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Home My WebLink About1582 ELM AVE - Building Permits(714) 754-5273 • Fax (714) 754-4656 • www.ci.costa-mesa.ca. LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1582 ELM AV Status: ISSUED Suite: - Applied: 10/01/2001 Vicinity: ADDITION & REMODEL OF EXISTING SFR & GAR Issued: 12/18/2001 Parcel Number: 13931214 Zoning: R1 R1 Applicant: VUKADINOV, SPASOJE - ISSUED BY: Address: 2969 JACARANDA AVE - .. ",Phone: (714) 557-5477' COSTA MESA, CA Zip: 92626 - Owner: VUKADINOV,"SPASOJE & LJUBICA Address 2969 JACARANDA AVE Phdbe: (714)557-5477,,--,...�'-�. COSTA MESA, CA- Zip: 92626 i Contractor OWNER -BUILDER Address: " Phone: Zip: License: -;; 0 Arch Eng: Address: - _ Address:' - - Phone: - Phone: , Zip: License: License: , _ SCOPE OF PERMIT DEMOLISH EXIST. SFR WHILE KEEPING PART OF _EXISTING-SLAB-ANDTOUNDATION. CONSTRUCT NEW 1 STY, 2605SF SFR, 504SF GARAGE, AND 117SF ENTRY PORCH. - - -- -- - Plan Check: $1,140.98 Permit: $1,755.35 SMIP Res: $23.60 SMIP Com: $0.00 Other: $0.00 Inspection: - $0.00 Total: $2 919.93 SETBACKS, Calc Valuation: .$235,953.54 Claim Valuation: $0.00 PLANNING& ZONING MAIN STRUCTURE Front 21- 0 Rear 10-0 Left- 5-4 - Right 5- 2, ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right:'- 0-0, f� PARKING Existing: 4 Required: 4 Proposed:' 4' ' NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and 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 / 24asas (sroo) WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance comer and policy number are: Carder: 0 Policy Number: (This section need not be completed /f the permit is valued at one hundred dollars ($100) or less.) ❑ I certify, that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,ODO), 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: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect. Lic. N Class x Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affiml 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 Sol 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. 1i7044, 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, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Coca: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. - Business and Professions Code for this reason: tSignature: `—�� //.� (—Data:— -, — C1 C� 7 lOwner ID verify river cense. ❑ Yes ❑ No Drivers License No. 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, 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 B, California Administrative Cade). ❑ 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 Cade 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 ocoupant 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 o1 compressed gas at standard temperature and pressure). ._.........__........_........._............ .. ........._.__.................__............. ................................................................ ............ _...... _...................................... ._............. ................. ........................................................ ... _........... . 3 Does or will theeppplioant 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 Cade 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 II en RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? [I Yes [I No ._.........._........._..........._............_............._..............._.................. __._.............. ............................................ .......................... _._.................................................... _............................................................... .......................................... _. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a pn e licatioakrnil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? II Yes 8 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 prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................... ........ _........................ _..........._............_._..................._........................................................................................... _..........................................................................................__............................_............_........................ _.. B (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �7t Pte% —/�— �Z — �.� — Z0 0 1 Si ature Of gal Owners) Da e lI— And/Or Authorized Applicant Date CODE #, INSPECTION TYPE INTMA CODE ! INSPECTION TYPE ga¢" INS$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -_ 200 Final Re -Root 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 Al 204 Final Demolition 250 Final BuildinglOccupancy ) SUBCONTRACTOR LIST City of Costa Mesa — Planning Division P. O. Box 1200, Costa Mesa, CA 92628-1200 Builder AddressIfGtQ��i ALZ Phone Job Site 177(f2 J5<fN e LOST�s� /e5�3 Date Permit# 90/-015-4i Valuation TRADE SUBCONTRACTOR ADDRESS PHONE STATE LIC. NUMBER ASPHALT CABINETS ( 2 CARPETS CARPENTRY CEMENT CONT..Ml'I a_ COr i m /�I 10012 Cly°937 7p' 0.rSolt,33/0<0 4p 7JG_ 70 i3-7 k & -2- CEMENT CEMENT TRANSITQ,�TSav'S �o CLASSIFIED SPEC. CLEANUP/HAULING N22 C goo z ��2°sg 3 _ l4 S7 4 DOORS (GARAGE) /4.254 C -4AAGG l%cox-s .0" fv'7/L( DRAPERIES DRY WALL f636 E En��1 S,A. 2g�-QSiR7 ] S T C ELECTRICAL ELEVATOR EXCAVATION Gen,2iQ�e2 Go�eST.co lo° t2asi5 -11 Lf4 G- 40'10 y�2 FENCING - FIRE EXTINGUISHER FLOORING/DECKING FORMICA FOUNDATIONS C'o+�r•2� ef""ev ro Ic�O Z C/�as _ 070 y-� i GLAZING HEATING INSULATION sc.4^)o INs LANDSCAPING LATHING ``pe '�'� ¢�/ , 7 24ik 2- LINOLEUM/ASPHALT LINOLEUM/ASPHALT TILE/GUNITE MASONRY - PAINTING PLASTERING 297 &2 - PLUMBING I AAA/ .-Q 23 SMA -4 �' 4 POOL +29 ^t o SBHT,d' 4f. REFRIGERATION ROOFING .. SANDBLASTING SEWER SHEET METAL SHOWER DOOR SOLAR SPRINKLERS STEEL REINFORC. STEEL STRUCT. STUCCO e qpg 214 TZs TRUSSES/GLU-LAMS TV ANTENNAS WALL COVERINGS WEATHER STRIPPING OTHER SPECIALTY C MPF 0701 -30, Tuy. 10/85 CITY OF COSTA MESA . DEVELOPMENT SERVICES DEPARTMENT PLANNING DIVISION OWNER BUILDER CERTIFICATE OF EXEMPTION 1 am fully aware of the responsibilities as owner builder. The persons named below are my employees and I agree to withhold the following required deductions: Federal and State Income "Taxes, Social Security payments, and Workmen's Compensation Insurance Premiums. My employer's number is Further, 1 hold no objection to a copy of this certificate being forwarded to any governmental agency upon their request for same. Employee's Name Address Social Security No. Under penalty"of perjury, I declare that the above statement is true and correct to the best of my knowledge and belief. Signature Address _ Date (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Jab Address: 1582 ELM AV Suite No Vicinity: ADDITION & REMODEL Parcel Nunmber: 13931214 Applicant: VUKADINOV, SPASOJE Address: 2969 JACARANDA AVE - - - Phone: (714)557-5477 COSTA MESA, CA Zip: 92626 Owner: .VUKADINOV, SPASOJE & LJUBICA Address 2969 JACARANDA AVE COSTA MESA, CA Contractor: OWNER -BUILDER Address: I , Phone: (714)557-5477 Zip: 92626 Phone: Zip: License: 0 Status: ISSUED Applied: 12/18/2001 Issued: 12/18/2001 SCOPE OF PERMIT ELECTRICAL PERMIT FOR ADDITION & REMODEL OF EXISTING-SINGLEFAMILY RESIDENCE.. - INSTALL 51 LIGHT FIXTURES, 35 RECEPTACLE OUTLETS,'32 SWITCHES; & 1 ELECTRICAL , SERVICE TO 200 AMP. REF: B01-01547 i COMMENTS / SPECIAL CONDITIONS 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) 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 %i 0 New Res (3+units) .$0.00 0 Transformers up to-tkva/kw- �, $0.00 �' 0 - - - Pool ISpa --_ $0:00 ` - 0 - % "' ........ :c......up to 10 kJa/kw%`1: ! .$0:00 0 - Lighting Fixts,, $44.63'. ��$54.85 51 - ._ ....up to 50 kva%kw ""$0.00 i,` 0 ' Recept Outlets 65 - ..... .....up to 100 kva/kw"'�-� - $0.001 0 - - Switches - " $30.76 32 . 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, - 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 $0.00 0 Circus'( gen or ride) .- "$O.i 0 Motors to 1 h $0.00 0 Circus (mech ride or lights) . '- $0.00 0 Motors to 11 $0.00 0 - - Christmas Tree Stand; .; x'"$0.00 0 Motors to 501 $0.00 0 Fireworks Stand, $0.00 0 Motors to I $0.00 0 ' " Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $184.24 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS 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 all Jim under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maint}in workers' compensatlon insurance, as required by section 3700 of the Labor Cade, far the performance of the work far which this permit is issued. My workers' compeltsation Insurance Carder and policy number are: Carder: Policy Number: (This section need not be completed i1 the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to became subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERSCOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOL ARE ($100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Uc. 1i Class R Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a Construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a 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 Ucanse 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).): t❑_- 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. C__ 044, 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 em exempt under sec. Business and Professions Code for this reason: Signature: (Date/:-�12 Owner ID verifi diner icanse. ❑ 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 e 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, or200cubic feet of com. ........... . ......................... ............... '""............................ _...................................................................................... ........_.... ........................... .............. ...................................................................................... .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 theappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes 11No (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 wlll the applicant or present or future building occupant require for the work which is the subject of this .application a ff"it for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U 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 WIII any pan 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 fill 01 the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (If 'y0ac, 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: 1 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�purpso�I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection. 12— Signature Of Legal Owner(s) Date- f-1- And/Or Authorized Applicant Date CODE I. INSPECTION TYPE 2&M INTMALs COOE1 INSPECTION TYPE 2M Ifs 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1206 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Placa 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 PLUMBING PERMIT Job Address: 1582 ELM AV Suite No Vicinity: ADDITION & REMODEL Parcel Nunmber: 13931214 ISSUED BY: Applicant: VUKADINOV, SPASOJE Address: 2969 JACARANDA AVE Phone: (714) 557-5477 _ COSTA MESA, CA Zip: 92,626 Owner: VUKADINOV, SPASOJE & LJUBICA Address 2969 JACARANDA AVE Phone: (714)557-5477; COSTA MESA, CA Zip: 92626 Contractor: OWNER -BUILDER " Address: _ Phone: Zip: - License: 0 Status. ISSUED Applied: 12/18/2001 Issued: 12/18/2001 Arch / Eng Address: - l Phone: _ Zip:, License: SCOPE OF PERMIT PLUMBING PERMIT FOR ADDITION & REMODEL OF EXISTING SINGLE FAMILY RESIDENCE. INSTALL 4BATHTUBS, 1 DISHWASHER, 6 GAS OUTLETS, 1 GAS REPIPE, 1 WASHER, 4 SHOWERS;,1 MBAR -' SINK, 1 KITCHEN SINK, 5 WATER CLOSETS;` WATER HEATERS, 1 WATER PIPING, & 5 WASH BASINS. - - REF: B01-01547 -` COMMENTS I EC AL CONDITION EXPIRATION: This permit shall automatically exp wl in 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 (6100) 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 $39.20 4 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 $49.00 5 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 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $49.00 5 Drain, Roof $0.00 0 Shower $39.20 4 Water Heater / vent $24.60 2 Drinking Fountain $0.00 0 Sink, bar $9.80 1 Water Piping (Inst or Rep.) $9.80 1 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (1-4 outlets) $6.15 1 Sink, kitchen $9.80 1 Water Softener $0.00 0 Gas (Over 4 outlets) $2.20 2 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $000 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULAIEU FEEb: $2131.85 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related COMMENTS I EC AL CONDITION EXPIRATION: This permit shall automatically exp wl in 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 (6100) I ECLARATIONS 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 wh" this permit is issued. ❑ I have and will-maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Cartier: ` o Polity Number: (This section need not batomplated it the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. q Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code), Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the fallowing 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).): 19:�I; as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt der seBusiness and Professions Code for this reason: c tSignature: Dae: 2 U Ower n by d ers license. ❑ Yes ❑ No Dnvees'License No. Expres: - 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 B, California Administrative Cate). ❑ 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 Cade 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, or200 cubic feet of compressed . ............................................... _...................................................................................................................................... ...................... ............. .................................... ............ _........................ 2 Does or will the applicant or present or future building ocoupant 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 theaDplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ Ido (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ....................................................................................................................................................................................................................................................................................... ......................I...................................................................... 4 If en 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 application appemlil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be 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 re..... .............. ............... ..................... ................................. ..................................................................................... ... .. .......... 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 Cale Section 42303 been made? ❑ Yes ❑ No ..._............ .........................._..................._...................._............................................................................................................................_............................................................................ 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Ignature Of Legal Cwner(s) - fDate And/Or Authorized Applicant Date CODE I. INSPECTION TYPE PAIF. IKITALS CODE INSPECTION TYPE 1AR IIi1ITALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical Lr 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final BlocWRetaining 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 (714) 754-5273 • Fax (714) 754-4856 - www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 1582 ELM AV Suite No Vicinity: ADDITION & REMODEL Parcel Number: 13931214 Applicant: VUKADINOV, SPASOJE Address: 2969 JACARANDA AVE Phone: .(714) 557-5477 COSTA MESA, CA Zip: 92626 Owner:-'VUKADINOV, SPASOJE & LJUBICA Address: 2969 JACARANDA AVE COSTA MESA, CA Contractor: OWNER -BUILDER Address: Phone: (714)557-5477 Zip: 92626 -Phone: Zip: License: 0 ISSUED BY: Status: ISSUED Applied: 12/18/2001 Issued. 12/18/2001 SCOPE OF PERMIT MECHANICAL PERMIT FOR ADDITION & REMODEL OF EXISTING SINGLE FAMILY RESIDENCE INSTALL 2 FAU'S, 1 GAS PIPING, -1 FACTORY, FIREPLACE, 4 VENT FANS,- & 1 HOOD WITH MECH EXHAUST. "- ' REF: B01-01547 ISSUE FEE $23.50 Inst FAU <100 k BTU $29.60 Inst FAU >100 k BTU $0.00 Repair/ Alt Cooling/Heat $0.00 Inst / Rep. Recess Wall Htr $0.00 Refrig Sys <100 k BTU $0.00 Refrig Sys >100 k BTU $0.00 Gas Piping $6.15 Factory Fireplace $10.65 Hood w/Meth Exhaust $10.65 VAV Box $0.00 Vent Fan / Single Duct $29.00 Appliance - $0.00 Fire Dampers $0.00 Smoke Dampers $0.00 Inst or Relocate Appl Vent $0.00 Air Handlers < 10000cfm - $0.00 Air Handlers > 10000cfm $0.00 Floor Furnace $0.00 Floor or Suspend Heater $0.00 Quantity tEE SUMMARY - Quantity Repair / Alt Absorbtion Unit $0.00 ' 0 " Repair/ Alt Refrigeration Unit $0,00 0 Ventillation System '$0.00. � 0 Evaporative Cooler $0.000 -':Commercial Incinerator $6 00 !0 - -- -. Domestic Incinerator <'- $0.00 - -0 Compressors /Absorption Systems /,/" X10 -` Up to 3 hp /,IQ* BTU.�t;" - > - -� $0.00 3 To 15 hp / 500 k BTU' ' som 0 15 To 30 hp/ 1,000 k BTU, ,$O.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 3 hp $0.00 0 3 To 15 hp - ='/ $0.00 0 15 to 30 hp $0.00 0 30 to 50 hp - , iii $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 $109.55 COMMENTS I SPECIAL CONDITIONS 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 I 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 2aa6a6 (6100) DECLARATIONS WORKERS' COMPEN5ATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of Consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carrier 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.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION W06 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # Class # Contractors Signature: Date: CONSTRUCTION. LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I'as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. t�7044, Business and Professions Cade: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Cade: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). -0-1 am exempt under sec. Business and Professions Code for this reason: -Signature: r - Dato: — 2 on Owner I by d es license. ❑ Yes [I 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, An 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 hes 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). ........................._................... ............... _........... _....... __............. _................... _._............... ...................................................................... _._............................................. _................................ -............. ........................................................_... 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 an RMPP is presently required, has Section 25534 of the California Health and Safety Cade been fully complied with? ❑ Yes ❑ No ......._...................._.................................. -..............._.............._............................................-................................._...................................................................... ..........._.................................................................. .................. I.............................. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 15 No (Section 65650.2 of the California Government Cade requires that the requested information be furnished on applications for non-residential building permits). .................................................................................................... ..................... ..._................... .................................... ............................................................................... 8 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a School? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ................................................................................................._..................................................................................................................................................................................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ..................... .............................................................................................................................................................................................................................. B (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 7 S atur egai Owners) �_ _ And/Or Authorized Applicant Date CODE t. INSPECTION TYPE QA¢, ItiImELS CODE INSPECTION TYPE 2AM ILLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical f 1..-0�( Qi/ 1266 Pool Spa Final 208 Final Plumbing _ 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.&ULDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1582 ELM AV Suite: Vicinity: ADDITION @ SIDE & REAR OF HOUSE Parcel Number: 13931214 Zoning: R1 R1 Applicant: VUKADINOV, SPASOJE Address: 2969 JACARANDA AVE Phone: (714)557-5477 COSTA MESA, CA Zip: 92626 owner: VUKADINOV, SPASOJE & LJUBICA Address 2969 JACARANDA AVE COSTA MESA, CA Contractor: OWNER -BUILDER Address: Zip: Arch : Address: Phone: Phone: (714)557-5477 Zip: 92626 Phone: License: 0 Eng Address Status: ISSUED Applied: 02/08/2001 Issued: 06/04/2001 ISSUED BY: Phone: Zip: License: License: SCOPE OF PERMIT RECONSTRUCT EXISTING SINGLE FAMILY RESIDENCE ON EXISTING FOUNDATION; CONSTRUCT NEW 784 So FT. ADDITION ATTACHED TO SIDE & REAR OF HOUSE. ALSO, CONSTRUCT NEW 430 So FT ATTACHED 2 -CAR GARAGE. _ FEE SUMMARY ' Plan Check: $977.18 Calc Valuation: $190,216.36 Permit: $1,503.35 Claim Valuation: $0.00 SMIP Res: $19.02 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $2,499.55 SETBACKS MAIN STRUCTURE Front 20-0 Rear 10-9 ACCESSORY Front 0-0 Rear 0-0 PARKING Existing: 2 Required: 2 NOTES PLANNING"&ZONING Left 5-4 Right _ - 5-2 ; Left - 0-0 Right .-0-0 Proposed:' 2 - 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 (WO) G DECLARAVONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workerscompensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and policy number are: .. Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars ($100) or fess.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION JIGS OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Llc. A Class k Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects me applicant to a civil penalty of not more than five hundred dollars ($500).): rW/ 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: SignaW`re --"� _ ✓ rP ) Dater —YD Owner '1D verified by is licerfeC. ❑ Yes ❑ No Driver's License No— Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): E ^ ,� 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 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. ......._........_.........._.........._......a,n,_......*e.q.._................_.................._._.......................a"l'i......_.......................................................................fu.1'1.............................................. .............._............................................................................. 4 If en RMPP is presently required, has Section 25534 of the California Heelih and Safety Cotle been fully complied with? ❑Yes ❑ No ..................................................................................................................... ildi..........................................................................................................................................pliC...........................................................................................difi................ 5 Does or will the applicant u present or future building occupant require for the work which is the subject c this a plication a allo for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency.? � Yea � 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 (It 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _............._........._........._..........._............_............._.........._..........................._—.__............istr...._.............___._.__.__._........................................_.................. -is...................................................................................ub-j......................... 7 a a permit from the South Coast Air Ooscri Management District or other air pollution control 303 been made? ❑Ves ❑ No 8 (If'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to Comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to Occupy or allow Occupancy of any building authorized by this permit until final inspection. SignatureOf Legal Owner(s)� _ _ Date - Ir J Anci/Or Authorized Applicant Date CODE r. INSPECTION TYPE PATF INTRIALS CODE INSPECTION TYPE qT INTmALS 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 BlocWRetaining 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 FAIN UHIVL, GUb IA MtSA, UA VZOZO ELECTRICAL PERMIT Job Address: 1$82 ELM AV Status: ISSUED Suite No Applied: 06/04/2001 Vicinity: HOUSE & GARAGE Issued: 06/04/2001 Parcel Nunmber: 13931214 Applicant: VUKADINOV, SPASOJE ISSUED BY: Address: 2969 JACARANDA AVE Phone: (714) 557-5477 COSTA MESA, CA Zip: 92626 Owner: VUKADINOV, SPASOJE & LJUBICA Address 2969 JACARANDA AVE Phone: (714)557-5477 COSTA MESA, CA Zip: 92626 M "01D Contractor: OWNER -BUILDER Address: Phone: Zip: License: 0 ICATE-za-491m QM SCOPE OF PERMIT ELECTRICAL PERMIT FOR ADDITION'& REMODEL OF EXISTING SINGLE FAMILY RESIDENCE. ' INSTALL 24 LIGHT FIXTURES, 70 RECEPTACLE OUTLETS, 31 SWITCHES, & UPGRADE ELECTRICAL SERVICE. 'REF: B01-00189 FEE SUMMARY_ Quantity - - - - Quantity; ISSUE FEE $23.50 _ - Temp Dist System / Lighting $0.00 0;, , Temp service test" $0.00 , , ;, Busway /100 It $0.00 --1,10 Res. a/c package - $0.00 Standing Section $0.00 - ;"/,o New Res (1-2 units) $0.00 0 Misc Electrical Equipment _ $0.00 % WORKERS' COMPENSATION DECLARATION: EEL- 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. ❑ I have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: _ Cartier: Policy Number:.__ (This section need not be completed i1 the permit is valued of one hundred dollars ($100) or less.) ❑ 1 certify that In the performance of the work for which this permit is Issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUWECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. N Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirn that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit sub' cts the applicant to a civil penalty of not more than five hundred dollars ($500).): . I,.asowner 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. It, 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 and sec. Business and Professions Code for this reason: - Si netury At�� /�� Expires Verification of Ownership by (type of document, i.e. - property tax'bili or deed):"-'� DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 1 ' r r ❑ I hereby certify that no excavation five (5) ar 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, or20............................................ . ............................................................. ........................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves ❑ 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 theappplicant 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 II an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ..............................................................................ro..e........._......................_...................................................................................-h.i............................................................................................................................_.............._......................_... 5 Does or will the applicant u present or future b District occupant require for the work which is she subject c this a plication a ermit far such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Ves � No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ......__................................................................................................................................................................................................................................................................................................................................................................. 6 WIII any pan of the facility t0 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). I...... ......................... ........................................... ............_........................................................................................ ...................................................................... ............................ ................................ ......................................... ..._......... ................. 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 ................................................................................................................................................................................. ...................................................... B (II 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 ]the 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 u above-described property for inspeTttion purposes. I a ree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ��_` �, Zr-2=00 S atur�gal Owner(s) T� LDale } And/Or Authorized Applicant Date CODE I. INSPECTION TYPE INTMALS CODE. INSPECTION TYPE QAN INTRULs 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 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 MECHANICAL PERMIT Job Address: 1582 ELM AV Status: ISSUED Suite No Vicinity: HOUSE & GARAGE Parcel Number: 13931214 Applicant: VUKADINOV, SPASOJE Address: 2969 JACARANDA AVE Phone: (714)557-5477 COSTA MESA, CA Zip: 92626 Owner: VUKADINOV, SPASOJE & LJUBICA Address: 2969 JACARANDA AVE COSTA MESA, CA Contractor: OWNER -BUILDER Address: Phone: (714) 557-5477 Zip: 92626 Phone: Zip: License: 0 Applied: 06/04/2001 Issued: 06/04/2001 ISSUED BY: SCOPE OF PERMIT f MECHANICAL PERMIT FOR ADDITION & REMODEL OF EXISTING SINGLE FAMILY RESIDENCE. INSTALL 2 FAU'S & 5 VENT FANS, REF: B01-00189 ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Hlr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Meth Exhaust VAV Box V / Vent fan /Single Duct: Appliance ' Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers> 10000cfm Floor Furnace Floor or Suspend Heater _ FEE SUMMARY Quantity - - - $23.50 $29.60 2 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0,` '. so.do 0 • � $0.bo 0, is $36.25- $0.00 0 '� $0:00- $0.00 0 -$0.00 "'o $0.00 ' $0.00. 0 $0.00 0. '$0.00---: 0 $0.00 -0- $0.00 0 Repair /Alt Absorbtion Unit Repair/ Alt Refrigeration Unit Ventillahon System ; Evaporative Cooler Commercial Incinerator Domestic Incinerator i Quantity . $0.00 _ 0 $0.00 0 $0.00 0 , $0.00 0 $0.00 0 $0.00 0 ' Compressors /Absorption Systems Up to 3 hp / 100.k BTU,_ $0.00 0 3 To 15 hp / 500"k'BTU_' $0.00 0 15 To 30 hp / 1,000 k BTU ", $0.00' 0 X30 To 50 hp 1, 1,750 k BTUj ,-i j ;� $0.00 0 - - Over 50 hp / Over,1,750 BTU ' f.- -, �� i. $0.00 0 Boilers Up to 3 hip $0.00 0 3 To 15 hp,.". $0.00 0 15 to 30 hp',. $0.00 0 30 to 50 hp i $0.00 0 Over 50. hp $0.00 0 .� - Other Mechanical 41e " Investigation Fee- $0.00 - Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $89.35 COMMENTS / SPECIAL CONDITIONS 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 per mit. FOR INSPECTIONS CALL: (714) 754-5626 r 24463616/00) CONSTRUCTION AND PLANNINGPOC APPROVALS - Permit # Date Inspector ;PA - AppROVAALS 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 OF ER Grnd. - 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduif-Undrgrnd. - 8' Foundation 59., Gas Pipe, ❑ Undrgrnd.; Test 9. Water Pipe-Undrgrnd. 60.. Backwash Lines,'P-Trap, O 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. RoughElectricWiring - " 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-[] -Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing - 73. Undergrnd. Storage Tank O Gas ❑ Oil 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: 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 _ r 42. Backflow Preventer 43. Backflow Irrigation 44- .Landscape Irrigation System 45-. Sound Attenuation �l 46. Handicap Regulations • 47. FINAL STRUCTURE &BUILDING i 148. Special Requirements Completed I49. Electric Release to Edison, r' I50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY 'p. Date _ - , COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 317 COSTA MESA. CALIFORNIA fOit APPLICANT TO F/LL /N COMPLETELY TYPE OR PRINT I® COSTA MIESA, CALIFORNIA 0 FEE _RECEIVED FINANCE DEPT. APPLt"TtlpnfRFMFARMIT BUILDING FOR Off/CE USE ONLY OWNER Knightwell Land Company, RECEIPT NO. I Y PERMIT NO. MAILRECEIVE 419 E. 17th Street BY DAT REC IVED ED PATE ISSUED 1I A ADDRESS l �. g Costa Mesa, Calif T1EOLTI 81159 BUILDING CITY ARCHITECT Carlson & LIC. 'NEERNO. COSTA MESA, CALIFORNIA OR ADDRESS Garden Grove FIRE ZONE TYPE GROUP Dike & Colegrove, Inc. STATE 167293 APPROVED CONTRACTOR LIC. NO. BY DATE sE. 17th St., Costa Mesa 419 ADDRESS ZONING LEGAL LOT 487 20 NO. OF USE OF NEW I DESCRIPTION NO. 0 BLOCK TRACT PLANS ll, / BUILDING APPROVED A.P. NO. BV L(/ DATE SIZE 100 NO, of BLO1 1 Non YARDS OF LOT X NOW ON LOTT REQUIRED ALLOWED USE OF.R None (CENTER LINE ST.) EXISTING BLDG. FRONT FT. IN. SETBACK LINE FROM �1 551 271 CENTER OF STREET REAR YARD R. SIDE FT. IN. SIDE YARD ILEFT 51 (RIGHT 101 L. SIDE FT. IN. DESCRIPTION OF WORK REAR FT. IN. NEV X ALTERATION ADDITION - REPAIR I II MOVING II DEMOLISH BUTNO. OF SIZE161,7ROOMS 7 STORIES EXTERIOR WALL ROOF � COVERING Stucco COVERING Shake QFC }+/ USE OF BUILDING AND WORK TO BE PERFORMED y Sin le fa nil residence with attached garage 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT BROWN UNDER VALUATION 19 FOR THE THE PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCT( N. VALUATION SIGNATURE OF PERMIT FEE $ 36.00 PERMITTEE $ 16,862 PLAN CHECK S 18.00 Dike & olegrove, Inc. AUTHORIZED AGENT TOTAL FEE $ 54.00 _J Pr1I0 7?—,F-100 647�i d* * i 72 C;1-00 647 * *** w COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 }7.05 0 0 nrn_ APPLICATION FOR�Bl71 -DING PERM"t IT�rt,=>''� For Applicant to Fill in Completely RECEIVED BY DATE RECEIVED DATE SUE BUILDING . ADDRESS OWNER r L LONG A.P. NO. '3•/pZ_ PE IT MAIL, ADDRESS S�'"Z BUILDING ADDRESS /^-1 rr// CITY (� i�T'ti N1FaQ NO. J`��`72 TRACT � LOT V BLOCK U Z Q CONSTRUCTION NEW ADD A T R REPAIR LENDER !/ (n Co N BRANCH / OWNER - ADDRESS SE C! VALUE ARCHITECT TEL. U Q K OR ENGINEER N• ZONE TYPE 'GROUP ADDRESS � y(� OCONTRACTOR ATLPs 13U1t -D:FrLS APPROVED 7 BY 1 el� DAT / ./ Q ADDRESS Airy JZ Z Ir w = ZONE NO.OF PLANS USE' NEW BUILDING G TEL. CITY Cdsrz �Qr 04 NO. 545 X443 STATE CITV LIC. NO. -11-7444 LIC. NO. V��f YARDS APPROVED MAIN BUILDING - YARDS APPROVED ACCESSORY BUILDING U (r O - SIZE rr / NO.OF BLDGS. OF LOT �J k O NOW ON LOT (FROM C/L STREET) FRONT FT. O FT. USE OF �+QQ EXISTING BLDG, f••'J R SIDE F,. FT. N z SIZE OF ._ NO. OF NEW BLDG. ROOMS STORIES L. SIDE FT. FT. L% EXTERIOR WALL COVERING ROOF COVERING REAR FT. q /� FT. USE OFy�-tUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & `'"�'�d�0'^-�"�r^`•f MAIN BLDGS. ACCESS. BLDGS. 0 Gl^^¢tw.0 g /ic-c•C.[ VAR. # C.U.P.# DATE APPROVED / APPROVE ' �.% /' Z 0 U 0 C47 I hereby acknowledge that I have read this application and state that the above information, is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. UtAlft p I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, SQ. FT. 9yw�,,vy THE AMOUNT SHOWN UNDER M-rl IS FOR Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A EE ONLY: am exempt from provisions of the State of California Business and Professli o "visio Chapter VALUATION QO QV PERMIT FEE $ •� Signature Permitte $ PLAN CHECK $ Authorized Agent TOTAL FEE $ }7.05 0 0