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Home My WebLink About312 SYDNEY LN - Building PermitsCOSTA MESA, CA Zip 92627-2030 Owner: WILSON, BRYCE AND, CARMEN Address 312 SYDNEY LN.' ' Phone: 949-642-3623 COSTA MESA, CA . Zip: 92627-2030 _ Contractor: OWNER -BUILDER Address: Quantity ISSUE FEE Phone: _ ' - Zip: - License: 000000 Temp service lest $0.00 - SCOPE OF PERMIT $0.00 MINOR KITCHEN REMODEL. REPLACE/RELOCATE FIXTURES. ELECTRICAL TO INCLUDE: 4 OULETS. 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 it 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 applica�an'd all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446.46 (6/00) FEE SUMMARY Qu entity _ - Quantity ISSUE FEE $23.50 - - - - - Temp Dist System / Lighting $0.00 0 Temp service lest $0.00 - Busway /100 It $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 $0.00 0 ' .............:..up to 50 kva/kw $0.00 0 Recept Outlets $4.40 4 .......... ...... up to 100 kva/kw $0.00 0 Switches $0.00 0 ..................over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Service to 200a $0.00 0 _ - Misc. Conduit $0.00 0 Service to 1000a $0.00 0 - - Misc. Conductor $0.00 0 Service over -1000a $0.00 0 _ Circus ( gen or ride) $0.00 0 Motors to 1hp . $0.00 0 Circus (mech ride or lights),- $0.00 0 Motors to 10hp $0.00' 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 .Other Electrical Fee $0.00, Motors over 100hp $0.00 0 _ - 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 $27.90 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 it 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 applica�an'd all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446.46 (6/00) DECLARAVONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have end will maintain a certificate of consent to self -Insure for workers' compensation, as prgdded forty section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. ❑ 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 carrier and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued atone hundred dollars ($100) or less.) V7ty 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 the se provll }�?/ ,Affillcant Signature:,¢ 1Y/v lVvWv� �/�J�X/� -Date`: 1 GI- (Z �WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. 4 Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby of irn that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Lew (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 fora 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 I 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 axe oder Sec. Business and Professions Code for this reason: .Signature: _ LErpires: Verification of Ownership by (type of dcou enL i.e. - property tax bill ordeed— DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ 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 tiling 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 Doea or will the applicant or present or future building occupant require for the work which is the subject of this a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the 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). F.W. _ ................ 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 ............. ...................................................................................e.f..o.IT,................................................11ut................................................................................................................................................. ........................................................................ 8 (It'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. figree 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-d9np�d above -Md for inspection poses. agree not to occupy or allow occupancy of any building authorized by s permit until final inspection. Signa` t/l.LegaICwner(s)_-_____r And/Or Authorized Applicant Dale CODE E. INSPECTION TYPE DAFT IIf1ID9LS CODES INSPECTION TYPE 2M INi111AL5 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 1ZJob Address: 312 SYDNEY LN MECHANICAL PERMIT Suite No Vicinity: Parcel Number: 93519007 ISSUED BY: Applicant: WILSON, CARMEN Address: 312 SYDNEY LN - Phone: 949-642-3623 COSTA MESA, CA _ Zip: 92627-2030 " owner: �WILSON,.BRYCE AND CARMEN Address: 1312 SYDNEY LN _ Phone: 949-642-3623 COSTA MESA, CA Zip: 92627-2030 Contractor: OWNER -BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT MINOR KITCHEN REMODEL. REPLACE/RELOCATE FIXTURES. MECHANICAL TO INCLUDE: 1 HOOD W/MECH EXHAUST. Quantity ISSUE FEE $23.50 Inst FAU <100 k BTU $0.00 " - 0 Inst FAU >100 k BTU $0.00 0 Repair/All Cooling/Heat $0.00 0 Inst / Rep. Recess Wall Htr $0.00 '0 Refrig Sys <100 k BTU $0.00 _ 0. Refrig Sys >100 k BTU $0.00 . .0 Gas Piping $0.00 0 Factory Fireplace $0.00 0 Hood w/Mech Exhaust $10.65 1 VAV Box $0.00 0 Vent Fan / Single Duct $0.00 0 Appliance $0.00 0 Fire Dampers $0.00 0 Smoke Dampers $0.00 01 Inst or Relocate Appl Vent $0.00- _ 0. -' Air Handlers < 10000cfm $0.00 0 " Air Handlers > 10000cfm. $0.00 0 Floor Furnace $0.00 , 0 Floor or Suspend Heater „$0.00 0 - Other Mechanical Fee Status: ISSUED Applied: 09/21/2006 Issued: 09/21/2006 FEE SUMMARY Quantity - Repair/ All Absorbtion Unit $0.00 0 Repair/ Alt Refrigeration Unit $0.00 0 Ventilation System $0.00 0 Evaporative Cooler $0.00 0 .Commercial Incinerator $0.00 0 Domestic Incinerator $0.00 0 - Compressors/ Absorption Systems Up to3 hp/100k BTU $0.00 0 3 To 15 hp 1500 k BTU $0.00 0 15 To 30 hp / 1,000 k BTU $0.00 0 30 To 50 hp /-1,750 k BTU $0.00 0 Over 50 hp / Over 1,750 BTU $0.00 0 ' - Boilers Up to']; hp $0.00 0 - - 3 T 15 hp- $0.00 0 15 to 30 hp _ - $0.00 0 30 to 50 hp $0.00 0 . Over 50 hp $0.00 0 - Other Mechanical Fee Investigation Fee $0.00 Plan Check Fee - $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $34.15 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 abandofied for a period of 180 days. 100 INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicablydes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expirationrortthis permit. FOR INSPECTIONS CALL: (714) 754.5626 2446-46 (15M) 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 Cade, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' cornpensalion 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: Carder: Policy Number: R is section need not be completed if the permit is valued at one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws 91,Califomia, and agree that Off hould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these on Applicant J1/_\__ p ^ Applicant Signature: X/I/ I V V W P W `__ Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. Lic. # Class # Contractors Signature: Date: 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). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora 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 L s.). ❑ I am ex e �t d r sec. Business and Professions Code for this reason: Signature: _ nDate: — _0,9 Owner ID verified by tlnvers license. Yes ❑ No Driver's License No. Expires: S - Verification of Ownership by (type of docu en , i.e. - property 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, The 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ......................................................................................-.................................................................................................................................................................................................................................................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ 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)? ❑ 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. ........................................... ........................................... -.......................................................................................................................................................................................-................. ... .......... .........................................................I................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ......................................................................................_..........fu*t*......................................................u'i'r.........................................................................t'....ion'.'a.......-........................................_.................................... ........... 5 Does or will the applicant or present or future builtling occupant require br the work which Is the subject of this a plication aEEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency.+ Vas LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..................................................... .................................................................................................................... ............................................................................................................ -............. _....................................... .... .......................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? []Yes ❑ 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 .......................................................................................................................................................................................................................................................... ................................... ..................... ........ ........................................ 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 1 have read this application and state that the information given is correct. I el 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-descr' d property for inspection purposes. I so ndgt to occupy or allow occupancy of any building authorized b This permit until final inspection. 4 W 0/1A -C 4W �i JL/� Signature Of Legal Owners) Date And/Or Authorized Applicant Date CODE t• INSPECTIONTYPE p9g INTmALS CODE P INSPECTION TYPE 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/Retaming 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 312 SYDNEY LN Suite No Vicinity: 2 Parcel Nunmber: 93519007 Applicant: WILSON, CARMEN Address: 312 SYDNEY LN Phone: 949-642-3623 COSTA MESA, CA Zip: 92627-2030 Owner; /WILSON,-BRYCE"AND,CARMEN Address '312 SYDNEY LN - -- - ' Phone: 949-642-3623 COSTA MESA, CA, - Zip: 92627-2030 Contractor: OWNER -BUILDER Address;' Phone: Zip: License: 000000 SCOPE OF PERMIT MINOR KITCHEN REMODEL. REPLACE/RELOCATE FIXTURES. ISSUED BY: Status: ISSUED Applied: 09/21/2006 Issued: 09/21/2006 7X/K PLUMBING TO INCLUDE: 1 ICE CONNECTION, 1 KITCHEN SINK AND 1 WATER PIPING. FEE SUMMARY ' AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 , 0 Swimming Pool . $0.00 0 Backflow Prevenler $0.00 0_ P -Trap - - $0.00 "'0 Trap Primer $0.00 0 Bathtub $0.00 0`_ - Pressure Regulator - $0.00 _ 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect (Ice,Soda,etc) $9.80 1 Receptors 1$0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 _ 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo ` $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) $0.00 0 Drain, Roof .$0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0:00 0 Water Piping (Inst or Rep.) $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) $0.00 0 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: $52.90 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 abandons 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, d all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this FOR INSPECTIONS CALL: (714) 754.5626 244848 (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 pennit 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 Garner and policy number are: Carder: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' / compensation laws of C��lifffpmia, 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 provis Applicant Signature: rd`sV V AYLysjvDate: /ao WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. LIC. N Class k Contractor's Signature: Date: 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). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: 1 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 pormit 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 ursuant to the Contractors License Laws.). ❑ 1 am a /am I under sec. n Business and Professions Code for this reason: Signature: f� ✓V1 p/t�_. Expires: 5=� Verification of Ownership by (type of docu a 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 WIII 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 tiled 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 ...................................................................................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency?Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ........................................................................................................................................................................................................................................................................................................................................................................................... 8 WIII any pert 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 It 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 ag 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 -des Ib operty for inspection purpose : egr a not to Occupy or allow Occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE t. INSPECTION TYPE PATE INITTIAL CIDDE#i INSPECTION TYPE 26M INTMAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 �r Final BlocklRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval T, 203 Final Sign 222 Final Site 204 Final Demolition - 250 Final Building/Occupancy OWNER BALALIS & PIGNERI DATE 3-1-77 10B ADDRESS 312 Sydney Lane BUILDING PERMIT NO. 43354 'I-ENERAL CONTRACTOR Pieneri Construction DESCRIPTION of WORK Res. w/arr_ garage _ Al AP No. t 1 S-,),)n-nz LOT TRACT FIRE ZONE VALUES oo oc nn SUBCONTRACTOR PROP. SWR. LINE LJ HOUSE CON. Lf SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING' TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ROUGH WIRING TRENCHES FORMS STEEL REINF FLOOR SYSTEM BOND BEAM ❑ 'STEEL REINFORCE ❑ SHEATHING FRAME AND FLASHING LATHING - IN PLASTER. BROW COAT STRUCTURAL, FINAL HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ❑ ELECTRIC, FINAL BUILDING. FINAL J` ri/� v17J'a COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDINGl C ADDRESS - f �" s IYL i-`C� OWNER Q blfSMAIL ADORES QSADORESI L A clry (��, ."LNoK73."LNoK;73 CONSTRUCTION I FNnFR BRANCH ADDRESS TEL. Nn. 'AN 2n-771HS.00 8?6'% ***e-65.511 APPLICATION FOR STRUCTURAL PERMIT R ECEIVED BY DATE RECEIVED DAT ISS ED 02` i A.P. ?PQMI O. BUILDING ADDRESS O. OF PLAN$ USE OF NE" BUILOIN TRACT F STATE CITY LIC. NO 0� '7 LIC. NO. 6 7o YARDS APPROVED MAIN BUILDING BLOCK EW A SIZE NO. OF SLOGS. (FROM C/ S`ryga OWNER OF LOT NOW ON LOT RONT $ V $ IS FOR ONLY: CONTRACTO 1 aQJC -{- BY r— U.I t ADDRESS L CCJ. f A TEL./ ,l c CITY NO. b Dj- v O. OF PLAN$ USE OF NE" BUILOIN F STATE CITY LIC. NO 0� '7 LIC. NO. 6 7o YARDS APPROVED MAIN BUILDING YARDS A ACCESSOR w SIZE NO. OF SLOGS. (FROM C/ S`ryga a OF LOT NOW ON LOT RONT G USE OF .N. EXISTING BLDG.SIDE 61. y FSeparate permits are required for L. SIDE T electric, plumbing and heating work. C REAR w F USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLD �Q ; VAR.+ TE y� ..I � C.U.P. �� APPROV Tl' >tAPPROVE >. u G(/ a'7 Cn7:r Anr•e'+.r t_ w 4 O 1 hereby acknowledge that I have read this application and note -- pQ that the above information is correct and agree to comply with 0. all laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation laws of w the State of California. _ IIJ SQ. FT. 3 I hereby certify that I em properly licensed as a contractor under THE AMOUNT SHOWN UNDER VALU the State of California Business and Profession, Code, Division 3, Chapter 9, and that such licenses are In full force and affect, or I THE PURPOSE OF ESTABLISHING A PERI am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ end Professions Code, Division 3, Chapter 9. Signature of q PLAN CHECK S M Permittee S �/ TAX $ v) / Authorized Agent TOTAL PAID $ IS FOR ONLY: PP" 717 —1-77PMi` 00 09^ ui::.,i I?7.00 COSTA MESA BUILDING -SAFETY DEPARTMENT N P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 n m APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in C mpletely,— Use Ink Only SQ. FT. a THE AMOUNT SHOWN UNDER VALUATION IS FOR RECEIVED BY DATE RECEIVED DATE ISSUE[ BUILDING �%r VALUATION PERMIT FEE $ I ADDRESS J PLAN CHECK $ m 0 0 PERMIT NO. OWNER A.P. NO. u s� TOTAL PAID $IQ I BUILDING V MAIL ADDRESS ADDRESS TEL. TRACT LOT BLOCK CITY NO. BRANCH ADDRESS ARCHITECT CONTRACTOR / ADDRESS TEL. CITY NO. STATE CITY LIC. NO. LIC. NO. SIZE NO. OF BLDGS. OF LOT NOW ON LOT USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED FIRE ZONE APPROVED DATE ZONE P° NS I BUILDING USE OF NEW YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET) /VAR. IV- DATE C.U.P. d+ I APPROVED I r APPROVED I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of Permittee Authorized Agent N n m i m SQ. FT. a THE AMOUNT SHOWN UNDER VALUATION IS FOR D THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE $ I sl N PLAN CHECK $ m 0 0 u TAX S vi u s� TOTAL PAID $IQ I LL/ V