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Home My WebLink About495 CABRILLO ST - Building Permits', � � � � Aoolicant to fill in all a wa nv n1 ennc. wHn:n neavv ee.tlw. linea antl a�on all aooreoriale tleelarations CITYOFCOSTAMEpSA CON�SnTRUCTIONPERMIT PE��jj�� 7a0Of'J ' �o^a2Na UNITNO, Ap�y f�7_ 3.73 � D� zo�e ./Z� Project Address �J � f+A/;.7-�((,(-Q '��r/�f'£� S Main Building: Accessory Building: Applicant's Mailina Address !�O �� TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E Z ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' 7 Ffant G O Owner's Name �%�� Phone � N ,ios. �.��iT/` DESCRIPTION OF WORK/USE OF BLDG. A Rear / � � Addresz 'f� �'�'� "� � �� I,� I C Right � N Arch/Eng. License No. a76L�`T� TYPE OF PERMIT GRAOING FOUNDaTiON STaUCTURn� � K rf G Addre55 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL . g� LCft rI AGH�L� R Contracmr's Nam �L P ne �� U �'OTHER Ping. Ref. �p Parking ReqJProvidetl Q '. PROJECT DESCRIPTION 5c1. FT, oCCUaANCv � Addresslm'I�ngl-707SI0 �� =��vG CONSTRUCTIONTVPE VALVATION$ ICeQO= PlanningNotes: �j� C�.� ��/` T CityLiCen5CN0. �Z�S ZONE GRADINGCU.YDS. ACRES S. LICENSED CONTRACTOR DECLARATION I hereby dl�lrm Ihd[ 1 am Ilcensetl untler provislons ol Chartnr 9(commencing Remarks: l a wilh secllon ]000) of DlviSion 3 0/ Ihe Businoss antl PrO�C521on5 Cotle, antl my Ilcense is in /ullJorqe�a�r p eltecL `Z�� ELECTRICAL FC�' ' License G s �-- `f•7 L Date _ Signatura PLUMBING FEES Auromatic Washer Transformer ❑ 15-50 KW ❑ 50+KW WORK RS' COMPENSATION DECLARATION CO�St�utti0ll POI¢SUb. 1 nereby aHirm that I hava a certilicate ol consent to soll-Insure or a<mtlilcata Bar Sink ShowCrs oi WOrkors' COmpansation InturaOco, or d certHletl opy tho/Oof (SnCtion Cooking Unit M¢LC� ❑up IO 1�OdrtIpS 3800, Lab. C f Backflow Preventer Service Sink Poiicy No. �' �77y -� Company ��Z Backflow Irrigation Sewer Cap Dishwasher Meter ❑over t00amps Gert(fl¢tl Copy Is heroby fumi5hetl. D�y¢�s OGas ❑EI¢cl�iC $Ub P8�21 Date�r ilo co iy jllOtl with [ne tlty I g I. ISIO /�� 88LhtubS Sewer Connection Appllcant �y_6�IQ � Fen Motors 041 HP �1 X- 8 EXEMPTION ROM WORKERS' COMPENSATION DECLARATION Clefifief5 Solar COIIeCLOrs (Thi55eclion neetl not be <ompletetl if the permit Is for one huntlretl (E100) or F,A,U. Int.SOlar �9�15 HP �16-15+ lesz). Dishwasher Solar Piping I certlfy Ihat In th¢ parto�mance of t�e work 1or whlth thls pe�ml( ISIssuGtl I FixtU�¢5 MiCrouPdv¢ shall not employ any person in any manner so as to becoma subject [o the D�inking Fount3in5 Solar Tank �Workers' Compensation Laws o/ California. D2vicE Box¢5 Pole Li ht Date Si9nature Floor Drains Swimming Pool w/Spa 9 �NOTICE: It, alter makin9 this tletlaralion, you ShOUIp UecOme subject to lne Ou[lets Ran ¢ Workers' Compensatlon provi5ion5 of the Labor CoUe, you must forthwilh Floo� Sinks U�inal 9 comply with Such O�ovlslOnt Or thii pa�mit shall be Ceemetl �evok¢tl. SwltCh¢5 CONSTRVCTION LEIVDING AGENCV GasService Dutl¢t5 W3t2fCIOSEt $Ig� 1 hereby aHlrm t�at [here I5 a tonSV ucUon lentling agency lor the performance - Ga�ba e Di osal Standin $ectiOns of t�e work for wbich this permi[ is issuetl (Section 3097 Civ. C.) Interceptors W2ter Heater 9 � 9 LenOer'S Name Lenaer•z Atlaress Kitchen Sink Water Service Generator 00.5 KW �5-75 KW Trash Compactor OWNER BUILDER DECLARATION I her¢by affirm thal I am ex8mpt frOm Ih¢ COnlfacto!'s License Ldw fo1 the �BVdtOfi¢5 A1110-WBSh followin9 reason (SetNon ]033.5 Business antl Professional Cotle: Any city or counry wnich raquires a permit to construcq alter, Improve, tlemolisn or reoalr P—Trap Laundry Tra'ys any SVuc[ure, prior to its issuance, al5o requires the applicant for such permlt to tile a signetl statement tnat he/she is IicenSCtl pursuant to tne provisions ot Roof Drains tne Con[ractor's Ucense Law (Chapter 9(commencing with Section ]000) of Div'�sion 3 of t�e Business antl Protessioni CoOe) or tnat he/she is exempt Reinspection Fee $15 Issue Fee $ 3 tnerefrom antl ihe basis tor the alle9etl exemptlon. Any violalion ot Section ]031.5 by dny appliCan[ fOr d permit Zubjec[s lne appllcant (O d Civll enalty o� �ot more than tive hundred aoiiars (E500�. DEVELOPMENT SERVICES REQUIREMENTS: /�,� p � I, as owner o/ tne property or my empioyees with wagez as their sole Reinspection Fee $15 Isue Fee $ 3 ZoninB APP�oved By '_`�Date o'�a Compensatlon, will tlo �ne wo�k, antl the st�ucture IS Oot intentletl o� otfe�etl for sale (Settion ]044, Businezs an0 Pro/e55ional CoAe: Tha Contra<tor's MECHANICAL FEES Building Approved By Data Ucensa ldw tlaes not apply to an Own¢r ot a O�oparty wh0 builtls o� Imp�ove5 p �� inereon, a�tl who tloes such work himielf/hertel7 or throu9h his or her own Appli�ation Issued 6y Datt[. �� employ¢Cs, prOvitlCtl thal su<h ImprovemMls ar0 nOt Inten�00 or offCre� tOr BOil2f HOOd Of Typ¢ I ❑ saie. II, however, tna bWming or Improvement Is soltl wltnin one year ot com- Canopy Type 11 ❑ SUMMARV OF FEES pleUon, tna owner w111 have the burtlen of proving ne/sne tlltl mt builtl or Im- Duct - Under Ground ev �� rove tor the purposo oi salo). BUILDING PERMIT $ SMIP $ I, as owner ot the property, am exclusively contracting wllh Iicensetl con- Duct -SVucturel Refrigeration SyStem PLAN CHECK $ � PERMIT traCtOrs t0 constluct lhe project (SCctiOn 7044, Bu51n055 an� Pr0(e55ioni COUe: Tne Contractor•i License law does not aDP�Y to an owner ol property who Ducl - Veniilating �P700,000 BTU ❑100,000 BTU PLUMBING $ ISSUANCE $ builtls or imoroves tnereon. antl wno contracts 1or suth oroiects with a con- tractar(s1 �iaenso pursuam ro me Convactors Llconso Lzw). I am awara that Exhaust System ❑ Multiple � System Repair�Alt¢ratian FL.AN CHECK 25% $ ENERGV P.C. $ prool of [neir Worker's Compansatlon insurance snoultl Dn provitletl to me. ELECTRICAL j GRADING $ ❑ I am oxempt untlor Section B. 6 P. C. for this roason Firepl/Fatt. BIt. ICBO �`- Fire Dampers p�,qN CHECK 50% $ MICROFILM $�_ Date ' Ownar Heating System & Ducting Fegisters MECHANICAL $ TOTAL FEE $ �� ` I nereby corUy tnat I have reatl tnis applicatlon antl state tnat tho above ❑6100,OOOBTU �100,000BT - Inbrmatlan is correct. I agree to co ob wlth all clty antl county ortlinances PLAN CHECK 25% $ � antl Reta laws r01 ng la bUil nstructlOn, dntl horeby authorize r¢Or¢- sentatives ot t tlty t t abovo-montlonoe pro rt �n:vecuon 2 y �� Signatum Date Drivars' Licanso ar 55 qp �� Reinspection Fee $15 Issue Fee § 3 01 00012583-0001?5&5 TOT 61.55 0665-a6, rev. o/ua Wnite - BWltling: Canary - AppllcanL PMk - Accounting; Goldenrotl - Assossor DRiE� OS/2Z/88 TSf1E� I1�J/ . . � CONSTRUCTION AND PLANNING � POOL & SPA APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole `' � 52. Pool & Equipment Location .,��' 2. Soil Pipe-Undrgrnd. '•� �� 53. S[eel Reinforcement E�� i � 3.,Electcical Conduii Utility�Undrgrnd. �%, � � 54. Forms �/I �� 4. Elec{ric�' I Conduit-Undrgrnd. � � 55. Electrical Bonding � 5. Steel�Reinforcement • 56. Rough Plumbing & Pressure Test ��'•�f � • �. 6. Electrical UFER Grnd.' 57. APPROVAL TO COVER-GUNITE �`•' �� '' .� 7. Fpotings ' .^� ..%;" 58. Electrical Conduit-Undrgrnd. .' 8. Fpundation �� '� 59. Gas Pipe, � Undrgrnd., Test 9. W�ter Pipe-Undrgrnd. • 60. Backwash Lines,P-Trap, O Undrgrnd. ,7 i. 10. St�uctural Floor System '� l' 61. APPROVAL TO DECK � 11. Property,6ewer.'Lirie & House Conn�ction � �� 62. Backwash & Receptor�Final 12. Sewer Cap� � � , � 63. Heater & Vent-Final ��i.� � 13. Roof Drains ' :;7 � 64. Plumbing System - Final 74. Rough Plumbing' ^ � 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final • :j6. Rough Electric W�ring 67. Fencing & Access Approval 17. Rough Wiring S�gn 68. APPROVED FOR PLASTERING 78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning FIRE DEPT. REQl11REMENT 20. Rough factory Fireplace '� APPROVALS Permit # 21. Duc[s,in Structure � 70. Underground Hydro 22. Ducts, Ventilating . 71. Produc[ Piping OGas ❑Oil 23. Gas Pipe-Rough & Test . 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing •� 76. Dry Standpipe 28. Lathing & Siding - 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing '�� • HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-7est 36. Hood or CanopY 37. Final Factory Fireplace 38. Final Plumbing � 39. Water Service-Final 40. Gas 6ervice-Finel 41. Solar pomestic-Final 42. Backflow Preventer. ' �43. Backflow Irrigation . ., 44. Landscape IrrigEtion SYstem , • . 45. Sound Attenuation • 46. Handicap Fegulations 47. FINALSTRUCTURE&BUILDING � �J y`� v d8. Soecial Requiremenu Completed 49. Electric Release to Edison ' 50. Gas Release to 5outhem California Gas Co + - 51.CERTIFICATEOFOCCUPAP' � ' No. Date � � � ' . i � 1 . CITY OF COSTA MESA � o�`""'F=, BYILDING DIVISION r . •'► , i�� 77 FAIR DRNE. COS (A MES� CA 92626 •(714) 754-5273 • Fax (714) 754-0856 • www.ci.costa-mesa.w.us F � FOR INSPECTIONS CALL: (714) 754•5626 ��o �� PERMIT TYPE APN: 11737308 Zoning: , JOB ADDRESS: vicinity: SQ. FT: 0 B_MISC 495 CABRILLO ST CM PERMIT NUMBER: BX09-00283 STATUS: ISSUED DATE ISSUED: 12/22/2009 ISSUED BY: KJB Suite/Unit " � Primary Occ Const Type :?? Valuation: Y9,900.00 ' � - �- SCOPE OF WORK: WINDOW CHANGE OUT. WINDOWS IN TWO LOCATIONS WILL CHANGE IN SIZE. NO STRUCTURAL OR HEADER CHANGES FOR WINDOWS TO BE ALTERED. NEW SIDING TO BE INSTALLED ON FRONT OF RESIDENCE ONLY. HARDIE PLANK SIDING TO BE INSTALLED. . OWNER: VITKA$, LINAS City/State: COSTA MESA, CA Phone: APPLICANT: BEACH, DANIEL City/State: Phone: 714-549-0278 CONTRACTOR: Address: City/State: Zip Code: ARCHITECT: Phone ENGINEER: Phone D BEACH COMPANY 2575 COLUMBIA DR COSTA MESA,CA 92626 F�E SUMMARY Building Plan Check: Building Permit: Electrical Permit: SMIP Residential SMIP Commercial Bldg Std Admin Fund TOTALFEES Address:: 495 CABRILLO Zip Code: 92626 Address: Zip Code: License No. 460893 Phone 949-574•5031 License No. License No. $0.00 $181.25 $0.00 $0.99 $0.00 $1.00 $183.24 Unit - ., �'� Unit Unit: • , Cell: ,; ,,. , , , _ Er^. �?-i;\h:F,G� '.idl: ',ili�.F�;, l'J ;iruf „ l:li,i:: � U;'it: NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Cali(ornia sfatutes and related �regulations. (Ord. No. 92-28, § 1, 12-21-92) ' - , • , EXPIRATION: PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPEC710NS: 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 £nal approval must be obtained. Failure to obtain inspections and final approval will resWt in the expiretion ofthislpermit. 60pE1, INSPEC➢ONTYPE OATE INTITIALS COOEt INSPECTIONTYPE �DAiE r�_��.�INTI ALS 1616 Fixed System Final Fire Prevention 208 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical ..b7: 201 Fina! BIocWRetaining Watl 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Appmval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ,� `�S -�n ��y 6�� WORKERS' COMPENSATION DECLARATION: I hereby aKrm un'er penalb of perjury one of the foliowing declarations: 7 ❑ I have and will maintain a certifcate of consent to self-Insure for vrorkers' compensation, as provided for by section 3700 of the Labor Cotle, for ihe performance of the vrork for which this permit is issuetl. ❑ I have and vrill maintain wurkers' compensation insurance, as required by sectbn 3700 0/ the Labor Code, for the peAortnance of [he work for which this pertnit is issuetl. My workers' compensati�rance carner antl policy number are: ('� � � Carrier. �.._.1C_LJ/� (Thissetlanneeono(o cnm et dthepe� rtisvaluedalanehundretltldlurs(Si00)orlessJ Policy Num r: ertify that in the peAortnance of the work tor which this permit is ed, I shall not employ any person in any manner so as to become subject to the workers' compensalion laws of California, and agree that if I shoultl become subject [o the vrorkers' compensation provisions o( Section 3700 of or Code, I sh fo � l�pl�hese provisions. i Z -z-z- o R AP��'s Signawre Da�e WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE 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 IABOR COOE. INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapter 9(commencing vnth Section 7000) of Division 3 of the Business and Professions Code, and my license is /in/fu/ll force and effecl. � Li �'7 LR �d g�� 3 class # ��f"�.,�....Q L �k.,.� /z-zz-o9 Contractor's SgreWre Daie CONSTRUCTION LENDING AGENCY: ❑ I hereby affvm that there is a construction lending agency fw t�e performance of the vurk la v.fiich lhis pertnit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Sienalure OWNER-BUILDER DECLARATIONS: I hereby aKrtn 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 ciry or county which requires a permit to construct, alter, improve, demolish, or repair any struclure, prior to its issuance, also requires the applicant for such permil to fle a signed statement that he or she is licensed pursuant to the provisions o( the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 0� the Business and Profe55iOn5 Code) of Ihal he Or she i5 exempl there(rOm and the basis for the alleged exemption. Any violalion o( Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalry of not more than five hundred tlollars ($500).): ❑ I, as ovmer of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, antl the structure is not intended or oftered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not appty to an owner of pmperty 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 oRered for sale. If, however, the building or improvement is sold within one yeai of completion, the ovmer-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 WI7M LICENSED CONTRACTORS ro construct the pmject (Sec. 7044, Business antl Professions Code: The cont2ctors License Law does not apply to an owner of property who builds or improves [hereon, and who contracts for such project with a contractor(s) license pursuant to the Contraclors License taws.). ❑ I am exempt under sec. Business and Professions Code for Ihis reason: Owner ID verifetl by driver�nse. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ovmership by (rype of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certi(y thal no excavalion frve (5) or more feet in deplh into which a person is requiretl to tlescend, will be made in connection vrith vrork authonzetl by this pertnit, and Ihat no building sWclure, scaHdding, falsewurk, or demolitan or dismantling thereof, will be more than thirly-six (36) feet high. (Chap. 32, Grp 2, M 2, Sec. 341, Ttle 8, California Administralive Code). ❑ As ovmer-builder. I will not empl0y anyone to do work which v.ould require a permit from the Division o/ Industrial Safery, as noted above, unless such person has a permit ro do such work fmm the division. Applitanl'S SignaWre Division of Industrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or tuture building occupant need to fle and certity a Business Plan for emergency response to release or threatened relea5e ol a hazardous ma[erial? ❑ Yes ❑ No (Seclion 25505 of the Calilomia Health antl Salery Code requires, with some eaceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time tluring a reportetl 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 (eet o! compressed gas at standard temperaNre and pressure�. 2. Does or vrill the applicant or present or (uWre builtling occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of Ihe Calitomia Health and Safety Code, with some ezceptions, requires registralion vrith Ihe Costa Mesa Fire Department by each business which a1 any one time has on hand a quantity of acutely hazartlous malerials equal ro or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o! compressetl gas at standard temperaWre and pressure). 3. Does or will the applicant or present ar fuNre 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 Safery Cotle provides Ihat the Costa Mesa Fire Departmem may require the preparation, certification and fling with Ihe Fire Department o( an RMPP by businesses whic� are required lo register acutely hazardous materials with the Fire Department. 4. If an RMPP is pre5ently required, ha5 Section 25534 0( Ihe California Health and Safety Cotle been fully complied with? ❑ Yes ❑ No 5. Does or will the applicanl or present or future builtling occuDant require for the work which is the subject of this application a permit for such construction or motlification from ihe South Coasl Air �ualiry Management Dislrict or trom any other air pollution conlrol district or agency? ❑ Yes ❑ No (Sectqn 658502 of the Cali(omia Govemmenl Code requires that the requestetl in(ormation be fumished on applications !or ron-residential builtling pertnits). 6. Will any part ot the lacility to be consWCled under Ihis pertnit be within 1000 feet from the outer boundaries of a school? ❑ Ves ❑ No Qf "yes", the (acility must meet the requirement of Sec�ions 25534 and 42303 of the California Health and Safery Code). 7. If a permit from Ihe South Coast Air Quality Management Dislrict or other air pollWion coMrol districl or aqency is requiretl for the work which is Ihe su6ject of this application, have all of the disclosures prescribetl by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf yes", attach certificate of compliance from the appropriate air pollution control offcer). 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 regartling Hazardous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read Ihis application and s[ate that the information given is correct. I agree to comply with all state laws and city ortlinances relating to building consWction, an0 authorize represen�atives of the Cicy of Costa Mesa to enter upon the above-described property for inspeclion purposes. I agree not to occupy or allow occupancy of any building authorized by this permit unlil final inspection. " naWreolLeBal� er�s Date sgnawre oaie / L- Z2 — d�'j 3051-46(3/O]) Antl/O� P.ul�onxe0 AppLca� Dme Applicant to fill in all soaces except tnose within heavr boraer lines anG sign all aDPropriate tleclarations. CITY OF COSTA M � C I T U� ION PERMIT PEpM1T N. �� TRACT NO. LOT NO. UNIT NO. ProieckAdtlress ' • Applicant's Mailing Addres�/ Q TVPE OF CONSTRUCT�ON NEW nDO ALTERATION REPAIR Owner's Name�„ � �� % hone ❑ ❑ Address � Arch/Eng. License No. - Address Contractor's Nama ��'A�� h�p1�n.!e�_ I � � Addreu (ma'fnq) �y/'.�.�� O /�//7(/r� r'+r.c__ Ciry Licenu No. sl—�[P�/�b7 LICENSED CONTRqCTOR DECLARATION I ner¢by affirm thdt I am Iicensetl untle� O�ovisionz of Chartet 9(mmm¢ncing with section ]000) of Division 3 ot the BuSi n n Pro(ezsi s�tl my license is i�Jrnto!¢�Antl etfect. y/ � '�. ucense ass C.., sJ(P--�m //r� � Date.� `/_��.�� ciy � /i'„i e WORKER 'S COMPENSATION DECLARATION I hereby attirm that 1 have a certlticate of consent to self-insure or a certiticate of Worker5' C�o�m��p�en�sat�io�n� InSYrance, or a certHletl coDY th�ere]�of� (Sectlon 3800. Lab. f�/�y(/``/�D// �� //��A� Policy No. � y Compan �ertifietlqb py% s hcreby turnisnetl. tifi/e�//�e�$/�/,��JJ/'�} ea with the city Bu vlsi .lale____ f APPlicant EXEMPT ON FROM WORKERS' COMPENSATION �ECLAftATION (Thiisection neetl nOt be Complatetl if th¢ permit i5 (or one huntlretl (5300) or iess). I certlty [hat in the pCr/o�mance of the wOrk for whlcM1 Inls perm�t is issuetl, I sM1all not employ any parson In any manner so a5 to become subject fa Ihe Workers' Compensatlon Laws ot California. Dato Slgnature NOTICE: If;after making this tleclaration, you shoultl become subject to the Workers' Compensation provisions of the Labor Cotle, you must forfhwith <omply wl[h Such provl5lDn5 or this permit shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I Itereby alfl�m thal tnere is a Conz(ruction lentling agency for the performance of the work fOr which tnls permi[ is ISSuetl (Settion 309] Civ. CJ lRntler's Name Lentler'S Adtl�ess OWNER BVI�DEN DECLARATION I her¢by affirm tha[ 1 am ex¢mpt trom Ihe Contractor'S License Law for tne /ollowing reason (Socllon 7031.5 Business antl Professlonal Cotle: Any city o� county whlch �equiros a permit to conz[ruct, alteq Improve, Cemolish or repair any Slructure, prlor to It5 i55uance, also requires the apD��ant for such pe�ml[ to file a zignetl stat¢men[ that he/She i5 litenzetl pursuan[ [o [he provisions ot the Contraclor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Protessions Code) or that he/she is exemOt lhe�¢from dntl the ba515 tOr the allegetl exem0��on. Any violation of SecUOn ]031.5.by any applican[ for a Permi[ subjett5 IM1e applicant to a civll ee�dlty o7 not mo�G Ihan hve huntlrea t1011ars (E50�). LJ I, as owner ot me properry or my employees with wages as their sole 'omp¢nSa[io�, will tlo thG wOrk, antl the SVucture is no[ intentletl Or offer¢tl rt salG (Section 7044, Buslness antl Professional COtle: The Cont�acto�'S .Icense Law tloes not apply to an owner oi a property who builtlz or improves thereon, ana who tloes such work himseH/nerself or through his or her own employee5, provitletl that Suth improvements are not In[entletl or otteretl for sale. If, however, [he builtling or Improv¢ment I5 soltl within one year of com- pletion, ihe owner wlll hav¢ th¢ burden of O�ovin9 he/she tlitl not bui10 or im- prove tor the OurpOse of Sale). ❑ I, a5 owne� ot [he properly, am exclusively cont�actlnq with IicenSetl COn- t�aclOrs to con5trucl Ihe project (SeCtion 1044, Bu5ine25 antl P�ofe55ions Cotle: TM1e ConVactor's Litunso Law tloes not appy to an owner of property who bulltls or ImD/oves Ih<reon, antl who conVacts f0� such projects with a Con- VaCtOr(z1 Ilcense pufsuant t0 the ContraCior's Llcense Law). t am awafe tbat proof of th¢ir Wo�k¢r's COmpenSatlon insu�anc¢ Shoultl be provitletl to m¢. ❑ I am exem0� untler $ection B. & P. C. for this reason Date I hereby certity that Intormation is mrrec antl state laws rela sentatives of thi� insPectlon purpa � Signature Drivers' License or 55 CMF 0865-46, rev. 30/84 Owner antl that ❑ CONVERSION DEMOLISH OTIjF�,{j._ _� q,p.# D � IPTION OF WORK/USE OF BLDG. ��f�� S Main Building: E TVPEOF.'PERMIT GRADING FOUNDATION STRUCTVRAL ` T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL B Reaf ❑ OTHER A PRQIECT DESCRIPTION Sa. FT. oCCuvarvCv C Right CONSTRUCTION TYPE VALUATION 5 g Left � ZONE- GRADING CU. VDS. ACRES Ping. Ref. # Remarks: > Planning Notes: $ink Preventer Irrigation Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Sink Trep of Drains Reinspaction Fee � S75 Boiler Duct - Under Ground Duct - SvucNral Duct � Ventilating Exhaust System O Multiple Firepl/Fact. Blt. ICBO # Hea g System & Oucting 100,000 BTU 0100,000 Reinspec[ian Fee � '$15 White - BUlltling; Canary - Appllcant; Pink - qCcounUn9; Goltlenrotl - A55¢sSOr FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Piping ' Solar Tank � Swimming Pool w/Spa Urinal Water Cbset Water Heater Water Service A uto-W ash LaundryTrays ' laue Fee ' g 3 1ANICAL FEE Hood or Typel ❑ Canopy 'Type II ❑ Refrigeration System ❑0-100,0006TU ❑100,OOOBTU System Repair/Alteration – Fire Dampers Registers - • Issue Fee � � $� Automatic Washe Consvuction PoIE COoking Unit Dishwasher � Dryers ❑Gas. C Fan F.A. U. Fixtures Device Boxes OuHets Switches Garbage Disposal Generetor �0-5 lectric KW 05-15 KW 1 ' ' Zone _' Accessory Building: Parking ICAL Transformer ❑ 15-50 KW ❑ SO+KW Meter ❑up to 100amps Meter ❑over 100 amps Sub Panel tvtomrs �0-1 HP �1X-8 Inc.Solar �9�15 HP ��16-15+ Microwave Pole Light Ran9e Sign Standing Sections . . Trash Compactor , � Reinspection Fee �$15 I � Issue Fee DEVELOPMENT SERVICES RE�UIREMENTS: 2oning Approved By Buildine APP�oved By � Appliwtion Issued Bv � � u FEES $ 3 Z O N I N G R E Q M T S SUMMAHY OF FEES ' ' BUILDING PERMIT $ SMIP $ � PLAN CHECK S PERMIT � PLUMBING S ISSUANCE � S PLAN CHECK 25% S ENERGY P.C. $ ELECTRICAL $ GRAOING $ PLAN CHECK 50% $ � �� `Q��ROFILM $ � MECHANICAL $ 9iOTA�FEE $ PLAN CHECK 25% $ V! 1"IJL'i'�� L_I�'�TI�J ' ♦ . :,ar� Oi."�n:;;� Tii'F: .�v'7 CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector 1. Temporary.`.Electrical Service or Pole 52. Pool & Equipment Location 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. ElectricalConduit-Undrgrnd. 8. .Foundation 59. Gas Pipe, O Undrgrnd., Test � i 9.�,Water Pipe-Undrgrnd. 60. Backwash Lines,P�Trap, O;Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK � i.: 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final � 12. Sewer Cap 63. Heater & Vent-Final `1 13. Roof Drains � 64. Plumbing System - Final 14. Rough Plumbing � 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final • 76. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # � 21. Ducts, in Structure 70. Underground Hydro -22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush . 24. Roof Framing . 73. Undergrnd. Storage Tank 0 Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling IStructural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 2S. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat . 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED . 33. Final Electric . Notes: .a �.,� � ��- �� ,�,A i 34. Final,Heating & Air Conditioning � dt (�A � � 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Fac[ory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar.Domestic-Final 42. Backflow Preventer ' 43. Backflow Irrigation . ;_�=�• ` .�. I. � isr,�. . 44. Landscape Irrigation SYstem � 45. Sound Attenuation 46. Handicap Regulations - 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed . 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co � . 51. CERTIFICATE OF OCCUPANCY . Na Dace , i Costa Mesa Building Department � � 117 EAST 20th STREET � . �COSTA MESA, CALIFORNIA FOYL APPLICANT TO JH' IN Building ''A�� /J/% Address ��J� � Costa, Mesa, California � Owner / ess Contractor Address �/ APPLI ATION FOR PERMIT �Q6� �U I L D,l N G � FOR OFFICE USE ONLY . I . Receipt No.. Permit N� /O 5��' Received by Date Rec'd. Data I�ui . ��-� /.!� :C � Costa Mesa, California Nearest L //��, Tel..../� �) Cross St. �////�i,� - No.,�(i.A' ��.�a 2one A _ I No. of I Tvpe .. I (Attach Metesand Bounde) SizeofLot P��/X%�� Use of Existing Bldg. Setback Line from ( Center of Street / � � DESCRIPTION New I.� I Alteretion Building /5.� :rior Wall / Coverino A I hereby acknowled and state that the a with all City Ordi building constructia Signatureof �„/ Permittee � I Authorized Agt. � Valu�ation s /2 �00 ClIHM 206 G-M 2M 3-56 ', City Lic. �, No. "0� /t n Rooms I Roof Cove Lot � No. ot s Room 'ard ard ,�' ' IRH Addition ihat I have read this Application ✓e is correct and agree to rnmply ices and State Iaws regulating . .. . _ Plan Check Total Fee APPROVATC Foundation Lxation I Inspector Forms, Materials, Bond Beam FINAL Date O 9 � 2 D r a Lvi a auai� Show locatlon and distances from , property line and between buildfngs. ':;�A 19•SSPD.aesan787a . ' 35.00 �.rsra _ < , ' . _ ; r,c;. � . _ ._ , �. �. _ , • • - ' ' ; . .