The URL can be used to link to this page

Home My WebLink About332 15TH ST - Building PermitsCITY OF COSTA MESA O`''p "'FSq BUILDING DIVISION 4 F,...., 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 www.ci.costa-mesa.ca.us ". " FOR INSPECTIONS CALL: (714) 754-5626 �"�°°°R°°` PERMIT NUMBER: E11-00207 PERMIT TYPE ELEC APN: 42531101 JOB ADDRESS: 332 E 15TH ST CM Vicinity: REAR SCOPE OF WORK: UNDG ELEC FOR ABOVE GROUND SPA OWNER: SAMUELIAN FAMILY TRUST PHONE: APPLICANT: GARD KHACHERIAN PHONE: 949.500-0037 CONTRACTOR: SPARKLING FRESH POOLS Address: 751 S WEIR CANYON RDUnit: City/State: ANAHEIM HILLS, CA ZipCode: 92808 ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $42.80 Reinspection Fee $0.00 TOTAL FEES $42.80 STATUS: ISSUED DATE ISSUED: 09/08/2011 ISSUED BY: MDM Suite/Unit: Address: 20741 IRVINE AVE Unit:STE 103 City/State/Zip: SANTA ANA HEIGHTS Address: Unit: City/State/zZip: License No. 808447 PHONE: 949-500-0037 CELL: t,. 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODE INSPECTION TYPE DATE INTITIALS COOED INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical _ /o — /a 201 Final BlockfRetaining 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 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: (Thu seoion need rp10e compered itthe pal u vatued at one hundred dollars (s 100) or less.) Policy Number: ❑ 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's 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 DOLLARS ($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 CONTRACTOR% 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. # Connector's Signature Class # Data CONSTRUCTION LENDING AGENCY: ❑ I hereby arm that there is a construction lending agency for the performance of the work for which INS 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 contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Owner ID verified by driver a license. ❑ 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: ❑ 1 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. Applioant's Signature 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? ❑ 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? ❑ Yes ❑ No S. 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 Quality Management District or from any other air pollution control district or agency? ❑ 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? ❑ 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? ❑ Yes ❑ 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 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 owners) 305746(3N7) AMPor Autlrer¢ed Airw.nt Date (714) 754-5273 • Fax (714) 7543856 • www.ci.costa-mesa.8W4L1DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 332 E 15TH ST Suite: Vicinity: Primary Occ: R-3 Dwellings/ Cong Res <10 Parcel Number: 42531101 Applicant: NIEMANN, DAVID DAIMI Address: 1273 STARLIT DR LAGUNA BEACH, CA Owner: SAMUELIAN, STEPHEN E Address 20371 IRVINE AV SUITE 210 SANTA ANA, CA Contractor: DAVID KAIMI NIEMANN Address: 1273 STARLIT DR LAGUNA BEACH, CA Zip: 92651 Arch Address: Zip: Phone: License: Phone: Zip: 92707 Phone: 415-871-9945 License: 828096 Eng: Address: Phone: License: SCOPE OF PERMIT CONSTRUCT NEW 1571 SF 2 -STORY SFD (639 SF FIRST FLOOR AREA AND 932 SF SECOND FLOOR) WITH A 420 SF 2 -CAR ATTACHED GARAGE. THERE WILL BE A SUPERIOR FIREPLACE (MODEL RD -36: WH REPORT J9902 -5865C-23) IN THE GREAT ROOM AND MASTER BEDROOM. ALSO CONSTRUCT 182 SF PATIO COVERS (42 SF AT FRONT AND 140 SF AT REAR) AND 17 SF BALCONY. 3 BEDROOMS, 2.1/2 BATHROOMS REF: G04-00023 AND PA -04-22 Plan Check: Status: ISSUED Permit: Applied: 01/05/2005 SMIP Res: Issued: 05/30/2007 Type of Construction: V -N $0.00 Zoning: $0.00 Phone: 415-871-9945 ISSUED BY: Zip: 92651 Phone: Zip: 92707 Phone: 415-871-9945 License: 828096 Eng: Address: Phone: License: SCOPE OF PERMIT CONSTRUCT NEW 1571 SF 2 -STORY SFD (639 SF FIRST FLOOR AREA AND 932 SF SECOND FLOOR) WITH A 420 SF 2 -CAR ATTACHED GARAGE. THERE WILL BE A SUPERIOR FIREPLACE (MODEL RD -36: WH REPORT J9902 -5865C-23) IN THE GREAT ROOM AND MASTER BEDROOM. ALSO CONSTRUCT 182 SF PATIO COVERS (42 SF AT FRONT AND 140 SF AT REAR) AND 17 SF BALCONY. 3 BEDROOMS, 2.1/2 BATHROOMS REF: G04-00023 AND PA -04-22 Plan Check: $860.70 Permit: $1,324.15 SMIP Res: $15.86 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $2,200.71 FEE SUMMARY Calc Valuation: $158,591.28 Claim Valuation: $0.00 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 on 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 applicabllees, 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. V FOR INSPECTIONS CALL: (714) 754-5626 2466<8 (6100) C 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. E0-1 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 Polby Number: --- s section need not be completed i/ Ne permit is valued at one hundred dollars ($100) or less.) I certify that in the performance of the work for which this peril Is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calllornl9, an rae that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply With mese provi s. II{x,,7 -Applicant Sloaft e: T - �W�k Ny Dae:_ } -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 DODARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed underplpvisiyng(Q s I)apter 9 (commencing with Section 7000) of Division 3 of the Business and P�lessions Code, and my license is in full -force and'effect: Clc-s----��LFh CJ`1 b Maas a f5 C- I S �rs w -Contractods.Signature:—. CDetei — • 3O • O �— CONSTRUCTION LENDING AGENCY: ❑ I hereby afir 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 affin 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 Tile 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 contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ 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? ❑ 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 for for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Cade, 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 tha applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Zction 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 Dartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................................................................. ......................... .................................... ............................................................. ..... .......................... ...................................................... I ................................... _.............. _..................... I............................. 4 If an RMPP is presently required, has Section 25534 01 the California Health and Safety Code been fully compiled 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 ,a,ppplication agermit 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 LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). ......................................................... ............................. ............... ................................................. ............................. .......................................................................................... .............................................................. .... _......... -........................ any N 6 Will an an of the facility to be constructed under this peril be within 1000 feet from the outer boundaries of a school? C1 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 proscribed by California Health and Safety Code Section 42303 been made? []Yes ❑ No ....._._...........___ ........................ ... _................................ _... _................... ___.......... _.................... .._.............. _.... __._................ _........ _.... _._._..................................... __.._...................................... _...............__............... _.... B (II 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 Intonation given is correct. I agree to comply with allst a 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 inspe o purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ign- I e O egat Owner(s) \ D to S_18 � OrAut4vrizad Appllcant-- - (,-'Date CODE r. INSPECTION TYPE PACE l Iliums CODE If INSPECTION TYPE 2&U INTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 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 Buili ing/Occupancy (714) 754-5273 • Fax (714) 754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 332 E 15TH ST Suite No Vicinity: Parcel Number: 42531101 Applicant: DAVID KAIMI NIEMANN Address: 1273 STARLIT DR - LAGUNA BEACH, CA Owner: ,STIEFEL, LINDA L. Address: 3358- VIA TIVOLI i COSTA MESA, CA Contractor: DAVID KAIMI-NIEMANN Address: 1273 STARLIT DR LAGUNA BEACH, CA MECHANICAL PERMIT Phone: 415-871-9945 Zip: 92651 Phone: 949-350-2867 Zip: 92626 Phone: 415-871-9945 Zip: 92651 License: 828096 ISSUED BY: Status: ISSUED Applied: 05/30/2007 Issued: 05/30/2007 SCOPE OF PERMIT REVISED 06-07-07: ADD RADIANT FLOOR HEATING. NEW 1,571 S.F. 2 STORY S.F.D. MECHANICAL INCLUDES: 1 REPAIR/ALT COOLING/HEAT, 1 FAU < 100K BTU, 5 VENT FANS, 1 GAS PIPING, 1 FACTORY FIREPLACE, 1 HOOD W/MECH EXHAUST, 1 ' COMPRESSOR/ABSORPTION SYSTEM 3-15 HP: REF: 605-00012 FEE SUMMARY _ Quantity Quantity ISSUE r $23.50 _ - i Repair / Alt Absorption Unit $0.00 0 Inst FAU <100 k BTU $14.80 1 - - - - ' ' Repair / Alt Refrigeration Unit $0:00 0 Inst FAU >100 k BTU $0.00 0 - Venlillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 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 $6.15 1 '• _ - :.. Up to 3 hp / 100 k BTU - $0.00 0 , Factory Fireplace $10.65 1 -•," �'. '' �� ,3 -To -15 hp / 500 k BTU $0.00 "o Hood w/Mech Exhaust $10.65 1 15 To 30 hp / 1,000 k BTU _ $0.00 '0 VAV Box S0.00 0 - 30 To 50 hp F1,750 k. BTU $0.00 .0 Vent Fan / Single Duct " $36.25- 5 - . Over 50 hp / Over 1,750 BTU $0.00. 0 Appliance $0.00 0 - Boilers Fire Dampers $0.00 0 - Up to 3 hp S0.00 0 Smoke Dampers $0.00 0 > 3 To 15 hp_ $27.15 1 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 - S0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater '$0.00 0 Investigation Fee $0.00 - Plan Check Fee 50.00 Reinspection Fee $Q00 ' - - TOTAL CALCULATED FEES $152.65 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 C - 2"6 6 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. -0-1 have and will maintain workerscompensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this pemlit 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 ($160) or less.) Q)I certify that in the performer of thew f r 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 Califo nla, and ee t it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provision . - v r4plicant Signature: _Date: WARNING: FAILURE TO SECURE W R PENSATION COVERAGE IS UNLAWFUL AND SHAD. SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSANDDOLLAR (5100,000), IN A m TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed un fpvlsi pr' Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Proles ns Code, license is in full force and effect. Lic. N t� Class H lC>Py _ — ,Contractor's Signature: Date: - • O 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 Cade). 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).): ❑ 1, 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 Cade for this reason: Signature: Date: Owner ID verified by drivers 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? ❑ 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, 200 cubic feet of compressed gas at standard temperature and pressure). ,or .............................................................................................................................................................................................................................................................................................................................................................. 2 Does or will the applicant or present Or future building occupant need to file a registration toren for acutely hazardous materials? ❑ 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 appplicant or present or future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ;T1 ❑ Yes C1 (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, hes Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes El 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 ermit for such construction or modification LJ from the South Coast Air Quality Management District or from any other air pollution control district Or agency? Yea 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 ❑ 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 ❑ No .......................................................ific................................................................pro..p-r-i....................................o-int...............eI.................................................................................................................................................. B (If 'vas", attach certificate of compliance tram 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 slate that the information given is correct. I agree to comply wi jI 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 nspection purposes. 1 agree not to Occupy or allow Occupancy of any building authorized by this permit until final inspection. Signal re OIL gal 0 Rar(5�' Dat O ^ And/Or Au prized Applicant ate CODE t. INSPECTION TYPE ga¢, INTME4S CODE r INSPECTIONTYPE gs¢, I11in1ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 3-3-act _&L 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 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 NEWPORT -MESA UNIFIED SCHOOL DISTRICT CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AS 1600 AND AS 181 To: ( ) City of Costa Mesa City of Newport Beach ( ) County of Orange Applicant: - , Address: AA / Q-YkA-rJL,` N° 6632 District Receipt No. Plan Check Noce `�� n i"� ( UVEA ?fit �� cel `�'26'� i Telephone Number: L4'1 Tract/Parcel and Lot Number(s): Location of Project: Number of Square Feet of: Residential Space Commercial and Industrial Space CommercialAndustrial Project is: (Check One) Warehouse _ RBD Movie Theater Mini -storage Heavy Industrial Regional Shops Light Industrial This project is exempt because C u-�; $1.84 x $.30 Motel _ Bank Neighborhood Shops Racquet/Heatih Hotel _ Medical Office Office Park Total I .0 Preschool Auto Repair Hospital Large Office Office Bldg. Restaurant Fast Food This certifies that the above-named Developer/Applicant has paid school faafity fees in compliance with Government Code sections 53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport -Mesa Unified The above representation as to square footage is true. Applicant agrees that if itis lat determined that such representations are not true, then this certificate shall automatically terminate and appy ' to City/Cous notifi Date: _ (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 332 E 15TH ST Suite No Vicinity: Parcel Number: 42531101 ISSUED BY: Applicant: DAVID KAIMI NIEMANN Address: 1273 STARLIT DR Phone: 415-871-9945 LAGUNA BEACH, CA Zip: 92651 Owner: STIEFEL, LINDA L Address: 3359 VIA TIVOLI FEE SUMMARY. Phone: 949-350-2867 COSTA MESA, CA Zip: 92626 Contractor: DAVID KAIMI NIEMANN Repair/ Alt Absorbtion Unit $0.00 Address: 1273 STARLIT DR $14.80 1 Repair / All Refrigeration Unit $0.00 Phone: 415-871-9945 $0.00 LAGUNA BEACH, CA Zip: 92651 0 Repair/Alt Cooling/Heat License: 828096 Status. ISSUED SCOPE OF PERMIT NEW 1,571 S.F. 2,STORY S.F.D. MECHANICAL INCLUDES: 1 REPAIR/ALT COOLING/HEAT, 1 FAU < 100K BTU, 5 VENT FANS, 1 GAS PIPING, 1 FACTORY FIREPLACE, 1 HOOD W/MECH EXHAUST, 1 COMPRESSOR/ABSORPTION SYSTEM 3-15 HP. &F i 40j. FEE SUMMARY. Quantity Quantity ISSUE FEE $23.50 Repair/ Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $14.80 1 Repair / All Refrigeration Unit $0.00 0 Inst FAU >100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 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 $6.15 1 Up to 3 hp / 100 k BTU S0.00 0 Factory Fireplace $10.65 1 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 $0.00 0 30 To 50 hp 11,750 k BTU $0.00 0 Vent Fan / Single Duct $36.25 5 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 $27.15 1 Inst or Relocate Appl Vent $0.00 0 15 to 30 no $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 50.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $142.85 COMMENTS I 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) 7545626 // 240646 (SM) 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. �_Lha_ve and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: FOarrler: �P-olieyNumb�r:—= s section need not be complefed if the permit Is valued at one hundred dollars ($100) or less.) 1 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 f Cali Is, 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 p I i I x p��> O� �App�licant.Signature: L� IVUd�L-Dste✓— (WAR ZGrFAILURE TO SEC RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUWECT AN EMP&YER 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 licensetl un er provi. o s of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and ,Pr�ofessions Code, and my license is in full -force and effect-Lic..H. �� 0 l 1 Class_p.CS �- 'Conlrectote9ignature: - ��--- rDatej 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 Cade) 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. It, 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 contractors) 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. ❑ 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 Tore 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? ❑ 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 iha applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ 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). ...............................................................................................................................................................................................................................................................................................................................................................................I........... 3 Does or will the appplicant 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 en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................................................... .................................... ........................... .............. ......................................................................... ....................................... ................................................... ................... -........................................ 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication a ffrmit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LI 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 ❑ 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 Cade Section 42303 been made? []Yes [INo ..... ....................................................................................................................................................................................................................................................................................................................................................................................... 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 inspect! purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. S natu a Legal Owners) Date 3G -O k nd/Or rizedAppli (!Date. CODE f. INSPECTION TYPE PSIE INTmALS CODE# INSPECTION TYPE QATE INmuLs 1616 Fixed System Final Fire Pe-ration 206 Final Mechanical 1266 Pool Spa Final 208 ' al Plumbing 200 Final Re-Root Final Electrical 201 Final Block/Retaining Wall 2 2 Fine Prev Ion 202 Final Factory Fire Place 2 nn oval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mes' 1E1bTRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 332 E 15TH ST Status: ISSUED Suite No $0.00 0 Applied: 05/30/2007 Vicinity: New Res (1-2 units) Issued: 05/30/2007 Parcel Nunmber: 42531101 0 Pool / Spa Applicant: DAVID KAIMI NIEMANN Lighting Fixts $6.60 Address: 1273 STARLIT DR $3.30 3 Switches $2.20 ISSUED BY: Non Res Appl $0.00 Phone: 415-871-9945 Res Appl $0.00 0 LAGUNA BEACH, CA Zip 92651 $0.00 0 Owner: STIEFEL, LINDA L Address 3359 VIA TIVOLI Phone: 949-350-2867 COSTA MESA, CA Zip: 92626 Contractor: DAVID KAIMI NIEMANN Address: 1273 STARLIT DR Phone: 415-871-9945 LAGUNA BEACH, CA Zip: 92651 License: 828096 SCOPE OF PERMIT NEW 1,571 S.F. 2 STORY S.F.D. ELECTRICAL INCLUDES: 1,571 S.F., 6 LIGHT FIXTURES, 3 OUTLETS AND 2 SWITCHES FOR THE GARAGE. Ar" ms,OZ011 Quantity ISSUE FEE $23.50 Busway/100 ft Temp service test $0.00 $0.00 0 Res. a/c package $0.00 Transformers up to 1 kva/kw New Res (1-2 units) $87.98 1571 New Res (3+units) $0.00 0 Pool / Spa $0.00 0 Lighting Fixts $6.60 6 Recept Outlets $3.30 3 Switches $2.20 2 Non Res Appl $0.00 0 Res Appl $0.00 0 Service to 200a $0.00 0 Service to 1000a $0.00 0 Service over 1000a $0.00 0 Motors to ihp $0.00 0 Motors to 10hp $0.00 0 Motors to 50hp $0.00 0 Motors to 100hp $0.00 0 Motors over 100hp $0.00 0 Communication drops $0.00 0 Sub panel to 200a $0.00 0 Pole Light Pkg $0.00 0 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 Intermed Pole $0.00 0 FEE SUMMARY Quantity Temp Dist System/ Lighting $0.00 0 Busway/100 ft $0.00 0 Standing Section $0.00 0 Misc Electrical Equipment $0.00 '0 Transformers up to 1 kva/kw $0.00 0 ................up to 10 kva/kw S0.00 0 .................up to 50 kva/kw $0.00 0 ...........:.....up to 100 kva/kw $0.00 0 ..................over 100 kva/kw $0.00 0 Low Voltage Equipment $0.00 0 Low Volt Wiring System / Ckl $0.00 0 Misc. Conduit $0.00 0 Misc. Conductor $0.00 0 Circus (gen or ride) $0.00 0 Circus (mech ride or lights) $0.00 0 Christmas Tree Stand $0.00 0 Fireworks Stand $0.00 0 Other Electrical Fee $0.00 Investigation Fee - $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $123.58 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 c�s, a required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration j6pls permit. FOR INSPECTIONS CALL: (714) 754.5626 p� 2aa6�6l6rool DECLARATIONS I WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. p,_ I.h`aV s and will maintain workers' compensatlon 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: - 626RE.Number. — Garlror sscneed not be completed if the permit is valued atone hundred dollars ($100) or less.) I certify that In the performance of the wprk for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensationlaws f C III a, 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 p i 044. 1 AppllcS Ignature:- � yV P W Det _�' �� • O � 1 *ARMING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUWECT AN EMkMER 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 37M OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I aim lice undo/pjq+Isions Q hagter 9 (commencing with Section 7000) of Division 3 of the Business and Pr salons Cody"nd my license is in full force.and e�Llc..a. -- - W l� H nA Clesy R.` C_ ( S IL;orltracto�gnature:-- CONSTRUCTION LENDING AGENCY: ❑ 1 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 then 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. 11, 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers 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: ❑ 1 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 ISorad 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). .._.._..........._._...............__.........................__............._........................................................._..a-ed..........i-io. a r...__..........n I........ f-o-...._._...--1jy-........................................l-s-7..._....._ _............_........__............_.............._............_. 2 Does or will the applicant or present or future building occupant need to lila a regisiralion form for acutety hazardous materials? ❑Ves ❑ 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 ❑ No . .................._................_................__................. ............ .............. __._.............................................. .__........................ _....................................... _.............................. .............._............................ ............................................. ... .................. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this 92plication apennit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? LJ 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). .................................................................._..................................................................................................................................................................................................................... ..I................. ...................................................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (I1 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 Alr OualiN 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 prescrlbed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ....................................................................................................................... __................................................................................................................................................................................................................................................................. 8 (If yes', attach certificate of compliance frorn 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 slate 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. S n o f Legal Owner(s) Date C f r Authorized Applicant---- CODE If INSPECTIONTYPE QAIE IIIIIDALS CODE I INSPECTION TYPE DAif. ItIIIDALS 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 Weil 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 (714) 754-5273 • Fax (714) 754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626 PLUMBING PERMIT Job Address: 332 E 15TH ST Suite No Vicinity: Parcel Nunmber: 42531101 Applicant: DAVID KAIMI NIEMANN Address: 1273 STARLIT DR Phone: 415-871-9945 LAGUNA BEACH, CA Zip: 92651 Owner: STIEFEL, LINDA L Address 3359 VIA TIVOLI Phone: 949-350-2867 COSTA MESA, CA Zip: 92626 Contractor: DAVID KAIMI NIEMANN Address: 1273 STARLIT DR Phone: 415-871-9945 LAGUNA BEACH, CA Zip: 92651 License: 828096 ISSUED BY: Status: ISSUED Applied: 05/30/2007 Issued: 05/30/2007 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 aba 11 cloned 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 appllcable-codes, and all required Inspections end final approval must be obtained. Failure to obtain Inspections and final approval will result In the expiration o7this permit. FOR INSPECTIONS CALL: (714) 754-5626 2418-4e (omo) SCOPE OF PERMIT NEW 1,571 S.F. 2 STORY S.F.D. PLUMBING INCLUDES: 1 BATHTUB, 1 GAS (1-4 OUTLETS), 4 P -TRAPS, 1 PRESSURE REGULATOR, 1 SHOWER, 1 KITCHEN SINK, 4 WASH BASIN, 3 WATER CLOSETS, 1 WATER PIPING AND 1 WATER HEATER. Ars 60 S' jai)1 FEE SUMMARY ' AMT QTY AMT QTY AMT ISSUE FEE 23. 550 Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation 50.00 0 Swimming Pool 50.00 0 Backflow Preventer $0.00 0 P -Trap S39.20 4 Trap Primer $0.00 0 Bathtub $9.80 1 Pressure Regulator 59.80 1 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr BkBow(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 50.00 0 Wash Basin $39.20 4 Dishwasher $0.00 0 Sewer Cap for Demo $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 Closet (Toilet) $29.40 3 Drain, Roof 50.00 0 Shower $9.80 1 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 - Sink, bar $0.00 0 Water Piping (Inst or Rep.) $9.80 1 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 $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) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 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: $198.75 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 aba 11 cloned 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 appllcable-codes, and all required Inspections end final approval must be obtained. Failure to obtain Inspections and final approval will result In the expiration o7this permit. FOR INSPECTIONS CALL: (714) 754-5626 2418-4e (omo) WORKERS' COMPENSATION DECLARATION: ` I hereby all nn 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: rifer. Pr WjGy.Number. Is section need not be completed if the permit is valued at one hundred dollars ($100) ar less.) f3'� t a work far which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' I certify that in t=ADDMON compensation land a e that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with the, Q O Ap IicanI.SignstUm:'-V ` FAILURE TOCOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($N TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3/06 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attiml that I em licensed under provfL�sLlo s f he er 9 (commencing with Section 7000) of Division 3 of the Business an rofessions Code, and my license is in full (7� forca.eDd,effect--Uc..N.�—"^ V =;IC ass.tl_ EiS _ Contraclods;5lgnature:.-.---._.__ _ r-�, par �710-0 fi-`• CONSTRUCTION LENDING AGENCY: ❑ I hereby all min 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.). ' ❑ 1, 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. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - properly tax bill or dead): 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, Tide B, Celifomla 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 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 reportetl 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 forth for acutely hazardous materials? ❑ 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 Gods 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 thisa plication a emit for such construction or modification N 19 from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). ......_._............._.......................__......_....................___...._.....................___.................................. .._._............................_._.......................... _............................................. _..__..............................._............ ......................_............. per 6 W III any pan of the facility to be constructetl untler this mit be within 1000 feet from the outer boundaries of a school? [I Yes ❑ 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? ❑Ves ❑ 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 inspect qn purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. at re\ f Legal ner(s) Data CODE S. INSPECTION TYPE gdTE IMRIAL9 CODE r INSPECTION TYPE QLTE Its 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pcol Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 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