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Home My WebLink About1783 CRESTMONT PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1783 CRESTMONTPL Suite No ISSUE FEE Vicinity: 03/22/2005 Parcel Number: 42426112 Applicant: GREY, WAYNE Address: 21907 ERIE LN Repair/ All Cooling/Heat LAKE FOREST, CA Owner: Address: Contractor: Address: MECHANICAL PERMIT ALONSO, ROSEMARY NICOLE 1783 CRESTMONT COSTA MESA, CA QMHSINC 21907 ERIE LN LAKE FOREST, CA Phone: 949-707-5222 Zip: 92630 Phone: Zip: 92627-3673 Phone: 949-707-5222 Zip: 92630 License: 591333 ISSUED BY SCOPE OF PERMIT REF: 1305.00458 - REPLACE 2 BATH 8 1 LIVING ROOM WINDOW WITH SAME SIZE WINDOW AND IN SAME LOCATION, REPLACE GARAGE LAUNDRY SINK,REPLAC�RNACE. FEESUMMARY Repair / Alt Absorbtion Unit Repair / All Refrigeration Unit Ventilation System Evaporative Cooler Commercial Incinerator Domestic Incinerator Compressors / Absorption Svstems Upto3hp/100k BTU 3To 15hp/500k BTU 15 To 30 hp 11,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU' Boilers Upto3hp 3 T 15 hp 15 to 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee - Investigation Fee " Plan Check Fee Reinspection Fee Status: ISSUED Quantity ISSUE FEE $23.50 03/22/2005 Inst FAU <100 k BTU $14.80 1 Inst FAU >100 k BTU $0.00 0 Repair/ All Cooling/Heat $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Refdg Sys <100 k BTU $0.00 0 Refrig Sys >100 k BTU $0.00 0 Gas Piping $0.00 0 Factory Fireplace $0.00 0 Hood w/Mech Exhaust $0.00 0 VAV Box $0.00 0 Vent Fan / Single Duct $0.00 0 Appliance $0.00 0 Fire Dampers $0.00 0 Smoke Dampers $0.00 0 Inst or Relocate Appl Vent - $0.00 0 Air Handlers < 10000cfm $0.00 0 Air Handlers > 10000cfm $0.00 0 Floor Furnace $0.00 0 Floor or Suspend Heater $0.00 0 FEESUMMARY Repair / Alt Absorbtion Unit Repair / All Refrigeration Unit Ventilation System Evaporative Cooler Commercial Incinerator Domestic Incinerator Compressors / Absorption Svstems Upto3hp/100k BTU 3To 15hp/500k BTU 15 To 30 hp 11,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU' Boilers Upto3hp 3 T 15 hp 15 to 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee - Investigation Fee " Plan Check Fee Reinspection Fee Status: ISSUED Applied: 03/22/2005 Issued: 03/22/2005 Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 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 Mil -lu-0 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compenullon insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' Com en at Insurance in antl policy number are: —7 Cartier: Sri Policy Number: (This section need not be Completed if the pertnif is valued at One hundred dollars ($100) or less.) ❑ 1 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 Celifomia, and a r _ iat it I should become subject to me workers' compensation provisions o1 Section 3700 of j((he Labor Code, I shall forthwith comply with Nese provisions. i / Applicant Signature: �� Date: O p z+ WARNING, FAILURES ( SECURE WORKERS' CON PE COSTED COMPENSATION, IS UNLAWFUL AND SHALL SUBJECT I N EMPLOYER TO F THE LAB PENALTIES AND CIVIL ONES O NEY*S HUNDRED THOUSAND DOI.IAPE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31050E THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: hereby affirm that I am licensed der provisio of Chapter 9 (commencing with Section 7000) of Division 3 of the Business an ofessions Code, and my license is in full force and effect. Lic. a ss Clak Contractor's Signature: Date CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: ig Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) Of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ 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) feel high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ 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 at standard temperature and ............................................................. pressure).. ............................................................................................................................................................................................................................................................................................................................. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .........................................................................................._.................................__.._......................_.._......................................................................................................................................................_.........................................................._.... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Ves ❑ No ......................................................................................................................................-...................................-............................................................................................................................................I--......................................................._..... 5 Does or will the applicant or present or future building Occupant require for the work which Is the subject of this ,application a6gunit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control tliSVict or agency? a Ves LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). . .... ............................................................_....................... ............................................ ................... -.............................................................................-.......................................... ..................................................................................... 6 Will any pan of the facility to be constructed under this permit be within 1000 feel from the outer boundaries of a school? ❑Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ..... ..........................................................................................................................................................................................................-........................................................................................................................................................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................................................................................................................................... ............................................................. .-...................................................................... ........... ....................... .................... ___ ...... 8 (If yes", attach certificate of Compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Owner(s) — 2 / 5—Data ate nd/Or Aull Ized Applicant �T Data CODE E, INSPECTION TYPE PAiF INT1UEL5 CODE 1 015PE0014TYPE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 7"0 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754.4856 • www.cl.costa-mesa.& ILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1783 CRESTMONT PL Suite: Vicinity: Primary Occ: Type of Construction: Parcel Number: 42426112 Zoning: Applicant: GREY, WAYNE Applied: 03/22/2005 Address: 21907 ERIE LN SMIP Com: $0.00 Other: $0.00 Phone: 949-707-5222 LAKE FOREST, CA Zip: 92630 Owner: ALONSO, ROSEMARY NICOLE Address 1783 CRESTMONT Phone: COSTA MESA, CA . Zip: 92627-3673 Contractor: Q M H S INC Address: 21907 ERIE LN Phone: 949-707-5222 LAKE FOREST, CA Zip: 92630 License: 591333 Arch Eng: Address: Address: Phone: ISSUED I Status: ISSUED Applied: 03/22/2005 Issued: 03/22/2005 Phone: Zip: License: License: SCOPE OF PERMIT REPLACE 2 BATH & 1 LIVING ROOM WINDOW WITH SAME SIZE WINDOW AND IN SAME LOCATION, REPLACE GARAGE LAUNDRY SINK, REPLACE FURNACE. I - ' ' Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 FEESUMMARY Calc Valuation: Claim Valuation: PLANNING & ZONING Rear 0-0 Left 0-0 Right 0- 0 Rear 0-0 Left 0-0 Right 0-0 Required: 0 Proposed: 0 $2,100.00 $2,100.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 ».o -,o raver 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. ❑ I have and Will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' cc Do Insuran a carder and policy number are: Career: / -/7 Z94Z Policy Number: /_ 71�OS� IThis section need notes completed if the permm is valued atone hundred dollars ($100) or less.) ❑ 1 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 California. end gee that If 1 should become subject to the workers' compensation provisions of Section 700 o1»�Labor Code, I shall forthwith comply with these provision Applicant Signature: Date: 3 Zz� S WARNING: FAILURE TO SECURE WORKERS' &MPENS9 ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL PINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADDITION TO THE T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the BusinessPJ Professions Code, and my license is in full force and effect. Lia F Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: 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 fare permit subjects the applicant to a Civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he of 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 Cade for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more toot 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, Tele 6, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ 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 then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of Compressed gas at standard temperature and pressure). .......................................................................................................................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire ........................... Department. .........._..........................__......................._.............................................................-....___.................-......................_........................._-............................................................ ............................................ ......._.............. __..... .................. 4 If an RMPP is presently required, has Section 25534 o.. the California Health and Safety Code been fully complied with? ❑Ves ❑ No ................................... 5 Does or will thetcor present or future building occupant require for the work which Is the subject of this explication egermit for such construction or modification from the South ChesoasAir t Air Qualify Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ........................................................................................................................................................................................................................................................................................ 6 Will an facility ................................................................................................. y pan of the facili to be constructed under this permit be within 1000 teat from the outer boundaries of a school? ❑Ves ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................1............ ............................................................................................................................................................................................................................................................................... ..........Soul .......... 7 a a permit from the South Coast Air Quality Management District or other air pollution control district3bo n 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? ❑Ves ❑ No ................................................_...........................................................................................................11ut................trol..offi........................................................................_................................................................................................................. 8 (If yes'. attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. 1 agree to Comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sa Of Legal Owners) D d/Or Autho' ed Applicant Date CODE P. INSPECTION TYPE GATE INTITIALS CODE INSPECTION TYPE GATE INTR11L5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 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 Buil z 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4656 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1783 CRESTMONT PL Suite No Vicinity: Parcel Nunmber: 42426112 Applicant: GREY, WAYNE Address: 21907 ERIE LN. LAKE FOREST, CA PLUMBING PERMIT Phone: 949-707-5222 Zip: 92630 Owner: ALONSO, ROSEMARY NICOLE Address 1783 CRESTMONT Phone: COSTA MESA, CA Contractor: Q M H S INC Address: 21907 ERIE LN LAKE FOREST, CA Zip: 92627-3673 Phone: 949-707-5222 Zip: 92630 License: 591333 ISSUED BY: Status: ISSUED Applied: 03/22/2005 Issued: 03/22/2005 SCOPE OF PERMIT REF: B05-00458 - REPLACE 2 BATH & 1 LIVING ROOM WINDOW WITH SAME SIZE WINDOW AND IN SAME LOCATION, REPLACE GARAGE LAUNDRY SINK, REPLACE FURNACE. - Via 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 Via FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P -Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect `$0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor - $0.00 Sink, kitchen $0.00 Sink, service/mop $9.80 Spa (private) $0.00 Spa (public) $0.00 QTY AMT QTY 0 Sump Pump $0.00 0 0 Swimming Pool $0.00 0 0 Trap Primer $0.00 0 0 Urinal $0.00 0 0 Vacuum Brkr Bkflow(1-4) $0.00 0 0 Vacuum Brkr Bkflow(5+) $0.00 0 .0 Wash Basin $0.00 0 0 - Wash Basin Set $0.00 0 0 Waste and Vent System $0.00 0 0 Water Closet (Toilet) $0.00 0 0 Water Heater / vent, $0.00 0 0 Water Piping (Inst or Rep.) $0.00 0 0 Water Re -pipe $0.00 0 0 Water Service $0.00 0 0 Water Softener $0.00 0 1 OTHER $0.00 0 VIOLATION $0.00 0 ", PLAN CHECK $0.00 - . - REINSPECTION $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 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 pennit is issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workerrppe satio�urancp carrier and policy number are: Cartier: (( P� i�'/�� Policy Number: 1715,:5515-1 (This sect/on need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 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, end g e that It I should become subject to the workers' compensation provisions of Section 370e Labor Code, I shall forthwith comply with these provisions. Applicant Signature: �� .Date: 4122Z> WARNING: FAILURE TO SECURE WORKERS' COMPENS ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL IES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE (St00,00m, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisiopyt Chapter 9 (commencing with Section 7000) of Division 3 of the Businessan�ofessions Code, and my license is in full force and effect. Lic. N Class q Contractors Signature: - Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.- 7044. 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 of 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.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 704x, 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 contractors) 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 drivers 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 certity 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, scaff Dicing, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIA -S 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 materiel? ❑ 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? ❑ Vas ❑ 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 head a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .__..........._.....__—._.............................................._._._.................................... _.. ....................... __................ _.................... _... _....................... _.-.......................... _............................... -.__.................... _ ............. __._........... __. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ NO (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, cenification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ....................................................................................._........................................................................................................................................................................................... ....I.......................................... ........................... ................ ._. 4 If fln RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully compiled with? ❑Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which Is she subject of this a plication a$ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Ves j� NO (Section 65850.2 of the California Government Code requires that she requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (it yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .......................................................................................................................................................................................................................................................................................................................................................................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures .prescribed by Califomla Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ...... ...................................................... ............................................................................................................................................................................................................................................................................................................................. 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 OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection. re OI Legal Owners) Date 3 zz o cAnd/or Au odzed Applicant —�—� e CODE x. INSPECTION TYPE 2AN INTRIALS CODE I INSPECTION TYPE DATE Its 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing r2r? 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Piece 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1783 CRESTMONT PL FEE SUMMARY Status: ISSUED Suite: $0.00 Applied: 11/26/2003 Vicinity: RESIDENCE ONLY Issued: 11/26/2003 Parcel Number: 42426112 Zoning: Applicant: ALONSO, ROSEMARY NICOLE ISSUED BY: Address: 1783 CRESTMONT Inspection: $0.00 Phone: 949413-3396 Total: COSTA MESA, CA Zip: 92627-3673 Owner: ALONSO, ROSEMARY NICOLE PLANNING & ZONING Address 1783 CRESTMONT MAIN STRUCTURE Front 0-0 Phone: Right 0-0 ACCESSORY COSTA MESA, CA Zip: 92627-3673 - - Contractor: OWNER -BUILDER Required: 0 Proposed: 0 Address: Phone: Zip: Arch : Address: Phone: License: 000000 Eng: Address: Phone: Zip: - License: License: SCOPE OF PERMIT REROOF RESIDENCE ONLY: T/0 EXISTING B.U.R. AND INSTALL NEW B.U.R. 2208 SF NOTES: 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 It work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days, I . - INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 z"a 6lei00l FEE SUMMARY Plan Check: $0.00 Calc Valuation: $5,500.00 Permit: $125.25 Claim Valuation: $5,500.00 SMIP Res: $0.55 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.80 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existin : 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void It work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days, I . - INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 z"a 6lei00l DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation Insurance, as required by section 3700 of the tabor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carder and policy number are: Cerner: Policy Number: (Thi action need not be completed i1 the permit Is valued at one hundred dollars ($ t00) or less.) I certify that in the perfo of the work for which this permit is issued, I shall not employ any person in any manner so as to became subject to the workers' compensation laws; la , and agree that If I should become subject to the w ars' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these prov' s. Applicant Signature: Date: 12tol"63 WARNING: FAILURE TO SE RE WORKERS' COMPENSAT ON COVERA� LA IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE AND CIVIL FINES UP TO ONE HUNDRED THOUSANDDOLLARE($1 ,000),INADDITIONTOTHE OF OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE BOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: / I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Seaton 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. P Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code), Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a sign 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 Businew,affid Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subje916 the applicant to a civil penalty of not more than five hundred dollars ($500).): I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am mpt rider sec. Busines d Professions Code for this reason: Signature: '/ _ --1—M 1.0/ _ " Expires: Verification of Ownership by (type of document, i.e. -property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certity that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ 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 standartl temperature and pressure). ...................__...... ........... ..___..._............................_.___.....__.__............................._..___...................._.............................................. _..................._._............................................................................. _.................................................... 2 Does or will the applicant or present or future building occupant need to file a registration torn 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 aqua to or greater than a weight of 500 pounds, or a volume o1 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................ .............................................................................. .................................. -.................. ........................... ................................. ... ................... ........................................................... .... ... ......................................................... __.......... 3 Does or will the appplicant 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 o plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ves LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ............................................................................................................................................................................................................................................................................................................................................................................................ 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Ves ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................................................................................................................................................................................................................................................................................................................................................ 7 If a Permit from the South Coest 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 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: CE9pFI OF COMPLIANCE AND AUTHORIZAT10N OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is rrecl. I to comply with all state laws and city ortlinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the . cn ed property for ins aboyapection purposes. I agree not to occupy o allow occupancy of any building authorized b this PER until final inspection. z 43 r Signature Of LegalOU – Eris) I Date And/Or Authorized Applicant Date CODE r. INSPECTION TYPE PAR II®ELS CODEr INSPECTION TYPE PATE I[tIITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof /„?-5-03 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy August 24* 1959 Mr. Herald Spies 1783 Crestmont Costa Mesas, California Dear Mr. Spiese We have received complaint of fence on roperty in rC excess of 6 feet. The h jb fished by -t limits 48 as Ordinance No: 32, is 6 feet. \a Please remove portion Of ce over and above 6,feete t IA there is any uestionj, plea contact Mr. Dump Planning tors, for th City. Yours very trulyp DALE C. LITCHFORD DEPUTY BUILDINO OFFICIAL' DCL:ja E -OWNER 63 Crestmont DATE GENERAL CONTRACTOR Wilton $ Gale VALUE$ 15,167,00 o. —15 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Res. W det. gar. GROUP I & i TYPE V ZONE Rl.I PLAN NO. ✓j7. INSPECTIONS I DATE I SUBCONTRACTOR Final Gas Test PERMITS ISSUED 8719 COSTA MESA BUILDING DEPARTMENT f P.O. BOX 317 COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN BUILNG Afl RDFIS_S /L / A j / ( / _Ifo'/ / moa RcOSTLBm - s,nr5250 roo�.FrPila APPLICATION FOR PERMIT BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. •�F/ i OWNERgffif (v RECEIVE. BY DATE RECEIVED D TE MAIL ADDRESS ZrI -:2 —� a G` TEL !2 BUILDING $ P QTY `7 NO. - Q ADDRESS CP:P$'mo�i ARCHITECT VAWLIC. OR ENGINEER NO. COSTA MESA. CALIFORNIA �1 FIRE ADDRESSraga;e44 W W47! ZONE TY LIC. ZONE NO.OF TYPE GR VP PLANS CONTRACTOR NO. % G 1 APPROV ADDRESS p N, I%Q NO. �� BY [i DATE J LEGAL LOT , ,rte CORRE ONS OESCRi PTION NO BLOCK TRACT A.P. NO. e /Po —/ 4 ;i SIZE�4 OZ NO, OF BLDGS. APPROV OF LOT N % now ON wrNOW- L USEOF `J` CIT CZ?_ 'A -, 0I BLDG h SETBACK LINE FROM [ f D /. • LA Ire . PLA REG. CENTER OF STREET J REAR YARD 7 1 _LG. DEPT. }�pZO SIDE YARD RIGHT V..7 LEFT(/ � DESCRIPTION OF WORK BY DATo' NEW ALTERATION ADDITION REPAIR MOVING DEMOLISH BUILDING [.' NO.OF / K SIZE ROOMS STORIES EXTERIOR W LL ROOF COVERING COVERING USE OF NEWA BUILDING IHEREBY ACKNOWLEDGE THAT I RAVE READ THIS APPLICATION AND //�� /i *TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL (/�(, '4 CITY ORDINANCES AND STATE L E REGULATING BU DING CONSTRUC- VALUATION 6 O TION. SIGNATURE OF PERMIT FEE $ ,3S v PERMITTEE �J /4 4 7 PLAN CHECK $ TOTAL FEE S AUTHORIZED AGENT VIIF