HomeMy WebLinkAbout2190 PLACENTIA AVE - Building Permitsr `
(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 2190 PLACENTIA AV
Suite: D
Vianity: UNIT D
Parcel Number:
Applicant: SAHAGUN, JOAQUIN
Address: 3165 HARBOR BL #D
Zaning:
Phone: 714-5455759
COSTA MESA, CA 2ip: 92626
Owner. SAHAGUN, JOAQUIN & REGINA B
Address 3165 HARBOR BL #D
Contractor:
Address:
Zip:
•. • Wch :
Address:
COSTA MESA, CA
Phone: 714-54&5759
Zip: 92626
Phone:
License:
.. .� ' . Eng:
Address:
Phorie:
Status: EXPIRED
Applied: 04/17I2001
Issued: 07I17I2001
ISSUED BY: � /1-.I�
'l // lJ"
��''/
Phone:
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT NEW 1540 SQ FT SINGLE FAMILY RESIDENCE (4 BEDROOM/2.5 BATH), WITH 400 SQ FT 2-CAR ATTACHED GARAGE FOR
UNITD. 147SF BALCONYIPORCH.
REF: DR-01-02 (ONE UNIT OF A 4-PLEX ON ONE PARCEL)
Plan Check: $806.10
Permit: $1,240.15
SMIP Res: $14.32
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $2,060.57
SETBACKS
MAIN STRUCTURE Front 20- 0
ACCESSORY Front 0.0
PARKING Existina: o
Rear 20- 0
Rear 0. 0
Reouired: 16
FEE SUMMARY
PLANNING & ZONING
Lek S 0
Left 0- 0
Proposed: 14
Calc Valuation:
Claim Valuation:
Right 23- 0
Right 0. 0
$143,186.64
so.00
NOTICE: The work authorized by this permit shall compty with all applicable handicap access requiremenis under Califomia statutes and relate^d
regulations. (Ord. No. 9248, § 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 suspende�a� ned
for a period of 180 days.
INSPECTIONS: In orUer for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlrad Inapeetlone end flnal epprovel must be obtained. Failure to obtain inspections and final approval will result in ihe expiratiori of�lhls permit.
i :
FOR INSPECTIONS CALL: (714) 754-5626 �� �
aa�e (aool
WORKERS'COMPENSAnON DECLAHAnON: '
I hereby ettirtn undar penalry of perjury one of Ihe tollowing decleretions:
❑ I heve and will meintein e tgniilcete of consent to sell-Insure lor workers' compensetion, es praWtled tor by section 3700 of the Labor Code, for ihe peAortnence of the
work for which ihis pertnii is issuetl.
❑ I have and wlll meintein workers' compensetion insurence, as requiretl by sectlon 3700 ot Ihe Lebor Cotle, Por Ihe pedortnence oi Ne work for which this permit is issued.
My workers' compensatlon Insurance carder and policy number ere:
Carrler: Policy Number:
(This sec(ion need not be comp/eree il the perm/f Is veluee et one hundred dollars (5100) or less.)
❑ I certity Ihet in ihe peAortnanca of tha work for which t�is permit Is Iuueq I s�all not employ eny person in eny menner so as �o bewme sub�eci to the workers'
wmpensatlon laws ol Cell�omia, entl egree Ihet If I should become sub�ect to the workers' compensatlon provislong of Sectlon 3700 of Ihe Lebor Cotle, I shell forthwith
comply vn�h Ihese pravisions.
Applicent Signelure: Date:
WMNINO: FAILURE TO SECURE Wp{p(ERS' COMPENSATION G1�VERAGE IS UMAWFUL AND SHALL SUAIECT AN EMPLOVER TO CRIMINAL PENA�TIES AND CML FlNES UP TO dJE HIINDPEO
TTIOUSAND DOLLARE (E100,000), IN qDDfTIIXJ TO TME COST OF fAMPENSRTIIXJ, �MMGES AS PROVIDED FOR IN SECfION 37060F THE UBOR WDE, INTEREST, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirtn that I am licensetl under provisions of C�apter 9(commencing with Section 7000) of Division 3 oi ihe Business antl Professions Code, and my license is in full
force and eflect. Llc. R Cless N
ContredoYs Signature: Dete:
CONSTRUCTION LENDING A6ENCY:
❑ I hereby aHirm that there i5 e consiruc�ion lending agency lor tha peAarmence ol the work for which �his Dermit is Issued. (Sec. 3097, Civil Gode).
Lentlefs Neme: Lentlers AtlAress:
SigneNre: Date:
OWNER-BUILDER DECLARA170NS:
I here6y aHirtn thet under peneliy ot per�ury t�et I em E%EMPT FROM THE CON7RAC70R5 LICENSE LAW tor the following reeson (Sec. 7031.5, Business en0 Professions
Code: Any dry or wunry which requires e parmit to construcL elter, improve, demolish, or repeir eny slructure, prior to its issuance, elso requires the epD���ent for such pertnit
to tile e signed stetemen� that he ar she Is Ilcensetl pursuant m the proWsbns of Ihe Contrectors Llcense Lew (Chepier 9(cammendng wlth Sectlon 7000) ot DlWslon 3 of the
Business end Pmfessions Code) or that he or she is ezempt thereirom end the Eesis tor tha elleged exemption. Any violation ol Sectlon 7031.5 by eny eODlicant for a pertnit
subjects the applicant to e civll penalry of not more ihen live hundred dollers (E500).):
❑ I, es owner of the property, or my employees with wages es their sole compensation, WILL DO TFiE WORK, and ihe sWCNre is not Intentled or ofleretl for sale (Sec.
7044, Busineu antl Profe&sions Code: The CONractoro llcense Law tloes not appy ro en owner ot propetly who builds or improves ihereon, ana who tloes such work
himself or herself or through his ar her own employees, providetl that such imprwemenis are not intended or oNeretl for sale. If, however, Ihe builtling or Improvement Is
�old within one year of completion, the ownerbuilder will have Ihe burden of pwvinq that he or s�e tlid not builtl or improve tor purpose ot saleJ.
I, a5 owner of Ihe property, am E%CLUSIVELV CONTRACTNG WRH LICENSED CONTRACTORS to construcl the projecl (Sec. 7044. Business and Professions
J`� Cotle: Tha contractors Ucbnse Lew tloes not epply to en owner ot property who Duilds or Improves ihereon, and w�o contracts for sucti project with a coNractor(s)
I'rcense pur,yan! to the Contreaore L'rcertyg Laws.).
❑ I em exe t untler sec. Business and Professions Gode tor this reason:
.Sigaatme: �Dat� " —
Owner ID fied by vers Ilcbnse. �- ❑ No Driv_er9:Lifense�No � �E�pires_ '
Venticetl oi Ownership by (type ot tlocument, i.e. - pmpetly te�c �iil or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATON:
❑ I hereby certlty I�eI no exCavetlon five (5) or more feet In tlepth into which e person Is requlrad to tlescenQ wlll be made in connection wiih work euthOrized by ihis
pertnit, entl t�at no building slructure, acettoltling, lelsework, or demolitlon or dismantling thereoi, will be more then thirry-six (38) feet �Igh. (Chap. 3.2, Grp 2, Ar12, Sec.
341, Tule B, Celifomla Adminlsiretiva Code).
❑ As owner-builder, I will nOt employ enyone to do work which would require a pertnil from ihe Divislon ol Indusirial Salery, es noted ebove, unless such person hes e
permil to do such work irom Ihe division.
Signamre: Date:
Division of Indusirial Sefery Permit Number:
CER7IFICATE OF COMPLIANCE AND AUTMORVATON OF EMRY: I cenily under penelty of perjury ihat I heve read t�is epplicelion entl state t�at Ihe intormatlon given is
correc gree to compty with all steD aws end dry ordinances relaling lo bullding conslruction, end euthotlze representetives of the Ciry ol Coste Mesa to entar upon ihe
ebov -tl cribed properry tor inspectl purposes. I egree not to occupy or ellow occupanry oi eny building eu�horized by t�is permit until final insDedion.
_f— 27— 67
Ig ure OfC6 wne ar[Za �A
And/Or Authorized Applicent Date
COpE �. INSFEC710N TYPE Q�i jE �Li
1616 Fized System Final Fire Prevention
1268
200
201
202
203
Pool Spa Final
Final Re-Roof
Final Block/Reteining Wall
Final Faclory Fire Place
Finel Sign
204 Final Demolition
COUE 1 INSPECTION TYPE
206 Final Mechanicel
200 Final Plumbing
270 Finel ElectriCal
272 Finel Fire Prevention
220
222
250
Final Planning Approval
Final Sita
Final Building/Occupency
PdIE II�dLS
e
,. . _, . -_ __. _ . _.. ,. . ., . _ . .--- _....------ -- -
Job Address: 2190 PLACENTIA AV
Suite No � ��
Vicinity:
Parcel Number: 42241230
Applicant: SAHAGUN, JOAQUIN
Address: 3165 HARBOR BLVD #D
COSTA MESA, CA
Owner. SAHAGUN, JOAQUIN
Address: 3165 HARBOR BLVD #D
COSTA MESA, CA
C o n trado r: O W N E R-B U I L D E R
Address:
MECHANICAL PERMIT
Phone: 714-545-5759
Zip: 926262503
Phone:
Zip: 926262503
Phone:
Zip:
Llcense:000000
SCOPE OF PERMIT
REF B01-00517.
1 FAU<100KBTU, 1 FIREPLACE, 1 KITCHEN HOOD, 2 VENT FANS.
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair / PJt Cooling/Heat
Inst / Rep. Recass Wall Htr
Refrig Sys �100 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhausl
VAV Box
Vent Fan / Single Duct
Appliance �
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
Air Handlers > 10000cfm
Floor Fumace �
Floor or Suspend Heater
FEE SUMMARY
Quantity
323.50
314.80 1
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$10.65 7
$10.65 1
$0.00 0
$14.50 2
$0.00 0
ao.00 0
$0.00 0
$0.00 ` 0
$0.00 ����0
$0.00 0
$0.00 0
ao.00 0
Status: ISSUED
Applied: 10l09I2002
tssued: 10/09/2002
ISSUED BY: �J
Repair / Alt Absorbtion Unit
Repair / Alt Refrigeration Unit
, VenUllation System
_ Evaporative Cooler.
. Commerciallncinerator
Domestic Incinerator
Compressors / Absorption Systems
Upto3hp/100kBTU
3To15hp/SOOkBTU
15 To 30 hp / 1,000 k BTU
. 30 To�50 hp / 1,750 k BTU
- Over 50 hp / Over 1,750 BTU
Boilers
Uplo3hp
3To15hp
1510 30 hp
30 l0 50 hp
Over 50 hp
Other Mechanical Fee
, InvestigaUon Fee �
; Plan Check Fee
. Reinspection Fee
Quantiry
ao.00 0
50.00 0
$0.00 0
$0.00 0
ao.00 0
$0.00 0
ao.00 0
so.00 0
50.00 0
so.00 0
$0.00 0
so.00 0
50.00 0
50.00 0
50.00 0
$0.00 0
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES 574.10
NOTICE: The work authorized by this permit shall comply with all app�icable handicap access requirements
regulations. (Ord. No.9248, § 7, 7241-92)
EXPIRATION: This permit shall automatically ezpire and become void il work Is not commenced within 1B0 days
for a period oi 180 days.
INSPECTIONS: In order for ihe work authodzed under this permit ro be considered legal, such work m t coi
required inspectlons and tinel epproval mus� be obtained. Failure to obtflin Inspections and linal approval will re
FOR INSPECTIONS CALL: (714) 754-5626
2aacae �aroq
statutes and related
is suspended or abandoned
with all applicabie codes, and all
in the expirelion of this permit.
WORKERS' COMPENSATION DECLARA710N: -
I nereby eHirtn untler penalry of perjury one oi ihe lollowing tleclarations:
❑ I heve end will maintain e certificate of wnsent to self�lnsure lor workers' campensation, es provided tor by sectlon 3700 0l the Lebor Code, for the pertormance of the
work for which this permit is issuetl.
❑ I have entl wI0 maintain workers' compensatlon insurance, es reQuiretl by sectian 3700 of Ihe Labor Cotla, for the peAortnance of No woMc tor'v.T?ti ws permit is tssued.
My workers' compensatlan Insurance carrier end poliry num�ar ere:
Cerdor. Policy Number.
(r�fs sectlar need no! Oe camde(ed if Ne permif is velued et one huiMred dd/ers (S 100) or Ie55J
❑ I cenily that in �he Oortortnflnce of Ihe work fw which t�is permit is issued, I shall not emplay eny person in eny manner so es to becwne sub�ect to the workers'
compensatlon laws oi Celifomia, and agree that it I shoultl become sub�ect to the workers' compansatlon provlsions ol5ectlon 3700 0l the Lebor Cotla, I shell forthwiN
comply with Ihe58 provisions.
Applicenl Slgnatura: Date:
WARNINO: FAI WNE TO SECURE WORKERS' COMPENSATION ODVEMGE IS UMAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE MUNDRED
T/KK15AND OOLURE (Sf 00,000), IN FODITION TO THE COST OF COMPENSATION, DAMNGES AS PPOVIOED FOR IN SECTION 3]OB OF THE LABOR CODE, IMEFEST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATON:
I horeby effirm thal I em Ilcensetl under provisions ot Chapter 9(commencing wlih Sectlon 7000) of Divislon 3 0l ihe Business antl Proles5ions Catle, antl my li�ense Is in full
lorce end etloct. Lic. a Cless p
Contrector's Signeture: Date:
CONSTRUCTION LENDING AGENLY:
❑ I �ereby eflirm I�el lhere is e wnstruction lendinp egency lor Ihe peAormenco oi t�e work for which Ihis permit is issuetl. (Soc. 3097, Civil Cotle).
Lentlor'e Nemo: LBnCofs Address:
Slgnature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eMirtn Ihet untler penelry oi perjury t�at I am E%EMPT FROM THE CONTFiACTORS LICENSE LAW for Ihe lollowing rea5on (Sec. 7031.5, Business and Prafessions
Cotle: Any ciry or counry which requires a pertnit ro construct, al�er, improve, tlemolish, or repair any swcture, prior to its issuance, elso requires t�e applicant lor such pefmit
to Ille e signetl statement Ihet he or she is licensed pursuant to t�e provisians at t�e Contrectors License Law (C�epter 9(commencinp with Sectlon 7000) oi Division 3 01 Ne
Business end Professions Code) or that he or she is ezempt theretrom and the basis lor Ihe allegetl exemption. Any violelion at Sectlon 7037.5 by eny epplicant for e pertnit
suD�ects the eppliceN to a civil penelry oi not more t�an �ive hundratl dollars (5500).):
❑ I, as owner ol the properry, or my employees with wages es thelr sde compensetion, WILL DO 7ME WORK, end the strucwre Is not imentled or oMeretl far sale (Sec.
7044, Business and Professions Cotle: The Coniractors Ucense Lew does not eppty to an owner of property who builds or improves Ihereon, an0 who does such work
himsetl or herself or Ihrough his or her own employees, provided that such Improvemenis ere nat intendea or oHered lor sale. II, howaver, the DuilCing or Improvement is
sold within one year of completion, t�e ner-builder will have Ihe burden al proving that he or she did not builtl or improve tor purpase ol sale.).
�/� I, es owner of �he property, em EXCL IVELY CONTRACTING WITH LICENSED CONTRACTORS to consirucl the pro�ect (Sec. 7044, Busineu end Professions
,Cotle: The ntractars Licanse apply t0 en owner ot pmpetly who bulltls or Improves theraan, end who canirecis tor such pro�ett wlih e conirador(5)
_��• licen an� t ors cense Lews.).
untler sec. Busineu end Pmtessions Code for this reason:
oaie: — 9 — ��'z
by tl� s lice e. ❑ No nvers Li sa No. E ires. �
ip by (rype of docum�i.e. - property 1en bill or tleatl):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION:
❑ I hereby certlty that no excavetion tive (5) or more teet in tlepi� Imo which e Oaroon is required lo Eescend, will be mede in connection wiih woM authodzed by Ihls
pertnit, end thet no building swcWre, scaHolding, talsawork, or tlemditlon or dismentling thereot will be more t�an Uirry-sia (38) teet hiph. (Chap. 3.2, Gry 2, Art 2, Sec.
341, Tltle B, Celitomla AtlmInlSUetive Cotle).
❑ As owner-builtler, I will not empioy enyone to tlo work whlch would roqulre a permit from the DiNsion at Intlustnal $afery, es notetl ebove, unless such person hes e
permit to tlo Such work irom �he divi5ion.
Signeture: Date:
DIvlSion Of InduSlriel Setety Permit Number:
CERTIFlCATE q OMPLIANCE AND AUfHORI TON OF EMRV: I cenity under penelty of perjury thal I have read this epplication antl slele lhat the iniortnatlon given is
correct. I egrpG t wmply with ell state laws an Gry ortlinances relaUng to Oulldinp construction, entl authodze representetives ot the City ot Caste Mesa to enter upon Na
ebove-desc 6e propeM �or inspection pury � s. I gree no� to occupy or allow accupancy ol any builtling euihorized by this pertnit until linal inspection.
6-- — O
u I galOwn � �e
cooex INSPEC110NTYVE
1818 Flxed System Final Fire Prevention
1288 Pool Spe Finel
200 Final RB-Rool
201 FIneI BIocWRetelninp Well
202 Finel Factory Fira Place
203 Finel Sign
204 Final Demollllon
Date
Qdg �� $�,j INSPECTIONTYPE �a �y ��§
206 Finel Mechanical i2 jL
20B
210
212
220
Final Plumbing
Finel ElecUical
Flnal Fire Prevention
Final Planning Approvel
222 Final Siie
250 Final Bullding/Occupency
i..��..,�..�... ._..�...�._. .___ ....__'_'""_._.___.__..__
Job Address: 2190 PLACENTIA AV
Suite No D
Vicinity:
Parcel Nunmber: 42241230
Applicant: SAHAGUN, JOAQUIN
Address: 3165 HARBOR BLVD iiD .,
COSTA MESA, CA
Owner: SAHAGUN, JOAQUIN
Address 3165 HARBOR BLVD #D
COSTA,MESA, CA'
Contractor: OW NE R-BU ILDER
Address:
Arch / Eng :
Address:
ISSUE FEE
Backflow irrigation
Backflow Preventer .
BaNtub
Clarifier Syslem
Connect pce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roo1
PLUMBING PERMIT
Status: ISSUED
Applied: 10/09/2002
Issued: 10/09/2002
�a
ISSUED BY ,�
Phone: 714-5455759
Zip: 92626-2503
Phone:
Zip: 926262503
' Phone:
, ZIP
License: 000000
� . _ Phone: �
Zip:
�
• �� License: � �
SCOPE OF PERMIT �
REF 801-00516.
2 COMBO TUB/SHOWER, 1 BACKFLOW PREVENTER, 1DISHWASHER, t GAS 1-0 OUTLETS, 1 OVER 4
OUTLETS, 1 GAS SERVICE, 1 LAUNDRY, 1 SEWER CONNECTION�, 1 KITCHEN SINK, 3 WASHBASINS,
3�TOILETS, 1 WATER HEATER, 1 WATER METER. 1 GARBAGE DISPOSAL.
AMT�, QTY � �
$23.50 ` "� � 'Laundry Tub / Washer
$0.00 � 1 � ; ,. . Landscape Inigatlon
- $9.80 , -. 0� ��' � „ P-Trap
519.60 2 � ; Pressure Regulator
80.00� � 0% �-.Process Piping (per 10 ft)
' $0.00 � 0, � Receptors �
$0.00, '0, � ' � Septic Tank
$9.80 _�, t � - - , Sewer Cap for Demo ,
$0.00 , 0 ' Sewer Connect
$0.00 0 . Sewer Privata"Line
$0.00 0 Shower �� �
— �
AMT QTY
$9:80 1
$0.00 0
$0.00 0
ao.00 0
$0.00 0 .
30.00 � 0
$0.00 0 -
$0.00 �0
$24.65 1
$0.00 0
$0.00 0
SumpPump
Swimming�Pool
Trap Primer
Urinal
-Vacuum Brkr Bkflow(1d)
Vacuum Brkr BkFlow(5+)
Wash Basin �
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements unde�
regulations. (Ord. No. 9248, § 7, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if
for a period of 180 days.
INSPECTIONS: In order for the work au�horized under ihis permit to be considered legal, such work mus� corrl �y w
required Inspeetlona and final epproval must be obtained. Failure to obtain inspections and final approval will� ult in
/
FOR INSPECTIONS CALL: (714) 7545626 i✓
24a6-a8 (fy00)
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$9.80
$19.60
$29.40
$12.30
Qn
0
0
0
0
0
0
0
1
2
3
1
statutes and related
suspended orabandoned
ith all applicable codes, and all
the ezpiretion of this permit.
WOFJSERS'•G3MPENSA710N OECLARATION: ' '
I here�y aflirm untler penalry ol perJury one of the following tledareiions:
❑ I have enA will maintain e cerGlicaie ol consent to self-Irisure lor workere' compensation, as provided tor by sectian 3700 0l Ihe 1�6nj Code, lar the pertortnence at Ne
work lo� which this permit Is issued. '- + �;
�
❑ I have antl wlll malnWln warkers' compensatlon Insurence, es requireA by sectlon 3700 of Ihe Lebor COEe, for Ne peAortnance ol Ihe wark for whlM tWs p¢milt Ls issued,
My workers' compensatlon insurence cerrier enC polity number are:
Cartier: POlity Number:
(iTis sectlon need not be camp/eled I7 the perm/f 75 valued at one hundred dollare ($700) w less.)
❑ I cenily that In Ihe pertortnance oi the work tor whlch this permit is Issued, I shall not employ eny person In eny manner so es to bocome subject lo Iha workers'
compensation laws oi Celifomla, antl epree thet if I shoulC becoma sub�ect to tha workers' campensetlon provlsions ol Sectlon 3700 0l the Lflbor Cotle, I shall torNwiN
comply with thesa provisions.
Applicant Signeture: Date:
WMNINO: FNLURE TO SEWRE WOiV(ERS' COMPENSATION COVERAGE I$ UNUW FUl rW D SHAl15lIB1ECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO IXJE HUNDRED
T110USAND DOILARE (5100,000). W AODRION TO THE COST OF COMPENSATION, DAMAGES AS Pf�.T�IDED FOR IN SECiION 31O80F THE LI�BOR OODE, INTEREST, AND ATTORNEVS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirtn that I am licensed under provisions at Chapter 9(commencing with Section 7000) of DlWslon 3 of the Buslness antl Prolesslons Code, and my license is in full
torce end eflecL Lic. p Class #
Contrectors Signature: Dete:
CONSTRUCTION LENDING AGENCV: '
❑ I hereby eMirtn that ihere is a consiructlon lentlinp agonty lor the pedarmance of the work tor which this pertnit is issued. (Sec. 3097, Civil Code).
Lendefs Neme: Lentlets Address:
SignaWre: Date:
OWNER•BUILDER DECLARATONS:
I hereby attirtn thet untler penalry ot per�ury ihat I am EXEMPT FROM TME CON7RACTORS LICENSE LAW br ihe tdlowing reason (SocJ031.5, Buslness and Prafessions
Cada: My ciry or counry which requires e permit to consiruct, atler, impmve, demolis�, or repair eny structure, prior to Its issuence, elso reqWres the epplican� br such permit
to file a slgned statemem that he or she is Ilcensetl pursuant to the provisions ot the Contrectors License Lew (Chepier e(commenGng with Sectlon 7000) of Divisbn 3 oi Ne
Business end Professlons Cada) or thet he or She Is exempl Iherefrom end Ihe 6esis for Ihe alleged exemption. Any vidatlon ol Sectlon 7031.5 by eny applicant for a pemtit
subjecu the epplicent to e Wil penalty ol not more than Iive hundred tlollers (5500).):
❑ I, es owner ol ihe property, or my employees wlth wages as thelr sole compensation, WILL DO THE WORK, entl the sUucture is not Imentletl or oflered for sale (Sec.
7044, Business antl Professions Cotla: The Coniractors License Lew tloes not appy to an owner of property w�o 6uilds or imprwes Ihereon, anO who does such work
himsetl or herself or Ihrough �is or her own e ployees, providetl Ihat such improvemenis are not imended ar otteretl lor sale. II, however, the building or improvement Is
edd within one year ol completion, the own -builtlar will heve Ihe burden oi proving Ihat he or she did not build or improve tor purpase ol sale.).
�1, e�s owner of Ihe property, em EXGLUSI ELV CONTRACTING WITH LICENSED CONTRACTORS to conSWct the prqect (Sec. 7044, Business aiW Professions
Gode: The [rector5 LICenSe Lew C nol eOPN �o an owner ol property w�a builEs or Improv85lhereon, entl who wntrect9 br such project wtl� e contrector(s)
license pur nt to the Coniractors se Lews.�.
�❑ am eze p under sec. Business and Prolessians Cotle tor t�is reeson:
Date: "' � '- �
Owner ID v ri' by drivef cs . G e ❑ No Drivef� o. �- Z�"a�
Vedficatio Ownere ' (type o1 d en ,.e. - property tac EIII or Ceetl): ��
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certity thet no eacavetion live (5) or more feet in depth into which e porson is required to descend, will be metle In connec�lan with work euthorizad by this
permit, entl that no Dulltlinp siruclure, scettolding, lalsework, or demolition or dismaniling t�ereol, will be more then thirry-siz (38) foet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, Callfomia Atlminlstretive Cotle).
❑ As owner-bullder, I wlll not employ anyona to tlo work w�lch woultl mpWre n Oermlt Irom the Divislon of Intlustdel Sefery, as nototl ebove, unless such person �es e
permit to tlo such wark Irom the tlivislon.
slgoawre:
Division oi lntlusirial Safery Permit Number:
Date:
AflDOUS MATERIALS AND EMISSIONS CERTIFICATION:
Will the applicant or preseN ar tuture building occupem naetl to file entl certity a Business Plan for amergenry response to releese or IhreateneC releasa ol a hazerdaus
materiel? ❑ Ves ❑ No
(Section 25505 0l Ne Celilomia Heel�h antl Selery Cotle requiro5, wilh 5ome exceptions, that B BuSinesS Plan be liletl with the Cosle Mese Fira Depertment by Bvery
Dusiness which has at eny one tima tluring e repanetl yeer e quentlty ol ha:ardous materials equal to or greater than e weipht ol 500 pounds, or e volume of 55 gallons,
ooes or win tne appucam or present or iuwre ouuoing occu0em neea to nie a reqatrauon rwm ror acuteiy nazemous metenais't U V09 {.J No
(Section 25533 0l the Calllomla Healih entl Salety Code, wlth some e:ceptions, requlres registratlon wil� the CoSW Mese Fire Depariment by each 6usiness which at any
one lime hes on hand e quantity of ecutely hazerdous meteriflL9 equal to or 9reater ihan e weight of 500 pountls, or e vWume al 55 gallons, or 200 cubic feet ot
Compressed gas al stendard tempereture and preuure).
................._........................................."""'"_'"_".........................................._....__._.........................._..._............................................................__......._...._.._.......................__'._........._..._...._._
Does or will the applicani or present or future 6uiltling accupent need to prepare en RMPP (Risk Menagement entl Prevenuon Program for ecutely hazar0ous matenals)?
I of the Califamia Heslih
en RMPP by businesses
Fire Department mey require the preperefion, cenilication end tiling with the Fire
materlals with the Fire Depertment.
If en RMPP is presently requireQ has Section 25534 at the Celibmla Hoalih antl Setety Cotle been tully complie
_""�...... . —._....._...__..___..- ........................._.. .....................__...__"_'—_.._.......................
Daes or wlll�the�applicam or present or luture bullding occupaN require tor Ihe work w�lch is t�e su6�ect ol I�Is
Irom Ihe South CoeSt Air Ouelity Menagomont Dlslrict or trom eny o�her air pollulion conirol dislricl or egencyl
(Seclion 658502 ot Ihe Celilornia Govemment Code requlres that Ihe requested inlormetion be furNshed on ep�
.............__................__.._..._.._......._. . ... ....................___..._..__......................._................__..__.....__...............................
Will any part af the tacility to be conswcted under this pertnil be within 1000 teet Irom the outer baundedes ol e
a
the faUliN must meet t�e
have all of Ihe di5Cl0.sure9
Sections 25534 entl 42303 ot t�e Califomia Healih antl
entl
LJ Yes L7 No
. ..__ ................__.............._.._.—....
on e permit lor such constructlon or
u No
lof non-rBSitlonllel bulldin0 oertnitsl.
or agency is reqwrea tOr me �
m matle7 ❑ Ves ❑ No
CERTIFICATE OF COMPLIANCE: I cerlity I�aI untler penelry ol perjury the informatlon given above is correct. I agree to comply with all state laws entl ciry orOinances
regarCing HazarCous Materials end Emissions.
Sipneture: q Date:
CfATFlCATE OF COMP CE AND AlliHOHVATO �OF Y: I certify under penalry ot perjury that I have read Nis epplication entl state t�at Ihe information given is
corteq. I agree to 5omp ith all slate laws end ci rdlnanc relating to building consWIXion, and euthonza represenUtives oi Ihe Ciry ol Coste Mesa lo enter upon Ihe
above-dascribed rope tor inspection purposes. ee not occupy or ellow oauDancy ol any building authorized by Ihis pertnit yuniil tinal inspection.
/��—�Z-
rrdtuta�Ot.lepal�0 `--'��
emm�. mnhnd>wf nnnliran� Dai9
COUE �, INSPECiqNTYPE
7616 Fixed System Final Fire PrevenNon
1268 Pool Spa Final
200 Finel Re-Root
201 Flnel BIocWRetaining Wall
202 Final Factory Fire Place
203
�
Finel Sign
Finel Demolltion
�ff It�
COOE 1 INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Finel Elecirical
212 FIneI Flre Prevention
220 Final Plenning Approval
222 Final Slle
250 Finel Building/Occupancy
Q�g II�LS
v i ►
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
2190 PLACENTIA AV
�D
42241230
Applicant: SAHAGUN, JOAQUIN
Address: 3165 HARBOR BLVD #D
COSTA MESA, CA
Owner: SAHAGUN, JOAQUIN
Address 3165 HARBOR BLVD #D
COSTA MESA, CA �
Con tra ctor: O W N E R-B U I L D E R
Address:
ISSUEFEE� �
Temp service test
Res. a/c package
�lew Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fix4 .
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a'
Service to 1000a
Service over t000a.
Motors to 1 hp � �
Motors to 10hp
Motors to 50hp
Mofors to t00hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Status: ISSUED
Applied: 10/09/2002
Issued: 10/09/2002
ISSUED BY: ��_
Phone: 714-545-5759
, Zip: 92626-2503
Phone:
Zip: 92626-2503
Phone:
' ZiP: .
License: 000000
SCOPE OF PERMIT
REF 801•00517. 1540SF SFD. IN THE GARAGE 1 OUTLET. 1 SWITCH AND 1 LIGHT.
Quanlity
$23.50
$0.00
ao.00
$86.24 1540 �
$0.00 0
$0.00 0
$1.10 1
$1.10 1
$1.10 1
$0.00 0
� $0.00 0
50.00 0 ,
$0.00 � 0
, . 30.00 � , ��. o � . .
, $0.00 ,�:0•; , .,
� so.00 ��. �o- �
. ' $0.00 ' ,� 0 �-' -
so.00 0
� $0.00 - � 0� --� �
$0.00 � � 0 , ,
$0.00� - - 0 '
$0.00 . 0
$0.00 a .
�
' FEE SUMMARY '
Temp Dist System / Lighting
Busway /100 ft � � �
Standing Saction
Misc Electncal Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit � .
Misa Conductor '
Circus ( gen or ride) �
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand- .
ONer ElecVical Fee
Investigatlon Fee �.
Plan Check Fee ,
Reinspection Fee -
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
ao.00 0
$0.00 0
$o.00 0
$0.00
$0.00
$0.00
$0.00
0
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under �lif-ia statutes and related
regulations. (Ord. No. 9248, § 1, 7241-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or i( wor Is suspended or abandoned
tor a period of 180 days. /�j
INSPEC710NS: In order tor ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeetiona and flnal epproval must be obtained. Failure to obtain inspections and tinal approval w��ult in the expiration oi this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaas-ae �amo�
n
�
WORKERS'COMPENSArONDECLARAnON: '
I hereDy eHirm under penalry of perjury ona oi ihe followin9 tleclarations:
❑ I heve entl wlll maintaln e cenificate of wnsent to self-Insure br workers' compensation, es pmvided for by sectlon 3700 0l the Lebor Cotle, lor the peAartnance ot Ne
work tor wMch ihl5 permit i5 issued.
r �
❑ 1 have entl wlll mSntain warlcers' compensation insurance, as required by section 3700 ol Ihe Labor Cotle, for Ihe peAortnence of Ihe work tor whkh Ihb pemut Ls LS.wetl.
My workere' wmpensation Insurance wrrier and pdicy numbar ere:
Cerrlor. Policy Num6er:
(TAis sectlon need no( �e competed tl(he perml( is valued et one huntlretl tlollars (S100J or /euJ
❑ I certity thet in Ihe OeAormance oi Ihe work tor which this pertnit is issued, 1 shall not employ eny person in any menner so as to become sub�ect to Ihe workers'
compensetlon laws ol Calilomla, entl agrea Nat If I s�ould bacome suh�ect to the workers' compensatlon provislons oi Section 3700 ot the LeDor Cotle, I sha�l torthwlt�
Comply wit� the5e proWslonS.
Applicant Signeture: Dete:
WARNINO: FAILURE TO SECURE WOPI(ERS' COMPENSATIIXJ COVEMGE IS UNLFwFUL AND SHALL SUBJECT MI EMP�OVER TO CRIMIwLL PEN�LTES M1D GVI� FlNES UP TO ONE HUNDRED
TIqUSrWD OOLURE (E100.000�.IN ADDRION TO THE WST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31080F THE LABOR COUE, IMEPEST, ANO ATTORNEYS PEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm lhet I em Iicensed under praNsions of Chepter 9(commencing with Section 7000) ol DlNsion 3 0l the Business antl Pro'essions Coda, end my license L5 in full
lorce entl ettect. Uc. q Class a
ConlrectoYs Signeture: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eMirm Ihet thera Is e constructlon lending agenty tor Ihe pertortnanca ot the work lor which ihis pertnit Is issued. (Sec. 3097, Civll Cotle).
Lentlels Name: Lendefs Atldress:
5lgnature: Dete:
OWNER-BUILDER DECLARATIONS:
I hereby eillrm Ihet under Denelty ot per�ury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business antl Professians
Cotle: Any city or wunty which requires a permit to construct, elter, improve, tlemolish, or repair any simcture, prior to its Issuance, elso requires Ihe eppliwnt tor such pertnit
to tile e signad slatement thet he or sha is Iicensetl pursuant to tha provisions ot the Contrectors License Lew (CheO�er B(wmmenGng wlth Sectlon 7000) ol DivLsion 3 oi the
Business end Prolessions Cotle) or lhat �e or s�e is ezempt Iheretrom and the basis for Ihe elleged axemption. Any violetlon of Soction 7031.5 Dy eny epplicent for e pertnit
sublecis Ihe applicant to e civil penalry ot not more than tive hundred dollars ($500).):
❑ I, es owner oi Ihe property, or my employees with waqes as ihelr sole compensetlon, WILI DO THE WORK, end the structure is not Intentletl or oMered for sele (Sec.
7044, Business and Professions Code: Tlie Contractors License Law tloes not apply Io an owner of property who builds or improves Ihereon, entl who does such work
himself or her5eit or through his or har own employees, provided that such improvemenis ere not intended ar oHered for sale. II, however, iha building ar improvement is
/ soltl wi��in one year ol comple�ion, the owner6uilder will have the hurden of proving that he or she did not buiid or impmve lor purpose oi sale.).
;S I, es awner af e praperty, em E%CLUSIVEL CONTRALTING WITM LICENSED CONTRACTORS to Construct the proJect (Sec. 7044, Bu51ne55 end Protessions
� Code: ThB C aCtors LitenSe Lew does no � O�Y �o en owner ot pmperty who builtls or impmves thereon, entl who contract5 br 5uch prolecl wllh e wntrector(5)
i�pu u nt to the Comractors Licens •awsJ.
�m ex under sec. Business and Professions Cotle for �his reeson:
i re: Dat � � �C `7.—
Owner ID ' iad by ddver' li se. es ❑ N efs Lic se No. ��% Eapir :�x�
Vatlllcat at Ownership (type of tlocument, i.e. - pro rty terz bill or tleetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFILA710N:
❑ I �ereby ceNty that no ezcavation five (5) or more feet in depth into which e person is requireA to descentl, wlll be mede in connection wit� work euthorizeE by t�ls
permit, antl that no Wilding siruciure, scaHolding, falsework, or demolition or tlismamling ihereot, will be more t�en ihirry-six (38) leet high. (Chep. 32, Gry 2, A� 2, Sec.
341, Tltla B, Calilomia Atlminfstrative Code).
❑ As owner-bulltler, i will not empby enyone to do work w�kh woultl require e parmit trom the Division ol IntlusMel Selery, es noted above, unless suU person hes e
pertnit to tlo sucA work Irom t�e tlivision.
Signature: Dale:
Divislan oi Intlustrlal Satery Permll Number:
CODE �. INSFECTONTYPE
1616 Fi:etl System Final Fire Prevemlon
1286 Pool Spa Final
200 Final Re-Roof
201 Finel BIocWRetaining Well
202 Final Fectory Fire Place
203 Final Sign
204 Final DomWlibn
Q�i �
COUE I INSPECTION TYPE
208 Final Mechanical
208 Final Plumbing
210 Final EleCtriCal
212 Final Fire Prevention
220 Final Plenning Approval
222 Final Site
250 Final BuiltlingiOccupency
PAffi II�EL6
7R� �I'��