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Home My WebLink About3481 SAN RAFAEL CIR - Building Permits(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress� 34$1 SAN RAFAEL CI Suite No Vicinity: Parcel Numbec 41205125 Applicant PUIG, ALLEN / ,, Address: . . -� / ' . � � � � � /� i, � ' • � owner.'. EILERTS, WILLIAM TR Address: 3491 SAN R4FAEL CIR � COSTA MESA, CA MECHANICAL PERMIT Status: ISSUED Applied: 07/27/2001 Issued: 07/27/2001 ISSUED BY: � Phone: 714-634-8860 . , ., , � Zip. . � �� ''�\ � \ ,, Phone: , �� . Zip: 92626 � � , Contracror: ALPS AIR CONDITIONING 8 HEATING Address: 2020 E HOWELL AVE #J � . ` � , Phone�i (714)634=8860 ' ANAHEIM, CA - . � Zip:� 92806 � i a � , � License:667953 SCOPE OF PERMIT , � ' REPLACE FURNACE AND ADD AIR CONDITIONING. � . , - , , . _ � _ 'i ' • . _ . . _ , . � - - FEE SUMMARY �� , , � � Quantity � - �Quantity;� � ISSUE FEE $23.50 �� Repair / Alt Absorbtion Unit ,� $0.00" 0 � Inst FAU <100 k BTU $0.00� 0� � . ' � � Repair/Alt Refrigeretion Unit � � $0.00 � 0: � � Insf FAU >100 k BTU $1820 1-- ' �' - - - - - Ventillation System � - $0.00 0� Repair / Alt Cooling/Heat $0.00 0 - - Evaporetive Cooler � $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Commercial Incinerator , $0.00 0 `� Refrig Sys <700 k BTU $0.00 0 Domestic Incinerator $0.00 0 . Refrig Sys >700 k BTU 50.00 0 Compressors / Absorption Systems - Gas Piping $0.00 0 , Up to 3 hp / 100 k BTU . ,$0.00 � 0 ' Factory Fireplace � $0.00 0 ,- .�'3 To 15 hp / 500 k BTU ,"�' ' $0.00 , 0 � Hood w/Mech Exhaust $0.00 0 �� 15 To 30 hp / 1,000 k BTU -,, 80.00 0 VAV Box� � $0.00 0 �� 30 To 50 hp / 1,750 k BTU � .$0.00 - 0 Vent Fan / Single Duct � �, $0.00. . 0 . .. � Over 50�hp / Oyer4;750;BTU -. , � 50.00 � .0 Appliance `. ' . ��$0.00-��0�� Boilers � � � � � Fire Dampers , , � � $0.00, 0 � � �- � � � Up to 3 hp " � , $7470' 1 Smoke Dampers � � 50.00 , '0 � 3 To 15 hp - � . , . , , �$0.00 0 Inst or Relocate Appl Vent �- 50.00 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 �� 50.00 � 0 Other Mechanical Fee .- , Floor or Suspend Heater � .� 50.00 0 Investigation Fee - - , $0.00 -. . Plan Check Fee SO.00 � . Reinspection Fee . . $0.00 � TOTAL CALCULATED FEES E56.40 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) E%PIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all raquired Inspectiona and final approval must be obtained. Failure to obtain inspections antl final approval will result in the ezpiration of this pertnit. FOR INSPECTIONS CALL: (714) 754-5626 2C46-0B (B/00) WORKERS'COMPENSATION DECLARATON: I hereby aHirtn under panelry of perjury ane ai the following daGaratlons: ❑ I have entl will maintain a certificate of consent to self-Insura for workers' compensatlon, es provided tor by section 3700 of the Lebor Gode, for ihe pertormence of Ihe woAc tor w�ich ihis pertnit Is issued. �I have arM will maintein workers' compensa6on insurance, as requiretl by section 3700 of the Le6or Cotle, fo� Ihe peAonnance of t�e work for which ihis pertnit is iuuetl. My workers' compensation Insurence certler entl policy number are: Carner: Policy Number: (TAis section need nof be comp/eted ll Me pem " !u� at one hundred dollars ($100) or Iess.J ❑ I certify thet in the pertortnencey e work fq')dnich thi pertnit is issueQ 1 s�ell not employ any person in any manner so es to become su6ject ro the worke5' wmpensetion lews ot Calltorpi4, and egr 'i 5t Ii sho become sub�ect to the workero' compensetion provislons oi Sectlo^ 3700 0l ihe Lebor Cotle, I shall forthwith compty with these provisio C ^�� /^ ` ApplicentSigneture: Dete: �/ �— U , WARNINO: FAILURE TO SECIIRE ORKERS' PESlSATION C1�VERAGE IS UNLAWFUL AND SW1LL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED TTIIXISAND DOl1ARE (E100,000), I �TO1FE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]OB OF THE LABOR CADE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECIARATION: I hereby attlrm that I em Iicensetl under sic force entl eHect. IJc. N ContrectoYs SigneWre: CONS7RUC710N LENDIN .CI � I hereby aflirtn that there Lenders Neme: Signatura: �pter 9ZC mmencing with Section 7000) ot Division 3 of Ihe Business and Pmfessions Code, and my Ilcense Is In tull � C1855 k %— Da�e: % % � � � landing egency for the pedormance of the work tor which this pertnit is issuetl. (Sec. 3097, Civil Code). Lenaer's Atltlress: Date: OWNER-BUILDER DECLARATIONS: I hereby atfirtn thet under penalTy oi perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe follawing reason (Sec. 7031.5, Business end Protesslons Code: Any ciry or counry whic� requires a pertnit lo wnsiruct, elter, improve, demolish, or repair any structure, Prior to its luuance, also requires the applicant for such pertnit ro fle a signeO stetement thet he or she is Ilcensed pursuent to the provisions of �he Contrectors License Lew (Chapter 9(commencing with Sectlon 7000) 01 Dlvlsion 3 of the Business entl Professions Code) or thet he or she is e:empt therefrom end �he basis for Ihe alleged exemption. Any violation of Sectlon 7031.5 by any epplicant for e pertn+: su6jects ihe epplicant to a civil penalry ot not more then live hundred dollers ($500)J: 0 I, es owner of Ihe property, or my emplayees with wages es t�eir sole compensation, WILL DO THE WORK, and the structure Is not iniended or oHeretl for sale (Sec. 7044, Business antl Professions Coda: The GONractors License Ww does not apply to an owner of properry who builds or improves thareon, and who doas such work hlmseB or herseli or Ihrough his or her own employees, pmvided that such improvements ere not intendetl or oNered for sele. I( however, ihe building or improvement is sold wiihin one year of complation, ihe owner-builder will have ihe hurden ot proving that he or she did not builtl or improve for purpose oF sele.). ❑ I, as ownar ot tha property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business end Protessions Code: The coniradors License Lew tloes not appty to en owner ot pmperty who builds or Improves thereon, end who comracts for such project wlih e contrector(s) license pursuant to the CoNractors License Laws.). ❑ I am exempt under sec. Signature: Owner ID verified by dnvers license. ❑ Ves ❑ No Business antl Professions Code for ihis reason: Vedficetion of Ownerehip by (type o1 dxument, i.e. - property tac bill or tleetl): Driver's License No. Date: Expires: DIVISION OF INDUSTRIAL SAFETV PERMR CERTFICATION: ❑ I hereby certiy that no eacavetion five (5) or more feet in depth into which a person is required to descenq will 6e made in connection wit� work authodzetl by Ihis pertni�, end Ihet no builtling structure, scaHolding, falsework, or demolition or dismantling thereof, will be more ihan �hirry-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Calilomia Atlministrative Code). ❑ As owner-builder, I will not employ enyone to do work which woultl require a permil from the Division of Industriel Setery, es notad ebova, unless such pereon has a permit to do such work from ihe division. Signature: Data: Division of Industnal Safery Permit Number: CERTIFlCATE OF COMPLJANCE AND AUTHORVATON OF ENTAV: I certiy under penalry ot parjury �hat I have read Ihis applicalion and state Ihet ihe intortnation given is correct. I agree to comply with ell state lews and ciry ordinences relating to bullding construction, and authonze represeniatives otthe Clry of Costa Mesa to enter upon Ihe ebove-described properry tor inspection purposes. I egree no�occupy or allow acupancy of any building authonzed by this permit until finel inspection. COpEI, INSPEGf10NTYPE � Qej[ INTRIpLS 1678 FixeG System Final Fire P ention 1266 200 201 202 203 Pool Spa Final Final Re-Roof Final BIocWRetaining Well Final Fectory Fire Placa Final Sign 204 Final Demolition � /� -z�/ �o�ta ate CQOE� INSPECTIONTYPE 206 Final Mechanical �� 200 210 212 220 Finel PIum6ing Finel Electncal Finfll Fire Prevention Final Planning Approval 222 Final Site 250 Final BuiltlincyOcwpancy (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: $481 SAN RAFAEL CI Suite No Viciniry: Parcel Nunmber: 41205125 Applicant: PUIG, ALLEN Address: i,s . �.� ,, ;: . ' ; . i��. , " • ',� - , Owner:/�EILERTS,'WILLIAM%TR Address� �3491"SAN RAFAEL CIR` COSTA MESA, CA Phone: 714-634-8860 Zip: Phone: Zip: 92626 Contracror ' ALPS AIR CONDITIONING & HEATING Address: 2020.E HOWELL AVE #J , � , � - �, � ' �Phone: p14) 634-8860 ANAHEIM, CA � " ' � Zip:- 92806 � � � License: 667953 � ��.� Stams: ISSUED Applied: 07/27/2001 Issued: 07/27/2001 ISSUED BY: SCOPE OFPERMIT , . _ � _ , REPLACE FURNqCE AND'ADD`AIR CONDITIONING. � � ! . � . ISSUE FEE Temp service test . Res. a/c package New Res (1-2 units) . New Res (3+units)� Pool / Spa Lighting Fixts Recept Outlets Switches''�� , Non Res Appl� ` � Res Appl Service to 200a. �� ' Service to 1000a ' Service over 1000a Motors to 1 hp Motors to 10hp Morors to 50hp Mators to 100hp Motors over 100hp Communica[ion drops Sub panel to 200a Pole Ligh[ Pkg Sign Circuits Temp Pwr Pole Intermed Pole Quantity � $23.50 $0.00 $0.00 $0.00 0 $0.00 0 $0.00 0 $0.00 0 S0.00 0 50.00 0 , $0.00-. ,�. '.' p; � .' ,- $0.00 .� 0 . . � $0.00 _ .�.p - $0.00 0 $Q00 ' ' 0 � � . $0.00 0 $0.00 0 � $24.60 � � - 1 $0.00 0 $0.00 0 $O.oO 0 $0.00 0 y0.00 p 50.00 0 $0.00 0 $0.00 0 FEE SUMMARY ' ._- - ' _ � � � - QuantitY , - Temp Dist System /.Lighting $0.00 0 � Busway /100 N � $0.00 0 � • Standing Section $0.00 0 Misc Electrical,Equipment $0.00 0 Transformers up to 1 kva/kw $0.00 0 :.. �. .......>.........up to 10 kva/kw $0.00 - 0 � .�� .._.._.........up to 50 kva/kw $0.00 ' 0 � � � ..._............up to_400 kva/kw $0.00 ,' .� 0 - ......._.........over 100 kya/kw . $0.00 � 0 � Low Voltage Equiprrfent '� � � - $0.00 0 � � , Low Volt Wiring System / Ckt $0.00 � 0 Misc Conduit � $0.00 0 �_ Misc. Conductor �� $0.00 ; � 0 � � Circus ( gen or ride) $0.00- � 0�, ' Circus (mech ride or lights) $0.00 � -0 Christmas Tree Stand -50.00 0 ' Fireworks Stand � $0.00 . 0 Other Electrical Fee 50.00 Investigation Fee �. " �$0.00 Plan Check Fee ; - � � - $0.00 ' - Reinspection Fee - $0.00 TOTAL CALCULATED FEES $48.10 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatiqally 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. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applica6le codes, and all required Inspectiona 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) 7545626 2466-661��) WORKERS'COMPENSAnON DECLARATON: . � I hereby ettirtn under penalry of perjury one ot the following Oeclarations: ❑ I heve and wlll maintain e certificete o1 consent to self-Insure for workers' compensetion, as providetl for by section 3700 of Ihe Labor Code, for the pedortnance of the w or which Ihis Dertnit is iuuetl. I have entl will maintaln workers' compensation Insurance, as required by sectlan 3700 oi Ne Labor Code, for the peAortnence ot lhe work for which Ihis pertnit is I5sue0. My workers' compensatlon Insurance cartier and poliq number are: Cartier: (This Se hundred dollars (8100) ar /ess.) PoliCy Number: ❑ I cetlify thet in the pertormence of Ihey�e o� ihis p rmit is issued, I shall not employ any person in any mflnner so es to become subJact m the workers' wmpensatlon lews oi Cellfomia riH agree t f f I ahaul ewme subJea ta Ihe workers' compensation provisions oi S tlon 3700 of the Lebor Cotle, I shall farthwith comply with these provisions , _ � �`2 � � ,� � Applicent Signature: Date: � WARNING: FAILURE TO SECUR WORKERS' ATION COVEMGE IS UNIAWFUL AND SHALL SUBIEGT AN EMPLOVER TO CRIMINAL PENALTES PND CIVIL FlNES UP TOONE MUNDRED hKK15ANDDOl1ARE(5100, OTHEC0.STOFCOMPENSATIIXJ,DAMAGESASPROVIDEDFORINSECTION31080FTHELABORODOE,IMEREST,ANDATTORNEV'SFEES. LICENSED CONTRACTORS DECLARATION: � I hereby alTirtn that I em Ilcensetl force antl eHecc Lic. N Contractofs Signature: _� CONSTRUCTION LENOtNG-I ❑ I here6y ettirtn Ihat Ihere Lender's Neme: Signature: Section 7000) ot Division 3 of ihe Buslness end Professions Code, antl my license Is in full _ CI855 M Dete: lending agency for the pertortnance of Ihe wark tor which ihis pertnil is issued. (Sec. 3097, Civil Code). LentleYs Atltlress: Date: OWNER-BUILDER DECLARATIONS: I hereby eNitm thet untler penalry of perjury that I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW tor Ihe tollowing reason (Sec. 7031.5, Business end Professlons Code: Any ciry or counry which requires e permit to consiruct, alter, improve, demolish, or repair any structure, pnor to its issuance, also requires ihe epplicant for such pertnit to file e signed stetement thet ha or she Is Iicensetl pursuent to the proNsions oi ihe Gontradors License Law (C�epter 9(commenUng with Section 7000) of Dlvision 3 of ihe Bu5ine53 and Protessions Code) or thet he or she i5 exempt therelrom and the basis for I�e alleqed exemption. Any violation of Seclion 7031.5 by eny epplicant br 8 perm�l su6�ects the epplicant to a civil panalry of not more ihen Nve hunCretl tlollers ($500).): 0 I, es owner ot iha properry, or my employees wlth wages as Ihelr sole compensation, WILL DO 7ME WORK, end ihe structure is not Intended or otteretl for sale (Sec. 7044, Busineu and Professions Code: The Coniractors License Law does not apply to an owner of property who builds or improves ihereon, entl w�o does such work himself or herself or ihrough hls or her own employees, praviaetl that such improvements are not Intanded or oflered for sale. H, however, the building or Improvement Is sold within one year ot completion, the owner-builtler will heve ihe Curtlen ot proving ihat he or sha did not builtl or improve for puryose of sale.). ❑ I, as ownar of the property, em EICCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (SacJ044, Business entl Professions Code: The conirectors Llcense Lew does noi appty to an owner ot property who bullds or improvas t�ereon, and who comracts for such pro�ect with a contrector(s) license pursuant to ihe Contractors licensa Laws.). ❑ I am exempt under sec. _ Signature: Owner ID veniietl by dnvers license. ❑ Ves ❑ No Dnvels License No. Vedfiwtlon oi Ownership by (type of documenL i.e. - proparry tax bill or deed): eusiness and Professions Code for this reason: DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: Date: Expires: ❑ I hereby certity ihat no e:cavetion fve (5) or more feet in depth into which e person is required to descen4 will be mede in wnnection with work euthonzed by Ihis permit, anC tha� no building siructure, scaflolding, falsework, or demolition or tlismantling Ihereot, will 6e more Ihan ihirty-si: (36) feet hlgh. (Chep. 32, Grp 2, Art 2, Sec. 341, 7tle B, Cali(omia Administrative Cotle). ❑ As ownervbuilder, I will not employ anyone to tlo work w�ich would requlre e permit irom ihe Division of Industnel Sefey, es noted above, unlass such person has e permit to da such work irom the division. Signature: Date: Division ot Industriel Setery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVJITION OF ENTAY: I certify under penelty of perjury that I have read this appiicetion antl state ihat the infortnetion given is wrrecf. I egree to comply with all stata laws end ciry ortlinances relating to Duiltling consiruction, and authorize representatives ot the City ot Costa Mese to enter upon the ebove-descnbed property for inspection purpases. I egree noi to occupy or �lavfoccupancy oi eny building authonzed by this Dermit until final inspection. CppE t. INSPEC710NTYPE �� QejF 1616 Fixed System Final Fire Prevention 1266 200 201 202 203 204 Pool Spa Finel Finel Re-Root Finel BIocWRetflining Wall Final Factory Fire Place Finel Sign Finel Demolition � � � O � Date T— � Date IMRULS 400E• INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 220 Final Fire Prevention Final Planning Approvel 222 Final Site 250 Final Builtling/Occupancy PAIF 1t�4$ I �� 29550 COSTA MESA BUILDING-SAFETY DEPARTMEMT P.O. BOX 7Y00 � COSTA MESA, CALIFORNIA 926Y6 For Applicant ro Fill In Completaly TYPE OR PRINT BUIL�IN6 3481 San Rafael ��Q,� ADDRES8 COSTA ME3A, CALIFORNIA US8 OR arr 5' I R�arrr R' DESCRIPTION O! WORK 1 cl 1 H8R8BY ACRNOWLtDOC TXAT 1 MAV6 RBAD TIIIB APP�ICATION AHo e'JwT6 THAT TN6 ABOV6 �t CORR6G! AND AORE6 M COM. PLY WITX /�LL CITY ORDIl4�NCf0 ANG YTAT! LAWD Ri0YN1TINa BUILDINO CONBTRYCTION. SIGNATURH OP PERMITTi AUTHORIZfiDAG6NT ' � �CL� JAN -7-69PA�°DO 180+� *** �M_, 128.C� APPLICATION FOR PERMR BUILDINf3 For OffJco Use On1y sv ZONINfi Ho. oR uoc �un� o euu YARDe MPROVBD MAIN BUILDIN6 o�sr�ncs ecr. MAIN BLOOi. VAR. �C iX8 AMOUNT sNOW' PURPO88 OP 6YiAl VALUATION y r� (/� �J�vV SNALL B8 LE88 THAN YARDS MPROV ED ACCEII60RYBUILDINO owTe - �- 1 l � " a w � yb� � 0 VALU�TON 19 fOR TH[ j A PEPMIT PlH.ONLV. ). ��J•�/` 7 ITFEH $ y(} �S �p G .......... a �% 7 W PPDJECT ROONESS: 3.�.� 1 SAN RAFAEL� S I �� MOWNEfl'SNAMF:`EIi RTS WILLIAM"'" aooxess: 3481 SA{1 RAFAEL CIR COSTA�MESA,CA 92626 UNIT: 557-9158 APCNIENGINEEfl: SIM LANGSTON xec.xo.:C29373 RUOPESS: SBOO E 17TH ST UNIT: ].OL SANTA ANA CA 92701 renmiTreeFAIRWAY ROOFING INC. (719)454-9228 aooeess: 26002 MARGUERITE PARKWAY 299. MISSION VIEJO CA 92692 LICENSEO CONTBqCTOfl OEClABl1TIUN: I hereby attirm tha� I am Iicense0 under Orovisions ot ChaD�er 9(commencing wi�� Sec�ion 7000) ol Div�sion 3 of Ihe Business and Pmfessions Cotle, antl my license is in �ull force antl eflec�. c�Truc.:053665 STATELIC.:6S39% cuss:C39 � . �ate'. �` �� Signature: WOflKEflS' COMPENSRTION OECLABATION: I hereby alfirm �hat I have a cetlifica�e oi consent �o sell�insure or a ceni�icale of Workers' Compensa�ion vy a c,e� ifi cp py Ihereo� (Section 3800. Lab POIICYNO.: �L&iL�� L E%P.DRTE: 3/OS�93 camvaNr: STATE FUND � Cetlified caDY is hereby fumishetl. � C¢rti�ie0 topy is liled with �he ti�y BUil�ing Division. "�e'. � "7�/��. FPPlicanl: ��/�� E%EMVIIONFBOMWOPKEBS'COMPENSRTIONDECNPATION: (Thi55ec1ionneeAno� ecomplet ilthepermitisforonenunAreO(51001orless�. I certity t�a� in ihe pedmmance ol �he work to� w�ich this permi� is issuetl, I shall no[ employ any De�son in any manner so as �o become sublecl m the Workers' Campensa�ion Laws o� Calilomia. Oate: � Signalure: NOTICE: If. alter making ihis Oeclaration, you shoul0 become su6ject to the WorkeR' Compensaiion pmvisions of ihe Labor Cotle. you musl �orihwil� comDly wi�� such pmvisions or �his permil shall Ee deemed revoketl. CONSTBUCTION LEN�ING RGENCY: I here�y aflirm that there is a canstruction lending agency for ihe pedormance o( tAe work tor which Ihis perm�� is i=5uetl (Seclion 3097. Civ. C). LENDEfl: aooqess: OWNEB BUILDEfl OECIABATION: I hereby afiirm ��at I am exemp� Imm �he Coniracmrs' State �icense Law tor Ihe I011owinA reason (Seclian 7031.5 Business and Pw�essional Cotle'. Any ci�y o� couniy which reQuires a De�mi� �o coretmcl, alter, improve, tlemolish, or repair any simcture. prior to its issuance, aiso requires Ihe appfcant tor such permit to file a signea statement ihat helshe is IicenseU pursuam �o �Ae pmvisions oi Ihe Commcmrs' Siate License Law (Chapler 9(commencing vn�� Section 7000) a� Division 3 0� Ihe Business antl Pmfessions Cotle� or Ihat he/she is exempt Iherelmm and the basis �or �he allege0 exemp�ion. Any viola�ion ol S¢clion 7Q?1.5 by any applicani lor a Dermii suble��s I�e applicant Io a civil penaliy o� not more �han five hundre0 Ooilars (E500�. I, as owner ol t�e pmpeny or my employees with wages as Iheir sole com0ensation, will Uo the work, and the ❑ simcWre is no� inten0e4 or offered �ar sale (Section 7044, Business ana Pm�essional Code: T�e Contrac�ors' S�a�e License Law does nat apply to an owner of a Oroperty who builtls onmproves ��er¢on, and who does 5uch wo�k himsel�/herseli o� lhmugh his or her awn employees, providetl ��at such Improvemenis are no� imentletl or ofleretl for sale. I�, however Ihe 6uil0ing or impmvemenl is soltl within one year of completion, �he owner vnll have Ihe 6uraen o� proving he/she Aid no� builA or imDmve lor ine purpose ol sale). I, as owner o� the pmperty, am exclusively comraciing with IicenseA contrac�ors �o cons�mc� �he pwle�� (��ion 7044, Business ❑ antl Pm�essons CoAe: The Con[ractars' State License Law Oaes not apply to an owner oi pmperty who bwltls or ImD�oves �hereon and w�o conirects br such pmlecis wrt� a conlrac�or(s�license pursuan� to I�e ConVactors' State License Law),I am aware Iha� pmo� ol �heir WOBeYs Compensa�ion insurance shoultl 6e pwvitletl lo me. � I am exempt untler Section: B. 8 P. C. �or Ihis reason: Daie: Uvnec I tlo �ere0y cenity that I am aware of antl un0erstantl Ihe reQuiremenis of Califomia Healih and Salety Cotle Sectians 25505. 25533, anA 2553a and tha�l orany�uWre builtling ocapaniwilllwillnol (circle one) nee0�o comply vnih saitl stale co0e5 an0�he requiremenls�or a peimit for consimclion or motlificalion Imm Ihe Nir Oualiry Management �isVict. Resideniial cons�mction aDDlications are ¢x¢mpt iwm �hese pmvisi0ns. �a�e: Npplicani'. I hereby certily ihat I have reatl Ihis apDlica�ion antl sta�e that ihe above in�armation is carrec�. 1 agree m comply wilA all ciry and counry ordinances an0 S�alelaw5relalingio �mlding can5imtiion and herehy au�harizerepresenla�ives o��hi5 Ci�y�O en�eruDonlhe above�men�ianed pmperty lyor inspection purposes. ' / -Daie'. T1 `Z'G�'�— Si9naWre: ��¢�(�_ _r�`�j1� Driver's License o� Social Security p: � �$ t6al nb Wh�te—BUAtlina: Green—Cotle Enlorcement; Canarv—Aool¢am: Pink—Revenue: Goltlanrotl—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERMIT NO; H 058725 � PLAN CHECK NO: 03225-92 S CONSTRUCTION TYPE: V-N PERMIT TYPE: STR i." PURPOSE: ALT JOB DESCRIPTION ; T/OFF RESHT, REROOF W/PIONEER TILE SQ FT; 6,309 CLAIM VALUE: 6,304,00 CALC-VALUE: 6,304.00 GROUP OCC; R-3 / COMMENTS• SMOKE DETECTOR RE�UIRED ��r�t�r�r�r�r�r***+r****�*�t�rx****�r�t �****�r**�t�r�r�t�t*�r�e*�t***�t�t�r�r�r**�r*�r**�r�rx�r�r�r*+��r�t�r�t*�t�t*�r�r Z O N I N GS ERTEB�AUCIKRSE M E N T S ------------ MAIN BUILDZNG ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN-REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN PARKING REQ • PROV: PARCEL; 41205125 ZNE; REF NO; PLANNING NCSTES> C' % n iF 1FlF 1k if if �f if if iF ff if iF it 1E if 1k ik 1F iF if� iFiE iFlF �F!! if iF iE 1E iFlE If iE iF k iF 1F1! 1E iE iE jf iE iE iE iE iE 3f if iE 1k �k iE iE �f !E 1E �FlE iF iF iF 1E 1Flf fF9F iE ff fk �E iF 1F iE 3F 1F i!� D E V E L O P M E N T S E R V 2 C E S R E Q U I R E M E Ni�<T S i . ZONING APPROVED BY DATE: `' HUILDING APP.ROVED BY : ��%- �P�r� DATE: �'�_��-•' APPLICATION 'ISSUED BY; ` DATE; �C3'y—�/Z ik iF 1E iE iE 1E 3ElE iE �E iE �F'1E iE fE iElEik it iF i6 * 1E fE iE �E 1E iE iF iE ikiEi��{�iE if �kikfElFiF1EiE1FiEiEiF1EiF�F1E�FiEiEiEifiPiElfikififiPlf�EifikiFiFiFifiEiliF iFiEifiE�EiF�FltikiliEifiEiEiFiflfiflfiEikifiFlFiEiEiEiE'iFi(�1EiFiFif�FiEiFiE LEGALIZATION;N F E E S U M M A R Y STRUCTURAL'SEGMENT;Y BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT 90.00 PLAN 58,50 ,r_,j ISSUE FEE BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTALS----> 90,63 0.00 '^ 58,50 FIRE SMIP/R63 GRADING SMIP/NON-RES TOTAL PAID DUE 149,13 149,13 ,00 �1 REVE:NUE DIVISION TOTALS--> COLLECTED; 149.13 OVER/SHORT; ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK 90.00 �+ ;,. , 63 Sg, SO i! iE 1E if iklk iE ik 1k k ik 1F 1f 1E if iF iF iF ik 1k iFiF if iE 1f iF iE iF ff ik iE �E if iE iF IE.ifiFlF iE �f if 1f iE if iE iE iE if iE If iE 1E 1f if if fF1ElE iE iE ik iE IE 1E 3E iEiE iE iE iP �1F IElE �F * iF iE iE I N D I V I D U A L` F E E B R E A R D O W N � TYPE QTY D E S C R I P T Ir0 N�, UNIT COST TOTAL COST SFR 6304 REROOF HY VALUE AESIDENTIAL NOZONE 1,U0 6,30q,00 END OF FEES T �A Li '�fli��l.:1!".'i..l4_� .+.--: .. r,;�;�; n�,�,�;a� -T;,- i�:�,;. � _ CONSTRUCTION AND.PLANNING : - POOL a SPA , Date Inspector Date Inspector APPROVALS Permit # � - � . - APPROVAIS Permit # �. .' 1. Temporory Elecirical Service or Pole , �. , 52..Pool-& Equipmeni Location � �`2. Soil Pipe-Undrgrnd. �;i �- 1 � 53. Steel Reinforcement , ` �3.=ElectficQf Co�d`uit' Utility-Undrgrnd. � - 54. Forms ' - - � � � J4. EtectricatCoriduiFUndrgmd: � 55. Elecfncal8onding � ' 5.,�5'teel.Reirifor� rtient ', �- 56. Rough Ptumbing & Pressure Test '_fi.. E4ectrical:UFER Grnd. � " 57. APPROVAL TO COVER�GUNITE - 7.,Footing§ - �` '! � � � � 58. Electrical Conduit-Undrgrnd. � ,� ' '�' . 59. Gas Pipe, � Undrgrnd., Test �- 1` j ��.�Poundati0n �, ! A'9.`�Water Pipe-Undrgmd. �" %�� 60. Backwash Lines, P-Trap, 0 Undrgrnd. � �"� 10� Structural Floo�~ ystem i' 61. APPROVAL TO DECK . '� � 11. Rroperty Sewer LSne & HoliseConneciion '� . 62. Backwash & Receptor�Final ,, �. 12. SEwer Cap � �J, ' /�� 63. Heater & Vent-Pinal �'� 13. Foof Dreins- ��, � �� . 64. Plumbing System � Final ,% ' 14. Rough Plumbiri9 f � - 65. Electrical-Final 15. Rough,ElCct�ical-Conduii 66. Solar System-Final 76. Rough Electri`�Wiring 67. Fencing & Access ApProval 17. Rough Wi±fng�6ign 68. APPROVED FOR PLASTER�NG 16. Rough EI¢ctriC�i�T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REnUIREMENT ' _ ` ' :u. +. :U 20SRough F7 cto�'�ry F�rpplace � T S2 � ' ""�,, � ,,APPRDVALS %"'Pe'� it # �q _ r�, - a.. -�- ;c.� r: ._. � ��-• : � , �-_�-• -= T .:� 21y.DuCts, in Structure, .... ��z � 5 ' •+= x.70. Underground Hydro < 22. Ducts, �/entilating �' � �' �'''�• '•;77; producj�Fiping �Gas L70i1 �l !. �. < ' C1 'k ' r1 i. k: -f ,� r. r F.' i' �Y .. T• _ . �: r � - J 23�GaS,Pipe:Rough&�1"est � Pj '.j � � r�. p-72. UndergroundFlu'S,F,., �. - _ 24 �Roof Framing �= �-- •� �'�Z`j� ��'� : 73' Undergrnd. Storage,Tank� Ga5 ❑ Oil 25. RoO,f Shea[hing;r,. -' " r �- C • - .J , r - r �.-.: 'z ;, �, , �;�jx ,; ' 74i.Overhead Hydro � , 26:�T�Bar Ceiling (Structurel) &:1Nonocoat � � ? '_7 S �• 75:; Dry Chemical " � - { > ti 27%Frame and f.,lashing -,^,.�y � - y� " 76'�Dry StandPipe : �' , � � _ �28.� Lafhing.& Siding � . -�i�^ �^ ' � -� =� 77� FIXED SYSTEM FINAL' y � T � 78: FIRE PREV. FINAL '�29. Insulation '' �� ` s •.. _ q , - 'L. T30. Drywall Naitlng r�� -� '� - I- <� � HEALTH DEPR FEQUIREMENT `�37. Plaster BFown Coat .- � , .�, _ _79� FINAL INSP.ECTION , ' ��32:-Electrical PowerMeter�Final J J s:.; _80.�POOD CERTIFI6ATE ISSUED 33�Final Electr � "' �_ ; J ;� • � "', � Notes: _ � ' _ , i' _7�Z-_' - �� -34, Fi�alHeeting&AiGConditionmg, �< ~ . (�:.. ; , ' O�-'�--/c �35^Firial Gas P�pe-Tes�; ��= � x r^ r.1 . _O �36 'Hobd or_=CanoPY .. - t . - -- . � �6 . s � � ' � y.r � - + M '37',�Final Factory Fireplace, ' '? '� ` ( `�' • ' I r � ;;5 ,; .. �' , .. . _ ,, � - -38rFinal Plumbing x - - _ � .� p' �"39. Water Service=FinaF � I ,; �`�. _ � � y � .. r40: Gas Service-F,,inal � y �. , K„ ( �;. . _ . ' ' '.41.�Solar pomestic-Final� •- � :} � � � . - ,42': Backflow Prevente? " � � , .t, a � � .0 . - 43. Backflow Irrigatiort' > > ' � , - i F _ �.-; V , , v `_44. Landscape irrigation System- r ., � i . . - „- x c t .. - - . ,i• r- '-'45.�Sound �Atteouation - � ' � ' �� ' � ' - ' - � � < - 1 -,46: Handicaq Re,gulatiQns = :� �� ;; . : , 47.;FINAL STRUCTURE & BIItLDINGI � �" - ��'��-> � - 8 -`/? 6 �-.' .. 48:_F{NALPLANNING , '� . � � ;r` 4 � j l r �_ .•49. Electric Release to Edison � �� +' �� f �' w 50. Ga;,Re�ease to Soulhem California Gas Co � � . � ' ` _ ` - . . ', . `-"51. CERTIFICATEOP,OCCUPANCY ,. � . ` , � ; < - No. Date