The URL can be used to link to this page

Home My WebLink About1064 CATAMARAN CT - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 1064 CATAMARAN CT Suite No Vicinity: GARAGE Parcel Nunmber: 42451130 Applicant: SANCHEZ, JENNIFER Address: 24707 SAN FERNANDO RD Phone: (661)259-7131 SANTA CLARITA, CA Zip: 91321 Owner: TEAGLE, H HARTSELL Address 1064 CATAMARAN CT Phone: COSTA MESA, CA Zip: 92627 Contractor: AFFORDABLE WATER HEATERS & PLUMBING Address: 24707 SAN FERNANDO RD Arch / Eng: Address: Phone: (661)259-7131 SANTA CLARITA, CA Zip: 91321 License: 627368 Phone: Zip: License: Status: ISSUED Applied: 02/11/2002 Issued: 02/11/2002 ISSUED BY: SCOPE OF PERMIT REPLACE 50 GALLON GAS WATER HEATER (SAME LOCATION - GARAGE) QTY FEE SUMMARY AMT ISSUE FEE $23.50 Backflow irrigation $0.00 Backflow Preventer $0.00 Bathtub $0.00 Clarifier System $0.00 Connect (Ice,Soda,etc) $0.00 Dental Units $0.00 Dishwasher $0.00 Drain, Floor $0.00 Drain, Rainwater $0.00 Drain, Roof $0.00 Drinking Fountain $0.00 Expansion Tank $0.00 Gas Earthquake Valve $0.00 Gas (1-4 outlets) $0.00 Gas (Over 4 outlets) $0.00 Gas Repipe $0.00 Gas Service $0.00 Interceptors (Grease, Oil) $0.00 Interceptors (Sand Auto ) $0.00 QTY FEE SUMMARY AMT QTY AMT QTY Laundry Tub / Washer $0.00 0 - Sump Pump $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Septic Tank S0.00 0 Wash Basin $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Shower $0.00 0 Water Heater / vent $12.30 1 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Spa (private) $0.00 0 VIOLATION $0.00 Spa (public) $0.00 0 PLAN CHECK 50.00 REINSPECTION $0.00 0 COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: $35.80 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244646 (6=) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of th work for which this permit Is Issued. ee compensati Insuurra�nccercarnergp�poticy nurpokere: �] J ;__�hBve er:, ( ]i'�'��LUTrN—V. rr hs Policy Number: Ibsi 3-3 5-- �a s section need not be com rated it the V rmit is valued atone hundred dollars (5/00) or less.) ❑ 1 certify that in the pert ance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws lifomia, gree that it I sh uId become subject to the workers' compensation provisions of Sectpppn 3700 of the Labor Code, I shall forthwith comply with the$ rovi ions. I I l ppllcantSlgnaWm:--- Dalai I^� ARNIN SECURE ERS' COMPENSATION COVERAGE IS UN L AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TO ONE HUNDRED THOUSANDDdlAR ($100,000),1 DDITIONTOTHECOSTOFOOMPENSATION, GES AS PROVIDED FOR IN SECTION 30e OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CON RAC S D CLARATION: I hereby affirm that I am Ii ensed un ' i ns Chapter 9 (commencing with Section 7000) of Division 3 of the Busine and Pr fessio Code, and my license is in full {{}}ppiroe end affect. Lic_q cia$a a� 3�0 }'TC �+i�rctor's Contractor's 5lgnature:� Date: si ^ 11—O mill CONSTRUCTION LEN G AGEN : ❑ 1 hereby affirm that th struction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders 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 fore permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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, 1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater 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? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 Pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas al 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 ❑ No ........................................................................................................................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li 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 WIII any part of the facility to be constructed under this permit be within 1000 fest from the outer boundaries of a school? [-)Yes ❑ No (If yea", 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? ❑ Yes ❑ No .................................................................................................................................................................................................................................................I.......................... .................. _........................ B (II 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 OFMPLIANCE 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 t 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-tlescnbe ropert or inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig turBO gal wn ) Lite r uth - - d p Ica — a Date--- TYPE INTMALS CODE-! INSPECTION TYPE RATE. REELS 161 Fixed S tem Final Fire Prevention 206 Final Mechanical 1266 pa 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 BuildinglOccupancy It PROJECTADD,e °s: 1064 CATAMARAN CT UNIT: 84 awxER'S: KAUFMANN E BROAD ADDREss:180 N. RIVERVIEW DR SUITE 30P ANAHEIM, CA 92808 ARCH/ENGINEER: MIKE WOODLEY REG.NO.:C1Far30 ADDRESS: 180 N. RIVERVIEW DR D I'30:0' PERMITTEE: ANAHEIM CA 92808 ADDRESS: 180 _S BROAD (714)921-0500 180 N. RIVERVIEW DR 300 ANAHEIM CA 92808 LICENSED CONTRACTOR DECLARATION: 1 hereby affil eFMrn7icensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 o the Business and Professions ode, antl my lice a is in lull force and effect. CITY LIC.: (r1 8(3 STATE IIC.:33 (*(* LASS. B- -7 n.. ` Signature: WORKERS' DMPE ATION DECLARATION: I hereby affirm that ve a certificate of consent to self -insure or a certificate of Workers' Compensa on Insurance, or a certified copy thereof ,Section Lab. Q. POLICY NO.: 4189-1090 EXP. DATE: 03/07/90 ^OMPANY:T ANS. INS Certified C y is h eby famished. k Certified py is filed ith the city Building Date: Applicant: EXEMP IONROMWORKERS- COMPENSATION DECLARATION- section need not be Completed if the permit is for one hundred ($100) or less). I certify the in the performance of the work for which this pimat is issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California:) ,+,4 •• Date: Signature: NOTICE: If, after making this declaration, you shoulA become subject to the Workers' Compensation provisions of the Labor - Code, you must forthwith comply with such provisions or this'permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that therols a.constroction lending agerietfor tfie rperformanca of the work for Which this permit is issued (Section 3097, Civ. C)_ LENDER: ADDRESS: OWNER BUILDER DECUBATION: 1 hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicard,igr such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/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 em loyees with wages as their sole compensation, will do the work, and the El structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve .for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for Such projects with a contractor(el license pursuant to the Contractors State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section: B. S P. C. for this reason: Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533 , and 25534 and that I or any future building occupant will/will not (circle one( need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and stga ordinances ands[ a taws relating to building construct n propeify for ins coon poses. Date: J / Signature: Driver's L1 rise or Social Security 11: - is correct. I agree to comply with all city and county ntatives of this W "ter upon the above-mentioned rwr-na Conn-nuuamg; careen -woe tnrorcemem: canary -Applicant; rine-mevenue; ooioenrco-nssessoi CITY OF COSTA MESA - BUILDING PERMIT PERMIT NO: G 044968 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V -N PERMIT TYPE: ELE MEC PLU STR PURPOSE: NEW JOB DESCRIPTION i SFD SQ FT: 2.537 CLAIM VALUE: 144,063.00 CALC-VALUE: 144.063.24 GROUP OCC: R -3 /M-1 COMMENTS: PC#234-89A PD $129.51 Z 0 N I N GS ER TEBQAUCIKRSE M E N T S - MAIN BUILDING --------- --- ----- ACCESSORY BUILDING -- - FRNT=5 FT IN REAR: 13 FT IN FRNT: FT IN REAR: FT IN LEFT: 5 FT IN RGHT: 6 FT IN LEFT: FT IN RIGHT: FT IN PARKING REQUIRED: 2 PARKING PROVIDED: 2 PARCEL: 0424331 ZONE: PDRM O PLANNING NOTES> SINGLE FAMILY RESIDENCE WITH ATTACHED GARAGE. HALF OPEN > PARKING SPACE 1PER UNIT PROVIDED FOR GUEST PARKING 90M D E V E L O P- M,E IN :T ."f S E R V I,C E.;5..;; R -E Q U I R E M E N T'•5.;,, ZONING APPROVED BY % ''_`� _ DATE: BUILDING APPROVED BY - DATE: _Q77, -'A4� APP.LICATION,ISSUED BY: DATE: LEGALIZATION:N F E_ S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 797.00 3925% 6950% 3225% SMIP/NON-RES PLAN ISSUE FEE 3.00 15:0 15.00 BUILDING -DIV-> PERMIT ' ISSUE PLAN=CHECK TOTAL PAID DUE TOTALS-_-> 949.19, 33.00. 0.00 982.19 982.19 .0.3 REVENUE DIVISION TOTALS--> COLLECTED: 982.19 -OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 797.00 42.50 84.86 47.75 LD.08 IND IVI DUAL :F E E B R E A K D O W N TYPE OTY D E S C R I P T I O UNIT COST TOTAL COST SFR 1996 DWE-TYPE V -WOOD FRAME;' -GOOD 67.70 135,129.20 SFR 76 RES -BALCONY, EXTERIOR STAIRWAY 13.54 1,029.04 SFR 465 RES -GARAGES TYPE V 17.00 79905.00 ELE 1996 NEW RES BLDG FOR 1 OR 2 UNITS/ SQ FT .03 69.86 MEC 1 INSTALL FORC/AIR. FURN <= 100 K BTU/H 9,00 9.00 MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/" 9.00 9.00 MEG 5 GAS PIPING SYS 5+ OUTLETS PER OUTLET .75 3.75 MEC 1 FACTORY FIREPLACE 6.50 6.50 MEC 1 VENTILATION FAN CONN TO SINGLE DUCT 4.50 4.50 PLU 2 BATHTUB 2.00 4.00 PLU 1 DISHWASHER J 1...2.00_._ 2.00. JW CONSTRUCTION AND PLANNING POC . SPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 41 . Temporary Electrical Service or Pole _ 52. Pool &Equipment Location .'2-.. Soil Pipe-Undrgrnd.. ` 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd: I 54. Forms ' A.Elecirical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steet Relnfdreement 56. Rough Plumbing & Pressure Test 6.r Electrical'UFER Grnd. :` �Q�.(!r Gtr 57. APPROVAL TO COVER-GUNITE 1 -� • '7.:Footings r`^ 4'��f-Qp �'f• 58. Electrical Conduit-Undrgrnd. 6 .Foundation. _ ' 2<l�f-� G/ 59. Gas Pipe, 0 Undrgrnd., Test i •' 1 9.. Water Pipe-Undrgrnd. (�� (�Q 60. Backwash Lines, P -Trap, ❑Undrgrnd. , 10. Structural 'Floor System 61. APPROVAL TO DECK 11. Property Sevver Line-& Hoylse'Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater &Vent -Final � 13. Roof Drains, .. 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit Solar System -Final 16. Rough Electric -Wiring . Fencing & Access Approval ' '17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating &Air Conditioning FIRE•DEPT. REQUIREMENT #. > nr ;APPROVALS -:.,r Permit # - - ` ^nnri r 1.' - 20: Rough Factory Fireplace ; :, r {_ c L6,05° _ ,. r t• , 21 ^Ducts, in StructuFe I "" "= V F �-; X70. Tndergioynd Hydro ,• , _ 22. Duces, Ventilatin- 9 '' 01. Product Piping O Gas d3bil 23.•Gas:Pipe- Rough & Test r ground C72. UnderFlush- +. r d - F- 24: -Roof Framing 24: , , C Storage,T,ank �0 Gas 0 Oil _ , „73rUndergrncb. 25. Roof Sheathing t. t' 4 r 74, Overhead Hydro, 26., -Bar CEVling-(Str(lctural) &N�riocoaf :_;ter-: i � 75, Dry Chemical tti t-: .� 27.- Frame and Flashings - ` `_ ��(•� C '• 76. Dry Standpipe ' ` •� �- _ .; •� i �"i'• i �= _ > 28nLathing & Siding' '.`1�i�l. 777-iFIXEDSYSTEM:FINALr• r =-29. Insulation ;, 78�.FrIRE P,REV. FI(VA.L F ! Drywall Nailing '- , ;; K�(y�Q C afm DEPT;,REQUIRENIE`NT. r30. .`'• �. , r�HEALTH 31. Plaster Brown Coag 79. FINAL INSPECTION- NSPECTION• *•' ! c.. 32 '-Electrical Power Meter-Finalr a 32.'-Electrical I �I 1 r 'SO.�FOOD CERTIFICATE ISSUED,_ I 31* Final Electric, ,: 1 1 "C - I 1 Notes: - f rt r i �34.tFinal Heating.& Air'Coniditiolriing 8W FOR,SPECIAL REQUIREMENTS- ;. X35: Final Gas Pipe -Test•.. 1 .. ••1 36. Hood or Canopy I ' _ "' `'' r' I I' it <, . _ r.l. a. - • 1 r i r -37.i Final Factory Fireplacer 1 1 QQj C.:ft: h• •-+ # ' ' 38. Final Plumbing ' ' • ' 39. Waier Service Final" 1. �1 t 40. Gas Service -Final '• 1 _ - i' . f 1 bt- •_ _ ..:1• `41. Solar Domestic -Final' i' i ` Ii -r• 42. Backflow Preventer!. r -. • ' t 1 I !;> •r, - I l •- t. w. f 1 c - r - •• 43. Backflow Irri ationy_ 44. Landscape Irrigation System L ti• r � - G F- 45 --Sound Attenuation*, ',.i: •_ ! t •. c c FC 46.• Handicap Regulations r 47` FINAL STRQCTURE&BUILDING 4B:.FINAL PLANNING r 49 Electric Rel ase to Edisonit • 50. --Gas Release to Southern California Gas Cv :G?: .n _I =:� • I.: ' +-- • i •- 1 . 1 r t•t r..r 51. CERTIFICATEOF•OCCUPANCY iri.>- 1- ,. No. Date '"` PROJECT ADD _ UNIT: OWNER' . dE,\ ADDRESS: ARCH/ENGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE: ADDRESS: LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 71000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: Date: Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800. Lab. C). POLICY NO.: EXP. DATE: 'OMPANY: Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This sector need not be completed it the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of CAlifomia. Date: Signature: NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097, Civ. C), LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant far such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/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 am layers with wages as their sole compensation, will do the work, and the E3 structure is not intended or offered for sale (Section 7094, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property Who builds or improves thereon, and who does such work himself/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 will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the properrty. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business El and Professions Code: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Date: Owner: I do hereby certify that l am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant 11/will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. Date: Driver's License or Social Security k: Signature: 1641-46 White—Buildinn; Green—Cotle Enforcement: Cenerv—ApplicanC Pink—Revenue; Goldanrotl—Assessor PERMIT NO: G 044968 PLAN CHECK NO: N PAGE: 2 TYPE QTY D E S C R'I P T I O N UNIT COST TOTAL COST PLU 1 LAUNDRY TUB OR WASHER 2.00 2.30 PLU i SHOWER 2.00 2.00 PLU I SINKS, KITCHEN 2.00 2.00 PLU 4 WASH BASIN 2.00 8.00 PLU 3 WATER CLOSET (TOILET) 2.00 6.00 PLU 1 WATER HEATER AND/OR VENT 2.00 2.00 PLU i WATER SERVICE 2.00 2.00 PLU 5 GAS PIPING SYS 5+ OUTL-PER OUTLET .50' 2050 PLU 1 GAS SERVICE 2.01 2.00 PLU i CONNECTION TO BUILDING SEWER EA 5.00 5.00 END OF FEE CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POS . SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location y}2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd, B. Foundation 59, Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68.-APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning r FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory_ Fireplace _ _ _ _ : 21. Ducts; in Structure r ,> 70. Underground Hydro 22. Ducts�,Ventilating 71. Product Piping O Gas OOil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof'Framing"`_ ""u `'` n 73. Undergrnd. Storage TankOGas ❑Oil 25.-Roof-Sheathing 74. Overhead Hydro - 26. T-Ba"Feiling (�truEt ura�i) &;4Monocoat 75. Dry Chemical 27. Frame.and Fla'shing,- r 76. Dry Standpipe 28. Lath ing&,Siding'_ 77. FIXED SYSTEM FINAL 29. Insulation r '•-•-+C �:c = r..-.,L 78. FIRE PREV. FINAL 30. Drywall Nailing r i :,'r ,l F. HEALTH DEPT. REQUIREMENT i 31. Plaster Brown Coat - 79. FINAL INSPECTION 32. Electrical Power Meter-Final 1. 80. FOOD CERTIFICATE ISSUED 33. F.inalPectric,m rri i.i, Notes; 34. FinalHeating & Air Conditioning 35. 1 inalpas Pipe-Test - r,;;, 36. Hood+or Canopy z' -''T h r, .1, 37. Final factory Fireplace 38. Final'Plumi)ing r' E d 39. Wate Service-Final 40. Gas Service-Final 41. Solarpomestic-Final 42. Backflow ;Pre venter 43. Backflow,IrrigatioP 44. Landscape IrrigationSystem 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50.tGas Release to SouthernCalifomia Gas Co 51. CERTIFICATEOF-OCCUPANCY• No. Date ms. IWA ENGINEERS 17390 Brookhurst Street, Suite 100 Fountain Valley, California 92708 (714)968-1221 • FAX (714)968-9286 May 18, 1990 J.N. 207-03 City of Costa Mesa Building Department 77 Fair Drive Costa Mesa, Ca. 92628 Attn: Mr. Victor Clift Subject: Fine Grade Certificate I hereby certify that the fine grading for lots 21, 59 through 61 and 78 through 87 of Tract 13224 were graded as shown on the approved precise grading plans for said project. 4114x� Z�4_�------ Llewellyn D. Incledon RCE 17593 J*� lDC9J �A-TAuw GoC ?r�L'J A &MqV Ft NkLC�L k