Loading...
HomeMy WebLinkAbout2162 STATE AVE - Building Permits 4`#01 It%9 CITY OF COSTA MESA , o rfi BUILDING DIVISION IF ( t,,, = i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER a PERMIT E00-00974 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2162 STATE AV Status: ISSUED Suite No Applied: 10/06/2000 Vicinity: KITCHEN Issued: 10/06/2000 Parcel Nunmber: 42242401 - Applicant: AMBURGEY, RAY In ISSUED BY: ,l(S Address: 817 W 17TH ST UNIT 9 Phone: (949)645-0729 COSTA MESA, CA Zip: 92626 Owner AYALA, RAUL A Address 2162 STATE AVE Phone: COSTA MESA,CA Zip: 92627 • Contractor: ELECTRIC RAY / v Address: 817 W 17TH ST 9g'�� UNIT 9 Phone: (949)645-0729 , COSTA MESA,CA Zip: 92626 License: 480485 SCOPE OF PERMIT ELECTRICAL PERMIT FOR NEW KITCHEN ADDITION&REMODEL. INSTALL MOTOR FOR NEW NC - ' • CONDENSOR, 5 LIGHTS, 7 OUTLETS,& 10 SWITCHES. - ' , REF: B99-01133 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 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 $5.50 5 up td/50 kva/kw $0.00 0 Recept Outlets $7.70 7 up to 100 kva/kw,•= -$0.00 0 - Switches $11.00 10 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment . $0.00 , 0 Res Appl I $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 1 hp $0.00 0 Circus(mech ride or lights) -,$0100 - 0 Motors to 10hp $12.30 1 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 ' $0100 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 $60.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California 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 J required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. f FOR INSPECTIONS CALL: (714)754-5626 • 2446-46(6/00) V (-----) --) 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 rction need not be completed if the permit is valued et one hundred dollars($100)or less.) Crtify 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•"��,omla,�and agreeQthat If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the =.ons. W� Applicant Signature: Date: d O – – tr-o WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(S1 W,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirmCUut-I.am fjcensed 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 eftedi-Ucr4f LI C• I'L a (Class a ( C – I o Contractor's signature:_- 't� � — Date:. ---7 to –(0 –c.-0 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 civltpenalty of not more than five hundred dollars($500).): /(h, 0 I,as owner of the propnerty,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 oviner;builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of Ira tors m Law do not a pO to WITH LICENSEDwhCONTRACTORS h ro constructn, the ntect(Sec.704Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 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 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? IID Yes IJ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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 properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 'gra a Of Legal Owner(s) Date \ c. -2 C o –c– –coo 1--And/Or Authorized App - tt ( Date-------�,� CODE! INSPFCTIONTYPE PATE PSL$ BODE! IBSPECTION TYPE PAIS IKTISALS 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 Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy e-. CITY OF COSTA MESA i`yBUILDING DIVISION ,..1 "!'t ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER • PERMIT %bo""`°Tr B99-01133 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: e 2162 STATE AV Status: ISSUED Suite: Applied: 07/20/1999 Vicinity: KITCHEN @ REAR OF HOUSE Issued: 08/16/1999 Parcel Nunmber: 42242401 Zoning: • Applicant: CRAWFORD, KEN ISSUED BY: ` Address: 2079 NATIONAL AVE. _ CA , ' Phone: (949)548-6685 COSTA MESA-,/;/, Zip: 92627 Owner AYACA,!RAUL�A V Address 2162 STATE AVE - - ,e715>, ('1 i1 IIig ,,,,/ COSTA MESA,,CA Zip: 92627 - /,_/ i-:///,' / /'' Contractor. '�CRAWFORD_CONSTRUCTION �� y /Address: 2079 NATIONAL'AVE. v ' '1 ,' CA Phone:. (949)548-6685 \\\• `� �' � /A / i <;/ COSTA MESA /y( Zip: > 926277' License: 464356 ;, - ' iArch /1"� _ ' Eng: .. .� Address:- • _ r- '; 1 Address: ., . ' Phone: - , Phone: V .1.,e \ Zip: , .,/`e_ `N License: / •License; 2 . f SCOPE OF PERMIT N EXTEND;EXISTING KITCHEN(83 S.F.)5'6"X 15' - - _• - • FEE SUMMARY _ ' Plan Check: - $105.46 _ , , j- , Calc Valuation: . . $10;000.00 Permit $162.25 Claim Valuation: . ,, , . _ $10,000,00- SMIPR , es. ,', ` ', $1.00 - - . 7 / //SMIPCd`m:�c " $0.00 , '' . \' ''Other: , $0.00 .;, �, ; ' vInspection: $0.00 i //2Total: $268.71 . . , PLANNING &ZONING , ;- , - - SETBACKS, - 3 MAIN STRUCTURE-Front 23-0 Rear ,0-0 Left 22-6 - Right -0-0 , / ' 'i ACCESSORY ' Front 0-0 Rear 0-0 Left 0-0 Right 0-0 , PARKING Existing:" -0 Required: 0 'Proposed: 0 ' NOTES: . • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • DECLARATIONS 1 C 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 l/the permit Is valued at one hundred dollars($100)or less.) eI certify that In the performan f 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' gimpensation laws of Califo and agree that if I should beco ubje the workers'compensation provisions of Section 3 00 of th Labor Code, I shall forthwith Crovisip CHS --_T__ � �y� L' Applicant Signa .re: fi Date: / T '• SA URE TE($100,000),IN WORKERS'COMPENSATION GENS IS O ,UNLAWFULAMAND SHALLPROVIDED SUBJECT AN CRIMINAL ER DA AND CIVILFINES UP TO ONE HUNDRED T '• SAND DOI.LARE IN ADDITION TO THE COST OF PENSATION,DAMAGES AS FOR IN SECTION 3706 OF THE R CODE,INTEREST,AND ATTORNEYS FEES. LICENSED C•. : •CTORS DECLARATION: I h: .':. - rm that I am lic.- ed under•ovisior s f Chapter 9 .mmencing w Section 7000)of Div' ' 3 of the Business and Professions Code,and my license is in full arca and effect.Lic.ft 4' t / Class# Contractor's Signature:g '�_ ��/� 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: ri v_ • 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`equire`sa 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 sne 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 Yee 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 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 ❑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 a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the 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. :.nature Of Lege '• : / D-te •A...•r Aut i.Ized Applicant •-to CODE F INSPECTIONTYPF RAI& INTITJALS CODEC INSPECTIONTYPE PEE Vj 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 Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 • a CITY OF COSTA MESA )49 ,1 BUILDING DIVISION t ' , PERMIT NUMBER DEVELOPMENT SERVICES DEPARTMENT • PERMIT %fr°"°"°st E99-00766 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • ELECTRICAL PERMIT Job Address: 2162 STATE AV Status: ISSUED Suite No Applied: 08/16/1999 Vicinity: - Issued: 08/16/1999 Parcel Nunmber: 42242401 Applicant: CRAWFORD ,KEN • ISSUED BY: �/I�'� Address: 2079 NATIONAL AVE. CA Phone: (949)548-6685 - - , COSTA MESA,' ' Zip: 92627 i' , Owner: /AYALA,RAUL'A . \ _\ /(/„ J Address 4,2162 STATE AVE •v i . __ Phone: /,.," / C ' " . ,„.v • � i / v ", COSTA MESA;CA=- Zip: 92627 -v, = ,', < - i A�, /Contractor:-, CRAWFORD CONSTRUCTION .' / r :Address: 2079 NATIONAL AVE. QA� ' . Phone: ' (949)54876685 • / COSTA MESA - ' ,-Zip: 92627, - � • „ i � ; - "License: 464356 h ' \ SCOPE OF PERMIT �� 1 V' V�- - r RELOCATE COMBO METER AND SUB PANEL REF B99-01133. / / 4 FEE SUMMARY a Quantity Quantity ' • \ ISSUE.FEE ,,,, $23.50 - .. --,47-Temp Dist System/Lighting ,, $0.00 0 r' . . l QTemp service tes ., $0.00 .test, -. Busway/100 R: - - $0.00 0 ' • • '1, \F,tes.'a/c package ,, $0.00 - _ Standing.Section' $0.00 0 , New Res,(1-2 units) ,.,• $0.00 0 Misc Electrical Equipment $0.00 0 2 ' .' : 1 /' New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0/ / Pool7.Spar- $0.00 0 up to 10 kva/kw . $0.00 Lighting Fixts\ v', $0.00 ' 0 up to 50 kva/kw 1 $0.00 l0/ Recept Outletsv ,-' . $0.00 0 . - up to 100 kva/kw •. $0.00 y'-0% - r/% SwitchesN,. " " ' ,$0.00 `i 0 - over 100 kva/kw _'$0.00 10 - -' Non Res,Appl ' ' - ` $0.00 0 ' . ' Low Voltage Equipment - $0.007/'' 0 i ' Res Appl. " ' $0.00 0 Low Volt Wiring'System/Ckt ' .$0.00; 0 . - Service to 200 , $0.00 , " 0 - - " Misc.Conduit ' •. _$0.00, 0 - Service to 1000aN. /, $0.00" -'0 Misc.Conductor $0.00 0 Service over 1000x- ,' $0.00 ' , 0 Circus(gen or ride) , - $0.00 : ' 0 Motors to 1 hp ` ` ` ' $0.00 0 - . • Circus(meth 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 $30.50 1 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 TOTALCALCULATED FEES $54.00 Intermed Pole $0.00 0 • COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California 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 DECLARATIONS 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.) "� I certify that in the performance a work for which this permit is i ed, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California nd agree that if I should become ' m to the workers'compensation provisions of Section 3 r0 of the Labor Cade,I shall forthwith ase provision Applicant Signature: E TO SECU ORKERS'COMPENSATION COV GE IS UNLAWFUL AND SHALL SUBJECT AN E - OVER TO e 'INAL- NAMES + D CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,ODu),IN ADDmON TO THE COST OF PENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICE . N • = s •'S DECLARATION: •- _. ate^ affirm that I am lice d andpr isionns/of Ch}aptter 9 • ening with Section 7000)of Sion 3 of the Business an. -rofessions Code,and my license is in full force and effect.Lic.M 7 G 7 - / Class it Contractor's Signal P. e: "iia 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 toe civil penalty of not more then five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec, 341,Title 8,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? ❑Yes 0 No (Section 25533 of the California Health and Safely Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑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 aagernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 0 No (Section 65850.2 of the California Govemment Code requires that the requested information be fumished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes 0 No B (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 end 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 0i Legal Owne / Date aa. An. •r •uthori =•,•plica , - r.te CODE 1 INSPECTION TYPE BEE =AU CODE• INSPECTION TYPF PATE " INTTRALS 1016 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing / �^ 200 Final Re-Roof 210 Final Electrical ¢/7r�/D 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 PROJECT ADDRESS: 2162 STATE Al.! UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 054987 OWNER'S NAME: AYALA, RAUL A Li q ? ADDRESS: AYALAMERCEDES A . PERMIT NO: E 054987 PLAN CHECK NO: N GOVT: Y SUPP: N 2162 STATE AVE • COSTA MESA,CA 92629 CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE PURPOSE: OTH 631-0167 ' ARCH/ENGINEER: • REG.NO.: JOB DESCRIPTION : SERVICE CHANGE Si CONNECTION • SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALL-VALUE: GROUP OCC: R-3 / PERMITTEE: AKS ELECTRIC ( 714 )641-3550 • • ADDRESS: 1315 EAST ST. ANDREWS PLACE C COMMENTS: *** CITY PROJECT NO. 91-07 *** SANTA ANA CA 92705 *+E*********EE*****rt*************************************+E**+E*************+E***aE** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed'under provisions of Chapter 9(commencing with Section ' . Z ONING R 'E Q U I R EMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY LIC.: Q 5 fi 110 STATE LIC.: 480224 CLASS: Q --lith —I!!/ / Signature:_ frA `yam—' MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self-insure or ace wale of W. ers' FRNT: FT . IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance or a certified copy thereof(Section 3800.Lab.C)_ • ' LEFT:- FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PDLICY ND.: HP80540504 EXP. DATE: 10/01 /92 =par FIREMANS FUND PARKING REQ: PROV: PARCEL: 42242401 INE; REF NO: C CCeenifitied/coopp is hereby furnished. [X Cenified co�tiled with the city Building Division. PLANNING NOTES> .> ;;3R' '1///a/,) Applica� �'" y /�il ****1E**************************iFiF*,***iF***************jFif********************�E*** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is fo . e hundred($ .1)or less). DEVELOPMENT t'5,. E R VICES REQUIREMENTS I certify that in the performance of the work for which this permit is issued.I shall not employ any person in a y manner •. to become subject to the Workers'Compensation Laws of California. - • ZONING APPROVED BY - DATE: Date: Signature: NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ,. } CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• Lin'1 :+ '"�Y^E"w �'�" DATE• I I -1 -9 jI which this permit is issued(Section 3097.Civ.Cl. `• iF LENDER: ****************************BE***.**7********************************lk**********ik* ADDRESS: LEGALIZATION:N 'F 'E' E; SUMMARY STRUCTURAL SEGMENT:N . OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason • BLDG PMT PLUMBING 6,ELECTRIC MECHANIC FIRE SHIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city,of county which requires a permit to construct,alter,improve.demolish,or PERMIT 18 50 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed Q Z SM I P/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business • PLAN and Professions Code)or that he/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). ISSUE FEE - 1500 00 ' I. as owner of Inc property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> • 0. 00 0.00 0. 00 0. 00 • 00 • 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees. provided that much improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> . COLLECTED• .00 OVER/SHORT• 00 epursold lhin one year of completion.the owner will have the burden of proving he/she did not build or improve for the purpose oisale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business ❑ and Professions Code: The Contractors'Stale License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware **************************************************************************3f**** ' E that proof of their Worker's Compensation insurance should be provided to me. IND I VIDUAL F E E BREAKDOWN . ❑ I am exempt under Section: B.S.P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST• • TOTAL COST Date: Owner: ELE .1 SERVICES BELOW 600 V 6 BELOW 201 AMP �i r18�SO,i_. 18 . 50 I do hereby certify that lam aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES `/i c J1 7{'xT' tt s t -` 25534 and that I or any future building occupant wilOwill not(circle one)need to comply with said state codes and the requirements for a - CA7�` �'�/ S,ist TT'1^ 17:55.: permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from 'L"` these provisions. • Date. Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereb authorize representatives of this city to enter upon the above-mentioned property f/orcins ecli/on purposes. •Signature: `• r...// �� _— ' 1641-46 Wlnte—Bmltlmg:Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod • sessor r • CONSTRUCTION AND PLANNING POOL 'A ' APPROVALS Permit# �Dafe Inspector APPROVALS Permit# Date Inspector . 1. Temporary Electrical Servite or Pole 52. Pool & Equipment Location ' ,str 2. Soil Pipe-Undrgrnd. xc~^• 53. Steel Reinforcement . (c.^r'� C 1-^ 'Votliiee'al CondrTili4 t.6ility-9ndrgrnda S 54. Forms _ �•1F.4ett ill CondgitlUyadrgrnd. • rack 55. Electrical Bonding :J C 03 5. ,SirF Reinf orcetif !t - 4.6' t! 56. .Rough Plumbing & Pressure Test I !^ J . rZh{3 tical UF4C,E T1d. c,--2; s • 57. APPROVAL TO COVER-GUNITE 'Ii 1' .. L w 7.rFQntings fl tV LA 58. Electrical Conduit-Undrgrnd. S.ri'aundation � - 59. Gas Pipe, 0 Undrgrnd., Test re re 9. Water Pipe-UndrOid. 60. Backwash Lines, P-Trap, 0 Undrgrnd. • ri, 10. Structural Floor.ystem o 61. APPROVAL TO DECK • 11. Property Sewer LARe,& Haase Conn, ction 62: Backwash & Receptor-Final ,r. ` 12. Sewe Cap V'n r% • y 63. Heater & Vent-Final at: y - 13. Roof Drains -,� 64. Plumbing System - Final 14. Rough Plumbing t'-' 65. Electrical-Final • 15: Rough Electrid1-Conduit 66. Solar System-Final 16. Rough Electrie4Viring 67. ,Fencing & Access Approval . 17W,tough Wiring LSi,gn 68. APPROVED FOR PLASTERING , •18viough Electrical-T Bar Ceiling • 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT ' 20;-Ro&gh ect6ty b-aplace i Qin S"i y' 0 o Cx i. -'PPReeVAASCnPe mit # * .- t� n• c rn .r T'.- , 'fl9• ,i L'S J c 4 r-'X. x re :lyd t-4 `-> S •tt 21 Duc4ts,in_Stcucttkr. 1 r-��; stS ' 1-: •--.1 `' 'a 70. allde'5 ' H gro 'K rr; i.,1.. �, z ..r .,. ,t - . .. r-.tJ 22.tDugas, V9ntatirig;K 05 a_ S ICK :K c71. Produd Jing ! s 0-Oil S -i r• - s - t r. !--t rc _ 23�'ia§,..Pipe'zRough &'. est I ms In P ,e O* y: 72. Under t b S-,s•t ? L grr' un F Q�s' r:i x +: 1 tr Er L NJ -i '1, Cr S. x i r- V > > r 24 -fio Foaming :. ;K I HH •-_ a: 7 C c .,. .k 73.*Undergrrtd-.StorarTank 0 Gas 0 Gil ..- .•- C v" f 25. Robf Slwathing * £ N * "f 1-ti' =' Co:f: :' 745Overhead'1-I dro"t" 26„6 ,- r-=A' * to J'l. * S...' 4' 7-f3ar Ceiling (St.Qturall 844opocoat l to p: En* * 757.Ory Chemical '7 : cu 27pFrame and Flashinf�. 'J•'� :e_ to -;. i 76:-Dry Stan�rbivpe H S to aG N om' 2 j; 1 t7' W'X -1t c of r.± X28'La LIR inf& Siding W v 7K X F_ * r 777 FIXED V5TEid€INALxQ _ r. >29. Insulatlrt 1.K C' ,-, ... .. > :r in I 1r K 7( ▪FIRE PREY. FIN4L u Ct n w c e tcl ct ErF30. Drywall-Nailing i. a - .-d r -, IHEALYIi-DEPt.FtEQUIRAgMENT ;2,31. Plaster ` owj Cat'. 1 rrrr y , _ I ! a`�▪FINAL I $$ECT N *; 0 ' Q N32,�•Electrictei P wer�jletel.,Finah `.r. t > 1 fe ' . .,. ,FOOD CER•TIF1€ZTE ISSO'Ef ro 33•.-CFinT1 Electrih 1 .4 1 r '� s'' ,6Ies.' 7 "• t- ,K >+ `.tr.;, !ti to 4 I; , K i t. i^o] 'V'S Erin 3. 1s t.,J34,-1Firi ! Heating&tt`;ir� on„�iti¢rt�ctg. ti *. .r tz •P-1 •S :1= s 35 1Firfal 611PiFe-Testr L., x r it".1 ' ribs. Or. ins .1: tr 0 n r .. .. t. ' -'• .:o * Wit' I v- • .s 1' :r to • .-r, .t to Cl to36:•Ho a or�t#anopy -c 0 1 tl.y a v h IT:- * g no a .: Or -37i:Finnr 81 Factory Fireplace ! S ' -s - t'II I r -:K • = r :.stn x b„•• i •• •• rn 3 ;J t' k ( to :t. tel ti38. Final Prumbing , t a y I Ir . S _, 1: ill o .t t♦, i . r: , 139. Water Service-Final r I ' tt -K in M j v740. Gas Service-Final 'r C-i -. K 'K to .: r•, ¢n'Ir S a. m I ; : 00 Dal •iCr '''‘11. . ,. • -r 4 t1. Solar Domestic-Finales ,ia r' •- * .r 1 / IY. :K -' I-•, Y .. tit ti + � Ia. x U.. •-•;./r .ti *. r F'42=Backflow Prevente i" co * •' 1 • • b F 'F uP.H .xic b ti 43. Backflow Iraigation: tr.SS '� .---1 .k .i r-Cr., y 0 C- •• t rt Y: 4" •i - is r i . !".C: -P T y ' n: :r: 7. 0 P.I ?,44. Landscape ♦♦ -igatign SysterD,ta(J I.0 t in a 0 O-r * ,. CU is Mi'D s CC 0 g E45i'�Sound Attenuation r`c(- it .-t H •-�.. 't:11 x 1- i-, IT 1t is u Ir /. .. .. `t In n rt••i. .'K rT IT S ♦ t-<0 .Y. 46FHandicapRegulati&ns y siri .. .. ♦♦ y : p •• *- . y: + rS _47;„FlItAL ST1;19CTU$E & BI. LDING • .r I I`.-ax a. o: :S .« 48°F!WEAL PLANNING. , wry I - .. w u-.7 r v .7 U I HFI * tV ..^t :l to <( "r f-• U' 049.-Eleclric Release to Edison I I I (p _ .: --.1 ' I, i - nr 1. �50�Ga`Release to Sot thorn California Gas Co w I I l� ;� x; °'51. CERTIFICATE OFFOCCUPA CY ; 114 114i:, MJ - y. _. o it No. Date / '