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Home My WebLink About273 BRENTWOOD PL - Building PermitsCITY OF COSTA MESA ��pMFq BlIILDING DIVISION � tt � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us �, .� : �. ` FOR INSPECTIONS CALL: (774) 754-5626 4aq�o�o.{? PERMIT NUMBER: BX09-00266 PERMIT TYPE B MISC STATUS: ISSUED APN: 43933222 DATE ISSUED: 12/24/2009 Zoning: , ISSUED BY: JOB ADDR�SS: 273 BRENTWOOD PL CM Suite/Unit: Vicinity: ROOF Primary Occ: Const Type :?? SQ. FT: 105 Valuation: $6,000.00 , . SCOPE OF WORK: INSTALLATION OF 6 PHOTOVOL7AIC SOLAR PANELS/SYSTEM ON THE ROOF OF AN EXISTING 2-STORY SFD. ELEC: 1 INVERTER, 1 A/C & 1 D/C DISCONNECT, CONDUIT ,. OWMER: SARY, TONY City/Slate: COSTA MESA, CA Phone: APPLICANT: KEMME, JENNIFER City/State: Phane: 909-754-8300 CONTRACTOR: Address: City/State: Zip Code: ARCHITECT; Phone ENGINEER: Phone SUNBELTSOLAR SYS7EMS 26881 PRAIRIE DOG LANE MORENO VALLEY, CA 92555 FEE SUMMARY Building Plan Check: Building Permit: Electrical Permit SMIP Residential SMIP Commercial Bldg Std Admin Fund TOTAL FEES Address:: 273 BRENT4VOOD PL Unit Zip Code: 92627-1366 Address: Unit: Zip Code: � , r �. L. ti License No. 530809 Unit: Phone 1-800-794-1972 Cell: . License No. License No. �'i.'. ELFC: -� $81.41 $125.25 :,i;i; $72.20 $0.60 $0.00 $1.00 Un�t: $298.66 �: nr,: NOTICE: The work authonzed by this permit shall wmply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS; In order (or the work authorized under this permit to be considered legal, such work musl 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 thisipe�it. CODEt. INSPECTIONTYPE Dr1TE INilllpl5 COOEt INSPEGTION7YPE �RTE INP71AL5 7876 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spg Final 208 Final Plumbing f�,� 200 Final Re-Roo/ 210 Final Electncal �(J � CI `� 201 Final Blq�g/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site ZU4 Final Demolition ' 250 Final BuildinglOtcupancy �� :,i:,' WORKERS' COMPENSATION DECLARATION: I hereby a�rm under penalty ol perjury one of Ihe following tleclarations: ❑ I have and will maintain a certi6cate of consent to selt-Insure for vrorkers' compensation, as provided for by section 3700 of the Labor Code, for the performance of Ne work for which Ihis permit is issued. ❑ I have and vnll maintain workers' compensation insurance, as required by sectbn 3700 of the Labor Code, (or the peAormance of [he v.vrk for which mis pertnit is issuetl. My workers' compensation Insurance cartier antl policy number are: Canier: (ihis secfinn need rrof 6e rompeted d tne peim� k valvetl al one nvndretl tlollars (Sf00) o� less.) PoGc Number: I certify thal in lhe pertormance o( the work for which lhis permit is is4 ea. I shall not em loy any person in any manner so as to become subject to th� workers' o ensation laws of Califomia, and agree lhat it I shoultl become subject to e vrorkers' compensalion provisions o! Section 3700 of the Labor Code, s II fonhwith comply vnth these provisio . � � wre Da WARNING: FA R TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm [hat I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Divisi n 3 f Ihe Business and Professions Code, and my license is in full torce an eff c �ic-n �J 08�� G s�s�..�' � ii� -" 2 �GCn� actuc's�Sl ne CONSTRUCTION LENDINQ/yGENCY: ❑ I hereby affrm that ttfere is a conslructbn lending agency for the peAortnance of the v.ork !or v.fiich this pertnit is issued. (Sec. 3097. Civil Cotle). Lentler's Name: lender's Adtlress: Date OW NER-BUILDER DECLARATIONS: I hereby aHirm ihat under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5, Business antl Professions Code: Any city or county which requires a permit to conslmct, alter, improve, demolish, or repair any struc�ure, prior to its issuance, also requires the applicant for such permit to fle a signetl statement that he or she is licensed pursuant to the provisions of the Contracrors License Law (Chapter 9(commencing with Section 7000) o( Division 3 of Ihe Business and Professions Code) or lhat he or she is exempt therefrom and the basis for lhe alleged exemption. Any violation o( Section 7031.5 by any applicant (or a permit subjecls Ihe applicant to a civil penally of not more �han fve hundred dollars (3500).): ❑ I, as ovmer ol Ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the sWcture is not intendetl or oKered 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 ovm employees, provided that such improvements are not intended or oftered for sale. I(, however, Ihe building or improvement is sold vrithin one year o( completion, the owner-builder vnll have the burden of proving that he or she did nol build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conslruct the projecl (Sec. 7044, Business and Professbns Code: The contractas License Law dces not apply to an owner of property who builds or improves thereon, and vmo contracts for such project with a cmtracta(s) license pursuant tothe Contractors License lavrs.). ❑ I am exempt under sec. Business antl Professions Code for this reason: Slgnalure Dale 305]�a6(3/0]) Owner ID venfied by driver s license. ❑ Yes ❑ No Dnver's License No. Expires: Verification of Ovmership by (lype of document, i.e. - property lax bill or tleed�: DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I hereby certAy that no excavation (rve (5) w more feet in tlepth into �+fiich a person is required to descend, vnll be made in connection with work aulhonzed by this pertnit, antl that no building structure, scaffdding, falsewvrk, or tlemolition or dismantling thereof, vrill be more than thirty-siz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Califomia Administ2tive Code). ❑ As ovmer-builtler, I will not employ anyone ro tlo 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 Ihe division. ApdiwN's SignaWre Division of Induslrial Safety Permit Number _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or (uture building occupant need to fle and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Cali(ornia Health and Safety Code requires, with some exceptions, that a Business Plan be fled with Ne Costa Mesa Fire Department by every business which has at any one time dunng a reported year a quantity of hazartlous materials equal to or grealer than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressetl gas at standard temperaWre and pre55ure). 2. Does or will ihe applicant or present or future building occupant need to file a registration (ortn (or acutely hazardous materials? ❑ Yes ❑ No (Section 25533 ot the Cali(ornia Health and Safery Code, with some exceptions, requires registralion with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity o( acutely hazardous matenals equal to or grealer than a weighl of 500 pounds, or a volume o! 55 gallons, or 200 cubic feet o! wmpressed gas at standard temperature and pressure). 3. Does or will ihe appliwnt or present or fuWre building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous malenals)? ❑ Yes ❑ No (Section 25534 of the Cali(omia Health antl Safery Code provides [hat the Costa Mesa Fire Department may require me preparation, certifcation and fling with Ihe Fire Department of an RMPP by businesses which are required to register acutely hazardous matenals vrith the Fire Department. 4. If an RMPP is presently requireQ has Section 25534 ot the Cali(ornia Health and Sale[y Code been fully complied with? ❑ Yes ❑ No 5. Does or vnll the applicant or present or future building occupant require for the work which is lhe subject of this application a permit (or such construction or modifiwtion from the South Coast Air Quality Management Distnct or from any other air polWtion control district or agency? ❑ Yes ❑ No (Section 658502 of the Califomia Govemment Cotle requires that the requested information be fumished on applications fa non-residential building pertnits). 6. Will any part of the lacility to be constructed under this permit be within 1000 feet from the outer boundanes of a school? ❑ Yes ❑ No pf'yes", the taciliry must meel the requirement of Sec[ions 25534 antl 42303 of the Califomia Heal[h and Safery Cotle). 7. If a permit from the South Coast Air Quality Management District or other air polWtion contml disMct or agency is requiretl for the work which is the subject of this application, have all ot the disclosures prescribed by Califomia Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If'yes", attach certificate of compliance from the appropnate air polWtion control o�cer). CERTIFICATE OF COMPLIANCE: I certify that unCer penalry of perjury the information given above is correcL I agree to comply with all state laws and city ordinances regardinq Hazardous Materials antl Emissions. Da�e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this appliwtion and state that the infortnation given is correct I agree to comply with all state laws antl city ordinances relating to builtling consWction, antl authorize representatives of the Ciry of Costa Mesa to enter upon the above-0escnbed property for inspection purpo es. I a ree not to occupy or allow occupancy ot any huilding aWhorized by lhi pe i until final inspection. Signal e Owner�s) Da�e � v m z"_` Aod�cant � . .—�,Oatc�l � ) CITY OF COSTA MESA �'�pMF B!/ILDING DIVISION F�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(7�4) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us °�q�`m fi� FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: E09-00290 PERMIT TYPE ELEC APN: 43933222 JOB ADDRESS: 273 BRENTWOOD PL CM Vicinity: ATTIC STATUS: ISSUED DATE ISSUED: 12/0312009 ISSUED BY: RMD Suite/Unit: SCOPE OF WORK: ELECTRICA� PERMIT FOR 1 LIGHT FIXT, 1 OUTLET AND 1 SWITCH FOR THE RELOCATION OF AN FAU TO ATTIC AREA FOR A SFD. REF#: M09-00114 OWNER: SARY, TOMY Address: PHONE: APPLICANT: IBqNEZ, ADOLFO B PHONE: CONTRACTOR: ECONO AIR Address: 3101 ENTERPISE STREETUnit: City/Stale: BREA, CA ZipCode: 92821 ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $26.80 Reinspection Fee $0.00 TOTAL FEES $26.80 273 BRENTWOOD PL Unit: City/State/Zip: COSTA MESA, CA Address: Unit City/State/zZip: License No. 445220 PHONE: 800-503-2666 CELL: NO710E: The work aulhorized by this permit shall comply vrith all applicable handicap access requirements under California statutes and related re9ulalions. (Ord, No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must wmply with all applicable codes, and all required inspections and £nal approval must be obfained. Failure to obtain inspections and final approval vnft result in the expiration of this permif. 0 � INSPECTION1ypE 1616 Fixed Syst@m Final Fire Prevention 1268 Pool Spa Final 200 Final Re-Roof 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Dem0lition D�TE INTIPALS G UE� INSPELPONTYPE 206 Final M��haniCal 208 Final Plumbing 210 Final Eiectrical 212 Final Fire Prevention 220 FinalPlanningApproval 222 Final Site 250 Final Building/Octupancy U�IE INPTIALS WORKERS' COMPENSATION DECLARATION: I hereby a�rm under penalry of perjury one of the follovnng declaretions: ❑ I have and will maintain a cetlifcate of consent to sel6lnsure for vrorkers' compensation, as provided for by section 3700 of the LaDor Cotle, for the peAormance of the work for which Ihis permit is issued. ❑ I have antl will maintain workers' compensation insurance, as required by sectbn 3700 of ihe Labor Code, for ihe pedortnance of the wnrk for which ihis permit is issued. My workers' compensation Insurance cartier and policy number are: p.,� n � � / . Carriery�,,f % � � "—a?�"� ��-•� �(Thrs sec(ron nee0�n�of jbe wmple(etl A f�e perm� is valuetl al one huntlretl tlollars (8�100/) 1o� less.) Po�cy Number. W�l ��`" �' � 7` `-%b� G i�' 7-/ �.— ❑ I ceAify that in the per(ormance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to lhe vrorkers' compensation laws of Califomia, antl agree that it I should become subject to lhe workers' compensation provisions o( Section 3700 of the Labor Code, I s�all fo hwi co ply with these provisions. � /z-�''"` � A00� �?,�B�a�we-T Date �='1.... 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 DOLLARS (5100.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATiORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapter 9(commencing with Section 7000) o! Division 3 of the Business and Professions Cotle, an0 my license is i(n 6fy( II force antl eflect. Licr#-� ��' �� Class#:� C� � � -. � -_ � � � - _% 2 c y'� Comracl6' SlgnaNre (��ale�„ CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn ihat there is a consWction lending agency for the perfortnance of the Nark for wfiich this pertnit is issued. (Sea 3097, Civil Cotle). Lentler's Name: Lender's Adtlress: SignaWre OW NER•BUILDER DECLARATIONS: I hereby aKrm that under penalty of perjury Ihat I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5, Business and Professions Cotle: Any city or counry which requires a permit to construct, alter, improve, tlemolish, or repair any sWCNre, pnor to its issuance, also requires the applicant for such permit to file a signed statement lhat he or she is licensed pursuant to ihe provisions of the Contracrors License Law (Chapter 9(commencing vrith Section 7000) o( Division 3 of the Business and Professions Cotle) or that he or she is exempt therefrom antl the basis for the alleged exemption. Any violation of Section 7031.5 by any appliwnt for a permit subjects the applicant to a civil penalry ot not more than fve hundred dollars ($500�.�: ❑ I, as ovmer of Ihe property, or my employees with wages as their sole compensation, WILI DO THE WORK, and the stmcture is not intended or offered for sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law does not apply to an owner of property who builds or improves lhereon, and who does such work himself or herselt or through his or her ovm employees, provided Ihat such improvements are not intendetl or offered tor sale. I!, however, the buildinq or improvement is sold within one year ot completion, the owner-builder will have the burden of proving that he or she did not builtl or improve for purpose of sale.). ❑ I, as owner of the propeRy, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to wnstruct the project (Sec. 7044, Business antl Professbns Code: The wnt2ctors License Law dces not apply to an ovmer of property wfio builtls or improves thereon, and wfio coN2cts for such project with a contractv(s) license pursuant to the Contractors License LavS.). ❑ I am exempt under sec. Business and Professions Code lor this reason: SignaWre Date 305]-46(3I0]) Owner ID verified by driver s license. ❑ Yes ❑ No Driver's License No. Expires: Veri(wtion o( Ownership by (type of document, i.e. - pmperty [aa bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify thal no excava[ion frve (5) w more feet in deplh inro which a person is required to descentl, vnll be made in connection with work authorized by this pertnit, and that no building structure, scaHdaing, talse�wrk, or demolition or dismantlinq thereof, will be more than thirty-six (36) fee[ high. (Chap. 32, Gry 2, M 2, Sec. 3A1, Ttle 8, California Administra[ive Code). � As ovmer-builder, I will nol employ anyone to do vrork which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work trom the division. AOW��'s SignaWre Da�e Division o( Industrial Safery Permit Number _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applican[ ar present or fuNre building occupant need to fle and certily a Business Plan (or emergency response lo release or threateneC release of a hazardous malerial? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safery Code requires, with some exceptions, that a Business Plan be filetl with the Costa Mesa Fire Department by every business which has at any one time tluring a reportetl year a quantity of hazardous matenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feel of compressed gas at standard temperature antl pressure). 2. Does or will the applicant or present or fuNre building occupant need lo fle a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registra[ion with Ihe Costa Mesa Fire Department by each business which at any one time has on hand a quantiry o/ acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o( compressetl gas al standartl temperaWre and pressure). 3. Does or will the applican[ or present or fuWre building occupant need to prepare an RMPP (Risk Management and Prevention Program tor acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provitles that the Costa Mesa Fire Department may require ihe preparation, certification and fling with the Fire Depatlment o( an RMPP by businesses which are required to register awtety hazardous materials wi[h lhe Fire Department. 4. If an RMPP is presently required, has Sec[ion 25534 of ihe California Health and Safely Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or preseN or future building cecupant require for the work which is Ne subject of this application a permit for such construction or modifcation fmm ihe South Coast Air Quality Management District or from any other air polWtion control dislnct or agency? ❑ Yes ❑ No (Sectbn 658502 of the Calitomia Govemment Code requires that the requested information be fumishetl on applications !or non-residential builtling pertnits). 6. Will any part of the facility to be consWcted under t�is permil be within 1000 leel from the outer boundanes of a school? ❑ Ves ❑ No Qf "yes". the faciliry must mee[ [he requiremen[ of Sections 25534 and 42303 of the California Health and Safey Code�. 7. If a permit from the South Coast Air �uality Management District or other air pollution control disVict or agency is required for Ihe work which is the subject of this application, have all of the disclosures prescribetl by California Health and Sa(ely Code Section 42303 been made? ❑ Yes ❑ No 8. (If'yes", attach certificate of compliance fiom the appropriate air pollution control oKcer). 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 regardin9 Hazardous Materials and Emissions. SignaWre Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity under penalty of perjury that I have reatl this application antl state that the informalion given is correct. I agree to comply vrith all slate lavrs and city ordinances relatinq to builtling construction, antl authorize representatives of the Ciry of Costa Mesa to enter upon the aboveEescnbed pmperty for inspection puryoses. I agree not to occupy or allow occupancy of any building authorizetl by this permit unG f n N ection. r � nerl ,`_� -Da1e �� Antlbr Aut� nze0 Ap01¢ant Dat� CITY OF COSTA MESA 05�pMFq BUILDING DIVISION F�� 77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.wsta-mesa.ca.us ° FOR INSPECTIONS CALL: (7'14) 754-5626 �"'°""`°`� PERMIT NUMBER: M09-00114 PERMIT TYPE MECH STATUS: ISSUED APN: 43933222 DATE ISSUED: 12/03/2009 ISSUED BY: RMD JOB ADDRESS: 273 BRENTWOOD PL CM Vicinity: ATTIC SQ. FT: 0 Suite/Unit: SCOPE OF WORK: MECHANICAL PERMIT TO REPLACE AND RELOCATE FAU <100 K BTU TO ATTIC AREA, ALTER DUCTING AND GAS PIPING FOR SFD. C(,`�� ilL .1 ��K� OWNER: SARY, TONY Address: PHONE: 949-548-2616 APPLICANT: IBANEZ, qDOLFO B PHONE: 800-503-2666 CONTRACTOR: ECONO AIR Address: 3101 ENTERPISE STREETUnit: City/State: BREA, CA ZipCode: 92827 MECHANICAL P�RMIT FEE SUMMARY MECH ITEM FEE: $58.15 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $58.15 273 BRENTWOOD PL Unit: City/State/Zip: COSTA MESA, CA Address: Unit: City/State/zZip: License No. 445220 PHONE: 800-503-2666 CELL: NOTICE: The work authqrized by this permit shall comply with all applicable handicap access requirements under Califomia statules and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable wdes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will resWt in the ezpiration of this permit. CODEN. INSPECTIONTYPE �ATE IN1111AL5 CODE% INSPEC710NTYPE DATE IN 5 1616 Fixed System Final Fire Prevention 206 Final Mechanical Z/O (O 1266 Pool Spa Final 200 Final Re-Roof 201 Final Block/Retaining Wall 202 Final Factory Fire Place . 203 Final Sign 204 Final Demoli�ion 208 Final Plumbing 210 Final Electri�l 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATION: I hereby affrm untler penalty of perjury one of the follovdng declarations: ❑ I have and will maintain a certifcate of consen[ [o sel6lnsure for workers' compensation, as provided for by sec�ion 3700 of the Labor Code, (or the pertormance of Ihe vrork for which this permit is issued. ❑ I have and will maintain vrorkers' compensation insurance, as requiretl by section 3700 of the Labor Code, for the peAortnance of the vrork for which this pertnit is issued. My workers' compensation Insurance �arrier and policy number are' � 1 i.J 1�.-�ti^^ o �� Carrier. (Tlus setlm neetl �not)Oe rompeted d t�e pertn4 is valuetl al one hurMretlOo9ars (5100)' 'a lCe�ss ) Policy Numher: �vC^� •�� t y� C v�� .Y/ � I certi(y Ihat in the peAormance of the work (or which this permit is issued, I shall not employ any person in any manner so as to become subject to the vrorkers' compensation laws of California, antl agree lhat if 1 shoultl become subject lo Ihe vrorker ' pensation provisions of Section 3700 0( [he Lab-or Cotle, �I hall fo � co y tvn h these provisions. `�t Z� � . Appli 1' SignaWre Date 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 DOLLARS ($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 licensetl untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in ( IlI ftorce and eRect. Lic. # � 1 � �"" � Class # C �^, a� �y� �� Conv or's5lgnaWre Date CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm Ihat there is a construction lending agency for Ihe pertortnance of the wurk fa which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Date OWNER-BUILDER DECIARATIONS: I hereby aHrtn that under penalty of Oerjury that I am EXEMPT FROM THE CON7RACTORS LICENSE LAW lor the (ollovring reason (Sec. 7031.5, Business and Pmfessions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any swcture, prior ro its issuance, also requires the appliwnt for such pertnit to file a signed statement Ihal he or she is licensed pursuanl to Ihe provisions o( the Conlracrors License Law (Chapter 9(commencing with Section 7000) of Division 3 0l the Business antl Professions Code) or that he or she is exempt therefrom and the basis for Ihe alleged exemption. Any violation of Seclion 7031.5 by any applicant for a permil subjects the applicant to a civil penalry of not more than fve hundred dollars (5500�.): ❑ I, as owner of Ihe 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 Pmfessions Code: The Contractors License Law does not apply to an ovmer of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided Ihat such improvements are not intended or offered for sale. If, however, Ihe building or improvement is sold vnthin one year of completion, the ovmer-builder will have the burden of proving that he or she did not build or improve (or purpose of sale.). ❑ I, as ovmer of lhe pmperty, am EXCLUSIVELY CONTRAC7ING WITH LICENSED CONTRAC70RS to consWct the project (Sec. 7044, Business and Professbns Code: The cont2ctors License Law dces not apply to an ovmer of property who builds or improves thereon, and wfio contracts for such project with a contracta�s) license pursuant to ihe Contractors license Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: SignaWre Oate 305]�a6(3/O)) Owner ID venfied by driver s license. ❑ Ves ❑ No Driver's License No. Eapires: Verifcation of Ownership by (type o( tlocument, i.e. - property tax bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereDy certify ttiat no excavation frve (5) or more feel in depth into wfiich a person is required to descend, will be made in connecl'an with vqrk authorized by this permit, and that no builtling slrucNre, scafldding, false�wrk, a demolition or dismanUing �hereof, vrill be more Ihan thitly-six (36) fee� high. (Chap. 32, Gry 2, M 2, Sec. 341, Title 8, Calilomia Atlminist2Gve Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit (rom lhe Division o( Intlustrial Safery, as notetl aDove, unless such person has a pertni[ to tlo such work from Ihe division. AVP��nl's SignaWre Division o( Industrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 7. Will the applicant or present or future building occupant need to file antl certify a Business Plan tor emergency response to release or lhrea�ened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safery Cotle requires, vrith some eaceptions, that a Business Plan be fled with the Costa Mesa Fire Department by every business which has al any one time dunng a reporled year a qUanlity of hazartlous matenal5 equal IO or grealer than a weight o( 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas al standard temperaWre antl pressure). 2. Does or will the applicant or preseN or fuNre building occupant need to file a registration fortn for acutely hazardous malerials? ❑ Yes ❑ No (Section 25533 0( lhe California Health and Safety Code, with some exceptions, requires registration with the Cosla Mesa Fire Department by each business which a[ any one time has on hantl a quanti[y of acutely hazardous materials equal to or greater Ihan a weight ot 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas al stantlard temperature and pressure). 3. Does or will the applicant or present or future builtling occupant need to prepare an RMPP (Risk Management antl Prevention Program tor aculely hazartlous matenals)? ❑ Yes ❑ No (Seclion 25534 of the Califomia Health and Safery Code provides that the Costa Mesa Fire Department may require ihe preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register awtely hazardous materials with the Fire Department. 4. If an RMPP is presently require0. has Section 25534 0( the Califomia Heal(h and Safety Code been fully complied with? ❑ Ves ❑ No 5. Does or will the applirant or present or fuWre building occu0ant require for the vrork which is the subject of Ihis application a permit for such construction or motlifcation fmm Ihe South Coast Air duality Management District or (rom any other air pollution wntrol distncl or agency? ❑ Yes � No (Section 658502 0! the Califomia Govemmenl Code requires that the requested information be fumished on applications for non-residential building pertni[s). 6. will any part of the faciliry to be consWcted under this permit be within 1000 feet from the outer bountlaries o( a school? ❑ Yes ❑ No (If'yes", the facility must meet the requirement ol Sections 25534 and 42303 o! lhe Califomia Health and Safery Code). 7. If a pertnit from the South Coast Air �uality Management District or other ai� pollution control tlistrict or agency is required for the work which is the subject of this application, have all of Ihe tlisclosures prescnbed by Calitornia Health and Safe[y Code Section 42303 been maae? ❑ Yes ❑ No 8. p( "yes", attach certificate of compliance from the appropriate air pollution coNrol oKcer). CERTIFICATE OF COMPLIANCE: I ceAify that under penalty of perjury ihe inlormation given above is correct. I agree to comply with all state laws antl ciry ordinances regarding Hazardous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this appliwtion and s[ate that the infortnation given is correct I agree to comply with all state laws and ciry ordinances relating to builtling wnsWction, and authonze representalives of the City of Costa Mesa to enter upon the abovetlescnbed pmperty for inspection purposes. I agr not � ccupy or allow occupancy of any building authorized by this permit ntil final ins ection. S aNreolle me� � Dale MtllorAu� nze0Ap01iwm �te/ � � I �DUNESSOFBNLOW�: ONNERS NWE IF IPlOIIN: D � �ooxesa C �vr�, xuuxa �oonesx AHCXRECTOPFNtlNFEN: THOMAS TR OOD PL ,CA 92627 car'm�crarsn�ueLEE ROOFING cam�croas�uiwo 1653 SUPERIOR �p�COSTA MESA 9z6z� CA UCENSE� CONTNRCTONS DECLAN�TON: I hraly dlim uNx paWy d psryiy Net I em la.�eno�p wil� Sx�ian 1000) d Divuion � d Ne Bwimsa erd PMeasiona Code. ard my I' cw�e'cNo.:069337 ue.cuss:C-39 uc.No.: 3496${�, uc. No.: VNT: UNT: (714)642-7223 ucwo.: 349686 UNT: �icen..a udx wowio�. a cnawa 8 weme ie in full lwcs end elletl. EXP: 02/98 0 BUIL6EH DECCARATION: 1 hmeby el(um uMx penely d tMt 1 em esamq han �he Com�etlus licanea lew la ttw ' reason (Seeion ]W 1.5 Bus'vnea md Prdesabro CaEe: Nry Y a aouivy r.fiirh iequirm e perm4 to cansWtl. elim. improve. :�macn. «rw� �r �^,nure: w�« b b ewenoe. aho mo� �n. wp� r«.,rA o� �o N.. apred.teiemeM mm ne «sne �-� lu� a d Prd�ofu c aeal a nmdn «�''n� anqne�rel�mmw'aCi,e �M �%« � c� ��w�,. ��b mon �af3s tl,iw ]IX11.5 by enY aVV�icenl Iw e parmil whjeCe IM epWice�� to e oW penelry d ml mae Ihen fi:e huMreC Edbn �550011. � i.e.ow�«ainewwa+r«�n«�Ww«s.nn.wmmma:edemmro�+�+.•ioeomewakenemea�mn��e:�aw.�dae or ollered I« aeb (SecUon )OCI. Buvrma eM Prdeasiona Code: Tha Canireeon Liranae Lawdoae ewt epply Io en ownerd pmpa�ly who WiAa a mpmroa ilwraon. eM Mw doe+auef� wk hinxtl a MnN a Yvaph hs a har own mmqqaae. pwided thet aueh imvrovammb era nd inieMad a atleieE la veb. tl. howerer. tM WYdi'p a inpwemmq b edd wuhin om Y� d mmplelbn. the owmr-0uiMx xill luw iM EuNen d yw'up he a ehe dk nd duk or improva lu Ile purywa d eebl. � I. as oxmr d Ihe prapaery. em euVwirely eanlredip wiN lieantsd eonVaeton lo wnebua Ne qqetl (�� . Buainma eM r�re.aae cod.: me cwvreeon �en+e i.. aoes m moN n e� �.,b. d ww�r wno w�m « v�ww« ma.o� .�d ..no convecb M wM pqeea wnh a mmndw(e) IieemeA pursueM Io IM Caprotla+Limeua lew). � I am uemq uMm Swyon: B.8 P.C.. br ihn meam: Dme: �w I do MrebY �e�M �het I em ewera M md Wrs1eM Ne �W��a�b d Callmim HsaEA ud `.b1elY CaAe Sed'pne P5505� 25SU, eM ]SSSa, eM Nei I a eiry Mun Wikmp omryen� T/ wil mi (ercb aw) neeE to oomply xvh aeid mte mdu ud iM rpui�emame br e permN tac«ntrvabnrc modificmionhanlMAr�v�q�mwnt Dinrie. Retidmtielmnstrutlion appirslioruve a�emq /mn thme o�.: rod�v: WORKEP'4 COMGENS�TION DKL�N�TON: I Meby effum Wa peiWty d perjuy ons d tM Idbwiiq dedveturo: � IhevsenExilmeintenecentlicusdmuemiovaXarouroMwAsseompenmlbn.mW�ed�aW3eeion3)Wd�helabor Cods, la IM pMmnuice d Ns xM la whirl� Nu pemd u bustl. �� ner. ene w meiman.on�em m�o�� . m nm,uw M seeYn aroo a me �.no. wd.. ro. �na w�rormeme a m. wM la whitli iM pemlil b uaued. MY ��' �Po^+d�^^ ^��e u� � V^�wY numEr vs: c.�.: STATE FUND EXPIRES vou�r+�me� - 06/30/96 .(1hn ee[fion nse0 mf ds camO�M / UpYm'��/ u b ons hvGeO adbn (SIPO� a� Ias.1 _� I eenfY IMt in Ne pMormerce d the wark Ia wM1c� thu permil e inusd. I 4WI ew� anpby enY M� in anY mennor eo u lo pxpna wbjeq ta tM �wlwa' mmpraetion M�x d CWami�. eM yre� ihel Y IyDaytl Esmms abjetl lo IM xwka�' comeenm�wn awivio�� d Sedpn 3100 d IM1a Inbar Code. I eyyplqlhr.ilry,q�p1/ M��h►� D�l�i W /np: F u� ro�{cun w�k�ra'rompwuetlon rovsrp� l� vnMrM ahlfv'!/�ct �n wtWloyr ro cNminel pm�ltlu en0 vll IIMs ro om hinJrM flwua�nE tlollw (SIOq000), M MCltlo N� cwf ol romv�ruelbM1 Mmnp� �� povlESC br In Sxtlon J)06 0l Ms Ldor Co6. /irt.ru4 �d attomry'� INa CONSTHUC110N LENDINO GOENCI': I Mmb/ dfvm ivMv px�eCy d per'�vy tIW Ihse u e canat�udion bMirp epom.y la tM perlOrmeMe d IM wwk M whiN th"v Po�i u ewed (Saaion J091. Cw. CI. LENDEP'S N�IIE LENDEN'S �D�NESS: 1 eenity Ihe� I here reed Nn eppliraiion vd nele tAm Ne eEws iNamelion e ea�ad. I epree lo oomply wilh eA eiry eed mumy wdinenme eM.wa le„s rdeiiq w buiN'v�u oonso-ueion w n«abr.wwrse npraeanietnw d ihb inr w smer uv� �he abwe-mamimed woceM ��°��'�"�MZKE BURHE • A il PtlN / � Whne-Buildvp 8 Seley; OreeMFb: Ge�wy-Appicenl: Pink-Rmmue; OokenmA-Asseamr CITY OF COSTA MESA - HUZLDING PERMIT ��$�6DDS(P PERM NO: B 086556 PERMZT NO: H 086556 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTZON TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH JOH DESCRIPTZON : T/OFF RESTH W/OSB & REROOF W/COMP. SQ FT: 6,200 CLAIM VALUE: 6,200.00 CALC-VALUE: 6,200.00 GROUP OCC: R-3 / COMMENTS: SMOKE DETECTORS ARE REQUIRED *�t�r�t*�t*+r****�t�r�**+t+t�tx�*-�***�*-�t**�t�r**at�x-x�-x-�t*x�*�t�r*+t�t�t�t-�x��t��t�-+r*+t*-�t�-+r-��-xrt*+�*-x�*�r*�*�-�-x� Z O N I N G R E Q 0 I R E M E N T S S E T H A C K S / ------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT ZN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 43933222 ZNE: REF NO: PLANNING NOTES> �, � !F'1E'1E iE fF iF iE iE �E 1! iElE iE it if iF �F iE �E iE'IElF iE 1f iE if'%ik jf 1E if iE ik iE i(� iE 1E 1E iE dE �E iE �E 1E iE if if iE iE iE it if fE iE jE 3E jk 3E jk fE �E k�f !E ik iE iE if if iE-jf iE iE 3E ib k 3E iE �)E D E V E�L.O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONZNG APPROVED BY DATE; HUILDING APPROVED BY ; DATE: : � APPLICATION ZSSU�D BY: /��— DATE: � itiE�EiliEikiElEiElEifillEihiE�E3kjFiE�EiE1E��i�iF3F��iFiF3f�iFTF3F3FiFiEjWFiPSFiF��iF3fiE�f�f�3f�F'�fiFiE3E1F�E1falaFif�E �F LEGALIZATION:N F E E S U M M A R Y STRUCTURA S GMEN :Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIAE SMIP/RES GRADING PERMIT 124.75 62 SMIP/NON-RES PLAN ISSUE FEE BUILDING-DIV-> PERMIT ISSUE PLAN-CHECiC TOTAL PAID DUE TOTALS----> 125.37 0.00 0.00 125.37 125.37 .00 REVENUE DIVISION TOTALS--> COLLECTED: 125,37 OVER/SHORT: .00 BLD24PM5 PLUMBING ELECTRIC MECHANIC FIRE SMIP/T6z GRADING PLAN-CHECK 1f 1F fE iE iE 1E fE 1E �F �)F 1E �k �)E �E �E �IE jE if iE 1k if ik 1E it 1E i! 1E 1E ik ik M �k �E IE 1E �f i! 1f 1E �E 1ElE �E iE 1E iE ik k 1E iE fk jk �4 iE 1f �7F M if if iflt iE if i(� IE 3F dk fk iE 1k it 1E iE 1k if iE fE iE �f I N D I V Z D U A L F E E B R E A x D O W N TYPE QTY D E S C R I P T Z O N UNIT COST TOTAL COST SFR 6200 REROOF BY VALUE RESIDENTIAL N020NE 1.00 6,200.00 END OF FEES 81-14-1398/88:26 AK/f125.37 RCPTN:01-Ei01B079 F'EkMIT=086556 , i t /!ONSTRUCTION AND PL�NNIN� �,iPPROYALS Permit # 1. TemporarY Eiectrical Service or Pole 2. Soil PipB-Undrgrnd;_ 3. Electrical Cpnduii Utility�Undrgrnd. '� 4. Electrica� Cond4iAUndrgrnd. 5. Steel Reinforcement- 6. Electrical UFER Grnd. 7. Footings - 8. Foundation 9. Water Pipe•Undrgrnd. . 10. St�uctural Floor Svstem 11. Property Sewer Line & House Connection 72. $ewer Cap . 13. Roof Drains 14. Rough Piumbing 15. Rough E�ectrical-Conduit � � 16. Rough EleCtriC Wiring 17. Rough Wiring Sign 18. Rough Electricai-T Bar Ceiling , 79. Rough Heating & Air Conditio�ing - 20. Rough Factory Firepiace 21. Ducts, in Structure 22. Oucts, Ventiiating 23. Gas Pipe-Rough & Test 24. Roof Framing . 25. Roof Sheathing ' /.. L 26. -T•Bar Ceiling (Structurap & Monocoat 27. Frame and Flashing 28. Lathing & Siding �' 29. Insulation 30. Drywall Nailing 31. Plaster Brown Coat 32. Electriwl Power Meter-Fina� 33. Final Electric - 34. Final HeSting & Air Conditioning 35. Final Ga5 P�Pe-Test 36. Hood or CanopV 37. Final Factory Fireplace 38. Finai Plumbing 39. Water Service-Final 40. Gas Service-Finai . 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation ---____.. _.._ 44. la�dscape Irripation System 45, Sound pttenuation 46. Handicap Regulations 47. FINAL5TRUCTURE&BUILDING / 6� 48. FIfVAI PIANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Cc No. Date Date rv�� arH �nspector qppROVALS Permit # 52. Pool & Equipment Locatio� 53, Steel Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER•GUNITE 58. Electrical Conduit�Und�grnd. 59. Gas Pipe, O Undrqrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. 67. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing SYstem - Final 65. Electrical•Finat 66. Solar SYstem-Final 67. Fenciny & Access ApProval 68. APPROVED FOR PLASTERING 69. PQOI/SPASYSTEMSFINA� -" � FIRE DEPT.-REQUIREMENT , , � APPROVALS_ Permit # 0 . Date Inspector 70. Underground Hydro 71. ProducTPipingOGas ❑Oil � 72. Underground F4ush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe . 77. FIXED SYSTEM FINAL . 78. FIRE PREV. FINAL HEALTH DEPT. REQUIR�EMENT 79. FINAL INSPECTION - 80. FOOD CERTIFICATE ISSUED Notes: - 0 � � 17?_79 COSTA MESA BUI4DING•SAFETY DEPARTMENT P. O. BOX �77 COBTA MHBA. CALIFORNIA Fo� .4pplieant to Fill In Comple+ely TYPE OR PRINT BUILDING � 73 L � A�DRE63 COSTA MESA CALIFORNIA � SIZ� OF LOT IISE OF EXISTING 9LDG BHTBACK LIN6 FROM d�'L � //t�-.�{�.j:; _: � p�/ _ JUN 141962 �� i �r:''�I'�� '�._?�. APPLICATION �F,OR FERMI�TH „i:S,l BUILDING For Office Use Only PECEIPT NO. � Pl�IF�}T/1�SJn ar I oh �R��V-�� JUIV 6UILDI / D �(Z .....e� I n� I NO. OF BLDG9. b NOW ON LOT 61DE YARD I LEFT ` � ' I RIGHT �[l ' DESCRIPTION OF WORK NEW I L II ALTERATION I II ADDITION REPAIR I IIMOVING I IIDEMOLISH B,ZE�ING �� ROOMS � 570RII E%THRIOR WALL ROOF '�I S COVERING �- COVERING (�a/ USE OF BUILDING AND WORK TO BE PERFO ED COSTA MESA. CALIFORNIA FIRE ZONE APPROVEO ZONING 20NE NO. OF UBE OF NEW J/h �%�a �`{ I PLAN9 Z I BUILDING �I� � l ��„� (,�'- s �-.� `� � z 9 DEBCAIPTION A. P. NO. YARDS EVES APPROVED fCfiNTEP L�N! 6T.1 � FRONT � R. SIDE �� L.SIDE �� o�,e 33 .2 _ ry�i p"� 7 0- 1 HBREBY AGKNOWL�66 THAT 1 XAVE pBAD I9 MPIJGTION }HE AMOUM BXOWN UNU6F ALl1ATION IS FOR THE AND 8TAT6 THAT THE ABOVE 18 GORRECT AN� AGRHE TO GOM- pURP09E OP EBT�BLIBHINO • nERMIT FEE ONLY. PLY WITH �LL C11Y OIiDINANCEB AND BfATE LAWB li¢6ULATNG Bu1LDINo CON9iRUCilo . � VALUATION // 31GNATURE aF ��y��(,Pj)� PERMIT FEE $ �7— PERMITTE $ /� (/��— PLAN CHECK $ � / � £ AUTHORIZEO AGENT � TOTAL FEE y