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Home My WebLink About317 ROBIN HOOD LN - Building Permits T . • �• CITY OF COSTA MESA 4 t BUILDING DIVISION r DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER lnalihn IPPligh PERMIT B03-02130 st.(714)754-5273'* -4.-4 • Fax(714)754-4856 • www.ci,costa-mesa.ca us. ING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 317 ROBIN HOOD LN CUI Status: ISSUED Suite: Applied: 12/12/2003 Vicinity: FIRE DAMAGE AT FIREPLACE Issued: 12/12/2003 Parcel Number: 42622114 Zoning: I Applicant: DRAKE, MELODY ISSUED BY: Address: 300 ROBINHOOD LN Phone: 949-642-2239 COSTA MESA,CA Zip: 92627-2134 Owner DRAKE, JOHN ROBERT JR TR Address 300 ROBINHOOD LN Phone: COSTA MESA,CA Zip: 92627-2134 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REPAIR FIRE DAMAGE AT FIREPLACE.WORK TO INCLUDE MINOR FRAMING WITH ABANDONMENT OF THE FIREPLACE,CLOSE WALL AND DRYWALL;MINOR ELECTRICAL WIRING AT FIREPLACE. NO OTHER WORK AUTHORIZED WITH THIS PERMIT. FEE SUMMARY Plan Check: $0.00 Calc Valuation: 51,700.00 Permit: $60.10 Claim Valuation: 51,700.00 SMIP Res: $0.00 SMIP Corn: $0.00 Other: $0.00 - Inspection: $0.00 Total: $60.10 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 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(WOO) 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 Ihis.permit is Issued. ❑ I have and will main)ain 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'compeppation Insurance carrier and policy number are: Carrier: r Policy Number: .11s1(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 Calitomla,and agree that iffII should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with es9 ear ' ions re: N r r`I ` Applicant Signature:— r1 A Date: I a.- 1 - (3 3 WARNING:FAILURE TO SECURE WORKERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,0)0),IN ADDn10NT E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.LJc.0 Class 4 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: O 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(5500).): O 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.). • 231 I las 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.). O I am e , ••t. der s- . — ,a SrBu 3 ess and Professions Code for this reason: Signature: �i __ Expires: S-aa-09 Verification of Ownership by(type of d•4 ent,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation INe(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health end 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 ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4—If an RMPP is presently required,has Section 25534 of the California Health LinerSafety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit 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? ❑Yes 0 No (It yes,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Solely Code). __._ _.._..e .r....._....._....___uti __._.__...._ 7 If a permit from the South Coast res Qualitycri edManagement is al or other airtpollution tioncontrol district3or agency is required fothe work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No B (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 wit all state laws end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desc ... .rope• for i spec'on • goose agree A to occ 4 or allow occupancy of any building authorized by this permit until final inspection. 5 Signe • : .1 Legal Owner(s) Date 7 And/xr A thorized Applicant Date 000E I 1NSPFDTION TYPE PAM ltilm9A CODE( MOM= PATE 1IITIDELS 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 /2-02101.. � ��y �/� 204 Final Demolition 250 Final Building/Occupancy lvH v1- -"t--(" • .�9 CITY OF COSTA MESA t BUILDING DIVISION F•i .-�' DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER t � • PERMIT E03-01151 Rano (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 317 ROBIN HOOD LN Status: ISSUED Suite No Applied: 12/12/2003 Vicinity: FIRE DAMAGE AT FIREPLACE Issued: 12/12/2003 Parcel Nunmber: 42622114 I Applicant: DRAKE, MELODY ISSUED BY: Iir. Address: 300 ROBINHOOD LN Phone: 949-642-2239 COSTA MESA,CA Zip: 92627-2134 Owner: DRAKE, JOHN ROBERT JR TR Address 300 ROBINHOOD LN Phone: COSTA MESA,CA Zip: 92627-2134 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT REPAIR FIRE DAMAGE AT FIREPLACE.WORK TO INCLUDE MINOR FRAMING WITH ABANDONMENT OF THE FIREPLACE,CLOSE WALL AND DRYWALL;MINOR ELECTRICAL WIRING AT FIREPLACE. NO OTHER WORK AUTHORIZED WITH THIS PERMIT. 2 OUTLETS,2 SWITCHES • REF:B03-02130 FEE SUMMARY 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 Fists $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $2.20 2 up to 100 kva/kw $0.00 0 Switches $2.20 2 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 $0.00 0 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 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $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 it 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(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.) yI'comity 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 •ecome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with a tigvisio s. `i 1 l Applicant Signature: a Date: I - 03 WARNING:FAILURE TO SECURE WORKERS'i PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT Ni EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION(rQ 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 lull force and effect.Lic.k Class# 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.). 11,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 properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exam• •er se . . 1:usiness and Professions Code for this reason: Signature: 1.. s bean law Date: 1 a.- j a.- a) Owner ID verified by drivers license a: es ❑No Driver's License No. Expires: S_Laa—c_ itl Verification of Ownership by(type o'••cument,i.e.-property lax 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 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 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 greeter 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 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 apermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? LJ yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑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 Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No ........._..(_ B (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 r ating building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-dparty f r in ection purposes.I agr not too pyo flow occupancy of any building authorized by this permit until final inspection. '11 �a- \a- a3 Signature Legal Owner(s) Date J ( And/Or t rized Applicant Date C00E 1 INSPECTION TYPE OATH 1MDIALS CODE macaw= OdIE NOM 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 12_,0-19 7 201 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 FCITY OF COSTA MESA I it 4BUILDING DIVISION F „_,� "�) DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER TA • PERMIT 1E03-00170 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 317 ROBIN HOOD LN Status: ISSUED Suite No Applied: 03/11/2003 Vicinity: Issued: 03/11/2003 Parcel Nunmber: 42622114 Applicant DRAKE, JOHN ROBERT JR TR ISSUED BY: Or'( Address: 300 ROBINHOOD LN Phone: 949-642-2239 COSTA MESA,CA Zip: 92627-2134 Owner: DRAKE, JOHN ROBERT JR TR Address 300 ROBINHOOD LN Phone: COSTA MESA,CA Zip: 92627-2134 Contractor: OWN E R-BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT YPGRADE SERVICE UP TO 200 AMP.7 LIGHTS,9 OUTLETS AND 2 SWITCHES. FEE SUMMARY 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 $7.70 7 up to 50 kva/kw $0.00 0 Recept Outlets $9.90 9 up to 100 kva/kw $0.00 0 Switches $2.20 2 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 1hp $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 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 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 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 244&46(600) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: le . ❑ 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 I ormance 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'skied. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the penult is valued et 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 these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37030F 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 If 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). 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.). ❑ -. exempptt,un5,%7 �J Business and Professions Code for this reason: Signet . /PI I� L d.: .LZv—t) / 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 material? ❑Yes 0 NO (Section 25505 of the Califomia 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 ❑No (Section 25533 of the Califomia 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 ThOes or wlll theapplicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0N (Section 25534 of the Califomia 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 presentty required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No v _ ____.._.__ ...._e_.._....__....__. 5 Does e will the o st Air or present or future building occupant al requirer for the work which is the subject of this application aggertnit l0!such COnSimclion or modiTicailon from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LI No (Section 65850.2 of the Califomia 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? ❑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 prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (II yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all slate 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 ell tat ews end dry ordinances relating toe building construction,and authorize representatives of the Cityof Costa Mesa to enter upon the �>above-described eny 'nsp ti es.I agree not to occupy or allow occupancy of an building authorized by this perpuntil(nil insppe n. J Q� 11 Signature OI Legal Owner(s) Date And/Or A 1Q'ca'nt /-Date ;ODE0 INSPECTIONTYPE ME MALE LODE/ 'd DATE Mai 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 41_10-03 201 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 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITVtOF COSTA MESA I PE MIT NO. • TRACT NO. LOT NO. BLDG.NO. - CDNS"fRUCTION PERMIT — J S 95 _ • Project Address �-S/7 thi±t±.r / TYPE OF CONSTRUCTION U NEW r �•� 0 ADD U ALTERATION U REPAIR Applicant's Mailing Address "arra• ft/AC' JJ q 0 CONVERSION 0 DEMOLISH 0 OTHER - q,p•�!, [Zone , Owner's Name ��//,,y�- 2 4 �t{tM Phone c4 7/A DESCRIPTION OF WORK bay' /�!rYYJy-�T_•CpI �• S Main Building: Accessory Building: Z Address G S/T PTVL'T -. E . 0 • TYPE OF PERMIT U GRADING' U FOUNDATION U STRUCTURAL T Front N Arch/Eng. License No. 0 TENANT 0 ELECTRICAL 0 PLUMBING 0 MECHANICAL . B. Rear Address' .❑ OTHER A N • 00 Contractor's Nam. • +..' ' r L.a_9"IC Phoney ,3TQ09 PROJECT DESCRIPTION So. FT. OCCUPANCY• - C Right • CR Address(mailing) 2(-I,2 Sr�! dL+'sl�F '' /n V. CONSTRUCTION TYPE VALUATIONS s Left E City License No. ZONE GRADING CU.YDS. • ACRES 0 NQG 93 Q _ • _ Ping- Ref.# Park.Fees $ LICENSED CONTRACTOR DECLARATION U Remarks: Parking Req./Provided 1 I hereby affirm that I am licensed under provisions of Charter 9 (commencing R with section 7000) of Division 3 of the Business and Professions Code,and Use of Building: - E my license Is in full for e and effect. p [y Imo, M •774-7ry7 PLUMBING . FEES Planning Notes: .l:icen acs lass ! • L, nse No • I • NDate "`- -•.� Signature 1�'" - •• . . - ' fRKERS'COMPENSATION DEC • RAT!. Bar Sink • Showers reby affirm that I have a certificate of Consent to self-insure or a certificate . r • f T Backflow Preventer Service Sink S Workers' Compensation Insurance;or a certified-copy thereof'(Sectlon ' -- ' - -- - -- -- - - - - -- - - - 3800, Lab. C.) �' �s � !,',e Baiktlow Irrigatioh Sewer Cap ELECTRICAL FEES Policy No. a 0;c$ 9 3f�3 Company U [L-CO /-L.,s-e.� ; • • BCertified copy is hereby furnished. • r • Bathtubs Sewer Connection — Automatic Washer •Transformer 0 15-50 KW Certified py i filed with the city ding Vivi n. _ 1 0 50+KW Date /1 -7-x'% Applicant/g sy0Gs4z . Clarifiers • Solar Collectors Construction Pole Sub. EXEMPTION-FROM WORKERS'.COMPENSATI DECLARATION• • - Diih Washer' -- - - -" -Soler Piping' - l- - - Cookie Unit 1 - • - "`Meter QU to 100 amps " ' - (This section need not be completed If the permit for one hundred($100) or 9 P less) j • DrinkingFountains • ' I certify'that'in the performance of the work for which this permit Is Issued 1 Solar Tank Dishwasher i Meter Dover 100 amps t shall not employ any person in any manner so-as to become subject to,the . . - - _ - Workers' Compensation Laws of California. - - ' Floor Drains• •, Swimming Pool w/Spa Dryers OGas ❑Electric ' •;Sub Panel j - Date Signature - ' NOTICE:If,after making this declaration,you should become subject to the , Floor Sinks ; Urinal Fan i Motors 00-1 HP 01 h-8 • Workers' Compensation-provisions of the Labor Code, you must forthwith - - - comply with' such provisions or this-,permit:shall be deemed revoked.. . -I. Gas Service - 4--Outlets Water Closet '.- 5C F.A.U. I - Inc.Solar'09-15 HP 01.6-15+ CONSTRUCTION LENDING ,AGENCY ( - •- - I hereby afflrbr that there is a construction lending agency for the peiformance ' Interceptors Water Heater • Fixtures ' r Microwave I 1 i of the :work .for which' this permit is Issued .(Section 3097 CIv. C.) ' - - '- - , Lender's Name -- - - Kitchen Sink Water Service .' • Device Boxes Pole Light i ' Lender's Address - • - • , Lavatories., ' .- OWNER BUILDER DECLARATION. - Outlets • Range I hereby,affirm that I am exempt from the Contractor's Ucense Law for.tho ' p_7yo following reason (Section 7031.5 Business and Professional Code:Any city or P - - Switches • Sign 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 . RoofDrains Garbage Disposal Standing Sections to file &signed statement that he/she is licensed pursuant to the provisions of _ - ll Contractor's License Law(Chapter S (commencing with Section 7000)of s - . I inion'3 of the Business and Professions Code) or that ho/she is exempt • j _ r , , . . • _ - Generator ❑Q5 • KW❑5-15 KW ,Trash Compactor ell 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 Reinspection - $ 3 Cenalty of not more than five hundred dollars($500). • pe $25 Issue Fee' I ' I, as owner of the property or. my employees with wages as their Sole Reinspection Foe . ' $25 Issue Fee, ' $ 3 compensation, will do the work,and the structure is not Intended or offered . MECHANICAL FEES for sale (Section 7044, Business and Professional Code: The• Contractor's - - _ , - - • PUBLIC SERVICES REQUIREMENTS: i ' License Law does not apply to an owner of a property who builds or Improves Boiler • `. Hood or Type I 0 i - , • ' i thereon, aptl•who does such work himself/herself or through his or her own Zoning Approved By • Date employee-provided that such Improvements are not Intended or offered for - 0 Canopy Type IIS . sale. If, however, the buildingor improvement is sold within oneyear of com- - . Duct-Under Ground : p ApplicationApprovedByjap Date pletvon, the owner will have the burden of proving he/she did not build or im- for the purpose of sale), Duct-Structural r Refrigeration System 1 . Application Issued'By '. 4g / Date /7"/J/Tf-3 I, as owner of the property,am exclusively contracting with licensed con- ❑0.100,000 BTU ❑100,000 BTU tractors to construct the project (Section 7044,Business and Professions Cdde: Duct- Ventilating _ 'SUMMARY OF FEES ' • The Contractor's License Law does not apply to an owner of property who .. . .. __, . .,_, . . . - BUILDING• PERMIT • $ SMTP builds or Improves thereon,and who contracts for such projects with a con- Exhaust System Multiple System Repair/Alteration • $ - • tractor(s) license pursuant to the Contractor's License Law). PLAN CHECK $ PERMIT • • 0 I am exempt under Section B.& P.C.for this reason ' Firepl/Fact.fBlr. -CBO# PLUMBING $ Sr ,s-Cs ISSUANCE $ • Date ��?- — Owner • Heating System& Ducting • PLAN CHECK $ ENERGY P.C. $ I hereby certify that I have read t is appli tion and state that the above 00.100,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $ information Is correct. I agree to comply wi all city and county ordinances - and state laws relating to building construction,and hereby authorize repro- PLAN CHECK $ MICROFILM $ sentatives of this,city to enter upon the above-mentioned property for '_1 Inspection purposes. C/ Signature Date - MECHANICAL $ TOTAL FEE $ . s - Inspection License or SS Reinspection Fee $25 Issue Fee $ 3 PLAN CHECK $ ' - - i • CMF 0865-46 rev. 7/83 White-Building;Canary-Applicant;Pink-Accounting:Goldenrod'Assessor • • r CONSTRUCTION AND PLANNING POO(l_ 8:iSPA APPROVALS Permit# Date Inspector • APPROVALS Permit# Date Inspector j.t. Temporary Electrical Service or Pole 52. Pool & Equipment Location • . 2. Soil Pipe-Undrgrnd. - - 53. Steel Reinforcement • _3. Electrical Conduit Utility-Undrgrnd.' • • 54. Forms • 4. Electrical Conduit-Undrgrnd. • - 55. Electrical Bonding 5. Steel Reinforcement - • 56. Rough Plumbing& Pressure Test 6: Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7.. Footings 58. Electrical Conduit:Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater& Vent-Final 13. Roof Drains • 64. Plumbing System-Final 14. Rough Plumbing - 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring . - 67. Fencing&Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING ' 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL "' • 19. Rough Heating& Air Conditioning • FIRE DEPT.REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permits 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil .23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing • 73. Undergrnd.Storage Tank 0 Gas 0 Oil ' 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • 27. Frame and Flashing 76. Dry Standpipe • 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. 'Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED • 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test /1/7/,, #/i-RC • 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final • • 42. Backflow Preventer 43. Backflow Irrigation • 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY No. Date •