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Home My WebLink About323 CANAL WAY - Building Permits(714)754-5273 • Fex(�ia��sa-aess • www.c�.cosca-mesa.c��JILDING PERMIT Job Address: 323 CANAL WY � Suite: Viciniry: MODEL 1 GUNGALOWS ON BAY ST Primary Occ: R3 Dwellings/ Cong Res <10 - Type of Construction: V-N Parcel Number: TPN006051 Zoning: App�icant ROBERT CHAVEZ Address: 1450 N TUSTIN AV SUITE 105 SANTA ANA, CA 77 FAIFI UHIVE, GU51A MtSA, l:A 9262ti Phone: 714-245-9760 X32 ISSUED BY: Zip: 92705 Status: ISSUED Applied: 06/02/2006 Issued: 07/182006 Owner: RICHMOND AMERICAN HOMES Address 16845 VON KARMAN � SUITE 100 , , Phone: 949-756-7373 - _ IRVINE, CA Zip: 92606 � , Contractor: RICHMOND'AMERICAN HOMES OF CALIFORNIA INC . Address: 5171 CALIFORNIA AV . � - SUITE 120 Phone: 949-467-2600 . � IRVINE, CA � � . - Zip: 92617 � License: 487535 ' nrch : eng: GARY A MCCLANAHAN Address: Address: OPTION ONE CONSUL.TING ENGINEERS Phone: NEWPORT BEACH, CA Phone: 949-553-1916 20311 ACACIA SUITE 240 Zip: License: 92660 License: C042553 SCOPE OF PERMIT PHASE 3 BUNGALOWS ON BAY ST MODE�1 CONSTRUCT 2180 SF TNO-STORY SFD WITH 419 SF ATTACHED GARAGE AND A 88 SF PORCFI. REF: BOS-01808 PEE SUMMARY . . Plan Check: $1,086.38 Permit: $1,671.35 SMIP Res: $22.07 SMIp Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $2,779.80 ` PLANNING &'ZONING SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0• 0 PARKING � Existin : o � Rear Rear � Reauired: ! Calc Valuation: $zzo,eez.zs Cfaim Vafuation: $o.00 0-0 Left 0-0 Right 0-0 0- 0 Left 0- 0 Right 0- 0 0 Pr000sed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell requlred Inepectlons and tinal epprovel must be obtained. Failure to obtain inspections and final approval will result In ihe expiration of this permit. FOH INSPECTIONS CALL: (714) 7545826 zaae�as (siao) WORKERS' COMPENSATION DECU1RA710N: � � I hereby aXirtn under penalry oi perjury ane of the following declarations: � . ❑ I heve enC will meintain e cenitiwte of consent to self-Insure for warkers' compensation, es provided far by sectlon 3700 of the Lebor Code, tor Ihe perfortnence of the work for which Ihis permit is issued. � I hav'e an0 wlll meintein workers' compensatlon insurance, as requiretl by seclion 3700 of Uie LeUor Code, for ihe peAortnance of Ihe xrork for which Nis permit is issuetl. My wo ers' compens tion Insu nce car�ler end policy number ere: ��,/� Gamer: �'Mof.cdr� 6'M2. �Sil1.2M CA /PolicyNumber. !.�/CIc�Ii.b�T �(This'se`cnar need nof be cromp/eteC /I the permit is velued et one hundred Uollers ($f 00) or leu.) (_�_. _ ❑ I certify �hat in ihe performance f ihe work for whlch this pertnit Is Issued, I shell not emplay eny person In any manner so es to become su6ject to Ihe workers' compensatlon lews elHorn �, and egree ihat If I should become subJect to t�e workers' compensatlon provisions of Section 3700 of tha Lebor Cotle, I shall forihwlth comply with ihese p isi ns. � � AppI�LSigneture: __ �Dete:-�. -�Ir��O d� WARNINO: FNLURE TO SECURE WORKE ' COMPENSATION COVERAOE IS UNLAWFUL ANO SHALL SUBJECT AN EMPLOYER,TO CRIMINAC PENALTIES AND CIVIL FlNES UP TO IXJE NUNDRED T�OUSAND DOLLFRE (§100,000�, IN ADDITION TO THE COST OF C,OMPENSATION, DAMAOES AS PROVIDED WR IN SECTION �OB OF THE Lr1BOR CODE, INTEREST, ANO ATTORNEI^S FEES. LICENSED CONTHACTORS DECLAHATION: I h=reby eftirm that I em licensed under provisions of Chepter 9(wmmencing with Sectlon 7000) of Division 3 of the Business and Prafasslons Code, antl my license is in full }Orce entl eHBct. L1C. M_ �I �I��.S CI853 M C�nlrectoRe�5lgneture: � �Date '� �7 �� /'"_ CONSTiiUCTION LENDING AGENCV: ❑ I hereby aHirm Ihat ihere is a canstructian lending agency for ihe peAortnance ot t�e work tor which Ihis pertnit is issuetl. (Sec. 3097, Civil Code). Lenders Name: Lendefs Address: Signature: _ Date: OWNER-BUILDER DECLARATIONS: I hereby eflirm that untler penalry ot perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Business and Professlons Code: Any city or counry which requires e permit to construct, alter, improve, tlemolish, or repair any structure, prior �o its Issuance, elso requires tha epplicant for such permit to tlle a signed stetement thet he or she Is Iicensed pursuent ta the provislons of Ihe Contredore License Lew (Chepter 9(commencing wlih Section 7000) of Dlvision 3 of the Business end Professlons Code) or ihet he or she is exempt therefrom end ihe besls for ihe alleged exemption. Any vialetlon of Sectlon 7031.5 6y eny applicent for e pertnit subjeds the aDDlicant to e civil penelry of not more then five huntlretl dollers ($500).): ❑ I, as owner of Ihe properry, or my employees with weges es ihelr sola compensetion, WILL DO THE WORK, entl �he structure Is not Intended or offeretl for eale (Sec. 7044, Business end Protessions Code: The Contradors License Lew does not epply to an owner of property who builds or Improves thereon, end who does such work hlmseN or hereelf or through his or her own employees, provided thet such improvements ere no� intendetl or ofterad for sele. If, however, t�e builtling or imD�ovemen� Is sold within one year of completion, ihe owner-builder will heve ihe hurden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I, as owner of the property, em E%CLUSIVELV CON7RACTING WITH LICENSED CONTAACTORS to construct the proJect (Sec. 7044, Business end PrWeulona Code: The contrectors License Lew tlaes not epply to an owner of properry who builtls or improves thereon, enA who contracts 1or such project with a contractor(s) license pursuant to ihe Contractors License Lews.). ❑ I em exempt under sec. eusiness and Professions Code for this reason: Signeture: De1e: Owner ID veritied by tlnveYs Iicense. ❑ Yes ❑ No Oriver's Licensa No. Explres: Verlficetlon of Ownership by (type of dacument, i.e. - properry te�c DIII or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICA710N: ❑ I hereby certity that no excavation five (5) or more feet in tlepth into which e person is required to descend, will be made In connectlon with work authorized by this parmit, end that no 6uilding structure, scaXolding, falsework, or demolltion or dismantling ihereof, will be more than �hirty-slx (38) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltle B, Callfarnla Adminisiretive Cade). ❑ As owner-builder, I will not employ anyone to do work which would require a permil from the Division of Indusiriel Sefety, as noted ebove, unless such pereon hea a permit to tlo &uch work from �he division. Signetura: Dete: Division oi Indusinel Sefery Pertnit Number: CERTIFICATE OF COMPLIANCE AND AUTHORVATION OF ENTRV: I cenity under penalry of perjury that I have read this epplicatlon end sWte Ihe[ the information given is correct. I egree to comply with ell state lews end ciry ordinances relating to bulltling consiruction, and euthonze representetives of the Ciry of Costa Mesa to enter upon ihe eDove-described property for inspection purposes. I egroe not to acupy or ellow acupancy oi eny building euthorized by this permit until final inspection. CODE �. ixsvecnoxrrre 7616 Fized System Final Fire Prevention 1266 Pool Spe Final 200 Finel Re-Roof 201 Finel BIacWRetaining Wall 202 Final Factory Fire Place 203 ez�r Flnal Sign Final Demolition .. PAg I[�ALS 206 ' Final Mechanical 208 Finel Plumbing 210 Final Electricel 212 Finel Fire Preventlon �� 220 Finel Planning Approval 222 Final Sita 250 , Finel Building�Occupenq � �� ption �' �ne oussu��i.vo cac�.veex� STRUCTURAL OBSERVATION REPORT FORM RICHMOND AMERICAN HOMES THIS REPORT INCLUDES ALL CONSTRUCTION WORK THROUGH THE: 20'"Day o(Apri12007. PAGE I OF I PROf&CT: ��&mealowsat8ay5treeP'-SFD OPTIONONEIN.: Oti05-120i LOCATION: Costa Mest Califomia BLDG. PERMIT No.: OWN6R: Richmond Amcrican Homzs LOCATIONIDIVISION: OrangcCoumy ARCHITEC"P�. Mark Gross & Assuciates ARCHITFCT J.N.: MGA-3880 STRUC'f. 065. OF RF.CORD: Garv A. McClanahan, P.G UC. or RGGISTRA'fION Nos.�. C-d2�53 STRUC"I'URAL06SERVER: losc Mams, P.G C-69hIR OIiSIsIi\'1?D S'IRUCI'URAL ELEMG,N"fS S THEIR CONNRC'PIONS: L6f(5) � 1'11A5G OI4SI3RVi'sD: Intcripr and Erterinr Gcneral F7aming; i.e, mof trusscs, mo(shcathing, •Lot 4,-Ylan-lA, 323 Canal'Way, � shear elements, holdox�ns, tloor sheathing, Floorjoisis/[russes, beams, hcaders, Phasc 3, l'ract k 16693, and gcncral hardwarc. Costa �Icsa, Cali(ornia OQ$ISRVF,DDEFICIG\CIE$: (A!lACNAODITIONALGaGESIFNECESSARYf The dcficiencies anNor non-conformin� itcros noted during observation risit hare becn corrected nnd installed by a copnborated effon ol the projcct superiniendrn� nnd Oie Iraming forcman. Initial / Comnlclion Dntc: J.:H. /OL10-07 ConS¢uc�ion � HVAC 0 Electrical � Plumbing e—i�a� ,ble-SdeA 0 Plywd CI'g ❑ [�rck- Stage: SI:-�..,,;-.-a.' � I,id(s) 9pFiw Note.� Lyhen box is checked, il indka=s fhat construcfion stage is in progress, and "A has Irot yef 6een canpleled af the lime observafion was conducfed. � STRUCTURALSYSTE�7WASVISUALLYOBSERVEDTOBEINGCNERALCOMFORMANCEWI'fHTHHAPPROVEDPLANS. ❑ STRUCTURAL DEPICIENCIES ARE OF A MINOR NATURE & MAY BE REVIEWED BY CITY BLDG INSPECTOR FOR COb1PLI.V�CE. 1 DECLARE THAT l'l1E FOLLO��'I\'C STATE\IE\'I'S ARE'lHUE TO THF. 13EST OF pIY KVO��'LF,DGE fi RF,I.IF,F' L I,ubi THE REGISTERED ENGMEER N'HO HAS RESPONSI6LE CHARGE FOR THB STRUCTUR:IL OBSERVATION. z� �, OR AIVOTHER QUALIFIED-CHARGE OBSERVF.R \VHO 1 HAVE DESIGNATED ABOVE AND IS WDER 61Y RESPONSIBLE CHARGE•, HAS NERFORMED l'HE REQUIRED SITE VISITS AT EACH SIGNIFICANT CONSTRUCTION STAGE TO VERIPY IF THE STRUCTURE IS IN GENFRAL CONFOR�IANCF, WITH THE APPROVHD �'LANS AND SYECIFIC.4TIONS. 3. ALI. DGPICIE�CIFS, \I'HICH I DOCU\dENTf;D, HAVL ISIi13N CORRIiCfGU UN LBSS OTHER W ISE L\�DICATGD ABOVL. 4. ALL OBSERVEU DEFICIENCCS SHALL I313 CORRECTED AND APPRO\'ED HY 7'l1E OBSERVGR PRIOR TO PNAL ACCCPTANCE OF THE STRUCTURAL SYSTEMS 6Y THE BUII.DMG DEPARTMENT. �. 7HIS ILEPORT IS PROVIDED TO THG 011'N8R AS A I'ART OP THE OWNGRS OV[RALL CONSTRUCTION QUAI.I'1'Y CONTROL PROGRAM. 6. OP'I'ION ONE HAS PROVID[U STRUC'I'URAL OBSERVA"PION IN ACCORDANCE WITH THE SEAOC RECO�IMENDED GUIDELINES FOR 1'HE PRACTICE OF STRUCTURAL ENGINEERMG IN CALIFORNIA. SIG�6D BY: �� S'1'A�IP & �VETSICNATURE OF S7NUCTUR.IL OUSF,RVER OF RECORD 20'" Uay of �lpril 200�. STRUCPURAL OUSF,R�'AT10��' DOES NOT 14AIVE THE REQUIREMENTS FOR IhSPEC"1'IONS BY CITY BUILDMG MSP�CTORS. ALL WORK ib1UST COMPLY WITH THE APPROVED PLANS AND APPLICA6LE STATE & LOCAL CODES. D:11200's1120110bservatienslPhase_313BISOR F_Lo�4_P1A.doc(Rev.115105) Opfion One Tel 949.553.1916 Consulting EngineHrs 20311 Acacia St., Suite 240, Newport Beach, Ca. 92660 Fax 949.553.9720 (714) 754-5273 • Fex (714) 754•4856 • www.ci.costa-mesa. ELECTRICAL PERMIT n FAIR DRIYE, COSTA MESA, CA 92626 Job Address: Suite No Viciniry: Parcel Nunmber: 323 CANAL WY MODEL 1 BUNGALOWS ON BAY ST TPN006051 npplicant CHAVEZ, ROBERT Address: 1450 N 7t1STIN AV SUITE 105 Phone; 714-245-9760 X32 SANTA ANA, CA Zip 92705 Owner: RICHMOND AMERICAN HOMES Address 16845 VON KARMAN . - Phone: 949-758-7373 IRVINE, CA � , Zip: 92606 - Contractor: RICHMOND AMERICAN HOMES OF CALIFORNIA INC Address: 5171 CALIFORNIAAV . SUITE 120 � Phone: 949-467-2600 IRVINE, CA Zip: 92617 License: 487535 ISSUE FEE � Temp service tesl Res. a/c package New Res (t-2 units) New Res (3+units) Pool / Spa Lighting Fi�As Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 7000a Service over 1000a Motors to thp Motors to tOhp Motors fo SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Cimuits Temp Pwr Pole Intermed Pole Status: ISSUED Applied: 07/182006 Issued: 07/18Y1006 ISSUED BY: SCOPE OF PERMIT PHASE 3 BUNGALOWS ON BAY ST MODEL7 CONSTRUCT 2180 SF TWO-STORY SFD WITH 419 SF ATTACHED GAR4GE AND A 88 SF PORCH. REF:BO6-00855 � ' GARAGE: 2 LIGHT FIXTURES, 3 OUTLETS, 1 SWITCH $23.50 $0.00 $0.00 5122.08 $0.00 $0.00 $2.20 $3.30 $1.10 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 so.00 $0.00 $0.00 $0.00 Quanlity 2180 ' 0 0 2 3 1 0 0 o . 0 0 0 0 " 0 0 0 0 ' 0 0 0 0 0 , FEE SUMMARY Temp Dist System / Lighting Busway/100ft � Standing Section � Misc Eleclrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ...................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Oiher Electrical Fee Investigation Fee Plan Check Fee Reinspedion Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 D 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 50.00 $0.00 50.00 TOTAL CALCULATED FEES §152.18 COMMENTS I 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) � � EXPIRA710N: This permic shall automatically explre and become vold if work is rroi commenced wiihln 180 days, a if work'is suspanded or abarMoned for a period of 780 tlays. � INSPECTIONS: In order for the xrork authorized under this permit to be considered legal, such work must comply with al� epplicable codes, and all I requlred Inspeetione and finel approval must be obtainad. Fallure to obtain inspections and finai approval will result in the expiration of lhis pertnit. FOR INSPECTIONS CALL: (714) 754-5628 2aa&IB (8/00) WORKERS'COMPENSA710NDECLARATON: I hereby aHirtn under penelry of perjury one of the tollowing tlaclaretlons: ❑ I �eve end wlll melntein e certificate af consent to seN-Insure for workers' campensetlon, es provided for by section 3700 of ihe Lebor Code, for ihe pertortnence of the __.work for which this pertnit is issued. 3nsation Insurance, as reQuired by sectlon 3700 of Ne Lebor Code, tor Ihe pertortnance ot Ne woAc for which this peimlt is Issued. cartier entl poll�{ number are: / r� �� 1 i� �M1� n �.b : Policy Number. �� I rX ertnit is velued et one hundred dollars (5100) or Ie55J -_ ❑ I certify �hat in Ihe peA flnce ol � e work far which t�ls pertnit is issued, I shell nat employ any Derson in eny menner so as to became subject to ihe workers' compenmtion lews of Iliomle, d egree that If I shoulA became sublect to ihe workers' mmpensetion DroWsions of Section 3700 oi ihe Labor Cotle, I shell tonhwith comply wlth Ihese pr ' ions. 'AppilcantSignewre:_ - r-Dete:-�� 7�'ia di VlARN G-FNLURE TO SEWRE WORI(ERS' ENSATION COVERAGE IS UNLAW R1L AND SW1LL SUBIECT AN EA�I.OYER TO CRIlANAL PENALTIES AND CML FlNES UP TO ONE HUNDRED T/qUSAND DOLLARE (E100,000), IN ADDITION TO THE COST OF COMPENSATION, DMNGE$ AS PROVIDED WR IN SEGf10N 3�OB OF TME LABOR CODE, INiEREST, AND ATTIXiNE1^S FEES. LICENSED CONTRACTORS DECLAHATION: I hereby ettirm Ihat I em.11censetl untler pr,ovisions of epter 9(commencing with Sectian 7000) oi Divislon 3 of the Business entl Professians Cotle, end my Iicense Is In full force�entl ettect. Llc. q U�1 S3S n �qess N� Contrectors Slgneture: Dete: 7 �� ,.::',.-. �, � � CONSTRUCTION LENOING AGENCY: ❑ I hereby aflirtn ihat Ihere is e cons�ruction lending egency tor ihe pertormence oi �he work for which ihis permit Is Issued. (Sec. 3097, Civil Cotle). Lendefs Name: Lender's Address: Signeture: OWNER-BUILDER DECLARATIONS: Date: I �ereby aHirm ihet untler penalty ot perjury ihet 1 am E%EMPT FROM THE CONTRACTORS LICENSE LAW for t�e following reason (Sec. 7031.5, Business entl Professlons CoOe: Any ciry or counry which requires e permit to conslruct, elter, improve, demolish, or repalr eny structure, prior to Its issuence, elso requires the applicent for such permit to flla e slpneA sletement t�at he or she Is licensed pursuant to Ihe praWsions of the Coniractors Llcense Law (CheD�er 8(commenUng with Section 7000) of Dlvlsion 3 0l Ne Business and Professions Code) or thet he or she is ezempt therefrom end the besis for Ne alleged e:emptlan. Any dolallon of Section 7031.5 by eny applicent Por e permit sub�ects the applicant to e civil penalry oi not more then flve huntlred dWlars (5500) J: ❑ I, as owner af the property, or my employees with wages es t�elr sole compensetian, WILL 00 THE WORK, end Ihe strudure Is not Intentletl or oHeretl for sele (Sec. 7044, Business end Pmfessions Code: Tha Contrectors License lew does not apply to en owner of property who bulids or Imprwes thereon, flnO who does auch work hlmself or hereelf or ihrough his or her own employees, provided ihel such improvemenis ere not Intended or aHereG for sale. If, however, the bulitllnp or Improvement I9 sold wlthin one yeer of complation, ihe owner-builder wlll heve ihe burden oi proving that he or she did not build or improve for purpose of sele.). ' � I, as owner ot the property, em E%CLUSNELY CON7RACTING WITH LICENSED CONTRACTORS to construct �he projed (Sec. 7044, Business end Profesalone Code: The comractors Llcense Lew tlaes not epply to en owner of property who builds or improves thereon, end wha contrac�s for such project with e contrector(s) Ilcensa pursuenl to the Contractors License Lews.). ❑ I em exem0� under sec. Business and Professions Code for Ihis reeson: Sipnature: Date: Owner ID veritled by driver's license. ❑ Ves ❑ No Drivefs License No. Vedllcation of Ownership by (type of document, I.e. - properry tex bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICA710N: Expires: ❑ I hereby certily that no excavetion tive (5) or more feet in tlepih Into which e parson is required �o tlescentl, will be made in connecUon wiN work euthorized by NLs pertnit, end that no building sWcture, sceflolding, felsework, or demolltion or dismantling thereof, will be more than ��Irry-su (36) taet high. (C�ap. 32, ory 2, A� 2, Sec. 341, Tltle B, Celitomia Administrative Cade). ❑ As owner�builAer, I will not employ enyone to do work whlch would roquire e pertnit trom the Division of Intlustriel Satery, es noted ebove, unleu such peraon hea a pertnit to do suCh work trom the division. Sipnature: Date: Divlslon oi Indusiriel Safery Pertni� Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVJITON OF EMiiY: I certify under penalry ol perjury thal I heve read this epplication end state that tha Informetlon given is correct I egree b comply with all state lews and Gry ortlinences relating to bulltling construcUon, end euthodze representetives of Ihe Ciry of Coste Mese to enter upon t�e ebove-descnbed pmperty ior inspection purposes. I egree not �o occupy or ellow occupancy af eny building authodzed by t�is pertnit unlil finel inspection. � , v� /�u�rvn w^YMiiwi�� . . F CODE �. INSVECTIONTYPE � � PdIE 1[�LS 1616 Fi:ed System Flnal Fire Prevention � 1266 200 201 202 203 Pool Spa Final Finel Re-Root Flnal BIaWReteining Wall Flnal Fectory Fire Place Final Sign Final Demolltion. �QQEj INSPECTIONTYVE 206 Final MeChenlcel 208 Final PIum6ing 210 Final ElecVicel 212 Flnel Fire Preventlon 220 Flnal Plenninp Approvel 222 Final Site 250 Flnel Bullding/Oaupenry (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR ORIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job AddresS; 323 CANAL WY Suite Np Vicinity; MODEL 1 BUNGALOWS ON BAY ST ParcelNumber: TPN006051 ISSUED BY: App�ican�: CHAVEZ, ROBERT Addresg: 1450 N TUSTIN AV SUITE 105 SANTA ANA, CA Phone: 714-245-9760 X32 Zip: 92705 Owner: RICHMOND AMERICAN HOMES Address: 16845 VON KARMAN � IRVINE, CA Phone: 949-756-7373 Zip: 92606 Contractor: RICHMOND AMERICAN HOMES OF CALIFORNIA INC Addres5: 5171 CALIFORNIAAV SUITE 120 Phone: 949-467-2600 IRVINE, CA Zip: 92617 - License: 487535 SCOPE OF PERMIT PHASE 3 BUNGALOWS ON BAY ST MODELt CONSTRUCT 2180 SF TWO-STORY SFD WITH 419 SF ATTACHED GARAGE AND A 88 SF PORCH. REF:BO6-00855 1 INST FAU > 100K BTU, 1 REFRIG SYS < 100K BTU, 1 FACTORY FIREPLACE, 1 HOOD W/MECH EXHAUST, 3 VENT �FANS/SINGLE DUCT ISSUE FEE Inst FAU <100 k BTU Insi FAU >700 k B7U RepairlAlt Cooling/Heat Inst I Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single quct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> 10000cfm Floor Furnace Floor or Suspend Heater $23.50 $0.00 518.20 50.00 50.00 $14.80 50.00 50.00 510.65 $10.65 $0.00 821.75 50.a0 50.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 Quantiry 9 FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Retrigeration Unit Ventillation System Evaporetive Cooler Com mercial I nci nerator Domestic Incinerator Comoressors / Absorotion Svstems Upto3hplt00kBTU 3 To 15 hp / 500 k BTU 15 To 30 hp I 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 8TU Boilers Up to 3 hp 3To15hp 1510 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee Stalus: ISSUED Applied: 07/18/2006 Issued: 07/18/2006 Quantity $0.00 0 $0.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 ' 30.00 0 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES 599.55 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related regulations. (Ord. N6. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically explre and become void if work is not commenced wlthin 180 days, or If work Is suspendetl or abandoned for a period of 780 days. INSPECTIONS: In order for the work authorizetl under this permit to be considered legal, such work must comply with all applicable codes, and ell requlred Inepeetiorle end final approvel must be obtainad. Failure to oblain inspections and final approval will result in ihe expiration of this permit. FOH INSPECTIONS CALL: (714) 7545828 . zawa �eroo� WORKERS'COMPENSATION DECLARATON: — I hereby ettirm untler penelry of perjury one oi ihe tollowinp declaratlons: ❑ I heve end will meintaln e ceniiicete of consent lo sell-Insura tor workers' compensatlon, es provided lor by sectlan 3700 0l the Lebor Code, for ihe pertortnance of ihe work for w�ich t�is permit is issued. �` i have antl will maintaln workers' compensetion Insurance, es requlretl 6y sectim 3700 ot Ne Lebor Cotle, for Ne peAormance ot Ne work for wh�h this pertnit is Issuetl. �My wa/rkfers' campenseitLbn In�s�ureflc�e �carder en0 policy number ere: WGI ^'�� Cartier. _�}SVY1¢Ncr.r� Iti�� M71l�ihnc2 C.o POIIcyNumber: oc GThis sectlon need nof be completed ll the pertn/t 7s velued ef one hundred tlollers (5100) or less.) �— -� ❑ I certiy thet in the perto anca ol he work tor whlch Ihis pertnit is Issued, I shall not employ eny person In any manner so as to become subjecl lo ihe workers' compensetlon laws of Iibmia, r�d egree that N I shoultl become sub�ect ro the workers' compensaUon provisions of Sectlon 3700 of the Lebor Cada, 1 shell torthwith COmply with �hese pr ions. Appllcant Sig ,nature: � rDete: !' 7/�/(1� WAWlINCi�FAILURE TO SECURE WORKE ' C ENSATION WVERAGE IS UMAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRINJNAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED TilIX15AND DIX1ME (E100,000�. IN ADDRION 70 THE COST OF COMPENSATION, OAM1UIGES AS PROVIDED FOR IN SECf10N 3108 OF THE LABOR CODE, INTEFEST, PND ATTORNEVS FEES. LICENSED CONTRACTORS DECLAPATION: 9(cammencinp with Sectlon 7000) ol DNLslon 3 at the Busin� end Pmtessions Code, entl my Iicense is in full CONSTRUCTION LENDINO AGENCY: ❑ I hereby affirm that t�ere is a consirudlon lending egenty for the pedortnance of t�e work for which t�ls pertnit is issued. (Sec. 3097, Civil Cotle). Lenders Neme: Lenders Address: Signatura: OWNER-BUILDER DECLARATIONS: Date: I hereby ettirtn that under penelty oi per�ury Net 1 am E%EMPT FROM THE CONTRACTOHS LICENSE LAW far the following reesan (Sec. 7031.5, Business entl Professions Code: Any ciry or counry which requires e pertnrt to conSlruct, elter, Improve, demallsh, or repeir eny structure, pdor to its issuance, elso requires the epDlicant for such permil to fle a signetl statement Ihat he or she Is Iicensed pursuant to ihe proNslons ol lhe Conlradors Ucense Law (Chepter 8(commendng with Section 7000) of DlNsion 3 of Me Business end Professions Cotle� or thet he or ahe Is eaempt therefrom entl the Desis for the ellepetl e:emptlon. Any vldation ot Section 7031.5 hy eny applicant for e pertnit subjects Ihe epplicent to e civil penalry of no� more Nan flve hundred dallars ($500).): ❑ I, as owner of ihe property, or my emplqrees with wages as t�eir sole compensatlan, WILL DO THE WORK, ena Ihe stmdure is not InteiWetl or oflered for sele (Sec. 7044, Business antl Protessions Code: Tha Contractors License Lew does not epply to an owner of properry who bulltls or improves therean, and who daes such work hlmself or herself or Ihrough his or her own employees, proviCetl Ihel such Improvamenis are not Intendetl or oHereO tor sale. II, however, the huilding or improvement b sold within ona yeer of comDletlon, ihe owner-builder will heve t�e burtlen of praving that �e or she tlid not build or imDrove for purpose ot sele.). ' ❑ I, as owner of the proDerry, em E%CWSIVELV CONTRACTNG WI7H LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Busineas end Protessions Code: The contractore lJcense Lew Coes not eDPN �o an owner ol property who bulltls or Imprwes thareon, entl who contrects far suc� pro�ect wlth e wnirador(s) license pursuam to Ihe Contractors License Lews.). ❑ I am exempt untler sec. Business entl Professions Coda tor this reason: Signature: Date: Owner ID verified by drivefs license. ❑ Yes ❑ No Driver's License No. Vedficatlon of Ownership by (type ot dacument, I.e. - property ta¢ CIII or deed�: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Expires: ❑ I hereby certify Ihet no excevatlon five (5) or more teet In deplh Into w�lch e person is requlred ro tlescend, wlll be made in wnnection with work euthodzeC by this pertnit, end ihat no building siructure, scettolding, telsework, or tlemolition or tllsmantling ihereof, will be more Ihen ihirty-six (38) feet hiph. (Chap. 32, Gry 2, Atl 2, Sec. 341, Tille 8, Celifomia Atlministralive Code). ❑ As owner•builtler, I wlll not employ enyone to do work whlch would raqulre e permit from ihe Division of Indusirlal Satery, es noted ebove, unless such person has e permit �o do such work irom the divlsion. Signature: Data: Division of Intlustrial Sefery Permi� Number: CEH7IFlCATE OF COMGLIANCE AND AUTHOR¢A710N OF EMAY: I certiy under penalry ot perjury that I have read ihis appliceUan and stete that ihe informatirn given is cortect. I egrea ro compy with ell stete laws end clry orUlnances releting to Euiltling construction, end euthorize representatives ol the Ciry of Costa Mesa to enter upon the above-descnbed properry �or inspe�on purposes. I egree not to acupy or ellow occu0enq of eny building euthonzed by ihis pertnit until finel inspection. cooe �. 1616 1266 200 Fixetl Sysiem Flnel Fire Prevention Pool Spa Finel Finel Re-Rool - 201 Final BIocWRetaining Well 202 Final Fectory Fire Plece 203 Finel Sign 204 Finel Demolillon Owner�s) QdIF It�dLi CO�E I INSPECTION TYPE 206 Final Mechenlcal 208 Final Plumbing 210 Final Elec�dcal 212 Final Fire Preventlon 220 Flnal Planninp Approvel 222 Flnal Sita 250 Finel Bulltling/Occupenq � Q • ' l� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIFi DRIVE, COSTA MESA, CA 92626 Job AddrEss: Suite No Vicinify: PLUMBING PERMIT 323 CANAL WY MOOEL 1 BUNGALOWS ON BAY ST ParcelNunmber: TPN006051 ApplicanC CHAVEZ, ROBERT Add�@55: 1450 N TUSTIN AV SUITE 105 SANTA ANA, CA Phone: 714-245-9760 X32 Zip: 92705 Owner: RICHMOND AMERICAN HOMES Address 16845 VON KARMAN .- � . IRVINE, CA Phone: 949-756-7373 Zip: 92606 Contracror: RICHMOND AMERICAN HOMES OF CALIFORNIA INC Address: 5171 CALIFORNIA AV SUITE 120 IRVINE, CA Phone: 949-467-2600 . 2ip: 92617 � License: 487535 ISSUED BY: Status: ISSUED Applied: 07/18/2006 Issued: 07/182006 SCOPE OF PERMIT PHASE 3 BUNGALOWS ON BAY ST MODEL 1 ' � ` � CONSTRUCT 2180 SF TWO-STORY SFD WITH 419 SF ATTACHED GARAGE AIJD A 88 SF PORCH. REF:606-00855 ` 1 BATHTUB, t DISHWASHER, 1 RAINWATER DRAIN, 1 GAS OUTLET (1=4), 1 GAS SERVICE, 1 LAUNDRY TUBNVASHER, 1 LANDSCAPE IRRIGATION, 1 PRESSURE REGULATOR, 1 SEWER CONNECT SHOWERS, 1 KITCHEN SINK, 1 VACUUM BRKR BKFLOW (1-0), 3 WASH BASINS, 1 WASTEAND VENT SYSTEM, 3 WATER CLOSETS, 1 WATER HEATERNENT, 1 WATER SERVICE ISSUE FEE Backflow irrigatiqn � Backflow Preventer Bathtub Clarifier System Connect (Ice,Sotla,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 oullels) Gas (Over a outlets) Gas Repipe Gas Service Inferceptors (Grease, Oii} Interceptors (Sand Auto ) AMT $23.50 so.00 $0.00 59.80 $0.00 $0.00 $0.00 $9.80 so.00 $9.80 so.00 $0.00 $0.00 $0.00 $6.15 �0.00 $0.00 $9.80 $0.00 $0.00 QlY FEE SUMMARY AMT LaundryTub/Washer $9.80 Landscape Irrigation - $14.80 P-Trap 50.00 Pressure Regulator $9.80 Process�Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank 50.00 Sewer Cap for Demo 50.00 Sewer Connect $24.65 Sewer Private line 50.00 Shower $19.60 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $9.80 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTv 1 1 0 1 0 0. 0 0 1 0 2 0 0 0 1 0 0 0 COMMENTS I SPECIAL CONDITIONS SumpPump Swimming Pool , Trap Primer Urinal Vacuum Brkr Bkflow(14) Vacuum Brkr Bkflow(5+) Wash-Basin � Wash Basin Set � Waste and Vent System �Water Closet (Toilet) � Water Healer I vent Water Piping (Inst or Rep.) Water Re-pipe Water Service'/ Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $12.30 $0.00 $29.40 $0.00 $9.80 $29.40 512.30 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: $260.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This pertnit shall automatically expire and become void if work Is not commenced within 180 days, or if H for a period of 180 days. �3_N_. 0 0 0 0 1 0 3 0 7 3 7 0 0 1 0 statutes and related orabandoned (NSPECTIONS: In order (or the work authodzed under this pertnit to be considered legal, such work must comply wi(h all appilcable codes, and a(t required Inspectlons and final epproval must be obtained. Failure to obtain inspections and final epproval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaasea�aroo� WORKERS'COMPENSA710N DECLARAnON: � - I hereby eftirtn untler penelry of perjury one ot the following declarations: ❑ I have and wlll maintaln e certificate of consent ro setl-Insure for workers' crompensetion, as providetl tor by section 3700 ot the Lebor Code, for t�e pertormance of the work for which ihis pertnit i5 i55ued. �^I heve and wlll maintain workers' compensetion insurance, as reQuiretl by sectlon 3700 of the Labor Cotle, for Ihe peAortnance of ihe work for which Ihis pertnit Lv Issued. �_My wo ers' compensatl Insuren%� cartier antl policy number are: ` � Carrier.�` �1M¢rt('cqn "617'� ri5i��.�[o Ca /�� ollcy.Number.._ �il�U��a�'is'1 (ThLv section need nat 6e crompleted il Ihe permit is veluetl et one hundred dollers ($100) or /ess.J �s'� - ❑ I cerlity that In the performenc of the work for which this pertnit is issued, I shell not employ eny peroon in eny manner so es to become subject to the workers' compensetlon lews Califo I, end egree that It I should become sublect to the workers' compensetion provislons ot Section 3700 of the Lebor Catle, I shell forthwith comply with these isi as / � ApDlicent�5lgnature:'.. rD'flte: ' 7 � Q� WAPNINCi:�FAICURETOSECUREWORK R MPENSATIONCOVEMGEISUNLAWFULANDSHALLSUBIECTANEMPIAVEfiTOCRIMINALPENALTESANDGVILFINESUPTOONEHUNDRED �T}IOUSPND DOLIARE (2100.000), IN FDD TO THE COST OF COMPENSATION, DMUGES 0.S PROVIDED FOR IN SEC(IIXJ 3108OF TME LABOR CODE, IMEREST, AND ATTORNEI^$ FEES. LICENSED CONTRACTORS DECLARATION: 9(commencing with Sedion 7000) o� Gless a Professions Cotle, end my license is In full CONSTRUCTION LENDING AGENCY: ❑ I hereby attirtn �ha� there is a consWction lending agency for ihe pedortnance of the work for which ihis pertnit is issued. (Sec. 3097, Civil Cotle). Lender s Name: Lentler's Address: Signalure: _ OWNEH-BUILDER DECLARATIONS: Date: I hereby aHirtn thet under penelry of perjury thet I am E%EMP7 FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Buslness entl Professions Code: Any ciry or county which requires a pertnit to construcL alter, improve, demolish, or repair any structure, pnor to its issuance, also requires iha epplicant tor such pertnit to file a signed statement that he or she is Ilcensetl pursuant ta the proNslons of Ihe Contredors License Lew (Chepter 9(cammencing with Section 7000) of Dlvlsion 3 0l the Business end Protesslons Code) o� thet �e or she Is exempt iheretrom end iha basis far Ihe ellegetl exemptian. Any Wolatlon of Sectlon 7031.5 by eny applicent tar a pertnit suhjects tha applicent to e civll penelry of not more then five hundred dollars ($500).): ❑ I, es owner ot the property, or my employees with wages es their sole compensetion, WILL DO THE WORK, end iha struqure Is not Intended or otferatl tOr eele (Sec. 7044, Busineu and Professions Code: The Coniractors License Law tloes not apply to an owner of D�operry who builds or improves ihereon, end who does such work hlmself or herself or through his or her own employees, provitled thet such improvemenis are not Intended o� affared for sale. If, however, the building or Improvement is sold within one yeer of comDletion, Ihe owner-buildei will heve the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I, as owner of Ihe property, am EXCWSIVELY CONTRACTING WITH LICENSED CON7RACTORS to construct the project (Sec. 7044, Busineas entl Professlona Cotle: iTe contrectore IJcense Law tloes not apply to an owner of property who bullds or Improves t�ereon, and who comrects tor such proJect with a contractor(s) license pursuam to the Contractars Licensa Lews.). ❑ I am exempt under sec. Business antl Professions Gode tor ihis reason: Signe�ure: Dete: Owner ID verified by drivels Ilcense. ❑ Ves ❑ No DriveYs License No. Ezpires: Vedficetlon of Ownership �y (type oi document, i.e. - properry ta�c blil or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMR CER7IFICATION: ❑ I hereby certify t�at no exwvation five (5) or more feet in depth into which e person Is required fo tlescentl, will be matle In connectlon with work euthorized by this permit, antl thet no builtling struclure, scaHolding, falsework, or tlemolition or dismentling thereof, will be more than ihirry-six (38) feet high. (Chep. 32, Gry 2, Art 2, Sec. 341, Title B, Celitomia AtlmlNstretive Cotle). � ❑ As owner-builder, I wlil not employ enyone to tlo work which would require e pertnit tmm the Division ot IntlusMal Setery, es nated ehove, unleu such person has e pertnit to do such work from the divisian. Signeture: Date: Division af Industnel Safery Permit Number: CERTFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I certity under penelry of perjury that I have read this epplication and stale thet the infortnation given Is correct I egree to comply with ell state lews end ciry ordinances relating to bullding consiruction, end authanze representetives ot ihe Clry ot Coste Mesa to enter upon the above-descnbeQ,property tohinspection puryoses. I agree not to occupy or ellow occupancy of eny building au�honzed by t�is pefmit until finel inspecNon. vi i �; '�tT Or Authorized App COUE 1, INSPECTIONTYPE 1616 Fixetl System Final Fire Preventlon _ 1266 Pool Spe Final _ 200 Final Re-Root _ 201 Final BIocWRetaining Wall _ 202 Final Factory Flre Plece _ 203 204 Finel Slgn Final DemWition U�TE f�Q�$ � COOEt INSFECTIONTYPE 208 Final Mechenical 208 Final Plumbing 270 Final Electncal 212 Flnel Fire Prevention 220 Flnal Plenning Approvel 222 Final Slte 250 Final Bullding�Occupency (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa•mesa.ce.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Jo4 Address: 323 CANAL WY Status: ISSUED Suite: Applied: 07/17/2006 Viciniry: BUNGALOWS ON BAY STREET Issued: 07/26/2006 Parce� Nunmber: TPN006051 Zoning: nppliwnt GUZMAN, MARCUS ISSUED BY: Address: 705 E HARRISON STREET- STE 200 �� Phone: 800-915-3473 XT 2508 . CORONA, CA , Zip: 92879 . ' , � Owner: RICHMOND AMERICAN HOMES � Address . 16645 VON KARMAN � - , '. - Phone: 949-756-7373 - �� . , � . IRVINE; CA � ' . Zip: 92606 � - ' � � � �� Contrador. FIRE SPRINKCER SYSTEMS INC �� Address: �705 E HARRISON ST � � � ' SUITE 200 Phone: 800-915-3473 � � . . CORONA, CA 2ip: 92879 . . � � License: 684600 . �� , �_ SCOPE OF PERMIT FIRE SPRINKLER SYSTEM FOR THE CONSTRUCTION OF A PHASE 3 BUNGALOWS ON BAY ST, MODEL . . , A, CONSTRUCT 2180 SF 7LV0-STORY SFD. REF.: BO6-00855 - � � , FEE SUMMARY Plan Check: $54.11 Calc Valuation: Sz,soo.00 Permik $83.25 Claimed Valuation: Sz,soo.00 Other: $0.00 - ; . , . . _ Total: $137.36 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 suspendetl or abandoned for a period of 180 days. INSVECTION5: In order tor ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred In�peetlons and flnal approvel must be obtainetl. Failure to obtain inspectlons and final approval will result in lhe expiratlon of ihis parmit. FOR INSPECTIONS CALL: (7/4) 7545826'�� . �m�ae (e�oo) WORKERS'COMPENSATION DECLARAnON: � - I hereDy attirm under penalty of perjury one of the tollowing tleclerelions: � ' ❑ 1 heve and will malntain e cartlticete ol consent to selt-Insure tor workers' crompensatlon, as provlded far by sectlon 3700 oi the Lebar Cade, for the pertortnence ot the work for whlch ihis pertnit is issueE. � I heve and wlll maintaln workers' compensation insurence, es requiretl by sectlon 3700 of Ne Lebor Gode, for the peAortnance of Ne work for whlch this pertnit is issuetl. My wn P�mpensatl Insurence cartler antl policy number are: 2 /I Cartier h .(� Policy Number. LIJ�A.-7 �"t �7O (This secflon need naf be completed i! the permlf !s veluetl et one hundred dollers ($100J or less.) ❑ I certify �het in the peAortnence ot Ihe work tor whlch this permit Is Issue4 I shall not employ any person in eny manner so es to �ecome subject to the workere' compensetlon lews ol Celitomia, and eprea that If I should become sub�ect to the workers' campensetion provisions of Sectlon 3700 ot the Labor Cade, I s�ell forthwith compty with these provisi s. � / q ^-1 �7/ %� ApPlicant Signature: Q� /%Jl/f XL� Dete: /—/ !O' �V WARNINO: FAILUflE TO SECURE WORKERS' COMPENSATION WVEMOE IS UNLAW FUL AND SHPLL SU6IECT AN EMPIOYER TO CRIMINAL PENALTIES M10 pVIL FlNES UP TO ONE NUNDPED T}IOUSrW 0 OOLLARE (E100,000), IN ADDITIW TOTHE CQST OF COMPENSATION, DAAUGES A$ PROVIDED F-0R IN SECiION 3lW OF THE IABOfi CODE, INfEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTOPS DECLAFiAT10N: � hereby atlirtn Ihat I em Ilcensed un er provisions ol C�aptar 9(cammencing with Section 7000) of Division 3 0l the Busineisi r�d_Protessions Code, and my Iicense Is in lull (orce and ettect. Lic. p �i�� CU _ Class q �� (/� Comreqofs Signature: L Date: -I�9(n -C CONSTRUCTION LENDING AGENCY: ❑ I hereby atfirtn Ihat there Is e consiruction IenCing agency for Ihe peAortnance ot Ne wark far which ihis pertnit is issued. (Sec. 3097, Civil Cotle). Lendefs Neme: Lender's Atldress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aNirm Ihet untler penalry ot per�ury that I em El(EMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Buslness entl Professlons Code: My city ar counry which requires e permit to construd, alter, improve, demolish, or repair any struqure, O�or to iis issuance, elso requires Ihe eppllceN for such pefmit to file e signed statement thet he or s�e is Iicensetl pursuent ta the provlslons ot Ihe Contrectors License Lflw (Chapter 9(wmmencinq with Seclion 7000) of DlNsion 3 af 1he Business end Prafesslons Code) or thet �e or she Is exempt therefram antl the besis for the alleged exemption. Any violetlan af Secllon 7031.5 by eny epplicent for e permit sub�ecis the appllcenl lo a clvll penelry of not more ihen ilve huntlred dollars ($500).): ❑ I, as owner ol the properry, or my employees wlih wages es their sole wmpensetlon, WILL DO THE WORK, end Ihe siructure is not Intended or oHeretl for sele (Sec. 7044, Business and Professlons Cotle: 7Te Contractors License Law does not apply to an owner of properry who builds or Improves thereon, end who does 5uch work himsetl or herselt a thmugh his or her own employeas, provitletl that such Improvements are not intended or ottered for sele. It, however, �he bulldlnp or Improvement Is soltl within one yeer of completion, ihe owner�bullder will have ihe burden of p�oving that he or she did not build or improve tor Durpose of sale.). • ❑ I, es owner of ihe property, em E%CLUSIVELV CONTRACTING WI7H LICENSED CONTHAC70RS to construct the proJect (Sec. 7044, Businesa entl Profasslons CoEe: 7he cantwctors License Lew does not apply to en awner of properry who bullds ar impraves Uereon, end who contracts tor such proJect with a conirector(s) Ilcense pursuent to ihe Coniractors License LewsJ. ❑ I am exempl untler sec. Business entl Professions Code tor this reason: Sipneturo: Dete: Owner ID verified by dAvels Ilcensa. ❑ Yes � No Dnvals Licanse No. Expires: Vedflcatlon ot Ownership by (lype of Gaument, i.e. - praperty tex bill ar deetl): DIVISION OF INDUSTRIAL SAFE7Y PERMR CERTIFICATION: ❑ I here6y certlly ihat no ezcavetion five (5) or more feet in tlepth into which a person is requlred to descend, will be maOe In connectlon with work euthorized by this permit, and �het no builtling sirucWre, sceNoltling, lelsework, or demolition or dismantling Ihereot, will be more then ihirty-slx (38) feet high. (Chep. 32, Grp 2, Ar12, Sec. 341, 77tle 8, Ca111om1a Administretive Code). ❑ As owner-bulltler, 1 will not employ anyone to do work which wauld require e permit from the Division ot Industrial Satery, as noted ebove, unleas such pereon hes e permit to do such work irom the division. Signature: Date: Divislon ollndustrial Safary Permit Number. CERTIFlCATE OF COMPLIANCE AND AUiHOR¢ATON OF EMRY: I certity under penalty of perjury that I have read this epplication and stale that the informetlon given is correct. I agree to comply wit� all stete laws end ciry ordinences relating to bulltling construction, and aut�odze representetives of the Clry of Coste Mesa lo enter upon the above-described property tor inspedion purposes. I egree not lo occupy or ellow occupancy of eny building authorized by ihi9 pertnit until final Inspection. �Igr(a�e O��ga O er(s) Al� AnN(3rAu onzadAp icant CODE �. INSPECiIONTYGE 7fi78 Fixetl System Finel Fire Preventlon 1266 Pool Spe Finel 200 Finel Re-Roof 201 Finel BIocWRetaining Wall 202 Final Fectory Fire Plece 203 204 Final Slgn Final Demolition PdIE L�LS Date %7l�-n�� Date CO�E I INSiECTION TYPE 206 Final Mechanical 208 Finfll Plumbing 210 Finel Electdcel 212 Finel Fire PrevenUan 220 Finel Planninp Approval 222 Final Slte _ 250 Flnal Buliding/Occupenry QAIE It�Lfl )-S-o� Gw