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HomeMy WebLinkAbout2009 BALEARIC DR - Building Permits CITY OF COSTA MESA 9 BUILDING DIVISION >•`jinikalarlit , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4Pi PERMIT E01-00110 q `0k.0 O`4* (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2009 BALEARIC DR Status: ISSUED Suite No Applied: 02/06/2001 Vicinity: Issued: 02/06/2001 Parcel Nunmber: 13945402 Applicant: COOTER, LYLE ISSUED BY: Address: 11 WRANGER CT. Phone: (949)766-9500 TRABUCO CANYON,CA Zip: 92679 Owner: JOHNSON, RICHARD J TR Address 2009 BALEARIC DR Phone: COSTA MESA,CA Zip: 92626 Contractor: BILL PASLAY HEATING A/C & ELECTRIC Address: 2860 E GRETTA LN UNIT P Phone: (714)666-2799 ANAHIM, CA Zip: 92806 License: 511695 SCOPE OF PERMIT ELECTRICAL PERMIT FOR INSTALLATION OF NEW 4 HP MOTOR FOR NEW NC UNIT. • FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $12.30 1 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $35.80 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 2466-66(6/00) DECLARATIONS ( '1 �"' 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: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) frar I ceitity 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:- [Dater-- `Z— 6 to O WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provishnns of Chapter 9(commencing with Section 7000)of Division 3 of.the.Buslness and Professions Code,and my license is in full force and effect Lic.q 1 S /)/' 75 [nags p -/ C 7 o I-l/c ContractoCs.Signature: Dater x Z b)C1 i i.._-- — 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 drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly 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? ❑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 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(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 end 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 Of Legal Owner(s) Date ��/ ._2. ( -6 / Zoo: And/OrAuthoriz Applicant. __ -_ - (,Date—^-- CODE r INSPECTION TYPE PEE 1Nf1TIALS CODES INSPECTION TYPE PATE 1NODAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing r 200 Final Re-Roof 210 Final Electrical alt//D/ LC 201 Final Block/Retaining Wall 212 Final Flre Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ,501 F CITY OF COSTA MESA BUILDING DIVISION -- >:l „' ,It DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J PERMIT ISRIV41n1 Existing: 3 Required: 4 Proposed: 0 B03-01209 q, -"Rnouro`e . NO (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.c&uS.ILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2009 BALEARIC DR BUILDING Status: ISSUED Suite: Applied: 07/17/2003 Vicinity: ROOF Issued: 07/17/2003 Parcel Number: 13945402 Zoning: R1 R1 /�---� Applicant: ERIC PETERSON ISSUED BY: Address: 1653 SUPERIOR AVE Phone: (949)642-7222 COSTA MESA,CA Zip: 92627 Owner: JOHNSON, RICHARD J TR Address 2009 BALEARIC DR Phone: COSTA MESA,CA Zip: 92626 Contractor LEE ROOFING OF COSTA MESA Address: 1653 SUPERIOR AVE Phone: (949)642-7222 COSTA MESA,CA Zip: 92627 License: 349686 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 1/2"O.S.B.,30#FELT,50 YEAR COMPOSITION SHINGLES,PRESIDENTIAL. 18 SQUARES INCLUDES ATTACHED GARAGE. • FEE SUMMARY Plan Check: $0.00 Calc Valuation: $5,900.00 Permit: $125.25 Claim Valuation: $5,900.00 SMIP Res: $0.59 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.84 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existina: 0 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 r-, WORKERS'COMPENSATION DECLARATION: I hereby affirtn•und'ei enalty of perjury one of the following declarations: 1 ❑ 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. dkI 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. i My workers'compens tion Ins oce carrier(land policy number are: Carrier: ' P U UNA CJI Policy Number: ,20cY S— - 200M (This section need not completed i/the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the w•. • - ' •er 't is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and ogre= at if I should••=me subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: L. v �.—_._ Date: 7/ f 7 �3 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL E TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($10 .o00),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 provi ion of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# 0---- Contractors /Contractors Signature: - Date: CD 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 end 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 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 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 a_pPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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? 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 propertyy for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. j �:aurroln•t•r-:: ciiiiiii DaI o 3 An. •r Authorized Applican ate ;ODE I. INSPECTION TYPE QAIE INTRIALS CODEk INSPECTION TYPE REEF IITITIAI$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final208 Final Plumbing 200 Final Re-Roof ' 7-7/y9; 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy _ p ' 'F 9 CITY OF COSTA MESA BUILDING DIVISION . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 171 IIP PERMIT PCIlk ar "wroo c` / V M01-00068 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2009 BALEARIC DR Status: ISSUED Suite No Applied: 02/06/2001 Issued: 02/06/2001 Vicinity: Parcel Number: 13945402 ISSUED BY: Applicant: COOTER, LYLE Address: 11 WRANGER CT. Phone: (949)766-9500 TRABUCO CANYON,CA Zip: 92679 Owner: JOHNSON, RICHARD J TR Address: 2009 BALEARIC DR Phone: COSTA MESA,CA Zip: 92626 Contractor: BILL PASLAY HEATING NC & ELECTRIC Address: 2860 E GRETTA LN UNIT P Phone: (714)666-2799 ANAHIM,CA Zip: 92806 License: 511695 Arch/Eng : Address: Phone: Zip: License: SCOPE OF PERMIT MECHANICAL PERMIT FOR CHANGEOUT OF EXISTING FAU AND A/C. 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 $14.70 1 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 $53.00 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS • WORKERS'COMPENSATION DECLARATION: I hereby 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: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) —I 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: 1�� ate:. 'Z 1-� 7 Tye/ WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3.of-the Busigess and Professions Code,and my license is In full force and effect.Llc.# 1 5 I/64 5 ( CIass.#- c- 2_o fh c Contractor's Signature: •- ,S/ e' - J wor 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 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,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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ Yes IIU 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 this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 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 Of Legal Owner(s) Date 7 And/Or Authorize - plicant . - LDate OODE t INSPECTION TYPE PAIL INTRIALS COQEU INSPECTION TYPE 41-0(DATE 1�LS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 3 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 SEE RECEIVED MAR 2 2 1963 COSTA MESA BUILDING-SAFETY DEPARTMENT _. FINANCE DEPT. P.O.BOX 317 COSTA MESA,CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Comphttely APPLICATION FOR PERMIT Q4, './3 41 f' TYPE OR PRINT 6-7.69 BUILDING BUILDING �(� n ,n- For Office Use Only ADDRESS ^Q 0 9 /'I-7-4-1�O ry'1.GCi 4. A RECEIPT NO. PERy1T O. ////COSTA MESA, CALIFORNIA /) 1y 1C ED OWNER[J((- tl// C�l/�iJ'( RECEIV DBr D�A�TE RECEIVED 73.-/j PLR DAT2E 19 U1943_ MAIL �J./ • n, J BUILDING •1 ADDRESS /; c? P7C- el-t-Ca /C YOU ADDRESS_ FIRE 1// I� (�� CITY m1.Q.otti NO. 3 9�TEL. ZONE TYPE GROUF�� / jf ' ARCHITECT ��/j�� LL // TEL. 7112---- APPROVED U OR ENGINEER . 2a7;2 t1C.'AC NO. a,, G. / BY DATE `f�� n ///� ZONING ADDRESS ?7/721. >r�j�Gl.l��y0,4{ L"/ti„ icNQ NO.Osi_ USES OAF NE 1��1 CONTRACTOR al.4. /Z�-QC A.-0-1_,2((�� ��(�l bbr LEGAL4 I-111-- i-2I B( �A�[ryD I •r T 1 ' 1 ADDRESS /os3 )/7 14.44.!_ti, / C/ DESCRIPTION J T CJl 1 eat Y��---- l i A.P.NO. L,� CITY 7'/c � Qpi / NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATETEL.A !/7/l /, NO. r$Z- O 3 2/� SO"TO SIDE a REAR P.L. LIC.NO. �" // 9 EAVES OF LOT IO $ /0 0 SIZE I NOW ON LOTS 0 ALLOWED (U.B.C.REQUIREMENT) YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. � ..5-1.3REAR YARD-3%k it (FROM FRONT CS O3rr./L rr. SETBACK LINE FROM CENTER OF STREETG SW.YARD I LEFT I I RIGHT 8 R.SIDE pSFT. FT. DESCRIPTION OF WORK L.SIDE /FT. Fr. NEW j� ALTERATION ADDITION REAR �JL(FT. l9 FT. DISTANCE BET. BET.MAIN& REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS. BUILDING q p_,, ,A NO.OF VAR.j{' DATE SIZE Gyn^ c9 .0'`�I BROOMS jr STORIE C.U.P.�{' APPROVEDEXTERIOR �'-/T COVERING .0 c-C.p-1 COVERING � N BYPROV�� DATE I--/ USE OF BUILDING AND WORK TO B PERFORMED _�/ f.�r ,l,Q-C�O.rc s.e_.., LeV I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE A VE IS CORRECT AND AGREE TO COM• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY O IN NCES AND STATE WS REGULATING ypLUAT10N /-// q BUILDING CORE OF U ON.re PERMIT FEE $ / 2- jN SIGNATUPERMITTEF OF C! N reI / $ (PO/ 90?_ PLAN CHECK $ .? G °' AUTHORIZED AGENT /, (/ TOTAL FEE $ 1 OWNER PACF.SFTTFJ2 WEST JOINT VFN'1'IIRF DATE 3_22-63 JOB ADDRESS pOO9r,Pal esri e Thel ye BUILDING PERMIT NO. 19125 GENERAL CONTRACTOR Andros T.nnd Company VALUE $ 22,592.0Q AP No. LOT lel TRACT 4348 FIRE ZONE DESCRIPTION OF WORK res att gar INSPECTIONS Signature DATE GROUP 1&J TYPE V ZONE Ni Soil 1/ 1///,_/z PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBEI Water ty zeiv. re-6.; z-_-:-1/2"Rough Com. Refrig. 0 Air Cond. ❑ Rough Heating (L-//s- / -2744 r2Ei[rol_ _ ,i ISL 6 ,1 /_‘ Rough Plumbing /_ //J{_ %, '7-(, _ Miscellaneous / - / -_-yL " a Prop.Swr.Line gHouse Con. ❑ St.Swr. 0 ' W e/ d-/,-6_3 ,3,s�j(�\ Sprinkling System --� Construction Pole 4t�1(91 Underground 0 Power ❑ �//''j� fI1_ Rough Wiring r" -4 I-C� SeaoY ue csa.✓ e-y,�-r/,3 yo/ 9 — Trenches Icl-- Forms (B —Steel Remf.'11 ',yp! —,r Floor System /q' j/-?f Bond Beam 0 Steel Reinforce 0 , f Sheathing ;..W-43 Frame and Flashing 5 71-41 Lathing — In II-•'-OutB----- 'FJ� 7-n Plaster, brown coat f/, t h'.it Fy Refrig. 0 Air Cond. 0 Final Heating, Final Q. ,(, Al.? -4'7 i Plumbing Fixtures, Final ` el,5J 67-Q--C? Final Gas Test ,/c-i f "7- ,W__ _e)-.Q'• f Y Electric Fixtures, Final ` "LOS Lori-63 Building, Final 7/�'( An—t1_, OCCUPANCY FORM BU4.5M — 761