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Home My WebLink About109 ASPEN LN - Building Permits4-6 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant Bill ijCompletely — Use Ink Only BUILDING , /j,. .) OWNERfjj&-&Te MAIL ADDRESS TEL. CITY NO. BRANCH ADDRESS ARCHITECT TEL. ADDRESS CONTRACTOR ADDRESS CITY TEL. NO. STATE CITY LIC. NO. LIC. NO. SIZE NO. OF BLOCS. OF LOT NOW ON LOT Separate permits are required for electric, plumbing and heating work. E OF BUILDING AND WORK TO BE PERFORMED I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of Permittee _ Authorized Agent k 7928 j0k3 78 2-155.00 T� 7`92B 10/30/78 -218.000K16 79.28 '0000446961 " APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY I DATE RECEIVED DATE ISSUED 4 A.P. NO. PERMIT NO. BUILDING ADDRESS Q I IITRACT LOT BLOCK W JADD I ALTER [REPAIR OWNE �. VALUE USE417,G*iliiC$ FIRE ZONE TYPE GROUP APPROVED BY DATE ZONE NO. PLANS USE OF NEW BUILDING YARDS APPROVED MAIN BUILDING YARDS APPROVED ACCESSORY BUILDING (FROM C/L STREET) FRONT FT. FT. R. SIDE FT. FT L. SIDE FT. FT. REAR FT. FT. DISTANCE BET. MAIN SLDGS. BET. MAIN & ACCESS. BLOCS. VAR.# C.U.P.# DATE APPROVED -77 APPROVED QATF 10. �I ' SO. FT. THE AMOUNTSHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION $ PERMIT FEE $ PLAN CHECK $ TAX $ TOTAL PAID $ CITY OF COSTA MEG,. BUILDING DIVISION PERMIT NUMBER DEVELOPMENT SERVICES DEPARTMENT PERMIT ✓ M99-00227 (714) 754-5273 Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 109 ASPEN LN Status: ISSUED Suite No Applied: 05/13/1999 Issued: 05/13/1999 Vicinity: CONDENSING UNIT REAR OF PROPERTY. Parcel Number: 43917213 ISSUED BY: Applicant: ARTHUR, MARIA Address: 3148 YELLOWSTONE DR Phone: 714434-9120 COSTA MESA, CA Zip: 92626 owner: SCOTT CALDWELL, STEPHEN Address: 109 ASPEN LN Phone: COSTA MESA, CA Zip: 92627 Contractor: ARCTIC REFRIGERATION Address: 3148 YELLOWSTONE DR Arch I Eng: Address: Phone: 714-434-9120 COSTA MESA, CA Zip: 92626 License: 523761 Phone: Zip: License: SCOPE OF PERMIT INSTALL NEW 3 -TON CONDENSING UNIT, FURNACE 8 COIL. FEE SUMMARY ' Quantity Quantity ISSUE FEE $22.00 Repair/ Alt Absorption Unit $0.00 0 Inst FAU <100 k BTU $13.25 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 $13.25 1 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/500k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp 11,000 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 $48.50 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 AOL 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. 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' cos�p/e%p�jS�ation Insurance carrier and policy number are: Carder: ("� / t�� i� Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation#�rvCisaions.N of lifornia, and agr t if I should become subject to the workers' compensation provisions of Be ti 3700 1 the Labor Code, I shall forthwith comply with th� P�� Applicant Signature22 4 Date: / /WARNING: FAILURE TURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI�NALPENALT AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOUARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is 0 full force and effect. Lic. Class If -Contractor's Signature Date: CONSTRUCTION LENDING AGENCY: Q 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects 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.). ❑ 1, 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 ❑ 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 bm7dfng structure, scaffolding, fatsework, or demolition or dismantling (hereof, will be more than thfay-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Celifomia Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes . ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. __- 4 If an RMPP is presently required, hes Section 25534 of the California Health and Safety Code been fully complied with? []Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aermit 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 Govemmant Code requires that the requested information be furnished on applications for non-residential building permits). 6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. Signature L I OyR)§t(—� Se� ' And/Or Authorized Applicant Date gOPFJ INSPECTION TYPE 26B IIS" CODE INSPECTION TYPE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 800 Final Re -Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval. 803 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46