HomeMy WebLinkAbout2527 SANTA ANA AVE - Building Permits CITY OF COSTA MESA
a"!!G`�,� BUILDING DIVISION
'Zt. "" v' : DEVELOPMENT SERVICES DEPARTMENT
PERMIT PE IT NUMBER
%"almyieb 99-00101
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2527 SANTA ANA AV Status: ISSUED 04/07
Suite No Applied: 02/18/1999
Issued: 02/24/1999
Vicinity:
Parcel Nunmber: TPN980100
Applicant CERNICH, ERIC
Address:
Phone:
Zip:
Owner: MESA BUNGALOWS, LLC
Address 3535 E.COAST HWY.,#155
Phone: 949 722-8120
CORONA DEL MAR,CA Zip: 92625
Contractor: •
Address:
Phone:
Zip:
License:
Arch/Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
PLUMBING FORE NEW SFR, REF"B98-01818:2 TUBS, 1 DM, 1 AHOER, 1 KIT. SINK,2 SINKS,
1 WASH BASIN SET,3 TOILETS, 1 W/H, 1 W/SERVICE,6 GAS OUTLETS, 1 GAS SERVICE, 1
SEWER CON., 1 WASHER& 1 LAWN SPRINKLER SYSTEM.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $22.00 Laundry Tub/Washer $8.75 1 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $13.25 1 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $17.50 2 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $17.50 2
Dishwasher $8.75 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $8.75 1
Drain,Floor $0.00 0 Sewer Connect $22.00 1 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $26.25 3
Drain, Roof $0.00 0 Shower $8.75 1 Water Heater/vent $11.00 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Ins(or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $8.75 1
Gas(1-4 outlets) $5.50 1 Sink, kitchen $8.75 1 Water Softener $0.00 0
Gas(Over 4 outlets) $2.00 2 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $8.75 1 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $198.25
COMMENTS/SPECIAL CONDITIONS
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 codas, 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
DECLARATIONS �
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: .
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is Issued. .
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance tenor and policy number are:
Carrier: Policy Number:
(This section need not be completed U 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 provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(s103.000),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
force and effect.Lic.x Class a
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement Is
❑ sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.).
E/I,as owner of the pr••arty,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions
Code:The ••t act./ License La •oes not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pu . a to,, e Contracto ' 'cense Laws.).
❑ lame •mpt di sec. :us' :ss and P •fessi• s C•se for this refason:, ept
Signature' A _ �� �.[_ rpr1-4
... r J. r��'k�^�`- Date: �--c — ( I
Owner ID -" :•by drivers license. U Yes U No r Y*E vers 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,1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,With some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the 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 a,Brmit 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 ❑No
(Section 85850.2 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.1 agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICA OF O ANCE AND AUTH TION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I ree w with all state la rid cityordinances relating to building construction,and authorize representatives of the Ci:7:3;7
of Costa Mesa to enter upon the
above- son ro for inspectio se 1 agree not/(/ Occu(/py o(yyee'lowoocccupancy of any building authorized by this permit
final iinnspection.
Signature Of Legal Owners) ! �� O Date
Me5,%2?1%-,4v r L GLi
And/Or Authorized Applicant Date
CODE 6 INSPE[nONTYPE DATE INUBAIS CADF I DNSPECRON TYPF DATE .Illi. :
1616 Fixed System Final Fire Prevention 208 Final Mechanical / r
1266 Pool Spa Final 208 Final Plumbing .:as:s:
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
2446-46
. jtJ!
CITY OF COSTA MESA
:it'll tBUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT PERMIT NUMBER V
E99-00109
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2527 SANTA ANA AV Status: ISSUED W"
Suite No Applied: 02/18/1999
Vicinity: Issued: 02/18/1999
Parcel Nunmber: TPN980100
Applicant: CERNICH, ERIC
Address:
Phone:
Zip:
Owner: MESA BUNGALOWS, LLC
Address 3535 E.COAST HWY.,#155 '
Phone: 949 722-8120
CORONA DEL MAR,CA Zip: 92625
Contractor:
Address:
Phone:
Zip:'
License:
SCOPE OF PERMIT
ELECTRICAL FOR NEW SFR, REF:B98-01818: 1962 SO FT, 1 OUTLET, 1 FIXT., 1 SWITCH,AND
1 METER.
FEE SUMMARY
Quantity - Quantity
ISSUE FEE $22.00 _Temp Dist System I 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) $98.10 1962 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $1.00 1 up to 50 kva/kw $0.00 0
Recept Outlets $1.00 1 up to 100 kva/kw $0.00 0
Switches $1.00 1 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $27.25 1 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand. $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $150.35
Intermed Pole $0.00 0
COMMENTS I SPECIAL CONDITIONS
•
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work is suspended or abandoned
fora 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 .
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:
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 forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($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
force and effect.Lic.N Class If
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: 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.).
EV1, as owner of t roperty, EXCLUSIVELY NTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The co rac rs Lic e Law does not y to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license purs nt to the Co actors License .).
❑ I am exe t and sec. Business and Professions Code for this reason: q
Signature: Date: X7'7 " 5
Owner ID veil' d nvers 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 B,Califomia Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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 Irom the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (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:
CE•• RCA OF/OMPLUWCE • •. AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have reed this application and state that the information given is
.• act. I ail ee comply wit state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
bove-de ' - property f•�spection p Poses.I ogre:not 1 :'or .flow• u•:-cy of any byilding authorized b this permit until final inspection.
L� .1 to tjc( A'i141�L 3 Sf
Signatur:Of Legal Owner(s) , / / Date
And/Or Authorized Applicant Date
nnoF 0, INSPECTION TYPE DEE IIQfAi$ CODE INSPECTION TYPE DAIS N®ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical ,T
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical 613v j4'F
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
2446-46
t�.-
� CITY OF COSTA MESA i
Y:* .4 BUILDING DIVISION 4-oboes
' •`�""'� , ,,' DEVELOPMENT SERVICES DEPARTMENT
` ,*�; PERMIT IbddgtER
%(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 •
MECHANICAL PERMIT
Job Address: 2527 SANTA ANA AV Status: ISSUED tA
Suite No Applied: 02/18/1999
Issued: 02/18/1999
Vicinity: '
•
Parcel Number TPN980100
Applicant: CERNICH, ERIC
Address:
Phone:
Zip:
Owner MESA BUNGALOWS, LLC
Address: 3535 E.COAST HWY.,#155
Phone: 949 722-8120
CORONA DEL MAR,CA Zip: 92625
Contractor:
Address:
Phone:
Zip:-
License: ..
Arch/Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
MECHANICAL FOR NEW SFR:898-01818: 1 FAU UNIT, 1 A/C UNIT,9 REGISTERS, 1 F/P,
1 HOOD,8 2 VENTS.
FEE SUMMARY
QuantityQuantity
ISSUE FEE $22.00 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $13.25 1 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $12.25 1 Evaporative Cooler $0.00 0
Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $13.25 1 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 $9.50 1 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $9.50 1 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $13.00 2 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $92.75
COMMENTS/SPECIAL CONDITIONS
•
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
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate o1 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 sect/on 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 provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML 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(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full
force and effect.Lic.x Class If
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued.(Sec.3097,CMI Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars(5500).):
❑ 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 Cale: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
�°Id 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.).
(9�I, as owner of the pr••'rty. am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code: The contra• •rs cense ' does not apply to an owner of properly who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursue. to the Contrac,i License Laws.).
❑ I am exam• under.:c. Business and Professions Code for this reason: x
Signature: Date: 3- F — 9`",
Owner ID vedfi:• ••,.• - s tic nsa. ❑Yes No Drivers License No. Expires:
Verification of Ownership by( •- • •• - :nt,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,faLsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2.Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: • Date: _,_
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions.requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Cafe been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisapplication appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes ❑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
6 (If"yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify mat under penally of perjury the information given above is correct.I agree to comply with ell state laws end city ordinances
regarding Hazardous Materiels and Emissions.
Signature: Date:
/
CERR A OF ..• ply with
CE ANy • ORIZATION OF EMAY:I certify under penaltyof perjurythat I have read this aves of ion and state that the Information given is
Cort t. I ae :e t•'comply with al . e laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
a ve-de; rib:.•property for i•-;C- '• v poses.!agree/p/pt t py•r allow occupancy of gQy building thodz by this permit until final Inspection.
/ Signet e Of Legal Owner " l L C Date
/I . 6 //alar - . r S
And/Or Authorized ••plicant Date I
CODE L INSPFf.TN1N TYPF DATE VOWS DDDE1 IBSPFCTIONTYPE
1616 Fixed System Final Fire Prevention 206 Final Mechanical a 1
1266 Pod Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining wall 212 Anal Fire Prevention
202 Final Factory Are Place 220 Final Planning Approval _
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446.46
CITY OF COSTA MESA
1- t BUILDING DIVISION /
DEVELOPMENT SERVICES DEPARTMENT /PERMIT PERMIT NUMBER
B98-01818
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT ((�J
Job Address: 2527 SANTA ANA AV Status: ISSUED
Suite: Applied: 10/08/1998
Vicinity: Issued: 03/01/1999
Parcel Nunmber: TPN980100 Zoning:
Applicant: MESA BUNGALOWS, LLC
Address: 3535 E.COAST HWY.,#155
Phone: 949 722-8120
CORONA DEL MAR,CA Zip: 92625
Owner: MESA BUNGALOWS, LLC
Address 3535 E. COAST HWY.,#155
Phone: 949 722-8120
CORONA DEL MAR,CA Zip: 92625
•
Contractor:
Address:
Phone:
Zip: License:
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT 1 SFD OF A 10 SFD PROJECT.TRACT 15732 LOT 10:PLAN 2A-1962 SQ FT(804 1ST FL AND 1158
SQ FT 2ND FL)426 SQ FT GARAGE,4 BDRM&2 1/2 BATHROOM PLUS 1 F/P.ICBG#(WILL BE GIVEN PROIR TO
ISSUANCE.)
SEE DR-98-08/T-15732.THREE OF THE OPEN PARKING SPACES PROVIDED IN DRIVEWAYS OF 2537,
2539,2541.
FEE SUMMARY
Plan Check: $201.05 Calc Valuation: $169,062.00
Permit: $1,237.25 Claim Valuation: $0.00
SMIP Res: $16.91
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $1,455.21
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 20-0 Rear 10-0 Left 9-4 Right 33-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 30 Proposed: 31
NOTES:
•
•
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 Inapectlond 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
DECLARATIONS I 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 end policy number are:
Carrier: Policy Number.
(This section need not be completed if the permit is valued et one hundred dollars($100)or less.)
❑ I certify that In the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100,000),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
force and effect.IJc.a Class a
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
I,as owner of •: property,am EXC'•SIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The •ntr: ors cense La. oes not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license••rsua tot • Contracts/ .--nse Laws.).
❑ I am : empt d•, ec. / (I S. Business and Professions Code for this reason: ZZ G
Signature: / f r'7 �r /
Date: --(--/7
Owner ID v: . :d by• s license. ❑Yes ■ No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Di Yes ❑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:
CE• - A OMPLI 'AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
car •ct.I agr comply it at state laws and city ordinanc's relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
:.ove-de props I'Io-•- 'on purpose- I agre- - o• p oral• Occup: cy of any ilding authori :• by this pf it until final Ins•'ctlon.
A ALA 6._ i / I
MI l Signature Of Leal Owner(s) 1
q � `/1 / Date
And/Or Authorized Applicant Date
CQQE I. INSPEZIKB nEE DATE !EMS Out INAPFCTIDN TYPF Dell I ALS
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 Signm 222 Final Site
204 Final Demolition 250 Final Building/Occupancy �� SS
2446-48