslons Code: Any ciry or county which requires e permit to constmct, elter, improve, demolish, or repair any stmcture, prior to its issuance, also requires ihe epplicaM for such parmit to tile a signetl statement ihat he br she is licensed pursuent to Ihe provisions of the Comractors License Law (Chapier 9(commencing with Sectlon 7000) of Division 3 of ihe Business end Protessions Cotle) or Ihet he or she is exempt therefrom end ihe basis tor the elleqed exemption. Any violetion oi Section 7031.5 by any epplicant for a permit su6jacts Ihe applicent to e civil penalty of not more then five hundred doilars ($500).): � I, as owner of the properry, or my employees with weges es Ihelr sole compensation, WILL DO 7ME WORK, and the struc�ure is not intentletl or oHered tor sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves Ihereon, and who tloes such work himself or herself or ihrough his or her own employaes, provided ihat such improvements ere not intended or oflered For sale. If, however, the builtling or improvement is sold within one year of complation, the owner-Ouiider will have ihe burden oi proving that he or she did not build or improve for purpose oi sale.). ' � I, as owner ot the pmperty, em E%CLUSNELV CONTRACTING WI7H LICENSED CONTRACTORS to construct tha project (Sea 7044, Business and Professions Code: The coniractors License Law tloes not epply to en owner of propeny who builds or improves theraon, end who conirects for such project with a comractor(s) litense pursuent to the Contrectors Licen58 Lews.). ❑ I am exempt under s c. __ Signe�ure: � Owner ID verifietl by dnve IicenSe Venficetion of Ownership by (rype of Business and Professions Code for this reason: S ❑ NO Driver'S LiCen50 No. i.e. - pmperty taz bill or deetl): DIVISION OF INDUSTRIAL SAFETY VERI�IT CERTIFICATION: � exp�res: 4-Z6-n9 ❑ I hereby certify tha� no excayetion �ive (5) or more fee� in depih into which e person is required to descend, wlll be made in connection with work euthodzed by this permit, and that no building sirucWre, scaHolding, falsework, or demolition or dismantling thereoi, will 6e more than thirty-six (36) feet high. (Chap. 32, Gry 2, Ah 2, Sec. 341, Title e, Celifomia Admiqistrative Gode). � As ownervhuildar, I will not employ anyone to do work which would require a permit from ihe Division of Industriel Sefery, es noted above, unless such person hes e pertnit to do such work from (he division. Signature: Oate: Division of Intlustrial Safety Pertnit Number: CERIIFlCATE OF COMPLIANCE qND AUTHORIZATION OF ENTTiV: I certiy under penalry of perjury iha� I have read ihis appiication antl state that ihe informa�ion given is correct. I egrae to comply with ell stete laws and clty ordinences relating to builtling consimction, antl authorize represen�atives of ihe Gty of Costa Mesa to en�er upon �he ebove-descnbed property for ins ' n purposes. 1 egree not to occupy or atlow occupancyof eny building authonzed by this permit until finai inspection. �.— �-23-0`1 Sig�a�ure egalOwner(s) Date And/Or Authorized Applicanc CODE�. INSPECTONTYPE OA INiRIALS 1616 Fi:ad System Final Fire pravention 1266 Pool Spa Final 200 Final Re-Roof 201 Final Block/Retaining W ell 202 Final Fectory Fire Place 203 Finaf Sign 204 Final Damolition CODEt INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 212 final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy P'^IFr. �f Z'�.) (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2441 ELDEN AV Suite No A Vicinity: UNITA Parcel Nunmber: 43928137 Applicant: BLYLEVEN, PAM Address: 1130 W DEWEY DR ANAHEIM,CA PLUMBING PERMIT Phone: 714.750.5461 Zip: 92802 Owner: DECINCES, DOUGLAS AND KRISTI Address 12 STRAWBERRY FARMS ROAD IRVINE, CA Contractor: BLYLEVEN'S PLUMBING INC Address: 1130 W DEWEY DR Arch / Eng : Address: ISSUE FEE BackFlow irrigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor ANAHEIM, CA Phone: 949.417.4280 Zip: 92612 Phone: 714-750-5461 Zip: 92802 License: 761484 Phone: Zip: License: Status: ISSUED Applied: 04/29/2004 Issued: 04/29/2004 ISSUED BY: SCOPE OF PERMIT UNIT A NEW 2,249 S.F. S.F.D. WITH 433 S.P. ATTACHED GARAGE. ' � 2 BATHTUBS, 1 ICE CONNECT, 1 DISHWASHER;1 GAS OUTLET (1-4), 1 OUTLET OVER 4, 1 GAS SERVICE, 1 LAUNDRY TUB/WASHER, 3 SHOWERS, 1 Kli'CHEN SINK, 2 SERVICE/MOP SINKS, 3 WASH BASIN, 1 WASH BASIN SET, 3 WATER CLOSETS, 1 WATER HEATERNENT REF: B03-02098 AMT $23.50 $0.00 $0.00 $19.60 $0.00 $9.80 $0.00 $9.80 $0.00 FEE SUMMARY QTV AMT Laundry Tub l Washer $9.80 0 Landscape Irrigatlon $0.00 0 P-Trap $0.00 2 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 1 Receptors $0.00 0 SepticTank .$0.00 1 Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 �TY 1 0 0 0 0 0 0 0 0 SumpPump Swimming Pool ' Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.40 $9.80 $0.00 QTY 0 0 0 0 0 0 3 1 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void ii work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaawe�r�oo) WORKERS' COMPENSATION DECLARATION: I hereby aHirtn untler penalry ot perjury ona of the following tlecleretions: • ❑ I heve end will maintain a cenifiwte of consent to selbinsure for workers' compensation, as pmvitled for by section 3700 of the Labor Code, for Ihe pertormence of the work for which Ihis permit is issued. ❑ I heve and will maintain workere' compensation Insurance, as requiretl by section 3700 of tha Lebor Code, for the pedormance ot ihe work for which this pertnil is Issued. My workers' compensation Insurance carner and policy number are: Carner: Policy Number: (This section need not be comp/eted il the permit is velued af one hondred dollars ($f 00J or less.) �I I cenify that in tha pedormance oi the work for which this pertnit is issueq I shall not employ any person in any manner so as to become subject to Ihe workers' compensetion lews of Calitornia, and agree Ihat if I should 6ecome subject to Ihe workere' compensetion provisions of Section 3700 ot the Labor Coda, I shall forthwith comply with ihe visions. (� '(� Applican� Signe�ure:��An/�� V 1.nY R�I.YP�l� oa�a: �/aq /o y WARNINO: FAILURE TO SECURE WORKERS' COMP TION COVERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN� CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOq CADE, INTEFEST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLAHATION: I hereby eNirm that I am licensed under provisions ot Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Pmfessions Code, anC my license is in tull force and eMect. Lic. N �.�D ��i i5� Class a �. 3 GONrector's SigneWre: QM.� � oate: l-� % a-Cf 6 CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm ihat ihere is a consiruction lentlinq agency tor ihe peAormance of the work for which this pertnit is issued. (Sec. 3097, Civil Code). Lentler's Neme: Lenders Address: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby aNirm that under penelty of perjury ihat I am EXEMPT FROM 7ME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Codo: Any city or counry which requires a permit to constmct, altar, improve, demolish, or repair eny stmcture, pdor to its issuance, also requires ihe applicant for such permit b tila e signed statement that he or she is licensed pursuent to the provisions of ihe Contractors Llcense Law (Chapter 9(commencing with Section 7000) of Division 3 oi the Business antl Professions Code) or ihat he or she is exempt iherefrom and the basis for the alleqed exemption. Any violetion of Section 7031.5 by eny applicant for a pertnit sublacis the epplicent lo a civil penalry of not more than five huntlretl dollars ($500).): ❑ I, as owner oi ihe property, or my employees wi�h wages es Iheir sole compensation, WILL DO 7HE WORK, end the structure is not intendetl or oflered for sale (Sec. 7044, 8usiness and Protessions Cotle: The Contractors License Law does not apply to an owner oi properry who builds or improves ihareon, an0 who does such work himself or herself or Ihmugh his or her own employees, provided that such improvements are not Intended or ofteretl for sale. It, however, the building or improvement is sold within one year of completion, ihe owneo-builder will have Ihe burden ot proving ihat he or she did not build or improve for purpose of saleJ. ' ❑ I, as owner ot the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the proiect (Sec. 7044, BuSiness and Professions Code: 7he contwcbrs License Law does not apply to an owner of property who builds or improves thereon, end who wniracts tor such project with a contrecror(s) license pursuant to ihe Contractors License Laws.). ❑ I am e:empt under sec. Business and Professions Code for this reason: SignaNre: Date: Owner ID veritied by dnver's license. Yes ❑ No Driver's License No. Vetlficetlon of Ownership by (type of document, i.e. - propeny tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION: Expires: � I hereby certity that no eacavation tive (5) or more tee� in depih into which e person is required to tlescend, will be made in connection with work authonzad by Ihis permil, and ihat no building simcture, scalloltling, talsework, or demolition or dismantling ihereof, will be more ihen ihirty-six (3fi) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title B, Californie Adminisirative Cotle). ❑ As owner-builder, I will not employ enyone to tlo work which would require a pertnit from the Division of Indusinel Sefety, as noted ebove, unless such person has a permil to do such work imm Ihe division. Signature: Date: Division ol Indusirial Safery Permit Number: CERTIFlCA7E OF COMPLIANCE AND AUfHORIZATION OF ENTRV: I certity under penalry ot perjury ihat I have read this apDlication antl state that the Information given is corroct. I agree to comply with all state laws antl cily ordinances relating to 6uilding construction, end euthorize representatives of Ihe Ciry of Costa Mesa to enter upon the above-descnbed property tor inspection puryoses. I egree not to wcupy or allow wcupancy of any building euthorized by ihis permit until final inspection. Of Legal Owner(s) Date ,�-�,,,,- �\ la�l a�+ ithorized Aoolicent Date COOE t' INSPECTIONTYPE f�¢, � IN IAL 1616 Fixed System Final Fire Prevention 1266 Pool Spe Final 200 Finel Re-Root 201 Flnel BIaWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition CODE 1 INSPECTION TYPE 206 Final Mechanical 20B Finel Plumbing 210 Finel Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Finel Building/Occupancy OpTE INTITIRLS