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HomeMy WebLinkAbout1136 SEA BLUFF DR - Building Permits CITY OF G`OSTA MESA fr AAg BUILDING DIVISION > %J r.,,•. l .. DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER �, 1 w.!!±�AN I PERMIT J B05-00141 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT • Job Address: 1136 SEA BLUFF DR Status: ISSUED Suite: Applied: 01/25/2005 Vicinity: KITCHEN Issued: 02/02/2005 Parcel Number: 42232209 Zoning: ww Applicant: FRANK RAMIREZ ISSUED BY: /Address: 17150 NEWHOPE SUITE 1110 Phone: 714-434-1428 FOUNTAIN VALLEY,CA Zip: 92708 Owner: HITOMI, RODNEY AND NANCY Address 1136 SEA BLUFF DR Phone: COSTA MESA, CA Zip: 92627 Contractor: FORMALINE DESIGN & CONSTRUCTION INC Address: 17150 NEWHOPE ST UNIT 1110 Phone: 714-434-1428 FOUNTAIN VALLEY,CA Zip: 92708 License: 449242 ' Arch : Eng: KHALIL M SHAKHTOUR Address: Address: 5943 NAPLES PLAZA Phone: Phone: 562-433-8882 LONG BEACH,CA Zip: License: License: 59663 SCOPE OF PERMIT ADD 10 S.F.TO EXISTING S.F.D.WORK TO INCLUDE:REMODEL AND EXTEND'EXISTING KITCHEN,ADD NEW WINDOWS,ELECTRICAL, MECH AND PLUMBING WORK. FEE SUMMARY • Plan Check: $108.71 . - - Calc Valuation: $9,000.00 Permit: $167.25 - - Claim Valuation: $9,000.00 SMIP Res: $0.90 SMTP Com: $0.00 • Other: $0.00 Inspection: $0.00 - - Total: $276.86 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right - 0-0 -- , PARKING Existing: 0 Required: 0 Proposed: 0 - - ' - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754.5626 2446-46(WOO) DECLARATIONS fl WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed i1 the permit Is valued at one hundred dollars($100)or less.) certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall idrthwlth comply with these proves' s Z — i)5� WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMTO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licens d under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Businnees,and Professions Code,and my license is in full force and effect.Lida 59� 2 /. Conte Mg". CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: 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 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,Tale 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? ❑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. ... l 4 If an RMPP iss presently tly required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Ves ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application ap ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI 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 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 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. Signature Of Legal Owner(s) Date 0 toA Or Aut r cent CODE f INSPECTION TYPE peg INTTTIALS CODE* INSPECTION TYPE prig MALI 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign222 Final Site 7-07-0? 204 Final Demolition 250 Final Building/Occupancy / 1 . Forrnaline Design& 17150 "fey,S' Unit 1110 Fountain valley,CA 92708 (714)434-1428: FAX(714)43445827 eneral Contractors License 9449242 Construction, Ie-mail: kit nedesien.com Inc.11111111... kitcrencoOdesi8n®aol.com RECEIVED CITY OF COSTA MESA July 3, 2008 '1171/Cl(In'An.17 Crr.•.nnC^ n City of Costa Mesa Building Division JUL 3 2008 Attn: Ed Petros, Chief of Inspection cf f o/Jtn � Re: Hitomi family Trust 666 1136 Sea Bluff Drive Costa Mesa, CA 92627-4068 Permit Numbers: B05-00141, E05-00060, M05-00041,P05-00057 Project Address: 1136 Sea Bluff Drive, Costa Mesa Hello Mr. Petros I acknowledge receipt of the letter regarding final inspections on the above mentioned permits. I would like to request an extension and call for inspection on July 9, 2008 • • Thank you, Frank Ramirez, Jr. cell # (949) 394-6912 `501 M CITY OF COSTA MESA 4 BUILDING DIVISION h ••e„' , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER . _ 4 PERMIT J �o. i E05-00060 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1136 SEA BLUFF DR Status: ISSUED Suite No Applied: 01/25/2005 Vicinity: KITCHEN Issued: 02/02/2005 Parcel Nunmber: 42232209 a • Applicant: FRANK RAMIREZ ISSUED BY: refs. Address: 17150 NEWHOPE ST UNIT 1110 Phone: 714-434-1428 FOUNTAIN VALLEY,CA Zip 92708 Owner: HITOMI, RODNEY AND NANCY Address 1136 SEA BLUFF DR Phone: COSTA MESA,CA Zip: 92627 Contractor: FORMALINE DESIGN & CONSTRUCTION INC . Address: 17150 NEWHOPE ST UNIT 1110 Phone: 714-434-1428 FOUNTAIN VALLEY,CA Zip: 92708 License:449242 SCOPE OF PERMIT ADD 10 S.F.TO EXISTING S.F.D.WORK TO INCLUDE: REMODEL AND EXTEND EXISTING KITCHEN, ADD NEW WINDOWS, ELECTRICAL, MECH AND PLUMBING WORK. REF.:805-00141 ELECTRICAL TO INCLUDE: 14 LIGHT FIXTURES, 12 OUTLETS,AND 6 SWITCHES. • FEE SUMMARY . Quantity '..- Quantity/ ISSUE FEE $23.50 • Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft . $0.00 0, Res.a/c package $0.00 _ , Standing Section $0.00 0 • New Res(1-2 units) $0.00 0 _ Misc Electrical Equipment , $0.00 < 0 New Res(3+units) $0.00 0Transformers up.to 1 kva/kw $0.00 ' 0 .- Pool/Spa $0.00 0 - - ,up to 10 kva/kw $0.00 0 • Lighting Fixts $15.40 14 up to 50 kva/kw• ` -.$0.00 0 Recept Outlets $13.20 12 up to 100 kva/kw $0.00 0 Switches • $6.60 6 over 100 kva/kw $0.00 - 0 • Non Res Appl $0.00 - 0 Low Voltage Equipment, •: $0.017. ;" "0 Res Appl , $0.00 0 Low Volt Wiring.System/Ckt , $0.00 (0, Service to 200a '$0.00 0 • -Misc. Conduit - Service to 1000a $0.00 0 Misc.Conductor $0.00 - / 0 ' Service over 1000a $0.00 0 Circus,(gen or ride) $0.00 ,0 Motors to 1hp $0.00 0 • Circus(mech ride.or lights) -$0.00 0 Motors to 10hp $0.00 . 0 Christmas Tree Stand' / , $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand - $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee ' " - $0.00 Motors over 100hp $0.00 0 - - ; 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 �J` 2446-46(WOO) 'elf DECLARATIONS r-) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall fdrthwlth comply with these provi ' _ li t meC W— Z7-2--10 WARNING:FAILURE TO SEW ORKERS'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 37060F THE LABOR WOE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that Iicens dunder provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busines d Professions Code,and my license is In full force and effect.L c17N� tKS ligatOnigignature: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore 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 properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly 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 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? ❑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 end 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 0 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 California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes U 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? ❑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. Signature Of Legal Owner(s) Date —ga a pp Icant " CODE, INSPECTION TYPE QATE INTmALS con T INSPECTION TYPE O6g 1NTmA1A 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 7��VQ - 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 4`, F 9 CITY OF COSTA MESA BUILDING DIVISION • ,/ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4tPi h PERMIT " ,e , M05-00041 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT -. Job Address: 1136 SEA BLUFF DR Status: ISSUED Suite No Applied: 01/25/2005 Issued: 02/02/2005 Vicinity: KITCHEN ISSUED BY: Parcel Number 42232209 41. --. Applicant: FRANK RAMIREZ Address: 17150 NEWHOPE ST UNIT 1110 Phone: 714-434-1428 FOUNTAIN VALLEY, CA Zip: 92708 Owner: HITOMI, RODNEY AND NANCY Address: 1136 SEA BLUFF DR Phone: COSTA MESA,CA Zip: 92627 Contractor: FORMALINE DESIGN & CONSTRUCTION INC Address: 17150 NEM-SORE ST UNIT 1110 Phone: 714-434-1428 FOUNTAIN VALLEY,CA Zip: 92708 License:449242 SCOPE OF PERMIT ADD 10 S.F.TO EXISTING S.F.D.WORK TO INCLUDE:REMODEL AND EXTEND EXISTING KITCHEN,ADD NEW WINDOWS;ELECTRICAL, MECH AND PLUMBING WORK. REF.:B05-00141 • MECHANICAL TO INCLUDE: 1 HOOD W/MECH EXHAUST FEE SUMMARY - Quantity - • Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit • • $0.00 0 Ins(FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit , $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00' 0 Repair/Alt Cooling/Heat $0.00 0 - - Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 - Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic•Incinerator - $0.00 - 0 Refrig Sys>100 k BTU '$0.00 _ 0 " ". Compressors/Absorption Systems',' Gas Piping $0.00 0 • , Up to 3 hp/100.k BTU • • • $0.00 0 Factory Fireplace $0.00 -0 3 •To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $10.65 1 15 To 30 hp/1,000 k BTU, - .- .. $0.00 0 VAV Box -0 ' _ . . . 30 To 50 hp/1,750 k BTU • ' " $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp./Over 1,750 BTU . $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• • c. $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 - OtherMeehanical Fee Floor or Suspend Heater $0.00 0 - ' InVestigation Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1130 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) err DECLARATIONS 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,es provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) '� I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall tdrthwlth comply with these provisions. App' SI na ate' Z'—z — 1C WARNING:FAILURE TO SECURE WOR • ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADD ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed d !provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect. gayr-. (Classes Tj stere: Z Z O CONSTRUCTION LENDING AG CV: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ 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 W III 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 lime 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 ❑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? ❑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 lJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 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? ❑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. Signature Of Legal Owner(s) Date / Andtilisant eU CODE INSPECTIONTYPE DAIS INTRIALS CODES INSPECTION TYPE DATE R�A13 1616 Fixed System Final Fire Prevention 206 Final Mechanical -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 Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. - i -CITY-OF COSTA'MESA' - --PER NO2„: ' -- ----TRACT NO.` I LOT NO: - BLDG.NO.- ' - ' "^ "' - ' '-' - _. " -' -.- -. - _ CONSTRUCTION PERMIT /7�1p'x - t. A-tel. k x �- /6-/ { W I ,,/ _ 'l '�' �. 9050 12/04/81 12.50 TLI Project Address I/1-1,/, S`e- .' JJGu?/c,e. TYPE OF CONSTRUCTION' y~ • -Owner $4,/i' -«5Ai7, Phona/f/5'Gh97 ❑ NEW: ❑ ADD ' ❑ ALTERATION •' -Address- — --- L cD-REPAIR CONVERSION-0 DEMOLISH • _ _ �Y^ / SP. p/7.,FP pr. 1 ZONING REGULATIONS, , `Arch/Eng:----- -----.. - __ - - License No.- - - - D-OTHER-.'' _ 1 _ . �- - - A.P.9f •._ , -Address - -- '-- - _ DESCRIPTION OF WORK 11 I - (t -• 'I"t _ - - - —__ .___-. _ZONE__.. _ .PLNG REF.qf, •. ' -Cdntractor • - - -- Phone -' - - -- -- - ^-^" - "BVILDING - - - B ILDIN - - '1 m,-G' 1.57A,--4-2,:- SSX 9aed� TYPE,OE PERMIT . , "'- -" Tp t/ G - -•AHdresS ,y l- G lTias/ 1e'�ns S•4i+.i-4.z -- STRUCTURAL-I SETBACKD-LST.- - - " , PER-, )", NE rr - /. ❑ GRADING FOl3N DATION--'0 - SIDE VARD • -LICENSED CONTRACTOR-DECLARATION • - ) 1 ' NT SIFT -- - _") 1,1,1_, f rl I hereby affirm0.7E I ' !( : TRICAL-�hUMBING ©MECHANICAL RIGHT - - mendng-wit that am 100)-of under provisions thCharter ss--and 7 r 1 i I! r- +} j RIGHT -- - .--- _ l h section-9000 of Oimsion-3-of-the Businessantl -(]-OTHER - - • Professions Code', �d my license is in full force and effect. REAR VARD(TO P/L) „ I //�- _ P.ROJECTDESCRIPTION _ __ License-Bra-Si S"" .. /`I\ i f ens, No 1. - , R , 11 - .PKC.SPACE REQ. - , PROVIDED, j - Date 1- 'Si sat are- '• - � - ,• .' SQ.FT. _ _ - �( g CCCfIF"'EE6G!"'ti( ) STREET WIDTH PARK-FEE$ I -WORKERS'COMPENSATION L RATION __ _1....... OCCUPANCYr' h. CONSTRVCTION TYPE _ I hereby affirm that I have a certificate of consent to self-insure.ora s ZONING APPROVED B• -i- . DATE -certificate-of Workers'-Compensation Insurance,-or a-certified=copy VALUATION' -'t _ ZONE_ _ _i _ __ _ + ' - ^ '• _- thereof(Section 3800, Lab.C.). 1 • GRADING'CU.YDS. ' ACRES SPECIAL CONDITIONS: _i,-�, , PblicY No. - -_ ._.. -Com an _ _. _ _ _ - _ __ _ -_ _ ._ _ _ _ .-,. - _ -� Cert ltled�ca py.is.hereby.f urn ishetl. ___--_ - __ ... _ - °cR•:' "REMARKS _ - _ ._ .__ _ _ _ _n"L >i.., l 9 --r ified copy is filed with the city Building Division. -' y� �`, 'EXEMPTION'FROMWORKERS'COMPENSATION'-DECLARATION' jn..Z. - it - - - '- ' ---' " - - -^ - -- _ - - _(This_section need..not be completed if the,permit,is for one hundred.. • _ • _ _i- _ _ __ __ _ _ _____ _ ($100) or less). ,r.. __. _. _..__. _ _ . _I_certify_that In the.performancetof.theworkfor which this permit is - - Issued, I shall not employ any person in any manner so as to become -PLUMBINGI ..'•""j.�-PLAN CHECK'--'-- ` - " _ 'ELECTRICAL" - - _'- -'PLAN CHECK • - - - _subjectto the,Workers'Compensati+ .ws of California: . - uWELLINt, - . - -t,AHAbE Date/� .i 1 BATHTUBS - • SHOWERS - �! Signature _ _ _.____ SO FT Sq T - -. NOTICE: If after imaking thisCr. S ion, you should become subject TOILET , ,, URINALS-- - " - GENERATOR"--0-1 KW 140 KW • - -' to the Workers' Compensation''. 9 islons of the Labor Code,you must TRANSFORMER forthwith comply with such pro inions or this permit shall be deemed LAVATORIES^ 1 - DOUBLE LAYS- - ' "' `- APPLIANCE---10-50 KWh-,5C1-+ KW - - ,^!'T SD, _revOketl._--L-___ _ _ .-_ ,- _., - - -_-- _-. -KITCSINKS-- : 'DISHWASHERS"- "1a--- "'- - -"` 'MOTORS--- - --0-1"HP_1-10-HP- _ -`i CONSTRUCTION LENDING AGENCY , i , I hereby affirm that there i5 a construction lending agency for the per- SERVICE SINKS' IL' SUMPS - `- -` '-' - ` '(INC.SOLAR) - -10-50 HP=-50•+ HP -- - - - - -- - formance of the work for which this permit-is issued. (Section 3097 - - i"- - - . •^ I 'Civ:C:)----- -^ - --•- ------ -•--- -------- - -FLOOR SINKS - FLOOR DRAINS - r-'- �-FIXTURES """-OUTLETS SWITCHES - - "l Lender's Name - --' - - _ _____ ._ _.. ---_-__ _ _- - _.___T...._ .____.. _._ Lender's Address DRINKING FOUNTAINS'I I '-'-"- "-'- '--"GASTOBE - - -"---' OWNER BUILDER'DECLARATION---- --- -"'-- - --INTERCE- --PTOR- --- s ' - -CLAI-RIF-IERS - - --- - POL'E'L-IGHTS "--- • "! - -- I hereby affirm that I am exempt from the Contractor's License Law for - the-following reason (Section-7031.5-Business-and Professions Code: -SWIMMING'POOL - PIT. RAP- POLES RAP'--- '- -- -_ _-- _ _., Any city or county which requires a permit to construct, alter, POLEMETERED .SU B. .• ,_ 'Improve, demolish-or-repair any-structure,-prior to its issuance;also re- - WATER SERVICE "'ALTERATION-- ' -' - --- -PANELS- - ----MAIN"'.`- "',;SUB-" '--'- --"1 quires the ap{.licant for such permit to file a signed statement that he - �c, '-••'-- + -is'licensed-pursuant'to the-provisions of-the-Contractor's License-taw- --- - - -- ----- -' - -- ------ -- - (Chapter 9 (commencing with Section 7000) of Division 3 of the ' GAS SERVICE OUTLETS •� --" SERVICE' - "' - -"- -'AMP_-� „ • -Business-and Professions Code)'or that he is-exempt therefrom and the -WATER basis for the alleged exemption. Any violation of Section 70315 by -any-applicant for a permit subjects the applicant to-a-civil-penalty "SEWER-CONNECTIONS'-') -' _-' -- " -.- • - - of not more than five hundred dollars ($500). 1 • -0 1,as owner of the prdperty, or my employees with wages as their 'SOLAR'TANK-' COLLECTORS ---•••,....- "'----'- - ' - ' ' --- - - -.- • - ,sole•compensation,will do the work,and,the structure is not intended. ___ _ _ _ "' - + i " or offered for sale. (Section 7044, Business and Professions Code:The SOLAR PIPING SVS. • '11 - - j -_ � --ISSUE FEE•�- --- --i-..:,- -- - -- - - �- I--. wont builds improves doereo not dp is ownerty - -orand such mph Work himself or ISSUE FEE L, , .through.his.own employees,_provitletl the Lsuch improvements are not _ _ _ - - ' intended or offered for sale. If, however, the building or improvement' MECHANICAL PLAN CHECK"� ' ' v SUMMARY OF FEES , is sold within one year.of completion, the owner will have the burden _- C.\ - .(,.. .-' ` of proving he did not build or improve for the purpose of sale). - HEATING CTING SYSTEM 0-100,000 BTU _ - _ - PERMIT $ -• _.SMIP' ` :'$_^, -- I sedS contrs to construct the project contracting -with- -q ND'DUCTING' -' o -- ndnsrtl ssionscontractors :- ce'Crntr to s-Lice[ e-(Section 7044, Busapply ss 100,000 + BTU PLAN CHECK $ .1s ISSUANP and Proeof p Code:-The Contractor improves,thew does ndt apply to - - - -- • _.- -,,,j,“ .j. - C � an owner of uchi roj who builds improves thereon, and whoacon- REFRIGERATION 0-100,000 BTU PLUMBING $ t, l \N. -the Contractor's -ntr -tors License -a-contractor(s)with Ilcesneo-pursuant-to »SYSTEM-- - - - - - i. i -- -GRADING1. • i )' i the Contra stor'S Li tens¢ Law). 100,000 +BTU PLAN CHECK' $' [[��'''' ,�1 t`^J I •51 <$ -0"I am exempt under Section -'B'& P:C.for this" 4 1)-1 $ BOILERS BTV ELECTRICAL 5- t_F i _- -_ _- - - _ _ MICROFILM a' PLAWCHECK---$-' SYSTEM REPAIR,ALTERATION ? .3 (14s1r Date Owner TOTAL FEE$ ^MECRANICAL $' e ) I hereby certify that 1 have read.this application and state that the above EXHAUST SYSTEM MULTIPLE '' _ 'r17CCES5 AD _- __- information is tate f -I agree to comply with all city and county- - .t - PLAN-CHECK-$-` "--VANCE PC $ : o oropertyes an tate lawsrelating s, construction, herebyauthorize ^ - - . 'lg.` ,FINAL FEE__$ '/ �1 representabv o this-city-to enter upon the-above mentioned` ' ,property fo 5 eurposes Signature re Pink-Accounting;Goldenrod-Assessor - ,I CONSTRUCTION AND PLANNIN ?� - POOL& SPA' . i i APPROVALS Permit# --/ga3- Date a •Inspector`° APPROVALS Permit# `� - Date-. , • Inspector 1. Temporary Electrical Service or Pole • 43. Pool & Equipment Location - - • - - 2. Soil Pipe.Undrgrn - ., 44. Steel Reinforcement - • - - 3. Electrical Conduit Utility-Undrgrn 45. Forms - ' - 4. . Electrical Conduit-Undrgrn _ _ 46. Electrical Bonding - - 5. steel Reinforce - 47. Rough Plumbing&Pressure Test - _ _ • 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE - . 7. Footings . . - 49. Electrical Conduit-Undr.rn ' 8. Foundation . 50. Gas Pipe, Ill Undrgrn,Test . ' - 9. Water Pipe-Undrgrn 51; Backwash Lines, P-Trap, ❑Undrgrn "' -•• - 10. Structural Floor System • . . 52. . APPROVAL TO DECK - -- 11. Property Sewer Line & House Connection . • 53. Backwash & Receptor-Final - 12. Street Sewer Connection - 54. - Heater & Vent-Final • Rough Plumbing • 55. Plumbing System -Final - _ .. Rough Electric-Conduit -- •:56. Electrical-Final •- - 15. Rough Electric-Wiring . - - 57. Solar System-Final • - 16. Rough Heating & Air Conditioning . . 68• Fencing &Access Approval . 17. Ducts,-in Structure .. St APPROVED FOR PLASTERING • , : - 18. Ducts, Ventilating , x . . , _19.. Gas Pipe-Rough &Test • • 60. POOL/SPA SYSTEMS FINAL ' -'20. ' Roof Framing, - ' 21. Roof Sheathing - -- - - 22. Frame and Flashing - . . NOTES: - • - 23. Insulation . . - .. _. - 24. Lathing& Siding -- - - - • 25. Drywall Nailing . - - • 26. Plaster Brown Coat . . . . - 27. Electrical Power Meter-Final - ,. - ' ' - .. - 28. Final Electric _ . . - - 9. Final Heating & Air Conditioning .. - � , • �' ' Final Gas Pipe-Test .. - 1 .f.'--CJI. Final Plumbing - , _ - - 32.--Water Service-Final __ • - . 33. Gas Service-Final - . 34. Solar Domestic-Final ' ' /,/091/b' AVIM. ' 35. -Landscape Sprinkling System • 36. Sound Attenuation , - • 37. Handicap Regulations . • • • . •- . - - . 38. FINAL STRUCTURE & BUILDING . • 39. Special Requirements Completed - 40. Electric Release to Edison s - . - - - • 41. Gas Release to Southern California Gas Co.' ' •42. CERTIFICATE OF OCCUPANCY . No . Date -" p S A CITY OF COSTA MESA BUILDING DIVISION w , ; .;' : DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER �q a - PERMIT 05-00057 c o .4" (714) (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1136 SEA BLUFF DR Status: ISSUED Suite No Applied: 01/25/2005 Issued: 02/02/2005 Vicinity: KITCHEN ' Parcel Nunmber: 42232209 ISSUED BY: j/A. Applicant: Address: 17150 NEWHOPE ST UNIT 1110 Phone: 714-434-1428 FOUNTAIN VALLEY,CA Zip: 92708 Owner: HITOMI, RODNEY AND NANCY . Address 1136 SEA BLUFF DR Phone: COSTA MESA,CA Zip: 92627 Contractor: FORMALINE DESIGN & CONSTRUCTION INC Address: 17150 NEWHOPE ST UNIT 1110 Phone: 714-434-1428 FOUNTAIN VALLEY, CA Zip: 92708 License: 449242 • SCOPE OF PERMIT - - ADD 10 S.F.TO EXISTING S.F.D.WORK TO INCLUDE: REMODEL AND EXTEND EXISTING KITCHEN, ADD NEW WINDOWS, ELECTRICAL, MECH AND PLUMBING WORK. • REF.:B05-00141 ' PLUMBING TO INCLUDE: 1 GAS(1-4 OUTLETS)AND 1 KITCHEN SINK. • FEE SUMMARY ' • AMT QTY AMT QTY ; AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer: $0.00 0 Sump Pump - - $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation :$0.00 0 Swimming Pool . $0.00 0 Backflow Preventer $0.00 0 P-Trap' ' _ ' - $0.00- 0 Trap Prioied •$0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 '40 • _ 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 f $0.00 0 - Wash Basin Set $0.00 0 Drain, Floor $0.00 0 . Sewer Connect ' $0.00 ; 0 • - ,-Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line - ' $0.00 - '0' Water Cldset(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 TO • ; Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 _ Sink, Floor • $0.00 '0 "_,Water Service $0.00 0 Gas(1-4 outlets) $6.15 1 ; -Sink,kitchen - .- $9.80 1 �/- Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 - Sink,service/mop $0.00 -- 0 - OTHER $0.00 Gas Repipe $0.00 0 Spa(private) - - '$(00 .-0 ' VIOLATION $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 w 2446-46(6/00) !'f;7/�-- DECLARATIONS (l (' •`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. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) tar 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 Califomia,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall fdrthwith comply with these provi ns �7 Appfl r / — 1 -Or WARNING:FAILURE TO SECU ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed u .er provisio s of Chapter 9(commencing with Section 7000)of Division 3 of the Busine �•�yd Professions Code,and my license is in full force and effect. ,Lx.- .0r 7. — Cl ' 13 Contr.zjsx$4`r.r•:"i -• ' Batas 7 —2 _o,c CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 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,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? 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 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 aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes S No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is 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. +� Signature Of Legal Owner(s) Date z—Z—101_5 And/Or A 0 •ihtriSLIerrAA.• V COPE E INSPECTION TYPE PAIS 1f1TITIALS CODE! INSPECTION TYPE PAIS ItlIIDE\y L 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 7410? (67_____, 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 ir'- ' 1 CITY OF COSTA MESA • 0" "� t BUILDING DIVISION > ,,j' ' ,18 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t- l w��r 1 iOfteli PERMIT oeessro B04-01862 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT • Job Address: 1136 SEA BLUFF DR . Status: ISSUED Suite: Applied: 11/03/2004 Vicinity: ROOF Issued: 11/03/2004 Parcel Number: 42232209 Zoning: •. Applicant: VINNY LE ISSUED BY: Address: 9612 SUTHERLAND WAY .. • - - - __ Phone: (714)541-5351 - - , GARDEN GROVE;CA, ' i " - - Zip: 92844 • _ Owner: OGINO; NANCY R Address 1136 SEA BLUFF DR - • - , i - _ Phone: - - COSTA MESA,CA, : Zip: 92627 . „ Contractor: WESTMINSTER:ROOFING CO Address: 9612 SUTHERLAND WAY \ ,, - • Phone: (714)541-5351 • GARDEN GROVE,CA Zip: 92844 License: 694940 - - ' . • Arch : - Eng: Address:' -- Add• ress: Phone: __ Phone: .` Zip: - - License: ..License: ' SCOPE OF PERMIT TEAR-OFF EXISTING ROOF. INSTALL PR2093•MONIER-LIFE TILE,LIGHTWEIGHT TILE,-LESS THAN 6 LBS PER S.F:25 SQUARES-INCLUDES ATTACHED GARAGE. . .- -_ _ _�, /� --.. , ,�, - r,' ' - , FEE SUMMARY :: ` Plan Check:,, $0.00 _ _ ^-�_ - -. , %, talc Valuation: L .512,500.001 ' . Permit:'; $223.25 --— - -_ ---- -. • -' ' -/' "1 "--Claim Valuation: ' / "•� L• 11250000 SMIP Res:, $1.25 SMIP Com: $0.00 • �' ���i f ;,,,t / Other ` , $0.00 ;�,/, r- !/ ' Inspection y $0.00 Yi / ,- ' 1r i .'. �t l h ,`s - „ , (.2'4.1 ♦ / 0 / . \C;Total: $224.50 ,/r ' , .I, PLtANNING &'ZONING _ �A `� /� 1/1 I / -'� 1,, SETBACKS' - ' ,/ MAINSTRUCTURE`Front 0=0'. -.Rear, 0-0 - .Left 0 ,0_ ,- Right 0-0 �' ' � - ACCESSORY 'Flynt, 0-0 Rear 0-.0 - Left --0-0 - Right 0-0,- � i'. . PARKING Existing:, 0 - Required:-1 0 ' Proposed: --0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS 1 k.. ,.. a . 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. 0`711iave 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: Mr*: .�C.P, Policy Number: rrry3.7 . \(TMs section need not be completed if the permit is valued at one hundred dollars($100)or less.) (-_ . ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these - PaOle:-�'r-� pr s. ©�-C� A ig tilarn' S •.. WARlaN9^FAKtlRETOSECURE 'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full ce and effect:Lic.k-> -"/' r'�p S''d +-Clas q CtoCs Signature>_ - �� - Date: G CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Lew 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,end that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ 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 et 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? ❑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 gency? Yes C 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? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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 insp ction purposes. ree no to occupy or allow occupancy of any building authorized by this permit until pal inspection. /�eo y Signature Legal Own"). ate I _� -CMf .s.q _ CODE I INSPECTION TYPE PATE INTRIAL5 CODE I INSPECTION TYPE v ea INTRIAtS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof I/—l( 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 . 1 250 Final Building/Occupancy