HomeMy WebLinkAbout2653 ORANGE AVE - Building Permits (6)'M,r��Sti ��.Ttijr;�ti. ;j...:. f :-rti'-1� .r.: M • �� ..: v"`�i.,� .J"�y.�.:Z.j K � ��� ,� +.M�� *�'� Y,J i�N''Y �%,.5..��'�;-N,-4`,v _�
CITY OF COSTA MESA
Development Services, Division of Building and Safety
�
CERTIFICATE40F= OCGUPANCY
�
,
This certificate is issued pursuant to ttie requiiements of the Uniform Buiiding Code, Section 308 adopted by the City
of Costa Mesa certifies that at the Hme of its issuance the building shucture herein below described was inspected and
approvedforo[cupancyasfollows:_ . , - ' , �
. .., , . .. . .� .
BuildingAddress 2553" F Orange.Ave.' " `BIdg.PeimitNumber B09-00761
Use Residential'; . i ;: , " � 'n,
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ry
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Group R-3 TypeofConstruct�on``�' N�?'�' �'�!rL.',��e ° �� UseZone R2-MD
OwnerofBuilding Orange t7ozth Apt LI:C_= -��'�--? `���"'Tenant ��
P.O. Box 272" Downey, CA 90
Address �
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REQUIRED TO BE POSTED IN A CONSPICOUS PLACE
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: �
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
,lob Address: 2653 ORANGE AV
Suite: F
Vicinity: UNIT F
Parcel Number: 43922137
Applicant: ISAACMAN, BRETT
Address:
Status: ISSUED
Applied: 04/20/2004
Issued: 11/01/2004
Zoning: �
ISSUED BY:
_ , ' Phone:� � 949-476-3133 -- �
. � _ ,. Zip: � . ,
. , _. � `�:: ��. -
Owner: ORANGE NORTH�APT LLC � � ' � �
Address P O BOX 272 � � � � _ � � i � - �� ,� �\
, � � . -. - Phone: i � . � = �, ,.A
� \
' c DOWNEV, CA `� - �- Zip: 90247 0272 �_ �` 1 � � . . � ��� �
� .
Contractor: � �SOUTHERN;SUN•CONSTRUCTION CO �� ; � � � �.
Address: �17775 MAIN ST . .
, . STE B � � Phone: (949) 476-3133
` � IRVINE; CA" •- �� �� /
� Zip: 92614.� � License:; 509306 , � ., ,
.
Arch : . Eng: NELSON CONSULTINGENGINEERS
Address: . � , ; �_,—�. � �Address: WILLIAM M NELSON: , , � - �
: �, � � ' � - Phone: - � - � � � .. � . IRVINE, CA Phone: 949-752-2070
� - - - - � 17815 SKY PARK�Cf STE G , � � � .
Zip: � � License: 92614 � �- � � � License: 'SE3417 ' �
� = - - � SCOPE OF PERMIT � ' � .
UNIT F: CONSTRUCT A NEW 1687 SF TWOSTORY.SFD�AND�418 SF ATTACHED GARAGE.AST FLOOR 620 SF AND 2ND FLOOR,1071 SF; 2
�, BEDROOMS AND 2.5 BATHROOMS. ' � � '� ' � - : � .� ; �� V� � � - .
- REF: PA-03-20ANDG04-00004 � ��- `- ' �'` ' ' �-` �" -' "' '- � " -�" � . � �
� TO BE USED AS RENTAL UNIT � "`�� � � � ' � '
Plan Check'
� � Permit:
SMIP Resn
SMIP Com '
�-, :��Other �'
Inspection:
Total:
EE SUMMARY�„ _ �
$889.82 �%� � CalcValuation: ,", ', g�ss,o3s.zo
$1,368.95 � ' Claim Valuation: - So.00
.$16.60 � - --. .- � r,�'.� ,"
$0.00 ,-. : '
�$0.00 � „�kr �i.
fz� .' � �� .. �
$0 00� � •- , i „ /
�' "`- ' ;i
, .. 'G -ayv2 . i%/ . ,
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52,275 37 �. ,
. ._ • e � .'% l ` i .
� � _ — ' /. . . .' / , ' i � .
���� � ;' : -�r '����`��, - � PLANNING'& ZONING : ', ��'%:�' , ;'
�
SETBACKS � / , , _ - � _ ' ,;\:, �,
MAIN STRUCTURE Front �0. 0 �' ,, � 'Rear �. � 0- 0 Left , 0 �0 _ � �, Right� ` �0- 0 . � �
�� . � � i �; . � . ' .
ACCESSORY Fmnt 0. 0_ �. Rear 0.�0�. _ ,� Left� i� 0- 0 r, �- -� Right� �"0-�0
'�.� _' . _ , , ... �' /-,:
��
, ..� %
c �.�i � . _ �_i,- ' - �
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
�egulations. (Ord. No. 92-28, § 1, 1241-92)
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.
r ,:
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codas and"all
required Inapections and final approval must ba obtained. FaiWre to obtain inspections and final approval will result in tha expiratiop of� his�permit.
FOR INSPECTIONS CALL: (714) 754-5626 �"
zaes�ae I�aa) .
WORKERS'COMPENSAnON UECLARAnON: - . ' • �
I hereby eHirtn under penalry of perjury one of the following tleclaretions: � '
❑ 1 heve and wlll melnlain e certificate oi consent to selt-Insure for workero' compensatlon, es provided tor by section 3700 of the Lebor Cotle, lor Ihe pertortnance of Ihe
work tor whlch this Dermit is issuetl.
�� I have and wlll maintain woAcere' compensation Insurance, as requiretl Dy sectlon 3700 oi Ne Lebor Cotle, for ihe perlortnanca oi the work lor which Ihis pemiit is Issuetl.
My workers' compensatlon Insurence carrier entl policy numDer are: .
Carner. � �N�i aa�y.r_� ce.,: /65�3�5��/
�hls.�secNon need no( be camp/eted i( the permit is veluetl et one hundred dollars ($100) or less.) , � �
❑ I certity thet in the peAormance oi tha work tor which this permit is issued, I shell not employ eny person in any menner so�es to become subject to the workers'
compensetlon laws ol Californl nd agree ihat tl I should become sub�ect to the workers' compensation provislons ot Section 3700 of the Lebor Coda, I shell torthwith
comply with these pr ' s. /
Ap� IicenLSigneWre:. � _ Date: /�/�[�y
W�IN�:�FAI�UflE,TOS URE WOfiKEFS' COMPENSATION WVEMGE IS UNUWFUL AND SHPll SUBIECT AN EAQeLO�YEHSOCR�WV PENALTIES AND GVIL FlNES UP TO ONE MUNDRED
iHO05AND DOLURE (5100,000�, IN ADDRION TO THE COST OF COMPENSATION, DMAAGES AS PROVIDED FOR IN SECTION 310fi OF THE LABOfl CODE, IMEREST, AND ATTOHNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
of Chapter 9(commendng with Section 7000) ot Division 3 of Ihe Business nd Prolessions Code, entl my license is in full
r"r, a(«a�. �
CONSTRUC710N LENDING AGENCY:
❑ I �ereby eNirm Ihet ihere is a construction lentling agancy for the pertormance of ihe work lor which Ihis pertnit is issuetl. (Sec. 3097, Civil Code).
Lender's Neme: Lender's Atltlress:
SigneWre:
OWNER•BUILDER DECLARATIONS:
Date:
I hereby eflirm the� under penalry of perjury ihat I am EXEMPT FROM THE CONTRACTORS IICENSE LAW tor ihe tollawing reason (Sec. 7031.5, Business and Professlons
Code: Any ciry or counry which requires a permit to construct, alter, Improve, demolish, or repair any siructure, prior to its issuenca, elso requires iha epplicant tor such permit
to file a slgned stalement thet he or she is licensed pursuent to Ihe provisions ol the Cantrectors License Law (Chapter 8(commencing with Sectlon 7000) of Division 3 01 the
Business anE Pmfessions Code) or thet he or she is eaempt therelrom end the basis for the alleged azemption. Any violetion oF Sectlon )031.5 by any applicant for a pertnit
su6jects Ihe epplicant to e civll penalry of not more than five hundred dollers ($500).):
❑ I, es owner oi the proDerty, or my employees with wages as thelr sole compensation, WILL DO THE WORK, and Ihe siruciure Is not Intentletl or oHered tor sale (Sec.
7044, Business an0 Professions Gode: The Contractors License Law does not apply to an owner oi property who builds or improves thereon, entl who tloes such work
himself or herself or through his ar her own emplayees, pmvided that such improvemenis are not Intended or oflered tor sale. If, however, the builtling or improvement is
sold wiihin one year of completion, the owner-builtler will heve the burden of proving ihat �e or she did not build or improva for purpose ot sale.). '
❑ I, es owner oi the proparry, am E%CLUSIVELV CONTRACTING WITH LIGENSED COMRACTORS to consiruct the prolect (Sec. 7044, Business end Professions
Code: The contractors License law tloes not appty to en owner of property who builds or Impmves thereon, antl who conirects br such project wlih e wntractor(s)
licensa pursuent ta the Contractors License Laws.).
❑ I em exempt untler sec. Business and Prolessions Code tor this reason:
SignaNre: Date:
Owner ID verilietl by tlnveYs Ilcense. ❑ Yes ❑ No Drivefs License No.
Venlicatlon oi Ownership by (rype af document, i.e. - pmperty tae blll or tleetl):
Expires:
OIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICA710N:
❑ I hereby certily t�e� no excavation tive (5) or more fee� in Oepth into which e person Is requiretl to descen0, will be mede In connection with work eu�horized by this
permit, antl that no Dulltling structure, scaHolding, falsework, or demolition or dismantling thereof, will be more Ihen ihirty-slx (36) feet high. (Chep. 32, Gry 2, Art 2, Sec.
341, Tltle 8, Celltornia Atlminisira�ive Code).
❑ As owner-buildar, I will not employ enyone to tlo work which waultl requlre e permil irom ihe Division of IndusMel Sefery, es notatl e6ove, unless such persan has a
permit to do such work Irom iha division.
Signature: Data:
Divislon ot Industrial Selery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORVATION OF EMFiV: I certify under penelry of perjury Ihat I have reatl this epplication and state ihat ihe infortnaiion given is
correci. I egree �o comply with ell steie laws end ciry ordinences relating to building construction, and authonze representatives of ihe Clly ot Costa Mesa to enier upon the
ebove-described property for inspection purposes. I egree not to occupy ar ellow occupancy of eny building authorized by Ihis permit until final inspection.
COUE I. INSiELTIONTYPE
1616 Fixed System Final Fire Prevention
1266
200
201
202
203
204
Pool Spa Final
Finel Fe-Roof
Final BIocWReteining Wall
Final Fectary Fire Place
Finel Sign
Final Demolitlon
P�ff. I�
0
�QQE,( INSVECTIONTYPE
206 Finel Mechanical
208 Finel Plumbing
210 Final Elettncal
272 � Finel Fire Prevention
220 Finel Planning Approval
222 Final Site
250' Final Building/Occupancy
P� 1NIIDlLS
(714) 754=5273-_•�Fax�(714) 754-48565•�www.ci.costa•mesa:ca:us: 77 FAIR�DRIVEF.COSTA�MESA; CA 92626
ELECTRICAL PERMIT
JobAddress: 2653 ORANGEAV Status: ISSUED
Suite No F- . Applied: OS/20/2005
Vicinity: Issued: OS/20/2005
Parcel Nunmber. 43922137 �
Applicant: ISAACMAN, BRETT �.i-�..'-'c" �-�<=�;i �,„-` ��;<�;..� ISSUED�eY:
�'�.�i/G: ... . --- � .-:==�}-1_=
Address: 17775 MAIN ST -'. ��jC'�+�'."� _ ... - '�--���� '�:. � - '"".�:-;,�.�`..�-
„r' � �'.� " �'" /`� � ` <�.
,. �
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STE B � �' � -' i--+ �, Phone: (949) 4763133 � , �- - - �� �
#', fi" i —'' 1 ' ' "���'' '`--
IRVINE,CA,�_, f1a,.. � r` �� Zip��. , 92674 � i�-._�j, `�� ��. r .:���\,
.: �, , , ', � � '� � ,--- _ 1 . � � �"��
�-" G,-=� � �V A, ` Ye - ,i !' ' ' - = � - � . '• � � � � �
Owne� � ORANGE NORTH APT;LLC = � ����`��''�����{� , �� i ��� � �,
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Address P O:BOX 27� ��.. � � �� . � , f� � �
i�, , A�,
. . : `"';�>!C j, Phone: ���`��\��;'��� '
. , , i
� ,_ ; DOWNEY; CA - Zlp: 90241-0272 \��;<i.;�.,�
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el:
Contracror: 'SOUTHERN SUN CONSTRUCTION CO .�.. '� .
. . '.lJ e' �'^� � � ` . � �. �
, Address � .177-75 fv1AIN SY � � , �;�_.�1,.-� - ^'� � ` .. -
. �1i1 ...; � f ♦ 4 � j �
� � -STE�B r -�,t r,��� Phone-(949)476-3733'�� ' . " �
_' IRVINE CA : �a �> �" '- � Zip: 92614 . �. _ , �.�,.,., r _ ,;'� • ' �
S ,, � ,
,� , +�,
, , , l � License:509306 , . � , �. - , ,
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, . .. , ._.. .. . ..-- - - -- ' i
�:� . -.:'`. ;•",,7
�� � ', `UNIT F: CONSTRUI
' � 620 SF AND 2ND FI
'i - '' �.����:�ELECTRICAL'TOI�
'>}: ' `+'"" ,,c_ '
S�SF ATTACHED GARAGE. iST FLOOR �, �
200MS. REF.: B04-OW61 . � �
AND 3 SWITCHES. • �
' ' " FEE SUMMARY• „' , ` "` " `-
- , . Quantity . ��
ISSUE FEE � $23.50 Temp Dist.System"/ Lighfing
Temp,service test � . ..� $0.00 8usway %100 ft "'
Res. a/c.package , , ..$0.00 . ' Standing Section
New Res (1-2 uriits) � � � ,-� $94.47 - - 1687 ' '{^i'� Misc Electncal Equipment
New Res (3+units) �� �$0.00 0 ' "" " Transformers�up;to 1 kva/kw
Pool / Spa , � �. � �� $0.00 0 '' " � � - � � � up to 10!kva/kw�, �
Lighting Fixts � \ `�' $1:10.". �'?-1��'�. .� . ,� :............up to'S0 kJa/kwv-��
Recept Outlets �$7 70 ' 7��„ � up to 100 kva/kvi �
Switches \ �\ f / $3 30 � �\��3 ' � ....: over 100 kva/kw �'� �
NonResAppl � � ��$0:00� � ��0��� �'. LowVoltage'Equipment ���`'
Res Appl' .$0.00' �� 0���`� <� Low Volt Wmrig System-/.Ckt -
Service to 200a �; ,� $0.00., i i �� �,0 - - � Misc: CondwC �.i'� �� ��
Serviceto1000a . $0.00'�' �0�� ' � � Misc:Conductor. �l
Service over t000a $O:W `' �f0, '."�,. � - , � ,�.� . Circus ( gen-or ride) ��t� \r
Motors to 1hp $0:00��' -0 \,. -. -' 1 : `� , ; 'Ciras,(mech�nde;or•.lights)
Motors to 10hp $0.00-.� -�` 0 - �� � t,, � Christmas T�ee Stantl'` .'j
Motors to 50hp , $0.00 ` � �0.�, _ _ � " - �Firewoiks Stand� �--';�r �J ^
- /, .. �-. �"
Motors to 700hp $0.00 � 0 ; , �°-� :. =���, _ _ Ather�.Electrica� Fee'.%�, .--
Motors over 100hp $0.00 0 -_ . , , » -�..-�'-%= -? -' � -- `"
Communicalion drops � $0.00 0 . " InJestigalion Fee
Sub panel to 200a $0.00 0 Plan Check Fee
i ,
Quantity ' , ..
$0.00 0 �. - �
$0.00 0. ��' � � i �
$0.00 --0%'; ' - � �
$0.00 � 0/ � ' �
$0.00 �..�,0 � �
$0 00 ��� 0 �. . '' r
$0 00% 0 � _ , �
�$0 00 / 0 ��
$000��-��0 � �;, i
$0 00! -��Oi �� �
$O.W,� ,� 0
$0.00:�' 0 j ,.% � �
$0 00 -/0': � ...
$000'��% :0�
$0:00��;,�' 0
$0,00' 0
$0.00 0
$0.00
$0.00
$0.00
NOTICE� Tha.work�authoriied;by,this;permit;shall;compty.with+all applicable:handicap:access�requiremenis;underCalifomia statules and related
regulations: (O�d. No. 92-28, §;1; 12-21=92)� ,
EXPIRATIONl: Thls�pertniYshall automatically expire:and become:void.if work is�not commenced.withirc180:days, onif work is.suspended or abandoned
fora�period oP180 days:
INSPECTIONS: In�ordenfor.theawork,authorized!under.this��permitRo:be;considered:legal,.such�,work;mustcompty,with-all�applicable�.codes, and all
requlied:lnapeetlons��and�.tinal'approvaLmusfbe:obtained: FaiWre:�to:obtain�inspections�and:final approval wilf resulYin�the-expiratlon of ihis permit.
FOR�INSPECTIONS;CALL`:: (7.14) 7545626: ,�
za�ae �sioo� �
WOBKERS' COMPENSATION DECLARATION: �' � - ' � � .
I here6y aHirm untler penelty oi perjury one of Ihe tollowing declaretionsr e .. � . -' '
❑ I heve end wlll meintein a cartificete of consent to selbinsure,tor workers' compensation, es provided for by section 3700 of ihe Labor Code, tor the.pertoiniance of the
—/ wark for which this permit Is issued. - � � � ` ''�•�
�y I have antl wlll maintain 'workers' compenselion insurance, as require0 by section 3700 of Ihe Lebor Code, for the perfortnance of ihe work for which this pertnit is issuetl.
My workere' com ansa lon Insurent arnar end policy number are: / �7�+
Gerrler�: U'.'n li. �l �POIiCy:Number.r /}� ��Y T '� '
M� secnon��� ed /l t ' i velue t one hundred dollars ($100) or less.) �"'� �—=y� �—
❑ I cetlify that in the pertortnence of the work for�which this pertnit is issuetl, I shall not employ eny'person in eny manner so as to becbme subjecYto lhe �workere'
compansetion lews of , nd egree that if I should 6ecome subject to the workere' compensation provisions ot Seclion 3700 of ihe Labor Code, I shall forihwith
comply with Ihes ' s. /`
1�+/u�[ Sfyktri�s. —ird—__'. , / De� _ te:tr,�,.. S��.Ql
WTMA__I�[R JGrFAtCUR E WORKERS' COMPENSATION COVERFGE IS UNLAWFUL AND SW1LL SUBJECT AN EMPLOVE�O CRIMINAL PENALTIES AND GVII FlNES UP TOONE HUNDRED
TO JSAND DOLURE (510D,000), IN ADDfTIIXJ TO THE COST OF COMPENSATION, OAMAGES AS PiiOVI�ED FOR IN SECiION 37060F THE LABOR CODE, IfJ�EREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTOFiS DECLARATION:
provislons ot Chapter 9(commencing with Section 7000) of Division 3 of ihe Busines�qnd Professions Cotla, antl my license is in tull
CONSTRUCTION LENDING AGENCY: �
❑ I hereby aflirtn tha� ihere is a consiruction lending agency for the performance oi lhe work for which Ihis permit is issued. (Sec. 3097, Civil Code).
Lender'S Name: Lender'S Address:
Signeture:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby eHirm thet under penelry of perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe tollowing reeson (Sec. 7031.5, Business and Professlons
Cotle: Any city or county which requires e parmit to construct, alter; improve, demolish, or repair eny slructure, prior to its issuance, elso requires ihe epplicant for�such pertnit
to file a signed stetement Ihet he or she Is licensed pursuant to the provisions of the Contrectors License Lew (Chapter 9(commencing with Saction 7000) of Division 3 of the
Busineu and Professions Code) or �he� he or she is exempt t�eretrom antl t�e basis for the allegetl e:emption. Any violation of Section 7031.5 by any applicant for e pertnit
subjeds ihe applicant to a civll panelty oi not more ihan five hundred dollars ($500).):
❑ I, as awner at the property, ar my employees with wages as their sole compensetion, WILL DO Tl1E WOPK, entl ihe structure is not intentle0 or otteretl for sele (Sec.
7044, Business end Protessions Code: The Coniractors License Law tloes not apply to an owner of property who builds or improves ihereon, and who tloes such work
himself or herself or through his or her own employaes, provided that such improvemenis are not Intended or oflered for sale. If, however, the 6uiltling or improvement is
sold within one year of completion, the owner-builder will have ihe Durden of proving Ihat he or she did not build or improva for purpose of sale.�. -
❑ I, as owner of the property. am E%CLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to construct the project (Sec. 7046, Business and Professions
Cotle: The contrectors Llcensa Lew does not appty to en owner ot propeny who builds or Improves thereon, entl who comrects for such project with a coniractoqs)
license pursuant to the Contrectors License Lews.).
❑ I am exempt under sec. Business antl Protessions Code for �his reason:
Signature: � Date:
Owner ID verified by drivefs license. ❑ Yes ❑ No Drivers License No. Ezpires:
Venfication of Ownership by (type af document, i.e. - properry tax bill ar deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFIGATION:
❑ I hereby cenify that no azcavation tive (5) or mora teet in depih into which a person is required to descend, will be made in connadion with work authonzeG by ihis
pertnit, end that no building stmcture, scaftolding, talsework, or tlemolition or Oismantling thereof, will be more than thirty-six (36) teet high. (Chap. 32, Grp 2, An 2, Sec.
341, Tltle 8, Celifomia Adminisirative Cotle).
❑ As owner-builde4 I will not employ anyone to do work which would require a permit trom the Division oi Intlustriel Safery, as noted abova, unless such pereon hes e
pertnit Io do such work trom the division.
Signature: Date:
Division of Industriel Safery Permit Number.
CERTIFICATE OF COMPLIANCE AND AllfHORIZATION OF ENTRY: I certify under penalty of perjury that I have read ihis application antl state ihat the infortnation given is
correct I egrea to comply with all state laws end city ortlinances relating to builtling constmction, end authorize representatives ot the Ciry of Costa Mesa to enter upon ihe
ebove-described propeRy tor inspection puryoses. I agree not to occupy or allow occupancy of eny building authorized by ihis permit until finel inspection.
COUE I. INSPECTIONTYVE
1616
1266
Fixed System Final Fire Prevention
Pool Spa Finel
200 Final Ra-Roof
201 Final BIocWRetaining Wall
202 Final Fectory Fire Place
203 Final Sign
204 FinalDemoition
_ . o"h. .. . �.,
� � CODEI INSPECTIONTYPE �� ��
' 206 Finel Mechanical . �
20B Final Plum6ing
210 Finel Electricel .
212 Finel Fire Prevention
220 Finel Planning Approval
222 � Final Site �
250 Final Building/Occupency
o�re • 1ti�LS
�1-'1U-o(a . �-�^�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
2653 ORANGE AV
F
MECHANICAL PERMIT
Status: ISSUED
Applied: OS/20/2005
Issued: 05/20/2005
. Parcel Number: 43922137 ' � �,� � . _ � . ~ � '- - ISSUED BY:
' '��i:'l � ` - - ' ' "_
/ ,- ,
Applicant: ISAACMAN, BRETT'i�—� . , � j �l ,.-;; �� ;
i
Address: 17775�MAIN.ST � \ --� �, ' ✓�, , �'�� �,
,��••� , �' � �.' . _, i A�- -
STE�B ' % ". ., ��% '� j - ' Phone: (949) 47G3133 � � ` � ;. �A`= �.
IRVINE' CA V �� i, r� _ �Zip: 92614 � � � � �� � �. . �..
� �-�✓ i/„�� � V'C�- ��� � `�
Ow er. "ORANGE;NOj TH APT LLC � ��; � �� � � , �
Address: P O BOX-272 ' / '�� ' � V� ' � �
� Contractor.
Address
. `. _i
,•
,
� :,
- - Phone: �` �
,. ; ���.'��_ . . _
, � DOWNEY, CA Zip: ' 90241-0272 ��: �: , �
' � � ;� �
�
SOUTHERN SUN CONSTRUCTION CO;' ,, . „ �
. -,17775 MAIN ST '�-�%',i,'�� , - � ' r ,�, � ' _
:
�
i.STEB ; � ��' �-�� +- „ Phone`:�-(949)�47&3133__ � � � � .•
_ �".
� „ � �.
; �-IRVINE;CA�,,,. -- Zip: 92614 -� �.j,-.�,'"' .�•_ �.
]
License:509306 . � � ' •
' • T.; ,. _, - ; SCOPE"OF PERMIT ," " ' .
� UNIT F: CONSTRUCT A NEW 1687 SF TWO-STORY-SFD�AND:418 SF ATTACHED GARAGE. 1ST � � .
. FLOOR 620 SF AND'2ND FLOOR_107T SF; 2 BEDROOMS�AND2.5 BATHROOMS. REF.: �
B04-00761 ; - - - - � . _ .. _. _ .. .., . -'-. _ . . .,
� �
. �, .
.MECHANICAL TO INCLUDE: 1�FAU c100K BTU,--.1��REPAIR/ALT COOLING/HEATING, 1 .
• FACTORYFIREPLACE,-1-HOOD�N//MECH.EXHAUST,.3-VENT�FANS/SINGLE.DUCTANDI ' � ' - �
,• COMPRESSOR/ABSORPTION SYSTEM 3.T0-15 HP. '�� + ' -� - -- , �� � �
" FEESUMMARY .' �
� � � Quantity . -- -- � .` i �..�,� � � � `puantity
i
ISSUE,FEE -� � $23.50 +.r;%'ti��;,Repair/AltAbsorbtionUNl �,;,.;/ j $0.00. 0`� �
Inst FAU 1100 k BTU� $14.80 1 :'� �' .� � Repair./ Alt Refrigeration Unit ��,'�% $0.00 0"
Insl FAU >100 k BTU . � , $0.00 0 � . Ventillation $ystem �- � � , $0.00 �- 0
Repair/Alt Cooling/Heat,' � ��$13.70 1 ti�, .� � � � �>-Evapo}ative:Cooler d��_„�, , ���� `, �..$0.00�.'� 0
Inst / Rep. Recess Wall Htr �" $0.00"YO'^ �" . Commerclal Incinerator-'�,� ' $0.00 : 0
Refrig Sys <100 k BTU . � $0:00 �0 �� ' �, Domestic Inci,nerator .` i�i � � , $0.00� 0
RefrigSys>100�kBTU " ,,�$0:00�0 � a _ �.. �Compressors/Absomtion"Svslems� �-� /� "
Gas Piping " � � ; ��$0.00�`�.0 ��� . - Up to 3 hp / 100 KBTU% ( ; -- � </ / $0.00 0
Pactory Fireplace � ;,$10.65•. t��.� � 3 To 15 hp7�500 k.BTU /,., �- i� /; .,$0.00 0
Hood w/Mech Exhaust - �• �$10:65���1 ., ' _ �: ' ' . �- --'15 To30.hp /�1;000 k BTU� � � � - /� � �' $0.00 0
VAV Box _ -: �_ ,-: $0;00 � � 0 i �1 ��...� � � �-- � '30 To 50 hp /,9-,750 k BTUV /i'� � .!%� �� $0.00 0�
Vent Fan / Single Duct �� �� �,_$21.75 ��3\ �_-�' _� �` � �. - Over 50 hp-I Over 1,750 BTU� /, G' �- $0.00 0
Appliance , -$0:00 '--0' i : -,; i ..1', _' �'`�Boiler's � �t V�j �/,'�,�`
Fire Dampers �-$0;00 = 0_ - , � : ! � ; , "Up to 3 hp� -'-� ; �-/� ; ' $0.00 0
Smoke Dampers $0.00 0� . '� . _ � �' 3 To �75 hp . _ - $27.15 1
Inst or Relocate Appl Vent $0.00 0' � �, � _ � - -15 to 30_hp'� ��' "� � $0.00 0
Air Handlers < t0000c(m $0.00 0 � . _,_ ,_, �_' `30jo 50 hp �` $0.00 0
Air Handlers > 10000cfrn $0.00 0 Over 50 hp $0.00 0
NO710E: The xrork aNhorized by this permit shall wmpty with ail applicable handicap access requirements under Califomia slatutes and related
regulations. (Ord. No. 92-28, § 1, 72-21-92)
EXPIRATION: This pertnit shall automatically expire and become void if vrork is not commenced within 780 days, or if work is suspended or abandoned
tor a period of 180 days.
INSPECTIONS: In order for the work authorized.under this pertnit to ba considered legal, such wark must compiy with all applicable codes, and all
requlred Inspeetlona and flnal.approvel musl be obtafned. Failure to obtain inspections and tinal approval will result in the ezpiretion of this permit.
FOR INSPECTIONS CALL: (714) 7545628
zsawe fdool
WORKERS'COMPENSAnON DECLARATON: � � � � � �
I hareby eHirm undar penalry ot perjury one of the tollowing declaraUons: ". � ,, , �
❑ I have end will meintain a certificate of consent to self�lnsure for workars' compenseNon, as provitletl for �y saction 3700 of ihe Lebor Cotla, for Ihe peAormence of the
/^�ork tor which Ihis permit is issuatl. -
B" heve entl wiil maimain workars' crompensetion insuranca, as requiretl by secNon 3700 0l the Labor Cotle, for ihe pertormance of �he work for whlch this permit Is issued:
�+-� workers' c�o gen% allo/n�nsuranc carrler end policy number ere: /! ?��i
Cer� `/T.Ilft- �.f�f4!��,U r!; Pd�icy:N�um�er ��7� / 7� '
(T'hl's section neetl nof be complefed i! fhe Oermu s veluetl at one hunEretl dollers ($f 00) or IessJ tts+� �
❑ I certily thet in the peAormance ot the work for which ihis pertnit is issued, I shall not employ any person in any manner so as to become subject to the workers'
Campensetlon laws ol Celtlomi ' ree Ihal il I should become subject b t�e workers' compenSalion provisions oi Sectlon 3700 of the Lebo� Code, I s�all fotlhwlth
compty with Ihese.p�
nt'Slgn�(ure�.�; _`���%" /� �te:�, -s/?3'�T
W/�WIH�: FAILL/RE TO SE ERS' GVlAPENSATION COVERAGE IS UMAWFUL M!D SHALL SVBJECT AN EM�R TO CRIMINAL PEW�LTIES AND CML FlNES UP TO ONE HUNDPED
TlIOUSPND OOLLIRE (5100,OW� IN ADDITIIXJ TO THE WST OF COMPENSATION, DAAUOES AS PROVIDED FOR IN SECiION 3%OB OF THE UBOR CODE, IMEREST, AND ATTORNEVS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHlrm ihat I em licensad under provisions ot Chapter 9(commencing with Section 7000) of Division 3 of
CONSTRUCTION LENDING AGENCV:
Protessions Cotle, end my license Is in tull
❑ I hereby eMirtn ihat ihere is a wnsWction lentling agency for the pedormance ot the work tor which this permit Is iuued. (Sec. 3097, Civil Code).
Lentlers Neme: Lender's Adtlress:
Signature:
Date:
OWNER-BUILDER DECLARATONS:
I hereby eNirm thet untler penelry af perjury thet I em EXEMP7 FROM 7ME CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business entl Professions
Code: Any ciry or county which requires e permit to construct, alter, improve, demolish, or repair any structure, pnor to Its Issuence, also requlres Ihe applicent tor such pertnit
to file e signed stetement t�at ha or s�e is Ilcensed pursuant lo ihe provislons of Ihe Contractors License Lew (Chepter 9(commencing with Section 7000) of Division 3 ot the
Busineu antl Professions Code) or thet he or she Is ezempt thereirom and Ue besis for Ihe alleged eaemption. Any violetion of Saclion 7031.5 by eny epplicant for e Dertnit
subjects the epplicant to a civil penalry ot no1 more than tive hundred dollars ($500).):
❑ I, es owner of the property, or my employees with waqes as t�eir sole compensellon, WILI DO THE WORK, and Ihe slructura Is not intended or atleretl for sale (Sec.
7044, Business antl Protessions Cotle: 7Te Contractors License Lew tloes not apply to an owner oi property who builds or imD�o�es ihereon, and who does such work
himsetl or herself ar ihrough his or her own employees, providetl Ihei such improvements ere not intendetl or oNeretl for sale. tl, however, ihe buildinp or impmvement is
sold within one year of completion, the owner�builder will have the burtlen of proving ihat he or she did no1 build or improve for purpose of sale.). �
❑ I, es owner of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 76M14, Business and Professions
Cotle: The contrectars License Lew does not apply to en owner ol property who builds or Improves thereon, antl who contracts for such project with a contrector(s)
licen5e pursuan� �o �he Contrettor5 LitenSe LewS.).
❑ I em Bxempt under SeC. Busine55 and Profe551on5 Code lor thi5 reeson:
Signeiure: Date:
Owner ID vaniiea by driver's license. ❑ Yes ❑ No Drivefs License No. Explres:
Verifice�ion oi Ov.narship by (type ol document, i.e. - praperty tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON:
❑ I hereby cenify Ihat no excavatlon Ilve (5) or more teet in depth into which e person Is required to descend, wlll be made In connection with work euthorized by Ihis
permit, an0 that no building structure, scattoltling, talsework, or tlemolilion or dismantling Iheraot, will be more than Ihirty-siz (36) feet �igh. (Chap. 32, Grp 2, Art 2, Sec.
341, Title e, Califomia Administretiva Code).
� As owner-6uiltler, I will not employ enyone to do work which would require e permit from ihe Oivlslon ol Intlusirial Salery, as noted eDove, unless such person has a
permll �o tlo such work irom �he divisian.
Signature: Date:
Divislon o1 Indusirial Safery Permit Number.
CER7IFlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTAY: I certily under penalty of perjury tha� I have read ihis epplication and state I�aI �he Infortnation given is
corract. I agree to comply with all stete lews end ciry ortlinances relating to buildfng consiruction, and authodze representatives of Ihe Ciry ot Coste Mesa to enter upon ihe
ebove-described property for inspeciion purposes. I agree not to occupy or allow occupancy of eny building authorized by ihis permit until tinal inspection.
COpE,t. INSPECTIONTYPE . . ' `. PdIE.. .. .•.U1iIIlELS•.. '
1616 Fiaed System Final Fire Prevenllon
1266 Pool SOa Final
200 Finel Re-Raot � '
201 Final Block/Retaining Well
202 Final Fectory Fire Place � ' � �
203
204
Final Sign
Final Demolition
COOE� •INSYECTIONTYVE^�
206 Finel Mechenical
208 Final Plumbing
210 Finel Elettdtal �'
272 Final Fire Preventlon
2Y0 Final Planning Approval
222 Final Site
250 Final Building/Occupancy`
�.I IOI..
r � � 1
(714) 754-5273 • Fax (�ia) �sa-aess • wv�w.ci.costa-mesa.ca.us n rnin uNrvr., coa in mrsn, cn szbzb
PLUMBING PERMIT
1ob Address: 2653 ORANGE AV
Suite No F
Vicinity: UNIT F
Parcel Nunmber: 43922137
Applicant: ISAACMAN, BRETT
Address: 17775 MAIN ST : - -', " - ', , 1
STE B - ' . • Phone: (949) 478-3733; �
IRVINE, CA . � , ' Zip: 92614 _ ,
Owner: '.ORANGE NORTH APTLLC
Address P O BOX 272 �
DOWNEY, CA
i
Phone:
Zip: ,.90241-0272
Status: ISSUED
Applied: 10/29/2004
I ssued: 11 /01 /2004
ISSUED BY:
Contractor: SOUTHERN SUN CONSTRUCTION CO
Address: 17775-MAIN ST _ �
STE B � � - Phone: �(949) 4763133 �
IRVINE, CA � Zip: 92614 „ '
�. License: 509306
Arch/Eng:, . -/., , _ �;.� - -
� Address: � , , � . _ . . , , .'- . '— --_
Phone:
Zip:
' . ' _ __ _ . License: . - _ ->
/ '_ ,
i
SCOPE OF PERMIT ,'
UNIT F: CONSTRUCT A NEW 1687 SF TWO-STORY SFD AND 418 SF ATfACHED GARAGE. ; -.
�� ��2�BATHTUBS, 1 DISHWASHER, 1 GAS OUTLET (1-4),9 �GAS OUTLET OVER 4, 1 GAS SERVI6E,�1 - � . -
�� , � CAONDRY TUB/WASHER, 1 SEWER CONNECT-,2 SHOWERS, 1 KITCHEN SINK, 1 WASH BASIN, 1 WASH ,
�. � � ' BASIN�SET, 3 WATER CLOSETS, 1 WATER HEATERNENT, 1 WATER SERVICE � i;� � �'
� REF:-B04-00761 '�-'�`" ` , - �� -
. , A _ , , ' _ _ ., ,i �
�AMT
ISSUE FEE � , $23.50",
Backflow irrigahon � � � $0.00" '
Backflow Preventer� � � �� $0.00
Bathlub � � $19.60
Clarifer System `$0.00�
Connect (Ice,Soda,etc) $0.00
DentalUnits $0.00�
Dishwasher $9.80
Orain, Floor $0.00
Drain, Rainwater $0.00
� �� FEE SUMMARY � �� � ' . �
:.:QTY-� "� ; AMT 'QTY � . - ; � AMT
-. � Laundry Tub / Washe� �` 59:80 1 � Sump Pump ., $0.00
--0 � =Candscape Irriga6on'�, � �$0.00 : �0 ' Swimming Pool % � � $0.00
0 , � P-Trap-; �. _- _ - - $0.00 - 0 � �Tra'p Frimer -- � $0.00
2 - � - Pressure Regulator - - $9.80 1 � � Urinal � $0.00
0� - - Process Piping (per 10 ft) $0.00 0- � ���Vacuurri Brk� BkFlow(13) $0.00
-0 ` �Receptors ` � �- $0.00 0 � Vacuum Brkr BkFlow(5+) $0.00
0 � �' Septic Tank $0.00 � 0 � "Wash Basin $9.80
1 ,`- � � � Sewer Cap for` Deino,' -. : $0.00 � 0 '��Wash Basin Set $19.60
0 � �- -Sewer Connect $24.65 �, ;1-, -" � � Waste and Vent System $0.00
0 Sewer Pmate Line ����% 50.00 �" 0� Water Closet (ToileQ $29.40
QTY
0
0
0
0
0
0
1
2
0
3
NOTICE: The work authorized by this permlt 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 eutomatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandonad
for a perlod of 1 BO days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with al� epplicable codes, and-all
required Inepeetlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in Ihe expiration of ihis pe��
FOR INSPECTIONS CALL: (714) 7545826 //
2d48d8 (fl�00)
WORKERS' COMPENSATION DECLARATON: � . '
I hereby aNlrm under penalty of perjury ona of the following tleclaretions: �' �' ' �
❑ I heve entl will melnteln e cenificete oi consent to sell-Insure for workers' crompensation, es pmvided for by section 3700 oi the Lebor Cotle, for the�paAormence of Ihe
ork for which this permlt i5 is5ued.
/f �ave antl vnll maintaln workers' compensa6on insurarke, az requlre0 Dy section 3700 oi the Lahor Code, for the pertortnance of Ihe work tw whkh this permit is issuetl.
My workers' compensatlan Insurence carrier and poliq num0er ere: �
•.a+ ' ,+:_._.
:erner. 1 S'J'y�?� i2lN� Po cy.Number:,e- -✓ y3� y
(Ti(Is sectlon need nof be crompleretl il fhe permif is velued et one hundred tlollars ($100) or Iess.J , .
❑ I certity Ihet in �he peAortnance of the work for which this permit is Issued I s�all not employ eny person in any manner so as to bewme sublect to the workers'
com0ensetion laws of Celifomi nd egree that if I should became suhject to the workers' compensetion provislons of Section 3700 of the Lebor Code, 1 s�ell forthwith
comply with these prov i s.
ApPuican�ySi9neN�ea�''���'h/ afe:`�.....`L��i�
WAHNIN(3:�FAILURE TO SECtlRG9JORKERS' COMPENSATION WVERAGE I$ UNLAWFUL AND SHALL SI/BJECT AN EM� TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDFED
T{IOUSAND DOLURE (5/00,000), IN ADDfiIIXJ TO THE C0.ST OF f.OMPENSATION, DMIAGES A$ PROVIDED FIXi IN SECiION 3]O6 OF THE LI�BOfl CODE, INiEREST, AND ATTOWJEY'S FEES.
LICENSED CONTRACTORS DECLARATON:
I hereby aNirmlhat I,am Ilcensed under provislo
CONSTRUCTION LENDING AGENCY:
of Chapter 9(commencing with Section 7000) ol
Prolessions COCe, and my licanse Is In full
❑ I hereby efFirm Ihal ihere is e construction lending agency for ihe peAormance of the work for which this pertnit is issuetl. (Sec. 3097, Civil Cotle).
Lenders Name: LentleYs Atldreu:
Signature:
Date:
OWNER-BUILDER DECLARA710NS: �
I hereby efllrm Ihat under penalry of perjury ihat I em EJ(EMPT FROM THE CONTRAC70RS LICENSE LAW tor the following reason (Sec. 7031.5, Business antl Protessions
Cotle: Any ciry or counry which requires e permit to consiruct, alter, improve, demolish, or repair eny slructure, prior to its issuance, also requires the epplicant tor such pertnit
b file e signed stetement thet he or she Is Ilcensad pursuant to iha provislons of tha Contrectors License Law (Chapter 9(commencing with Sectlon 7000) of Divlsian 3 01 t�e
Business end Professions Code) or Ihat he or she is exempt theretrom end the basis for Ihe allegetl e:emption. Any violation ol Secllon 7031.5 by any applicent for e permit
subjects the applicant to e civil penalty ol not more then tive huntlred dollers ($500).):
❑ I, es owner of the property, or my employees with weges as iheir sole compensation, WILL DO THE WORK, and the siructure Is not intenGeC or ottered for sale (Sec.
7044, Business and Professions Code: The Contractors License Lew tices not eDP�Y to an owner of pmperty who builds or improves thereon, and who does such work
himsetl or herself or �hrough his or her own employees, provided that such improvemenis ere nol intended or otteretl for sale. It, howevar, Ihe building or Improvement is
sold wit�in ona year ol completion, the owner-builder will heve Ihe burtlen of proving that he or she ditl not builtl or improve tor purpose of seleJ. �
❑ I, as owner of lhe properry, em E%CWSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to conslruci the project (Sec. 7044, Business and Protession5
Cotle: The coMreaors License Lew tloes not apply lo en owner ol pmperty w�o builds or Impmves Ihereon, and who contracls tor such project with e contrector(s)
license pursuant to the Comracmrs License Laws.).
❑ I am exempt under sec.
Signeture:
Owner ID verifietl by tlriver's license. ❑ Yas ❑ No
Business and Pmlessions Code for this reason:
Verilication of Ownership by (rype of document, i.e. - property ta�c blll or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTFICATION:
Dnver's Licensa No.
Date:
Expir85:
❑ I hereby certify �hat no excavetion five (5) or more feat In depth Into which e person is requiretl to tlescend, wlil be made In connecilon wilh work authorized by Ihis
pertniL and that no bulltling siructura, scattolding, lalsework, or Oemolition or dismantling ihereof, will be more ihan thirty-six (38) teet high. (C�ap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, Calitomla Atlministretive Code).
❑ As owner-builder, I will not employ enyone to tlo work which waultl require a permit irom the Division ol Indusirial Satery, es noted ebove, unless such person has e
permit lo do such work Irom ihe tlivlslon.
Signature: Date:
Division of Intlustrial Salety Permit Number:
CERTIFICATE OF COMPIJANCE AND AUTHORIZATON OF EMAY: I certily under penalty of perjury thai I have reed this ep0liwtion antl state Ihat the infortnation given is
correct. I egree to comply wlth all state laws and ciry ordinances relating to builtling construction, and authonze representatives af the Ciry of Costa Mesa to enter upon the
ebove-described property tor inspection purpases. I agree not to occupy or allow occupancy of any building authorized by this permit un�il final inspection.
Legal
COOE t. INSPECTIONTYPE
1616 Fixed System Finel Fire Preventlon
1266 Pool Spa Final
200 Final Re-Roof �
201 FInaI BIocWRetelning Well ,
202 Final Factory Fire Place
203 Final Sign
204 Finel Demolition
PAg II�A43
cooe. ixsvecnoxTrve
206 Final Mechanical
208 Final Plumbing
210 Pinel EIBCMcaI
212 Flnal Fira P�aventlon
220 Final Planning Approval
222 Final Site
250 Final BuildinryOccupenty
GAg U�L4
��IA-O� �
�
Job Address: 2653 ORANGE AV
Suite: F
Vicinity: UNIT F
Parcel Number: 43922137 `
Applicant:
Address:
Owner.
Address
VALDAMIRE, MANYAK - .
ORANGE NORTH APT I.LC
P O BOX 272 . -
DOWNEY, CA ' , � .
Zoning:
Phone: 81&64&8911
Zip:
Phone:
Zip: 90241-0272 .
Status: ISSUED
Applied: 03/16/2005
�_
Issued: 04/08/2005
ISSUED BY:
Conuactor: NORKO ENTERPRISES
Address: 22156 DARDENNE ST � � ,
i
, Phone: 81&64&8971 � '
CALABASAS, CA , , Zip: 91302 ,
� License:. 612699
SCOPE OF PERMIT
UNIT F: INSTALLATION OF 24 OVERHEAD SPRINKLERS IN CONJUNCTION WITH THE
CONSTRUCTION
A NEW1687 SF TWO-STORY SFD AND 418 SF ATTACHED GARAGE.
REF: PA-03-20 AND G04-00004
(TO BE USED AS RENTAL UNITI � - ; _
REF:604-00761 - '
Plan Check: $63.21
Permit: $97.25
Other: $0.00
Total: $160.46
FEE SUMMARY
Calc Valuation: $a,000.00
Claimed Valuation: Sa,000.00
NOTICE: The work authorized by ihis 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 1 BO 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 cotles, and all
required Inspeetiona end final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihls permit.
FOR INSPECTIONS CALL: (714) 7545626 '
2aarwe (erool �T'1s
WORKERS'COMPENSAnON DECLARAnON:
I hereby eNirm under penelty ot perjury one ol ihe following declaratlons:
❑ I heve enC will meintein e certificete of consent to sell-Insure lor workers' compensatlon, as prwided lor hy section 3700 ot fhe Lebor Code, for the peAormence ot lhe
work far which this pertnit is issued.
�1 heve en0 will maintain vrorkere' compenselion insursnce, es required by sectlon 3700 of the Lebor Code, for ihe peAortnance o1 the work For which this pertnit is issued.
My workers' pensetion Insurence cerrler end pollcy number ere: � /j�/�%�r%
C fFi�r:�� 1 �� Pyjpypi7ry'iber: /�Y / `TJ
�' fbn need no( be complefed il the permi! is velued ef ona hundred dollers ($100) oi less.)
❑ I certily Ihat in Ihe peAortnence of the work for which ihis pertnll Is issued, I 5hall not employ any persan in eny manner so as to become subject to the warknrs'
compensetion laws ot ie, end egree Ihet II I should hecome sub�ecl lo the workers' compensation p�ovislons of Saction 3700 of tha Labor Coae, 1 shell fonhwith
cromply with these p i ns.,,/�� ,/fl %�/y// �j /J ����✓`
�igneturer, _�G'�/�'%^' / i � L9���Ca� � %'—C3 �G�
ARW NING�. FAIWRE TO SECURE WORKERS' COMPENSRi1pN COVERAG UNLAWFUL NN� SHALL SUBJECt AN EMPLOVER t0 CFIMINAL PENALTIES AND CNIL FlNES UP TO qJE HUNDRED
T}IOUSAND DOLLARE (5100.000), IN AODITION TO THE COST OF COMPENSAiION, DAMAGES AS PqpVIOED FOR IN SECTIpJ 3)O6 OF TNE IABOR CODE, IMEREST, AND ATTORNE`f5 FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirtn that rI �am license p� , /��5�' (�q9 ol Chep�er 9(cnmmencing wllh Sectlon 7000) ot Division 3 of ihe Busines/s a�nd Prpfetsions Code, and my license is in full
force anE ettecL Li6,Y� �% /, g p `' ^
CAoi dfe� � �%�f�
l s:.,rr""" t i J--
CONSTAUCTION LENDING A6ENCV:
❑ I herety eHirtn that there is a cronstruction lending egency br ihe pedormance ol the work br which this permil is issued. (Sec. 3097, Civil Cotla).
Lender'S Nema:
SignaWre�. _
OWNER-BUILDER DECLARATIONS:
Lender's Address:
Date.
I �ereDy eHirm t�at under penelry ot Perjury ihet 1 em EXEMPT F80M THE CONTRACTORS LICENSE LAW br the following reason (Sec. 7031.5, Business and Professions
Cotle: Any city or counry which requires e permit Io construct, alter, improve, tlemolish, or repeir eny stmcture, prior to its issuance, also requires the applicant for suc� pertnit
to file e signatl stetement that he or she Is Iicensed purouenl to ihe provlslons ol the Conlreclore License Law (Chepter 9(commencing with Section 7000) ot DlNslon 3 oi the
Business and Professions Code) or Ihet �e or she Is ezempt Iheretrom end the besis lor Iha ellege0 exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the epplicant to a civil penalry ol not more then five hundred dollers ($500).):
❑ I, as owner at Ihe properry, ar my employees wlth wages es their sole wmpensalion, WILL DO THE WORK, entl the siructure is not intentled or ofreretl for sale (Sec.
70ad, Business and Professions Cotle: The Contrectors License Law does not aDDty to an owner ot properry who builOs or improves thereon, antl who does such work
himself or herself or through �is or �er own employees, provided Ihel such Improvemenis are not intended or otlered for sale. It, �owever, ihe huilding or improvement is
soltl within one year ot comPletion, t�e owner�ulldar will heve the burden of proving that he or s�e did not builtl or imDrove lor purpose o1 sale.).
❑ I, as owner o( t0e property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct lhe project (Sec. 7044, Business antl Protessions
Cotle: The conirectors Licanse Lew tloes not epply to en owner of pro0erty who bulltls or Improves thereon, end who contracts for such project with a wniracror(s)
licen5e pursuant to Iha Con��actors license laws.).
❑ I em exempt untlar sac. �
SignaNre:
Owner ID venfietl 6y drivef51iC8�59.
Verification af Ownership by (rype of
Business end ProleSsions CoAe lor ihis reason:
Yes ❑ No
i.e. - propeM1y taz bill or deed):
Dnvefs License No.
Date:
ExD�res:
DIVISION OF INDUSTAIAL SAFETV PERMIT CERTIFICATON:
❑ I hereby certiy that no exc8�ation tive (5) or more feet in depth into which e person is required to descenq will be made in wnnection with work authonzeC by this
pertnit, antl Ihat no builtling siructure, swflolding, lalsework, or tlemolition or dismantling thereof, will be more Ihan �hirry-six (36) feet high. (C�ap. 32, Grp 2, AA 2, Sec.
341, T�le 8, Califomia Adminisira�ive Code).
❑ As owner-builder, I witl noC employ enyone to do work whic� would repuire e permit fmm the Division of Intlustnal Sefety, as noted above, unless such parson has e
pertnii to do such work from the division.
SignaNre: Date:
Division ot Intlusirial Safery Permit Number.
ICERfIFlCATE OF COMPLIANCE N�1D AUTHORIZA710N OF EMRY: I conify undor panalry ol Oerjury ihat I have reatl Ihis applicalion entl state t�at Ihe information given is I
wrrect. I egree to wmply with ell slete lews anG ci�y orGinences relating lo Gullding consimction, entl euthonze represenWlives of t�e Ciry of Costa Mesa to enter upon the
ebove-Oescribetl p�openy for inspeclion puryoses. I egrea na lo occupy w e11ow occupa�y of eny builAing aulhorixed by iMs permil until tinel inspeclion.
COOE �. INSYECTIONTYPE
1676 Fixed System Finel Fire P�evention
1266 Pool Spa Finel
200 Final Re-Roa�
201 Final8lock/Retaining Well
202
203
204
Final Faclory Fire Place
Finel Sign
Final Demolition
Q� INTITIRLS
Date
��� z�'r
�,
COOE I INSPECTION TYiE
20fi Finel Mechanical
208 Final Plumhing
210 Final Eleqrical
212 Final Flre Preventian
220 Final Plenning Approval
222 Final Site
250 Finel Builaing/Occupency
G�IE
.'3u-
�i¢a�s