HomeMy WebLinkAbout1580 SAN BERNARDINO PL - Building Permits,
�ti�1J' n CITY OF COSTA MESA C
BUILDING DIVISION • '
} . a DEVELOPMENT SERVICES DEPARTMENT PERMIt NUMBER
4.+ . PERMIT V105-01466
BUILDING PERMIT
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.t.a.ub 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1580 SAN BERNARDINO PL Status: ISSUED
Suite: Applied: 09/01/2005
Vicinity: Issued: 09/01/2005
Primary Occ: R3 Type of Construction: V-N
Parcel Number: Zoning:
Applicant: MOREL RODAS
Address:
.-. - Phone: - -
- _ - - ISSUED BY: 6,7 ('--
_ ' - Zip:
Owner - -
•
Address , , - / .
- -
Contractor %ISLAND BLUE POOLS
Address: , 960 CONGRESS; :-/-• 10 \- c
Phone: 949-64 ,A5---®
r COSTA MESA;CA
/ .' / p,/
r; Zip.i 92627 �i %License: 837526
i
Arch : -r „4/,/,)
'Address: , °/ ' -_-. - Address:
', .. Phone , ':- - _ - Phone: -
•
Zip: ' License _ y ,,j' License:,
l v.A • ._-.. -. -
` \ SCOPE OF PERMIT V"
INGROUND POOL-AND SPA _ - - - _ A
i .. .T. .. _ _ ,- .- .. - .
_ -t" FEE,SUMMARY.'/, `. r
• Plan Check: $441.19 - - - - - 4 • • Calc Valuation: $55,000.00
Permit: $678.75 Claim Valuation: , $55,000.00
SMIP Res: $5.50 -
SMIP Com: $0.00
Other: $0.00
1 Inspection: .v $0.00 � /
Total: \$1;125.44 ' c.c.:-.---, -i/i
_ , .
,0,, < . , .PLANNING & ZONING /% -
`
SETBACKS `-,N ��-^ r' i ' }. A ,/
MAIN STRUCTURE Front) 0- \�, -.fRear 0 0 1 Left o 0-0 Right 0 0 - • / 7
ACCESSORY\\ Front '1'0;0., „---'-.11-':'-'-\.>,c-
`Rear 0 0 : \ Left 0 0�� ';Right < 0-,0,--/,' ff i, ' '
PARKING
\H----\.\\,
,\Ezistinq /- 0/ Required\~Ole Proposed -"0" t\ ��,= j/ '
V 7/ -2-1-
-
�-'.
•
1-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) 11
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 ( ) r'h
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 perrrrormance 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.
eh.
work m�nsat tns)urrranga carder and policy number ere: umber: 7 4O S G'
section need not be completed if the
permit is valued at one hundred dollars($100)or less.) dip
❑ I certify that in the performance of th rk for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
co .•: :tion laws of California,an ee that if I should become subject to the workers'co sation provisions of Section 3700 of the Labor Code,I shall forthwith
.y wit• these provisions. /y
Apr ant Sign: re: 7A Date: % O L. S
A- m •LURE TO SECURE RS' PENSATION COVERAGE IS UNLAWFUL AND SHAH-SUB.' OVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
AIL• D DOLLARE(51011,000 DmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES.
LICENSED NTRACTORS DECLARATION:
I hereb fli I am licensed u provisions of Chapter 9(commencing with Section 7000)of Division 3 of the and Professions Code,and my license Is in full
force .Lie.x f 1 ?4 lass*I C—5
Co rectors ature: ...„042./._. 04-0/—U.r
CONSTRUCTION LEN NC GENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that h),ok5he is ex_ from and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects ihe'epplicant to a iFA penalryrof-not'mt,m ppre themefR ed dollars($500).):
r:r'Y.C:. it,. RCA t I i.3s.
❑ I,as owner of the property,or my employees with wages'a their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contraddrs 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 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 end filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aggernit Tor 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 fumished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
South Coast Air gem _.r ._
7 a permit fromv the South Coast res Qualityced by CaliforniaHeal or other air Pollution cion 4l district3be or ade?y is required for the work which is the subject of this
application,have all of the disclosures prescribed by Celifoia Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
//
• Legal Owner(s) Date
/ 7— OS
• •tLWe1i: plica
CODE e . ' •e..-.rait.
` QAIE MAfi MEI INSPECTION TYPE DATE DMA
1616 Fixed System Final Fire Prevention 206 Final Mechanical
n
1266 Pool Spa Final �-'1-0.5— 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 7 �
204 Final Demolition 250 Final Building/Occupancy jZ f—0s e63'l
.
;Y�i-L: ,, CITY OF COSTA MESA
t� BUILDING DIVISION
Y 14 ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT V055-00914
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. 1.€ CTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1580 SAN BERNARDINO PL Status: ISSUED
Suite No Applied: 09/01/2005
Vicinity: Issued: 09/01/2005
Parcel Nunmber:
Applicant:
Address: __ '
Phone: - ISSUED BY:
Zip -
Owner:
Address / :, '.'
,. ' -
Zip: ,�
r
N6,? M g\
t/.(/
ISLAND BLUE POOLS -cc ` /1 D/ s
ii VF %/ / La vC`LI Sipe.
Address v-! 960 CONGRESS r ,024.7.
�'-,-
•
' / . i ;/' ' Phone:=949-645-6726 /,..� ,Ard Irs r , _- •
-
- COSTA MESA,CA Zip: .4.92627 ,, - -�
/ / - ,• License:837528 - - -•
/
� - - _ -,.
V �
-- - '- SCOPE OF PERMIT �A ,, v ,
' i'INGROUND POOL AND SPA. REF B05-01466
V -
- _ -FEESUMMARY -_ - _ v -
.. . , , Quantity. / "-,ti -r ' 4
;
- r--:--, i r. .� ,.z. •,: Quantity ' -
ISSUE FEE ' $23.50 - - -' Tern-Dist System/Lighting N $0.00 0
' Temp service test $0.00 - Busway/100 ft - $0.00 0
Res.a/c package $0.00 Standing Section.T $0.00 0
New Res(1-2 units). , $0.00 Q.- \,- Misc Electrical Equipment - $0.00 0 ' '
New Res(3+units) , $0.00 : - 0 _ _ __ - _ _ ",- Transformers up to'1 kva/kw;; $0.00 . 0 ' 1::
Pool/,Spa $49.50 ,-. 1 - _ -uptolokva/kkw_ ), $0.00 0 r: ' ,
Lighting Fixts' $0.00 0 - ' _ up to 50 kva/kw $0.00 0 -Y
Recept Outlets , $0.00 0 up to 100 kva/kw $0.00 0: 1 % . - '
Switches Vii' $0.00 2
0 l' over 100 kva/kw $0.00 0r��;
Non Res-Appt- 1 , \-/ $0.00 0 Low Voltage:Equipment ' $0.00 7o' -
Res Appl;, \ -' $0.00 - 0 Low Volt Wiring System/Ckt , $0.00 O'
Service to 200ayyJ $0.00 0 .n'-f,„. :Misc.Conduit $0.00 7 4,0 --, * '
Service"to 1000s ,x $0.00 0 -, Misc.Conductor ,$0 00. 0
Service over/1000a A`$0.00 0 Circus(gen or ride) $0,00%;,' 0, r j
Motors to 1hp $0.00 I-' 0 -Circus(meth:ride orlights)r44 '$0.00 0 -v" 1-J ,'
Motors to 10hp t /> $0:ook 01'' ? `' -Christmas Tree Stand . -3_,,-;$"6.60 ., 0
Motors to 50h `
p � �� $0.00��' �� 0 -� -' Fireworks Stated" '-';*$0.00V ` 0 ' /
Motors to 100hpv�/N. \'/r x$000 �--0� - 1-` .,' ' Other Electrical:Fee ''`` $0.00 .'>j /I, ',
Motors over 100hp' ,-,. ��$0.00_ -0-� - " .'r
Communication dropsv, $0.00 / 0 ' _ - ---,-,,,....Investigation Fee $0.00/ ,-, i
Sub panel to 200a A' o` $0.00' '/ 0 N - -PIan-Check Fee ''�`.\ .$0.00� ,
Pole Light Pkg \\%,,,'..:/$0.00 -:`•r r 0-' ' �„_ Reinspection Fee - ""$0.004 'i v
Sign Circuits ,$0.00 , '0 " _ ,
Temp Pwr Pole $0.00-- -- 0'' ' '_TOTAL CALCULATED FEES 2$73.00
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 stasutes 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. P1
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
2446-48(WOO)
1
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
work for which this permit is issued.
❑ and will maintain workers' pensaten insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My orkers' ,r(pp'en Ion Insu carrier and policy number are: —7� 776 16/
Car. . �ot /e h/�(� P4 Number1 0 J 6
is section need not be complet if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that In the performance of I , '.•rk 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 /:.ree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
co these provisions. Aa 2- 9- h /-,^r
Appli : re: Gj!/ `M lJ (J
WARN-. LURE TO SECURy�,T�=yr'fy�"�� 'COMPENSATION OGVERAGE IS UNLAWFUL AND SHALL SUBJECT AN E YEA TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100,.•;T r' ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I here t I am llcens-• •er p ovtci•m of Chapter 9(commencing with Section 7000)of Divisio ire Busine laProfessions Code,and my license Is in full
fo ect.Llc.4 / /7 lass k
nature: AL7 n)_ Q r
CONSTRUCTION LE -(• •GENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit t0 construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fora permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as•w•eyof 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.
7• ss andIProfessionsCode .e Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
hi ,IT-17`:rself ough hl a d;n employes
e ,ff,-•vided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sol ' .ne yea mpletr -
lit .. ner buil yA Have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as ow •f the p rty,a $'r -R1 ELY -. •TNG WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contracto cons: •: not a•>- o:7''7 ner 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 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 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 personhas 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 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).
o
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 ,r ❑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 Flre
Depart)nent 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 implication 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 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 ❑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 subjectof this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
_.......__ l__.. _._.._ __ _.t_
8 (If yes",attach certificate of compliance from theeappropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. .
lure Of Legal Owner(s) Date
/'/I.!!i}fl!.;' .dAppli :- ' to
CODE• )N5PECTIO• PATI I ITIAT LS LODE( INSPECTIONTYPE \\\\ gen IMAL35
1618 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical I?rI-o
K r
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
•
.Nr, 'St.-, CITY OF COSTA MESA
4BUILDING DIVISION> �'.�..s. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
4.F l 'li I PERMIT j,M05-00495
It 6.
(714)754-5273
• Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 1580 SAN BERNARDINO PL Status: ISSUED
Suite No Applied: 09/01/2005
Issued: 09/01/2005
Vicinity:
Parcel Number: 42532132
ISSUED BY: G'
Applicant: - - -
Address: - - _2 - - • -'
Phone: , i / e
Owner , PAURI, FABRIZIO
Address 92'LEHIGH AISLE= -
Phone:
IRVINE;CA Zip: 92612-4107 �-- ,
r
j Contractor: , ISLAND_BLUE POOLS
.; Address:- 960 CONGRESS ,
. ! Phone: 949-645-6726
.COSTA MESA,CA '• Zip: . 92627 '_ -
);License:837526
•-
,
' SCOPE OF PERMIT '
' l; INGROUNDPOOL AND SPA REF B05-01466 ', / . .
- FEE SUMMARY • '
Quantity _. _ n• _ . . t . Quantity-- .
'ISSUE FEE 523.50, ' / •- - 'Repair/.'AIt-Absorbtign Unit ,- $0.00 0
Inst FAU<100 k BTU ' ' $0.00.0 1- =` ' -`_ - _` " Repair/Alt Refrigeration Unit - , $0.00 0/
Inst FAU>100.k BTU'. $18.20 1 Ventillation.System , , $0.00 0
Repair/Alt Cooling/Heat $0.00 0 -'-' Evaporative Cooler 4 '$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>100k BTU $0.00 -• 0 • -- - - . - Compressors?Absorption Systems r,` •
Gas Piping - $0.00 0 Up to'3 hp/100 k BTU • $0.00 0
Factory Fireplace $0.00 0 3 To-15 hp/500 k BTU /1 ' ' ,$0.00 - ' 0
Hood w/Mech Exhaust '_ $0:00 0 15 To 30 hp'/1,000 k BTU
VAV Box, v. A . \ ,y</, $0.00 0 30 To 50 hp/1,750 k BTU r 7,. _> $0.00 ,0
Vent Fan/‘Single'Duct '", $0.00 0 - �Z Over 50 hp/Over 1,750 BTU j/," ' $0.00 0
Appliances`. \ ,- N� $0,00 0 k.<t.',,4 Boilers C'
Fire Damper's, r \L� $0,00 0 ',- ' `' - - Up to 3 hp• ///� $0.00• 0
Smoke Dampers vA;A$0 00 0 r ' <7 3 To'15 hp ! " , $0.00 ' 0
Inst or Relocate Appl Vent ,�.$0 00 0+`•' _ i - '15 to 30 hp'' `, - •/ N $0 00, 0
Air Handlers‘< 10000cfm j, "�$0 00 0 - - 30 to 50 hp; _.;--_,-74/ $0.00 0
Air Handlers>'10000cfm7//' ,, , $0:00,1K:0 o ''Over 50 hp _. „..„•";:,,,--:,'"" /,` l,• , $0.00 0
Floor Furnace _ (/ // $0.00 .i0 "� Other Mechanical Fee. < .--,'-'4/„../ /�,"/,'
'7 $000, 01-::::::'. ti -„�, Investigation Fee= '' \�./% ' /� , $0.00
Floor or Suspend Heater - , ,
�. \-...,'-, .'/ �; - \_:_•\T--,-„Plan CheckFee Av`� C/ iI', $0.00
. '"N , ,_ - - Reinspection.Fee '\`� '�-' ,-? , $0.00
NI i'- .- _. A t /"�,/
�` - , , ' i"; ,( r -TOTAL CALCULATED'FEES $41.70
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,ls 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 (Th n
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
i rA and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for r_performance of the work for which this permit is Issued.
"""' rk 15 po`i�(''atlon I)fsu;enc� er and policy number are: / 6;0
Q /.
5-T/ �Vnl, Der: (q L
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensatio . . -of California, - ee that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
com. - these p •vislons. / /
{� �/� ^)
Appli r' ignature: �'/ ��/ .L Date: 9—�/ _L�
WA ' .PAI - •SECU-trii- •• -ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBI CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
• • •• -E(S10O.. $ ION 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 affi I am lice ed un.- p'visions of Chapter 9(commencing with Section 7000)of Division e sine*and Professions Code,and my license Is In full
force # A ill -b Class# ( - D
C tract re: �fr"�I_r/J e: 9_O/-of
CONSTRUCTION - Di. = AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file'Iafdlpned statement that he orshe là licensedipusuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Bus wst end Professions Code)or-that he or she`ll:eexernpt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subj6ctiAie applicant tda civil penalty ofnot morrifirmp fide hundred dollars($500).):
❑ I,es`oLviner of the propertymy-er� ss
ployeiWth ages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,,Business-I „ob
nd 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,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 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 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 0N
(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 agermit for such construction or modification
from the South Coact Air Duality Management District or from any other air pollution control district or agency? 0 Yes ❑No
(Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits).
__..dunder ithin 100_
8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
...._ _.es,_...._ _ _._........__._.._ _
8 (If yes,attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
A..- re Of Legal Owners) rj 0/--Of/�i to
4,j �•Jr� . .ripI t , Q Date
CODE 6 INSPECTION TYPE PATE INT1TIAL$ CODE6 INSPECTIONTYPE peg 1/11-
1616 Fixed System Final Fire Prevention 206 Final Mechanical 12_1-06 t
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
,
g1. 1`t r , CITY OF COSTA MESA •
BUILDING DIVISION •
H (" :moi DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
^RPpapr(o'" 405-00674
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1580 SAN BERNARDINO PL Status: ISSUED
Suite No Applied: 09/01/2005
• Issued: 09/01/2005
Vicinity:
Parcel Nunmber: 42532132
Applicant: ISSUED BY: .__6..
Address: - -
Phone:-
i. ;-. ,i Zip l _ - _
Owner' , PAURI FABRIZIO - = - _ >_•
Address !92 LEHIGH.AISLE % . 7/ 7
Phone:
IRVINE, CA Zip: 92612-4107
. /,,, / --p
Contractor: ISLAND BLUE POOLS
Address: 960 CONGRESS - e Phone:. r Phone' .949-645 6726 ,
- ' - 'COSTA"MESA CA Z p: 92627 , -
r • / License. . 637526. . - - _ - , , ,
• ' SCOPE OF PERMIT '� ' . '
` ' ` INGROUND POOL AND SPA REF B05-01466 - -- - - ' - ,
• . - "'FEE SUMMARY r . ' - .- ._.
AMT QT,Y AMT 'QTY AMT QTY
ISSUE FEE $23.50 Laundry,Tub/Washer $0.00 0 i Sump Pump ' $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation - .$0.00 • 0 Swimming Pool,,,.. ,. $60.75 ' 1
Backflow Preventer, } $0.00 0 - - P-Trap -. -'- - $0.00 0' , Trap Primer - $0.00 0
Bathtub $0.00 0 ' Pressure Regulator' ' - $000 . 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,;:�:�r - _ •$0:00 0
Dishwasher's ` \ ';$0.00 0 Sewer Cap for Demo . $0.00 0 Wash BasinSet - ' $0.00 0
Drain;Floor `,` - \,‘$0.00 0 Sewer Connect�,Y' '' `:--�� $0.00 0 Waste and7Vent System'; $0:00 0
Drain, Rainwater-- $0,00 0, Sewer Private Line " ..$0.00 0 Water Closet(Toilet)' / ,/$0.00 0
Drain, RoofJ'\ i. - $0:06:,\ 0 Shower ,'z. , $0 00 .i,. 0 Water.Heater/vent •
/x$0.00 0
Drinking Fountain ` _ $0.0 �.‘0 -Sink°bar $0 00 0 ...i...-,. Water Piping(Inst or Rep:)' ,$0.00 0
Expansion Tank" $0.00`-��0°- '`�`'i" Sink;commercial, , $0.06 ' 0 '� -''" Water Re-pipe - $0.00 0
Gas Earthquake Valve /$0.00 -'9 Sink, Floor - . . $0.00 . 0 " Water Service - $0.00 0
Gas(1-4 outlets)_ y�, c ,$0.00 7. 0-:"-•*:, Sink,kitchen • - ,. $0.00 - 0 - %;!Water.Softener /7 " " $0.00 0
Gas(Over 4 outlets)-N .$0.00 .r :0 Sink,service/mop -, , '$0.00 0 ".�," -OTHER' Cy' ', $0.00
Gas Repipe v��w$0.00'% -0,-,_ -Sps,(priv-ate)-;_v;,_\,_,,,,$30.25 .:5---"`' ,�r�VIOLATION ,/, / $0.00
Gas Service vA,$000'.) 0,r 1 P r-_ Spa(public)_=-- 2'..-:- --$0.00 -'0 S, .L PLAN CHECK' $0.00
' . Interceptors(Grease,Oip"/$0.00. '0- ' - ' , � , v 'REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00.;•-,0 . - �1 --
- ,, , i TOTALCALCULATED FEES: $114.50
2 • . . . . : . , , ,
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) fir1
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if worlds suspended or abandoned
for a period of 180 days. P;
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
2446-461N00)
DECLARATIONS �1 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
work for which this permit is issued.
❑ ha e 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 orkers'compensation Insurance carrier and policy number are:
ar Po Numbe 17 7 (,O S C
(This section need not be completed/l the permit Is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the 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,an