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Home My WebLink About1612 ELM AVE - Building Permits I. CITY OF COSTA MESA • ^o w'E `� BUILDING DIVISION :,, it II 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us t. ,, FOR INSPECTIONS CALL: (714)754-5626 itlIcirgot PERMIT NUMBER: B09-00218 • PERMIT TYPE B_ROOF2 STATUS: ISSUED APN: 13931221 DATE ISSUED: 10/01/2009 ISSUED BY: RMD JOB ADDRESS: 1612 ELM AV-CM' ` Suite/Unit:; :_. Vicinity: HOUSE AND GARAGE . Squares: 2800 Valuation $6,000.00 SCOPE OF WORK: TEAR OFF.(E)ROOF_MATEIRALS, INSTALL 2 LAYERS OF 30#FELT AND REROOF WITH 30 YEARS COMP SHINGLES ON AN ATTACHED,HOUSE AND GARAGE,APPROX 28 SQUARES. REPAIR AND REPLACE SHEATHING AS NEEDED. OWNER: NICHOLS, MARTIN.E TR,." - - -: Address: 1612•:ELM AVE .-- Unit: PHONE: - - - City/State/Zip: COSTA MESA,CA - APPLICANT: BROTMAN,'IFATAddress: 6212 AURA AVE ` - Unit : PHONE: 310-570-0077; - - ' - - . City/State/Zip: RESEDA,CA - CONTRACTOR: PRESTIGE REALTY AND CONSTRUCTION INC' - License No. ' -920935 Address: 6212 AURA AVEUnit: .. PHONE: . 310-570-0077- _ City/State/Zip: RESEDA,-CA -- . 91335 •- CELL: ARCHITECT: License No. PHONE:, ENGINEER: License No. . . PHONE: FEE SUMMARY Reroof Plan Check: - - _ • Reroof Permit Fee: -. $125.25_.- - , Reinspection Fee: $0.00 Bldg Std Admin Fund $1:00 ' _ _ - TOTAL FEES $126.25 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE#. INSPECTION TYPE DATE INnnALS CODE TS INSPECTION TYPE DATE INIITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof Ha 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 l WORIJL_IS'COMPENSATION DECLARATION: Owner ID verified by driver's license. ❑Yes ❑ No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: 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 Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm (This seaon need not be completed d The pennd a valued al one hundred dollars(S100)or less.) 2 Art 2Sec.341 Title 8.California Administrative Code). Policy Number: El As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless issued,I shall not employ any r,-rson in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensati•• of California, and agree that if I should become subject to the worke ' •.rmpensation provisions of Section 3700 of the Labor Code, I shall forthwit r, ply with these provisions. Applicant's Signature Date • to\t � Division of Industrial Safety Permit Number: • • - 'i Signature ` (�Datea\` HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? El Yes El No (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires.with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in/full force and effec. a registration form for acutely hazardous materials? 0 Yes El No Cla$s`.>Y'�' • (Section 25533 of the California Health and Safety Code, with some C••-jr . , exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely Contaadr'esigreture VDet'-' - _ -- 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). El I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ElYes ElNo (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER.BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes El No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes El No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested 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 information be furnished on applications for non-residential building permits). Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? El Yes El No applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044. Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? El Yes El No thereon,and who does such work himself or herself or through his or her own 8. (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and El I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044. Business and Professions Code: The contractors License Law does not apply to an owner of Signature Dale property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 u tt tial in pection. Signature of Legal O e s) Da1te Signature Date 5``\�(l 306)d6(3107) And orAuthonzG�ed Applican S~ [pple1_ "\ :.k • Its CITY OF COSTA MESA teal BUILDING DIVISION > : DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER tel j> PERMIT •�y! �, E07-00370 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaaECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • Job Address: 1612 ELM AV • Status: ISSUED Suite No Applied: 04/25/2007 Vicinity: KITCHEN AND BATH Issued: 04/25/2007 Parcel Nunmber: 13931221 Applicant: JIMENEZ, MANUEL Address: 29831 VISTA DEL ARROYO _ Phone:_818-262-6047 ISSUED BY: _ c_elil__ AGOURA HILLS,CA -, -.Zip 91301 " .. • • Owner: NICHOLS, MARTIN E TR ', Address 1612 ELM AVE - N. -Phone: - • b s • C. COSTA MESA,CA Zip: 92626-4953.- . I ,, Contractor: -QUALITY CONSTRUCTION " ' , Address: 29831 VISTA DEL ARROYO Phone:! 818-262-6047 , AGOURA HILLS,CA Zip: ; 91301 , License:852512 ' - . - SCOPE OF PERMIT , r • , MINOR KITCHEN REMODEL/REPAIR.REPIPE MAIN WATER LINE FROM METER TO RES-WITH COPPER, - 1 LIGHT, 1 PLUG, 1 SWITCH, REPLACE KITCHEN COUTNER TOPS.PLUMBING TO INCLUDE: 1 ' , '. KITCHEN SINK, 1 WASH BASIN,1 WATER RE-PIPE.NO STRUCTURAL WORK. , • ' 'REF:B07-00527 .''7 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 . , • i New Res(1-2 units) $0.00 , ".+ 0- _„ _ .' Misc Electrical Equipment i $0.00 0 New Res(3+units) , ' $0.00 0 Transformers up to 1 kva/kw , $0.00 Pool/Spa $0.00 0 -'up to 10 kva/kw - $0.00 0' ; Lighting Fixts $1.10 - 1 -up to 50 kva/kw $0.00 0 . ,, _ , Recept Outlets , _ $1.10 1 - up to 100 kva/kw $0.00 0 Switches, - $1.10 1 over 100 kva/kw $0.00 -i,:0' i '- - Non Res Appl. - -V ', $0.00 0 _- ,+,i'-, Low Voltage Equipment $0.00 S% A Res Appl=. - ` --\,,-$0.00 I 0 w ' d %.'` LowVolt Wiring System/Ckt •$0.00-/;', 0 Service to 200a - , -"$0.00 0 •,-,•,,:-..! -- Misc.Conduit-'-M. $0.00:i' 0 - Service to 1000a - `.$0.00 ;; 0 ^- Misc.Conductor„_.,, • `.c': t--- $0.00 0 " Service over 1000a , I> $0;00� _ 0. Circus(gen or ride) " - ' " $0.00 0 ' •Motors to lhp - ' ,-j '-$0.00" L , 0 : " Circus(mech ride or lights) . .,. ';$0.00 .0 ' Motors to l0hp • ,.$0.00 - N.•0,- - . "Christmas Tree Stand ' $0.00 0 - Motors to 50hp ' / .$0.00 , 0 Fireworks Stand .- '/ Motors to 100hp ,, - ,-$0.00 i ' 0- - ''_ _ ' Other Electrical Fee-' . $0.00 , Motors over 100hp - $0:00" , 0- - - - - Communication drops `<-"',', .-$0.00, , 0;/ - "'-Investigation Fee - ,, ,„ $0.00';$0.00;,' 1 Sub panel to 200a ' ' -10.00 ' _ , 0 -_ ,Plan Check Fee - ', -- $0,00 , Pole Light Pkg $0.00 0•, , ' ' 1, - Reinspection Fee' - I --$010'0- Sign Circuits $0.00 ' _. 0 's - ,:2 Temp Pwr Pole $0.00 - -0` . - - TOTAL CALCULATED FEES--$26.80 Intermed Pole $0.00 - -0 ,_ rnuueiiro r oner,w r nnunurunue 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 ( ) fl 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 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 ❑�I have and will maintain workers'compensation i icynce,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My works seompesatlon Insur Mer end liq number are: ,c,�� ,Cerra-�7 r' Number: fen\ /s I ;(?itis section need not be completed If the permit Is vs ed 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 To la,and agree th If ould become subject to the workers'compensation provisions of Section 3700 f the La or Code,I shall forthwith comply with these pr sion D /47 ApplicenbSigMnawre:� ate:' G(W'ICL " [ WARNO'FNLURE TO SECURE WORKERS'NMP Ti ERAGE IS UNLA AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PE TIES AND CIVIL FINES UP TO ONE HUNDRED THOI LSAND DOLLAAE($100,000).IN ADDITION TO THE F COMPENSATI GES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am license• rovisions of Chapter 9(commencing with Section 7000)of Division 3 otthe Business Professions Code,and my license is in full force and effect,, cLl 0-- fir iA Glass p- Contractbra SIgnatura:j e Dater 0 - 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. 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,em 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 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,Califomia 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: D ivision 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? 0 Yes ❑No (Section 25505 of the Califomia 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? 0 Yes 0 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 lime 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 0 N (Section 25534 of the Califomia 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 Califomia 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 permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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? 0 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 prescnbed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 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. Si. , re Of Legal Owner(s) Date lt ' a� O/ 7 q._".Autho'zed'Appli nt IV CODE L INSPECTIONTYPE DALE I[IIIDALS CODE I INSPECTION TYPt DATh DEALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1286 Pool Spa Final 208 Final Plumbing r�� 200 Final Re-Roof 210 Final Electrical Et 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 .- , ,5111 9 CITY OF COSTA MESA 4 BUILDING DIVISION - F _ii-Sn•Afi , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER .) I • PERMIT ,� E07-00370 4y -"peorrm0o ee ' (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mes--tLtuTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1612 ELM AV - Status: ISSUED Suite No Applied: 04/25/2007 Vicinity: KITCHEN AND BATH Issued: 04/25/2007 Parcel Nunmber: 13931221 Applicant: JIMENEZ, MANURE Address: 29831 VISTA DEL ARROYO - -•..-__ .Phone: 818-262-6047 ISSUED BY: AGOURA HILLS,CA Zip , 91301 Owner: NICHOLS, MARTIN.ETR ' ' - Address 1612 ELM AVE - Phone: COSTA MESA,CA- Zip: 92626-4953- - Contractor: QUALITY•CONSTRUCTION , Address: 29831 VISTA DEL ARROYO Phone: 818-262-6047 - ' AGOURA HILLS,CA Zip: . 91301 . , License:852512 r ' SCOPE OF PERMIT ' • MINOR.KITCHEN REMODEL/REPAIR.REPIPE MAIN WATER LINE'FROM.METER TORES WITH COPPER, : 5 LIGHTS;1 PLUG, 1 SWITCH,REPLACE KITCHEN COUTNER TOPS. - REF:B07-00527' N - • , - ' FEE SUMMARY - Quantity - . . - . .. - - - - Quantity ' ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 , ' Temp service test • $0.00 Busway/100 ft y $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'l kva/kw ' $0.00 0 i . , Pool/Spa -• ' $0.00 0 •up to 10 kva/kw $0.00 0 ' , Lighting Fixts , $5.50 - 5 up to 50 kva/kw • $0.00 0 - • - ; ' Recept Outlets ' $1.10 1 -up to 100 kva/kw Switches ' ' $1.10 1 over 100 kva/kw . $0.00 • 0 . Non Res Appl . - . $0.00 0 •1-:.::Low Voltage Equipment $0.00 ". 0 Res Appl `.'_ . $0.00 i 0 Low Volt.Wiring System/Ckt $0.00 '•0 Service to 200a ,$0.00 r 0 Misc.Conduit.,- $0.00 - 0 Service to 1000a ' x $0.00 0 - ' ' Misc.Conductor-„ $0:00'. 0 Service over,1000a - $0.00, ,i,-C • -0:. ;,' .. Circus(gen or ride))•'• ,.,$0.00 0 , Motors to 1 hp ' . $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 Feel '' :$0.00` Motors over 100h .' $0.00 Communication drops -,-`, $0. 00 , - 0 , - - _ Investigation Fee - 10.00 ,- : Sub panel to 200a N $0.00. ` -0, / - Plan Check Fee- . •,, $0;00.-•' ,' Pole Light Pkg $0.00 ' ' 0 '1 • - Reinspection Fee �, $0:00 , Sign Circuits $0.0001 , Temp Pwr Pole $0.00- ' _ 0 ' TOTAL CALCULATED FEES c' $31.20 Intermed Pole $0.00 ' -0..11.- 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 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 ( ) fl 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 workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. •m !•: :nd 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 wo e ' m iemotion Inr carrier d policy number are: '/ Carrier: `r- - Piiiailp /(z•T 3 is-- • section need not be completed if the permit/s slued 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' com::- : . -ws of C: omia,and agree that if I should become subject to the workers'compensation provisions of Sectio 3700 of the Labor Code,I shall forthwith / •ywith th: e pr• � , , / • •. x:FAILURE TO SECURE WORKERS'COMPENSATION•p ENERAGE IS UNLAWFUL •SHALL SUBJECT AN E •CRIMINAL PENALTIES MD CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($103,000),IN ADDITION TO THE COST OF•• •ENSATION,0 •,xAS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,MD ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby ani a. licensed under.rovisions of Chapter 9(commencing with Section 7000)of Division 3• •: = ne d Professions Code,and my license is in full force :-•'tD ` F / a /n br yLllrm� C., /i/Mii tit L-. - siii?: 477/' -7/O 6121STRUCTIONLENDING 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. 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 under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,Le.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)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? 0 Yes 0 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 then a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _.._r.._ 'building need ._ __ ...f_._._ 2 Does or will the applicant or present or future building occupant neeto file a registration form for acutely hazardous materials? 0 Yes 0 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 then 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? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aPPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ 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? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safely 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? 0 Yes 0 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. Signature •f e I•• ner(s) Date 7 ie/ And/Orrt4?flplicant ,r D. e v —0 CODE r ' •I.• •- IMIE IMrTIALD CODES INSPECTION TYPE GATE NmlALa 1616 FIxe•System Final Fire Prevent•n 206 Final Mechanical 1286 Poo Spa . . 208 Final Plumbing 200 Fine Re-Roof 210 Final Electrical 201 Final =IanWReta. e all l Final Fire Pr:•e.tion 202 Final 'actelilfre Place ' 220 Final PI- ing ••p •. 203 Final Si. 22- F'•. Site Air 204 Final Demolition_ 250 Final Building/Occupancy frOW e 9 CITY OF COSTA MESA . BUILDING DIVISION > .�- �I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 PERMIT B07-00527 . amid' (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.8UJLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: • 1612 ELM AV Status: ISSUED Suite: Applied: 04/25/2007 Vicinity: KITCHEN AND BATH Issued: 04/25/2007 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 13931221 Zoning: R1 Applicant: JIMENEZ, MANUEL • - Address: 29831 VISTA DEL ARROYO Phone: 818-262-6047 ISSUED BY: AGOURA HILLS,CA_ -' -Zip: 91301 - Owner: NICHOLS, MARTIN E TR - . ' Address 1612 ELM AVE _ - - - - YID . — - Phone: L COSTA MESA,CA . • .. - - Zip: 92626-4953 - -�EX��- O f A 1 Contractor •QUALITY CONSTRUCTION DATE Address: 29831 VISTA DEL ARROYO , . - Phone: 818-262-6047 . AGOURA HILLS,CA . Zip: 91301 License: 852512 - , Arch : . , Eng: Address: Address: - • Phone: - Phone: . . Zip: - License: i - License: ' - SCOPE OF PERMIT - ' MINOR KITCHEN REMODEL/REPAIR.REPIPE MAIN WATER LINE FROM METER TO RES WITH COPPER, 1 LIGHT, 1 PLUG, 1 SWITCH,REPLACE KITCHEN COUTNER TOPS. PLUMBING TO INCLUDE: 1 KITCHEN SINK, 1 WASH BASIN, 1 WATER RE-PIPE.NO STRUCTURAL WORK. FEE SUMMARY - . -- Plan Check: $0.00 ' - - . . ' : - ';Calc Valuation: $3,000.00' Permit: $83.25 Claim Valuation: -$3,000.00 SMIPRes: $0.50 ' • SMIP Com: $0.00 ' Other: $0.00 : : Inspection: • , $0.00 ' ' Total: $83.75 • . . • :'- .,,PLANNING &ZONING SETBACKS ' 4c-�:9'' �. - _` , MAIN STRUCTURE,Frbnt �0',0 Reels?...0 0 ' Left 0 0 , Right 0=09/ , - - .\ t--. • t°: - - �,` ACCESSORY Front,, 0-0 1„.: . ` -Rear: 0-0” - - Left 0-0 Right; ' 0-0, r. - / PARKING Existing://70„ 'Required: .0 „ Proposed: 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{6/00) DECLARATIONS ) , l WORKERS'COMPENSATION DECLARATION: 1 hereby affirm under penalty of perjury one of the following declarations: O I 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. J❑., 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. f workers' nation Insure 9 carrier and poll y number are: rCameC •76:71).‘ / �+ '-� ; w,`-�/ "Pdi be Numbr: o(Th/s section need not be completed if the permit is valu 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 Cal ia,and agree that should become subject to the workers'compensation provisions of Section �e bor Code,I shall forthwith comply with thesepro ,/ 0 7 Appticent Signature:— • '00 / \l-..Date:— WARNINO FAILURE TO SECURE WORKERS'COMPENSATI• ERAGE IS UNLAt 1UL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100.000),IN ADDrr10N TO THE COST OF COMPENSATION, AGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed itedne • • sio z.pf Chaster 9(commencing with Section 7000)of Division 3 tripe Business and ' ofessions Code,and my license Is in full force and efie-.LI ��J'� _ (Class.N_ Contractors Signature:. —%%L� ff. - ;,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 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).): ❑ 1,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.). ' O 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 contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's 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 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: I 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? 0 Yes 0 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? 0 Yes 0 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 Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant Or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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). 6 W III any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 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? 0 Yes 0 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. jar rr'lrrOwner s Date TTA • 'A ed Applicant ' 7 k [klte_. • Coot I MEMO= 261E ItlTMA CODE INSPECTIONTYPE DAM INTITIAL6 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1268 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 Sign222 Final Site 204 Final Demolition 250 Final Building/Occupancy Z' - 1 • 4`,On MF llik9 CITY OF COSTA MESA .. BUILDING DIVISION F ,i ; DEVELOPMENT SERVICES DEPARTMENT PER I NUMBER r,.�a PERMIT P07-00258 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.PL'UMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1612 ELM AV Status: ISSUED Suite NoApplied: 04/25/2007 • Issued: 04/25/2007 Vicinity: KITCHEN AND BATH Parcel Nunmber: 13931221 - Applicant JIMENEZ, MANUEL / L Address: 29831 VISTA DEL ARROYO . - ISSUED BY: :Phone:- 818-262-6047 _ _ AGOURA HILLS,CA ' - 'Zip: 91301 - - • Owner: NICHOLS, MARTIN E TR , . ' ' Address 1612 ELM AVE . , - - - - . ' Phone: - - - - - COSTA MESA,CA .-° - Zip: 92626-4953 - - ' contractor: QUALITY CONSTRUCTION Address: 29831 VISTA DEL ARROYO , Phone': "818-262-6047 AGOURA HILLS,CA Zip:: 91301 • . - License: '852512 • • - SCOPE OF PERMIT - '' . • ' • MINOR KITCHEN REMODEL/REPAIR.REPIPE MAIN WATER LINE FROM-METER,TO RES WITH COPPER, , ,, :REPLACE KITCHEN COUTNER TOPS.PLUMBING TO INCLUDE: 1 KITCHEN SINK, 1 WASH BASIN, 1 WATER RE-PIPE. 1 SHOWER NO STRUCTURAL WORK. 1 RELOCATE WATER HEATER TO THTE REAR OF THE HOUSE.'1,GAS REPIPE ' _ , - - - FEE SUMMARY - - - AMT QTY AMT QTY ' . AMT QTY ISSUE FEE -, $23.50 `Laundry Tub/,Washer $0.00 " 0' Sump Pump " ; • _ $0.00 0 •Backflow irrigation,. $0.00 0 _- :- Landscape:Irrigation " .- $0.00. 0P:- _ ,- Swimming Pool -'$0.00 . 0 Backflow Preventer $0.00 0 ` '. -: - P-Trap - $0.00 . 0 .. • Trap Primer , .- $0.00.; ' 0 Bathtub $0.00 0 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(5t) $0.00 • 0 Dental Units - $0.00 0 Septic Tank - ' $0.00 -' -0 Wash Basin-' , '$9.80 1 Dishwasher . , , '.ti- $0.00 0 Sewer Cap for Demo.. $0.00 0 Wash Basin -Set 4 $0.00" 0 Drain,Floor ' \$0,00 0 Sewer Conned,/ " ' ' $0.00 0 Waste and Vent System ; $0.00 0 Drain,Rainwater' 1.$0.00 0 Sewer Private Line --$0.00 0 Water Closet(Toilet). . , $0.00 0 Drain,Roof $0.00 0 Shower ' ; - $9.80 -1 Water Heater/vent -'$12.30 1 Drinking Fountain •. $0.00 ,0 t;.::, t:-,Sink,bar $0.00 0 --.--'Water Piping(Inst or Rep) $9.80 1 Expansion Tank. ,$0.00' ';0 • Sink,commercial . $0.00 0 . . Water Re-pipe ` $9.80 1 Gas Earthquake Valve „: $0.00 '0- ,;,, ' ' Sink,Floor $0.00 . 0 WaterService I. i; $0.00 0 Gas(1-4 outlets)' -/$0.00_ 0 ,--,,\, Sink,kitchen " $9.80 . , 1 " - Water Softener /•',' $0.00 0 Gas(Over 4 outlets) _ ' $0.00 0 ;',Sink,service/mop .. $0.00 0 - ' ' OTHER'. - $0.00 Gas Repipe '\ $9.80, '1' - Spa(private) , " , $0.00 ' 0 - VIOLATION '" " $0.00 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-CALCULATED FEES: $94.60 " . . - .-i COMMENTS I SPECIAL CONDITIONS,-- •ti • Y • 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) /1 EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if worlds 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: ❑ I 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. AA 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. 'compensation Ins carder aid policy number are: p� '/' • dnotbe ' J Pal /OL`YJ /J- ( -c on need not be completed if the permit Is valued at one hundred dollars($100)or lass.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of C- •mla,and agree that I ould•. ome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith Co'..�•��w•.NitfhI�}th�ese pr. mien _ / ApP'fly!I' A• ti /z _ ( Th$ / TO SECURE WORKERS'COMPENSATION• ERAOE IS UNLAWFU• „••SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TOONE HUNDRED • D OOLLARE(S100.000),IN ADDITION TO THE COST• ITI • PENSATION,D. C• S AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I her irm that I am!icon adelAsislons of Chapter 9(commencing with Section 7000)of Division 3 of the Businessfessions Code,and my license is in full to ss trema e: --/Q--c7 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). 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 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 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 buil0ing structure,scaffol0ing,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 W III 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? 0 Yes 0 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). __.._.._...._.pant need file_...._ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 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 neetl 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? 0 Yes 0 No 5 Does e will the tcAir u present or future buildingsoccupant at requirer for the work which the subject of this a pliestlan e0EeNnit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? �Yes u No (Section 65850.2 of the Califomia 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? 0 Yes 0 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? 0 Yes 0 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. Signatur. •f1;• ner(s) J Date Al And/• . r ••licant CODE• INSPECTION TYPE PAIS R®ALS COpE#• INSPECDONTYPE PATE iiim*tS 1818 Fixed System Final Fire Prevention 206 Final Mechanical Q 1268 Pool Spa Final 208 Final Plumbing 51/7 —67 & 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 O F CITY OF COSTA MESA BUILDING DIVISION . •:f `I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER Ft - ---.ALTELia i J PERMIT P07-00258 Rano • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesap u3MBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1612 ELM AV Status: ISSUED Suite No Applied: 04/25/2007 Issued: 04/25/2007 Vicinity: KITCHEN AND BATH Parcel Nunmber: 13931221 / Applicant: JIMENEZ, MANUEL Address: 29831 VISTA DEL ARROYO • _ -. tISSUED BY: i/4fr‘ • Phone: 818-262-6047 AGOURA HILLS,CA - ; Zip: 91301 • Owner: NICHOLS,-MARTIN E TR Address 1612 ELM AVE - - - - - - , - " - - Phone: - COSTA MESA,CA; ' --, : Zip: 92626-4953 Contractor: QUALITY CONSTRUCTION Address: 29831 VISTA DEL ARROYO - - Phone: 818-262-6047 N ' • AGOURA HILLS,CA Zip: i 91301 "" License: 852512 . - SCOPE OF PERMIT F ` ' ' • , MINOR KITCHEN REMODEL/REPAIR.REPIPE MAIN WATER LINE FROM METER TO RES WITH COPPER, ., • REPLACE KITCHEN-COUTNER TOPS.PLUMBING TO INCLUDE: 1 KITCHEN SINK, 1 WASH BASIN, 1 WATER RE-PIPE. 1,SHOWER NO STRUCTURAL WORK. ' • FEE SUMMARY , . AMT 'QTY ISSUE FEE , $23.50 - Laundry Tub/Washer $0.00 0. 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 , . -. j P-Trap ' - - - $0.00.,,'.0. , -. _ Trap Primer -.$0.00 0 Bathtub $0.00 0 ' --- Pressure Regulator _'$0p0, "OT ":` , - - Urinal Clarifier System $0.00 0 - - • Process Piping(per 10 ft)- $0.00 , 0 - • ?, Vacuum Brkr Bkflow(1-4) $0.000 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 , $0.00 0 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 VentSystem ; $0.00 0 Drain,Rainwater- `'•.$0.00 0 Sewer Private Line - $0.00 0 Water Closet(Toilet)'' ' ' $0.00 0 Drain:Roof \`$0.00 0 Shower_-- :'k ' $9.80 1 Water Heateh/vent-, 1 $0:00 0 Drinking Fountain `$0.00 0 Sink,bar 4-' " $0.00„_ 0 Water Piping(Inst or Rep.) , $9,80 1 Expansion Tank $0.00' . 0 Sink;commercial ' $0.00' .0 Water Re-pipe $9.80 1 Gas Earthquake Valve ` $0.001 o",--;_- ci,Sink,-Floor $0.00 .::0,. -. :Water Service, $0.00 0 Gas(1-4 outlets) ,$0.00' . 0•-. _ Sink,kitchen $9.80 -1V . ' Water Softener $0.00 0 Gas(Over 4 outlets) . -$0.00 0 ; Sink,service/mop " $0.00 - 0 OTHER .. ' ' $0.00 Gas Repipe - %$0.00 ' b „,. Spa(private) $0.00 < ,0-' , ` ' VIOLATION . ,' / $0.00 Gas Service - -$0.00. ,,`0 - Spa.(public) - $0.00'. ,0 - PLAN CHECK '! DECLARATIONS - -k fl 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 workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. •ve and will maintain workers'compensation insurance, required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. y workers'compensationsurence e[e7 nd policyn bar are: : er: -r /CeZ Kj7 A C is section need not be completed if the permit is valued et ne hundred dollars($100)or less.) o 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' compen-• '• . s of Califo la,and a ree that If I should become subject to the workers'compensation provisions of Section 700 of tie Labor Code,I shall forthwith /° with b: : pr ons _- •n�:=nt Sl• ure: r e: / ��/(� r:FAILURE TO SECURE WORKS r ENSATION RAGE IS UNLAWFUL AND SHALL SUBJECT PLOVER TO CRIMINAL PENALTIES AND CML RUES UP TO ONE HUNDRED THOUSAND DOLLARE(MOM IN ADDITI TO THE COST OF PENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. UCENSED CONTRACTORS DECLARATION: I hereby a • a I am licensed nder•rovlsions of Chapter 9(commencing with Section 7000)of Di ' '•-_. of the Business-:- •rofessions Code,and my license is in full force ar %"c. ' L --_ �� Cla _ t actors S• ure: ii `Et l ; ir e NSTRUCTION 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 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 end 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 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 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: I 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? 0 Yes 0 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? 0 Yes 0 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 Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes E 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? 0 Yes 0 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 ihis application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 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 COMPUANCE 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. Signature 0 e S• 'er(s) Da . _ O And/Or A r/r 7' •plicant - 'a-717r CODE L gfsPECBON TYPE v-r R(TtftAL5 CODE) INSPECTION TYPE '. 1 IMA45 1616 Fixed System Final Fire Prevention a 206 Final Mechanical 1266 Pool Spa Final ' OB Fin P mbin•. 200 Final Re-Roof ' 10 mal leair ctrica / 201 Final BIocldRetaining Wall / / 212 Fi I Fire Pr: •• 202 Final Factory Fire Place 2 mai • . g Approve 203 Final Sign _ 222 Final Site 204 Final Demolition 250 Final Building/Occupancy J t'9 CITY OF COSTA MESA BUILDING DIVISION ' ' ,I . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J 1,04 PERMIT liP07-00258 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaPLUMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1612 ELM AV Status: ISSUED Suite No Applied: 04/25/2007 Issued: 04/25/2007 Vicinity: KITCHEN AND BATH Parcel Nunmber: 13931221 it2_____ Applicant: JIMENEZ, MANUEL Address: 29831 VISTA DEL ARROYO _ ISSUED BY: - : 'Phone: 818-262-6047 AGOURA HILLS,CA ' , Zip: 91301 - ' Owner NICHOLS; MARTIN E TR - Address 1612 ELM AVE -- - ' Phone: _. COSTA MESA,CA ' '' Zip: 92626-4953 - "- Contractor: QUALITY CONSTRUCTION Address: 29831 VISTA DEL ARROYO • Phone: 818-262-6047 '• ,. -' AGOURA HILLS,CA Zip:. 91301 - , - • License: 852512' . SCOPE OF PERMIT - MINOR KITCHEN REMODEUREPAIR.REPIPE MAIN WATER LINE FROM METER TO4RES WITH COPPER, - 1 LIGHT, 1 PLUG, 1 SWITCH,REPLACE KITCHEN COUTNER TOPS. PLUMBING TO INCLUDE:.1 ' KITCHEN SINK,-1 WASH BASIN, 1 WATER RE-PIPE.NO STRUCTURAL WORK... r - FEE SUMMARY - "- ' \ AMT QTY - ' - - •'AMT QTY ' AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 , 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 6. . .. • $0.00 0-, _-_.Pressure,Regulator. __$0.00 ;' 0r -_J ' Urinal Clarifier System. _ $000 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 - $0.00 0 Sewer Cap for Demo , $0.00 -0 Wash Basin Set , . $0.00 0 Drain,Floor ' , .`$0.00 0 Sewer Conned '$0.00 -0 Waste and Vent System $0.00 0 Drain,Rainwater. `, • $0.00 0 Sewer Private Line,. $0.00 0 Water Closet(Toilet)' - $0.00 0 Drain,Roof . •\'$0.00 0 Shower -, �':� . , . $0.00 0 Water Heater/vent - $0.00 0 Drinking Fountain '$0.00 0' Sink,barr3 .. $0,00 0 Water Piping(Inst or Rep.) '$9.80 1 Expansion Tank $0;00 0 Sink,:commercial - , '$0.00-!1r,- .0 Water Re-pipe, %• $9.80 1 Gas Earthquake Valve $0.00,' \0 ( ;;-' 5 ,SinI Floor " , $0.00, -.,,:pc:. ;- -- Water Service - $0.00 0 Gas(1-4 outlets). $0.00.• `0. -r Sink;kitchen , , $9.80 . -1` ,, • : Wafer-Softener ' ' $0.00 0 Gas(Over 4 outlets) $0.00 6 -0.'.., .Sink,service/mop ' . $0.00 0 - OTHER' , / '' ' $0.00 Gas Repipe - - !x$0.00'• 0- -- Spa(private) . . $0.00 0- . - VIOLATION • $0.00 Gas Service 6 ' $0.00 `0 Spa(public) -$0.00 _ ,0_ --, - PLAN CHECK - 6 $0.00 Interceptors(Grease,Oil).� $0.00 0 - REINSPECTION- " " $0.00 0 Interceptors(Sand Auto)-`-•$0.00- - ,0 - _ _ - - - TOTAL CALCULATED FEES: $62.70 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 C-) fl 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 workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the r,-. ./..-work for which this permit is issued. ,❑ I have and will maintain workers'compensation insurance,as uired by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. \.My workers'corn atlonn Insurance carder and policy numb r are: tCarfeonrc LtAl& +lOgy"Number:. L Op� (�c3/ ^ `(This'section need not be completed if the permit is valued at one I undred 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 C: •mia,and agree that If should become subject to the workers'compensation provisions of Section 3 00 of the bor Code,I shall forthwith comply with theseprovi ` --y Appllcann Signa /i ' - . .n ',a� _ t�Dat'•ei',"` )d WARNING:FAILURE TO SECURE •- COMPENSATION•/- E IS UNLAWFUL HALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTIES AND CML NES UP TO ONE HUNDRED M THOUSAND DOLLE($100,000),IN ADDITION TO THE COST Of 2 PENSATION,OAMAG- PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am_licensed und' provisions of Chapter 9(commencing with Section 7000)of Division 3 ot.the;Business 3orofessions Code,and my license is in full force and effectSLic:'4 / _ Class 4- /L Contractor's Signature: an �iDate: r �n0 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(commenting 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's 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 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: I 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? 0 Yes 0 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? 0 Yes 0 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)? ❑ o ❑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 Cale been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 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? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). Quality Management 7 If a permit from the South Coast s prescri ed al or nd airpollution control district3 agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Californiaia Health and Safety Code Section 42303 been made? 0 Yes 0 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: I CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the-illtgrna i• 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 en 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. :galOwners) -.At, (An. O f thorized Appl>� A rC�0 LODE t INSPPECTIONTYPE LATE LNTIDAL6 ern - 1a• Atte , I ® DATE w. 1616 Fix=•S -tem Final Fire Prevention 2\\16 Fir■- ech/I.-I 1286 P••I Spa Intl 2,': •lu •• 200 Fin: Re-'cot 2 0 ectrical I� 201 Final : • RetainingWI. NW Final Fire Preve Ion A _ AI I 202 Final Fe '•t Fire Pla• �I� ' 220 Final Planning proval 203 Final Sig- 222 Final Site IIP V 1- 204 Fin: se ollti pn 250 Final Buildin 0 n� I _ `, ' •E - CITY OF COSTA MESA 4 ' BUILDING DIVISION FI ,I DEVELOPMENT SERVICES DEPARTMENT • PERMIT NUMBER 4. PERMIT B06-00764 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.SWILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1612 ELM AV Status: ISSUED Suite: Applied: 05/19/2006 Vicinity: THROUGH OUT HOUSE Issued: 05/19/2006 Primary Occ: R3 Type of Construction:. V-N Parcel Number 13931221 Zoning: R1 Applicant: JIMENEZ, MANUEL Address: 5419 SUNSET BL STE 227 • Phone: 323-464-4625 ISSUED BY: LOS ANGELES,CA Zip: 90027 Owner NICHOLS:MARTIN'E TR Address 1612 ELMAVE . . _ . ' _ Phone: ' COSTA MESA,CA . . Zip: 92626-4953 Contractor: ROYAL BUILDERS ' Address: 5419 SUNSET BL' . STE 227• , " " c,- Phone: 323-464-4625 . LOS ANGELES,CA - Zip:" 90027 •License: 803030 . • , Arch _ / // Eng: - • Address: Address: Phone: - . Phone: Zip: - ,' ..License: . . License: , SCOPE OF PERMIT DRYWALL REPAIR THOUGH OUT SFD AD NEEDED. `. , -, s _-FEE SUMMARY - ' Plan Check: $0.00 r - - — • ="Calc Valuation: , $6,000.00 Permit;,,, $125.25c,, - Claim Valuation: , • $6,000.00 SMIP Res: .' - $0.60 t H SMIP Com:`' $0.00 ;' .. / . Other r $0.00 Inspection: $0.00 Total:. $125.85 . . _ \ PLANNING &ZONING , • SETBACKS ' ; MAIN STRUCTURE .Front .0-0\ • _ Rear..�'0-0' L 'Left 0-0 _Right„; 0-.0' ACCESSORY-; Front 00'.x . Rear I 0-0r .. , ' "Left , 0-0 Right 0-0,-'�- ,,.. - PARKING" Existing: 0'` R a fired' 0 . Proposed: 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 244548(WOO) DECLARATIONS fl WORKERS'COMPENSATION DECLARATION: . . • I hereby affirm under penalty of perjury one of the following declarations: 0 I 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 Insu ance,as required by section 3700 of the Labor Code,for.the performance of the work for which this permit Is issued. LMy workers'co pensation Insur ardor and olicy number are: n Carne 1 ! Li Policy Number: / /�7 gc77& (This section need not be completed if the permit is v feed et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and a roe that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply.with rhes I Ions. (C WAR FAILURE re: �i�Q .t�.��g�� =ateTO ,7/tj sj WARNING:FAILURE TO SECURE WORKERS' NSATION COVERAGE$ONLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100000),IN ADDITION T E OUST OF COMP TION,DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that Iam li • -d oder rovii 'Qns of Chapter 9(commencing with Section 7000)of Division 3 of the Business rofessions Code,and my license is in full force and effect:Lie.# r •.•:fir �7J L-Class qz Co tractof> Signature: Ore , tin L�/yl�r�-7- Date� �-�.4)//ill (a CONSTRUCTION LENDING AGENCY: ///III ❑ 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). 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 the applicant to a cNll 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 sate(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 under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's 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 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? 0 Yes 0 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,ore 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 0 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 Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apemlit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes j�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? 0 Yes 0 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 Duality 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? 0 Yes 0 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 penally 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. . Signature•`'•411•. rr(s) PA LAnd1OrAut .01/.Applicant. �� ' ate— CODE I INSPECTIONTYPE pAm INTRIALS CODE! INSPECTiON TYPE PATE ______H 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 Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place - 220 Final Planning Approval _ • 203 Final Signm 222 Final Be 710/06 F H� 204 Final Demolition 250 Final euiltling/Occupancy, - CITY OF COSTA MESA BUILDING DIVISION > %J..,... `'• DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. ry"/e I PERMIT a "„roactw M01-00067 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1612 ELM AV Status: ISSUED Suite No Applied: 02/06/2001 Issued: 02/06/2001 Vicinity: Parcel Number: 13931221 ISSUED BY: Applicant: COOTER, LYLE Address: 11 WRANGER CT. Phone: (949)766-9500 TRABUCO CANYON,CA Zip: 92679 Owner: NICHOLS, MARTIN E Address: 1612 ELM AVE Phone: COSTA MESA, CA Zip: 92626 Contractor: PREFERRED AIR CONDITIONING SERVICE CO. Address: 11 WRANGER CT. Phone: (949)766-9500 TRABUCO CANYON, CA - Zip: 92679 License: 750418 Arch/Eng : Address: Phone: Zip: License: SCOPE OF PERMIT FAU CHANGEOUT FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $38.30 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 244646(6/00) nilli 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 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: 'Carder: (r {n` ~'/-(' G N L— Policy Number: -Ssw G ? 'e/ s+�,.�7 .8- ` -(This-sactlon need not be completed i/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: l 6 Z�j -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(5100,003),IN ADDRION 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 effecti Lia 4-7Th -7 5 4 1 S 1Contractor's Signature:—- Date: t 21 0 / 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). 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(commenting 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 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 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 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? 0 Yes 0 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? 0 Yes 0 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 Code been fully complied with? 0 Yes 0 No _ _ _..r......_-if.i__. 5 Does e will the oast Air u present a future building occupant at requirer for the work which isi the subject of this a pliestion appeNnit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? �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). 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 0 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? 0 Yes 0 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. Signature Legal Owner(s) Date 2 b2c0 / And/Or odzed-Applicant . - ;ADE I INSPECTION TYPE Pall. INTTALS GOOF I INSPECTION TYPE 3- SLS 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 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 r"v ESS OPBUILONG: 1612 ELM AV DNT' CITY OF COSTA MESA — BUILDING PERMIT EBS NAME IFne"NNICHOLS, MAR TIN E A° �ADDRES3:1612 ELM AVE PERM NO: B 076611 COSTA MESA, CA 92626 PERMIT NO: B 076611 PLAN CHECK NO: N GOVT: N SUPP : N 545-2120 APPL.MAIUNG ADDRESS CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: OTH ARCHRECT°RENGINEER: UC.NO.: JOB DESCRIPTION : ,INSTALL 'VINYL SIDING' PER ICBO# 2517 SQ FT: 10, 452 ARCH.OR ENG.'S ADDRESS: UNT: CLAIM VALUE: 10, 452 . 00 CALC—VALUE: 10, 452 .00 GROUP OCC: R-3 / CONRLACTOR'S HARE At4R E ( 714 ) 241-7402 CarnACTORSMAIMMG 3042 S. ORANGE COMMENTS; INSTALL VINYL SIDING TO RESIDENCE ADDRESS:SANTA ANA CA LiC.ND.: 473042 ***iEiElElEfEfEiElE1E1E1E1E1E3E*iErtiEfEitififiElEiE1E1E1f1E1EiEiE1E#dElE1E#IEIElE#iE1Ff ***iF#iEiEfEiEiffEiEiEfEIElEiEfE1E*iE1E****jE1tll** 92707 LINT: ZONING REQUIR EMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penaty of perjury that I am licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force end effect. CITvuC.NO.:049126 LIC.CLASS:B ` 1 3042 EXP: 10/96 MAIN BUILDING ACCESSORY BUILDING Dora: 1/25/950 cantrader: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN 11 LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of li t em exempt from the Contractors License Lew la the tollowng reason ISedion 7031.5 Business and Professions Code:Any d county(Mitt requires a permit to construct,alter,improve, +emolish,or repair any structure,prior to Gs issuance.also requires the applicant for such permit to file a signed statement that he or she PARKING REQ: PROV: PARCEL: 13931221 Z NE: REF NO: ' licensed pursuant to the provisions a the Contractors License Law(Chapter 9(commendng with Section 7000)of Dveion 3 a the PLANNING N TES> •031and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.My violation d Section > ss 5 by any applicant for epermit subjects the applicant toe civil penally anot more than five hundred dollars WOOD. ******************************************************************************* ❑ I,as owner of the propend or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply to an Owner of property DEVELOPMENT SERVICES REQUIREMENTS who builds or improves thereon,and who does such work Nmsee 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 ownebuiler will have the burden of proving he or she did not build or improve for the purpose a sale). ZONING APPROVED BY DATE: ❑ I.as owner of the property.em exclusively contradng with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors License Law does not appy to an owner of property who builds or improves thereon and who BUILDING APPROVED BY : • DATE: contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). q rr ❑ lamexempunder Section: B.3P.C.,for Nlsreason: APPLICATION ISSUED BY: • DATE: 2 2-C1 ca. Date: Owner: ********************************************** ****************************** I do hereby certifythat I ern aware of and understand the requirements d Califoria Health and Safety Code Sections 25505,25533,and LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;Y 25534.and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for e permit for construction ornwdification from the All Quaky Management District.Residential construction applicators are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 126 .00 1 . 05 Date: Applicant: SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one d the following dedaratons: PLAN ❑ I have and will maintain a certificate el consent to setinsure for workers' Labor compensation,as provided for by Section 3700 of the ISSUE FEE Code,for the performance ofthe work for wtchthis permit sissued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID • DUE ❑ I have end will maintain workers'compensation insurance,as required by Section 3700 a the Labor Code,for the performance of the' TOTALS————> 127 .05 0 . 00 0 . 00 127 .05 127 . 05 .00 - work for which this permit is issued.My workers'compensation insurance carrier and policy number are: Carrier. CONTINElliTAT. EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 127 . 05 OVER/SHORT: 00 Policy Number: WC902525038 11 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK .cis section need not be completed d the perml is for one hundred dollars($100)or less.) 126 . 00 1 . 05 I certfy that in the performance of the work for which this permit'-' ed,I shall not employ any person in any manner so as to become subject to tihe workers'compensation laws of Calif. • N:: B I should become subject to the workers' *************************************************************** ****************pen provi/ion of Section 3700 of the Labor Code with. h . provisions. � Data 2 2Ay (o Applicant: ( INDIVIDUAL F E E BREAKDOWN Warning: lureto Lire workers'compensation coverage laun! -nd dsubject an employer tocriminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil lines up to one hundred thousand dollars(SIOC{000),In add/fl , cost of compensation,damages as provided for In Section 37Osoithe Labor Code,Interest,and erconeyafees. SFR 10452 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 10, 452 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty d perjury that there is a construction lending agency for the END OF FEES performance of the work for which this permit is issued(Section 3097,Civ.Cl. LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and sate that the above information is coned.I agree to comply with at city and county ordinances EICPIRED and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. JU N SALCEDO DATE 5/� ' 1--) 1A) ' 1I ^ Paint Name � i `f 9Date: 04rJi LiG"0151 iG7nt,i1 TOT7.u` Sig at rad Owner/Agent/AppAranl/Comredor DF.,E: U7/_'Si,,. Tipint s.5 L (5151 d8 WP) White-Building A Safety:Green-Fle;Canary-Applicant;Pink-Revenue:Goldenrod-Assessor .. 1 I- CONSTRUCTION AND PLANNING POOL'`"".`r''A IC APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1.tTemporary Electrical Service or Pole 52. Pool & Equipment Location - 1 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -- ,3. Electrical Conduit Utility-Undrgrrid. 54. Forms '4. Electrical Conduit-tJndrgrnd. 55. Electrical Bonding " 5.. Steel Reinforcement''• 56. Rough Plumbing & Pressure Test • -6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings , 58. Electrical Conduit-Undrgrhd. 18. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. - 60. Backwash LinespP Trap('Q Undrgrnd. ' 10. Structural Floor System 61. APPROVAL TO DECK c -7 -. • 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Fiital • ' 12. Sewer Cap , 63. Heater & Vent-Final < 13. Roof Drains 64.- Plumbing System - Final 14. Rough Plumbing - 65. Electrical-Final -15. Rough Electrical-Coriduit 66. Solar System-Final. 16. Rough Electric Wiring - 67. Fencing & Access Approval, - 17. Rough Wiring Sign _ 6B: APPROVED POR,PLASTERING 18. Rough Electrical.T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditionirig_ - .-FIRE_OEPT. REQUIREMEN,I, r.. - 20. Rough Factory;Fireplace - - - 1 - • -APPROVALS..- Permit 21. Ducts, in Structure=." , ° - . . : .70. Underground H9&ro 22. Ducts, Ventilating° - . - ,•. - •• ;71. ProducrPiping O Gas DOil - - 23. Gas Pipe-Rough & Test _ - un '72. Undergrod Flush''- ' s ' -,. 24. Roof-Framing • _ - -73-Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof:Sheathing ; • - • '. 74i-Overhead Hydra '' _ 13.2 ti 26. T-Bar Ceiling (Structural) & Monocoat 75:,Dry Chemical -.17...1 �-r I 27. Frame and Flashing -• .t ' - _ 76. Dry Standpipe - ' . - 4 28. Lathir7g & Sidi9 - ; 77`rFIXED S-YSTEM -F. NALr i'' ' - I Z 29. Insulation - ' 78;-.FIRE PREV. FI[VAL .'- - - -- ` i ^ t c 30. Drywall Nailing : . -4 , HEALTH-DEPT: REQUIREMENT bt - 31. Plaster Brown Coat' `I 1 . '79.,FINAL INSPECTION .. ` 32. Electrical Power Mete.-Final ; a r. 80.-FOOD CERTIFteATE ISSUED.-. ' f 33. Final Electric f • - Notes: - •i34. Final Heating & Air Cpnditioning-` _ " - - i 35. Final Gas Pipe-Test.' . ; - . . - _ e 36. Hood Or GenopY _ .- - . . -37. Final Factory Fireplace - 38. Final Plumbing . e ' ''39. Water'Service-Final - - ,. r r40. Gas Service-Final 1 t r:.... ` 41. Solar Domestic-Final ; - : r. . _ 4 .- .. 42. Backf low Preventer ' - 43. Backflow Irrigation ,. , - - t -C r p • 44. Landscape irrigation System - - _ ` 45. Sound Attenuation . . - 'n ' . 46. Handicap Regulations p r 47. FINAL STRUCTURE& BUILDING _. I." - 48. FINAL PLANNING . - • -I r ' 49. Electric Release to Edison . . 4 T r r - 50. Gas Release to Southern California'Gas Co ' '= " 511. CERTIFICATE OF OCCUPANCY - - ' No Date • MF CIA) OF COSTA MESA co � 9 Q 6`. CALIFORNIA 92628-1200 P.O.BOX 1200 al*, o • nee« :0. O/ DEVELOPMENT SERVICES DEPARTMENT jPaOxmEe.�°� BUILDING DIVISION • NOTICE OF PERMIT EXPIRATION To: Amre Date: 5-15-97 3042 South Orange Permit: ft B76611 Santa Ana, CA 92707 Project Address:1612 Elm Avenue Costa Mesa CA 92626 Our records show that the listed permits were obtained for property improvement or alteration at • the above address and the project was not properly completed. The permits were obtained by: (X ) Contractor ( ) Owner Name: Juan Salcedo Phone:241-7402 License Number:473042 To construct or install: INSTALL `VINYL SIDING' PER ICBO # 2517 The permits are valid for 180 days from issuance or your last inspection,per Section 106.4.4 of the 1994 Uniform Building Code. Should we not hear from you within 10 days, your permits will expire and additional fees will be required to finalize the permit. Your permits will expire on May 25, 1997 Please be on notice that without a valid permit and required inspections completed, you will have encumbered your property with an illegal structure. If you need assistance, please contact THE BUILDING DIVISION, at (714) 754-5273, between 8:00 a.m. and 4:30 p.m. • • 77 FAIR DRIVE Building Division (714)754-5273 • Code Enforcement (714)754-5623 • Planning Division (714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 DyTp.MF . !ITYØFCOSTAMPSA 9 Q quo CALIFORNIA 92628-1200 P.O.BOX 1200 (ri .j "'s+c', e1 . .�(1 ye-1-74ma nE ,O A: :. Vi `JID Li DEVELOPMENT SERVICES DEPARTMENT {yryy p7w !tVE V.°Aena. `'' Clr/ O ®0G914 MESA • F x. ., HIVISIfN BUILDING DIVISION MAY 21 mi NOTICE OF PERMIT EXPIRATION . To: Amre Date: 5-15-97 3042 South Orange Permit: # B76611 Santa Ana, CA 92707 Project Address:1612 Elm Avenue Costa Mesa CA 92626 Our records show that the listed permits were obtained for property improvement or alteration at the above address and the'project was not properly completed. . The permits were obtained by: ( X) Contractor ( ) Owner Name: Juan Salcedo Phone:241-7402 License Number:473042 To construct or install: INSTALL `VINYL SIDING' PER ICBO # 2517 The permits are valid for 180 days from issuance or your last inspection, per Section 106.4.4 of the 1994 Uniform Building Code. Should we not hear from you within 10 days, your permits will expire and additional fees will be required to finalize the permit. Your permits will expire on May 25, 1997 Please be on notice that without a valid permit and required inspections completed, you will have , encumbered your property with an illegal structure. If you need assistance, please contact THE BUILDING DIVISION, at(714) 754-5273, between 8:00 a.m. and 4:30 p.m. ' • • 77 FAIR DRIVE Building Division (714)754-5273 • Code Enforcement (714)754-5623 • Planning Division (714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 - �� Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CIT,YbF COSTA MESA • CON TRUCTI N PERMIT PERMIT NO. TRACT,NO. LOT NO. UNIT NO. - � a, < ,� ✓a _ 'p 1 l 4j_0) I sips 11 /29/84 25,50 IL • Project Address W - I - - /(O! 1,-;/(1.—t CT VE(1 TYPE OF CONSTRUCTION -❑ NEW U ADD El ALTERATION U REPAIR - - �, ' Applicant's Mailin/gPdd1d�ryesss rpt -�^Owner's Name /x!/1F-tr), A /!t//•/O(SPhone445 Z1c(,/ -❑ CONVERSION CI ❑ OT A.P.# - - - I2one r /14/ DESCRIPTION OF WORK/USE OF BLDG. VVV a Address �� `•'/••� ✓ � S Main Building: Accessory Building:- Arch/Eng. License NO. TYPE OF PERMIT H GRADING ❑ FOUNDATION ❑ STRUCTURAL E Front - ZO Address - ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear - - N Contractor's Name /� Phone ❑OTHER. A - • I V PROJECT DESCRIPTION . FT. �! •4-- OCCUPANCY C Right N • Address(mailing) J ' 1 -- K . G City License No. I / CONST RUCTION TYPEALUATION $ r]�/ $ Left ZONE GRADING CU.VD ACRES R LICENSED CONTRACTOR DECLARATION - Ping. Ref.# Parking Req./Provided • E I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: • Planning Notes: M with section 7000) of Division 3 of t e Business and Professions Code, and M my license-is in full force and Oren I - T License Class ("') License No. 'S Date • Signature r PLUMBING FEES ' WORKERS' COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL • FEES hereby affirm that I have a certificate of consent to self insure or a certificate •• Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer . Service Sink - Automatic - - - - - 300, Lab. C.) - - Washer Transformer'❑'15-50,KW Policy No. Company Backflow Irrigation Sewer Cap. Construction Pole Sub. • 150+-KW ACertified copy is hereby furnished. Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Duo to 100 amps Date Applicant - _ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION 1 Clarifiers 1 Solar Collectors - Dishwasher Meter Dover 100 a mps' (This section need not be completed if the permit is for one hundred ($100) or - - - ' less), . Dishwasher Solar Piping , Dryers ❑Gas ❑Electric Sub Panel ' I certify that in the performance of the work for which this permitis I sued, I - - - shall not employ any person in any manners to be su le tot e Drinking Fountains Solar Tank Fan Workers a ssatii n Laws of Calif /��W/n5 .Motors❑0-1 HP ❑iX;8 Date // c PY�i- Signature •�/ '<yi Floor Drains' Swimming Pool w/Spa — F.A.U. 'NOTIC If,a Yet'making this declaration,you should be ome subject to the _ Inc.Solar ❑9-15 HP ❑18-1$+ , Workers'-Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal • Fixtures - - comply with such provisions' or this permit shall be deemed revoked. - Microwave • CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes - 1 hereby affirm that there is a construction lending agency for the performance - - 'Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) • Interceptors • Water Heater I Outlets Lender's Name ,; Range . Lender's Address - ' '- - Kitchen Sink - Water Service h, ' OWNER BUILDER DECLARATION - Switches Sjgn I - I hereby affirm that I am exempt from the Contractor's License Law far the Lavatories • Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal !Standing Sections county which requires a permit-to construct,alter,improve,demolish or repair P-Trap - , Laundry Trays -t - - Generator ❑0-5 KW❑5-15 KW ' • any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor , to file a signed statement that he/she is licensed pursuant to the provisions of • • Roof Drains , - r; the Contractor's License Law (Chapter 9(commencing with Section 7000)of: . . • - - • -Division 3 of the Business and Professions Code) or that he/she is exempt - _ t.,erefrom and the basis for the alleged exemption. Any violation of Section - . . - /., 1. • ' `-031.5 by any applicant for a permit subjects the applicant to a civil ' - - +'penalty of not more than five hundred dollars($500). AI - • U I; as owner of the property or my employees with wages as their sole -Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work, and thestructureis not intended or offered 1 - . Reinspection Fee I $15 Issue Fee • i $ 3 for sale (Section )7044, Business and Professional. Code: The Contractor's MECHANICAL • - FEES - 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 - DEVELOPMENT SERVICES REQUIREMENTS: ,• employees, provided that such improvements are not Intended or offered,for Boiler. - Hood or Type I • ❑ "� sale, If, however, the building or improvement is sold within one year of corn- Canopy Type II D _ Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or,im- Duct-Under Ground , - ' Building Approved ByDate prove for the purpose of sale). - D I. as owner of the property, am exclusively contracting with licensed con- ' Duct-Structural Refrigeration System Application Issued By Dat ' tractors to construct the project (Section 7044,Business and Professions Code: 1 -- - - - The Contractor's License Law does not apply to an owner of property who Duct-Ventilating l ❑0-100,000 BTU ❑100,000 BTU - S RY F FEES " builds-or improves thereon, and who contracts for such projects with.a con- - - - R^ tractor(s) license-pursuant to the Contractor's License Law). I am aware that ' Exhaust System 0 Multiple 0 System Repair/Alteration r, BUILDING PERMIT $ ' �V SMIP $ •S0 , proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK • $ • PERMIT 0 I am exempt under Section — ' s,8 P.C.for this aso • Firepl/Fact.BIt. ICBG# Fire Dampers £ ?JO"' ERMI NCE • $ ' )c i y I 1 PLUMBING $ J(\ I hert4�� Owner// sap 1i /i �t i Heating SYstem&Ducting Registers i' i 1. PLAN CHECK 25% $ ENERGY P.C. $ I here cert y hat I have read th application and s ate that the above - 00-100,000 BTU ❑100,000BTL— GRADING $ information is correct. I agree to comply with all city and county ordinances ' ' - ' ELECTRICAL $ , and:state laws relating to building construction, and hereby authorize repre- MICROFILM . $ ' sentatives of t 's cit. • e ter Bion tn. a,.ve-mentioned pro erty for • PLAN CHECK 50% $ y,•� inspection p ,sass •f I. _/ , �� /(� ) MECHANICAL $ TOTAL FEE $ z�•S1 ) ' Signature �� //-�( ... �/ Date 7 , .� Reinspection Fee $15 Issue Fee ' $ 3disimmoimmm' •PLAN CHECK 25% , $ - ' �\J(,\\ Drivers' Licen e or,SS# � i CMF 0865-46,rev.10/84 ' White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor - - ' CONSTRUCTION AND PLANNING . POG=-..e SPA. •- ' Date • Inspector Date Inspector PAPPROVALS - Permit.* „ APPROVALS - ' Permit # '_ •, 1. Temporary Electrical Service or Pole - , - 52. Pool &:Equipment Location - • . . • - ' 2. -Soil Pipe-Undrgrnd. - 4, 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 UFER Grnd. ' - 57. APPROVAL.TO COVER-GUNITE - ! 7.�Footings - - 58. Electrical ConduifUndrgrnd. - . ::, ;8r Foundation ` -) 59. Gas Pipe, 0 Undrgrnd.,Test , . • .9.•Water`-Pipe-.Undrgrnd. - - 60. Backwash Lines,P-Trap,0,Undrgrnd. ' 10. Structural Floor System • 61.-APPROVALTO DECK - - - -1;1. Pioperty Sewer Line & House Connection • ,62. Backwash'& Receptor-Final- _ - - -12. Sewer Cap ' r 63. Heater & Vent-Final 13. Roof.Drains1 64, Plumbing System - Final ' , 14. Rough Plumbing • - - 65. 'Electrical-Final . . • - . 15. Rough Electrical-Conduit - -66. Solar System-Final . - - - - - - 16. Rough Electric Wiring67. 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 - 20. Rough Factory Fireplace • APPROVALS. Permit# - 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.Stdrage Tank-0 Gas 0 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:140.5- Rave. ax a�l,r 5ei gnme 34. Final Heating& Air:Conditioning a _ -. O �'- e 47 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 I I .- _ . - - . . . _ 43. Backflow Irrigation - • - . 44. Landscape Irrigation System , • . - - 45. Sound Attenuation • I - 46. Handicap Regulations I - I• 47. FINAL STRUCTURE & BUILDING /1/C, C' /) / - , ) • = 48. Special Requirements Completed' ' - .. 49. Electric Release to Edison • -- - - - -I - - - - - - I - • 50. Gas Relea'se to Southern California Gas Co I - i • I I ; : 51. CERTIFICATE OE, OCCUPANCY.. ' 4. ' I -' ' ` Date - .! .- - - - ? - . . t 10760 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT .1-, P.O.BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT. CITY OF COSTA MESA fOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING 1612 Elm Street " ADDRESS USE MESA, CALIFORNIA fOR OFFICE USE ONLY OWNER Knightwell Land Company I RECEIPT NO. I _�� IIT NO. MAIL 419 E. 17th Street RECEIVED BY DATE RECEIVED DATE ISSUED ., ADDRESS `, //i f -jY ._ , yyry CITY Costa Mesa, Calif. TE Li 81159 BUILDING PI b 1UDII NO. Carlson & ADDRESS ARC' TENT LIG. COSTA MESA, CALIFORNIA ' OF NEER P4iddialanZS_ NO. ADDRESS Garden Grove FIRE �/ 11 ' ZONE TYPE GROUP di Dike & Co egrove, nc. STATE CONTRACTOR LIC.NO. 167293 APBY DATE ADDRESS 419 E. 17th St., Costa Mesaa ZONING /� LEGAL I LOT 83 3487 ZO NO.OF USE OF NEW / I DESCRIPTION NO. BLOCK TRACT �� PLANS '�I'BUILDING I\jf��(_J- APPROVED , 1 ) 3 BY I/ DATE [/ • - . YARDS tact 111 REQUIRED ALLOWED USE OF ii (CENTER LINE ST.) _ • FRONT CFT. IN. REARYARD + R.SIDE /0 FT. IN. SIDE YARD LEFT 51 I RIGHT 10 I ' -' L.SIDE S FT. IN. .- DESCRIPTION OF WORK 4 REAR 3 94r. IN. :. NE' IX 1ALTERATION 1 11 ADDITION 1 .REPAIR MOVING EXTERIOR WALL , ROOF 4 COVERING • COVERING R• USE OF BUILDING AND WORK BE PERFORMED . OSin le laza. • -nce with , Lh attached garage 4/31) . Plan 750 B . • I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION SIGNATURE OF PERMIT FEE $ 36.00 i:' PERMITTEE , '1 ,, $ 16 PLAN CHECK $ 18.00 AUTHORIZED AGENT Dike & Cole rove Inc.Inc. + = TOTAL FEE $ 54.00