The URL can be used to link to this page

Home My WebLink About2132 UNION ST - Building Permits 1, 1 4LwD CITY OF COSTA MESA elf ` BUILDING DIVISION F i "" `1 DEVELOPMENT SERVICES DEPARTMENT PEITNUMBER I 4 f jj PERMIT p07_00161 . m. (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa RLJJMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2132 UNION AV Status: ISSUED Suite No Applied: 03/15/2007 • Issued: 03/15/2007 Vicinity: ATTIC Parcel Nunmber: 42244104 Applicant: SULLIVAN,LAWRENCE W Address: 2132 UNION AVEISSUED BY: Phone: 617-320-8383 COSTA MESA,CA ' - Zip: 92627 Owner: SULLIVAN,LAWRENCE W Address .2132 UNION AVE - . Phone: 617-320-8383 - COSTA MESA,CA - •- Zip: 92627 Contractor: OWNER-BUILDER Address: , Phone: Zip: License: 000000 • SCOPE OF PERMIT PLUMBING PERMIT FOR NEW ELECTRICAL THROUGH OUT HOUSE. WORK TO INCLUDE: 1 BATHTUB,1 GAS(1-4 OUTLETS), 1 GAS REPIPE, 1 KITCHEN SINK,1 WASH BASIN, 1 WATER CLOSET, 1 WATER HEATER AND 1 WATER REPIPE. FEE SUMMARY AMT QTY AMT 'QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 -0 Sump Pump $0.00 .0 Backflow irrigation $0.00 0 Landscape Irrigation , $0.00 0 .. Swimming Pool $0.00 0 Backflow Preventer $0.00 0 --P-Trap - - - $0.00 0- Trap Primer $0.00 0 Bathtub $9.80 1 - Pressure Regulator- $0.00 0 " Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors , $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank . $0.00 0 Wash Basin $9.80 1 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 • Drain,Floor $0.00 0 , Sewer Connect . • , .. . $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private'Lirie , $0.00 0 Water Closet(Toilet) " $9.80 1 Drain,Roof $0.00 0 Shower. $0.00.. 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 , Water Piping(Inst or Rep.) $9.80 1 Expansion Tank $0.00 0 Sink,commercial $0.00 0 - • Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor "$0.00 0 Water Service - $0.00 0 Gas(1-4 outlets) ' $6.15 1 , Sink,kitchen $9.80 1 - Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 " '' OTHER $0.00 Gas Repipe $9.80 1- . - Spa-(private) $0.00 0 " -VIOLATION $0.00 Gas Service $0.00 0" Spa(public) $0.00 0 - . ' PLAN CHECK $0.00 Interceptors(Grease,Oil). $0.00 . 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 i TOTAL CALCULATED FEES: $100.75 COMMENTS/SPECIAL CONDITIONS " • • 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 wlds suspended nded 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 2446-46(6/C0) t 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'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'compensation Insurance carrier and policy number are: Carrier: Polity Number: (Thissectionneed not be completed if the permit is valued at one hundred dollars($100)or less.) -(VI-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,and a ee that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the p visions. 'applicant Signator e: 7R.4.. — . /.L V1� Date: 3 — I r—c WARNING:FAILURE SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOL ARE($110,000),IN ADDITION TO THE(TAT OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F 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 Business and Professions Code,and my license Is in full force and effect.Lie.# Class N 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: 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 fora 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.). ' (5...t7 I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions 11Code: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 Contracto License s.). ❑ I am e under sec. Business and Professions Code for this reason: Signature 1.Ln.— i� Expires:7—_3 I _I I 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 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: I 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? 0 Yes 0 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? 0 Yes 0 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 acutelyhazardous 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 en 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? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? EU Yes L1 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? 0 Yes 0 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? 0 Yes 0 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 corr ct. I agree to comply with all s laws d city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the abo a-des bed property for inspe n u es.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signator Of Legal Owners Late_ And/Or Authorized Applicant Date CODE 0 INSPECTIONTYPE DATE En/1U CODE I INSPECTION TYPE DAIS DIIImsLE 1616 Fixed System Final Fire Prevention 206 Final Mechanical n/ /// 1266 Pool Spa Final 208 Final Plumbing T" - - _V' /Mb)/ /317-77r 200 Final Re-Roof 210 Final Electrical / 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 'S 9 CITY OF COSTA MESA 4 BUILDING DIVISION - F �I $ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 0 PERMIT M07-00146 44%,0.arm 6' (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2132 UNION AV Status: ISSUED Suite No Applied: 03/15/2007 Issued: 03/15/2007 Vicinity: ATTIC Parcel Number: 42244104 Applicant SULLIVAN,LAWRENCE W ISSUED BY: Address: 2132 UNION AVE , Phone: 617-320-8383 COSTA MESA,CA Zip: 92627 , Owner: SULLIVAN,LAWRENCE W , Address: 2132 UNION AVE - - - - Phone: 617-320-8383 "COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: , , , Phone: Zip: , License:000000 ' , • , SCOPE OF PERMIT MECHANICAL PERMIT FOR NEW ELECTRICAL THROUGH OUT HOUSE: , WORK TO INCLUDE: 1 INST FAU<100 K BTU PROVIDE: _ 22"X30"ATTIC ACCESS WITHIN'20'-0"OF.UNIT ' • CONTINUOUS SOLID WALKWAY AT LEAST 24"WIDE- - - - LIGHT OVER UNIT W/SWITCH AT ACCESS F_EESUMMARY _Quantity - = Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 . 0 , Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 - . -Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping . $0.00 0 Up to 3 hp/100 k BTU • $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box N $0.00 0 ''30 To 50 hp/1,750 k BTU. - $0.00 0 Vent Fan/Single Duct . - - $0.00 `0 , - . Over 50 hp/Over 1,750 BTU 10.00 0 Appliance $0.00 0 Boilers - _ Fire Dampers / $0.00 0 Up to 3 hp . '$0.00 0 Smoke Dampers - $0.00 0 - 3 To 15 hp . $0.00 0 Inst or Relocate Appl Vent . - $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm ' - $0.00" 0 30 to 50 hp $0.00 0 Air Handlers> 10000dm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 ' 0 Investigation Fee $0.00 Plan Check Fee $0.00 ' Reinspection Fee $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.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 244646(6/00) 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'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'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This—/section need not be completed if the permit is valued at one hundred dollars($100)or less.) C _2"i certify that in the performance of the work f. hich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation la s of C:ifomia,and agree - If I • Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the-: prow.Ions. 2 -Applicant Signature: , -4_ . 4 / _ 'WARNING:FAILURE T- CURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND VIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100000),IN ADDITION TO THE COST 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 Business and Professions Code,and my license Is In full force and effect.Uc.8 Class* 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 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.). ' kas 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 t0 an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors A. ansa -ws.). ❑ I am ex:mpt der sec. / Business and Professions Code for this reason: "Signature: i.i 1 - - 7fl! ('-- L.—Expires:) — 3)-// 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 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). O As owner-builder, I will not employ anyone to d0 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 0 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 t0 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? 0 Yes 0 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 Flre Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application agpermit for such construction or modification from the South Coast Alr Quality Management District or from any other air pollution control district or agency? Yes Al 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? ❑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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 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 a ee to comply with tate law nd city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the ab ve-d ribed property for in ctio oses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owners) ate__ And/Or Authorized Applicant Date CODE* INSPECTION TYPE OATS iiimts CODE. INSPECTION TYPE e r 1616 Fixed System Final Fire Prevention 206 Final Mechanical — g. 7.I.r_- 1266 Pool Spa Final 208 Final Plumbing �o 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy . . 1 • o • 9 CITY OF COSTA MESA 4 BUILDING DIVISION . •f,.„,! , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. arlC!a� PERMIT 1407-00216 4Itl(714)754V 52733•• Fax(714)754-4856 • www.cl.costa-mesaELECTRICAL PERMIT 77 FAIR DRIVE,COSTA_ MESA,CA 92626 Job Address: 2132 UNION AV Status: ISSUED Suite No Applied: 03/15/2007 Vicinity: THROUGH OUT HOUSE Issued: 03/15/2007 Parcel Nunmber: 42244104 Applicant: SULLIVAN,LAWRENCE W Address: 2132 UNION AVE Phone: 617-320-8383 ISSUED BY: COSTA MESA,CA • Zip 92627 Owner: SULLIVAN,LAWRENCE W Address 2132 UNION AVE • Phone: 617-320-8383 COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER , Address: i :\ Phone: Zip: License:000000 , - SCOPE OF PERMIT ELECTRICAL PERMIT FOR NEW ELECTRICAL THROUGH OUT HOUSE. WORK TO INCLUDE:12 LIGHT FIXTS,36 OUTLETS AND 12 SWITCHES AND UPGRADE AND RELOCATE SERVICE PANEL TO 200A. FEE SUMMARY• i" Quantity - Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft - $0.00 0 Res.a/c package $0.00 - : Standing Section $0.00 0 New Res(1-2 units) $0.00 0 - " Misc Electrical Equipment $0.00 0 . New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 ' • Lighting Fixts $13.20 12 ' up to 50 kva/kw - $0.00 0 Recept Outlets $33.68 36 up to 100 kva/kw $0.00 0 Switches $13.20 12 over 100 kva/kw $0.00 0 Non Res Appl - $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 " 0 Service to 200a $30.50 1 Misc.Conduit : _ $0.00 0 Service to 1000a $0.00 0 , Misc.Conductor. . $0.00" 0 Service over 1000a $0.00 0 Circus(gen or ride)' $0.00 0 Motors to 1 hp .$0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 . ,0 Christmas Tree Stand $0.00 / 0 , Motors to 50hp _ $0.00 -0`, Fireworks Stand - - $0.00 7 0 Motors to 100hp $0.00 - 0 - \ Other Electrical Fee - " $0.00 ' 7 Motors over 100hp $0.00 - 0 - Communication drops $0.00 0 Investigation Fee - $0.00 Sub panel to 200a -$0.00 ' . 0 . Plan Check Fee $0.00. Pole Light Pkg $0.00 0 'Reinspection Fee $0.00 • Sign Circuits $0.00 0 Temp Pwr Pole $0.00 , 0 .\ TOTAL CALCULATED FEES" $114.08 Intermed Pole $0.00 0 COMMENTS I SPECIAL CONDITIONS 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. 6" 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 2446-46(6/00) • DECLARATIONS' ''r 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'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is ked ted. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) —I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of Califomla,and agre at if hould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these row ns. -Applicant Signature: [Date_ IS-t. O 7 WARNING:FAILURE TO CURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLT ARE 1510,000),IN ADDmON TO THE COST 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 Business and Professions Code,and my license is in full force and effect.Lic.N Class N Contractors 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: 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 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.). ' CJI as owner of the properly,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 Contractor Livens: 'ws.). ❑ I am e : nder sec. a/ Business and Professions Code for this reason: I 'Signature: Ilii.- �•�� I-Expires: f 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 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,An 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? 0 Yes 0 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? 0 Yes 0 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. 2 34 of . a iorna Health n.. a.. 4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? O Yes LJ No (Section 65850.2 of the California Qovemment 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? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 prescnbed 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; ORIZATION 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 st :ws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-d- crib•roperty for inspect• 11 :.s:..I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. , 07 L3na re Of Legal-Owner(s) Date AndlOr Authorized Applicant Date Boca# INSPECTION TYPE PAff. If1TmALS CODE r INSPECTION TYPE PATE MAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ./ -�7 200 Final Re-Roof 210 Final Electrical 9-10-67 201 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 _ �` A CITY OF COSTA MESA BUILDING DIVISION F • -, DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER !; f PERMIT 07-00254 t Ettitteltt (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa...o.,sGPCRMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2132 UNION AV Status: ISSUED Suite: Applied: 03/05/2007 Vicinity: HOUSE AND GARAGE ROOF Issued: 03/05/2007 Primary Occ: R3U1 Type of Construction: V-N Parcel Number: 42244104 Zoning: Applicant: SULLIVAN,LAWRENCE W Address: 2132 UNION AVE Phone: 617-320-8383 COSTA MESA,CA Zip: 92627 ISSUEt? Owner: SULLIVAN,LAWRENCE W Address 2132 UNION AVE - - Phone: 617-320-8383 • COSTA MESA,CA Zip: 92627 Contractor: .OWNER-BUILDER Address:. Phone: Zip: License: 000000 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF(E)ROOF MATERIALS,INSTALL A MINIMUM OF 2 LAYERS OF 15#FELT ON A ROOF PITCH OF 2:12 TO LESS THAN 4:12 OR A MINIMU LAYER OF 15#FELT ON A ROOF PITCH OF 4:12 OR GREATER,REROOF W/30 YEAR COMP SHINGLES ON AN ATTACHED HOUSE AND GARAGE 1200 SF.REPAIR AND REPLACE SHEATHING AS NEEDED. FEE SUMMARY. . Plan Check: $0.00 Calc Valuation: 53,000.00 Permit: $83.25 - Claim Valuation: 53,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 . Total: $83.75 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 Existing: 0 1 Required: 0 Proposed: 0 . 1 • 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 fora 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 2448.48(8/00) DECLARATIONS _ WORKERS'COMPENSATION DECLARATION: • A 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. 1 ❑- I hew d will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,f rthe performance of the work for which this permit is issued. f ork compensation Insurance carder and policy number are: - C. ' • li um r: h •cr'need n•t be completed if the permit is valued at one hundred dollars($100)or less.) -yl 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,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. tiSPlr icant Signature: `Date:-- WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT Mi EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(SI C0,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CO -ACTORS DECLARATION: //// I hereby affirm at I a --•d under provisionlbt C �J'9(commencing with Section 7000)of Division 3 of.the.Business a•• Professions Code,and my license is In full (loroe •••effe L Lt.)/Lt. .- / (Class/if -Contractor. . re: Dote: v r e/ CONSTR CTION LENDING AGENCY: ❑ I h' eby affirm that there is a construction lending agency for the performance of the work for ' ch this permit is issued.(Sec.3097,Civil Code). Lender' Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 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 DMsion 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 properly 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 'cense Laws.). ❑ I amxexe pt under sec. Business and Professions Code for this reason: Signatlireselna,r.. (.t/ f ate:J 3 — —0 7 Owner ID verified by driver's license. as 0 No Drivers license No. Expires:,7-3/ 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 feel 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,Califomla 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 divisi• . Signature:, , e . . ` Date: 5'— f- 07 Division of Industrial Safely 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? 0 Yes 0 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? 0 Yes 0 No (Section 25533 of the Califomla 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). .__ _._. _ need to mat. _.. 3 Does or will the applicant or present or future building occupant neetl to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materfals)7 ❑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 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this implication akermit for such construction or modificatnio from the South Coast Air Quality Management District or from any other air pollution control district or agency? jYes LJ No (Section 65850.2 of the California Govemment 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? 0 Yes 0 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 Oualiry 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? 0 Yes 0 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 AN to• ORIZATION 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 s iTr law :id city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the a ve- nbed property for ins•:• •n pu •• occupyI a roe not to or allow occupancy of any building authorized by this permit until final inspection. yv� 3— 7 re/ , 5-� Slgnattire Of Legal Owners} -- C..Date - And/Or Authorized Applicant Date ;ODEA INSPECTION TYPE PAIS ltd CODE A. INSPECTION TYPE PAIL INCL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final r.� 208 Final Plumbing 200 Final Re•Roof -477 CPC' Y 2W 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 CITY OF COSTA MESA BUILDING DIVISION •qa DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 4 Pk. . PERMIT rF B04-01677 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2132 UNION AV Status: ISSUED Suite: Applied: 09/29/2004 Vicinity: Issued: 09/29/2004 Parcel Number: 42244104 Zoning: Applicant: PRADO,SOFIA ISSUED BY: Address: 915 LAKE ST Phone: (714)404-9846 HUNTINGTON BEACH,CA Zip: 92648 Owner: PEASE, LAWRENCE E Address 2132 UNION AVE Phone: COSTA MESA,CA Zip: 92627 Contractor: JK CONSTRUCTION Address: 915 LAKE ST Phone: (714)404-9846 HUNTINGTON BEACH,CA Zip: 92648 License: 450297 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REMOVE AND REPLACE ALL EXTERIOR WINDOWS. BEDROOM WINDOWS SHALL COMPLY WITH 1997 UBC SEC.310.4 FEE SUMMARY Plan Check: $0.00 Calc Valuation: $4,500.00 Permit: $111.25 Claim Valuation: $4,500.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $111.75 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 Existing: 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 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)154-5626 2446-46(6/00) Ezzamisliisismeliass 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'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My worker 'c/of�pensatiop,lnsurance carrier and policy number are: `l/ /;�? ' Carrier: {'ot b cam -t Policy Number. (/ y (O (This section ne d not be completed if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws ojj,,Califomla,and agree that If 1 should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith Signature:ply with hese pripp Applicant /'� �ARR fuVA�UA%1/ Date: y � �l —d(/ WARNING:FAILURE TO SEQ.(E WOR ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S1CO,000),IN ADDITION TO THE COST 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 licens d under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.# 0 1 Class 4 Contractor's Signature: All A� A-�l M,, A Date: y x —U11 � 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: 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(5500).): ❑ 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.). . O 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 exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 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 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 B,California Administrative Code). O 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 hes e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file end certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 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? 0 Yes 0 No (Section 25533 of the California Health end 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? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Ul Yes LU 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? ❑Yes 0 No (II 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 Duality 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? 0 Yes 0 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. 1/T� j I In t r !Legal Owner(s) (fes 7Dett_e�-/ „ }V/Cyl')I")_^ll ' And/Or Authorized Applicant ( Date� l.`J' ;ODE r INSPECTION TYPE PATE lfrTOULS CODE I INSPECTION TYPE PAM IIEALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place • 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - 250 Final Building/Occupancy ;,) ,'• CITY OF COSTA MESA• 041,11* BUILDING DIVISION • •E" , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 J fl PERMIT AO PO4-00658 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2132 UNION AV Status: ISSUED Suite No Applied: 09/29/2004 Issued: 09/29/2004 Vicinity: ISSUED BY: Parcel Nunmber: 42244104 Applicant: PRADO,SOFIA Address: 915 LAKE ST Phone: (714)404-9846 HUNTINGTON BEACH,CA Zip: 92648 Owner: PEASE, LAWRENCE E Address 2132 UNION AVE Phone: COSTA MESA,CA Zip: 92627 Contractor: JK CONSTRUCTION Address: 915 LAKE ST Phone: (714)404-9846 HUNTINGTON BEACH,CA Zip: 92648 License: 450297 Arch / Eng : - Address: Phone: Zip: License: SCOPE OF PERMIT REPLACE WATER HEATER. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0. Sump Pump $0.00 0 • Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 . 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00• • 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4). $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor '$0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Ins(or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0:00 0 Water Service $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)754-5626 2446-46(MO) • 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 sell-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. kI have an 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 s'co persatiof14trsurance" rrier and policy number are: WO n Carder. /t� Policy Number /�7S (This section need not be comp fed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with then p tri ns 1/ ,� J/1 / —d r / Applicant Signature: A LIKA/`-^-4'v" l t Date: q --.--0-7 S� WARNING:FAILURE TO CURE ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST 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 licen e. ...r pr.visl. f f Chapter 9(commencing with Section 7000)of Division 3 of the Businesend Professions Code,and my license is in full force and effect.Lic.k Class n l / O L� 7 Contractor's Signature: I,�ari�AIN 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: 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,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 exempt under sec. Business and Professions Code for this reason: Signature: _ Date: Owner ID verified by driver's license. ❑Yes 0 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: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding.falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, 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 materiel? 0 Yes 0 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? 0 Yes 0 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 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application eggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 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? 0 Yes 0 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? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certity 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. ci //nppatu a Oi ga4- vne0y—? lat7f�r A thr ized Applicant ( Date ;ODE 6 INSPECTION TYPE all IDLE CODES INSPECTION TYPE PAIL BMW 1616 Fixed System Final Fire Prevention 206 Final Mechanical �/� 1266 Pool Spa Final 208 Final Plumbing '..0f W .200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 . Final Fire Prevention 202 Final Factory Fire Place • 220 Final Planning Approval 203 Final Sign 222 Final Site . 204 Final Demolition • ' ' 250 Final Building/Occupancy - - OWNER . PEASE. LAWRENCE E. DATE 10-1J1-58 _ JOB ADDRESS 2132 Union Ave. BUILDING PERMIT NO. 7796 GENERAL CONTRACTOR Owner VALUES 70.00 AP.4Nlol 04 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Wood Fence GROUP TYPE ZONE PLAN NO. PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam _ Frame and Flashing Lathing, In Out • Plaster, brown coat Underground soil W/G Pipe Test Top Out • Furnace Gas Vents Rough Plumbing Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbing Fixtures, Final • Final Gas Test Construction Pole Underground Power Rough Wiring Fixtures, Final gyp'�1L "LAO. •OCCUPANCY ( 4— O. Form 210.-5M-1-57 ✓ 7t96 COSTA MESA BUILDING DEPARTMENT P. -i i O. BOX 317 (� iv ED I 9796 COSTA MESA CALIFORNIA iEE RE 1 1 1-0-1 -1. FOR APPLICANT TO FILL IN C.L. OF STREET----- Ill /•f2- �� m7 FlN NCE BUILDING %'RESS i _ __ __-.-PROP. LINE _ _ _ I Sk Owner. sr..,..s i S. ► �J�. 10 FT. FOR 60 FT. STREET{�R(� O FT. STEER t7` - 7 �1��y�N ,.' I ISD FT. STREET Mail Address I I City 772‘414t_ Ph. No. — I I I Contractrth.<72 t4_ -6.4+ Ph. No. e I Address I 50 FTI IF FRONT City Lic. No. State Lic. No. IOF PROP. F, ISO FT_ A w OX AP No. Site of Lott l0� S' %� —Q 1 w ZI t- Setbacks: C/L Street V'0' ' 7— Rear 'Lit U JI ¢ a Side Yard - Right • 1- Left - I- I---- w �, ---a. V Type.of Fe ce " /t� I/�L' ��C I�', x (1 I LL \ALLEY QR PROP. LINE �.�. rcI ci L ! �Lt� t!ati'/� -a , 0. al J m F Z 'i- .-� -t a p —'� I hereby acknowledge that I have read this ap?lication and -vie Ci ¢ / u� H r ` that the above is correct and agree to comply with all City •rd- arp C.L.. p, w u_ I inances and State •ws regulating building co -trr3ction. i U I— > < 0 a I-. I Signature a �' — Q zo C IO I I of Permitter �a/ L_ /� J c4U Z m I Agent a o Z o e a FT TI I I 37 6 IN._ a. ).. .63, !.:), I I FT. Fm Z I ao I FOR OFFICE USE ONLY U m a Z w g I FT 1 I Permit No. Im I i ce o I f I 60 FT ST. Received by Date Received Date Issued a I ,1 /o —, y— ;i T 6 _/ y-y=e IF50 F T. S T. I I PROP LINE �` VALUATION �� 1- - 1C---- ' -- -- - - L —� / Permit Fee $ — $ Plan Check $ C.L. OF STREETS J I ,�tj TOTAL-FEE $ i - �/ MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES —— — --- MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES USE REVERSE SIDE FOR DETAILS