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HomeMy WebLinkAbout1578 SAN BERNARDINO PL - Building Permits • TCITY OF COSTA MESA 7411111k: • BUILDING DIVISION o°✓ F • ,_ DEVELOPMENT SERVICES DEPARTMENT \�\ PERMIT NUMBER 4 PERMIT \Q B02-01387 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1578 SAN BERNARDINO PL Status: ISSUED Suite: Applied: 08/28/2002 • Vicinity: SIDE AND REAR OF PROP Issued: 08/28/2002 ' Parcel Number: 42532132 Zoning: Applicant: VAN ALL E JOHMILIA ISSUED BY: Address: 1322 CALLE SMILIA Phone: 949-369-6971 SAN CLEMENTE,CA Zip: 92673 Owner: PAURI, FABRIZIO � Address 92 LEHIGH AISLE Phone: - G - • IRVINE,CA Zip: 92612-4107 Contractor: XTREME CONSTRUCTION Address: 1322 CALLE SMILIA Phone: 949-369-6971 SAN CLEMENTE,CA Zip: 92673 License: - 706125 Arch : Eng: Address: Address: Phone: - Phone: Zip: License: License: - SCOPE OF PERMIT CONSTRUCT 220 LF 4 FT HIGH RETAINING WALL ON THE LEFT AND REAR PROPERTY LINES PER CITY STANDARDS. REF: B02-00246 AND 002-00006 - FEE SUMMARY • Plan Check: $154.21 • Calc Valuation: $13,200.00 Permit: $237.25 Claim Valuation: $0.00 SMIP Res: $1.32 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $392.78 PLANNING &ZONING • SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left - 0-0 Right 0-0 ACCESSORY Front 20-0 - 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)754-5626 `3 r 2446-ae(sroo) c DECLARATIONS j^,1 (- 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. p 1 have and will rrgqaintain w corn ton insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My er ' odroepsti Ins ranee rrler and policy number are: Carrier: //--�y)1�11111 ` Policy Number: (This section need not be completed i/the permit is valued at one hundred dollars($100)or less.) r ❑ I certify that In the erfortr co o1 thg work 1• which th' permit is issued,I shall not employ any person in any manner so as to become subject to the workers'• compensation la s f Calf mla,an agr= if I sho$Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply withlhes pr ' i4 . /'rrth Applicant Signature: ti __ Date: (3 { '��� WARNING:FAILURE TO ECU E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT M EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S ),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 ' e. pr ns• hapter 9(commencing with Section 7000)of Division 3 of the Busi an-d�(�Rrraql'fe��pp ns ode,��eand my license is In full foContractors and effect.Lac.# L� • Class# 9.. Signature: t • I Date: r .CONSTRUCTION LE •I 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(commenting 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 toe 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,end 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. 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 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. 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 thisapplication apPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 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 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 COMPUANCE 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 t0 comp with all state laws and city ordinances relating td building construction,and authorize representatives of the City of Costa Mesa to enter upon the above- cribed pro7Si44wer(s) for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / o. /jT � to • And/0 prized Applicant Date OE INSPECTION TYPE - 2M INTR41L$ CODES INSPECTIDN TYPE PAIL 18IID61s 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 4:ill-//ii p r/ CA. 212 Final Fire Prevention 202 Final Factory Fire Place / U 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy - it. CITY OF COSTA MESA 4 BUILDING DIVISION ) y • 4 - H i I DEVELOPMENT SERVICES DEPARTMENT a1'u PERMIT NU BER PERMIT 0 +r else B 0246 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1578 SAN BERNARDINO PL Status: ISSUED Suite: Applied: 02/20/2002 Vicinity: DUPLEX(1578 AND 1580 SAN BERNARDINO) Issued: 06/03/2002 Parcel Number: 42532132 Zoning: Applicant: VAN BEEK, JOHN ISSUED BY: Address: Phone: 714-915-2814 Zip: Owner: PAURI, FABRIZIO Address 1580 SAN BERNARDINO PL Phone: COSTA MESA,CA Zip: 92627 • ' • Contractor: XTREME CONSTRUCTION Address: 1322 CALLE SMILIA Phone: 949-369-6971 • SAN CLEMENTE,CA Zip: 92673 License: 706125 Arch : WILLIAM MASON ARCHITECT Eng: ROHPER, PAUL Address: 3505 CADILLAC AVE Address: BLDG 0,SUITE 208B •. Phone: 714-427-0688 Phone: COSTA MESA,CA , Zip: 92626 License: C23759 License: S4340 SCOPE OF PERMIT ' CONSTRUCTION OF A 3214 SF DUPLEX WITH A 677 SF ATTACHED GARAGE. 1578 AND 1580 SAN BERNARDINO PL. 1580 SAN BERNARDINO:2381 SF(128 SF 1ST FL; 1253 SF 2ND FL)TO INCLUDE 2 BEDROOMS,2.5 BATHS&3 FIREPLACES;476 SF BALCONY. 1578 SAN BERNARDINO:833 SF(589 SF 1ST FL;244 SF 2ND FL)WITH 2 BEDROOMS AND 2 BATHS. REF:PA-01-40 AND ZA-01-59 . FEE SUMMARY Plan Check: $1,370.30 Calc Valuation: $298,178.62 Permit: $2,108.15 Claim Valuation: Moo SMIP Res: $29.82 SMIP Corn: $0.00 Other: $0.00 . Inspection: ,$0.00 Total: $3,508.27 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 20-0 Rear 15-0 Left 14-0 -Right 5-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 6 Proposed: 6 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. / 7 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(&'oel V DECLARATIONS_., U f - WORKERS'COMPENSATION DECLARATION: 1 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. . ave 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 c• feted if the permi is valued at one hundred dollars($100)or less.) ❑ I certify that in e. nce of the w for whic . permit iyissued,I shall not employ any person in any manner so as to become subject to the workers' compensation of•: mia,and g e that if riId becom: subject to the workers'compensation provisions of Section 700�f the Labor Code,I shall forthwith corn with Ih:.: . Signature: , �" �I�, Date: D/L.- Applicant WARNING:FAILURE T.SECU• WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOt1ARE 100,000 IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS •- LARATION: I hereby affirm that I a&se: •der provisions •f Chapter: mencing j ith Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Lic.# I Class# _ContractoYstre:M�11�-�.�_\�� Date: — CONSTRUCTION LENS•IN AGENCY: • ❑ I hereby affirm that •:re 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. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 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,Califomia 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 ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 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. 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 a permit 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 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? 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 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 COMPUANC • D AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I .•ree to comply with:II state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the :iii3-d: 'bed property for' spection purposes.I a•ree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Ali i �1 Wiii r—Jr (Q/31 `, Date ' :'.r' :•App'. ,_T lJ Date INSPECTION TYPE PATE INTRIAL@ CODE• INSPECTIONTYPE PM ltlICIAki 161• 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 S 204 Final Demolition - 250 Final Building/Occupancy IJ -f - - NEWPORT-MESA UNIFIED SCHOOL DISTRICT 142 4000 CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 !J�/ 7� / T To: ( City of Costa Mesa District Receipt No/G tO &D ( ) City of Newport Beach /� ( ) County of Orange Plan Check NoU2- 00 ZWC Applicant: Pa„,_ 6-wad Q Address: ___,/57/5 ,34r' alti.1'] 4'1 M> a // / Cm') Telephone Number: Tract/Parcel and Lot Number(s): / Location of Project: /57K /� l�n� d i a PT. Number of Square Feet of: — Residential Space (2 3/ ( �x $1.84 Total 15 � , /7 cQ /A goo 0 Itna) Commercial and Industrial Space x $ .30 Total Commercial/Industrial Project is:(Check One) � Warehouse _ Motel _ Preschool R 8 D Bank Auto Repair Movie Theater _ Neighborhood Shops _ Hospital Mini-storage Racquet/Health _ Large Office Heavy Industrial _ Hotel _ Office Bldg. Regional Shops _ Medical Office _ Restaurant Light Industrial _ Office Park _ Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport-Mesa Unified School Dis ' . B • kJ / Authofi= • Representative The above representation as to square footage is true. Applicant agrees that if it is I temined that such representations are not true,then this certificate shall automatically terminate and the appropriate City/Co .11 be nob'fitd i 2802/11:49 NR/1 4257,76 06 - I I .- Qo 2_ g kcpli:01-0096566 12206 Da . O d� L ��te4a/ LA,. ApQ nt_,Y 4• 11 6 y. CITY OF COSTA MESA ... 4 @@ BUILDING DIVISION > .�_ .,�. DEVELOPMENT SERVICES DEPARTMENT ' y� PERMIT NUMBER Ft --.. I p o PERMIT `III E02-90,432 Rano V (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1578 SAN BERNARDINO PL Status: ISSUED Suite No Applied: 05/28/2002 Vicinity: Issued: 06/03/2002 Parcel Nunmber: 42532132 Applicant: VAN BEEK, JOHN ISSUED BY: - Address: Phone: 714-915-2814 - Zip: Owner: PAURI, FABRIZIO . Address 1580 SAN BERNARDINO PL Phone: COSTA MESA,CA Zip: 92627 Contractor: XTREME CONSTRUCTION • Address: 1322 CALLE SMILIA Phone: 949-369-6971 • • SAN CLEMENTE,CA Zip: 92673 License: 706125 -- SCOPE OF PERMIT REF:B02-00246. ELECTRICAL FOR NEW 3214 SQ FT DWELLING, 1 TEMP POWER POLE,GARAGES . TO INCLUDE:2 PLUGS,2 LIGHTS 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) $179.98 3214 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 $2.20 2 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 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 $23.50 1 TOTAL CALCULATED FEES $233.58 Intermed Pole $0.00 0 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 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 • 2446.4616/00) DECLARATIONS U - f 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 awork for which this permit is issued. t pf;t I have and will maintain workers'compensation insur nce,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. \l" My workers'compensation Insurance carrier and••Ilcy number are: Carrier: Policy Number: ,(This section need not be corn. d if the permit is v:Med at one hundred dollars($100)or less.) El certify that in he•erfo - - ' of the work f. which this.ermit is I t ed,I shall not employ any person in any manner so as to become subject to the workers' compensation aws .f al and a.ree at If ��',ecome 5 ••lett to the workers'compensation provisions of Sectiop 37 of the Labor Code, shall forthwith comply with th. e p lit.. l/ �/ Applicant Signature: 1i_. 1-4------fit, Date: LP 9 nit, WARNING FAILURE TO- •E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ),IN ADDITION TO THE COST OF.• PENSAT1ON,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRAC •RS DEI .ARATION: I hereby affirm that I esed provisions .f errCha• = mmy menc4 with Section 7000 . Division 3 of the Business and Professions Code,and license is In full force and effect.Lic.a �� 1 . 41.4 a Class a - Contractor's Signature:-`ll��`��' Date: ' CONSTRUCTION LEN* AGENCY: . _ ❑ I hereby affirm that -re 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 penally 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 drivers license. 0 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 material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 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 Calif omia 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? 0 Yes 011 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 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 ❑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• •UTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I a•ree to comply with all st.te laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the a••ve-des:•ed property for inspe•ion purposes.I agree not t. occupy or allow occupancy of any building authorized by this permit until final inspection. 1 ._ 1 '� _ 7j' i,e Of , ' ° Latte/l C-rd/Or:Atitho - • nt l Date • INSPECTION TYPE gag INnfUL$ CODED INSPECTION TYPE PAIS MAL$ 161• Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ��{��)�� n _ 200 Final Re-Roof _ _ 210 Final Electrical el /yam/•______ 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 • p F 9 CITY OF COSTA MESA - - • BUILDING DIVISION > • �. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1a \ '5 y r/� I PERMIT kkv 114. M02-00213 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1578 SAN BERNARDINO PL Status: ISSUED Suite No Applied: 05/28/2002 Issued: 06/03/2002 Vicinity: ��//.j�,�/� Parcel Number: 42532132 ISSUED BY: !/ Applicant: VAN BEEK, JOHN Address: Phone: 714-915-2814 Zip: • Owner:: PAURI, FABRIZIO Address: 1580 SAN BERNARDINO PL Phone: COSTA MESA,CA Zip: 92627 Contractor: XTREME CONSTRUCTION Address: 1322 CALLE SMILIA Phone: 949-369-6971 - SAN CLEMENTE,CA Zip: 92673 License:706125 SCOPE OF PERMIT REF: B02-00246.MECHANICAL FOR NEW 3214 SQ. FT. DUPLEX,TO INCLUDE: 1 FAU<100 K BTU,2 FAU>100 K"BTU,2 FACTORY FIREPLACES,2 HOOD/W EXHAUST,DUCT WORK AND REGISTERS.4 VENT"FANS TO A SINGLE DUCT. FEE SUMMARY 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 $36.40 2 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 $21.30 2 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $21.30 _2 15 To 30 hp/1,000 k BTU" $0.00 0 VAV Box . $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $29.00 4 Over 50 hp/Over 1,750 BTU $0.00 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> 10000cfm $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 TOTAL CALCULATED FEES $146.30 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 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 (_ ) fl WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O 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 I� work for which this permit is issued. _L1�T 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. t] My workers'compensation Insurance carrier and poli number are: Carrier: Policy Number: (This section need not be comple :d if the permit is ed at one hundred dollars($100)or less.) ❑ I certify that in t orma ic,of the work to whi noir is iss :d,I shall not employ any person in any manner so as to become subject to the workers' compensation la •• Calif I+,and ree at it I ecome SJ'ject to the workers'compensation provisions of Sec n 37 0 of the Labor Code,I shall forthwith comply with then '.'•n- ti .'.n a ' (� ^/ c ,Applicant Signature:2' V v , 's I Date: � 3 v `- WARNING:FAILURE T•' ECU' WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALT-ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE -100,.•.),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACT DE RATION: I hereby affirm that I a liven ed L n r provlslo of• 9(camncing with Section 7000)of Division 3 of the Business and Professi ns Code,and my license is in full force and effect.Lic.a .. IClass M `Contractor's:Signature:' n_.,..n_.,.. / L___ /� Date: CONSTRUCTION LE IN GENCY: ' ❑ I hereby affirm that ere 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 Cale)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 properly,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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 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,Ttle 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 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. 4 If an RMPP is presently required,has Section 25534 of the Calif omia 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 a permit 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 0No (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? ❑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 correct. I agree to comply with all .tate laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the ve-de- bed property for in section purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 0 ��, ee Of - gD• nails) ( ` /5J �ate <<An. •��horizetl •� � Date INSPECTION TYPE PSIS INTRIALS CODE 0 INSPECTION TYPE DAM 111! Fixed System Final Fire Prevention 206 Final Mechanical 8-(9-0)4 Inme 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 • ,STA F CITY OF COSTA MESA BUILDING DIVISION4 F tlras( DEVELOPMENT SERVICES DEPARTMENT AD) PERMIT NUMBER V PERMIT \``� \I / ole I / P02-00319 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1578 SAN BERNARDINO PL Status: ISSUED Suite No Applied: 05/28/2002 Issued: 06/03/2002 • Vicinity: Parcel Nunmber: 42532132 ISSUED BY: Applicant: VAN BEEK, JOHN Address: . - - Phone: 714-915-2814 - ' Zip: N. Owner: PAURI,-FABRIZIO . Address 1580 SAN BERNARDINO PL Phone: ' COSTA MESA,CA Zip: 92627 Contractor: XTREME CONSTRUCTION , Address: 1322 CALLE SMILIA Phone: 949-369-6971 • - SAN CLEMENTE,CA Zip: 92673 • License: 706125 Arch / Eng: ' Address: . Phone: Zip: License: SCOPE OF PERMIT REF: B02-00246. PLUMBING FOR NEW 3214 SQ. FT.DUPLEX.TO INCLUDE:4 BATHTUBS,2 DISHWASHERS,4 ROOF DRAINS, 1 GAS SYSTEM(1-4 OUTLETS)9 ADDITIONAL OUTLETS,1 GAS SERVICE,2 LAUNDRY TUBANASHER,4SHOWERS,2 KITCHEN SINKS, 1 BACKFLOW,4 WASH BASINS, 1 WASH BASIN SET,5 TOILETS,2 WATER HEATERS, 1 WATER SERVICE. FEE SUMMARY AMT QTY AMT QTY - AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $19.60 2 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 $39.20 4 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) $12.30 1' 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 $39.20 4 Dishwasher $19.60 2 Sewer Cap for Demo $0.00 0 Wash Basin Set $9.80 1 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) $49.00 5 Drain, Roof $39.20 4 Shower $39.20 4 Water Heater/vent - $24.60 2 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst 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 $9.80 1 Gas(1-4 outlets) $6.15 1 Sink,kitchen $19.60 2 Water Softener $0.00 0 Gas(Over 4 outlets) $9.90 9 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $9.80 1 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 TOTAL CALCULATED FEES: $370.45 NOTICE: The work authorized by this permit sIOOMMS(4 fB dl8Wa16N4l& serimmetss 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(6/00) DECLARATIONS O l l 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 ork 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 carder and policy number are: Carrier: Policy Number: (This section need not be completed if a permit is valued t one hundred dollars($100)or less.) ❑ I certify that in t e pe ormance 1,he work for whi Is rmit is is ued,I shall not employ any person in any manner so as to become subject to the workers' compensation la s o Califomia, :nd agree that i 5 ou become bject to the workers'compensation provisions of Section 37 of the Labor Code,I shall forthwith comply with thes ro is; s. '') plpplicant:Signawre:—- Date:COMPENSATION FAILURE TO SE U =WORKERS' (JOVE GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES A D CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100 ,IN ADDmON TO THE•• T OF COMPENSATION,DAAMGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACT•RS •ECLARATI6N: I hereby affirm that I a '-J.nder pr•visionsa pier 9(••mmendng with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Lic.# ) Dlassate: # _` v Gontracio%s.Signawre:�� 1�ar► �— - Date: CONSTRUCTION L= DING AGENCY: ❑ I hereby affirm th. th-re 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 end 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 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 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 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 apermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? 0 Yes LU 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 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 COMPUANC 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 and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for spection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ` ` Signa(Of Legal mar(s) 619/ _ / ate [/_/- A r�n 9;Ap Iwn l"o!/ Date 4yJ�,UI„INSPECTION TYPE PEE INTRIALS CODEC INSPECTIONTYP' gig INTITtAL5 16118'/ Fixed System Final Fire Prevention 206 Final Mechanical p 1266 Pool Spa Final 208 Final Plumbing (i i 9 ' 'c' _la _` 200 Final Re-Root • 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - 250 Final Building/Occupancy CITY OF COSTA MESA BUILDING DIVISION 4 � , •Y %1 f,�. • DEVELOPMENT SERVICES DEPARTMENT ,�,(� PERMIT NUMBER �t /s PERMIT 1/ st B01-01598 r e•- , (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1578 SAN BERNARDINO PL Status: ISSUED Suite: Applied: 10/08/2001 Vicinity: Issued: 10/08/2001 Parcel Number 42532132 Zoning: Applicant: VAN REEK, JOHN ISSUED BY: ¢ - Address: 1322 CALLE EMILIA _ -Phone: 949-369-6971 ' SAN CLEMENTE;CAS Zip: 92673 - • Owner: PAURI, FABRIZIO Address 74 TURNBURY LANE - . . Phone: 714-505-0100 ,IRVINE,CA - Zip: 92620 - - , " Contractor: 'XTREME CONSTRUCTION . Address: 1322 CALLE EMILIA • - Phone: 949-369-6971 , '; v SANCLEMENTE,CA , Zip: 92673, License:: 706125 • - • Arch : _ , Eng: Address: Address: - - - _ ; Phone: Phone: Zip: License: - •License: SCOPE OF PERMIT 7 DEMOLISH 900 SQ. FT. RESIDENCE. NO GARAGE.CAP SEWER,GAS AND ELECTRICAL. , FEE SUMMARY Plan Check: $0.00 Calc Valuation: . -$4,000.00 Permit: '. $97.25 • — -- - Claim Valuation: . $4,000.00 , SMIP Res: $0.00 „ • -SMIP Corn: $0.00 Other:- . $0.00 Inspection: $0.00 ,• Total: $97.25 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)754-5626 2446-46(6/00) DECLARATIONS f (l 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. ave and will maintai workers'compensati•r insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers' fJShsa Ion Ins ra ca er a'd••Icy num rare: • Carrier: amit •-:" '! Policy Number: (This section need not be completed if the permit is tel-ed at one hundred dollars($100)or less.) . ❑ I certify that in the •==L orm- -of the work for hich is permit is• sued,I shall not employ any person in any manner so as to become subject to the workers' compensation law LTi alit• a,and agree t•-t if • Id becom:subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these • sion / I 1 _ u yQ' v r-' Applicant Signature: -.111 L_ ` A--- UP° .� Date: 10 - _ 1 WARNING:FAILURE TO CUR: WORKERS'COMPENSATION COVERAGE IS UNLA' Fl1L AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(51",•••,IN ADDf11ON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. I LICENSED CONTRACTORS CLARATION: I hereby affirm that I a ns oder provision of Ch 9(comma Ging with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lie.# Class# Contractor's Signature: 110 `___ 'v`" I / Date: /0"-' b`/` o CONSTRUCTION LE AGENCY: ❑ I hereby affirm tha ere 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 penri 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. 0 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,Califomia 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 ❑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 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). 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 Quality Management District or from any other air pollution control district or agency? Yes j5 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 QualityManagement 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 -ate 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 insp:ction purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. A Date And/Or Authori ••p cant Date CODES 9l•• x' MI IMBUES GORE! INSPECTION TYPE RATE UIRTULS 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 �`ry� 203 Final Sign 222 Final Site Q rf 204 Final Demolition 250 Final Building/Occupancy OCT 03 '01 12:54PM SU AIR TOXICS ASBESTOS WIT r.,...-a rr i \i'l a L:.. ig- fR pIt ?;`,I, SOUTKCOASTAIR.OUA LITYMA AGE:0-NT 0 - , ti ; ( • : :` • .1 NOTI RCABONOFDfIOLIT100NORASBESTOS VAL 1 ; t 2fBBWE.C> D�6e,thansattBr.448170S41�b «, . j�,,� :MAIL PO EEE , 'PEFNSEN N:L64ANCEt 3Ch'JODIHI% ia3Ct-sfrf I COMP EWEDer.Mental BUM.% COMPANY PHONE 14 .545 01 /4•:101:: e./ DATE tt.(4 -O( . OIw% FEES 44 4/ • PROJECT. • NOTWICAT!»ILDffS •- ONGI t- Rsvmararts �,�2 wlai+ ReOnesplgricAS CNCENA ma .. RBd P ¢CFTVPE 0[wnna rHm � DeDrHs n amo�G Raode' Eirnanrr RueHx Piece Reim OPUS MTh a1FORMATION SITE MME 7_#4vRt ke.Ste* 'E SITE ADDRESS 1578 S j#4 le Ns kith,1A G NA.cE. CR08aaTREf 16 S'7R. "W . city ObS lA rreSA smTE 04 ZIP 9262,2 couww O&,W4C °ES tail,-P I TIgn ArStat 1 FSS tht pad org te. i �A:S' �}' t((3' *A�2atii �7�tw�R PrenRsN� } l.�vl� /Lacey �.ateR r�+.0/."Lk;�+C;77�Aws1? 4's.��$ � ILCOP I'o4Q^Tie- . BUILDING 82E(430 FT) 1.bb O MASER OF FTAORS 1 BUIWING AGE O EPR5T S3, NUMBER OF DWELINO UNITS 1 . ` SIM PWOR+V HSE SOSO* llea+m► beasmr4 OOwr O--- PBeaao scan SLIP macouem 'SITE OYTNER Meat Lo ?.4+u R 1 - ... ADDRE88 .. 7i1P-N GeV 9, 4.40344;- ,- CITY Ii2J4/SNC _ STATE cm IIP' LW& CONTACT f f34 e-1 PHONE Ric SQ.s 01 • • RSQUME7BUIREI M ' •ASBESTOS -YES' NO AS8E51'0803 NO ASBESTOS 4Es(NON BUILDING TO BE NO r Imo' -"'—- MUNI, SURVEY?` REMOVED? i4 BEMOANED? PROiEBT'Od ru :START :Se TM tioct,1 -. END Per ci - 'tat) I Wows SHIFT(dam,acing,night) 4 , ASBESTOSNAD_UMTOBE.. _' FRWBLE MASS CLASS it . TOTJLLAMOUNT tmMSS REMOVED.MI some feet T 44I 16i z-- -Amami REMOYItl:FROM . : . ' S.PfACE8. ,. • .. , - PI S • --- - .COMPtNVENTB Mawr oFeAotTYPO'OF...... ACOUSTIC CEILING, LINOLEUM. . INSULATION FIRE PROOFING . DUCTING, -. STUCCO ' MASTIC . .PANESTOS On e�eu4q _ - 31 • . '. . 0 - FLOOR TILES-NAh)_. ..DRYWALL •PLASTER- •-TRANGITE ROOFING ' OTHER .. . ZO irate)' INC MATION ren. .--,r% OS4IARESt .,. AOMDrot - NAME- -rneg 1Z1.14 • ?ANA( . H. APORE88 74:- Tu RM Y 4,4ptis. 'Orf tRAI IAl --- STATE 04 - ZIP "2.6 ZS-.. SITE SUM _- . - PHONE 714- sal;-0(0- . PASSE TRANSPO !ERi1_ / )21.2,W. 244:(2-1_. ..-. LANDFILL it"WS t Lr?x4 At.CL,9>P"tR7i tlei ADDiffsa 74 leagrAiAu R-y LA'. ADDRESS Mil W ST ' 45TIV(1 1 - -_ CITY //La/J Ate-e- STATE C* !IP/26° , CRY• f eysy¢ STATE C4 ZIP 9/.AI • • BURROW 2121 E. Coast Hwy.,#1208 Corona Del Mar, CA 92625 • Es CROW SERVICES Phone(949)644-9390 Fax(949)644-2825 September 6, 2001 ESCROW NO: CO-12489-EG • Fabrizio Pauri 1578 San Bernardino Place Costa Mesa, CA RE: 1578 San Bernardino Place, Costa Mesa, CA Dear Fabrizio Pauri: The above referenced escrow closed on September 06, 2001. The following items are enclosed for your records: • • Check in the amount of$308.43 • Final Closing Statement • Please be advised that EQUITY TITLE - ORANGE COUNTY will forward the Policy of Title Insurance to you directly. Any original documents recorded for your benefit will be forwarded to you directly from the County Recorder's office. • TAX INFORMATION The next installment of property taxes is due 11/01/01 and must be paid by 12/10/01 to avoid penalty. Tax bills are furnished to you as an accommodation of the Tax Assessor's Office, USUALLY by November 1st each year. PLEASE CONTACT THE SELLER TO OBTAIN THE ORIGINAL TAX BILL . OR CONTACT THE TAX ASSESSOR'S OFFICE TO REQUEST A •DUPLICATE BILLING. The • payment of taxes is your responsibility; if they are not paid prior to the delinquency date, • penalties will be assessed. For any additional taxes which may be due by reason of the change in ownership, Supplemental Tax Bills will be sent to you from the Tax Collector separately from your regular tax bill. You normally must pay these taxes by a delinquency date which is separate from the regular tax billing. Please read these supplemental tax bills for the particulars concerning same and contact the Tax Assessor's Office with any questions you may have. If your loan is being impounded for payment of taxes, the taxes will be paid by your lender; however, Supplemental Tax Bills may be your responsibility. Please check with your lender regarding payment of any Supplemental Tax Bills. PLEASE BE ADVISED THAT WITHIN THIRTY (30) DAYS OF THE CLOSE OF THIS ESCROW, YOUR FILE MAY BE TRANSFERRED TO OUR OFF-SITE STORAGE FACILITY. TO RETRIEVE YOUR FILE FOR COPIES OF ANY DOCUMENTS THAT YOU MAY REQUIRE AT A LATER DATE WILL RESULT IN A$25.00 FEE. It has been a pleasure handling this transaction for you. Please do not hesitate to contact our office, if you have any questions regarding this transaction. Your Escrow Officer's email address is Elly.Gann@burrowco.com. • BURROW 2121 E. Coast Hwy., Corona Del Mar,CA 92o.,—.) ESCROW SERVICES Phone(949)644-9390 Fax(949)644-2825 August 3, 2001 Escrow No: CO-12489-EG Fabrizio Pauri 74 Turnbury Lane Irvine, CA 92620 • Property Address: 1578 San Bernardino Place, Costa Mesa, CA The undersigned hereby acknowledges receipt of the following: • Preliminary title report issued by EQUITY TITLE . Items A, C, and 1 through 5 on Schedule B will appear on the Policy of Title Insurance issued in connection with this escrow as exceptions to title. • Plat Map—Please initial on the enclosed copy where indicated and return. • Pursuant to the escrow instructions, you have five days from receipt of the above items for approval of same. • The items on this report may affect the use of the property. We will furnish a copy of any item upon request. In the event we do not receive written disapproval within the time allowed, the report will be deemed approved. • ` I !• p8 - © - O \ • Fabrizio Pauri Date Received • • • *""*PLEASE SIGN, DATE AND RETURN THIS LETTER TO OUR OFFICE*"** "**"RETAIN THE ATTACHED COPIES FOR YOUR RECORDS"" Sincerely, • Elly J Gann Escrow Officer • EG/CS Sent via mail 70111 rt- CITY OF COSTA MESA < , BUILDING DIVISION > • „,z I DEVELOPMENT SERVICES DEPARTMENT / , PERMIT NUMBER u �C�i PERMIT E01-00867 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1578 SAN BERNARDINO PL Status: ISSUED Suite No Applied: 10/08/2001 Vicinity: Issued: 10/08/2001 Parcel Nunmber: 42532132 ��� Applicant: VAN REEK, JOHN ISSUED BY: :-C�J�� Address: 1322 CALLE EMILIA - , - (� ".Phone: .949-369£971 SAN CLEMENTE,CA - • Zip: 92673 ' , . - j Owner:-/PA URI, FABRIZIO • - Address ,74 TURNBURY LANE - N.N - , • Phone: 714-505-0100 - - IRVINE,CA - Zip: 92620 , Contractor XTREME CONSTRUCTION Address: 1322 CALLE SMILIA " _ -Phone: 949-369-6971 " - - SAN CLEMENTE,CA Zip: -92673 License: 706125 • i - ,� SCOPE OF PERMIT , . DEMOLISH 900 SQ:FT.RESIDENCE. NO GARAGE:CAP SEWER, GAS AND ELECTRICAL. . , 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 $18.20 1 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 $0.00 0 up to 50 kva/kw $0.00 - ;' 0 Recept Outlets ,$0.00 0 - - - • up to.100 kva/kw $0.00 ., - 0 Switches - $0.00 0 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 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 $0.000 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 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $41.70 Intermed Pole $0.00 0 • COMMENTS /SPECIAL CONDITIONS J 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(6/00) DECLARATIONS • fl f1 WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: ❑ vI,h°arvke 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 V for which this permit is Issued. have and will maintain wo rs' mpensatlll����nnnn Insu ce, s required by se on 3700 of the Labor Code,for the performance of the work for which this permit H issued.My workers'compens ; n l sur wrdycapp poli n r are: Carrier: .�/ ,� Policy Number: (This section need not be completed if the permit is value at one hundred dollars($100)or less.) ❑ I certify that in th: •:-ormanc: f the work for w ch this • ' 's issued, shall not employ any person in any manner so as to become subject to the workers' compensation la s of•alifo 'i4 and agree the f I shoul• subjec o the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with thes=provi i•ns. - Applicant Signature: RzS. �• Date: 10 - _0 I WARNING:FAILURE TO - WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL/ME($ ),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 DEC ATION: I hereby affirm that I am li .•u provisions of hapt ommencing ith Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.4 Class 4 /I''`` [^A'� �7 Contractor's Signature: A` ('k D.Q. Date: /V V - l! / CONSTRUCTION LENDI 'e NCY: ❑ I hereby affirm that th= : 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 fore punt. 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 drivers license. ❑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 6,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 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. 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 Quality Management District or from any other air pollution control district or agency? 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 ❑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 I state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the abovi.-sescri,kid property for in pection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ignat e • :•al And/Or Authonzed Applican Date .. .-' hl•• E' lug INTTAL$ CODE! INSPECTION TYPE PLL¢. )NTITIAL$ 1616 -xed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing - 200 Final Re-Roof 210 Final Electrical 2/m104 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 O CITY OF COSTA MESA BUILDING DIVISION - o q ..4. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT v ‘- fay ft/ (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA "9PQP 2626 GRADING PERMIT Job Address: 1578 SAN BERNARDINO PL Status: ISSUED Suite: Applied: 04/16/2002 Vicinity: Issued: 06/03/2002 Parcel Nunmber: 42532132 Zoning: ISSUED BY: Applicant: VAN BEEK, JOHN Address: - _ Phone: 714-915-2814 ' Zip: Owner: PAURI, FABRIZIO _ Address ',1580 SAN BERNARDINO PL -• Phone: 714-505-0100 ' ' COSTA MESA,CA Zip: 92627 ' Contractor: XTREME CONSTRUCTION Address: 1322 CALLE SMILIA . Phone: 949-369-6971 ' SAN CLEMENTE,CA Zip: 92673 License: 706125 Eng: ITF ENGINEERING Address: P 0 BOX 50756 Phone: 949-857-1813 IRVINE,CA Zip: 92619 License: C052871 SCOPE OF PERMIT CUBIC YARDS 0 C.Y.CUT/150 C.Y. FILL. GRADING FOR NEW DUPLEX PROJECT ADDRESSED AS 1578 AND 1580 SAN BERNARDINO PL. REF: B02-00246,PA-01-40/ZA-01-59 150 FEE SUMMARY Plan Check: $33.00 Calc Valuation: $0.00 $0.00 Permit: $54.50 Other: $0.00 ,- ' $0.00 , Inspection: $0.00 $0.00 Total: $87.50 PLANNING &ZONING NOTES: • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. • FOR INSPECTIONS CALL: (714)754-5626 • 2446-46(6/00) DECLARATIONS I ) fl WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work f which this permit Is issued. -ave and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($f 00)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 37 of th@ Labor Code,I shall forthwith comply with these provisions. / '` -AppflcanfSlgnature:r Date: ( ll V 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 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS D CLARATION: I hereby affirm that I am nse. er provision- of Cha.��-P'9(com '=ncing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.N � ,` r r Class N 1 C�ontractors.Signature:-_�z i.1`A- _�Gsi II� Date: CO 3 '�'( / CONSTRUCTION LE DING •GENCY: ' ✓ ❑ I hereby affirm tha -- e is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: _ Lender's Address: 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 properly,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. 0 Yes 0 No Drivers License No. _ - Expires: __ _ Verification of Ownership by(type of document,i.e.-properly 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? 0 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? ❑Yes 0 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 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 Califomia 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 a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? D 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? 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 Califomia Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If'ryes",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 a ate laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desc' ed property for in action purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. NIigna .Of :gal Own: s) CO/3/ _�� /(,D �i lig �Al /. // e Date nWOr.AU' .,.:tl....Ica —� Date PECIION TYPE, PAMINTRIAL@ CODE INSPECTION TYPE PATE J( g 161; Qxed 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 4®b T 204 Final Demolition - 250 Final Building/Occupancy CITY OF COSTA MESA < BUILDING DIVISION /icit..„, 'x..41 DEVELOPMENT SERVICES DEPARTMENT PERMIT N9J BER PERMIT ,/t `// Jst"^a.` / ' • P01-00594 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1578 SAN BERNARDINO PL Status: ISSUED Suite No Applied: 10/08/2001 Issued: 10/08/2001 Vicinity: ISSUED BY: • Parcel Nunmber: 42532132 Applicant: VAN REEK, JOHN 1 ' . Address: 1322 CALLE EMILIA - i - Phone: 949-369-6971 /, - SAN CLEMENTE, CA Zip: 92673 - - \, Owner: 'PAURI, FABRIZIO Address 74 TURNBURY LANE , Phone: 714-505-0100 IRVINE;CA Zip: 92620 , Contractor: XTREME CONSTRUCTION Address: 1322 CALLE SMILIA Phone: 949-369-6971 , , SAN CLEMENTE, CA Zip: 92673 . License: 706125 , - - Arch / Eng : Address: - • ' Phone: Zip:, License: [ , SCOPE OF PERMIT DEMOLISH 900 SQ. FT. RESIDENCE. NO GARAGE.CAP SEWER,GAS AND ELECTRICAL. • . FEE SUMMARY ' ' AMT QTY •- AMT - QTY - AMT QTY ISSUE FEE , • $23.50, . . .. . 'Laundry Tub/Washer $0.00 .,0.- r' Sump Pump $0.00 0 Backflow irrigation. $0.00 0 : ' Landscape Irrigation $0.00 0 Swimming Pool ,$0.00 0 Backflow Preveriter 10.00 0 P-Trap $0.00 0 . ' .,Trap Primer $0.00 0 Bathtub $0.00 0 . . ,7 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 $9.80 1 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 $0.00 0 Drinking Fountain $0.00 0 : :Sink, bar $0.00 0 Water Piping (Inst 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 Gas(1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $9.80 1 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 TOTAL CALCULATED FEES: $43.10 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. 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(voo) DECLARATIONS (`� fl WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: I have and willmaintain 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. e and ' ma tain workers' •.nsation insu : ce,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My wo :rs' • •=ns. surance►rrier and po cy number are: Carrier: • Policy Number: (This section need not be completed it the permit Is slued et one hundred dollars($100)or less.) ❑ I certify that in e pert. ance of the work f.r which this permit is i sued,I shall n ploy any person in any manner so as to become subject to the workers' compensatlo s of 'fomia,and agre: hat If d become ubject t workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with titi . o - i ns. // yry Applicant Signature: mi. `i A./— Date: 6 O— a —O' WARNING:FAILURE RE WORKERS'COMPENSATION RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL AWES UP TO ONE HUNDRED THOUSAND DOLLARE ,..),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licens nder provision-of Chapter 9(commen g with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.#ilk �e / Class# /� Contractors Signature:`,A�yZatr Date: /0—A>r 0 CONSTRUCTION LE••GENCY: ❑ I hereby affirm that ere 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 pm* 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. 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 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: 11/4 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 l� material? 0 Yes 0 No r (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). 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 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 presently required,has Section 25534 of the Califomia 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 a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0No (Section 65850.2 of the Califomia 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 COMPLICE 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 th all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-d bed property f inspectin purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ,, Sign \ \r-' Y)1/ler(s) /0_ cDpte cc �� An3/6r AuthorizedAuzeApplicant Date gjINSPECTION TYPE PATE INTRIALS CODE' INSPECTION TYPE PATE IKTRIAL* 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 10-21-09 17 tii 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 SU•CT PROPERTY INFORMATION • 1) Property: 1578 SAN BERNARDINO PL, COSTA MESA CA 92627-3260 C037 APN: 425-321-32 Use: SFR County: ORANGE, CA Tax Rate Area: 15007 Total Value: $34,362 Census: 633.00 Prop Tax: $601.54 Land Value: $22,913 Map Pg: 31-D4 Delinq Tax Yr: Impry Value: $11,449 New Pg: 888-J5 Exemptions: Assd Yr: 1997 Phone: 760/360-1889 % Improved: 33% Owner: ROLFE EDWIN H/TR Mail: 37274 FESTIVAL DR; BERMUDA DUNES CA 92201 SALES INFORMATION IMPROVEMENTS LAST SALE PRIOR SALE Bldg/Liv Area: 1,092 Transfer Date: 07/12/91 05/11/70 #Units: Sale Price/Type: $6,000 UNKNOWN #Bldgs: Document#: 361366 931100128 #Stories: Document Type: QUIT CLAIM DEED $/SF: 1st TD/Type: Yrblt/Eff: 48 Finance: Total Rms: 5 Junior TD's: Bedrms: 3 Lender Baths(F/H): 1 Seller ROLFE EDWIN H Fireplace: Pool: Title Company: Bsmt Area: Transfer Info: Construct: SITE INFORMATION Flooring: Air Cond: Improve Type: Lot Size: A0.18 Heat Type: Zoning: Lot Area: 8,040 Quality: County Use: 1 Parking: Condition: Bldg Class: Park Spaces: Style: Flood Panel: 06059C-0054E Site Influence: Other Rooms: Phys Chars: Legal: L11 TR1267/N Comments: Copyright© 1996-97 Experian Page: 1 of 1