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Home My WebLink About222 DEL MAR AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 . www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 222 DEL MAR AV Suite No Vicinity: FRONTYARp Parcel Nunmber: 43921105 Applicant: PHUNG, PAUL f Address: 4922 W MAURIE AV SANTA ANA, CA , �� Owner.� �DO, LIEM.AND VU, MIEN Address 222 DEL MAR AV - COSTA MESA, CA Phone: 714-920-9684 � Zip: 92703 Phone: 949-650-6607 Zip: 92627-1321 Contractor: P P PAUL'S PLUMBING Address: 4922 W MAURIE AV � - � Phone: 714-920-9684 SANTA ANA, CA Zip: 92703 _ � � License: 606153 Arch / Eng : � � � , � " � , _- " � . %:. � Address: - - - ' � ' �" " Phone: Zip: - License: SCOPE OF PERMIT . ;, ' , �ON SITE SEWER LINE REPAIR. . . � ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifer System Connect pce,Soda,elc) Dental Units � Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Dnnking Foun[ain Expansion Tank Gas Earthquake Valve AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 So.00 $0.00 $0.00 on 0 0 0 0 0 0 0 0 0 0 0 0 0 Laundry Tub / Washer - � Landscape Irrigation P-Trap Pressure Regulator Process Piping (per 10 ft) Receptors Septic Tank ' SewerCapforDemo � Sewer Connect Sewer Private Line Shower Sink, bar Sink, commercial Sink, Floor " ' Status: ISSUED Applied: 12/09/2003 Issued: 12/09/2003 ISSUED BY: � �-/ � � � . - : � . �� ; \ � , �:AA i ' �: , �� .� �• � AMT �,QTY .� .� � AMT . $0.00 0 � _�. SumpFump � .�� $0.00 $0.00 " - 0 '� - � � - Swimming Pool � - � $0.00 $0.00 0 Trap Primer ' $0.00 $0.00 0 Urinal � � - $0.00 $0.00 0 . Vacuum Brkr BkFlow(1-4)� $0.00 $0.00 0 - Vacuum�Brkr BkFlow(5+) $0.00 $0.00 0 �- Wash Basin � ., � � $0.00 $0.00 0 . Wasli Basin Set' $0.00 $0.00 0 UJaste and Vent System $0.00 $24.65 1 Water Closel (Toilet) $0.00 $0.00 0 Water Heater / vent $0.00 $0.00 0 Water Piping (Inst or Rep.) $0.00 $0.00 . 0 ' Water Re-pipe $0.00 $0.00 � 0 Water Service $0.00 �TY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by ihis 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 becoma void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 780 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 requlred inspeetiona end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration oi this permit. FOR INSPECTIONS CALL: (714) 754-5626 2666-46 (N00) WORKERS' COMPENSATION DECLARATION: '� ' I hereby ettirm unCer penalry oi perjury ona ot Ihe tollowing declarations: � ❑ I have end will maintein e ceNficate of consent to self-Insure for workers' compensation, as pmvitletl tor by section 3700 ot the Labor Code, lor the pertortnence ot the work tor whlch tMs pertnit IS issued. ❑ I h� ve end will m Pnta� �rs' cwnpen`��equired by section 3700 of the Labor Code, tor the pedortnance of the work tor which this pertnit is issued. M workers' wm e atio sur n cam r entl i� er are: Carner: PoliCy Number: ��s sechon need not be com0/eted il fhe perm/f is ve/ ed et one hundred dollers ($100) or less.) rtify Ihet in the pertormance of the work for which Ihis permit is issued, I shall not employ any person in any manner so as to become subject to ihe workers' —�a compensatlon lews of Celitomia, and agree that If I sh uld become sub�ect to the workers' compensation provislons of Sectio 3700 f the Labor Cotle, I shell forthwith wmpty with these provLsions. 1 7�y% �� Applicant SlgneNre: � Date: I ZI C� i WARNINO: FAILURE TO SECUFE WORKERS' COMPENSAT70N COVERAGE IS UNLAWFUL AND SHA115U6)ECT AN EMPLOVER TO CRIMINAL PENPLTIES PND GVIL FlNES UP TOONE HUNDRED TFIOUSAND OOILARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEGTION 31W OF THE LABOR CODE, INTEREST, AND FTTOfiNEY'S FEES. LICENSED CONTRACTORS DECIARATION: I hereby aflirm that I em licensad under provislons ot Chepter 9(commencing with Section 7000) oi Division 3 of the Business antl Pmtessions Code, end my license is in full force end efleci. Llc. N Class x / Contreciofs Signature: D 2- .0 Dete: � T� CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirtn Ihat there is a consiruction lending egency for ihe pedortnance of the work for which Ihis pertnit is iuuetl. (Sec. 3097, Civil Code). Lendefs Name: Signature: _ OWNER-BUILDER DECLARATIONS: Lenders Address: Date: I hereby aHirtn that under penalry of perjury thet 1 em EXEMPT FROM THE CONTRACTORS LICENSE LAW for �he tollowing reason (Sec. 7031.5, Business and Protessions Code: Any ciry or counry which requires a pertnit to consiruct, alter, improve, demolish, or repair any slructure, pnor to its iuuance, also requires t�e epplicant for such permit to file a signed stetement Ihet he or sha is Iicensed pursuam to ihe pmvisions of the Contractors License Lew (C�apter 9(commencing with Sectlon 7000) of Division 3 ot ihe Busineu end Protesslons Gode) or that he or she is exempt therefrom and the besis for the alleged examption. Any violetion of Section 7031.5 by eny applicant tor e partnit subjects the ap011cent to e civil penalry of no� more ihan tive hundred dollars (5500).): ❑ I, as owner oi Ihe property, or my amployees with wages as iheir sole compensation, WILL DO THE WORK, and the siructure is not intentletl or oNerad for sale (Sec. 7044, Busineu end Protessions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himselt or herself or throu9h his or her own employees, provided that such improvemenis are not intended or oHered for sale. If, however, Ihe builtling or improvement is soltl within one year ot comple�ioq ihe owner-builder will have ihe burden of proving ihat he or she did not build or improve tor purpose of sale.). ' ❑ I, as owner of ihe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the projeci (Sec. 7044, Business and Professions Cotle: The contrectors Llcense Law tloes not apply to an owner of property w�o hullds or improves Ihereon, antl who contracts for such project wtlh a coniractor(s) licensa pursuam b iha Contrectors License Laws.). ❑ I am ezempt untler sec. Business and Professions Code for ihis reason: Siqnature: Data: Owner ID veritied by tlrivers license. ❑ Yes ❑ No Dnvar's License No. Venfication ol Ownership by (rype of ticeument, i.e. - property tan bill or deed): DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATON: Ezpires: ❑ I hereby certify ihat no excavation five (5) or more feet in depih into which e person is required to descend, will be made in connac�ion with work euthonzed by ihis permit, end that no building simcture, scalloltling, tatsework, or demolition or dismantling ihereof, will be more ihan thirry-six (36) feet Oig�. (Chap. 32, Gry 2, Art 2, Sac. 341, Tltle 8, California Atlministrative Cotle). ❑ As owner-builder, I will not employ enyone to do work which would require e parmit from Ihe Division of Industrial Safery, as noted ebove, unleu such pereon hes e pertnit ta do such work from the tlivision. Signature: Date: Division ot Industnal Sefery Pertnit Number: CER7IFlCATE OF COMPLIANCE AND AllT}fOFi¢ATION OF ENTHY: I certity under penalty of perjury that I have read this application entl stete that the information given Is correct. I agree to wmpty with all state laws antl ciry orGinances relating to buildinq construction, end auihorize represeniatives of the Ciry of Costa Mesa to enier upon t�e above-described properry for inspection p rposes. I agree not to occupy or allow occupancy of any builtling authonzed by this pertnit until finel inspection. �� J J' � Signature i Legal Owner(s) I^, � /�-� Date FTu �/ � //� V � 1 � —And/Or Aulhonzed ADPlicant �— ate COOE I. INSPECTIONTYPE 1616 Fixetl Sysiem Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Roof 201 Final BIocWRetaininq Wall 202 Final Factory Fire Place 203 Final Sign 204 Finel Demolition P� 1[�ELS COOEt INSPECTIONTYVE 206 Final MeChanical 208 Final Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Finel Planning Approval 222 Finel Site 250 Finel Building/Occupancy PAIF. II�LS (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 7J FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 222 DEL MAR AV Suite: Vicinity: Parcel Number: 43921105 Applicant: DO, LIEM Address: 222 DEL MAR AVE COSTA MESA, CA Owner: DO, LIEM AND VU, MIEN Address 222 DEL MAR AVE �' COSTA MESA, CA Contracmr: OW N E R-BU ILD ER Address: Zip: Arch : Address: Phone: Zip: �icense: Zoning: Phane: 949-650-6607 Zip: 92627-1326 _ Phone: 949-650-6607 Zip: 92627-t326 � . Phone: License: 0 � Eng: Address: Slatus: ISSUED Applied: O6/18/2002 Issued: 09/03/2002 �� I /!� �_ Phone: License: SCOPE OF PERMIT ADD 680 S.F. FOR S.F.R., INCLUDES: 1 BEDROOM, 1 BATHROOM, AND 1 FAMILY ROOM. WIDEN ENTRY WAY. CHANGE OUT EXISTING BEDROOM WINDOWS TO DOUBLE PANE GLASS BAY WINDOWS AND ADD A SLIDING GLASS DOOR TO KITCHEN. ADD A FIREPLACE IN NEW FAMILY ROOM. REROOF EXISTING HOUSE (998SF) AND ADD 40SF COVERED ENTRY, MALIBU TILE QCBO 4660) . ADD 529 S.F. ATTACHED GARAGE TO EXISTING DWELLING. ._ . PROPERTY WIDTH IS 72 FEET. SITE AREA - 7196 SQ.FT. BLDG. COVERAGE - 2207 SQ.FT. . PAVING - 916 S�.FT. COVERAGE-43% OPEN SPACE-57% 2 OPEN PARKING SPACES PROVIDED NEXT TO THE NEW 2-CAR GARAGE. Plan Check: $527.64 Permit: $811.75 SMIP Res: $7.37 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,346.76 SETBACKS MAIN STRUCTURE Front 33- 0 ACCESSORY Front 0-0 PARKING Existin : C Rear 12- 0 Rear 0- 0 Required: 4 FEESUMMARY Calc Valuation: g�3,sa7.so Claim Valuation: go.00 PLANNING & ZONING Left 5- 0 Right Left 0- 0 Right Proposed: 4 �:si7 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work aNhorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final epproval musl be obtained. Failure to obtain inspections and.final approval will result in the expiration of ihis permit. FOR �NSPECTIONS CALI: (714) 7545626 �.eJv 24tBd8 (8�W) � WOFKERS'COMPENSATON DECLARAnON: I hereby affirm unAer penalry ot perjury one ot the following dedaretions: • ❑ I heve end will maintain a cenificate of wnsent b sell-Insure for workers' compensation, as provideA for by seclion 3700 ot the Lebor Code, tor Ihe pertormence of the wOrk tor which Ihis pertnit is issued. ❑ I have antl will mainttin workeB' compensation insurance, as requiretl by section 3700 of the Labor Code, for Ne perfortnance oi the work for which this pertnit I5 Issuetl. My workers' compensation Insurence carrler antl policy number are: Carner: Policy Number: (Th(s ection need not be com0�eted I! the permit is va/ueU el one huntlred dollars ($f 00J or less.) �/ I cenify thet In the performance of tha work for which ihis pertnit is Issue4 I shell not employ any person In any manner so es to become subject to the workers' canpenselion laws ot Calitom' , end agree Ihai ii I shoulC become subject to the workers' wmpensation proWsions oi Section 3700 of the Labor Coda, I shall forthwith comply with Uese pro�risions. Applicant-Sign� ��J� � eDate:s� Q— � �� WAiiN1AG: FAILUflE TO SECURE W EFS' COMPENSAiION COVEMGE IS UNLAWFUL AND SHALI SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES FND CIVIL FINES UP TOONE HUNDPED THOUSAND DOI.lARE (E100,000), IN A�DITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIOED FOF IN SECTION 3106 OF THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATON: I hereby atfirtn that I em Ilcensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 oi the Business and Professions Code, end my licensa is in tull farce and ettect. LJc. M Class M Contracmfs Signature: Date: ' CONSTRUCTION LENDING AGENCV: ��. ❑ I hereby ettirtn that there is a wnsWction lending agency tor the peAormance of the work tor which this permit is issuetl. (Sec. 3097, Civil Code). �' Lentlels Neme: Lender's AdCress: SignaWre: Date: OWNER-BUILDER DECLARATONS: I hereby affirm thet under penelry of per�ury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions Code: Any ciry ar wunry which requires e permit to construct, elter, improve, tlemolish, or repair any structure, prior to its issuance, elso requires the epplicant for such permit lo tile a signed stetement Ihat he or she Is Ilcensed pursuent to the provisions of ihe Contrecrore Licensa Lew (C�apter 9(commendng with Sectlon 7000) 01 Division 3 of t�e Business and Professions Code) or thet he or she is exempt t�ereirom antl the besis tor the allaged examption. Any violation of Section 7031.5 by any applicent tor e permit suhjects Ihe epPllcant to a civil penalty of not more than five hundred dollars ($500).): ❑ �, as owner of ihe property, or my emplayees with wages es their sole wmpensation, WILL DO THE WORK, and the structure is not intendetl or oXered tor sale (Sec. 7044, Business antl Proteuions Code: The Coniractors License Law dces not epply to an owner ot properry who builds or improves thereon, anC who tloes such work himself or herselt or through his or her own employees, provided that such improvements are not intended or oHered tor sale. It, however, lha building or improvement is sold within one year of completion, the owner-builder will have the burden ol proving that he or she did no� build or improve tor purpose of sale.). ❑ I, as owner of the pmperry, em E%CWSIVELV CONTRACTING WITH LICENSED CON7RACTORS to consiruct the prolect (SecJ044, Business entl Professions Code: The coniractors License Lew aoes not apply to an owner of propeny who bullds or Improves thereon, antl who contrecis lor such project with e conirec�or(s) �license pursueN to ihe Contractors License Laws.). �'J I em e:empt un r sec. . gnature: Owner ID venfietl D nvers license. Venficatian oi Ownership by (type oi Business and Professions Cade tor this raason: s ❑ No i.e. - property tav bill or tleetl): DIVISION OF INOUS7RIAL SAFETY PERMIT CERTIFICATON: ❑ I hereby certity that no excavation five (5) or more teet in depih into which a person is required lo descentl, will be matla in connection with work authonzetl by this permit, antl ihat no building sWclure, scaHolding, talsework, or demolition or dismantling thereoi, will be more ihan Ihirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tipe B, Celitomia Administrative Code). ❑ As owner-huilder, I will not employ anyona to do work w�ich would require e permit irom the Division of Industrial Safety, as notetl ebove, unless such person hes e pertnit to do such work From the tliNsion. Signature: Date: Division ol Industnal Sefery Permit Number: CERTiFlCATE OF COMPLIANCE AND AUTHORVATON OF ENTAY: I certify under penalry of perjury that I have read this epplication and state that the infortnation given is correct. I egree to comply with ell state laws and ciry ordinances relating to building construction, and authodze representatives oi tha City ot Coste Mesa to enter upon the above-descnbed property for nspection purposes. I agree not to occupy or allow occupency of any building authonzetl by this Dermit until tinal inspaction. �%ro�l,� � �'�-_.�6 3 _ � � 'Slgn'eture'Ot L'egafOwner(s)—� (..Date_✓ ; Md/Or Authonzed Applicam Date COOE t. INSFECTIONTYPE i676 Fiaetl Sys�em Final Fire Prevenllon 7266 Pool Spa Final 200 Final Re-Raot 201 Finel BIacWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition PA7E INTITIALS eooe� ixsaernoxTrve 206 Finel Mechanical 208 Finel Plumbing 210 Final Eledrical 272 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy QAg 1t�Li � (714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 222 DEL MAR AV Suite: Viciniry: REAR OF PROPERTY Parcel Number: 43921105 Applicant: DO, LIEM AND VU, MIEN Address: 222 DEl MAR AV COSTA MESA, CA � Owner: DO, LIEM AND VU, MIEN Address 222 DEL MAR AV " COSTA MESA, CA Contractor: OW N ER-BU I LD E R Address: Zip: Arch : Address: � Zoning: Phone: 949-650-6607 2ip: 92627-1321 Phane: 949-650-6607 Zip: 92627-1321 � Phone: License: 000000 Eng: ' � � Address: Phone: License: ISSUED BY: Stalus: ISSUED Applied: 02/19/2003 Issued: 03/17/2003 Phone: License: SCOPE OF PERMIT ADD 495 S.F. TO EXISTING S.F.D. WORK TO INCLUDE� ADD A NEW BEDROOM (APPROXIMATELY 247 S.F.), NEW BATHROOM (APPROXIMATELY 55 S.F.) AND RELOCATE THE EXISTING KITCHEN TO TFiE REAR OF THE PROPERTY. CONVERT EXISTING 3 BEDROOM, 2 BATH S.F.D. TO A 4 BEDROOM, 3 BATH S.F.D, Plan Check: $392.50 Permit: $603.85 SMIP Res: $4.57 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,000.92 SETBACKS MAIN STRUCTURE Front 25- 0 ACCESSORY Front 0-0 PARKING Existinq: a Rear 25- 0 Rear 0- 0 Re uired: 4 FEESUMMARY PLANNING & ZONING Left 5- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 9-0 Right 0- 0 $45,738.00 $o.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 1 BO days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for ihe work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required inapectlons 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 zaasrel�oo) WORKERS' COMPENSATION DECLAHATION: . I hare6y ettirm under penelry of perjury one oi the following tleclarations: ❑ I heve entl wlll malntaln a certiticate ot consent to self-Insure tor workers' compensation, as pmvitled for by section 3700 oi ihe lebor Cafe, for the petlortnance of the work tor which Ihis parrliil is issuetl. ❑ I heve and wlll malntain workers' canpensaGon insurance, as requiretl by section 3700 of the Labor Cotle, for ihe pedortnance oi Ihe work for which Ihis pertnit Is Issuetl. My workers' compensat�on Insurence carner and policy number ere: Carrier: Policy Number: �(This ecNon need nof be comp�efed i/ the permit is valued et one huntlred dollers ($100) or less.) certify that in the peAo�ence oi �he work for which this partnit is Issued, I shall not employ any person in any manner so es ro become sublect to the workars' compensetlon laws ot Gelitomla, end agre that ii I should become sub�ect to Ihe workers' compensatlon provislons oi Sectlon 3700 ot ihe Labor Code, I s�ell forthwith comply with these provisfons. '/ ` Ayplicant Signature: ��N�'��( � Date: � — � � � � � a WAqMN(3: FNLURE TO SECURE WORKERS' COMP SATION WVERAGE IS UNLAWFUL PND SW1LL SUBJECi Ml EMPLOVER TO CRIMINAL PENALTIES AN� GVIL ES UP TO ONE HUNDRED T/IOUSrW 0 DOLLARE (5100.OW�. �N ADDITIIXJ TO iHE CQST OF COAIPENSATION, DAMAGES AS PROVIDED FOH IN SEGTION 31080F iHE IABOR COOE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECIARATON: I hereby ettlrm that I em Ilcensed untler Drovisions of ChaD�er 9(commencing wit� Section 7000) of Division 3 of the Business end Professions Code, and my license is In lull torce end eHecl Lia k Class a Contrecrors Signeture: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn thet Ihere is a consimction lending agency for Ihe pertormance af the work for which this pe�i� is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lentler's Address: Slgnature: Date: OWNER•BUILDER OECLARAnONS: I hereby ettirtn thel under penelry of perjury thai I am EXEMPT FROM THE CONTRACTORS IICENSE LAW for Ihe following reason (Sec. 7031.5, Business antl Protessions Code: My city or county whiGh requires a partnit to construct, elter, improve, demolish, or repair any siructure, prior to its issuance, also requires the applicant tor such pertnit to file e signed stetement tha� he ar she is licensed pursuam to �he provlsions oi Ihe Comractors Llcense Lew (ChaD�er 9(commencing with Sectlon 7000) of Division 3 of the Buslneu end Professions Code) or that he or she is exempt Iherefrom and iha basis for the alleged eaemption. Any Wolation oi Section 7031.5 by any appliwnt for e permit sub�ect5 the epplicant to e civll penalry of not more than tiva huntlretl dollars ($500).): ❑ I, as owner ol the D�opehy, or my employees with wages as their sole wmpensation, WILL DO THE WORK, and the structure is not intendad or ottered tor sale (Sec. 7044, Buslneu end Pro�essions Code: The Contractors License Law does not apply to an owner ot properry who builCs or improves Ihereon, antl who does such work himselt or herself or IhrOugh his or her own employees, provided that such improvemems are not intended or oHeretl for sale. If, however, the builtlin9 or improvement is —/ sold within one year oi Gompletion, ihe owner-builder will hava the burden oi Oroving that he or she did not build or improve lor purpose of sale.). � �jf' I, es owner Of �he prope�'. em E%CLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to Construct ihe projec� (Sec. 7044, Busi�ess and ProfesSions COGe: The wntwctors License Law tloes not apply to en owner ol pmpeny who bulitls or improves thereon, and who contracis for such project with a contrector(s) licensa pursuant to the Goniracbrs License Laws.). ❑ lem Signature: Owner ID � tlnver's I�ensa. .0'Fes ❑ No Business end Professions Code tor ihis reason: Veriticatlon of Ownership by (ryDe of documenL i.e. - property tex bill or deetl): DIVISION OF INDUSTRIA4. 5�ETY PERMR CERTIFICATION: Driver's License No. /' . � Expires: , ❑ I hereby certity that no excevation five (5) or more feet in depi� into which a person is required to descend, will be made in connection wi�h work euthorized by ihis pertnit, end that no building siructure, scaHolding, falsework, or tlemolition or dismantling ihereof, will be more �han thirty-siz (36) feet high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, Title B, Califomia Administrativa Code). ❑ As owner-builder, I will not employ anyone to tlo work which would require a pertnit from tha Division ot Intlustriel Sefery, es noted above, unless such person hes e peimii to do such work 1�� the division. Signature: Date: Oivision ot Indusinal Safety Permit Number: CERTIFlCATE OF COMPIJANCE AND AUTHORQA710N OP ENTRY: I cehify under penalry of perjury iha� I have read �his epplication and sta�e �hat the infortnation given is correct. I egree to comply witd ell state laws antl ciry ordinances relating to building construction, and authonze representatives of the Ciry oi Costa Mesa to enter upon Ihe ebove-descnbed property for inspeciio purposes. I agree not to occupy or allow occupancy of any building authonzed by �his permit until final inspection. i 3-/7-�� 9ignatu Of Legal Owner(s) Date COOE 1. INSPECTIONTYPE 1616 1266 A�d�OrAuthonzed Applicant Date Flxetl System Flnal Fire Prevention Pool Spe Finel 200 Final Re-Rool 201 Finel Block/Retaining N1all 202 Final Fectory Fire Place 203 Final Sign 204 Final Demolition Qdg INTRIALS � GO�EI INSPECTIONiVVE � 206 Flnel Mechanicel 208 Finel Plumbing 210 Final Elecirital 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtlingi0aupancy QdIF ItffID�L$ d ,- . (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 9262b ELECTRICAL PERMIT Job Address: 222 DEL MAR AV Suite No Vicinity: THROUGHOUTTHERESIDENCE Parcel Nunmber: Applicant Address: 43921105 DO, LIEM 222 DEL MAR AV COSTA MESA, CA Owner: DO, LIEM AND VU, MIEN Address 222 DEL MAR AV COSTA MESA, CA Contractor: O W N ER-B U I LD ER Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 uniLs) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches � . Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to SOhp Motors l0 100hp Molors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole Status: ISSUED Applied: 09/09/2002 Issued: 09/09/2002 ISSUED BY: [�� Phone: 949-650-6607 Zip: 92627-1321 Phone: 949-650-6607 Zip: 92627-1321 Phone: Zip: License: 0 SCOPE OF PERMIT ELECTRICAL TO INCLUDE: 15 LIGHTING FIXTURES, 43 OUTLETS, 11 SWITCHES ARE LOCATED IN BATHROOMS, BEDROOMS, KITCHEN,� LIVING ROOM/FAMILY ROOM AND 1 SERVICE TO 200 AMPS REF.: B02-00865 - - � - $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $16.50 $38.79 $12.10 $0.00 $0.00 $30.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 15 43 11 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 -FEE SUMMARY � Temp Dist System / Lighting Busway/t00tt Standing Section Misc Electrical Equipment Trans(ormers up to 1 kva/kw �� ................upto,tOkva/kw � . .................up to 50 kva/kw .................up to 100 kva/kw � ....:.............over 100 kva/kw Low Voltage Equipment �Low VOIt Wiring System / Ckt . �Misc. Conduit Misa Conductor Circus ( gen or ride) Circus (mech nde or lights) Christmas Tree Stand Fireworks Stand - Other Electrical Fee Investigation Fee PIan�Check Fee Reinspection Fee Quantiry 30.00 0 50.00 0 50.00 0 ' $0.00 0 $0.00 . 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0' $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES $121.39 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by ihis 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 1 BO days. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inapectlone and final approval must he obtained. Failure to obtain inspections and final approval will result in the expiration of thls permit. _ FOR INSPECTIONS CALL: (714) 7545626 l�' zaaws �aroo� WORKERS'CON�ENSAnON DECLARAnON: � � I hereby aHirtn �ntler penalry of perjury one of the following declaretlons: ❑ I have2nd will maintaln e certificete ol consent to self-Insure for workers' compensation, es provided for by section 3700 ot the labor Code, for ihe peAortnence of t�e workto! whiCh'IhiS pBrmi� IS IuuOd. . ❑ I hare anG will mainiain workers' cwnpensation insurance, es required by sectlon 3700 ot Ne Lebor Code, for ihe peAortnance of the work for which this pertnit is IssueO. MS workers' compens�tlon Insurance carner end policy number ere: Certur. Policy Number: (lT.j sec6'on neeC not be completed i/ the permit is velued at one huntlred dWlers (5100) or less.) '�( I certiy Nat in Ihe peAortnence of the work for which this pertnit is issued, I shall not employ any person in any manner so es to 6ecome suhject to ihe workers' .J cornpensetlon laws of Califomla, entl agree that if I should become subl�t to lhe woAcers' compensation provislons o1 Saction 3700 of ihe Lebor Cotle, I shell forihwith �mpywit�eseprovi s. A�plicantSignaNre: �� FDale:1 =�— �� WFRNINO: FNLURE TO SECUFE WORKERS' OJMPENSATION COVERAGE IS UNLAWFUL rWD SHALL SUBIECT AN EMPLOYERlO CRIMINAL PENALTES AND CML FlNES UP TOONE HUNDRED TFKKISAND �OIJ.AHE (E100.000). IN ADDfTION TO TME COST OF COMPENSATION, DAMAGES AS PROVI�ED FOR IN SECTION 3lW OF THE IABOR �DE, IMEREST, AND ATTORNENS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em Iicensed under pmvisions oi Chapter 9(commencing with Section 7000) of Division 3 oi Iha Business and Professions Code, antl my license is In full force and eHecL Lia N Cless q Contrectofs SignaWre: Dete: CONSTRUCTION LENDING AGENCY: ❑ I hereby aRirtn Ihat thera is a construction lending agenty for Ihe peRormance of the work tor which Ihis pertnit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lendefs AdUress: " Signature: Dete: OWNER-BUILDER DECLARATIONS: I hareby affirtn ihat un0er penalry ot perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reeson (Sec. 7037.5, Business entl Professlons Code: Any ciry or wunry which requires e permit to consWct, alter, improve, tlemolis�, or repair any structure, prior to Its issuance, also requires ihe epplicant for suc� pertnit to file e signeC stetement thet ha or she Is licensed pursuant to �he provislons of t�e Conirectors License Law (Chapter 8(commencing with Seclion 7000) oi Dlvlsion 3 o11ha Business entl Pmfesslons Code) or thet he or she is exampt theretrom end t�e basis for the alleged exemptian. Any vialatlon of Section 7031.5 by any epplicent 1ar e pertnit JSubjec the applicant to e civll penalry oi not more than tive hundred dollers ($500).): � I, as owner ot the properry, or my employees with wages es their sole compensation, WILL DO THE WORK, anC the structure Is not intended or oflered for sele (Sec. 7044, Business and Prolessions Code: The Coniractors License Law Ooes not apply to an owner of proparty who Duiltls or improves thereon, and who does such work himselt or herselt or through his or her own employees, provided that such improvemenis are not intended or oHeretl lor sale. If, howaver, ihe building or improvement Is soltl within one year of completion, the owner-builtler will hava ihe burden oi proving Ihat he or she did not builtl or improve tor Durpose of salaJ. ❑ I, as owner ot the property, em E%CLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construct Ihe proled (Sec. 7044, Business and Professlons Catle: The comraaors LJcense Law tloes nat appty ta en owner of propeny who builds or improves thereon, end who wntrects for suc� pmject wiih e conirectar(s) license pursuem lo lhe Coniradors License Laws.). exempt under ID verifietl by drive7s liCense. Verification of Ownership by (rype � Business and Professians Code for this reeson: fJC / Date�� Yes ❑ No Drivefs License No. �/ � � �% � � ri, I.e. - property tex 6ill or tleed): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION: ❑ I hereby certity Ihat no excavetion live (5) or more feet in depih Into which e person is requirad to descend, wlll be mede in connection with work authorized by this permit, antl that no building siructura, scettolding, falsework, or tlemolition or tlismantlinq thereof, will be more Ihen thirty-six (36) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Ttle B, Calilamia Atlminlstretive Cotle). ❑ As owner-bullder, I will not emplay anyone to do work which would require a permi� from ihe Division ot Intlusiriel Satety, as notad above, unless such person hes e pertnit ro do such work irom Ihe tlivision. Signaiure: Date: Division oi lndustrial Satery Pertnit Numbec CERTIFlCATE OF COMPLIANCE AND AUTHOR¢A710N OF ENfAV: I certity under penalty of perjury that I have read this epplication and slate lhat the intortnation given is correct I agrae lo wmply with all stete laws and ciry ordinances relating to builtling conswction, and authorize representetives of ihe Ciry ot Costa Mese to enter upon Ihe above-describetl property tor inspe ion purposes. I agree not to occupY or ellow occupancy ot any building euthorized by ihis pertnit until Tinal inspection. �eeQ�e-l�Q�� .` 4- 9 � d' �_ `Sign ure�(s) -Date Antl/OrAuthorized Applicant Date CQDE �. INSiECTON TYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Root 201 Final BIocWRetainlnp well 202 Final Fadory Fire Place 203 Final Sign 204 Final Demoliiion Qd¢, �� QQ€� INSPECTIONTYPE 206 Finel Mechanicel 208 Final Plumbing 270 Pinal Electriwl 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Finfll Building/Occupency PAIE lI�LS 0 I � � (714) 754-5273 • Fax (714) 754-4858 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 222 DEL MAR AV 43921105 Applicant: DO, LIEM AND VU, MIEN Address: 222 DEL MAR AV COSTA MESq, CA � Owner: DO; LIEM AND VU, MIEN Address 222 DEL MAR AV COSTA MESq, CA Contractor. O W N E R-BU I LDE R P:ddress: . ISSUE FEE Temp service test Res. a/c package New Res (7-2 units) New Res (3+units) Pool / Spa Lighting Fixls � Recept Outlels Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Motors to 10hp Mators to SOhp Motors to t00hp Status: ISSUED Applied: 04/24/2003 Issued: 04/24/2003 ISSUED BY: � Phone: 949-650-6607 Zip: 92627-1321 Phone: 949-650-6607 , - - � Zip: 92627-1321 � � � . � � -Phone: ' . .` . � � Zip: License: 000000 - . " � � SCOPE OF PERMIT ADD 495 S.F. TO EXISTING S.F:D. WORK,TO INCLUDE: ADD.A NEW BEDROOM (APPROXIMATELY 247 S.F.), NEW BATHROOM (APPROXIMATELY 55 S.F.) A7JD RELOCATE THE EXIST7iJG K7TCNEN 70 THE REAR OF THE PROPERTY. REF.: B03-00289 , ELECTRICAL TO INCLUDE: 13 LIGHT FIXTURES, 14 OUTLETS, 5 SWITCHES, AND 1 MOTOR TO 1 HP. $23.50 $0.00 $0.00 $o.ao $o,ao. $0.00 $14.30 $15.40 $5.50 $0.00 $0.00 $0.00 $0.00 $0.00 $4.75 $0.00 $0.00 $0.00 Quantity 0 � ' � 0 13 14 5 0 0 0 0 0 � 0 0 0 PEE SUMMARY � � � ' Temp Dist System / Lighling Busway /100 ft " ' � Standing Section Misc Electrical Equipment, , Transformers up to 1 kva/kw , ' ................up to 10 kva/kw ' ......::.........up to 50 kva/kw � . .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage� Equipment Low Volt Wiring System / Ckt - Misa Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Quantity $0.00 0 $0.00 0 $0.00 0 �o.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-g2) 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 ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlrad Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration o( this permit. C�" FOR INSPECTIONS CALL: (714) 75M5626 2448�68 (&00) WORKERS' COMPENSAnON DECLAFiAnON: . I hereby aHirm under penalry of perjury one of the following declarations: � I heve ana will mainiain a certificate ot wnsent to self-Insure tor workers' compensatlon, as provitletl for by section 3700 of the Lebor Code, for t�e pertormance of the work for whiCh IhiS p9�mit i5 issuetl. ❑ I have and will maintain workers' compensation insurance, as requiretl by section 3700 of ihe Labor Code, for the pedormance of the work for which this permit is issued. My workers' compensatlon Insurance carner antl policy number are: Cerrier: Policy Number: (This secfion need not be Completed il the permit is valued at one hundred dollars ($100) or less.) (((}� I certify that in the pedormance oi the work tor which this pertnit is issued, I shall not employ eny pereon in any manner so es ro 6ecome subject to Ne workers' compensatlon lews oi Califomia, antl agree ihat If I should become subject to Ihe workers' compensation provislons oi Section 3700 of the Lebor Cotle, I shell forthwlth comply with ihese OrP��sion _'np Applicant Signeture: �5��6'�� Dete: _ _ �. '2 /� � �% � WARNINO: FAILUHE TO SECUR RKERS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PE� AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,OW). IN ADOITION TO THE COST OF COMPENSATION, DAMAGES AS PROVI�ED FOR IN SECTION 31060F iHE UBOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirtn Ihat I am licensetl untler provisions of Chapter 9(commencing with Section 7000) of Division 3 oi Ihe Business antl Professions Gode, end my license Is in full foroe entl eHecL Lic. q Class N Coniractofs Signature: Date: CONSTRUCr10N LENDIP{G AGENCY: ❑ I hereby attirm that Idere is a construction lentling agency for ihe peAormance of ihe work tor which Ihis permit is issued. (Sec. 3097, Civil Code). Lendefs Name: Lenders Adtlress: Signeture: OWNER-BUILDER DECLAAAnONS: Date: I hereby eflirtn that under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Profeulons Code: Any ciry or counry which raquires a pertnit ro construcL alter, impmve, demolish, or repair any structure, pnor to its issuance, also requires the applicant for suc� permit to tile e signed statemeM thet he or she is licensed pursuant m Ihe provisions of the Contractors License Law (Chapter 9(commencing wit� SeGtlon 7000) of DlNsion 3 oi ihe Business and Professions Code) or that he or she is exempt therefrom and the basis tor the alleged exempiion. Any violation oi Section 7031.5 by any epplicant for e permit subjecis ihe eppliwnt to a �� Penalry of not more ihan five hunaretl tlollars ($500).): �as owner of the properry, or my employees with wages as their sole compensation, WILL DO THE WORK, and iha slructure Is not intendetl or ofleretl for sale (Sec. 7044, Business and P�ofessions Code: The Contractors License Law dces not apply to an owner ot property who builds or improves Iheraon, antl who does such work hlmselt or herseli or Ihrough his or her own employees, pmvided ihat such impmvemenis are nol imentletl or oflered lor sale. ll, however, ��e building or impmvament is sold within one year 0� �mpletion, ihe owner-builder will ha�e Ihe burden ot proving that he or she ditl no� build or improve for purpose of sale.). � ❑ I, as owner ot ihe pro�arty, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the pmject (Sec. 7044, Business end Pmfessions Code: The contractors License Lew does not apply to an owner of propeny who builtls or improves thereon, and who contraas lor such projeci wilh e contrecmr(s) license pursuant to tPe Contractors License Laws.). ❑ I am axempt SignaNre: Owner ID veriti a��ers rce�se. ❑ Yes ❑ No eusiness and Professions Coda br ihis reason: Vedfiwtion of Ownership by (rype of tlocument, i.e. - property tau bill or deetl�: DIVISION OF INDUSTRIA!-SAFETV PERMRCERTIFICA710N: Date: �=; Dnvefs License No. �� Expire5: ❑ I hereGy cenify t�at no excavation tive (5) or more feet in deplh into which a person is required to tlescend, will be matle in connection with work aut�odzed by this pennit, end that `w buildiag shucwra, scaftolding, falsawork, or dertwlition or dismaniling thereot, will be more than thiny-siz (36) taet hiqh. (Chap. 32, Gry 2, Art 2, Sec. 341, Ttle B, Califomia Adminisirative Code). ❑ As owner-builtler, I Will not employ anyone to tlo work which would require a permit irom ihe Division of Industnal Safery, es notetl ebo�e, unless such person hes e pertnit to do such wo� trom the division. Signeiure: Date: Division ol Intluslnal Safety Pertnit Number: CERTFlCA7E OF COMPLIANCE AND AUTTIORVATON OF EMAY: I certiy untler penalry ot perjury thai I have read this application and state that the Information given is correct. I agree to wmply With ell state laws and city ordinances relating to building consWction, and authonze representatives of the City ot Goste Mesa to enler upon ihe ebove-descnbed properly for ,i9spection puryoses. I agree not to occupy or allow occupancy of any building authorized by Ihis permit until final inspection. �/J��i�p0 _- !L- 22- � �-. igneture Legal neqs) Date � �— Antl/OrAuthorized Applicant COUE I, INSPECTIONTYPE 7616 Fixed System Final Fire Prevention 7266 Pool Spa Final 200 Finel Re-Root 207 Final BIocWRetain(ng Wall 202 Final Factory Fire Place 203 Final Sign 204 Finel Demolition P� �NTITIAIS COpE� INSPECTIONTYPE � 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSite 250 Final Building/Occupancy rC � 3 � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 222 DEL MAR AV Status: ISSUED Suile No Viciniry: Parcel Nunmber: 43921105 Applicant: DO, LIEM AND VU, MIEN Address: 222 DEL MAR AV . - i�. COSTA MESA(CA �.- � ' ,. � � . i, i� . �� /�,- �. � ' , Owner.�� DO .LIEM�AND VU MIEN` Address-/-222 DEL MAR AV �. � � i ./, \ � �. �". �, COSTA MESA, CA � /� Applied: Otl09/2003 Issued: 01/09/2003 � - - " ISSUED BY: � � Phone: 949-650-6607 t � _ Zip: 92627-1321 � r��' �� ' ��' � � . 1 ( �' � \ � � �, . .... _� '.^, �` ��,�� . � �; ��\A �` .v. . � / ��, '�-� �� .. /. , �'��' Phone: 949-650-6607 � �\ � ,� i � ? �� ,�\ Zip: 92627-1321 �� A�� , � ::� ��. Contractor. ; OWNER-BUILDER i .� � Address �-;., � - �. / � •' � , � � �.;Phone: " j' / ,\� - � ,, �� . - � � , � � > r� :A�� / �� . `� lr V' �. % ii y� \�� _ , ` 1 ti � � -'�� ' , . �t' 1 � �� .l �- , , i � ti�' � .. , � � ��`. , i� �� , ... V ` ; j \ i` : 1 License: 000000 - ��a' �K t;', 1,`� ., ,x�. ^ � ' �v -� -r,-r SCOP.E.OFPERMIT ; -.�. �,a «,� '-� � y ��' -ELECTRICAL TO INC�UDE: 1 TEMPORARY POWER POCE. REF�:;B02-00865 t�' � �, . .. � `ISSUE.FEE � � � $23.50 Tempservice�test��, � $0.00 � Res. a/c package ,�-�-. $0.00 New Res (1-2 units), �, � $0.00 New'Res�(3+unitsp� � $0.00 Pool / Spa�, �� " •; $0.00 Lighting Fixts ' - �_ �$0.00 Recept Outlets � � � `. $0.00 Switches \ � � �. � $0.00 NonResAppl;,' " ,. $0;00,� Res Appl ' / , �$0.00 � Service to 200a . A � �. $0.00 � Service to 1000a �. ` $0.00- Service over t000a � ' ' - $0.00 ' Motors to 1hp �, $0:00,' Motors to 10hp �� '-' $0.00� Molors l0 50hp � , � $0.00 Molors to 100hp $0.00.� � Motars over 100hp $0.00..� Communicalion drops $0.00 Sub panel to 200a $0.00 Pole Light Pkg $0.00 Sign Circuits $0.00 � � �� ;7;' � �' ��' �'' � J �ri� , ,`_� � �'.?'r � :�_FEE SUMMARY-'�-�. ,Ijzr�� 1jI ; " � �,j � ..,. . -- ' -� , Quantity- .— __ _ `._ .: -/ t . �� - Quantity �� ; i�,�`� � � � � � - �� Temp Dist System / Lighhng�-'= $0.00 0 �J': t 0 0 0 0 0 - '• Q , � 0 0 0 0 0 ' 0 0 0 0 0 0 0 0 Busway /100 ft-' $0.00 0�1=' .� , , Standing.Section �� . $0.00 Ol"-" ' � - , MiscElecfrical�Equipment $0.00 Oj'j`� � - _ Transformers up to 1 kva/kw $0.00 � 0; � �;,�� ,� ,. .,; - `_ �� 7 , .;�; n�; '_..._ .....up to 10 kva/kw ,$0.00 / ��0 � ' l ' ( .. � ...... ��' ' �• '.up to 50 kva/kw �$O.00�.,Y/0 �� ' `�" � ..",'.., , .- � ................ .. _; , ., .. , _ ,: --< � . .............:::.:up to:100 kva/kw �$0.00,�� 0 r, '� � i ✓.. : - .. ::z............ovei,t00�kva/kw.; ... _, -$0.00� 01�- -� .' r , " ' - Low Voltage Equipment ' � �' _ $0.00 0 `� / � � , �� 'Low Volt Wiring System / CkF� . '$0.00�� 0 .- ' _ Misc. Conduit = . ! $0.00''� 0 � �� ' Misa Conductor _ $0.00 �F� 0 !.,'; � . -� , . , � Circus,( gen or ride) � � : $0.00�. 0� . ' � _ � Cirws (mech ride or lights)�. � �.. $0,00� ;' 0 j � ChristmasTreeStand �; $0.00�.�/,0 . � - ,FlreworksStand'. _ , ' $0.00�� 0 � " � Other Electrical Fee - .� ��"�$0.00' _ � � �InvestigatlonFee-,-j,% � ��$0.00 " - � ' Plan Check Fee� ��' . - $0.00 � � Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 1 BO days, or if work is suspended or abandoned for a period of 180 days. ,� INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inepectlons and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446-46 (NW) WORKERS' COMPENSATON DECLARATION: ' � I hereby ettirtn undar penalry ot perjury one ot the followinq declaretions: ❑ I heve and will maintain e certificate o1 consent to self-Insure for workers' compensation, es provided tor by section 3700 ot the Lebor Code, for ihe performance oi the work for whith IhiS DBrmii is issuea. ❑ I have and will maintain workers' compensetion insurence, as required by section 3700 of the Labor Coda, for t�e pedormance of the work for which this permit is issuetl. My workers' wmpensa[ion Insurance wrrler end policy number are: Carrier: Policy Number: (This seciion neetl not be comp�eted if the permit Is valued af one hundred dWlars ($100) or less.) �jl cenity that in Ne pedormance oi the work for which t�is pertnit is issueq I shall not employ flny pereon in any manner so as to become sublect to the workars' wmpensation IWws oi CaliFomia, andppp gree thet If I should become sub�ect to the workers' compensetlon provisions of Saction 3700 ot ihe Labor Code, I shall forthwith comply wit� these provisions. �E�_ „ � �/� `App`t.S�gl'� net—u� � �1 �ate:'S �— � � Co �i WARNINO: FAILURE TO SEWPE WORKERS COAIPENSATION COVERAGE IS UNUWFUL AN� SHALL SUBJECT AN EMPLOVER TO CPIMINAL PENALTIES AND CIVIL FlNES UP TOONE MUNDRED TYIOUSAND DOLL4RE (5��),IN ADDRION TO THE W5T OF COMPENSATION, DAMAGES AS PROVI�ED FOR IN SECTION 3]O60F iHE LABOR CODE, INTEREST, AND ATTORNEVS FEES. i LICENSED CONTRACTORS DECLARATION: � I hereby attirtn that I am licensed under Orovisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business antl Professions Coda, antl my license is in full force afM eflect Lic. H � Class N Cantrectafs SignaWre: Dete: CONSTRUC710N LENDING AGENCV: ❑ I hereby aHirtn that there is a consiruction lenaing agenty for Ihe peAormance of Ihe work for which this pertnit is issued. (Sec. 3097, Civil Code). Lentlefs Name: Lendafs Address: Signature: Date: OWNER-BUILDER DECLARA710N5: I herehy aXicm that untler penalry ot perjury Nat 1 am EXEMPT FROM THE CONTRACTORS UCENSE LAW tor the tolbwing reasoa (Sac. 703t.5, Businau and Professions Code: My ciry or counry which requires e permit to consiruct, elter, improve, demolish, or repair eny strucWre, prior to its issuance, also raquires the applicant tor such permit to file e signed stetement that he or she is Iicansed Oursuant to the proWslons of ihe Contrectors Llcense Lew (Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Profess�ons Code) or ihat he or she is exempt therefrom and ihe besis tor the elleged axemption. Any violation of Section 7037.5 by any applicant for a permit �sub'ects the epplicent to a civil penalry of not more Ihan five hundred dollars ($500).): �I, as owner ot the property, or my employees with wages es thelr sole compensatlon, WILL DO TME WORK, antl the sWcture is not intentletl or otfered for sale (Sec. 7044, Business end Professions Cotle: The Contractors License Lew does not apply to an owner ot properry who builds or improves thereon, and who does such work himseN or herself or ihrough his or her own employees, provlded Ihat such Improvemems era not intendetl or ottered far sale. If, howaver, the building or improvement is sold within ane year oi completion, the awner-builder will have the burden ot proving that he or she did not 6uild or improve for purpose ot sale.). - ❑ I, es owner ot ihe properry, em EXCLUSIVELV CON7RACTING WITH LICENSED CONTRAC70RS to consiruct the pmject (Sec. 7044, Business and Pmfessions Code: The contlectors License Lew does not epply to an owner ol properry who builds or impmves thereon, and who comracis for such pmject with a conhactor(s) license pursuant to the Contractors License Lews.). ❑ I am exempt under s�.��_T Business and Pmfessions Cotla for ihis reason: Owner'IO varifie`d by ddveYs license. Ves ❑ No Varificetion ai Ownership by (rype af tlac m nt, i.e. - property tex 6111 or deed): DIVISION OF INDUSTRIAL SAFETV DERMIT CER7IFICATION: ❑ I hereby certify ihat no excavetion five (5) or more feet In depih into which e person Is requiretl to tlescend, will be mede in connection with work authonzed by this permit, and that no builtling siructure, scattolding, falsework, or demolition or tlismentling t�ereof, will be more than ihirry-six (36) teet high. (Chep. 3.2, Gry 2, Art 2, Sec. 341, Tltle 8, Cali�omia Atlminisirative Code). ❑ As owner-builtler, I will not emplay anyone to do work which woultl require a pertnit from the Divisian of Industdal Sefety, es noted ebave, unles5 such person has e permit to do such work from Ihe division. SignaNre: Date: Division of Indusirial Satery Permit Number. CERTIFlCATE OF COMPLIANCE AND AUTHORVJITION OF ENTRV: I certity under penalry of perjury that I have read this application antl state that the information given is correct. 1 egree to wmp�y with all state laws end ciry o�dinances relating to building construction, antl authonze representatives of t�e Ciry of Costa MeSa to enter upon the above-descnbed propU �or insDection purpases. I egree not to occupy or allow occupency ot any building authorized by Ihis pertnit until final inspection. �fo-��Pe�cP � / — 9 — � � 'SlgneWre Of Legal Owne7(s)� Date � l_.�..�,�� Antl/Or Aulhonzed Applicant Date SODE �, 1616 1266 200 201 202 203 204 Fi:ed System Final Fire Prevention Pool Spa Fin81 Final Ra-Roo1 Final8locWRetaining Well Final Factory Fire Place Finel Sign Final Demolition PdIE It�A6fl Pd COOE I INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy � 1I�L5 (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 222 DEL MAR AV Suite No Vicinity: Parcel Number: 43927105 Applicant: DO, LIEM AND VU, MIEN Address: 222 DEL MAR AV COSTA MESA, CA Owner: DO, LIEM AND VU, MIEN - Address: 222 DEL MAR AV COSTA MESA, CA Contractor: Address: OWNER-BUILDER MECHANICAL PERMIT Phone: 949-650-6607 ' Zip: 92627-1321 Phone: 949-650-6607 Zip: 92627-1321 Phone: Zip: License: 000000 Status: ISSUED Applied: 04/24/2003 Issued: 04/24/2003 SCOPE OF PERMIT ADD 495 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: ADD A NEW BEDROOM (APPROXIMATELY 247 S.F.), NEW BATHROOM (APPROXIMATELY 55 S.F.) AND RELOCATE THE EXISTING KITCHEN TO THE REAR OF THE PROPERTY:,REF.: B03-00289 �, MECHANICAL TO INCLUDE: 1 REPAIR/ALT COOLING/HEAT, 1 HOOD W/MECH EXHAUST, AND 1 VENT FAN/SINGLE DUCT. " � ' ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refig Sys <�00 k BTU Refng Sys »00 k BTU �� Gas Piping , Factory Fireplace , Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct � Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> 10000cfm Floor Furnace Floor or Suspend Heater $23.50 $0.00 $0.00 $13.70 $o.00 '$0.00 $0.00 $0.00 $0.00 $10.65 $0.00 $7.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System ,' . � Evaporetive Cooler � � Commercial Incinerator Domestic Incinerator Compressofs / Absofption� Systems Upto3hp/100kBTU , ,3 To 15 hp / 500 k BTU 15To30hp/1,OOOkBTU� - - 30 To 50 hp / 1,750 k BTU � Over 50 hp / Over 1,750 BTU � Boilers Up to 3 hp. � - 3To15hp 15to30hp. - 30 to 50 hp Over 50 hp Other Mechanical Fee � Investigation Fee Quantity $0.00 0 so.00 o ' $0.00 0 $0.00 0 So.oO 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period of 7 BO 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 requlred inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pe�mit: FOR INSPECTIONS CALL: (714) 7545626 -� 2446-08 (8/00) WORKERS' COMPENSAnON DECLAFiATON: I �ereby eNirm untler penalry oi perjury ona ot the following declarations: ❑ I have end will mainta�n a cenificate of consent to selt-Insure tor workers' compensetion, es provided for Dy section 3700 of Ihe Labor Code, tor the perfortnence of Ihe work for which this pertnit is issued. ❑ I have flnd will mainta�� worker5' compensation insurance, 85 requiretl by SecUon 3700 of Iha Labor Code, for the pedortnance ot ihe work for which this pertnit is issued. My workers' compensation Insurance wrrier and policy number are: Carrier: Policy Num6er: (This section need no( be C�p�eretl il fhe pertnif is velued a( one hantlred dollars ($100) or IessJ � I canity that in tha perfortnance of the work for which Ihis pertnit is issued, I shall not employ any person in any manner so as to become su6ject to the woticecs' compensetion laws o� Califomia, and egree that if I should becoma sub�ect to the workere' wmpensation provisions ot Section 3700 of the Labor Cotle, I shell forthwlth wmply with these provisions. ApplicentSigneture: �� Date: � WARNINO: FAILURE TO SECURE WO ERS' COMPENSAT1qJ COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES D CIVIL FINES OONE HUNDRED TIKKISAND DOLURE ($t00,OW)� IN ADDfiIIXJ TO TNE COST OF COMPENSATIIXJ, DM4IGES AS PROVIDED FOF IN SECiION 3lOfi OF THE LABOR CODE, INTEREST, AND ATTORNE`fS FEES. LICENSED CONTRACTORS DECLARA710N: I hereby eNirm that I am licensed untler provisions of Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Professions Code, and my license is in full force antl eflect. Lic. q Class M Contractor's Slgnature: Date: CONSTRUCTION LENDING AGENCY: ❑ I �ereby aNirtn ihat iPere is a construction lending agency for the pertormance of the work for which this parmit is issued. (Sec. 3097, Civil Code). Lentlefs Name: Lenders Address: Signetura: Date: OWNER-BUI�OER DECLMATIONS: I �ereby eMirtn that under penalry oi perjury that I am EXEMPT FflOM THE CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business antl Professions Cotle: Any city or counry Which raquires a permit to construd, elter, improve, tlemolis�, or repair any structure, pnor to its issuanca, also requires the applicant tor such permit �o file e signed stetement that he or she is licensed pursuant to the provisions o1 the Contrectors License Law (Chapter 9(wmmancing with Section 7000) of DiWsion 3 ot the Business and Prolessions Code) or that he or she is exempt iherefrom and tha basls for t�e alleged exemption. Any violation oi Section 7037.5 by any applicant for a pertnit subjects ihe epPlicant to e civil penalry of not more than five hundred dollars (5500).): �, es owner of Ihe pmpeny, or my employees wiih wages as Iheir sole wmpensation, WILL DO THE WORK, and the sWcture is not intended or oHered tor sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law does noi apply lo an owner of properry who builds or improves �hereon, antl who does such work �imselt or herseli or thmugh his or her own employees, providad that such improvements ere nol imended or otteretl tor sale. Il, howevar, ihe buildng or improvement is solA within one year oi complation, the owner-builtler will �a�e ihe burden of proving t�at he or she ditl not build or imp�ove for purpose of sale.). � ❑ 1, as owner oi the property, am EXCLUSIVELY CONTRACT�NG WITH LICENSED CONTRACTORS to construct the pmject (Sac. 7044, Business and Protessions Cotle: The contracto(s Licensa Law tloes not appty to an owner of pmperry who builtls or improves thereon, antl who contrects for such project wiih a conirecbr(s) license pursuam to tl+e Coniractors License Laws.). ❑ I am exempt under s. Business and Professions Code lor this reason: SignaNre: � � � Date: .— Owner ID verilied by driv s license. ❑ Yes ❑ Na Drivefs License No. ��' DIVISION OF INDUSTRIA!- SAFETY PERMIT CERTIFICA710N: ❑ I hereby cetlity that no exwvation five (5) or more teet in depth into which a parson is required to descend, will be made in wnnection with work au�horized by ihis pertnit, antl that no bu�ltling strucMe, scat(Wding, talsework, or tlemoUtio� or dismantling thereo(, will ba rtwre ihan thirty-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Tltle B, Califomia Administrative Code). ❑ As owner-builder, I Will not employ anyone to do work which would require a permit imm ihe Division ot Intlustriel Safery, as noted abo�e, unless such pereon has a pertni� to d0 5uch wofR irom Ihe divi5ion. SignaWre: Date: Division of Indusirial Safety Permit Number: CERTIFlCATE OF COMPLIANCE /WD AUT}iORIZATION OF EHTAV: I certify under penalry of perjury that I have reatl Mis application antl state that the information given is correcL I egree to wmply with all state laws antl ciry ortlinances relating to building conswction, antl authonza represeniatives of ihe Ciry of Gosta Mesa to enter upon the ebove-descnbetl property fo� insp ction purpases. I agree not �o occupy or allow acupancy of any building euthorized by this permit until tinal inspection. 2tPi' �-` Z�� ' / ' nature Oi Legal Owner(s) Date � And/Or Authonzed Applicant COOE 1, INSPECTIONTYPE 1616 Fixed System Fina� Fire Prevention 1268 Pool Spe Final 200 Final Ra-Roof 201 Final BIocWRetaining Well 202 Final Feciory Fire Place 203 Fina1 Sign 204 Final Demolition p�TE I I COUE 1 INSGECTION TYPE 206 Final Mechanical 208 Final Plumbing 270 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Fi�al Site 250 FinelBuilding/Occupancy _ �� (714) 754-5273 • Fax (714) 7544856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 222 DEL MAR AV Suite No Vicinity: Parcel Nunmber: 4392�105 Applicant: DO, LIEM Address: 222 DEL MAR AV COSTA�MESA, CA Owner:. DO, LIEM AND VU, MIEN Address 222 DEL MAR AV COSTA MESA, CA Contractor: OWNER-BU ILDER Address: Arch / Eng : Address: PLUMBING PERMIT ISSUED BY: Phone: 949-650-6607 Zip: 92627-1321 Phone: 949-650-6607 Zip: � 92627-7321 Phone: Zip: License: 0 Phone: Zip: License: Status: ISSUED Applied: 09/09/2002 Issued: 09/09/2002 SCOPE OF PERMIT PLUMBING TO INCLUDE: 2 BATHTUBS, 1 GAS (1-4 OUTLETS), 1 GAS LINE, 1 LAUNDRY TUB/WASHER, 1 SEWER CONNECTION, 1 KITCHEN SINK, 1 WASH BASIN SET, AND 2 WATER CLOSETS.REF.:B02-00865 ISSUE FEE BackFlow irrigation BackFlow Preventer Bathtub Clarifier System Connect(Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $19.60 $0.00 $o.00 $0.00 So.ao $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $6.15 $0.00 $0.00 $9.80 $0.00 $0.00 QTY 0 0 2 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landsrape Irrigation � � $0.00 P-Trap $0.00 Pressure Re9ulator '. $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 SewerCapforDemo -$0.00 Sewer Connecl $24.65 Sewer Private Line ' $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $9.80 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 �TY 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 SumpPump Swimming Fool Trap Primer Udnal -Vacuum Brkr BkBow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Waler Piping Qnst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 So.00 $0.00 $0.00 $0.00 $9.80 $0.00 $19.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: 5�2z.90 QTY 0 0 0 0 0 0 0 1 0 2 0 0 0 0 0 L NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspectlona and tinal approval must be obtained. Failure to obtain inspections and final approval will result in [he expiration of this permit. � FOR INSPECTIONS CALL: (714) 7545626 3'�i(:h:)] WORKEHS'COMPENSAnON DECLARATON: �� I hereby ettirm untler penalry of perjury one of the following declarations: ❑ I have and will maintain e cenificata oi cansent to sell-Insure tar warkere' campensation, es provided for by seMion 3700 of Ihe Lebor Cade, for the performence ot ihe work for which this permit is issued. ❑ I have antl will maintain workers' compensatlon insurance, as requiretl Dy sec�ion 3700 of Ihe Lebor Code, for ihe peAOrtnance ot Ihe work for w�lch ihis pertni� is issuetl. My workers' compensatlon Insurance carrier antl policy number are: Cerrier: Policy Number: (fhls sec(ion need not be complefed il the permit Is valued af one hundretl dallars ($f00) or less. J '�I certity that in Ihe pertormence of t�e work for whlch this permit is iSsueQ I shall not employ any person in any manner so es to become subject to ihe workers' wmpensatlon laws of Celifornla, enC egree t�ei H I shauld becoma subjact to t�e workars' compenselion provisions o1 Saction 3700 ot tha Labor Cade, I shall torthwith comply with these provisians. �Q �plicent Signat� Dete: �— � •- .V� � i WMNING:.FAILURE TO SECURE W ERS' COMPENSATION COVERAGE IS UNLAWFUL PND SHA11 SUBIECT AN EMPLOYER TO CHIMINAL PENAL ES M1D CML FlNES UP TO ONE HUNDRED TIqUSAND DOLLARE (5100,000), IN NODITION TO THE W5T OF COMPENSATION, DAAMGES AS PROVIDED FOR IN SEGTION 3]O60F THE IABOF CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATON: I hereby eHirm that I am licensed under provisions ot Chepter 9(commencing with Section 7000) of Division 3 of tha Business and Professions Code, and my license is In Full torce antl eHect Lic. q Cless p CoNrectofs Signeture: Date: CONS7RUCTION LENDING AGENCY: ❑ I hereby ettirm Ihat ihere is e consiruction lending agency lor the pertormance ot the work for which Ihis pertni� is issuetl. (Sec. 3097, Civil Coda). Lendefs Neme: Lendefs Addreu: SignaWre: Date: OWNER-BUILDER DECLARATIONS: I �ereby eHirtn thet under Denelty of perjury thet I em EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Profe55ions Code: My ciry or counry which requires a pertnit to construct, etler, improve, demolish, or repair any strucWre, pnor to its iuuance, elso requires ihe applicant tor such permil to file e signed statement ihat he or she is Ilcensed pursuent to the proNsions of iha Contractors License Law (Cheptar 9(commencing with Section 7000) of DlWsion 3 of the Business anC Professions Code) or Ihat ha or she is eaempt therelrom and the besis tor tha alleged exemption. Any vlolation oi Section 7031.5 by any applicent tor e pertnit subled ihe epplicant ro a civil penelty ot not more ihan tive hundred dollars ($500).): I, as owner of Ihe properry, or my employees wilh weges as their sole wmpensation, WILL DO THE WORK, and t�e strudure Is not intended or offeretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Law dces not apply to an owner of properry who builds or improves ihareon, and who does such work �imself or herself or through his or her own empiqrees, provitletl ihat such impmvemen4s ere not intended or oflered br sale. tl, however, t�e huilding or impravement is sold within one year ot wmpletioq the owner-�uiltler will have the burden ot proving that he or she tlitl not Duiltl or improve tor purpose of sele.). ❑ I, as ownet ot the Droperty, am E%CWSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Profeuions Cade: The wNrectors llcense Law does not eppty m an owner of pmperty wha builds or impmves thereon, antl who contracts for such pmject with a contrector(s) license pursuant to ihe Contraciors License Lews.). exempt Vedlicetlon Of Ownership Dy (rype oi Business and Professions Code for this reason: s ❑ No `'Dn'vels Cicense�No. r I.e. - property taa blll or deed)� DIVISION OF INDUSTRIAL SAFETY PEHMIT CERTIFICATION: ❑ I hereby certify that na e:cavation tive (5) or more teet in tlept� into which e person is requiretl to descenq wlll be made In connection with work euthorizad hy Ihis permi�, and that no building sWcture, scaflolding, talsework, or tlemolition or dismantling ihereot, will be more than ihirry-six (36) taet �ig�. (Ghap. 32, Grp 2, Art 2, Sec. 341, TIIIe B, Calilomia Adminisirative Cotle). ❑ As owner-bulltler, I will not employ enyone to do work which would require e permit from the Division of Industrial Sefery, es notetl ebove, unless such person hes e permit to tlo such work fmm ihe division. Sipnature: Date: Division ot IntlusMal Safery Pertnit Number. CEHTIFlCATE OF COMPLIANCE AND AUTHORVATION OF ENiAY: I certily under penalry ot perjury that I have read Ihis applica�ion and state tha� ihe infortnation given is Conect. I agree to compty with ell state laws and ciry ordlnances releting to building consiruction, and euthorize representatives ot the City of Costa Mesa to enter upon the ebove-Uescribed praperry tor inspecti n purposes. I agree noI �o accupy or allow occupency at any building euthonzed by this pertnit until tinal inspection. �eG�Gc�Pr- � ,� CSIg e O� , ._ � Dat� � AnNOr Authonzetl Applicant Date COUE �. INSPECTIONTYPE 1618 Fixetl System Final Fire Prevention 1288 Pool Spe Final 200 Final Re-Roo1 201 Final Block/Retaining W ell 202 Final Factory Fire Place 203 204 Final Sign Final Demolition PAIE II�ELS CODE 1 INSPECTION TYFE 206 Final Mechanical 208 Finel Plumbing 210 Final Electncal 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency I , �� —, �� I (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 222 DEL MAR AV Suite No Vicinity: Parcel Nunmber: 43921105 Applicant: DO, LIEM AND VU, MIEN Address: 222 DEL MAR AV COSTA MESA, CA Owner: DO, LIEM AND VU, MIEN Address 222 DEL MAR AV - COSTA MESA, CA Contractor: OW NER-BU ILDER Address: � Arch / Eng : Address: ISSUE FEE BackFlow irrigation BackFlow Preventer Bathtub Clarifier System Connec[(Ice,Soda,etc) Dental Units Dishwasher Drain, Floor PLUMBING PERMIT Status: ISSUED Applied: 04/24/2003 Issued: 04/24/2003 � ' ��/, / / � Phone: 949-650-6607 Zip: 92627-1321 Phone: 949-650-6607 Zip: 92627-1321 Phone: Zip: License: 000000 Phone: . ZiP: License: - SCOPE OF PERMIT ADD 495 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: ADD A NEW BEDROOM (APPROXIMATELY 247 S.F.), NEW BATHROOM (APPROXIMATELY 55 S.F.) AND RELOCATE THE EXISTING KITCHEN TO THE REAR OF THE PROPERTY. REF.: B03-00289 PLUMBING TO INCLUDE: 1 BATHTUB, 1 GAS (1-4 OUTLETS), 1 KITCHEN SINK, 1 WASH BASIN SET, 'I GARBAGE DISPOSAL, AND 1 WATER CLOSET. �� ._ - . � AMT $23.50 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $O.DO $0.00 QTY 0 0 1 0 0 0 0 0 FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator• $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 . Septic Tank $0.00 �Sewer Cap for Demo , , $0.00 Sewer Connect $0.00 QTY 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer , Urinal Vacuum Brkr BkFlow(1-4) Vacuum BrkrBkFlow(5+) Wash 8asin Wash Basin Set Waste and Vent System AMT 50.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $9.60 $0.00 QTY 0 0 0 0 0 0 0 1 0 NO710E: The work authonzed 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) EXPIRA710N: This permit shall automatically expire and become void it work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 1 BO 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 requlred Inepeetions 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 �� 2446-4fi(6/00) WORKERS' COMPENSAnON DECLAFiAnON: I hereby aflirm under penalty of peljury one of the following tleclarations: ' ❑ I have antl will maintain a ceAificate of consent to setl-Insure tor workers' compensation, es provided for by section 3700 ot Ihe Lebor Code, tor the pertormance ot the work for which this permit is issuetl. � I have and will maintain workers' compensation insurance, as required 6y section 3700 of t�e Lebor Code, for the peAormance ot tha work for which this permit is issued. My workers' compensation Insurance carrier antl policy number ara: Cerner. Policy Numher: (This section need not be completed il fhe permif is velued at ane hundred dollars ($100) or /ess.) � cartity thet in the performance of ihe work for which this permit is issued, I shall not employ any person in eny menner so es to become subject to ihe workers' compensation laws of Califomi , antl agree that if I should become subject to the workers' compensetion provisions of Section 3700 oi ihe Labor Code, I shall forthwith comply wiih ihese provisions. n e AppliCen� Slgneture: � ((�`��1�� Date: �Q � _ . .� WARNINQ:FAILURETOSECURE EFS'('.OMPENSATION UWFULANDSHAILSUBJECTANEMPLOYERTOCRIM PEr1N.TIES NDCIVILFINESU OONEHUNDRED T/IOUSAND DdlARE (E100,000), IN FDPITION TO THE COST OF COA9PENSATIIXJ, DAMNGES AS PROVIDED FOR IN SECiION 7/O6 OF THE LABOP CODE, IMEREST, AND ATTOFNEV'S FEES. LICENSED CONTRACTORS DEC�ATION: I hereby aMirtn thai l em licensed under provisions of Chapter 9(wmmencing with Section 7000) of Division 3 ot t�e Business end Professions Code, end my license is in tull torce end eflecL Lic. # Class a ContractoYs Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby alfirm that there is a �onsWction lending agency for ihe peAortnance of ihe work tor which this permit is issuetl. (Sec. 3097, Civil Code). Lentler's Name: Lenders Address: Signeture: Data: OWNER-BUILDER DECLARATIONS: I hereby ettirtn that under penalry o� perjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE lAW for Ihe tollowing reason (Sec. 7031.5, Busineu and Professlons Catle: My ciry or counry which requires a pertnit to conswct, alter, improve, demolish, or repair eny sWCNre, pnor to its issuance, elso raquires the epplicant for such permit ro file e signed statement that he or she is licensed pursuant to the provisions oi the Conirectors License Lew (Chapter 9(wmmencing with SecHon 7000) ot Divislon 3 ot the Busineu entl Protessions Code) o� that he or she is exempt t�ereirom and Ihe basis tor the alleged eaemption. Any violetian ot Section 7037.5 by any epplicant tor e Dertnit s�ubje�cts t�e applicam to a civil penalry of not more than five huntlreA dollars (5500)J: �/y �, es owner ot the properry, or my employees with wages as iheir sole compensation, WILL DO THE WORK, end the structure is not intended or oflered for sale (Sac. 7044, Business and Professio�s Code: The Conirectors License Law tices not apply to an owner of Oroperty who builtls or improves Ihereon, ana who does such work himself or hersell or through nis or her own employees, providetl �hat such improvemenis are no� intended or offered for sale. If, however, Ihe building or improvement is solC within one year ot wmpletion, the owner-builtler will have the burden ot O�o�ng ihat he or she did noi build or improve for Ourposa oi sale.). ' ❑ I, a5 owner oi the property, arti EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS Io con5truct ihe project (Sec. 7044, BuSiness antl Professions Cotla: Tha contractors License Law does not apply to an owner of pmperry who builds or Improves thereon, antl who conirects for such project wit� e contractor(s) license pursuant to the Conira�iors License Laws.). ❑ I am exempt un r c. Business and Professions Cotle for ihis reason: SignaNre: � Date: � Owner ID verified by drivef5liCen58. ❑ Yes ❑ No Dnvers License No. Vedticatbn oi Ownership by (type o� documertt, i.a. - property taz hill or tleed)�. DIVISION OF INDUSTRIAI SAFEY�' PERMIT CERTIFICATION: ❑ I hereby cetlify that no excavRUon five (5) or more teet in depih into which a person is required to Cescend, will be metle in connection with work authodzed by ihls permit, and ihat no building stNCNre, scaffolding, talsework, or demolition or tlismaniling thereot, will De mora Ihan ihirty-six (36) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Celifomia Atlministrative Code). ❑ As ownerbuilder, I will not emp�oy anyone to do work which woultl require e permit irom ihe Divislon of Industriel Satery, es notetl abova, unless such person has a parmit Io tlo such work irom Ihe division. Signeture: Date: Division ot Indusirial Safery Permit Number: CERTIFlCATE OF COMPLJANCE IWD AUTHOR¢A710N OF EMAY: I certity under penalry of perjury thal I have read Ihis application and state that ihe infortnation given is correct. I egree to comply with all state laws antl ciry ordinances relating to building consWction, and authonze representatives ot ihe Ciry ot Costa Mesa to enter upon the ebove-descnbed properry for in ec�ion puryoses. I agree not to acupy or aliow occupancy of any building authorized by this permit until tinal inspection. ._1�-f�2P�r�IO � �t. 7,L_ � ignaWraOfLegalOw ` Da�e— q�d/O� Authonzetl Applicant CODE �. INSPECTIONTYVE 1616 Fised System Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Rool 201 Finel BIocWRetaining Wall 202 Final Fectory Fire Placa 203 Final Sign 204 Final Demolition � INT� �QQ�j INSPECTIONTVPE 206 Finel Mechanical 20B Flnel Plumbing 210 Final Elecirical 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency �: 1 .11:11 , �� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-meSa.Ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 222 DEL MAR AV Suite No Viciniry: Parcel Number: 43921105 Applicant: DO, LIEM Address: 222 DEL MAR AV COSTA MESA, CA Owner: DO, LIEM AND VU, MIEN Address: 222 DEL MAR AV COSTA MESA, CA Contractor: O W N ER-B U I LD ER Address: MECHANICAL PERMIT Phone: 949-650-6607 Zip: 92627-1321 Phone: 949-650-6607 Zip: 92627-1321 Phone: Zip: License: 0 Status:- ISSUED Applied: 09/09/2002 Issued: 09/09/2002 • : 'c�� SCOPE OF PERMIT MECHANICAL TO INCLUDE: 2 VENT FANS/SINGLE DUCT AND 2 VENTILATION SYSTEMS. REF.: 802-00865 ISSUE FEE Inst FAU <100 k BTU � Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping, Factory Fireplace Hood w/Mech Exhaust VAV Box , Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers � Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Furnace Floor or Suspend Heater $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEESUMMARY Repair! Alt Absorbtion Unit- Repair / Alt Refrigeretion Onit Ventillation System Evaporative Cooler Commerciallncinerator � Domestic Incinerator Compressors / Absorption Systems Upto3hp/t00kBTU 3To15hp/500kBTU . � 15 To 30 hp / 1,000 k BTU ' ' �30 To 50 hp /�1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp - �� 3To15hp � , - 15to30hp � � , 30 to�50 hp , Over 50 hp � -. � Other Mechanical Fee Investigation Fee Plan Check Fee � Reinspection Fee . ' � TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity $0.00 0 $0.00 0 $21.30 2 $0.00 0 $0.00 0 $0.00 '0 $0.00 0 $0.00 0 $0.00 G $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $59.30 i NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and relateil 'i regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inepeetlone and final approval must be obtained. Failure to obtain inspections and tinal approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446-a6(N00) WORKERS'COMPENSAnON DECLARAnON: � �� I hereby anirtn under penalry ot perjury one of the following declarations: ❑ I have end will maintain a certificate of consent b salbinsure for workers' compensation, as provitletl for hy section 3700 ot t�e Lebor Code, for the pedortnence of the work for which this pertnit is issued. ❑ I have and will maintAin workers' compensatlon insurance, as requiretl by section 3700 of the LeDor Code, for Ne pertormance of the work for which Ihis pertnit is Issued. My workers' compensalion Insurance carrler and policy number era: Cartier. Policy Number: (�lh,i/s section need not be complefed il the permit is va/ued et one hundied dWlars ($f 00) or IessJ '� I ceriiry that in the paAortnance of the work for which this permit is issuetl, I shall not employ any person in any mannar so as to become suhject to t�e workers' / wmpensation laws of Califo ia, and agree that if I should become subject to ihe workers' compenution provisions ot Section 3700 oi ihe LaDor Cotle, I shall forihwith wmply with these provisions� �i�' ,' ^ � App icant SigJ re: .vK--Y� N �Datac� �� — � WARNING�FAILURE TO SECURE Wa (ERS' OOMPENSATION COVEPAGE IS UNIAWFUL AND SHALL SUBIECT PN EMPLOYERTO CRIMINAL PENALTIES AND CIVIL FlNES U� THOUSAND DOLLAflE (5100,000). IN ADOITION TO THE COST OF COMPENSATION, DAMhGES AS PROVIDED FOR IN SECfION 3IW OF THE IABOR CODE, IMEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aMirtn that I am licensed under provisions ot Chapter 9(commencing wiN Section 7000) of Division 3 of the Business and Professions Code, and my license is In full torce end eflecL Lia k Class N Contractofs Signature: Date: CONS7RUCTION LENDING AGENCY: ❑ I hereby attirtn that Ihere is a construction lending agency for the pedortnanca of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lendefs Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirtn ihat untler penalry of perjury Ihat I am EXEMPT FflOM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Professions Code: Any ciry or counry which requires a pertnit to consiruct, alter, impmve, demolish, or repair any stmcWre, pnor to its issuance, elso requlres the applicaN tor such pertnit to file e signed stetement that he or she is licensea pursuarn to the provisions oi the Contractors License Lew (Chapier 9(commendng with Secllon 7000) of DlWsion 3 of the Business and Professions Code) or that he or she is exempt iherefrom and the basis for ihe alleged exemption. Any violation of Section 7031.5 by eny applicant for e pertnit subjectS Ihe applicant to a civil penalry of not more ihan tive hundred tlollars ($500).): r�� es owner of the property, or my amployees with wages as iheir sole compensation, WILL DO THE WORK, and Ihe siructure is not intentletl or oHered for sale (Sec. � 7044, Business entl Professions Code: Tha Contractors License Law dces not apply to an owner ot properry who builds or improves t�ereon, antl who does such work himself or herselt or Ihrough his or her own employees, provided ihat such improvements are not intended or ottered tor sele. It, however, ihe building or improvement is soltl within one year ot completion, ihe owner-builder will have the burtlen ot proving that he or s�e tlid not Duiltl or improve tor puryose ot sala.). ❑ I, as owner of the property, am El(CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS lo construct ihe project (Sec. 7044, Business and Prolessions Cotle: The comractors Licensa Law tloas not apply to an owner of pmperty who builtls or improves Ihereon, antl who comracts for such prolect with e contracmr(s) license pursuent to the Coniraciors License Laws.). ❑ I am exempt under seq� Business and Profassions Code for this reason: by drive�S� license. �Ves ❑ No Verification of Ownership by (rype of docum�nC i.e. - properry tan bill or DIVISION OF INDUSTRIAL SAFETV PEHMIT CER7IFICATION: ❑ 1 �ereby cenity that no excevetion five (5) or more teet in depih into which e person is requiretl to Cescen4 will be matla In connection with work aut�onzed by this pertnit, and that no building strucNre, scallolding, falsework, or tlemolition or dismantling ihereoi, will be more than thirry-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Ttle B, Califomia Administrative Code). ❑ As owner-builder, I will noI employ anyone to do work which would require e permit from the Division ot Industnel Setery, es notetl ebove, unless such person hes e pertnit to do such work fmm the tlivision. Signature: Date: Division ot Indusirial Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVATON OF ENTAY: I certify under penalry of perjury that I have read this application and stale that the infortnation given is correct. I agree ro comply with all siate laws and ciry ordinances relating to builtling consiruction, and authonze represematives ot iha Ciry of Costa Mesa to enter upon the ebove-descnbed property for inspec�Cp n �purpase,s,. I agree not to occupy or allow occupancy of any building euthorized by ihis pertnit until final inspection. _.,l/f�/'.UulJ �- Ct` 4 ` � � Signra{ure Of Legal Owner(s � Date� AnNOr Aut�onzed Appliwnt Date � CODE �. INSVECTIONTYPE 1616 Fi:ed System Final Fire Prevention 7266 Pool Spa Final 200 Final Re-Root 201 Final BIocWRelaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final �emolition ppj$ �� 4Qp� INSPECTION7YVE 9��.� 206 Final Mechanical 208 Final Plumbing 270 Final Elactncal 212 Final Fire Prevention 220 Final Planninq Approval 222 Final Site 250 Final Building/Oaupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 222 DEL MAR AV Suite: Vicinity: REAR OF PROPERTY Parcel Number: 43921105 Zoning: Status: ISSUED Applied: O6/O6/2003 Issued: O6/O6/2003 Applicant DO, LIEM --' ISSUED BY: /'J� Address: _-,.. - � _ " _ �'� j' . - Phone: - _ �! /' - - ' , . Z�p; , - _ " �� .: i, �� . . . � .� Owner. DO LIEM'AND.VU, MIEN � � � � �,� Address '222 DEL MAR�AV � . - � � , �� ' � /,. . _ _ - . - . . � .�\ , � �� ••, '-, , � Phone: 949-850-8607 � � - - � ' � . /�, /�COSTAMESA,CA � Zip: 92827-1321 ,, i; � -. ��'. „�. ' �� i ' . �-. // /i/.. . - �'� � � ' � � �� Contractor: � OWNER-BUILDER �� '. ! �-,�� .� Address: � � � �` . , � Phone: _ , �, �V.,� ,\ . � Zip: , License: 000000 " . � � .', �, , . ��, � , , ' Arch'�: .� . . , . , . .: -, �- - E�g; � ' , _ . ; . ' Address: � ' � . � �� -. Address:- ` � , � , . � , � ,� � � ,�. � Phone: . , Phone: _ j. _ � - ' � " ' , Zip: ' , , , � �License: � �License: . , � � - ,. �� .; --_ �SCOPE OF�PERMIT . . � APPROX 50' LONG BLOCK WALL ALONG_REAR PROPERTY LINE; 6' HIGH:', ,/. ,�„ _' " ' � FEESUMMARY , � Plan Check: ''$25.19 Calc Valuation: Si,000.00 � Permit: • $38.75 —`' '- y Claim Valuation: So:oo �� SMIP Res: ° $0.50 � � � � � � � � ; SMIP Com: ' � � $0.00 � � t� _ � � ,'; % . � :,,� ,Other: V�'t, �$0.00 _ � . . � , , �� Inspectiori: A �,"$0.00 , " .. _;�:� _w � ,,"%" ' , ` �, i V ` iw } �r '�•:Total: $64:44 �� - � � " ` , �.� ' _ - ° -._ ., % �". . V�:,; , � � ` PLANNING & ZONING � ' � SETBACKS � " � �-� � MAINSTRUCTURE�Front 0-0 ' Rear. -0-0 .\�`� -' . � , .. ACCESSORY Front 0- 0�' . Rear _ 0- 0 � . PARKING ezistinq:; o' ` Required: � o NOTES: Left 0- 0 Right � 0- 0.- � � . '- . ,. �'� Lek 0- 0 Right „ 0- 0. _� �� Proposed: 0 , - : � NOTICE: The work a�thorized 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 it 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 expiratlon of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaas<s �e�oo� WORKERS' COMPENSATION DECLARATION: T � � I hereby eHirm under penalry of perjury one of the following declarations: ❑ I heve and will maintain a certiticate af consent to sel4lnsure tor workers' compensation, as provitled for by section 3700 ot the Lebor Code, for ihe peAormence of the work tor which Ihis permit Is issuetl. ❑ I have and will meintflin workers' wmpehsatlon insurflnce, as requireA by section 3700 of the Labor Code, for the peAortnance of Ne work for which this pertnit is Issuetl. My workers' compensation Insurence cartier antl policy number are: Carner. f Policy Number. (This section neetl not be camp/ete0 i! (he permit is valued at one huntlretl tlWlars (5100) o� less.) ❑ CI certity that in the peAormance oi the Work for which t�is Dertnit is issued, I shall not employ eny Oerson in any manner so as to become su�ject to Ihe workers' compensation laws ot Califomla, and agree Ihat ii I should bacome subject to Ihe workers' compensation provisions of Section 3700 ot the Labor Code, I shall torthwith comply with these provisions. 1n, Applicant Signeture: Y/ i.CQ� � Date: �y .�� i WAPNING: FAILUPE TO SECURE WORKE PENSATION COVEMGE IS UNUWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES D GVIL FlNES UP TOONE HUNDRED TMOUSAND DOLLARE (E100,000), IN ADDITION TO1HE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 31O60F iHE LABOii CODE, INTEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby attirm 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 tull torce antl eflect. Lic. p Cless a Contractors Slgnewre: Date: CONS7RUCTON LENDING AGENCY: ❑ I hereby ettirm thai thera is a consirudion lending egency for the pedormance of the work tor which ihis pertnit is issued. (Sec. 3097, Civil Cotle). Lendefs Name: Lenders Atldress: Signature: Date: OWNER•BUILDER DECLARATIONS: I hereby eHirtn Ihat under penelty ot perjury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor ihe tollowing reason (Sec. 7031.5, Business antl Protessions Code: Any city or counry which requires a permit to construc6 elter, improve, demolish, or repair any stmcture, prior to its issuance, also requires Ihe epplicant tor such pertnit to file e signetl statement thet he or she Is Iir�nsatl pursuant to Ihe provisions of the Conirectors License Lew (Chapter 9(commencing wilh Sectlon 7000) of Division 3 of ihe Business end Professlons Cotle) or �hat he or she is exempt theretrom and t�e basis for the elleged e:emptlon. Any vlolation oi Section 7031.5 by eny epplicant for e pertnit subjects the epplicant to e clvll penalty ot not more than five hundred dollers ($500)J: -� I, as owner of Ihe property, or my employees with wages es their sole compensation, WILL DO THE WORK, entl the structure is not intendad or oftered for sale (Sec. 7044, Business and Professions Code; The Coniractors License Law does not apply to an owner oi property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, pmvided that such improvements are not intended or oflered for sale. tl, however, ihe bulltling or improvemeM is sold within one year o1 completioq ihe ownerbuilder will havelhe burden of proving that he or she did no1 build or improve for purpase of saleJ. � ❑ I, es ownet ol the properTy, am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS Io conslruct the prqect (Sec. 7040, Busine55 end Profes5ion5 Code: Tha contractors Licanse Lew does not apply m an owner ol property who builtls or improves thereon, entl who contracts tor such project with a comractor(s) license pursuant to the Coniraciors License Laws.). ❑ I am exempt nder sec Business and Professions Code tor �his reason: Signature: �,�1 � � �/ Date: Owner ID verifiad dnvers license. ❑ Yes ❑ No Dnvers LicenSe No. /� Vedfication of Ownership by (type of tlocument, i.e. - property tax bill or deetl): �IVISION OF INDUSTRIAL SAFETY PERMI7 CERTFICATION: Ezpires: ❑ I hereby certity ihat no excavation five (5) or more teet in depth into which a person Is required to tlescenQ will he mada in connection with work authonzed by this pertniL end that no building siructure, scafloltling, falsework, or demolition or dismantling ihereof, will be more than ihir�y-six (36) feat high. (Chap. 32, Grp 2, Atl 2, Sec. 341, Ttle B, Califomla Atlminisiretive Cotle). ❑ As owner-builder, I will not employ anyone to do work which woultl require a permit tmm the Division ot IntlusMal Safery, as noted abova, unless such person has a pertnit to tlo such work irom the division. Signature: Da�e: Division oi Intlustnal Sefery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTMORVATION OF ENTRY: I certify under penalty of perjury that I have read Ihis application antl staie Ihat the infortnation given is correcL I agree to comply with all state laws end ciry artlinances relating ro building construction, antl authorize representetives of the Ciry ol Costa Mesa to enter upon t�e above-descnbetl property lor inspecf n purypses. I gree not to occupy or allow occupancy ol any building euthorized by t�is Dertnii unlil finel inspection. �� 6� (n' -c� � Signat re Of Legal Owner(s) Date 4 � AnNOr Authorizetl Applicant Date COUE �. INSPECTONTYYE 1616 Fixed Sys�em Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Root 201 Final BIocWRetaining Wall 202 Final Fectory Fire Place 203 Finel Sign 204 Finel Demolition QajE I AL / — �� QQf,j INSPELTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Finel EleClrical 212 Finel Fire Pravention 220 Final Planning Approval 222 Final Site 250 Final BuildinglOccupancy PAff I[��LS � Z Z s�i _v G — � Z N N 0 � � � � � n � a r � C � � � � ,% PII�ERIY UMC - - � - � :' � ..---'�- �a�nce_ax�__.._ ..._. � i � m � , � , -- -- � .a � r � ;i � � •4 � , , �,� a � � � I i� Dn'ISION OF B � � ; R CITyOF� t�. xn.e':n � —`� pI'R Od � z� and .e x;° � �; o �° or 'o .`L' C}'.j fieSE � y' �a �n��i zy �y i Z^ r Y�!. Y, � � C � y � -- _„�, �:,uns 5:5;G ' �' a7% Cir1 clC!`NO _ PI10KR1Y 11M[ _ _ Per UBC DINn A Y I �,� �� d Mhqnt��.. 'sunAwfulto a4wlam� '�^n,�: �,ti � P ov � ,�� and�or a al Srate a;,, — — e uilC'. . � � �i5 0/'. Of ��. � Cement Coping OPtional � Ghannel Bbck With 1�3/8� � Hori:onul Top ol all Fenca For Feneas 5' or Lets Ven. Bars 3/8"� at 4' �0" O.C. For Fencef Higher Than 5' Ven. Ban 3I8"� at 32" O.C. � Fill Cells Solid With Grout Where Steel Occurs Rcinl�rcing S1eel Shall Conlorm �o Sec.A�15�39 A.S. T.M. All Steel to he Lapped 14" orto Code NATUFALGRAOE• TWO J/8"O BARS CONTINUOUS TOP 6 BOTTOM HOQIZSTEEL MUST 6E TIED IN PLACE AT TIME OF TRENCH INSPECTION. TYPICAL alz 4 F x z 6�� CONCRETE BLOCK FENCE �n uA 'p ry A e � F-�--KIDTH , p SEE CH4RT L BELOW o , �4� �,., �� ....� WIDTH THICKNESS DEPiH OF EARTNTOOTH SPACING OF EARTHTOC 14. 24,� IQ' • _ l O 16 O [ AI J�.. .. . w-� � . NG •REQUIREMENTS 14�' 10" 20" 14� BUILDING DIVISION ♦ z.. GENERAL- NOTES MOFTAR; p�e Part Plastic Cement, and Three Porfs Sond GROUT: One Porf Cement TMee ana One Hul} Parts S�and COPING: One Port Cemenl, TAree Ports Sond CONCFETE: Weil M�ied 1:2-I/2:3-I/2 Mav ot 7-I/2 Goltens of Waler Per Sack nf Cement GROUT MAV 6E POURED FROM TME TOP OF iME FENCE IN CELLS WMERE STEEL OCCURS. CELLS AND AREAS OF MOHIZONTAL REIN FOHLEMENT SHALL BE CLE11H, CLEAN 6 FREE OF ALL MORTAR DEBNIS. ETC. � � � w rl � y : z: ;.. a _' � t _ �� ,_� µ ... iii : ) � � � yy'GC�TMi�(.�' L4RrM1�07H � : 1d �.. �t%�-��E-,yEiy7H Of EENCE �`� :B�LOW »96TTqM OF FOGT��NG �, �r ^''' SCALE: I/2�� =� �= 7 .� _- S � � 4y�... 1'` r : "1 \ � b. �+.� � ~� "� ~ : y/� ... -n ' �;.y PL � :.., c �.� �� - •;� .- 3� ' � 12�' � c c- 12� � 9 � ;=' `�' :� t= 6!" + 16�� - i�: '�:_; I 2� j 16' � 16�j ..�. __�r.._..�__�.,..... _.r..,---..,.J (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT .lob Address: 222 DEL MAR AV Suite: Vicinity: REPLACEALLWINDOWS Parcel Number: 43921105 Applicant: GREELEY, SHARON Address: 268 FLOWER ST COSTA MESA, CA Owner: GREELEY, SHARON Address 268 FLOWER ST COSTA MESA, CA Contractor: OWN ER-B U I LDE R Address: Zip: Arch : Address: �, Phone: Zoning: Phone: (949)642-1457 Zip: 92627 Phone: (949)642-1457 Zip: 92627 Phone: License: 0 . Eng: Address: Status: ISSUED Applied: O6/23/2000 Issued: O6/23/2000 ISSUED BY: `m'L Phone: Zip: License: License: � SCOPE OF PERMIT BUILDING PERMIT FIRE MINOR STUCCO REPAIR FOR REPLACEMENT OF (8) EXISTING WINDOWS WITH NEW SAME SI2ED WINDOWS.REMOVE EXIST. STUCCO , INSULATE AND DRYWALL THROUGH OUT TEH HOUSE, INSTALL WOOD SIDING AS PER 197 UBC. Plan Check: Permit: SMIP Res: SMIP Com: Other: I nspection: Total: $0.00 $153.25 $0.80 $0.00 $0.00 $0.00 $154.05 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existinq: o NOTES: Rear 0-0 Rear 0-0 Requiretl: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 PropoSed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0-0 �'1r'LS $a,000.00 sa,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 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 inspectlons and final approvel must be obtainad. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 754•5626 'WORKERS'COMPENSAnON DECLARAnON: I hereby ettirm under penalry oi perjury one ot the tollowing declarations: ❑ I have and will maintain a certificate ot consent to self-Insure for workers' compensation, as provitled for by section 3700 of the LeDor Cotla, for the pertormance of the work for which this permii i5 issued. � ❑ I have and wlll maintain workers' compensation insurance, as required by section 3700 oi the Labor Cotle, for ��e peAormanca of the work for which this pertnit is issuetl. My workers' compensation Insurance carner end policy number ere: Carrier: Policy Number: (Thls section need nof be comp/etetl i/ the permif is velued et one hundred dollars ($100J or less.) ❑ I certify that in the pertortnance of tha work for which this pertnit is issued, I shell not employ any person in any manner so as to becoma subject to the workers' compensation laws of Celifomia, antl agree that if I should become subject to ihe workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwi�h comply with thesa provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATIIXJ CAVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDPED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMNGES AS PRW IDED FOR IN SECTION 3]W OF THE LABOR CODE, IMEREST, ANO ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Professions Cotle, antl my license is in full lorce and etteci. Lic. a Class a Contracbr's Signalure: Date: CONS7RUCTION LENDING AGENCY: ❑ I hereby attirm thai there is a constmction lentling aqency tor ihe peAormance of the work tor which this permit is issued. (Sec. 3097, Civil Code). Lentler s Name: Lentlels Address: Signature: Date: OWNER•BUILDER DECLARATIONS: I hereby ettirm Ihat under penalry ot perjury Ihat I am E%EMPT FHOM 7HE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7037.5, Business antl Professions Code: Any ciry or county which requires a permit to consWct, alter, impmve, tlemolish, or repair any siructure, prior to its issuance, elso requires the appliceN for such permii to file a signed statement thet he or she is licensed pursuant to the provisions ot Ihe Contrectore License Lew (Chapter 9(commencing with Sedion 7000) oi Division 3 oi Iha Business antl Professions Code) or ihat he or she is exempt theretrom and Ihe basis tor the alleged exemp�ion. Any violation of Section 7037.5 by any applicani for a permit sub�acts tha applicant to e civil penalry ot not more than five hundred tlollars ($500).): ❑ I, es owner of ihe property. or my employees with wages as iheir sole compensation, WILL DO THE WORK, and the structure is not intentletl or oHered for sale (Sec. 7044, Business antl Professions Code: The Contractors License Law dces not apply to an owner of properry who builtls or improves thereon, entl who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or oHered for sale. If, however, the building or imOrovement is soltl within one year of completion, the owner-builder will have Ihe burden of proving Ihat he or she did not 6uild or improve tor puryose ot sale.). � I, as owner of lhe properry, am EXCWSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construcl the project (Sec. 7044, Business antl Protessions Code: The conirectore License Lew does not appy to an owner of Droperry w�o builds or improves thereon, antl who contrects tor such project with a coniractoqs) license pursuant to the Contractors license Laws.). e:em er sec. Business antl Professions Code for Ihis rea5on: v� Sianatu nlL//I/S.( o-.� i _ D e: % Od � ner ID verified by driver's licensa. es No Drive' ense .� �iras: �� Verifica�ion of Ownership by (rype of tlaumen�, i.e. - property tax bill or deed): DIVISION OF INOUS7RIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certiy that no excavation tive (5) or more feet in depth into which a person is requiretl to tlescen4 will be made in connection with work authonzed by this permit, antl that no building siructure, scattolding, falsework, or tlemolition or tlismantling ihereof, will be more than t�irty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, Califomia Administrative Code). ❑ As owner-builtler, I will not employ anyone to do work which would require a permit irom the Division of Intlustrial Safety, as notetl above, unless such person has a permi� to tlo such work from the division. , Signature: Date: Division of Intlustnal Safety Permit Number: COpE �. INSPECTIONTYPE OAT INTRIA 1616 Fixod System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demoli�ion 2C48d6 CODE 11 INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 270 Final Eleciriwl 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy 2� IHLITIRLS (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 222 DEL MAR AV Suite: Vicinity: HOUSE 8 ATTACHED GARAGE Parcel Number: 43921105 Applicant: GREELEY, SHARON Address: 268 FLOWER ST COSTA MESA, CA Owner: GREELEY, SHARON Address 268 FLOWER ST COSTA MESA, CA Contractor: OWN ER-B U I LDE R Address: Zip: Arch : _ Address: � � Phone: Zoning: Phone: (949) 642-1457 Zip: 92627 Phone: (949)642-1457 Zip: 92627 Phone; License: 0 C Eng: Address: Status: ISSUED Applied: 06/23/2000 Issued: O6/23I2000 ISSUED BY: � n , . �v / � .\n�\� �O ` Phone: Zip: License: License: , SCOPE OF PERMIT REROOF EXISTING SINGLE FAMILY RESIDENCE & ATTACHED GARAGE (9 SQ). TEAR OFF EXISTING LAYERS OF COMPOSITION SHINGLES, REPLACE EXISTING FASCIA 8 STARTER BOARDS, INSTALL 1 LAYER OF 30# FELT UNDERLAYMENT, & REROOF WITH 30 YEAR COMPOSITION SHINGLES. Plan Check: $0.00 Permit: $54.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $54.50 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING 8 ZONING Left 0- 0 Lek 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0-0 $1,500.00 si.soo.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 780 days. INSPECTIONS: In order for tha work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetions and final epproval must be obtained. Failure to obtain inspections and final approval will result in �he expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSAnON DECLARAnON: I hereby attirtn under penalry ol perjury one of the lollowing declarations: ❑ I have and will maintein a certificate ot consent to seli-Insure for workers' compensation, as provided for by section 3700 of the Lebor Cotle, for ihe peAormance oi the work tor which this permit is issued. � ❑ I have antl will maintain workers' compensatlon insurance, as required by section 3700 of ihe Labor Code, for the perfortnance oi ihe work for which Ihis Oermit is issued. My workers' compensation Insurance carner entl policy number are: Cercier. Policy Number: (7his secfion need not be cromplered i! fhe permit is va/ued af one hundred dWlaro ($ f 00J or less.) ❑ I certity that in the peAormance of the work for which this pertnit is issued, 1 shall not employ any person in any manner so es to become subject to �he workers' wmpensation laws ot Celifomia, and agree that if 1 should become subject to the workers' compensation pmvisions of Section 3700 of the Labor Cotle,�l shall lorihwith camply with Ihese provislons. Applicant Signature: Date: WAHNING: FAILURE TO SECUFE WOiiKERS' COMPENSATIIXJ CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CFIMINAL PENALTIES AND CIVIL FWES UP TO IXJE HUNDRED THOUSAND DOLLAFE (5100.000). IN ADDRION TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTIQV 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LILENSED CONTRACTORS DECLARATION: I hereby aftirtn ihat I am licensed under provisions ot Chapter 9(wmmencing with Section 7000) of Division 3 of Ihe Business and Professions Code, antl my license is in full fOrte antl eNect. Lia a qa55 a Contractors Signature: Data: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn Ihat Ihere is e consWction lending agency for ihe pedormance of ihe work tor which this permit is issued. (Sec. 3097, Civil Code). . Lender S Name: Lendefs Adtlres5: Signature: Date: OWNER-BUILDER DECLARATONS: I hereby aNirm thai under penalry of perjury ihat I em EXEMPT FROM TNE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a permit to conswc6 alter, improve, tlemolish, or repair any strucWre, prior to its issuance, also requires the applicaN tor such permit to file a signed stetement ihat he or she is licensed pursuant b the provisions of the Coniractors License Law (Chepter 9(commencing with Section 7000) ot Division 3 of �he Business antl Protessions Code) or that he or she is exempt thereirom and the besis for Ihe allegetl exemption. Any violation of Section 7031.5 by any applicant for a permit sub�acts the applicant to e civll penalry of not more ihan five huntlretl dollars ($500).): � I, as owner of the propany, or my employees with wages as their sole compensation, WILL DO THE WORK, and ihe stmcture is not intentletl 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 thmugh his or her own employees, pmvidad Ihat such improvements are not intended or ottered for sale. It, however, ihe building or improvement is sold within one year oi wmpletioq the owner-builtler will �ave the bur0en of proving that he or she did not build or improve for purpose of sale.). ❑ I, es owner of �he property, am EXCLUSIVELV CONTRAC7ING WI7H LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contracrors License Law does not apply to an owner of property who builds or improves �hereon, and who contracts lor such pmject with a coniractor(s) license pursuant to the Contractors License Lews.). ❑ I am e:empt er sec. Signature: =�i Owner ID verified by drivefs license. Business antl Professions Code for Ihis reason: ❑ Yes Q No Driver's License No. Verification of Ownership by (type of document, i.e. - property tax bill or deed): Date: 3 Do ' Eapires: � � DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N: � ❑ I hereby cenity thet no eacavation tive (5) or more teet in depth into which a person is required to tlescend, will be matle in connaction with work authonzetl Dy t�is permi�, antl ihat no Duiltling structure, scaHoltling, falsework, or demolition or dismantling thereof, will be more than ihirry-six (3fi) fee� high. (Chap. 3.2, Grp 2, Art 2, Sec. 347, Title B, Calilomia Adminisirative Code). . ❑ As owner-builder, I will not employ anyone to do work which would require a permit from �he Division of Intlustrial Safety, as notetl above, unless such person has a permit ro da such work trom the divisian. SlgnaNre: Date: Division of Industnal Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVATON OF ENTHY: I certity under penalry of perjury ihat I have read this application and state �hat �he information given is correcl. I agree to comply with all siate laws antl ciry ordinances relating �o building consiruction, and amhorize representatives ot ihe City of Costa Mesa to enter upon ihe a6ove-tle tl propeny for ins cu puryose/s "agree not to acupy or allow occupancy of any Duiltling euthorized by this permity ntil linal inspection. i _ ��.c� ��r � /��c-� ��L 3 /aa SignaWreOfLe IOwner � Date And/Or Authonzetl Applicant Date CODE �. INSiECTIONTYVE Qg� INTRI�LS 1676 Fized System Final Fire Pravention 1266 Pool Spa Final 200 Final Re-Roof 201 , final BIocWReteining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 2a4&46 COUE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecincal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildinryOccupancy DRT IMRIALS � (7/4) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 \BUILDING PERMIT � eob Address: 222 DEL MAR AV Suite: Vicinity: REPLACE ALL WINDOWS Parcel Number: 43921105 Applicant: GREELEY, SHARON Address: 268 FLOWER ST COSTA MESA, CA Owner: GREELEY, SHARON Address 268 FLOWER ST COSTA MESA, CA Contractor: OWN ER-B U I LDE R Address: Zip: Arch : Address: . , , Phone: Zoning: Phone: (949)642-1457 Zip: 92627 Status: ISSUED Applied: O6/23I2000 Issued: 06/23/2000 I ISSUED BY: Phone: (949) 642-1457 � // ' �Il1✓— Zip: 92627 �"" V� ��\ �`�^ Phone: \.\� /� V� License: 0 �, \ � . Eng: Address: Phone: Zip: License: License: , SCOPE OF PERMIT BUILDING PERMIT FIRE MINOR STUCCO REPAIR FOR REPLACEMENT OF (8) EXISTING WINDOWS WITH NEW SAME SIZED WINDOWS. Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existinq: o NOTES: Rear 0-0 Rear 0-0 Required: 0 FEESUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0-0 Right 0-0 sz,soo.00 52, 500.00 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 i( work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final epprovel must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. �� FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: I hereby aflirtn under panalry of perjury one ot tpe tollowing declarations: � ❑ I heve and wlll mainlain a certificate oi consent to self-Insure for workers' compensation, es provitletl for by section 3700 of the La6or Cotle, tor the pertormance of ihe work for which ihis permi� is issued. . � ❑ I have and wlll maintein workers' compensatlon insurance, as required by section 3700 of the Labor Code, for tha peAormance of the work for which this pertnit is issued. My workers' compenution Insurance carner and policy number are: Carder. Policy NumDer. (T61s section need not be comp/efed il fhe pennrt Is valued ef one hundred dWlers ($100) or /ess.) ❑ I certify that in the peAormanca ot the work for which this parmit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws ot Califomia, antl agree thai it I should 6ecome su6ject b the workers' compensation provisions of Section 3700 of the LeDor Code, I shall forthwith wmply with these provisions. Appliwnt SignaWra: Date: WARNING: FAILURE TO SECURE WORKERS' dJMPENSATIIXJ COVERAGE IS UNLAWFUL AND SHALL SUBIECi AN EMPLOYER TO CPIMINAL PENALTIES AND pVIL FINES UP TO ONE HUNDRED T110USAND DOLURE (5100,000�, IN ADDfrION TO iHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3)O60F THE LABOR COOE, IMEREST, AND AiiORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm ihat I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Oivision 3 ot the Business and Professions Cotle, and my license is in full forca end eflecL Lic. » Class a Coniractor's Signeture: Date: CONS7FUCTION LENDING AGENCV: ❑ I hereby aHirm thet Ihere is a construction lendinq aqency for the pedormance of the work for which this pertnit is issued. (Sec. 3097, Civil Cotle). I Lender's Name: Lenders Address: I Signamre: Date: OWNER-BUILDER DECLARATIONS: I hereby aMirtn �hat under penalry ot perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions Code: Any city or counry which requires a pertnit to consiruct, altar, improve, demolish, or repair any strucNre, pnor to its issuance, also requires the appliwnt for such permit to lile e signed statement that he or she is licensed pursuant to the provisions ot iha Coniractors License Lew (Chapter 9(commencing wlth Saction 7000) of Division 3 of tha Business antl Protessions Cotle) or that he or She is ezempi t�ereirom and the basis for ihe alleged e:emption. Any violation of Section 7031.5 by eny applicant for a pertnit subJects the applicant to e civil penalry of not more ihan tive hundred aollars ($500).): �s owner of the propeny, or my employees with wages as their sole compensation, WILL DO THE WOqK, and ihe siructure is not intended or oNered for sale (Sec. 7044, Business end Professions Code: TTe Contractors License Law does not apply to an owner of property who builds or improves thereon, end who tloes such work himself or herselt or ihrough his or her own employees, provitlad that such improvements are not intended or oHered for sale. It, however, Ihe 6uliding or improvement is sold within one year of completioq the oWner-builtler will hava t�e burden of proving ihat he or she did not build or improve for purpose ol sale.). ❑ I, as owner oi t�e property; am EXCLUS�VELY CONTRACTING WI7H LICENSED CONTRAC70RS to constmct the project (Sec. 7044, Business and Profassions Cotle: The contrectors License Law does not apply to en owner ot property who huilds or improves ihareon, and who contrects lor such project with a comractor(s) license pursuant to the CONractors License Laws.). ❑ I am eaempt sec. Business and Professions Code for Ihis reason: Signature: � / "�� • Dete: Owner ID verified by drivefs license. ❑ Yes ❑ No Driver's License No. / Expires: Venfication of Ownership by (rype of daument, i.e. - property taz bill or deed): _. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity Ihat no excavalion five (5) or more feet in depth into which a person is required to descend, will be matle in connection with work authonzed by this pertnit, antl Ihat no building swcWre, scaholding, falsework, or tlemoli�ion or tlismantling thereot, will De more ihan thirry-six (36) faet �igh. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Titla 8, Celifomia Adminisirative Code). ❑ A5 owner�builder, I will not employ anyone �o do work which would require a permit irom the Division oi lndustrial Satery, as noted ebove, unless such person has a permit to do such work tmm the dNision. Signawre: Date: Division of Industrial Safery Permit Number. CER7IFICATE OF COMPLIANCE AND AUiHOq�710N OF ENTRY: I certify untler penalty ot perjury Ihat I have read ihis application and state Ihet ihe informa�ion given is correct. I agree to comply with all state laws and ciry ordinances relating to builtling constmction, and authorize representa�ives of the Ciry ot Costa Mesa to enter upon ihe above�0escnbe erty for inspe urposes. gree noi to occupy or ellow occupancy of any building au�honzed by this p rmit until tinal inspection. lf �Z?� a Signature Of Legal �wne ) Date AndlOr Authorized Appficant Date SODE t. INSPECTIONTYPE 1616 Fi:ad System Final Fire Prevention 1266 Pool Spa Final 200 Finel Re-Roof 201 Final BIOCWRetaining Wall 202 203 204 Final Fectory Fire Place Final Sign Final Demolition 2nT� INi1TIAL5 GODEt IN¢PECTIONTYPE 206 Final Mechanical 208 Final Plumbinq 210 Final Electncal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy �� IM RL (714) �54-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 222 DEL MAR AV Suite No Vicinity Parcel Nunmber; 43921105 Applicant: HEYER, WALTER E Address; 30972 LUCIA LN LAGUNA NIGUEL, CA Owner: HEYER, WALTER E Address 30972 LUCIA LN Contractor. Address; Arch / Eng ; Address: LAGUNA NIGUEL, CA PLUMBING PERMIT Phone: 949-642-1457 Zip: 92677 Phone: Zip: 92677 Phone: Zip: License: Phone: Zip: License: Status: ISSUED Applied: 06/27/2000 Issued: 06127/2000 ISSUEDBY: �/Y�- �� m V O1 V' � SCOPE OF PERMIT WATER REPIPE FOR THEWHOLE HOUSE AND REPLACE EXIST TUB AND SHOWER. ISSUE FEE BackFlow irrigation BackBow Preventer 8athtub Clarifier System Connect Qce,Soda,Btc) Dentai Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Greas6. Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 SewerCapforDemo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $9.80 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 COMMENTS I SPECIAL CONDITIONS I i� SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Sokener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $D.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: $43.10 QTY 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 NOTICE: The work authorized by ihis parmit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § i, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In Order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requiretl inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSAnON DECLAFiATON: ' I hereby attirm under penalry of perjury one ot the tollowing declarations: � � ❑ I have antl will maintain a certiticate of wnsent to seli-Insure tor workers' compensation, es provided for by section 3700 of the Lebor Cotle, for Ihe pertortnance of the work for which this permit is issuetl. � ❑ I have anG will maintain workers' compensatlon insurance, as required by section 3700 ot Ihe Labor Cotle, for the peAortnance of the work for which this permit is issuetl. My workers' wmpensation Insurance carner and policy number are: Carrier: Policy Number: (This sec(ion need not be comp/eted /l the permit is ve/uetl et one hundred dollars (5100) or less.) ❑ I certify Ihat in Ihe pedormance of the work for which ihis permit is issued, I shall not employ any person in any manner so es to becoma subject to ihe workers' compensation laws of Celifomia, and agree that if I should become su6ject b the workers' compensation provisions of Section 3700 of Ihe Labo� Cotle, I shall forthwith camply with these provisions. Applicant Signature: Date: WARNING FAIWRE TO SECUFE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FWES UP TOONE HUNDFED THOUSAND DOLLARE (3100,000). IN A�DITION TO THE COST OF WMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CQOE, IIJ�EREST, ANO ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm that I am licensad under provisions ot Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Cotle, antl my license is in full bma and ettecL Lic. N� Class # Contrectofs Signature: Date: CONSTRUC710N LENDING AGENCV: ❑ I hereby aftirtn that there is e construction lending aqency for the peAortnance of the work tor which this permit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lentlers Address: SignaWre: Date: OWNER-BUILDER DECLARATIONS: I hereby attirm that under penelry ot per�ury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Protessions Code: Any ciry or counry which requires a pertnit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires Ihe epplicant tor such permit b tile a signed statement t�at he or sha is licensed pursuant to the provislons of tha Contractors License Law (Chapter 9(commencing wilh Section 7000) of Division 3 of the Business antl Professions Code) or thet he or she is exempt iherefrom end the basis for the allegetl e:emption. Any violation of Section 7031.5 by any applicant for e permit subJecis the applicant to e civil penalry of not more lhan five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as iheir sole compensation, WILL DO 7HE WORK, and ihe siructure is not intentletl or oHeretl tor sale (Sec. 7044, Business antl Protessions Code: The Coniractors License Ww dces 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 ihat such improvements are not intended or oftered for sale. If, however, the building or improvement is sold within one year oi completion, Ihe owner-builder will have the burden ot proving that ha or she tlitl not build or improve for purpose ot sale.). �I, as owner ot the pmperty, am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct the pmject (Sec. 7044, Busineu antl Pmfessions Code: The conirectors License Lew does not appty m an owner of properry who builds or improves thereon, and who contrecis for such project with a comrector(s) license pursuant to the Coniradors License Laws.). sec. and Professions Code tor ihis reason: Owrt�r fD verified by dnvers license. ��Yes ❑�l ` � Verification of Ownership by (�ype of document, i.e. - property laz bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIiICATION: ❑, I hereby certity that no excavation tive (5) or more feet in depth into which a person is requiretl to descend, will be matle in connection with work authorized by this pertnit, and Ihat no builtling sWcture, scaHolding, falsework, or demolition or dismantling ihereof, will be more than thirty�six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Division of Industnal Sa(ety, as notetl ebove, unless such person has a permit to do such work from ihe division. Signature: Date: Division of Industnal Safery Permit Numbei: CERTIFlCA7E OF COMPLIANCE AND AUTHORIZATON OF ENTAV: I cenify untler penalry oF perjury that I have read this application antl state that the information given is correct. I agree to comply with all state laws and ciry ordinances relating to building construction, and authonze representatives ol the City of Costa Mesa fo enter upon the above-descn � roperty lor inspectio p�p�oses. I �agr je-nppt to occupy or allow xcupancy of any 6uilding authori/��e,tl�by this permit ou9mil �fi,nal inspeciion. !!� L'/ ,)S-�s�/tr� �Z� ti �LL.(nn.! �/ \f �` !7 Signatur t Legal r(s) Date AnNOr Authorizetl Applicant � Da�e COpE 11, INSPECTIONTYPE OATE I IAL 1616 Fiaed System Final Fire Prevention 1266 Pool Spa Final 200 Final Ra-fioof 201 Final BIocWRetaininq Wall 202 Final Factory Fire Placa 203 Final Sign 204 Final Demolition 2666J6 CODEt INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildinyOccupancy PRTE INTRIRLS