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Home My WebLink About268 ALBERT PL - Building Permits� ' .- �_� �d::.� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 317 COBTA ME6A. CALIFORNIA For Applieanf fo Fill le Complefely YYPE OR PRINT BUILDING 26 B ?/beh'y"' LO T 32i} ADDRESS COSTA MESA. CALIFORNIA oWNeR 2OTH Q�NTURY HOME6� �NC�. wDOREss 2432 NEClPORT BOUL�EVARD�� GiTy i�.O6TA �MESA Np�-� 893 ARCNITEGT MEL �.OWE voL[ B93 nw wvr_�mwwa �C7oR 2OTH CENTURY-�HptdES� INC ,5 Q�3Q NEVPORT BOU�EVAR�D COSTA �ESA� CqLIFORNIA , 201a-667 '. No: • Ll 8 9388 ....rL..11 e I,n _'1 F,rGn _��o:.oF e�oos. � EXISTING BL�G. N � N E • BHTBACN LINE PROM eex�n oa aiaeer REAR Y � I LEFi � I RIGHT DESCRIPTION OF WORK IX II ALTERATION I II ADDITIO NG .� �23 ROOMS b STORIES � OR WALL P L A S T I ROOF '.NG R E D t40 0 D COVERING ' BUILDING AND WORK TO BE PERFORMED �r� r�cnnnll Y RFSI ❑ENCE 1 HEREBY ACKNOWLEDGE THAT I HAV6 READ THI6 APPLIWTION AND 6TATE THAT THE ABOV¢ IS CORRECT AND AGREE TO COM- PLY WITH ALL CITyYeOiyFt�DI1NA/N�CE6 ANO BTAT W8/�REOU/�LATING SIGNATURE OF� y y' ,�/ � 0' V'� � l. J'A. n� ■ AUTHORIZED AGENT m . FEE RECEIVED � NOV 3 199'1 F�NANCE DEPT. _ CITY OF COSTA AqESA APPLICATION FOR� PERMIT Bui��iN� : . For Offiee Use Only RECEIPT NO. PlNMIT'NO._ T—a`IIn I I NO9"i` BUILDI COSTA MESA. CALIFORNIA FIRE BYPROVE/�/1� OATE ///�� yL/ ZONING 20NEA J/ NO.OF q USE OF NEW 5/M1y, �j I PLANB C� I OUILDING{.��/� , o./� �/�/ a� LEOAV� �/ 3ZY �/� ///r I/j DEBCRIPTION {. A. P. NO_ II ��_ /" a' ��v (CENTER LINE BT.1 ' FRONT s� FT. IN. R.SIDE � FT. 'IN. L. SIDE j_ FT. IN. REAR 'S—v� �� FT. IN. BYPROVED LV�,� DATE ��3/6 / R�� tlOLD FOR SPEC[AL REQUIRFhiENT� TH8 AMOUNT BXOWN UNDER VALUATIONLI� FOH THE PURPOfiE OF EBTpBLI8HIN6 A PENMIT FEE ONLY. VALUATION ,/ � PERMIT FEE $ �^I' S/��{�� PLAN GHECK $ /—� «v�� S ' � ` -� ' � ^A r.i -; , R , , . . . ; °. .� . .� . . , . . ' - , I. _ Conditions,,liefore Final: !'t�'��'�.; , i',lj,�;i�: ,? :� :1.;: :77edication of all land 30' from the center line of existing Albert.Place to the City of Costa Mesa for street purposes. 2. That Street Lights be under the direction of the Street Lighting Supt. r ;_' ' " 3. Construction of 4' resmdential sidewalks on Albert Place the fu11 width of this property by th� �appli`cant at his TexpenseT, under the direction of the City Engineer., T 4. That'this Record of Survey meets all�the requirements of tkie" City Engr. dated 10-9-61. IJ �_ �_ j. Tbat coimnon sewer and water laterals be used for.these 5 lots subject to the approval oi the.Gity �ngineer.,, ;.. T City �gineer's Conditions 6. All construction shall conform to'the standards of the City of Costa Mesa. ,. i i_ �,. , T 7. Sidewa7.iis arid driveways shall be constructed of Portland eement from the cux�b to the property line. , . :: f . , f � i.,=� : .x:: 8. Co�on water services sha11 be used subject to the approval of the Costa Mesa County Water District. 9. Common sewex connections shall be used subject to the approval of the Costa Mesa Sanitary District. Lot 32�, �ar.� owNER �pt.h CENTURY HOMES, INC. dOB ADDRESS ��rt Place — AP No.��A_lf 7 ECTIONS S�__ I � coat DATE 11-ZIy-C71 BUILDING PERMIT NO. LOT �?�� TRAC7Npt.Hts. RIRE ZONE DESCRIPTION OF WORK Res.w/ati Signature DATE GROUP TYPE v 7.ONE _ L l/_ �y P�Rr1ITS ISSUEL ,� , , ��-T-•-q SUBCONTftACTOR ,,,,.,.n �...,..,,� . � _ 3669� COSTA MESA BUILDING-SAFETV DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Complefely BUIIDI ADDRE OWNER MAIL Q'y :�i�_TP��c0�131G'> .:.:,:.:c��.�0 APPLICATION FOR BUILDING PERMIT RECEIVEDBV DATEREC@IVED �oTFisc�u A.P. NO.I I �'}� BUILDING ADDRESS �(� Z. ...,., ., .`..�_ d U CIT O �' A I 1�JA NO` ` Q� TFA��1 Z2 Q CANSTFUCTI W ADD AL R O � LENDER am J � BRANCH J N OWNER m J ADDRE55 J m ARCHITECT TEL. S a OR ENGINEEIi N . U N FIRE wa ZONE T 2 ADDRESS aW W Z P.PPROVED J O CONTRACTOR (�ff �,t r% e�' m Z J � ADDRESS � w TEL. ZONE PLANS ' Z � CITY NO. � w � STATE CITV �'ARDS APPROVED � 2 L14 NO. LIC. NO. MAIN BUILDING �� SIZE NO.OF BL >:. (FROM C/L STF T OF LOT NOW ON LOT FRONT ,�. USE OF I EXISTING BL�G. SI �� T. F— SI2E OF NO. OF � Z NEWBLDG. ROOMS STORIES I.SIDE U EXTERIOF WALL ROOF COVERING COVERING REAR J USE OF BUILDING AND WOFK TO BE PERFOFMEO DISTANCE BET. a MAIN BLDGS. a Q o vna. # p O�vC Ei _ �_oc. rc c.u.P.# (n C NC j0 �� ,� APPROVED p 7 G° SL•�- . VI hereby acknowledge that I have reatl this application antl state � that the above intormation is correct and agree to comply with � all laws regulating building consttuction, antl 1 shall not employ � � any person in violation of the workman's compensation laws ot � Me State of Calitomia. z1 hereby certify that I am properly licensatl as a convactor untler SQ. FT. the State of Calitornia Business and Professions Code, Divisicn 3, THE AMOUNT SH01 Chapter 9, antl thar such licenses are in full force and effect, or 1 THE PURPOSE OF E5 am eaempc from tFe provi5ions of the State of Calitornia Business VALUATION antl Professions Cnog, Division 3, Chapter 9. $ Authorized �� L0T3Z'� BLOCK DATE NEW ,/�QC i �� )S APPROVED BET. MAIN ACCESS. BL DATE APPROVED TF � m � 0 JN UNDER VALUATION IS FOR � ABLISHING A PERMIT FEE ONLV: m ¢ ��7%L� m PERMIT FEE S � 7 m PLAN CHECK $ E �� `o LL TOTAL FEE $ �R COE. Merel uAit so�� GAS WATER 'ROUGH PLUMBING PROP. SWR. LINE � HOUSE CON. ❑ SPRINKLING SVSTEM MISCELLANEOUS ROUGH HEATING AN� AIR CONDITIONING TEMPORARV SERVICE OR POLE UNDERGROlINO ❑ POWER � ROUGH wIRING TRENCHES � FORMS � SiEE� REINF. FLOOR SYSTEM BOND BEAM �] STEEL REINFOACE n SHEATHING FRAME ANO FLASHING LATHING - IN ❑ OUT n PLP<iER, BROWN COAT URAL, FINAL h u, VEN7�, REFRIG. AN� A.C., FINAL PLUMBING, FINAL ANO GAS TEST n ELECTRIC, FINAL 9UILDING, FINAL SUBCONTRACTOR ^ AOP��anl to fill in all spaees within CITY"OF COSTA MESA cegi�61T no� �� COfQS�RUCTION PERMIT C� 9 Address ,Z� g NI.QER>- P,tACF Arch/Eng. License No. Address COntroctordlGRCn t. Da�rTF?rwa/ hor I hereby atfi�m that I am IlcenSeC untl¢r provislons ot Charter 9(tom- mencing with sectlon �000) o! Divlsion 3 ot the Business anC Professions Cotle, antl my license is In full torce antl eftect. Litense Class en o. - Date ff`�F' g� Signature WORKER$' COMPENSATION DEsi ARATION I hereby affirm [hat I have a certrticate ot con5ent to Self-insure or a certificate of Workers' Compensation Insuranca, or a certifie0 copy thereof (Section 3800, Lab. CJ. Por�v No.w-fa-/s9sic comPanv ��E��NT /A/OEMN/Ty ❑� C� rtifietl W py is hereby furnisnetl. I�YCerti(ietl cOpy is filetl with the city Builtling Division. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be complecetl if the permi[ is for one huntlretl (5300) or leSsJ. I CErhty that In the performance of th¢ work for whiGh this permit I5 i55uetl, I shall nOt employ any pe�son in arly manne� so as to bewme subject to the Workers' Compensation Laws of California. Date Signature NOTIGE: If after making this tleclaration, you shoultl berome subject to th¢ WOrkers' COmpensd[ion p�ovisions of the Labo� Cotle, you mu5t (o�thwith comply with such p�ovi5ions Or this permit Shall be tleemetl revok¢tl. CONSTRUCTION LENDING AGENCV I hereby atti�m that there Is a consiruction I¢ndin9 agency for the per- formance of fhe work tor which this permit is issuetl (Section 3097 a�. c.�. Noic/F - -- Lender's Name ` Lentler's AtlCress OWNERBUILDER DECLARATION � � I hereby affirm that I am exempt from tne Contractor's License Law for the following reason�(Section �031.5 Business antl Professi0ns Cotle: Any city or county which. requi�es a.pe�mit to construcf, alter, improve, tlemolish or repair any structur¢, prior to its issuance, also re- quires tM1e applicant tor such permit to file a signetl statement that he` is licensetl pur5uant to the p�ovisions of�the Contractor'S License Law (Chapter 9(commencing with Section ]000) of Division 3 of the Bu5ine55 antl Pro(essions Code) o� that he is ex¢mpt therefrom antl [he basis (or [he allegetl exemption. Any violation of Section ]031.5 by any appliCant fot a pe�mit subjects tne applicant to a Yivil penalty of not more tnan five huntlretl tlollars ($500). ❑ I, as owne� of tne p�operty, or my employees with wages as their sole compensation, will tlo the work, antl the stru<ture is not intentletl or o/fered for sale. (Sec[ion ]044, Business antl Professions Code: The Contractor's License Law tloes not apply t0 an owner ot a property who builds or improves lhereon, antl who tloes such work himself or tM1�ougM1 M1i5 own omployee5� provitletl [hai such improvemen[5 are not intentletl or ofleretl for sale. If, howeveq the builtling or improvemenl is soltl within one year of completion, the owner will nave the burtlen of provinq he tlitl nol builtl or improve for lhe purpose of sale). ❑ I, as owner ot the property, am exclusively mn[ractinq with Iicensetl contractors to construct the project (Section ]044, Business antl Professions Cotle: The Contractor's License Law does not apply to an owner of property who builtls or imp�oves thereon, antl who Con- tracts from such p�o�ects with a contractor(s) licesnetl pursuant [o the Contracfor's License Law). ❑ I am exempt untler Section B. & P. C. for thi5 Dortler lines ana sign all appropriate aeclaratior TRACT NO. LOT NO. BLDG. NO. TYPE OF CONSTRUCTION ❑ NEW ❑ ADD ❑ ALTERATION �REPAIR ❑CONVERSION ❑DEMOLISH ❑ OTHER DESCRI � ON OF �ORK TVPE OF PERMIT ✓ " ❑GRADING ❑ FOUNDATION �STRUCTURAL ❑ TENANT � ELECTRICAL G�PLUMBING �MECHAt ❑ OTHER PHOJECT DESCRIPTION SQ. FT. �I� i.A OCCUPANCY CONSTRUCTION TVPE VALVATION� ��ZONE GRA�ING CU. YDS. ACRES P�UMBING BATHTUBS TOILETS LAVATORIE$ KIT. SINKS SERVICE SINKS ORINKING FOUNTAIN! INTERCEPTORS SWIMMING POOL WATER SERVICE GASSERVICE� WATER HEATERS SEWERCONNECTIONS SOLARTANK SOLAR PIPING SVS. ISSUE FEE MECHANICAL PLAN CHECK SHOWERS URINALS DOVBLELAVS DISHWASHER$ SVMPS FLOOR DRAINS CLARIFIERS PTRAP �ALTERATION (� OVTLETS BTU OUTPUT � COLLECTORS PLAN CHECK HEATING SVSTEM 0-300,000 BTU AND DUCTING 100,000 + BTU REFRIGERATION 0-300,000 BTU SVSTEM 300,000 + BTU BOILERS BTU reason Date Owner • � SYSTEMREPAIR,ALTERATION 1 hereby certifythdt I have reatl tnis application antl State that the above EXHAUST SVSTEM MULTIPLE information is correcL I agree to comply with a❑ City antl county ortlinances anG slate laws relating to construttlon, antl he�eby autho�iie rep�esentafives Of [' ci y lo ler pon the above mentionetl property for ins u os s Signature Date � ' �� Drivers' Licenze or 5� �� ISSUE FEE CMF 0865-46 Whlte-Builtling; Canary-Applicanq Pink-Accounting; Goltlenrotl-Assessor �f,B9 F/�^/�I ZONING REGULATIONS A.0. � � ZONE � 1 PLNG. REF. � � To gV S�EaTBAC�KC LST. PROPE�RTVNLINE LIDE VARO 5EF R�IGHTA /1 REAR VARD (TO P/L PKG.SPACEREQ. PROVIDED STREET WIDTH PARK FEE $ ZONINGAPPROVEDBV �'�'�'� DATE SPECIAL CONDITIONS: ELECTRICAL .� h PLAN CHECK TRANSFORMER 0-1 KW_1-30 KW _ APPLIANCE 10-SOKW_SO+KW_ MOTORS 0-1 HP_1-10 HP _ (INC. SOIAR) 30-50 HP 50 + HP _ FIXTURES OUTLETS SWITCHES GAS TUBE SIGNS POLE LIGHTS POLES METERED SUB PANELS MAIN SUB SERVICE 'AMP ISSUE FEE APPLICATION P.PPROVED BV SUMMARV OF FEES PERMIT G g �7�/O�•Spfl SMIP PIAN CHECK $J_( � •�Z PERMIT PLUMBING $�� SSUANCE GRADING PLAN CHECK $� ELECTRICAL $�(•`�� PLANCHECK g MICROFILM �. MECHANICAL $� TOTAL FEE � PLAN CHECK $ LESS AD- VANCEPG ' 3' �'�/ -,�IJ/ S S FINAL FEE $ � �.�� , CONSTHUCTION AND PLANNING POOL & SPA , _ ,.� APPROVALS Permit # � Date Inspector pppROVALS Permit # Date Inspector ,' � 1. Temporary Electrical $ervice or Pole 43. Pool & Equipment Location � • . Soil Pipe-Undrgrn 44. Steel Reinforcement � - 3. Electrical Conduit Utility-Undrgrn . 45. Forms � 4. Electrical ConduibUndrgrn - ' 46. Electrical Bonding � . tee ein orce 47. Rough Plumbin & Pressure Test � 6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE � - ' ' 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51 . Backwash Lines P-Tra ❑ ndr rn 10. Structural Floor System 52. APPROVALTO DECK i t. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final ' Street Sewer Connection 54. Heater & Vent-Final t Rough Plumbing � 14. Rough Electric-Conduit 56. Electrical-Final 15. Rough Electric-Wiring - �J� 57. Solar System-Final 16. Rough Heating & Air �onditioning p� • encing & Access Approval 17. Ducts, in Structure 9. APPROVED FOR PLASTERING � 18. Ducts, Ventilating 19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing ' 21. Roof Sheathin 22. Frame and Flashin NOTES: 23. Insulation 3 - � 24. Lathing & Siding e[��/ 25. Drywall Nailing p� ' � 26. Plaster Brown Coat ' a 27. Electrical Power Meter-Final - � ' �8. Final Electric Final Heating & Air �nditioning { �Z ' cg� - .,J. Final Gas Pipe-Test , g � 31. Final Plumbing 32. Water Service-Final � � 33. Gas Service-Final � 34. .Solar pomestic-Final � � ' - 35: � Landsca e S rinklin S stem �� 36. Sound Attenuation ��- - • � ' 37. Handicap Regulations -� - 36. FINAL STRUCTURE & BUILDING /z, $. 39. Special Requirements Compl2ted 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATEOFOCCUPANCY • ' • No' Date TYPICAL Cement Coping Optionol —� Channel Block With I-3/8 � 0 Horizontal Top of all Fences 6'� Concrete Block Fence For Fences 5� or �ess —� Vert. Bars 3/8" 0 at 4'-0'�0. For Fences Higher Than 5� - Vert. Bars 3/8" 0 at 32" O.C. Provide Inspection and Cleanout Hole at Location of Vert. Reinforcement FII Cells Solid With Grout- Where Steel Occurs TWO 3/8' 0 CONTINUOUS STEEL MUST BE TIED IN PLACE AT TIME OF TRENCH INSPECTION. HEIGHT. . . . � WIOTH . THICKNESS . DEPTH OF EA SPACING OF f 0 � � r � a > x � � w x Z � O H � W a 1 � f� i � � v�iol�t D' ' � . 0 E�, GHkR" ,;d� BELDW. oc �sz�r�i Of �y < O ^ c r m oe DLi :%� � QO Q 6 H e_�� m ' Z Q 'l�' N�' �' _ F- _ � `° 3 A RT 6�� CONCRETE BLOCK FENCE W S.ir�n.J� Z.`S�.s�, e .- ,�,_' e a c� �. � —.� -.� �r'.' � " ` `' �� x x?wTo r�� 1 V K N Z� �� O C w N d� �� S Z O V K � m j� Z O � �- rj, Iw- 4 F �W -"Y K 2 T 1 g � _�'oc� � � m � m y � 3d �= ,`"-t �; r^ � z o � _; a �� LL a�o = o�. 'n = i:z � co w �„ ;w= ��zo ZZ Ow0�4y:� I�L L�� ti a w� rY- � �. , �� Qoz��o$ �, g `�4 .�.�.w.... . . w� �� _�a �z� � H .m. .O. . v �.. . F� W 1� W+� Q Y C5 N! H �Z � 1 6l K ? • •• • '-12J: . _ u. O �i ;? O .Q City of Costa Mesa, California Building Deparfiment FORM B112!_2M_B-B2 GENERAL- NOTES MORTAR: p�e Part Plastic Cement, and Three Parts Sand GROUT : One Port Cement Three and One Half Parts S'and rts I I � � n � '�`Wuter Fe►'•Sack-ef_CQ�ent - � � I � "-' _. - � � F}E]NFORCI �STEE ,SHAYL CONFORM;��{� �'�� SEC?A=15_�'A.S.T. M:": . , � i ALL STE�; LAPI WHERE SPCJCED;-2--`�0�� ' MINIMUM. i I '� .o ---� ! ; (�iOUT_MAY. �POURED-FROM-:TOP.?OFJ : k�NCE�WLCELLS�WHERE STEEL= OCC�}gS. j j F±OLE-S�,SHALL, BE-CLE'AR, CLEAN�'ANfS ( � FRE£:OF 43LL MQRAAR; DEBRIS�, ETC;WITH< ' IFISPECT.1@N HOLE§ Al'-BOTTOM�� r..; , BDNDS�SIiA'LL �BE•:PRWy DED BY_LAYING AlQ'CKS= IN STR ��H�H COURSES_"S0- � f�HAT VERTICAL'VOI�TS ALTERN TE�IN �� .� E'ACH COURSE� � i:=��-�� DEPTH OF EARTHTOOTH I/3 THE HEIGTH OF FENCE BELOW BOTTOM OF FOOTING. SCALE: I/2��= I' ] y j2 L- r 4� 3� w.�. . 12°.. ... .... 12�� .�. � �.�. 8 �� . . . . . . . 8 �� .o.O = . . . . . � 611 . . . . . . . . . . . � ��I �.�..... .9.'-.0. . . . . . . . I6�. . . . . . . . . . . I6� OWNERS NAME: _ _ _ _ _ _ _ _ _ _ _ _ _ _ JOB ADDRESS: _ _ _ _ _ _ _ _ _ _ _ _ _ PERMIT NUMBER;_ _ _ _ _ _ _ _ _ _ _ _ _ � SIGNATURE: _ _ _ _ _ _ _ _ _ _ _ _ _ _ � � W W � ti � �R�-�' � t'C3„o cOG �E p1'A'NNew6• ° �� 0.E� �3 ��" .�3. .S�'� DA� �p�ilNd by c�°} �v (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Number MECHANICAL PERMIT 268 ALBERT PL 42608419 Applicant NASH, LYN Address: 16691 GOTHARD ST SUITE W, Owner: Address: Contractor: Address: HUNTINGTON BEACH, CA MILICH, THOMAS MICHAEL 595 E PORTLAND AVE Status: ISSUED Applied: 12/13/2001 Issued: 12/13/2001 ISSUED BY: � Phone: 714-375-6468 Zip: 92647 Phone: FRESNO, CA Zip: 93720 ALL SEASONS HEATING AND A/C 76691 GOTHARD ST SUITE W HUNTINGTON BEACH, CA Phone: 714375-6468 Zip: 92647 lice�se:653620 SCOPE OF PERMIT REPLACE FAU IN EXISITING SFD. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refriq Sys <100 k B7U Refrig Sys >100 k B7U Gas Piping Factory Fireplace Hood w/Mech ExhauSt VAV Boz Vent Fan / Single DuGt Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Furnace Floor or Suspend He2ter $23.50 $14.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 Quantity 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEESUMMARY RepairlAltAbsorbtionUnit . Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler Comme rcia l I nci ne rator Domestic Incinerator Compressors / Absorption SVstems Upto3hp/100kBTU �.3 To 15 hp / 500 k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1�,750 BTU Boilers Up to 3 hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Invesligation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 538.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 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 vnth all applicable codas, and all requlred Inepeetlons and final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545826 zaasae �5ioo� WORKERS'COMPENSAnON DECLAFlAnON: � � I hereby aHirm under penalry of perjury one ot Ihe tollowing tleclarations: � � ❑ I heve end will maintain a ceniticate ot consent to self-Insure for workers' compensation, as provided for by section 3700 of lhe Labor Code, tor the peAormance of ihe work for which ihis permit is issued. ave and will maintain workers' compensation insurance, as required hy sec�ion 3700 of ihe Labor Cotle, Por Ihe peAormance of the work for which Ihis pertnit is issuetl. My workers' compensation Insurence cerrier and policy number are: Carrier: Policy Number: (7)iis section need not be cromplefed il the permit is valued at one hundred dollars ($100J or less.) ❑ I certity that in the padormance of the work for which this permit is issued, I shall not employ any person in eny manner so as to 6ecome sublect to the wakers' compensa[ion laws of Califomia, and agree th R I should �ecome suD�ec� to ihe workers' compensation provisions of Sectio 3700 ot t e Labor Code, I shall forthwith comply with these pmv" ionsy nn 7 /9 i ApplicantSignaNre: �-�i YlX1 �� Date: 1�/ I�I O I WARNING: FAILURE TO S UPF WORKERS' CO) PE SATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIM� ALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE (5100,000�, IN ADDITION TO THE COSi OF fAMPENSATIIXJ, OAMAGES AS PROVIDED f-0R IN SECTION 31060F THE LABOF CODE, IMEREST, ANO ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm Ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, entl my Ilcense is in full force entl ettect. Lic. N Class N f� (' Contrectors Signature:�" . _ e�� Date: CONS7RUCTION LENDING AGENCY: ❑ I hereby attirm that there is a consimction lending agency for the pertormance ot the work Por which ihis parmit is issued. (Sec. 3097, Civil Code). Lendets Name: Lenders Address: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby aHirm that under penalty ot perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe toilowing reason (Sec. 7037.5, Business antl Professions Code: Any city or county which requires a permit to consimct, al�er, improve, demolish, or repair any stmcture, pnor to its issuance, also requires Ihe applicant tor such permit to file e signad statement that he or she is licensed Dursuent to �he provisions ot the Coniractors License Lew (Chapter 9(commencing with Secllon 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt thereirom and ihe basis for the alleged exemption. Any violation oi Section 7031.5 Dy any applicent for e pertnit subjects the epplicam to e civil penalry of not more ihan five huntlretl dollars ($500).): ❑ I, as owner of the property, or my employees with wages es their sole compensation, WILL DO 7HE WORK, and the slmcWre is not intended or oHerad for sale (Sec. 7044, Business and Professions Code: The Contractors License Law tices not apply �o an owner ot property who builds or improves Ihereon, and who does such work himself or herseN or through his or her own employees, provitled that such improvements ere not Intended or oHered tor sale. If, howevar, ihe 6uilding or improvement is sold within one year of completion, the ownar-builder will have the burden of proving ihat 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 consimct the pwjact (Sec. 7044, Business antl Professions Code: The coniractors License Law does not apply to an owner of propeny who builtls or improves thereon, antl who contracts for such project with a contractor(s) licensa pursuant to ihe ConUactors License Laws.). ❑ I am e:empt under sec. Business and Professions Code for this reason: Signature: Date: Ownar ID varifietl hy driver's license. ❑ Yes ❑ No Driver's License No. Vedficetion oi Ownership by (type of tlwument, i.e. - propeny tax 6i11 ar tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Eapires: ❑ I hereby certify thai no excavation five (5) or more feet in depth inm which a person is required to descentl, will be made in connection with work euthonzed by this pertni�, and that no building strucWre, scaHolding, falsework, or demolition or dismantling thereoi, will be more than thirly-si: (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Calitomia Atlministrative Cotle). ❑ As owner-builder, I will not employ enyone to tlo work which woultl require a permit from the Division of Industrial Sefety, as notetl above, unless such person hes e pertnit to do such work irom ihe division. Signature: Date: Division ot Indusirial Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTFiV: I certiy under penalry of perjury that I have read this application and state ihat lhe information given is correct. I egree to comply with all state laws and city ordinances relating to 6uilding construction, and authonze representatives of the City ot Costa Mese to enter upon the above-descnbed properry for inspection puryoses. I agree not to occupy or allaw occupancy of any building authorized by this permit until finel inspection. ��ignet Qf L�7al Owner(s) I!I ��I �' Da�e '7/i+� �� And/O�Authonzed Applicant Date COOE f. INSPECTION TYPE 1616 Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Flnal BIocWRetaining Well 202 Final fadory Fire Place 203 Finel Sign 204 Final Demolition Q� �$ � COOE� INSVECTIONTYPE 206 Final Mechanical 208 Finel Plumbing 210 Final ElectriCel 212 Finel Fira Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency