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Home My WebLink About1552 ELM AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR UHIVE, UUS1A ME5A, GA 92626 BUILDING PERMIT Job Address: 1552 ELM AV Suite: A Vicinity: Parcel Number: 13930113 Applicant: DEAN, JAMES Address: Zoning: R3 R3 Phone: 714-273.9378 Zip: Owner: LANZA, LAWRENCE A 19521 POMPANO LN Address APT 109 2480, CA Phone: HUNTINGTON BEACH Zip: 92648-8265 Contractor: ' MANDEVILLA Address: 779 NEWTON DAY COSTA MESA, CA Zip: 92627, Arch : Address: Phone: 949-631-3022 License: 829181 Eng Address Phone: Zip: - License: ISSUED BY: Status: ISSUED Applied: 02/03/2004 Issued: 02/03/2004 Phone: License: SCOPE OF PERMIT . INTERIOR 924 SF REMODEL OF AN EXISTING UNIT A'IN A TRIPLEX. WORK TO INCLUDE: CHANGE-OUT/ADDITION OF KITCHEN CABINETS, RELOCATION OF THE WASHER/DRYER TO AN EXISTING WATER HEATER CLOSET (WATER HEATER TO BE RELOCATED TO THE REAR EXTERIOR), CHANGE -OUT OF A FAU WITH THE ADDITION OF A NEW A/C UNIT COMPRESSOR AT THE REAR EXTERIOR. A PARTITION WALL (TO THE ADJOINING CLOSET )WILL HAVE TO BE REMOVED AND RELOCATION OF THE CLOSET DOOR. THE CLOSET IN THE MASTER BEDROOM AND THE ADJOINING BEDROOM 3 CLOSETS WILL - - - - - - - —• - -- - - EXCHANGE CLOSET OPENING WITH A NEW WALL AND DOOR FOR EACH. 4 WINDOWS AND A SLIDING GLASS DOOR WILL BE CHANGED - OUT (MEETING EGRESS REQUIREMENTS). THE ELECTRICAL SERVICE WILL BE UPGRADED. REPLACED WINDOWS AND SLIDING DOOR SHALL BE OF THE SAME SIZE AND LOCATION. ' Plan Check: $145.11 Permit: $223.25 SMIP Res: $1.30 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $369.66 SETBACKS FEE SUMMARY PLANNING & ZONING Calc Valuation: $13,000.00 Claim Valuation: $13,000.00 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 if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446-46(&00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will malptain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the wo for which Ihis�permit is issued. .. ave and will maint��tnn workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compegation Insurance carder and policy number are: Carder: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certity that in the pe imance of the wort r hich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws alifomia, and e r e that If I should became subject to the workers' compensation provisions of Sec n 37Q0 of the bor Code, I shell forthwith comply with thejap ps. Applicant Signature: Date:WARNING: FAILURE TOE WORKERS' WMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMIWILVENAL ES AND C IL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(), INADDITION To COST OFCOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION WIXOF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lice a under provisionter 9 (commencing with Section 7000) of Division 3 of the Business and Profess' ns Code, and my license Is in full force and effect. Lic. a s h Class 4 Contractor's Signature: Date: CONSTRUCTION LE ING AGENCY: ❑ I hereby affirm at there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: l Signature: Date: tr OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 01 the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby cavity, that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsewerk, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or. ......................................................................................................................................._.........................................................................................................__...................._..............._............-.............._..........._I...............I............ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .�...._._........_........._............_.................._.........._............................ -........................................................................................................... ......................................................................................... _............ _.......... _ ............... _............... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ....................................................__............._........... _............................ _................................................................................................. ................................................. ........................ ............................................................................................ 4 If en RMPA Is presentty requiretl, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .................................._.............._................_......_...._.............................__......................................................'t-h-......................................_.........................t'h-I.....i-p-.........iori........................................................................ .............................. 5 Does or will the applicant or present or future builtling occupant require for the work which is the subject of this a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .. Will any .....ft_............._.........b_............................................................................ithi...................................................................................................................... ................................................. _.... ........._........................ B WIII an ah of the facility to be constructetl under this ermir be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ......_......._........_...................._..................................._......................................................................................................................................................................................_.............._..................._............._..............._............._........... 7 It a permit from the South Coast Air Quell N Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prow bed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ...9..._.(If yes', attach certificate of compliance from the appropriate air pollution control officer). ................................................_..........................._.......................................................... CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection pu es@s. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signet Ot a al Owners) Date An Or Authorized Applicant I Date COgE A, g61F INTMALS CODE If INSPECOyT PEONS TYPE pd¢. R�EL9 1616 ed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing _ 200 Final Ra Roof 210 Final Electrical 201 Final BlocklRetaming Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site �/�{ y'r-1�— 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us II FAIH UHIVL, OUS I A ViLbA, UA BZbZb PLUMBING PERMIT Job Address: 1552 ELM AV Status: ISSUED Suite No A Applied: 02/03/2004 Issued: 02/03/2004 Vicinity: Parcel Nunmber: 13930113 ISSUED BY: Applicant: DEAN, JAMES Address: " Phone: 949-631-3022 - - Zip: Owner: LANZA, LAWRENCE A 19521 POMPANO LN Address APT 109 2480, CA Phone: HUNTINGTON BEACH Zip: 92648-8265 Contractor: MANDEVILLA - Address: 779 NEWTON DAY FEE SUMMARY Phone: 949-631-3022 . COSTA MESA, CA Zip: 92627 ` QTY - License: 829181 Arch / Eng ISSUE FEE $23.50 Laundry Tub / Washer ' - - - - - - Address: 0 Backflow irrigation $0.00 0 Landscape Irrigation Phone: 0 Swimming Pool $0.00 Zip: Backflow Preventer $0.00 - - - - - -License: -" ' SCOPE OF PERMIT REF: B04-00293. PLUMBING TO INCLUDE: 1 BATHTUB, 1 DISHWASHER, 1 GAS (1-4 OUTLETS), 1 - LAUNDRY TUB/WASHER, 1 SHOWER, 1 KITCHEN SINK, 1 WASH BASIN, 1 TOILET, 1 WATER HEATER, 1 WATER RE -PIPE. - - FEE SUMMARY . - AMT QTY--- AMT QTY - -' AMT QTY ISSUE FEE $23.50 Laundry Tub / Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 _ P -Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 1 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $9.80 1 Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 - 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 6 Sewer Private Line $0.00 0 Water Closet (Toilet) $9.80 1 Drain, Roof $0.00 0 Shower $9.80 1 Water Heater! vent $12.30 1 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 244646 (SM) DECLARATIONS n WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance canner and policy number are: Carrier: Policy Number: (This section need noopo led if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in tnce of the work fo hich t is permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation lrnia, and agre at It I s uld become subject to the workers'compensation provisions of Sectio 3700 f the Labor Code, I shall forthwith comply with theApplicant Signature: Date: aqWARNING: FAILURE TORKERS' COMPENSATION GUVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTI SAND CI L FlNES UP TO ONE HUNDRED THOUSAND DOLLARE IDDmON TO THE COST OF COMPENSATION, DAMAGES A$ PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONT CTORS DECLARATION: I hereby affirm that lam lice ed nder provisions of actor (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. 0 Class 8 Contractor's Signature: Date: CONSTRUCTION LE G AGENCY: ❑ 1 hereby allirn t at there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lander's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or counly which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in Connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..........._.........._.........__.......__.......__..........._.___......__...................ildi.................pant_..................................................__....__....................................... o"u"_...t'e-............._..............._...-............................_................................ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................ ................................................................................................................... ................................................................. .................................. I ................ .......................................................................... 3 Does or will theaGpplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ IJo (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .......__........_...........__.........._......._........._............................................_................................................................................................................_........_....._........................ ......................................._............_............. _..................... a If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ..................... ................................................ -............................................................................................................................................. ............................ .- ........ ................................................ ...-.......... .............. .......... 5 Does or will the applicant or present or future building occupant require for the work which is the subject this a plication appermit for such construction or modification from the South Coast Air Quality Management Districtt or from any other air pollution control district or agencc y? Yes LJ No (Section 65850.2 of the California . Government Code requires that the requested information be furnished on applications for non-residential building permits). ...... ................................................................................................................................................................ ........... ......................... ............................................................. ........................ ................ .................. ................ -........................... ............. 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .......................................................................................................................................................................................................................................................................... ___ .................. .................... ................ -.............. _...................... ............... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures proscribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ..............._................................_............_..............._............._........................................................_._.__—__..._................_.........................................................._.._................__..............._............_..........._........._..........._.............._ 8 (Ii yes", attach cerificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to compty, with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspecti urposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Vi ature I Legal Owner(s) Date And/Or Authorized Applicant t L Date gAT( INTMALS CODE. INSPECTIONTYPE 2AM jNTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical —�- 1266' Pool Spa Final 208 Final Plumbing —ah v- 1266' Final Re -Roof 210 Final Electrical 201 Final BlocklRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIH UHIVE, GUS 1 A MhSA, GA 92626 MECHANICAL PERMIT Job Address: 1552 ELM AV Status: ISSUED Suite No A Applied: 02/18/2004 Issued: 02/18/2004 Vicinity: Parcel Number: 13930113 ISSUED BY: Applicant: DICKSONS INCORPORATED Address: 1918 S MAIN ST Phone: (714)5458289 SANTA ANA, CA Zip: 92707 Owner: ,LANZA, LAWRENCE A 19521 POMPANO LN Address: APT 109 2480, CA , Phone: HUNTINGTON BEACH Zip: 92648-8265 Contractor: DICKSONS INCORPORATED Address: 1918 S MAIN ST Phone: (714)545-8289 SANTA ANA, CA Zip: 92707 License: 401327 SCOPE OF PERMIT CHANGE OUT FAU AND ADD A/C FOR RESIDENTIAL REMODEL, ALTERATION OF MISC DUCT WORK. REF: B04-00293.- ELEC AND GAS BY OTHERS. - - - FEE SUMMARY Quantity ISSUE FEE $23.50 Quantity Inst FAU <100 k BTU $14.80- 1' - -- Inst FAU >100 k BTU $0.00 0 Repair/ Alt Cooling/Heat $13.70 1 Inst / Rep. Recess Wall Htr $0.00 0 Refrig Sys <100 k BTU ' $0.00 0 Refrig Sys >100 k BTU $0.00 0 Gas Piping $0.00 0 Factory Fireplace $0.00 0 Hood w/Mech Exhaust $0.00 0 VAV Box $0.00 _ .. . 0 Vent Fan / Single Duct $0.00 0 Appliance $0.00 0 Fire Dampers - $0.00 0 Smoke Dampers $0.00 0 Inst or Relocate Appl Vent $0.00 0 Air Handlers < 10000cfm $0.00 0 Air Handlers > 10000cfm $0.00 0 Floor Furnace $0.00 0 Floor or Suspend Heater $0.00 0 FEE SUMMARY Quantity Repair/ Alt Absorbtion Unit $0.00 0 Repair / Alt Refrigeration Unit $0.00 0 Ventillation System $0.00 0 Evaporative Cooler $0.00 0 Commercial Incinerator $0.00 0 Domestic Incinerator $0.00 0 Compressors / Absorption Systems - Up to 3 hp 1100 k BTU $0.00 .0 3 To 15.hp / 500 k BTU $0.00 0 - 15 To 301ip% 1,000 k BTU $0.00 0' 30 To 50 hp / 1,750 k BTU '- - $0.00 0 Over 50 hp / Over 1,750 BTU $0.00 0 Boilers Up to hp $14.70 '1 3 To 15 hp $0.00 0 15 to 30 hp $0.00 0 30 to 50 hp $0.00 0 Over 50 hp - $0.00 0 - Other Mechanical Fee Investigation Fee - $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $66.70 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446.46(6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the Wo for which this permit is issued. have and will maintain workers' compensation insurance, as required by section 3700 of the I^r Code tor the performance of the work for which this permit is Issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) Orissa.) ❑ 1 certify that in the pertortnanco of th ork for which this permit is issued, I shall not employ any person in any manner so as to bitcome sub'ect to the workers' compensation laws of o ia, en ree that if I herld become subject to the workers' compensation provisions of Section 3 of the Vabor Cogs I shall forthwith comply with these visio 11� b 11 �J I (�' I D / `"(� Applicant Signature Date: WARNING: FAILUREE WORKERS' COMPENSATION COVERAGE IS WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($10at0t IN ADDITION TO THE COST OF COMPENSA AMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licens or pr ions of Chopts 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. q Class A Contractors Signature:(/—'Date: - CONSTRUCTION LENDI G AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .................................................................................................................................................__......._____.___...................................................................................._..................._.............._......................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). . ...._...................._............................................................................................................................................................................................................................_......................._.._................................_.............................................................. 3 Does or will theapGplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the Calitomia Health and Safety Code been fully complied with? ❑ Yes []No _......._........._.........._......e—ipli.......................................................................................................................................................................u"bi'e"c"'t........t'h"i'......................................................................................................................itD'.... 5 Does or will the applicant or present or future b District occupant require for the work which is the subject of this a plication appermit for such construction or modlficotlon from the South Coast Air Quality Management District or from any other air pollution control distract or agency? � Yes u No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ............................... _............... _.._....... ..................................... __................................ .......... _..—_............. _........................................................................................................................................................................................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................._........................._..........._.................._...................................._._....................................................................... .......................................................................... ............................................................................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures proscribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No _........._..........................c,h-._.........................................................................................................0.11....................................ar-)............................ .... _._........ .............. .......... _...... .............. ..... ................. ._............ _......................... ................ _. 8 (II yes", affach certiliwte of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree dot to occupy or allow occupancy of any building authorized by this permit until final inspection. SI to f Legal Own r( n If 0 at u orized Applican (' Da INSPECTION TYPE BATE INmTIALS CODES INSPECTION TYPE gdIE 16 Fixed System Final Fire Prevention 206 Final Mechanical'O{ ' C3 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy s' c=Lrn f1ve, K2.p((tc-e -Furn4Kt i_ r p2c �I I4inimurnaD'se. f) ` New f�lc unit � I \ 2 S' QED PR CIT OF COS MESA PL NNING D VI$ION SUB]EC DEP\T,. RE 3. NOTE: A DITIONS DELETIONS, OR CO RECTION SHALfL B APPROVE ) BY THE I FANNING MV. 4TE A I (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 1552 ELM AV A UNIT A 13930113 Applicant: BOOMGARDEN, RICH ^, Temp Dist System / Lighting Address: 5267 WARNER AVE Busway /100 ft . $0.00 SUITE 125 Phone: (714) 840-7828 $0.00 HUNTINGTON BEACH, CA Zip: 92649 Owner: LANZA, LAWRENCE A 19521 POMPANO LN Address APT 109 " 0 " 2480, CA Phone: .................up to 50 kva/kw HUNTINGTON BEACH Zip: 92648-8265 Contractor: SUNBURST ELECTRIC Address: 5267 WARNER AVE SUITE 125 Phone: (714) 840-7828 HUNTINGTON BEACH, CA Zip: -92649 - License: 722125 ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Flxts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Motors to 10hp Motors to 50hp If FAI H UHI V C, GUJ 1 A MtbA, UA 826E6 ISSUED BY: . SCOPE OF PERMIT UPGRADE OF A METER AND AN EXISTING SUBPANEL-IN UNIT A OF A_ TRIPLEX. 1 SERVICE TO 200A,_1 SUBPANEL TO 200A 3/5/04; PERMIT SUPPL. TO INCLUDE ELECT. FOR A/C. NO OTHER WORK AUTHORIZED WITH THIS PERMIT- - REF: B04-00293 - FEE SUMMARY Quantity $23.50 ^, Temp Dist System / Lighting '$0.00 Busway /100 ft . $0.00 _ _ - Standing Section'.' - $0.00 01 Misc Electrical Equipment $0.00 0 Transformers up to 1 kva/kw $0.00 0 ................up to 10 kva/kw $0.00 0 .................up to 50 kva/kw $0.00 0 .................up to 100 kva/kw . $0.00 0 ..................over 100 kva/kw $0.00 0 Low Voltage Equipment $0.00 0 Low Volt Wiring System / Ckt $30.50 1 Misc. Conduit $0.00 0 Misc. Conductor ' $0.00 0 Circus ( gen or ride) $0.00 0 Circus (mech ride or lights) $12.30 1 - Christmas Tree Stand - $0.00 0 Fireworks Stand Status: ISSUED Applied: 03/03/2004 Issued: 03/03/2004 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 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 244646 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: 1 hereby affirm under penalty of perjury one of the following declarations: ` ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the A..� work for which this permit is Issued. I L7f_ I have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this P�mIt is Issued. L _My workers' compensation Insurance canner and policy number are: ' -7O ^ // Carder: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars 00) or less.) ❑ 1 certify that in the perfornanoe of a rk for whit this pe s issued s II not employ any person in any manner so as to become Object to the workers' compensation laws of Califomia, n gree that If I houltl oma suet t to he workers' compensation provisions of Sectio 3700 of t e Lebo ode, I shell forthwith comply with these provisions. r� Applicant Signature: Date �-/ WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAG IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL IIIENALTIES AND OVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: hereby affirm that I am lic and r pr isions of C ter 9 (commen 'ng with Section 7000) of Division 3 of the Business nd Professions Code, and my license is in full forceantl effect. I.C. N 2 /Class A —( Contractors Signature: S Date: O CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit t0 construct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) Or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building Occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...................._........._.........._................__............._........ ..................... -.__.._................................................................................... ......................................................... ........................................................................................................ _........ 2 Does or will the applicant or present or future building Occupant need to file a registration fond for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o1 compressed gas at standard temperature and pressure). ._..._—_......._......._............._..................................................................................... -.......... .............................................................................................................. _._.............. _............................. _.............. _........................................... 3 Does or will theaGGplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .............................................. a If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No _......_......_........__........._.............................................................................................................................................................................. -............ .................... _................................................. ............................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 19 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..................................................................................................................................................................................................................................._.__.._._............................................................................................................................ ..... Y P ry ... ... 8 Will an art of the facili to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cade). ...__........._...... _........... _........... _........... ._.........................................................................................................................-........................._................................................___.................__......._.................._..........._.........................................- 7 II a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ..._..........._................... _.......... ........................................................... .... ...................................................................... ................... __......................................................... _................................... ........................................... ............ ............... ........ 8 (It yes', attach certificate of compliance from the appropriate air pollution control Officer). CERTIFICATE OF COMPLIANCE: I cartity that under penalty of perjury the information given above is correct. I agree t0 comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to cogtWith all state I rs and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-describedpr ben or inspect pu sas, I • qr a not to Occupy or allow Occupancy of any building authorized by this permit until final inspection. D AndlOr Authorized Applicant ate CODE 0, INSPECTION TYPE gATfi KTmAL$ CODE INSPECTION TYPE Qd1E IiQITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �T 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 1552 ELM AV Status: ISSUED Suite No A Applied: 03/03/2004 Vicinity: UNITA Issued: 03/03/2004 Parcel Nunmber: 13930113 92649 Applicant: BOOMGARDEN, RICH ISSUED BY: Address: 5267 WARNER AVE 0 Temp service test SUITE 125 Phone: (714) 840-7828 Busway /100 ft HUNTINGTON BEACH, CA Zip: 92649 - Owner: LANZA, LAWRENCE A 19521 POMPANO LN Address APT 109 2480, CA Phone: HUNTINGTON BEACH Zip: 92648-8265 Contractor: SUNBURST ELECTRIC Address: 5267 WARNER AVE SUITE 125 - Phone: (714) 840-7828 HUNTINGTON BEACH, CA Zip: 92649 - License: 722125 SCOPE OF. PERMIT , UPGRADE OF A METER AND AN EXISTING SUB_PA_NEL_-IN UNIT A OF A TRIPLEX. 1 SERVICE TO 200A,- 1 SUBPANEL TO 200A - - NO OTHER WORK AUTHORIZED WITH THIS PERMIT. - - REF: B04-00293 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 2446-46 (6100) FEE SUMMARY - Quantity - - Quantity ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 ft $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res (1-2 units) '$0.00 0 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 - 0 - Transformers up to 1,kva/kw - $0.00 0 Pool / Spa , $0.00 0 - ................up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 .................up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 .................up to 100 kva/kw $0.00 0 Switches $0.00 0 ..................over 100 kva/kw $0.00 0 Non Res Appl - $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Service to 200a $30.50 1 Misc. Conduit $0.00 0 ' Service to 1000a $0.00 0 Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to lhp $0.00. 0 Circus (mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 - Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 1 00h $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 2446-46 (6100) DECLARATIONS WORKERS' COMPENSATION DECLARATION: , I hereby affirm under penalty of perjury one of the following declarations: `• ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 19— I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this pennit is issued. My workers' com etati/o/ppinsuran er and �/ olicy number are: �20 Carder: i'l1P"-'�- w Policy Number: l —r �y— (This section need not be completed it thd permit is valued at one hundred dollars IS 100) or less.) ❑ 1 certify that in the performance 99 work for which this pe is issuecj shall not employ any person in any manner so as to bet me subject to the workers' compensation laws of California tl agree that if should a me subj4 to the workers' compensation provisions of Section 370 of t Labor ode, I shall forthwith comply with these provision �l/]—�' Applicant Signature: l C Date: O WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS U FUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL IES AD CIVIL ANES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000), IN ADDITION TO THE COST OF COMPENSATI GES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provisionso �pter 9 (tom ting itl Section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. Lic. a L2-1 2'— Class a Contractors Signature: / r Date: O D CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Cade for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................_........_......._.... ...... _............................ ........................................................ __............. _.................................................................... ........................................................... ................. ..._..............................._........................_.......... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceplions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .............................._.................................... _........... __........................... _.............................................................. ................ ........................................... _............................ _............................ ............................................................................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register .acutely hazardous materials with the Fire Department. .... ........._...................................................................................... .............................................................._........ ..................................................................................................................................................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No . ........................................... _................... _.............................._......................................................._........................................................................................................................................................................................................................... 5 Does or if the applicant or present or future building occupant require for the work which is the subject of this as plication aPPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency! Yes u No (Section 65850.2 of the California Government Cade requires that the requested information be furnished on applications for non-residential building permits). B Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if "yes", the facility must most the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ......................................................................._...._......._..........................__................................................................................................................................................................................_............._...................................._..................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all Of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No .....__................................ ........... ......................... .... ...................... ............ _....................................... ._.....__._................................ ............................................................................................... ... ........................ ............ ._............ I................. _... 6 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cedity that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORLZAT10N OF ENTRY: I certify un r penally of perjury that I have read this application and state that the information given is correct. I agree to co y with all state laws and city ordinances relating to buil Ing co"Wclion, and authorize representatives of the City of Costa Mesa to enter upon the above-described props for inspection purposes. as not to occupy or alto occupancy of any building authorized by this permit until final inspection. Signal a Of La n r(s) -:2 , Qa (/ And/Or Authorized pplicanl if Da e CODE If INSPECTION TYPE gd1E NfmALS CODE INSPECTION TYPE HATE INITTELfl 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing , 200 Final Re-Roof 210 Final Electrical 201 Final BIock/Retalning Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy COSTA,� MS�E.S�SA_� Project Address Applicant's Mai�lin'gg Address Owners Name J(EGI LI! ION PERMIT Applicant to fill in all spaces except those within heavy border lines and.sign all appropriate declarations. AERMIT NO, TRACT NO. LOT NO. UNIT NO. - it�ng. License No. Address Contractor's Name - Phone L� Address (mailing) (16 City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that, I'am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate f Workers' Compensation Insurance, or a certified copy thereof (Section 800, tab. C.) Policy No. Company H Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. - Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Anycity or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to the a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or that he/she is exempt therefrom and the basis -for the alleged exemption. Any violation of Section 7031.5 by any applicant' for a permit subjects the applicant to, a civil galty of not more than five hundred dollars ($500). Rl I, as owner of the property or my employees with wages as their sole om pensation, will do the work, and the structure is not intended or offered for sale (Section 7044, BusinessandProfessional Code: The Contractor's License Law tloes not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale! If, however, the building or improvement is sold within one year of Com= elation, the owner will have the burden of proving he/she did not builtl or Im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively, contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such ,projects with a con- tractor(s) license'pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. 111 4m/exempt under Section / B. & ps,C.Aor this reason fy'that I have correct. I agre relating to bL this city to t, 2-1-2- R TYPE OF CONSTRUC ❑ CONVERSION 2 DE CRiAC.IPTOWF TYPE OF PERMIT ❑ TENANT ❑ ❑ OTHER PROJECT DESCRIPTI CONSTRUCTION Remarks: Bar Sink Backflow Preventer - Backflow Irrigation Bathtubs ❑ NEW LJ ADD U ALTERATION/v REPAIR SMIP. Jl DEMOLISH ❑ OTHER PERMIT A P #' ISSUANCE ' IK/USE OF BLDG. ENERGY P.C. $ GRADING $ - S Main Building: /�� 31aJ`-' TOTAL FEE , � E 3RA DING C1 FOUNDATION __ STRUCTURAL Front TRICAL ❑ PLUMBING ❑ MECHANICAL _T B A Rear _ Right ' SO. FT.-` OCCUPANCYMM�— -K - —VALUATION $ 2W0'� g' Left " GRADING CU. YDS.- ACRES Ping. Ref. - .Planning Notes: Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler, Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multi Firepl/Fact. Bit. ICBO # Heating System & Ducting 110-100,000 BTU ❑100,( Signature vwwL_ V YI Da[e. —/aTl " D ' s' L' SS Reinspection Fee CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Showers Service Sink - Sewer Cap' Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater _ Water Service Auto -Wash Issue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU 0100,00013T System Repair/Alteration Fire Dampers Registers i Issue Fee I 'FEES J$3" FEES i $ 3 2880 'I 0/24/85 32e50 TL Parking Req./Provided ELECTRICAL Automatic Washer - -' Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures - Device Boxes Outlets Switches Garbage Disposal Generator 1:10-5 KW E]5-15'KW Zone , Transformer Lt 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter El over 100 amps Sub Panel Motors 110-1 HP OVA - 8 Inc. Solar 119-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor. FEES Z O N 1 N G R E 0 M T S Reinspection Fee $15 Issue Fee I $ 3 DEVELOPMENT SERVICES REQUIREMENTS: r Zoning Approved By +l Date Building Approved By r"c f -r - -iDate_ � BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ FEES SMIP. Jl $ PERMIT ISSUANCE ' $ ENERGY P.C. $ GRADING $ MICROFILM $ /�� 31aJ`-' TOTAL FEE , � $ r NSTRUCTIONAND PLANNING VJ�AP'PROVA'� Permit # Inspector POOL u SPADate APPROVALS Permit # Date Inspector Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement - 3. -Electrical Conduit Utility-Undrgrnd- '54. Forms r 4. ,Electrical Conduit=Undrgrnd. 55. Electrical Bonding - 5 Steel Reinforcement 56. Rough Plumbing &Pressure Test 6!'Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7,.. Footings 58. Electrical Conduit-Undrgrnd. 8: Foundation - 59. Gas Pipe, ❑ Undrgrnd., Test 9r Water'Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. _1 10. Structural Floor System 61. APPROVAL TO DECK 11. Property -Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer, Cap 63. Heater & Vent -Final -- 13. Roof•DFains 1 .64. Plumbing System - Final a 14. Rough Plumbing 65. Electrical -Final 15.- Rough Electrical Conduit 66. Solar System -Final 16. 'Rough Electric Wiring 67. Fencing & Access Approval •17.,Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19.)Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # - 20. Rough Factory Fireplace 21. Ducts, in Structure '. 70. Underground Hydro , 22. Ducts, Ventilating r 71. Product Piping O Gas ❑ Oil _23. Gas Pipe -Rough &Test - "72. Underground Flush - - 24. Roof Framing - 73. Undergrnd. Storage Tank ❑Gas ❑Oil 25. Roof Sheathing - 74. Overhead Hydro H. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation ' 78. FIRE PREV. FINAL 30. Drywall Nailing „ HEALTH DEPT. REQUIREMENT 31 .'Piaster Brown Coat - 79. FINAL INSPECTION - - - 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: - - 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test - 36. Hood or Canopy - 37. Final Factory Fireplace 38. Final Plumbing - - 39. Water Service -Final, 40. Gas Service -Final , 41. Solar Domestic -Final 42. Backflow' Preventer 43. Backflow Irrigation 44. Landscape Irrigation System _ 45. Sound Attenuation 46. Handicap Regulations 47. FINAL'STRUCTURE & BUILDING 0 v 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas -Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. - Date _ _ y 1473 3/20/86 &501 TL Zone: Accessory Building: Z O I N I N R ParkingReq./Provided E O M T S - _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . PE T NO. TRACT NO. LOT NO. UNIT NO. I ' CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address /fss� &Z /-n ST • ' 1 Applicant's Mailing A dress. X03 �j .S. �A/.lJ' ST �/��.�� _ Owner's N p 15ACf /-LIA i � ' Address. �p L TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR - _ I t ❑ CONVERSION ❑-DEMOLISH ❑ OTHER _. A,P•# _ DESCRIPTION OF WORK/USE OF BLDG. E TYPE OF PERMIT GRADIry FOUNDATION STRUCTURAL' T I I S ERight TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B OTHER ' - - - J 1- A C PROJECT DESCRIPTION SQ. FT. • OCCUPANCY KAddress CON STRUCTION TYPE -VALUATION$ S ZONE GRADING CU. YDS. ACRES Ping. Ref. - Arch/Eng. License No. Address" Contractor's Nam ev 5 C.5 Phone I �O 3 �i .S- %�JA/.d ST• S�/Y (mailing) �hs !'l 3oS.5 City License NO. {� LICENSED CONTRACTOR,DECLARATION Remarks: - P� ze. .. - Planning Notes: I hereby, affirm that I am licensed under provisions of Charter 9 (commencing i with section 7000) of Division 3 of the Business and Professions Code, and Clarifiers Solar Collectors _ Dishwasher- _ Meter El over 100 amps'. `• my license is in full rc d effect. - License Class �� ' _ License No. Date - Signature _ Drinking Fountains Solar Tank - i . L- - PLUMBING - - FEES f ,. ` -' Floor Drains Swimming Pool vv/Spa. -F.A.U._ '- "- - - - - WORKE S' CO PENSATION DE A ATION " FA. _. -Inc. Solar ❑9-15 HP ❑16-15+ ._ - - . Date Signature NOTICE: after making to the 1473 3/20/86 &501 TL Zone: Accessory Building: Z O I N I N R ParkingReq./Provided E O M T S I hereby affirm that I have a certificate of consent to self -insure ora Bar Sink Showers _ _ _ I .. _ ELECTRICAL' r FEES ertifiGate of Workers' compensation Insurance; or a certified copy thereof (Sec ion 3800, Lab C.1 ., �Z-J�S DD,s� Policy No) 'rl Company 0� Q Certified co u9.0 py is hereby furn ishetl. I� erti cop filed with the city uil i iv' Date O APPlitant EXEMPTI N'F OM WORKE RS',CO MP ATION DEC LARA (This section need not be completetl if the permit is for one'hund tl ($100 or less). ) I certify .that in the performance of the work for which this permit is issued, Backflow Preventers Service Sink - Automatic Washer : _ Transformer ❑ 15-50 KW ❑50+KW. s Construction Pole Sub. Backflow Irrigation - 'Sewer. Ca 1 p - Bathtubs Sewer Connection +,� Cooking Unit' Meter' ❑up to 100 amps Clarifiers Solar Collectors _ Dishwasher- _ Meter El over 100 amps'. `• Dishwasher - .Solar Piping I - Dr I yers ❑Gas- ❑Electric Sub Panel , - Drinking Fountains Solar Tank - i . Fan _ t, Motors❑O-1 HP,❑1'h-8•' :J r shall not employ any person in any manner so as to become subject to the Workers'. Compensation Laws of California.. ` -' Floor Drains Swimming Pool vv/Spa. -F.A.U._ '- "- - - - - - " FA. _. -Inc. Solar ❑9-15 HP ❑16-15+ ._ - - . Date Signature NOTICE: after making to the Floor Sinks Urinal 1 FixturesMicrowave ' C provisions of the Labor Workers' Compensation provisions df the Labor Code, you must forthwith Code, ,you must comply ',with such provisions or this permit shall be deemed revoked- Gas Service Outlets' I Water Closet + Device Boxes Pole Light CONSTRUCTION LENDING AGENCY I I hereby affirm that there is a construction lending agency for the performance - nterceptors Water Heater Outlets ,Range of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name -' Kitchen Sink- ' 'Water Service - '- Switches - - _ Sign ! ' Lender's Address-- - - -- OWNER BUILDER DECLARATION T v I hereby affirm that I am exempt from the Contractor's License Law for,the following reason (Section 7031.5, Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit Lavatories Auto -Wash ' Garbage Disposal ; Standing Sections - P -.Trap ILaundry Trays ) - Generator ❑0-5 KW El 5-15 KW .Trash Compactor I Roof Drains ' I to file a signed statement that he/she is licensed pursuant to the provisions of Contractor's License Law (Ch apter'9 (commencing with,5ectiou 7000) of. ..theDivision 3 of the Business and Professions Code) or that he/she is exempt •' therefrom and the basis for the alleged exemption. Any violation of Section , 1 -, ' I ' 7031.5 by any applicant for a permit subjects the applicant to a civil malty of not more than five hundred dollars ($500). I I, as owner of thel property or my employees with wages as their sole compensation, will do the work, and the structure isnot intended or offered I for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon,-and'who does such work himself/herself or,through his or her own employees, Provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner Will have the burden of proving he/she did not build or im- re'for the purpose of sale). ; as owner of the.property, am exclusively contracting with licensed con- Reinspection Fee I 1 � $15' I Issue Fee ! $ 3 , Reinspection Fee $15 Issue Fee - 'MECHANICAL ! 'FEES DEVELOPMENT SERVICES REQUIREMENTS: ' �. Zoning Approved By - -Date ' Building Approved By l Dat ' Application Issued By ' Dat _ - Boiler, ' 1 Hood ort Type ❑ 1 Canopy Type II ❑ 1 1 - Duct - Under Ground Duct t Structural . Refrigeration System 1 f ! I y/7Jj tractors to construct the project (Seclion.7044, Business and Professions. Code: The Contractor's License Law ,d oes not apply t0 an owner of property who builds. or improves thereon, and who contracts for such projects with,a can- tractors) Ilcense pursuant to the,Contractor's License Law). I am aware that f insurance should be provided ro me. proof, of em' unceirWorkeSection ❑ lam exempt untlerSection - e.&P. C. for the season ❑0-100,000 BTU ED 100,000 BTU Duct -Ventilating - SUMMARY OF FEES, + BUILDING PERMIT $ I SMIP -. - $ - ' 'PLAN CHECK $ - PERMIT - -PLUMBING - -' $ r7-ttitLr' ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ . ELECTRICAL $ GRADING $ `- PLAN CHECK 50% $MICROFILMsentatives -, MECHANICAL $ TOTAL FEE $ - PLAN CHECK •25%I $- - Exhaust System ❑ 'Multiple'❑ System Repair/Alteration - -Firepl/Fact. Bit. ICBG#. - Fire Dampers - Date - .Owner ead this application and,state'that the above informatioto comply,with.all city and county ordi mm.es and state ling constr tion, and hereby authonae repre- ' I -hereby c9AV on a above-mentioned 'pr Percy forinspecton 4 ��y_„ Signature .-Date =J�2� Drivers' Llcen a or 55 _ Heating System& Ducting ❑0.100,000 BTU 0100,0006T _ Registers_ _ - - '. , - - - - Reinspection Fee $15 Issue -Fee I _ _ $ '3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor , Awl CONSTRUCTION AND PLANNING APPROVALS Permit # ` Date [inspector POOL & SPA APPROVALS Permit # •Date Inspector 1. ,Temporary Electrical Service or Pole - 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. .53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test ' 6. Electrical LIFER Grod. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62.Backwash, & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas • 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION• 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: . MIFA-Fe rte• Q LAAO 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test - _ -2X►'6 L61J " . 36. Hood or Canopy ` 37. Final Factory Fireplace 38. Final Plumbing 1"'2'I •dpi 39. Water Service -Final - 40. Gas Service -Final 41. Solar Domestic -Final. 42. Backflow Preventer ' 43. Backflow Irrigation 44. Landscape Irrigation System '. 45. Sound Attenuation - 46. Handicap Regulations ' 47. FINAL STRUCTURE&BUILDING - 48. Special Requirements Completed 49: Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. . Date