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Home My WebLink About2441 ELDEN AVE - Building Permits (8)c (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber. Applicant: Address: 2441 ELDEN AV B BACKYARD 43928137 KARCHER, CATHERINE L 2441 ELDENAVE COSTA MESA, Cq UNIT B Owner: KARCHER, CATHERINE L Address 2441 ELDEN AVE COSTA MESA, CA UNIT B ConVactor: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+uniLs) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over t000a Motors l0 1hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits OWNER-BUILpER Phone: 949-548-8855 Zip 92627 Phone: 949-54&8855 Zip: 92627 Phone: Zip: License: 000000 Status: ISSUED Applied: 04/25/2005 Issued: 04/25/2005 ISSUED BY: � `f /�+�-/ SCOPE OF PERMIT ELECTRICAL PEkM1T FOR 3 NEW GFI OUTLETS & CONDUIT IN BACKYARD FOR NEW FOUNTAIN & BBQ. $23.50 $0.00 $0.00 $0.00 30.00 $0.00 $0.00 $3.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 50.00 50.00 Quantity 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEESUMMARY 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 50 kva/kw .................up to 100 kva/kw ..................over.100 kva(kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misc. Conductor Cirws ( gen or ride) Circus (mech ride or IighLs) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investiga6on Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $18.20 1 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 50.00 $0.00 50.00 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, 72-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or il 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 wRh all applicable codes, and all required Inapeetiona and tinal approval rYwst be obtained. Failure io oblain Inspections and t'�nal approval will resull in tne expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 zm�as �s�oo7 WORKERS' COMPENSATION DECLARATION: I heroby aRVm under penalty of perjury one of ihe following tleclaretions: ❑ I �ave end will maintain a cenificate of consent to self-Insure for workers' compensatlon, es provided tor 6y section 3700 of the Labor Code, for Ihe paAormance of the work tor which Ihis permit is issued. ❑ I have and will maintain workers' compensation insuranca, as requiretl by section 3700 of the Labo� Code, for t�e pertortnance of the work tor which this pertnit is issued. My workers' compensation Insurence carner and policy number ere: Carrior: nat be completed!l Ihe permit is valued at one hundred dollars (5100) or /ess.J Policy Number: Q'" I certiy that in ihe pedormance of the work for w�ich this permit is iuued, I shall not employ any person in eny manner so as to become subject to the workers' compensation lews of Calitomia, and egree ihat ii I should beco e subject to the workers' compensation provisions of Section 3700 of ihe Lebor Code, I shell f6rthwith comply with ihese i ons. ,[/ 'Appli�ant�5lgneture: � �I LQ.J�[o �eiC _ De(e: � /,� � /� �� WARNING: FAILURE TO SECURE WORKERS' COA4PENSATIqJ CO GE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVEP TO CRIMINPL PENALTIES ANO GVIL FINES UP TOIXJE HUNDRED TFIOUSAND DOLLAiiE ($100,000�, IN AODITION TO THE COST OF COMPENSATION, DPMAGES AS PROVIDED FOP IN SECTION 3)O6 OF THE L4BOR CODE, INTEREST, AND ATiORNE1"5 FEES. LICENSED CONTRAC70RS OECLARATION: I hereby eHirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Divislon 3 ot Ihe Business and Professions Code, end my Ilcense is in full force antl eNect. Lic. q Cless a Gontractors SignaWre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aNirtn Ihat there is a construction lending agency for ihe pedormance of ihe work for which this pertnit is issued. (Sec. 3097, Civil Code). Lentler's Neme: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm ihat under penalry of pe�jury that I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions Code: Any city or counry which requires a permit to construct, alter, improve, demolish, or repair any sWcture, pnor to its issuance, also requires the applicant tor such pertnit to file a signed statement that he or sha Is Ilcensetl pursuent to ihe provisions of ihe Contractors License Lew (Chapter 9(commencing with Section 7000) of Dlvision 3 of ihe Business antl Professions Code) or thet he or she is exempt therafrom end the basis tor the alleged ezemption. Any violation oi Section 7031.5 by eny epplicant tor a permit subjecis the epplicant to a civil penalty ol not more than five hundred doilers ($500).): ❑ 1, as owner of Iha properry, or my employees with weges as their sole compensation, WILL DO TME WORK, and the sWcture is not intended or otteretl for sele (Sec. 7044, Business and Professions Code: The Conhactors License Lew 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 har own employees, provided iha� such improvemenis are not intentled or oHered tor sele. If, however, �he building or improvemeni is soltl within one year ot completion, the owner-builder will have the burden of proving that he or she ditl not build or improve for purpose of sale.). ' ,� 4,`+as owner of the property, am EXCWSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (SecJ044, Business and Professions Code: The contractors Licensa Lew tloes not apply to an owner ol property who builtls or improves thereon, end who contracis lor such pmject with a contractor(s) license pursuant lo the Coniractors License Laws.). lem Business Owner ID verifiad by driver'S1iCen5e. u'�s ❑ No Venfication ot Ownership by (type oi dwument, i.e. � pmperty ta< bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Protessions Code for�his reason: - -x - i.<,,,�,.,......r- C_:Eiiplres:- � - ❑ I hereby cenity �hat no excavation five (5) or more feat in depth into which e person is required to descend, will be made in connection with work authodzed by this permit, and that no building siructure, swHolding, falsework, or demolition or dismantiing ihareof, wili be more than thirty-siz (36) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Tule 8, Calilornia Adminis�retive Cotle). � ❑ As ownerbuilder, I will not employ enyone to do work which would require a permif from the Division of Industrial Safety, es noted above, unless such person has e permit to tlo such work from ihe division. Signature: Date: Division oi Industnal Safety Permit Number. CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I certify under penalry of peryury that I have read this application and state that the infortnetion given is correct I agrea to comply with all state laws and ciry ordinances rela�ing m �uiltling wnstmction, and euthonze representatives of iha Ciry of Costa Mesa to enter upon tha �eb escribed pmperty for inspec'on p s I agree not to occupy�qr ellow occupancy ot eny building authorized by thif-pe��untilS nal inspection. � l/�i A� �=. _ . IL`t / �BiS J 7 �� L' SignatGre L"e al Ownar s) `Data--�= ` Antl/Or Authorized Appiicanl Date COOE t. INSPECTIONTYPE 1616 Fized System Final Fire Prevention 1266 Pool Spa Final 200 Finel Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 204 Finel Sign Final Demolition DATE �NTRIALS CODE� INSPECTIONttPE 206 Final Mechanlcal 208 Final Plumbing 210 Final Etecirical 212 Final Fire Pravention 220 FinalPlanning Approval 222 Final Site 250 Final Building/Occupancy Q9If. INTRIALS . 4 (774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Add�ess: 2441 ELDEN AV Suite No B Vicinity: UNIT B- REAR YARD Parcel Nunmber: 43928137 Applicant: KARCHER, CATHERINE L Address: 2441 ELDEN AVE COSTA MESA, CA Phone: 949-548-8855 UNIT B Zip: 92627 Owner: KARCHER, CATHERINE L Address 2441 ELDEN AVE COSTA MESA, CA UNIT B Contractor: OWNER-BU ILDER Address: Phane: 949-546-8855 Zip: 92627 Phone: Zip: License: 000000 SCOPE OF PERMIT INSTALL NEW GAS LINE IN BACKYARD FOR FUTURE BBQ. ISSUE FEE Backflow irrigation BackFlow Preventer Bathtub Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher Draiq Floor Drain, Rainwater Drain, RoOf Dnnking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT szsso $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $o.00 $0.00 $0.00 50.00 50.00 $0.00 30.00 56.15 50.00 50.00 50.00 $0.00 50.00 QTY FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landsrape Irrigation $0.00 P-Trap � $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower 50.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor 50.00 Sink, kilchen $0.00 Sink, service/mop 50.00 Spa (pnvate) 50.00 Spa (public) $0.00 Status: ISSUED Applied: 04/14/2005 Issued: 04/14/2005 ISSUED BY: /� "-' QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum 8rkr BkFlow(1-4) Vacuum Brkr BkFlow(5+) Wash 8asin Wash Basin Set Waste and Vent Syslem Water Closet (Toileq Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT so.-oo $0.00 $0.00 $0.00 $0.00 $0.00 so.00 So.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: 529.65 QTY 0 0 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 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 periotl of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered le9al, such work must comply with all applicable codes, and all required Inspectiona and tinal approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244646(H00) WORKERS'COMPENSAnONDECLARAnON: � I hereby eHiR� under penelty of pery'ury one of ihe tollowing declaratlons: ❑ I heve end will meintein e certificete of cnnsent to sel4lnsure for workers' crompen5elion, as provitled br by seMion 3700 of the Labor Catle, for [he pedortnance ol Ihe woAc tor which this permit is issued. ❑ I have and will meintain vrorkers' compensation insurance, as required by sectlon 3700 ot Iha LeDor Code, for the perlortnance ot the work for which this pertnit is issueC. My workars' mmpensetlon Insurence carrier en0 pollcy number ere: � Cartier: Policy Number: (Riis s�cfbn �eed no( be crompleted if the permit is valuetl at ane hundretl tlallers (S /00) or less.) (y 7¢Tertily that in the pertortnance af the work for which this permit i issued, I shell not employ eny person in any manner so as �o become subject to the woMnrs' compensa�ion laws Celitomia, end egree ihet I� I should ec e sub�ed �o Ihe worker9' compensatlon prwisions of Sec�i n 3700 of Ihe Lebor Code, I shell forthwlih compl'y! with ihe r sians. '/ �/ � / � Ap,pl�cantSµ�neture: �,��(�f � rDete��Y � � WARNING�. FAILURE TO SECURE WORKERS' COMPENSATION VERAOE IS UNLAWFI/L AND SNALL SU&IECT AN EMGCOYER��OCRMAINAL PENALTIES ANDCIVIL FlNES UP TOONE HUNDRED THOUSAND D�RE (a100,000�, IN ADDITIIXJ TO TME C�T OF �AIPENSATION, OAMAGES AS PROVIDED FOR IN SECiION 3)O6 OF THE LABpR CODE, IMEREST, M'D ATTORNEI^$ FEES. LICENSED CONTRACTORS DEC4ARAT10N: I hereby attirm that I em licensetl under provisions of Chap�er 9(commencing wilh Sectlon 7000) ol Division 3 0l the Business and Professions Code, and my license is in full torce ana ettect. lic. a CIe55 k . Contractor's Signature: Dnta: CONS7RUCTON LENDING AGENCV: ❑ I hereby attirtn Ihal lhere is a Construction lending agency for Iha peAormance ol Ihe work for w�ich Ihis permit is issuetl. (Sec. 3097, Civil Coda). Lentler's Nart�e: Lentler's Address: I, Signature: Date: OWNER-BU��DER DECLARATONS: I hereCy ettirm Ihat under penalry of perjury Ihat I am EXEMPT FqOM THE CONTRACTORS LICENSE LAW for tha following reason (SecJ031.5, Business and Professions Cotle: Any ciy or crounty which requires e permit to wnstruct, alter, improve, Aemolish, or ropeir any slmcNre. Drior to its issuance, also requires t�e applicant lor such permit �o file a signdtl stetement ihat he or she Is Ilcensed pursuani ta iha provlsions ol ihe Comrecbrs Llcense Lew (CheD�er 9(commencing with Section 7000) ot Dlvislon 3 of fhe Business and Professions Cotle) or ihet he or she is exempt Iherelrom an0 the besis lor the ellegetl exemption. Any vidation o1 Section 7031.5 by any ap0licant for a permit suhjects the epplicant to e civil penalry ol not more then tive �undred tlollars (5500).): �I, es owner ol Ihe pmperty, or my amployees with weges es lheir sole wmpensetion, WILL DO 7HE WORK, and Ihe structure is not imerWeC or oRered for sale (Sec. 7044, 6usiness ena Pmfessions Code: The Contractors License Law tloes not epply to an ownor of properry who builtls or improves ihereon, and who does such work himseli or herseN or through his or her own employees, provitletl t�et such improvemenis ere not intentletl or offeretl for sale. If, however, t�e builtling or improvement is sold wiihin ona yaer of completion, ihe�owner-builtler will heve iho 6ortlen ol proving ihai he or s�o dld not build or Improve for purpose ot sale.). �I, es owner of Ihe Droperty, em EXC WSIVELY CONTRACTING WITM LICENSEO CONTRACTORS to constmct the project (Sec. 7044, Business antl Prolessions =C�e: The contreclors'License Lew tloes not apply to,en owner of property who bulltls or Impmves Ihereon, antl who contracts �or such project with a contractor(s) license p�qsuem to tha Coniracbrs License Lay's.).,' , ❑ I em e t untl c�--� Business end Prolessions Code lor this reason: 6Iigneture; '� = Verification d Ownership by (rype of documeni, i.e. - pmperry tan �ill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby �ertify ihet no excavation five (5) or mora feet in dept� into which e person Is requiretl to descen4 will be matle in connection with work authorizetl by Ihis permit, entl that no Duilding swcture, scaffolding, talsework, or tlemolition or disman�ling thereot, will 6e more than �hirty-siz (36) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Tlle B, Calitomia Adminisiretiva Code). ❑ As owner-builtler, I will not employ anyone to do work which woultl require a permil irom the Division of Industrial Safery, es noted abrne, unless such person has a pertnit lo do such work from t�e tlivision. Signature: Date: Division of Intlusirial Sefery Pertnit Number. CERTIFICATE OF COMPUIWCE AN� NJiMORVATI�N �F EN7RY: I conify undor pnnalty ot perjury lhat I have read this application and stata t�al lha iofo�mation given is correc agrBe to comply with all stete laws entl cit ortlinances retating lo building conslmc�lon, end authoriza represen�atives of ihe Ciry of Cosla Mesa to emer upon the abo d critled propeAy br inspectio ur se gree not to occupy o� ellow xcupancy of eny building au�hor¢�ep b Ihis pe/rmit until finel inspeclion. _ .L�.�'1L�t Q�.c�../ .(�_J i` �/`f/ DS- Slgnetu a Of LepaLOviner(s) �,pate._,_;,�� .. AndiOr Authorized AOPlicent Date CppE I. ix�oeLTONTYPE 1616 FixeA System Final Fire Prevention 1266 Pool Spe Final 200 Flnal RB-Rool 201 Finel BIxWReteining Wall 202 Final Fectory Fire Place 203 Finel Sign 20a Final Demolition DATE INilI1dW` Se4QE2 1115PECTIONTYPE 206 Final Mechanical 20B Finel Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Sile 250 Finel Building/Occupancy �Z� � (714) 754-5273 • Fan (714) 754-4856 • v+ww.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT �ob nddress: 2441 ELDEN AV Suite: B Vicinity: Parcel Number: 43928137 Applicant: EDGARDO J. GELSANO Address: 20351 IRVINE AV SUITE iC SANTA ANA, CA � Zoning: Phone: 714-641-1505 Zip: 92707 Owner: DECCINCES, DOUGLAS AND KRISTI Address 12 STRAWBERRY FARMS ROAD IRVINE, CA Contractor: OW N ER-B U I LDE R Address: Zip: Arch : Address: Phone: Phone: 949.417.4280 Zip: 92612 Phone: License: 000000 Eng: Address: Status: ISSUED Applied: 12/04/2003 Issued: 04/2Z2004 ISSUED BY: � �/ ' / /� '��I ////� Lr' �/ Phone: Zip: License: -License: SCOPE OF PERMIT LOT2 UNIT B PLAN 1B ' NEW 2,273 S.F. S.F.D. WITH 433 S.F. ATSACHED GARAGE. WORK TO INCLUDE: 1 ST STORY (1,031 S.F.) AND 2ND STORY (1,242 S.F.), 3 BEDROOMS AND 3 BATHS. ALSO INCLUDES 101SF FRONT PORCH AND 68SF DECK. REF.: 603-02094/2096/2098 AND G03-00021, PA-03-O8, PM-03-243 Plan Check: $1,097.30 Permit: $1,688.15 SMIP Res: $22.33 SMIP Com: $0.00 Other. $0.00 Inspection: $0.00 Total: $2,80778 SETBACKS ' MAIN STRUCTURE Front 33- 0 ACCESSORY Front 0-0 PARKING Ezistinq: c Rear 20- 0 Rear 0- 0 Reauired: 4 FEE SUMMARY PLANNING & ZONING Left 5- 0 Left 0- 0 Proposed: 4 Calc Valuation: Claim Valuation: Right 2& 0 Right 0- 0 $223,339.38 $o.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremen(s under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) ,; � ,. EXPIRA710N: This permit shali automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned tor 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 inspeetlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. i FOR INSPECTIONS CALL: (714) 7545626 ±aati-ao �auu� WORKERS' COMPENSATION DECLARATION: . � • + � I hereby aMirm under penelty of perjury one ot the tollowing tleclaratlons: . ❑ I have end will maintain a certificete of consenf to sell-Insure br workers' compensation, as provitled for hy section 3700 ot the Labor Code, for the pedormance of Ihe work for w�ic� this pertnit is issuetl. ❑ I hava and will maintain workers' compensation insurence, as required by section 3700 oi the Labor Code, lor the pertortnance of the work for whic� this permit is issuetl. My workers' compansation Insurence carnar and policy number ere: � Carner: Policy Number: (This section need nol be completed il Me permit is velued et one hundred dollars ($100) or less.) ' � ❑ I cenify that in ihe peAormance of ihe work for which �his pertnit is Issued, I shall not employ any person in any manner so as to become subject to ihe workers' compensation laws of Calitomia, end agree that if I should become subject to the workers' compansation provisions of Saction 3700 ot the Labor Code, I shall forthwith comply with these pmvisians. - Applicant SignaWre: Dete: WARNINO: FAIWRE TO SECURE WORKERS' CQNPENSATION COVERAGE IS UNLAWFUL AND SFULL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNORED THOUSPND OOLLAPE (5100,000), IN ADDRIIXJ TO THE COST OF CAMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECTION 31W OF THE LABOP COOE, IMEREST, AND ATTOFNEY'S FEES. IICENSED CON7RAC70RS DECLARATION: I herehy aHirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) oi Division 3 of ihe Business antl Professions Code, enC my license is In full force and eNecL Lic. tt Class q Contrecror s Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ 1 hereby aHirtn that there is a construction lending agency for Ihe pedormance of the work for which Ihis permit is issued. (Sec. 3097, Civil Code). �� Lentler's Neme: Lenders Address: Signe�ure: Dale: OWNER-BUILDER DECLARATIONS: I hereby ettirtn that under penelry of perjury lhal I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business end Professions Cotle: Any ciry or county which requires a permit to consiruct, alter, improve, demolish, or repair any stmcture, prior to its issuance, also requires the epplicant for such permit to file a signed stetement thet he or she Is licensetl pursuant to ihe provisions of ihe Contractors Licensa Law (Chepter 9(commencing with Sectlon 7000) oi Division 3 of ihe Business entl Professions Coda) or that he or she is exempt therefrom and the basis for the allegetl ezemption. Any viotation ot Section 7031.5 by any applicent for a permit subjects the epplicant to a civil penalty of not more then five hundred dollars ($500).): ❑ I, as ownar of ihe properry, or my employeas with wages as their sole compensation, WILL DO THE WORK, and Ihe siructure Is not intende0 or offered for sele (Sec. 7044, Business and ProFessions Code: Tha Contractors License Law does not apply to an owner of properry who builds or improves thereon, and who does such work himseN or hereelf or ihrough his or her own employees, providetl ihat such improvemenis are not intended or oHered for sale. If, however, ihe building or improvement is sold within one year of completion, ihe owner-builder will heve ihe burden of proving Ihat he or she did not build or improve for purpose ot sela.). � I;�as owner of the properry, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business antl Protessions '/Code: The coMrectors License Law does not epply to an owner oi property who builds or improves ihereon, and who contracts for such prolect with a comractor(s) ' license Dursuant to tha Contraaors License Laws.). ❑ I am exempt untler sec. Business and Protessions Code for ihis reason: Sign tua re: � D�te:� Z Own ler D verified by drivefs lice e. �- Ye� ❑ No o��ars uvsa r, " �P�� : Venficatlon of Ownership by (rype ot tlaument, i.e � property tax bill or deed): DIVISION OF INDUS7RIAL SAFETV PERMI7 CER7IFICATION: ❑ 1 hereby certiy that no exwvation five (5) or more feet in depih into which a person is requiretl to descentl, will be made in connection with work authonzad by this permit, and ihat no building simdure, scaHolding, talsework, or tlemolition or tlismantling thereot, will he more than thirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomia Atlminisirative Code). ❑ As owner-builder, I wili not employ enyone to do work which would require a permit irom �he Division of Industrial Safety, as noted above, unless such person has e permit to do such work from ihe tlivision. SignaWre: Date: Division ot Industrial Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZA110N OF EMRY: I certify under penalry oi perjury that I have read this application and state ihat the information given is correct I egree to comply wlih all state laws and ciry ordinances relating to builtling construction, and authonze representatives ot the Ciry of Cos�a Mesa to enter upon Ihe above-described property for inspection puryoses. I agree nol to occupy or allow occupency ot any building authorized hy Ihis permit until final inspection. COUE �, INSPECTION TYPE 7616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Finel Re-Roof 201 Final Block/Fi ining Wall 202 Final Factory Fir Place 203 Finai Sign 204 Final Demolition Q� �NTRIALS LOUE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Final Fira Prevention 220 Final Planning Approval 222 Final Site � 250 Final Building/Occupancy p�r Nrm � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us n ra,in urtrvt, w� i N mesn, cN azozo BUILDING PERMIT Job Address: 2441 ELDEN AV Suile: � Vicinity: Parcel Number: 43928137 npp�icant DECINCES,IM Address: 12 STRAWBERRY FARMS ROAD StaWs: APPLIED Applied: 03/02/2004 Issued: Zoning: / ISSUED BY: Phone: 949.417.4280 IRVINE, CA Zip: 92612 Owner: DECINCES, DOUGIAS 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: Phone: Zip: License: License: SCOPE OF PERMIT DEMOLISH FRONT HOUSE. COMPLY WITH APPROVED BMP. FEES WERE CHARGED TO B04-00474. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Ezistin : o NOTES: 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 so.00 so.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectlons and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 244666�N00) WORKERS' COMPENSATION DECLARATION: I hereby aHirtn untler penalty ol perjury one of the following tleclera�ions: ❑ I have antl will maintain e certificate ot consent to self-Insure br worker5' compensatlon, as pmvided for by section 3700 of the Labor Code, for Ihe peAormance of Ihe work for which this pertnit is issuetl. ❑ I heva antl will maintain woAcers' compensation insurance, as required by secGon 3700 of ihe Lebor Code, for the pertormance of the work tor which thls pertnit Is Issued. My workers' compensatlon Insurence carner antl palicy num6er ere: Carrior: Policy Number: (This secfion need nat be campletetl i/ Ihe pertnit is valued et one hunUred dollars ($100J or less.) ❑ I certify that in the peAormence of the work for which ihis permit is issueQ I shall not employ any pereon in eny manner so as to become suhject to the workers' compensallon lews of Callfomia, end egree ihat If I should become subiect to Ihe workers' compensation pmvislons of Section 3700 of Ihe Lebor Code, I shall fotlhwith tomply with these provisions. Applicent Signature: Date: WARNING: FAILURE TO SEWRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SW1LL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED TMOUSAND DOLLARE (5100.000�, IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDED fOR IN SECTION 3]OB OF TNE LABOH CODE, IMEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereDy eNirm that I am licensed under provisions ot Chepter 9(cammencing with Section 7000) ot Division 3 of Ne Business and Protessions Code, and my license is in full force and eflecL Lic. N Cless q Contracrors SignaWre: Date: CONSTRUCTON LENDING AGENCY: �' ❑ I hereby aNirtn that there is e cons�ruction lendinp eqency lor fhe pertortnance ol iha work for which ihis permil is issued. (Sec. 3097, Civil Cotle). Lentler'S Name: Lentler'S Atltlr855: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirm t�et untler penalty of perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Protessions Cotle: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuence, also requires the applicant tor such permit to Ole e signed statement that he or she Is licensea pureuant to the provisions of the Conirectors License Lew (Chaptar 9(commencinq with Section 7000) ot Division 3 0l t�e Businoss end Professions Code) or that he or she is eaempt t�eretrom antl the basis tor the elleged e:emption. Any violetion of Section 7031.5 by eny epplicant for e pertnit subJects the epplicenf to a civil penalry ot not more than flve hundred dollars ($500).): ❑ I, es owner oi tha property, or my employees with we9e5 as �heir sole compensation, WILL DO THE WORK, antl Ihe strudure is not IntenEed or oMered for sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law does not apply to an owner ot properry who builds or improves ihereon, antl who does such work imselt or hersetl or ihrough his or her own employees, provided that such improvemenis are not Intentletl or oHerea for sela. If, however, the bulltling or improvement is old within one year oi completioq the owner-Duilder will have ihe burden of proving that he or she did not huild or improve tor purpose oi sale.). � I, es owner oi ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The camractors License Law tloes not apply to en owner ot propeny w�o bullds or impmves thareon, end who comrects for such project with e contractor(s) license pursuan� to ihe Con�raCtors License Laws.). Business and Professions Code tor �his reason: ID veritiatl by tlriveYs license. �-Yes ❑ No D�veYs Licellfe No. ' '�1 Eapires: Venfication ot Ownership by (type of tlocument, i.e. � property taz blll or deedJ: DIVISION OF INDUSTFiIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify i�at no ezravation five (5) or more feet in tlepth into which a person Is required ro descend, will be made in connection with work authorized by this permi�, end �hat no building S�mcWre, scaHolding, 1915ework, or demolition or dismen�ling �hereof, will be more �han �hitly-six (36) leet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title e, Califomie Atlministrative Code). ❑ As owner-builder, I will not employ enyone m do work which would require e pertnit from the Division ot Intlusirial Sefery, as notetl ebove, unless such person hes a permit to do such work imm the division. Signeture: �ate: Division ot Industnal Satery Pertnit Number: CEHTFICA7E OF COMPLIANCE AND AUTHORIZATION OF ENTAY: I certify under penalry of perjury that I have read Ihis flpplication end state ihat Ihe informa�ion given is correct. I egree �o comply wilh ell state laws and city ordinances relating to building consiruction, end euthorize represematives of Ihe City of Costa Mesa to enter upon iha ebove-descnbetl property tor inspection puryoses. I egree not to aapy or allow occupancy of any building authonzed by this permit until finel inspection. [�7�7�'�Ii69]i�iil.li�NYi t61fi 1266 200 Fixed System Final Fire PrevenGon Pool Spa Flnal Final Re-Roof 207 Final BIocWRetaining W ell Qd¢, IMffIALS 202 Final Factory Fire Place 203 Final Sign �,_ —/y��/—� 204 Final Demoliiion � _j,(L �%�_�' ��ate_� COOE� INSVECTIONTYVE 206 Final Mechanical 20B Final PlumDing 210 Finel Electricel 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuilCing�Occupanry � � (714) 754•5273 • Fa�c (714) 754-4856 • www.Ci.Costa-mesa.Ca.US 77 FAIR DRIVE, COSTA MESA, GA 92626 lob Address: 2441 ELDEN AV Suite No B Vicinity: Parcel Nunmber: 43928137 Applicant DECINCES,IM Address: 12 STRAWBERRY FARMS ROAD IRVINE, CA PLUMBING PERMIT Phone: 949.417.4280 Zip: 92612 Owner: DECINCES, DOUGLAS AND KRISTI Address 12 STRAWBERRY FARMS ROAD IRVINE, CA Contractor. Address: Arch / Eng : Address: ISSUE FEE BackFlow irrigation Backflow Preventer Bathtub Clarifer System Connect pce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank REF 804-00474. SEWER CAP. AMT $23.50 50.00 50.00 50.00 50.00 50.00 $0.00 S0.00 50.00 $0.00 $0.00 $0.00 $0.00 QTY Phone: 949.417.4280 Zip: 92612 Phone: Zip: License: Phone: Zip: License: SCOPE OF PERMIT FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors 50.00 Septic Tank $0.00 Sewer Cap for Demo 59.80 Sewer Connect $0.00 Sewer Private Line $0.00 Shower 50.00 Sink, bar 50.00 Sink, commercial $0.00 QTY 0 0 0 0 0 0 0 1 0 0 0 0 0 Status: ISSUED Appl ied: 03/02/2004 I ssued: 03/02/2004 ISSUED BY: SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (foilet) Water Heater/ vent Water Piping (Inst or Rep.) Water Re-pipe AMT $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $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 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 tlays, 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 Inapectlona and final approval must be oblained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 266fi-46IN00) WORKERS' COMPENSATION DECLARA710N: I hereby aflirm under penalry of perjury one of ihe following declarations: - ❑ 1 heve end will maimein e certificate of consent to self-Insure tor workers' compensation, as pmvided tor by section 3700 of the Labor Code, for ihe peAormanca ot ihe work for which this permil is issued. ❑ I have an0 will maintain workere' compensation insurance, as requiretl by section 3700 of ihe Labor Code, tor Ihe pertortnance of ihe work forwhich Ihis pertnit is Issued. My workers' compensation Insuranw carder end policy number are: Carrier: Policy Number: (This secfion need not be completed il fhe permit is valuetl ef one hundred dollaro ($100) or less.) ❑ I certity that in Ihe per(ormance of ihe work for which this pertnit is issueQ I shell not employ any Derson in any manner so es to become sublect to ihe workers' compensation laws oi Celifornia, and agree ihat If I should become subject to ihe workers' compensa�ion provisions oi Section 3700 of the Labor Code, I shell forthwith comply with these provisions. Applicant Signature: Date: WARNING'. FAILURE TO SECURE WORKERS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND qVIL FINES UP TO ONE HUND(iED THOUSAND DOLLARE ($100,000�, IN AODITION TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CA�E, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirm ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Oivislon 3 of Ihe Business and Professions Code, and my license is in tull ��, force and eflect Lic. a Class # � Contractor's SignaNre: Date: i CONSTRUCTION LENOING AGENCY: I❑ I hereby attirm that there is a construction lentling agency tor the pedormance of ihe work for which this pertnit is issued. (Sec. 3097, Civil Code). '� i Lender'S Name: Lendefs Adtlress: lil '�` SlgnaNre: Date: OWNER-BUILDER DECLARATIONS: I heroby ettirm ihat untler penalty of perjury that I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions Cotle: Any ciry or coun�y which requires a permi� to consWci, alter, improve, tlemolish, or repair any sirucNre, prior to its issuance, also requires the applicant for such permit to ille a signetl statemaN thet he or she is license� pursuant to the provisions of the Contractors License Lew (Chapter 9(commencing with Sedion 7000) of Division 3 of lhe Business and Protessions Code) or ihat he or she is exempt theretrom and the basis for the alleged axemption. Any violation of Section 7031.5 by any epplicent for a pertnit sublecis ihe applicant to e civil penalry of not more ihen five hundred dollars ($500).): ❑ I, as owner of Ihe properry, or my employees with weges as iheir sole compensation, WILL DO THE WORK, and the strucWre is not intentletl or oHered for sale (Sec. 7044, Business antl Professions Code: The Contractors License Law tloes not apply to an owner of property who builds or improves theraon, and who tloes such work himself or herself or ihrough his or her own amployees, provided that such improvements ere not imended or ottered for sale. tl, however, �he building or improvement is d wi�hin one year of completion, ihe owner-builder wi�l have ihe burden of proving ihat he or she did not builtl or improve for purpose of sale.). as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business entl Professions Cotle: The comractors License Law does not apply to an owner oi propeny who builds or impmves ihereon, and who coniracis for such project with e contracbr(s) license pursuant to lhe Contractors Licensa Laws.). ❑ I em e mpt u ec. Business antl Professions Code for ihis reeson: re: ate: Z- 6 verifie by dnver's license. � ❑ No er's ' nse No. � Lqp es: _ Y-Z�i -� "� Veritication of Ownership 6y (type oi document, i.e. - proparty tart 6ill or tleed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity that no excavation five (5) or more feet in tlepth into which e person is required to descend, will be made in connection with work euthonzed by this pertnit, antl that no huilding sWcture, scaHolding, talsework, or demolition or tlismantling Ihereof, will be more ihan ihirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, T�le e, Calitomia Atlminisirative Cade). ❑ As owner-builtler, I will not employ anyone to tlo work which woultl require a permit irom the Division oi Industnal Safety, as noted a6ove, unleu such person has a permit to do such work from the division. Signature: Date: Division ot Indusirial Sefety Permit Number: CER7IFlCATE OF COMPLIANCE AN� AllT}IORVA710N OF ENTHY: I certity untler penalry of perjury that I have reatl this application and sWte that t�e information given is correcL 1 agree to comply with ell state laws antl ciry ortlinances rela�ing to buil�ing consWction, and authodze representatives of the Ciry M Costa Mesa to enter upon ihe ebove-described property for inspection purposes. I egree noi to occupy or ellow wcupancy of any building authorized by Ihis permit unlil final inspection. COOE 1. INSYECTIONTYPE 1616 1266 200 201 202 203 Fixetl System Final Fire Prevention Pool Spa Finel Finel Re-Rooi Final BIocWRetaining W ell Final Factory Fire Place Final Sign 204 Final Demolition .1 R: � �/Z/o � Date �� `—p 9 CODE� INSPECTIONTYPE 206 Finel Mechanical 20B Finel Plumbing 210 Final Electrical 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildincyOccupancy Q�, ItlllfUlS 26• � Job Address: Suite No Vicinily: 2441 ELDEN AV B Parcel Number: 43928137 Applicant: DECINCES,TIM Address: 12 STRAWBERRY FARMS ROAD IRVINE, CA MECHANICAL PERMIT Phone: 949.477.4280 Zip: 92612 Owner: DECINCES, DOUGLAS AND KRISTI Address: 12 STRAWBERRY FARMS ROAD IRVINE, CA Contractor: OWNER-BUILDER Address: Phone: 949.417.4280 Zip: 92612 Phone: Zip: License: 000000 Status: ISSUED Applied: OB/23/2004 Issued: 08/23/2004 ISSUED BY: SCOPE OF PERMIT MECHANICAL TO INCLUDE: 1 INST FAU < 100K BTU, 1 REPAIR/ALT COOLING/HEAT, 1 FACTORY FIREPLACE, 1 HOOD W/MECH EXHAUST AND 3 VENT FANS. UNIT B REF.: B03-02097 k ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall HV Refng Sys <100 k BTU Re6ig,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 AirHandlers> 10000cfm Floor Fumace Floor or Suspend Heater Quantity $23.50 $14.80 1 $0.00 0 $13.70 1 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $10.65 1 $10.65 1 $0.00 0 $21.75 3 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 � FEESUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporetive Cooler Comme rcial I nci n erator Domestic Incineretor Compressors / Absorption Svstems Up to 3 hp / 100 k BTU 3To15hp/500kBTU 15 To 30 hp-G1,000 k BTU 30 To 50 hp % 1,750�k BTU , Over 50 hp! Over 1,750 BTU Boilers � Upto3hp , 3 To 15 hp , - �. ` 15to30hp � � � . 30 to 50 hp Over 50 hp Other Mechanical Fee " � Investigation Fee � Plan Check Fee Reinspection Fee � - . � Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 �, � $0.00 0 $0.00 0 ' $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES $95.05 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 7, 1241-92) EXPIRATION: This permit shall automatically ezpire and become void it 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 inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permiC� FOR INSPECTION5 CALL: (714) 7545626 244&48 (6/00) WORKERS'COMPENSAnON DECLARAnON: I heroby atlirm under penalry of perjury one ot the tollowing declaretions: ❑ I have end will meintain e certlficete of consent to self-Insure tor workers' compensation, es provided tor by sectlon 3700 of Ihe Labor Code, Por iha pertortnence of the work tar which this permit Is Issued. ❑ I have and wlll maintain workers' compensation insurence, as requiretl by section 3700 of t�e Lebor Code, tor the peAortnance oi the woAc lor whlc� Nis pertnit is issued. My workers' compensation Insurance wrrier enO policy number are: Cartior. - Poliq Number. (This section need nof be compleretl il lhe permit Is ve/ued ef one hundred dollars ($100) or less.) �I certify Ihet in the pertortnance ol the work for whic� this permil is issued, I shell not employ eny person in eny menner so as to becrome sub�ect to tha workere' compensetlon laws of Calitamie, enA egree thet II I should become sub�ect to the workers' compensatlon provislons ot Section 3700 of the Lebor Code, I shall forihwith comD�Y w��h these provisi�on�s. � /J � Applicant SlgnaNre: �� r�//.el-,�-� Date: � 2�- o�-j WFRNINO: FARURE TO SECURE WOFUCERS' COM TIIXJ COVERAGE IS UNLaWFUL AND SHP115UBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED TIKKISAND DOLLARE (510D,OOO�.IN ADDIiION TO THE COST OF COMPENSATION, DAMAGES AS PRONDED WF IN SEGTON 3lOe OF THE IABOR COOE, IMEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I am licensetl under provisions of Chapter 9(commencing wilh Section 7000) ol Divislon 3 oi ihe Business antl Professlons Cotle, end my Ilcense is in full force and eHecL LJc. A Cless a Gontractofs SigneWre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm thet ihere is a construction lending agency for the perfortnance oi the work for which this permit is issued. (Sec. 3097, Civil Cade). Lendor's Neme: Lendefs Address: I Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirtn thet under penelry of perlury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Protessions Code: Any city or counry which requires e permit to constmct, elter, improve, demolish, or repair eny strucWre, pnor to its issuance, elso requlres the ap0�icant tor such pertnit b 81e a slgneE statement that he or she Is Ilcensatl pursuent m Ihe proNsions oi ihe COMrectors License Law (Chepter 9(commencing wlih Section 7000) ol Division 3 of the Business entl Professions Code) or thet he or she Is exempt tharefrom antl the Gesis for ihe elleged exemption. Any vlolation of Section 7031.5 by any a00�icant for a pertnit sublecis Ihe epplicant ta e civil penalry af not more then tive hundred tlollars ($500).): ❑ I, es owner ol the property, or my employees with weqes es �heir sole compensatlon, WILL DO TME WORK, end tha structure Is not Intended or oHeretl for sele (Sec. 7044, Business end Professions Code: The Contraciors License Law does not apply to en owner of property who builds or improves ihereon, end who tloes such work himseli or herself or through his or her own employees, provitled that such improvements era not Intentletl or oHered lor sala. It, however, Ihe building or improvement is �soltl within one year of completion, the owner-Guilder will have the hurtlen oi proving iha� ha or she did not buila or improve for purpose of sale.). I, as owner oi tha properry, am E%CLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to construd the prqect (Sec. 7044, Business and Professions otle: The wntractors License Lew does not epply to en owner ot pmpeny who builQs or Improves thereon, and w�o contracts for such pmJect with e contractor(s) license pursuant to ihe Coniractors License Wws.). ❑ I em e:empt unCer sec. Business and Professions Catla tor this reeson: SignaNre: � --r � Date: `%- 23- u�i Owner ID verllletl 6y tlnvefs license�� Ves ❑ No Dnvefs License No. �' $; Expires: �� - Zc -n 9 Vedfication ol Ownership 6y (rype oi daculpent; i.e. - property tex bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIf CERTIFICATION: ❑ I hereby certity that no excavation flve (5) or more feel In dapih into which e person is required to descend, will be made in connection with work euthonzed by ��is permit, and that no building stmcture, scaltolding, talsework, or demolition or tlismantling ihereot, will be more than thirty-six (36) leet high. (Chap. 32, Grp 2, An 2, Sec. 341, Tltle B, Celltomla Atlminisiretive Code). ❑ As owner-builder, I will not employ enyone to do work which would requira e permit trom the Division of Indusirial Satety, as notatl ebove, unless such person has e permit to tlo such work from the divislon. Signeture: Data: Division oi Intlusinal Safery Pertnit Number: CERTIFlCA7E OF COMPLIANCE AND AUfHORIZATON OF ENTAY: I certify under penalty ol perjury that I have read Ihis epplication end state that the intortnation given is correct. I agree to compty with all stete laws and city ordinances relating to building consiructlon, and euthorize reprasentatives of the Ciry ot Costa Mesa to enter upon the above-descnbed property for inspection purpases. I egree not to occuDY a� allow occupanty of eny building euthonzed by this pertnit until linel inspection. �� 9-?�-o y Si natu Legal Owneqs) Date And/OrAuthonzed Applicant GOpE I. INSPECTIONTYiE Qa[E INTRIALS 1616 Fixetl System Final Fire Prevemion 1268 Pool Spe Finel 200 Flnel Re-Root 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 FinalSign 204 Finel Demolilion CQOE 1 INSPECTION flPE 206 Final Mechanical 20B Final Plumbing 210 Final Electdcal 212 Final Fire Prevention 220 Flnal Planninq Apprwal 222 Final Site 250 FinalBuilding/Occupancy ^, `•� �rGi--�..�- (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2441 ELDEN AV Suite No B Vicinity: UNIT B 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 Clarifer System Connect Qce,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: 04/29/20 ISSUED BY: SCOPE OF PERMIT UNIT B NEW 2,273 S.F. S.F.D. WITH 433 S.F. ATTACHED GARAGE. 2 BATHTUBS, 1 ICE CONNECT, 1 DISHWASHER; 1 GAS OUTLET (1-4), 1 GAS OUTLET OVER 4, 1 GAS SERVICE, 1 LUANDRY TUB/WASHER, 3 SHOWERS, 1 KITCHEN SINK, 2 SERVICE/MOP SINKS, 3 WASH BASINS, 1� WASH BASIN SET, 3 WATER CLOSETS, 1 WATER HEATERNENT REF: B03-02097 AMT $23.50 $0.00 $0.00 $19.60 $0.00 $9.80 $0.00 $9.80 50.00 FEE SUMMARY QTY AMT LaundryTublWasher $9.80 0 Landscape Irrigatlon $0.00 0 P-Trap $0.00 2 Pressure Regulator $0.00 0 Process Piping (per �0 ft) $0.00 1 Receptors $0.00 0 Septic Tank $0.00 1 Sewer Cap tor Demo $0.00 0 Sewer Connect $0.00 QTY 1 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Pnmer Urinal Vacuum Brkr Bkflow(1-0) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Wasle and Vent System AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.40 $9.80 so.00 �TY 0 0 0 0 0 0 3 1 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all requiretl Inapeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446�4fi(6/00) WORKERS' COMPENSA710N DECLARATION: I hereby affirm under penalry of perjury one of ihe following declarations: ❑ I have end will malntain e certilicete ot consent to self-Insure for workers' compensation, es O�ovlded for by section 3700 of the Labor Code, for the performance of ihe work for which this pertnit is issuetl. ❑ I hava entl wlll malntain workers' compensation insurenca, as required by section 3700 ol the Lebor Code, for the peAortnance of the work for which this pertnit is issued. My workers' campensation Insurence ceMer end policy number are: Carrior: Policy Numbec (This section need nof be complefed 1! fhe permit is velued et ane hundretl tlallers ($f 00) or Iess.J �,!J I certity ihat in iha pedormance o1 ihe work for which Ihis pertnit is issuetl, I shall not employ eny person in any menner so as to become subject to the workers' compensetlon laws of CalHornle, antl eqree that If I should become sub�ect to Ihe workers' compensetlon pmdslons ol Section 3700 of the Labor Coda, I shell forthwith camply with ihese ovisions. Applicant Signature: ��4 �.a � P.u2�,� Dete: �"i /�'I /O �} WAqNING: FAILURE TO SECURE WORKERS' SATION COVERAGE IS UNLAWFUL AND SHFU. SUBIECT AN EMPLOVEP TO CRIMINAL PENALTIES AND pVIL FlNES UP TO ONE HUNORED THOUSAND Dq1ARE (5100,000), IN ADDITION TO THE COST OF WMPENSATION, OAMAGES AS PROVIDED FOR IN SECiION 3108 OF THE LABOR COOE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aMirtn that I am licensed under provislons ot Chapter 9(commentlng wlih Section 7000) ot Division 3 of the Business and Professions Code, anC my license is in tull mrce and enect. uc. a di� -�(e I'iS5 �{ Ciass a C- 3(O ConVactolsSlgnaiure: �JQ��`'t7iQ., 3, 2.�.rt.v�- Date: �-{ /9-9 O� CONSTRUCTION LENDING AGENCV: ❑ I hereby eflirm that ihere is a consiruction lending agency for ihe perlormance ot the work for which this pertnit is issued. (Sec. 3097, Civil Cotle). Lentler's Name: Lender5 Addre55: SignaNre: Date: OWNER-BUILOER DECLARATONS: I heraby ettirm Ihat under penelty of per�ury ihat I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business entl Professions Code: Any ciry or counly which reQuires e permii to consiruct, alter, improve, tlemolis�, or repair any structure, prior to Its issuance, also requires Ihe applicent for such permlt �o file e signeA stetement that he or s�e Is Iicensed pursuent to �he proNsions of Ihe Contrectore License Lew (Chapter 9(commencing with Sectlon 7000) at Divislon 3 ot the Business and Prolesslons Cotle) or Ihet he or she is exempt thereFrom and ihe basis lor the ellegetl ezemption. Any violetion of Section 7031.5 by any applicant tor e pertnit subiec�5 �he eppllten� �o e tivil penalty ol nol more lhan live hundred dollers (b500).): ❑ I, as owner of the propeny, or my employees with wages as their sole compensation, WILL DO THE WORK, and ihe siructure is not intended or oHerea for sele (Sec. 7044, Business and Professions Code: The Coniractors License Law does not ap01y to an ownar ot property who builds or improves Ihereon, and who Ooes such work himself or herself or ihrough his or her own employees, provitled that such improvements ere not Intanded or oHered for sale. If, however, ihe 6uiltling or improvement is sold within one yeer of completion, the owner�6uilder will have the burtlen o� proving ihet he or she ditl not build or improve for purpose of sale.). � ❑ I, as owner ol the property, em E%CLUSIVELV CONTRALTING WITH LICENSED CONTRACTORS to consirucl lhe project (Sec. 7044, Business end Protesslons Code: The contrectors License Lew does not epply to an owner ol propany who builds or Improves thereon, entl who coniracts for such project with e contrector(s) license pursuant to the Contrectors License Laws.). ❑ I am exempt unCer sec. _ Signature: Owner ID v8riliBd by drivers liCenSe. Venficetion ol Ownership by (rype of Bu5ine55 and Professions Code lor thi5 reason: Ves ❑ No i.e. - property tex bill or tleetl): DIVISION OF INDUSTAIAL SAFETV VERMR CERTIFICATION: DriveYs License No. �ate: Explres: ❑ I hereby cenity ihet no excavation five (5) or more feet in depih into which e person is required to descend, will be matle in wnnection with work authorized by Ihis pertnit, end that no building sirudure, scattolding, falsework, or demolilion or dismantling Ihereol, will be more Ihen thirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Celllornie Administralive Code). ❑ As owner-builder, 1 will not employ enyone to do work which would require e pertnit Irom the Dhnsion of Intlustnel Sefety, as natetl a6ove, unless such pereon hes e permit to tlo such work irom Ihe division. Signature: Date: Division of Intlustrial Setety Permit Numbar: CERTIFlCATE OF COMPLIANCE AND AUiHORIZATION OF ENTRV: I certity under penalry of perjury ihet I have read ihis epDlication and state ihat the Informatlon given is correct. I agree to comply with all stata laws end ciry ordinances relating to bullding conslrucilon, and eNhonze representatives of the City of Cos�a Mesa Io enter upon the ebove-descnbed property for insDectian purposes. I agree not to occupy or allow occupancy of any building authorized by this pertnit until final inspection. SODE I. INSFECTIONTYPE 1616 1268 200 207 202 Fixad System Final Fira Prevention Pool Spe Final Finel Re-Roof FInaI8locWRetelning Wall Final Factory Fire Place 203 Finel Sign 204 Finel Demolition PeIE IrmnA�4 � ��el �F a Date CODE1 INSVECTONTYFE 206 Finel Mechaniwl 20B Finel Plumbing 210 Final Elecincal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building�Occupancy D1TE U�dLi r �i2 ac5 � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmbec Applicant: Addr�ss: Owner: Address 2441 ELDEN AV B 43928137 DECINCES,TiM 12 STRAWBERRY FARMS ROAD IRVINE, CA ' ELECTRICAL PERMIT Status: ISSUED Applied: 08/23/2004 Issued: OB/23/2004 Phone: 949.417.4280 Zip: 92612 DECINCES, pOUGLAS AND KRISTI 12 STRAWBERRY FARMS ROAD IRVINE, CA Convactor: O W N ER-BU I LD ER Address: ISSUE FEE Temp service test Res. a/c paCkage New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a � - Service over t000a Motors to 1hp Motors to 10hp Motors to SOhp Motors l0 700hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Phone: 949.417.4280 Zip: 92612 Phone: Zip: License: 000000 SCOPE OF PERMIT ELECTRICAL TO INCLUDE: 2273 S.F. NEW S.F.D., 6 LIGHT FIXTURES, 4 OUTLETS AND 2 SWITCHES. REF.: 803-02097 UNIT 8 523.50 $0.00 $0.00 $12729 $0.00 $0.00 $6.60 $4.40 $2.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 2273 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 N00 R Standing Sectlon Misc Electrical Equipment �- Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to SO,kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Volfage Equipment Low VOIt Wiring System / Ckt Misc. Conduit - Misc. Conductor - . Circus ( gen or ride) Circus (mech ride or lighfs) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee . Plan Check Fee Reinspecfion Fee Quantity $0.00 0 $0.00 0 $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 $0.00 ' 0 $0.00 0 $0.00 0 ; 50.00= 0� $0.00 i 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 under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void il work is not commenced within 180 days, or iF work is suspended or abandoned for a penod 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, antl afl required Inspeetions end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSAnON DECLARAnON: I hereby ettirtn under penelry at perjury one of Ihe following declarations: ' � I have end will maintain e certificete of consent to selt-Insure for workers' compensatlon, es provided For by sedion 3700 of the Labor Cotle, for the peAormence of the woAc tor which Ihis pertnit is issued. ❑ I �ave antl wlll maintaln workers' compensetlon insurance, as requiratl by section 3700 of the LaDor Code, fw Ihe parfortnance oi Ne work for which this pertnit I5 Issued. My workers' compensation Insurance wrrier antl pollcy number are: Certier: Policy Number: (!h/s section need not be completed i! U�e permit is valued ef one hunered dWlars ($100) or less.) ��I certify t�a� In ihe peAormance ot the work for which ihis pertnit is issueq I s�all not employ eny person in eny menner so as to become subjact to t�e workars' compensetlon lews af Calllornie, entl egrae that if I should Eecoma sub�ect to Ihe workers' compensation provisions ot Sectlon 3700 at c�e Labor Cotle, I shell torthwith comply wlth these provisions. q ApplicantSignewre: ��7�� Date: 1 ��- (7� WFRNINO: FAILURE TO SECURE WORKERS' CUCBENSATION COVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMttOYER TO CRIMINAL PEWILTIES M1D CNIL FlNES UP TO dJE HUNDRED TIKKISAND DOLLARE (5100.000), IN ADDRIIXJ TO THE CQST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3108OF THE IABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby elfirm thet I am Ilcensed under Orovisions of Cheptar 9(commencing wit� Section 7000) ol Divislon 3 of the Business and Professlons Code, and my Ilcense is in tull force end eHecl. Lic. N Class q Contractofs Signeture: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby ettlrm thet Ihere is e conslruction lending agenty for the peAormance ol tha work br w�ich Ihis pertnit is issuetl. (Sec. 3097, Civil Cotle). Lentlefs Name: Lentlefs Adtlress: Signeture: Date: OWNER•BUILDER DECLARATIONS: I hereby aNirm thet under penalry of perjury Ihat I am EXEMP7 FROM 7HE CON7RACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Buslneu end Professions Code: Any ciy or counry which requires e pertnit to construct, alter, improve, tlemolish, or repalr any siructure, pnor to its iuuance, elso reQuires tha eppliwnt for such pertnit to Nle e signed stetement thet he or she Is Ilcensed pursuant to the pmvislons ot t�e Cantrectors LJcense Lew (Chepter 9(commendng with Sedlon 7000) oi Divlsion 3 of the Business and Prolesslons Code) or that he or she is e:emD� �herefrom end the basis for the allegetl e:emption. Any vialation of Section 7031.5 Cy any applicant for e pertnit subjects ihe applicant to e civil penalry of not more ihan five hundred dollars ($500).): ❑ I, es owner ot the pmperty, or my employees with wages as Iheir sole compensation, WILL OO 7HE WORK, antl the siructure Is not Intendetl or oHered br sale (Sec. 7044, Business end Professions Code: The Contractors License Law does not epply to en owner of properry who builtls or improves ihereon, antl who does such work himselt or herselt or through his or her own employees, provided thet such improvemenis ere not intended or oHered for sale. It, howaver, �he building or improvement is sold within one yeer oi completion, the owner-builder will heve tha burden ol proving that he or she did not build or improve for purpose of sale.). ' �' I, es owner of the property, am EXGLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business end Professions Code: The comrectors License Lew does not eppty to an ownar of propeny who builtls or Improves thereon, and who contracts for such pro�ect with a contrector(s) license pursuenl !o the Contractor5 License LawS.). ❑ I em exempt under sec. _ Signeture: � Owner ID vedfled by driver's licert. Verificetion ol Ownership by (type Business and Professions Code br �his reason: Date: ❑ No Drivefs License No. _. � Evpires: — - o properry tax blll or tleed): DIVISION OF INDUSTRIAL SAFETY PERh+IT CERTFICATION: ❑ I hereby caNfy ihat no excavetion five (5) or more faet in depih into which e person is requiretl to tlescend, will be made in connection wllh work euthorizetl by this pertni�, antl Ihat no building s�ruciure, scaHolding, talsework, or demolition or dismantling thereoC will be mora Ihen Ihirty-si: (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Callbmla Atlministrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require e pertnit from I�e Division oi Industnal Safery, as noteA e6ove, unless such person hes e permit to Oo such work from the division. Signature: Date: Division ot Industrial Safery Pertnit Number. CERTFlCATE OF COMPLIANCE AND AU7HORVATON OF ENTRY: I ceeify under penalty of perjury Ihat I have reatl Ihis epplication end s�ate that Ihe intormetion given is correct. I agree to comply with ell stete laws and ciry ordinences relating lo building wnstruction, end au�horize representaiives ot the Ciry of Cos�e Mesa to en�er upon ihe ebove-descnbed Oropert f� ection pu ses. I agree noi to occupy or ellow occupancy of eny 6uilding authonzed by lhis permqi�t until linel inspection. �� /`Z%—Uc.l Signeture egalOwner(s) Date AnNOr Authonzed Applicent Da�e 40pE �. IHSVECiIONTYPE PAIE L�AL$ 1616 Finetl System Final Fire PreveNion 1266 Pool Spa Finel 200 Final Re-Rool 201 FInaI BIocWReteining Well 202 Final Factory Fire Place 203 Finel Slgn 204 Finel Demolltion CODE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 270 Final Eledrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 FinalBuiiding/OcCupenCy Q�f. �