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Home My WebLink About980 EL CAMINO DR - Building Permitsr : 1, . (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 lob Address: 980 EL CAMINO DR Suite No 004 Vicinity: Parcel Nunmber: 14166524 Applicant: BICH VAN.XUAN NGUYEN Address: 980 EL CAMINO DR COSTA MESA, CA Owner.� NGUY�N; CALI�� Address 980 EL CAMINO DR � COSTA MESA, CA Contractor: Address: Arch / Eng : Address: ISSUE FEE �. Backflow irrigation Backflow Preventer Bathtub Clarifier System ' Connect pce,Soda,etc) Dental Units Dishwasher Drain, Floor Draiq Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve PLUMBING PERMIT Phone: 714-662-2934 ' Zip: 92626 . Phone: 714-747-1158 Zip: 92626 Phone: Zip: License: _ ` _ Phone: Zip: License: Status: ISSUED Applied: 01/07/2004 Issued: Ot/07/2004 ISSUED BY: ��Y ��4;�;� 94'� . . . _ . , � - . . , SCOPE OF PERMIT NEW GAS SERVICE FOR UNIT 4. - AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 �- $0.00 $0.00 $0.00 $0.00 $OAU $0.00 $0.00 $0.00 �TY 0 0 0 0 0 0 0 0 0 0 0 0 0 Laundry Tub / Washer Landscape Irngation P-Trap Pressure Regulator Process Piping (per 10 R) Receptors Septic Tank Sewer Cap for Demo Sewer Connect Sewer Private Line Shower Sink, bar � - Sink, commercial ' Sink, Floor AMT QTY..:� .- $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 . � S0.00 0 $0.00 0 AMT Sump Pump � � - $0.00 Swimming Pool � ' , "$0.00 Trap Primer., � $0.00 Urinal � � $0.00 Vacuum Brkr Bkflow(1-4) $0.00 Vacuum Brkr Bkflow(5+) $0.00 Wash Basin . $0.00 Wash Basin Set $0.00 Waste and Vent System $0.00 Water Closet (Toilet) $0.00 WaterHeater/vent $0.00 Water Piping (Inst or Rep.) $0.00 Water Re-pipe $0.00 Water Service $0.00 aTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) � i 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 reqWred (napectfons and itnal approval must be obiained. Failure to obtain inspections and tinal approvai wif! result in the expira[ion of this permit. FOR INSPECTIONS CALL: (714) 7545626 24464fi (6/00� WORKERS' COMPENSATION DECLARA710N: � I hereby ettirm under penalry of perjury one oi ihe tollowinq declarations: • � � ❑ I have end will maintein e cerlificate d� consent to self-Insure br workers' compensation, as provided lor by section 3700 of the Labor Coda, for the peAormence oi Ihe wark lor whlch ihis pertnit i5lssued. ❑ I have antl wlll mainWin woAcers' compensetlon insurance, as required by section 3700 ot Ihe Lebor Cotle, for the pedortnance of the work for which this pertnit is issuetl. My workers' compensetion Insurance �erner and policy number era: Cerrier: Policy Number: (1Thiysecfion neeC nof be crompleted i/ the permit is velued et one hundred dollers ($100) or leu.) YJ�, I�certify thet in the pertormance of the work for which this permit is iuued, I shall not employ any person in any manner so as to bacome sublect to Ihe workers' compensation laws oi Calitomia, antl a9ree Ihat If I should become sub�eq to the workere' compenution provislons of Section 3700 oi the LaDor Code, I shall forihwith comply with Ihese pr ians. ��% � � I� Ap011wnt SlBnaiure: '�� sT/ �_ L/ Date: � �� — U`-'� WARNINQ:'FNLURE TO SE E WORKERS' �aPENSATION COVERAGE IS UNLAWFUT AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES M1D GVIL FlNES UP TOONE HUNDRED THOUSANO OOLLARE (5100,000�. IN AD�RION TO T11E COST OF COMPENSATION, OAMAGES AS PROVIDED FOR M SECTION 3]O60F THE IABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm that I em licensed under pro��sions of Chaptar 9(commencing with Section 7000) ot Divislon 3 ot the Business and Pmlessions Code, and my license is In tull torce entl eNect Lic. x Class k Contrectofs SlgnaWre: Dete: CONS7RUCTION LENDING AGENCY: ❑ I hereby affirtn Ihat ihere is a consiruG�ion lending agency for Ihe pedormance of the work for which this pertnil is issuetl. (Sec. 3097, Civil Cotle). Lendefs Name: Lender's Atltlress: SignaNre: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalry ot perjury ihat I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professlons Cotle: Any ciry or counry which requires a permit to consiruct, alter, improva, tlemolish, or repair any structure, pnor to its issuance, elso requires the applicant for such permil ro file a signetl stetemem Ihat he or she is licensetl pursuent to the provisions of the Contractors License Law (ChaD�er 9(commencinq with Section 7000) of DiWsion 3 of ihe Business and Professions Code) or that he or she is e:empt therefrom and the basis for the alleged exemption. Any violation o1 Sactlon 7031.5 by eny applicent For a partnit subjecis ihe epplicant to a civil penalry ot not more ihan five huntlred dollars ($500).): ❑ I, as owner ol the properry, or my emp�oyees with wages as their sole compensation, WILL DO THE WORK, antl t�e structure Is not intentletl or ottered for sele (Sec. 7044, Business and Protessions Codo: The CONrectors License Lew does noi apply to an owner ot properry who builtls or improves thereon, antl who does such work himselt or herseN or ihrough his or he� own employeas, provitled that such impmvements ere not intended or oHeretl for sale. It, however, Ihe building or improvement is sold within one year of completion, tha owner-Duiltler will have Ihe burden ot proving ihat he or she did not build or improve for purposa of sale.). ' ❑ I, as ownar ot tha properry, em EXCWSIVELY CON7RACTNG WRH LICENSED CONTRACTORS to constmct Ihe project (Sec. 7044, Business antl Professions Cotle: The comractors License Lew does not appty to an owner of pmperty who builtls or Impmves Ihareon, antl who conirects tor such projact with a contrador(s) license pursuent to ihe Coniracbrs License Laws.). ❑ I am exempt unaer sac. _ Signamre: Owner ID venfietl by dnvefs license. Vedficetlon ot Ownership by (type of Business and Professions Cotle tor ihis reason: �5 ❑ No Dnver'S LiCenSe No. i.e. - property tez bill or tleed): Da�e: Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATON: ❑ I hereby certify thet no excavation tive (5) or more feet in tlepih into which e parson is required to Oescentl, will be made In connecilon with work euthorizad by this permlt, end that no building stmcture, scattolding, falsework, or demolition or Oismantling thereof, will be more �han thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, 7tle B, Celifomie Atlministrative Cotle). • ❑ As ov.•ner-builtler, I will not employ anyone to tlo work which would require e pertnit from the Division of Industnal Sefery, es noted ebove, unless such person hes e permit to do such wark from the division. Signature: Date: Division ol Indusirial Salery Permit Number: CERTIFlCATE OF COMPIJANCE ANO AUTMORRATION OF ENTHY: I ceriity under penalry ot perjury that I have read ihis eppliwtion and state thet Ihe Intormatlon given is wrrect. I eqree to comply wlih ell state laws end ciry ortlinances relating to building consiruction, and authonze representatives ot the Ciry of Cos1a Mesa to enter upon the above-descnbad property tor inspection purposes. I aqree not to occupy or allow occupancy of any building authonzed by Ihis pertnit until finel inspection. ignature f Legal Owner(s) Q� — 07 — O� Date � � And/Or Autho�aed Applicent Date COOE1. INSPEGTIONTYVE PAIE UIIIDELS 7676 Fixetl System Final Fire Prevention 1266 Pool Spa Finel 200 Finel Re-Roo1 201 Finel Block/Retaining Well 202 Final Fectory Fire Place 203 Flnal Sign 204 Final Demolition COOE 1 INSPECTION TYGE 206 Finel Mechanical 20B Finel PlumDing 210 Final Elec�nwl 212 Finel Flre Prevention 220 Finel Planning Approval 222 Final Site 250 FinelBuiltling/Occupancy GdIF II�LB � DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS Bldg. Permit # This Permit # Street A— d— dress� �R� 6L CAlvtiho ti� � q- Co� h/1a�a Cit � 6�� AP Number. � 1, ,I�(we), �U N , declare that I am the Owner of Title of the above referenced real property, and that I(we) hereby authorize: Name: X Pl1C.G �Gl.vl NGi �-I-2.VL� Telephone Number. `�I�{i 66.z' Z��i �} Street Address: q g U �,L CGtVtiti v�o �%( ��} Ciry: Cos'�/ ��Sq State: � z�P: 97-62.G „ � � } , . _ to obtain pertnits in my behalf, as owner/builder, for �'i�n'}�'%{,� L� �. �� .�S t;h"lfL�2(�, 5 i ;.; �-;� �_ at the above referenced property. � ��r 2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or o�cers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of pery'ury that the foregoing is true and wrrect Executed this day of 0779-A6 (mv.11100) 20_,at Print Name: � J`�i-1 NG Uy� S�re:. �� G��E'��/�!%�i��—� rDat� 01— 07— 0� Note: This authorization does not grent authorization to perfortn the work as owner, it soley provides for limited power of attomey to secure this pertnit in any behaH. California. ,a � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA. CA 92626 Job Address: Suite No Vicinity: 980 EL CAMINO DR UNITS 1 -4 Parcei Nunmber: 14�66524 Applicant: NGUYEN, BICH VAN XUAN Address: 980 EL CAMINO DR COSTA MESA, CA Owner. NGUYEN, CALI Address 980 EL CAMINO DR COSTA MESA, CA Contractor: OWN ER-BUILDER Address: Arch / Eng : Address: PLUMBING PERMIT Status: ISSUED Applied: 08I05I2002 Issued: 09/26/2002 ISSUED BY: Phone: 714-747-1158 Zip: 92626 Phone: 714-747-1158 Zip: 92626 Phone: Zip: License: 000000 Phone: Zip: License: SCOPE OF PERMIT INSTALL 4 NEW GAS OUTLETS AND 4 GAS REPIPES FROM EXISTING GAS METER TO THE KITCHENS OF 4 UNITS (1 BLDG: 4 PLEX). NO OTHER WORK AUTHORIZED WITH THIS PERMIT. ISSUE FEE BackFlow irrigation . Backflow Preventer Bathtub Clarifer System Connect (Ice,Soda,etc) Dental Unils Dishwasher Drain. Floor Drain, Rainwater Drain, Roof Drinking Founfain Expansion Tank Gas Earthquake Valve Gas (1-0 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip 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 $6.15 $0.00 $39.20 $0.00 $0.00 $0.00 QTY NOTICE: The work authorized by this permit regulations. (Ord. No. 92-28, § 1, 12-21-92) FEESUMMARY AMT Laundry Tub / Washer 50.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 k) .$0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect 30.00 Sewer Private Line $0.00 Shower Q0.00 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 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(1-0) Vacuum Brkr 8kflow(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 Soflener OTHER VIOLATION PLAN CHECK REINSPECTION TOTAL CALCULATED FEES AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 So.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $66.85 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 access requirements under Califomia statutes and related 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 Inspeetlona 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 2aa6-aBIN00) WORKERS'COMPENSAnON DECLARAnON: " — I hereby aHirm under penelty of perjury one oi the following tleclaratlons: ❑ I heve end will malntain a certifiwte of consent to seli-Insure for workers' compensation, as providetl for by section 3700 of the Lebor Cade, for the pertormance of Ihe wOrk tor whiCh �his Dermit is i55u80. ❑ I heve antl will mainfain workers' compensation insurance, as requiretl by sectian 3700 oi the Labor Cotle, for the perfortnance ot Ne work for which Ihis pertnit is issued. My workers' compansatlon Insurance carrler antl policy num6er are: Cerrier: Policy Number. (This section need no( be completed i! (he permit Is valued af one hundred dollers ($100) ar less.) ❑ I certity that in t�e pertormance of Ihe work for which this pertni� is IssueO, 1 shall not employ any person in any manner so as to become subject to t�e workers' compensatlon laws ot Celitomie, antl agree that if I should become sub�ect ro the workers' compensetion provisions oi Saction 3700 of the Lebor Code, I shell iorihwlth wmply with these provisians. Applicant SigneNre: Dete: WARNIN6: FAILURE TO SEWFE WORKE0.S' COMPENSATION COVERAGE IS UNLAWFUL AND SMALL SUflIECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDRED THOUSAND DOLLAHE (5100.0OO�.IN ADDITION TO THE W5T OF COMPENSATION, DAMAGES AS PROVIOED FOR IN SECTION 3%O60F THE LABOR WOE, INfERE$T, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: � I hereby aHirm Ihat I am licensetl untler provisions of Chapter 9(commencing with Section 7000) of Divlsion 3 ot the Business antl Professions Code, end my license is In tull �', torce en0 ettect. Lic. x qass a �' Contrectofs SigneNre: Date: 'I CONSTRUCTION LENDING AGENCY: ❑ I hereby attirm that there is e construction lending agency for the peAortnanca of the work for which Ihis permit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lentlers Address: SignaNre: Date: OWNER-BUILDER DECLARATIONS: I hereby eflirtn Ihet under Denelty oi DBQury Ihet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor IhB tollowing reason (SeC. 7031.5, Bu5in855 Bnd Pmtession5 Code: My ciry or counry which requires e permit to construct, alter, impmve, demolish, or repair any strucWre, prior to its luuance, also requires the epplicant for such pertnit to file e signed statement ihat he ar she Is licensed pursuent to the pmvisions of the Camrectors License Lew (Chepter 9(wmmencing with Sectlon 7000) of Didslon 3 ot ihe Business and Professlons Code) or that he or she is exempt thereirom and the basis for Ihe elleged exemption. Any violation oi Section 7031.5 by eny applicant tor e pertnit subiects the epplicant to e civll penalty of not more then tive hundred tlollars ($500).): ❑ I, as owner ot Ihe property, o� my employees with weges as their sole compensation, WILL DO TME WORK, and lhe siructure is not Intended or oHeretl fo� sale (Sec. 7044, Business end Protesslons Cotle: The Contraciors License Law does not apply to an owner of properry who builds or improves thereon, ana who does such work �himself or herself or through his or her own employees, provitled that such improvements are not intendetl or ottered tor ule. If, howaver, the building or Improvemam is sold within one year of complation, the owneo-builtler will have the burden of proving ihat he or she tlid not build or improve tor purpose ot saleJ. I, as owner of the property am EXCLUSIVELY CONTRAC7ING WITH LICENSED CONTHACTORS to construct the projact (Sec. 7044, Businass antl Professions Cotle: The contractors License Law does not apply to an owner oi property who builds or improves ihereon, end who comracts for such project with a comractor(s) licensa pursuam to the Contractors License Laws.). ❑ I em exempt erq sec. Business entl Professions Cotle for Ihis reeson: Signature: ��1� � � Date: Owner ID ve' ied by river5licen58. �es ❑ No DriveYs License No. ��%-� Vediication of Ownership by (type of document, i.e. - property tex blll or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTFICATION: Expires: � I hereby certlty iha� no excavation tive (5) or more feet in depth into which a person is required to descen4 will be made in connection with work authonzed by this pertnit, and that no builCing structure, scaHolding, falsework, or demolition or dismantling thereof, will �e more than thirty-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, 71t1e 8, Caltlomla Administretive Code). ❑ As owner-builder, I will not employ enyone to tlo work which would require a pertnit trom ihe Division ot Indusirial Satery, es noted above, unless such person has e permit to tlo such work fram Ihe division. Signawre: Date: Division ot Intlustrial Sefery Pertnit Number: CEfi7IFlCATE OF COMPLIANCE AND AUTHORVATION OF EMRY: I certiy under penelty ot perjury ihat I have read ihis epplication and sta�e the� the intormation given is correcL I agree to comply with all stete laws antl nry ordinances relating to builtling consiruction, entl euihorize representatives oi the Ciry ot Costa Mesa to enter uDon the ebove-describetl propeAy for inspection purposes. I egree not to occupy or allow occupancy oi any builtling authonzed by this pertnit until final inspection. Signature Of Legal Owner(s) Z a�Z �%�y/U�iLL _ 5 o n� � b �� A�Ihonzed Applicant Tr Date COOE I. INSVELTONTYPE 7676 Fized System Final Fire Prevention 1266 Pool Spe Final 200 Finel Ra-Roof 201 Finel BIocWReteining Wall 202 Finel Fectory Fire Place 203 204 Final Sign Finel Demolition P� ItIIID94@ CODE� INSPECTION7YPE 206 Final Mechenical 20B Final Plumbing 210 Final Electriwl 212 Final Flre Prevention 220 Finel Planning Approval 222 Final Site 250 FinalBuilding/Occupancy Psg. II�A�S �-a8-o3 3�L_ ;� DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS Bldg. Permit # This Permit # Stree� t Addres's: / n � �/ C�m� �O J/7"� AP Number: 1 i.(we)� �!�Z/ NG�/7��% , declare that I am the Owner of Title of the above ✓" referenced real property, and that I(we) hereby authorize: Name: ��Gf/_1/�RN X N�vr��v TelephoneNumber. I%l�i / Z�` 7- I�SO StreetAddress: 9�U �� CQml�O !Jr ,7� 1/. Ciry: ws fq �-/e-5 q State: G� Zip: �°� 6°�i 6 to obtain pertnits in my behalf, as owner/builder, for � n.SfCYI�/ �7C/ 77E- � �Ju� �` "� atthe above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, 1 understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correct. Executed this � � �� day of ��" "�'�^ 20Ue7� , at � S � ��Q , California. Print�Name:--' G � �� G vY�� Date� G�— �i".� G.`� �.- Note: This authorization does not grant authoriza5on to perform the work as owner, it solely provides for limited power of attomey to secure this pertnit in any behaH. 0779-C61rev.11/00) CITY OF COSTA MESA eva��N� �nr�s�oN DEVELOPMENT SERVICES DEPARTMENT PERMIT (714) 754-5273 • Fax (714) 754-4856 Job Address: 980 EL CAMINO DR Suite No Vicinity: Parcel Nunmber: 14166524 PLUMBING PERMIT Applicant: MATHEW 8 STACY MATZEN Address: 110 25TH ST � Owner: Address � Cont�actor: Address: Arch/Eng: Address: NEWPORTBEACH;CA i' ii, . MATHEW & STACY MATZEN - 110 25TH ST NEWPORT. BEACH, CA Phone: (949)723-66884 Zip: 92663 Phone: (949)723-66884 Zip: 92663 Phone: Zip: License: Phone: Zip: License: _ 3ER 43 � 77 FAIR DRIVE, COSTA �SA, CA 92626 Status: ISSUED Applied: 03/03/1999 Issued: 03/03/1999 ' SCOPE OF PERMIT , , , REPLACE EXISTING WATER HEATER WITH NEW UNIT. (SUBJECT TO FIELD INSPECTtON). ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System � Connect Qce,Soda;etc) Dental Units Dishwasher Drain, Floor Drein, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earlhquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptore (Sand Auto ) AMT $22.00 $0.00 $0.00 50.00 $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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEESUMMARY - 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 Sewer Private Line $0.00 Shower $0.00 Sink, bar -$0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) 50.00 Spa (public) $0.00 Qrv 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS AMT Sump Pump $0.00 Swimming Pool � $0.00 Trap Primer . `$0.00 Urinal " � � -$0.00 Vacuum Brkr Bkflow(i-4) � $0.00 Vacuum Brkr Bkflow(S+j $0.00 Wash Basin . $0.00 Wash Basin Set � $0.00 Waste and Vent System $0.00 Water Closet (Toilet) $0.00 Water Heater / vent $11.00 Water Piping (Inst or Rep.) $0.00 Water Re-pipe $0.00 Water Service $0.00 water Softener $0.00 OTHER $0.00 VIOLATION � $0.00 PLAN CHECK $0.00 REINSPECTION $0.00 TOTAL CALCULATED FEES: $33.00 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within 180 days, or if work is suspended or abandoned for a period ot 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 Inapectlona and flnal epproval must ba obtained. Failure to obtain inspedions and final approval will result in the expiration ot Ihis permit. FOR INSPECTIONS CALL: (714) 7545826 WORKERS' COMPENSATON DECLARA IJN: \ I hareby aHirtn under penelry of perjury one ot lhe following tleclarations: . ' � ❑ I heve entl wlll malntain e certificete oi consent to self-Insure for workers' compensation, es provitletl for by section 3700 oi ihe Lebor Code, tor ihe peAormence oi the work for which ihis permit is issued. � . ❑ I heve and wlll malniain workere' compensatlon insuranca, as requiretl by seIXion 3700 ot the labor Code, for the peAortnance oi the work for which thls pertnit Is issued. My workers' compensation Insurance cartier entl policy number are: Cerrier. Policy Number. (Th/s secfion need no( be completetl i( the pe�m/t is velued ef one hundred dallars ($700) or less.) � '' ❑ I certify Ihat in the performance of the work for which Ihis pertnit is iuued, I shall not employ any person in eny menner so as to bewme subject to the workers' wmpenseNon lews ai Califamia, and agree thet if I shoula became subjaq to the workers' compansation provisions of Section 3700 of the Lebar Code, I shell lorthwlih comply with ihese provisions. ApDlicent SlgneWre: Dete: WARNIN�: FAILURE TO SECURE WORKERS' COFAPENSAT1dJ WVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE MUN�RED iFi0U5AND DOLLARE (E100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECfION 31W OF THE LABOR CODE, INTEREST, AND ATTORNEI"5 FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirtn that I em licensed under provisions at Chapier 9(cammencing with Seqlon 7000) ot Division 3 ot the Business and Protessions Cade, entl my Iicense is in full forca and etfect. Lic. # Class k ConVactors Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby affirm thet ihere Is a wnsWcUon lending agency for the peAortnance of the work tor which Ihis permit Is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lentlers Atldress: SignaWra: Date: OWNER-BUILDER DECLARATIONS: I hereby aKrtn Ihat under penalry of perjury Ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reeson (Sec. 7031.5, Business entl Professions Code: My ciry or counry which requires a pertnit to construct, alter, improve, tlemolish, or repalr eny strucNre, pnor to ils issuance, elso reqWres t�e applicam for such parmit to flle e siBneC stetement thet he or s�e Is Iicensetl pursuant to the provisions ot ihe Contractars License Law (Chepter 9(commencing with Sectlan 7000) oi Dlvision 3 of Ihe Business end Professions Code) or that he or she is exempt therefrom and the besis tor ihe alleged exemption. Any violation of Sedion 7031.5 by eny epplicant for e permlt suD�ects ihe epplicant to e civll penalry of not more than five hundred dollars ($500).): �I, es owner of t�e property, or my employees with wages es thelr sole compensation, WILL DO THE WORK, antl Ihe strucNra is not intended or oHered tor sele (Sec. 7044, Business end Profeuions Code: The Contractors License Lew tloes not epply to an owner of properry who builtls or improves thereon, end who does such work hlmself or hersetl or through hls or her own employees, proNtled thet such Improvements ere not intentletl or oHeretl fo� sale. 11, howevar, the bulltling or Improvement Is soltl within one yaer ot completlon, iha owner-builder will have the burtlen of proving Ihat he or she did not builtl or improve for purpose of sale.). ❑ I, es owner of the property, em EXCWSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct ihe projed (Sec. 7044, Business entl Protesslons Cotle: The con�rectors License Law tloes not apply to an owner ot properry who builds or Improves thereon, entl who contrecis for such project with a contrector(s) license pursuant � �e Conirectors License Lews.). � I em exem r y��/ Business and Professlons Cotle for Ihis reason: SlgnaWre: ,.,� . , , ,�, _ Dete: Owner ID venfi rs Ilcensa. ❑ Yes No Drivers License No. Expires: Venflcation of Ownership by (rype of document, I.e. - property W�c bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ❑ I here�y cenity thet no azcevation Nve (5) or more teet in tlepth into which e person Is requlred to descend, will De metle In connection with work authonzetl by ��is perml6 entl thet no builCing sWcture, scettoltling, falsework, or demolitlon or dismantling Ihereot, will be more then �hirty-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Tltle 8, Celtlomla Atlministrative CoCe). ❑ As owner-6uiltler, I wlll not employ anyone to Oo work which would requlre e pertnit from ihe Divisian at Industrial Safery, as note0 ebove, unless such person hes e pertnit to do such work from the division. SigneWre: Date: Dlvision of Industnel Setery Permil Number: CERTIFlCATE OF COMPLIANCE AND AUiHORVJITON OF EHTRY: I certify under penfllty ot perjury ihet I have reetl Ihis applicetion end stete Ihet Ihe infortnetion given Is correct. I ag�ee to comply with ell sta{e laws and city ordinances relating to building construction, end authonze representatives of Ihe iry of Coste Mese to enter upon the above-described pro e 'nSre 6n pury s. agre ot to occupy or allow occupancy of eny building authorized by this it un � fnal I�jaiOn. n o 7 � gneture Of Le §19 r�a s) � ate �/ AnNOr Authonzed Applicant Date CODE �. INSPECfIONTYPE �¢ ItII�lL$ 7678 FIzeE System Flnel Fire Preventlon 1288 Pool Spa Final 200 Finel Re-Roof 201 Finel BIocWReteining Well 202 Finel Fectory Fire Plece 203 Final Sign 204 Final Demolilion r�..�r:� LQpEf ItlSPECTIONTYVE 206 Finel Machanicel 20B Finel PlumDing 210 Finel EleMncal 212 Finel Fire Preventlon 220 Finel Planninp Approvel 222 Final Site 250 Finel Building/Ocaipancy �ff I�� Z a U ZQ � N d m J � J V1 f0 J J m Q U� Za W � aW WZ J Q m Z J � W W O ZF w� N Q 70 � ,34�2 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BUX 1200 COSTA MESA. CALIFORN�A 92626 !v 13-7?rn�a00 75^ar �e+�,;�5.03 ForApplicant to Fillin Completely APP��CATION FOR BUILDING PERMIT FE,�C�/A� V/�,p V D TE RECEIVED DATE ISSUEO BVIIDING a�iLl �L � 7� , j " / /� �/5'-�� ,S lS-7�' ADDRESS j5 �,�; iiiJ� , ,y / � /J A.P.NO. - ,s� �,3 PERMI'F OWNER ,/f /�G �1� ^�/ �J G'�C . MAIL , BUILDING j+iy n �, ADDRESS ' /aDDRESS I D L�ij bv� TEL. " TRACT��I � CITV NO. BLOCK CANSTRUCiION W A D A P LENDEP L�� ✓ � BRANCH a OWNER ^ ADDRESS VALUE AFCHITECT TEL $ �O — OR ENGINEER ' N FIRE ADDRESS ZONE ' TVPE GROUP s� [ APPROVED CONTRACTOR /y�L jTJt," _ � {T (�L,�l�j BV DATE ADORESS .,JJ� �� 'C j �� ZO NO.OF USE OF NEW CITV �;��L�.J T�O�%� NOL P�� BVILDING C�� STATE CITV VAROSAPPROVED VARDSAPPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING SIZE NO.OF BLDGS. (FROM C/L S REET) OF LOT NOW ON LOT ROM FT. FT. VSE OF EXISTING BLDG. T FT SIZE OF . NO. OF NEW BLDG. ROOMS STORIES L. SIDE O FT. FT. EXTERIOR WALL ROOF ` y COVERING COVERING FEAR TFT. �L FT. USE OF BUILDING AND WOFiK TO BE PERFORMED DISTANCE BET. , BET. MAIN & MAIN BLDGS. ACCESS. BLOGS. � J �n _ ��, /�G VAR.# DATE / I [, C.U.P.� APPROVED •� y; / ` � APF VE � _� c' V � J I hereby acknowledpe that t'have read this application antl state ST,9 that the'above intormaiion is correct antl agree to comply with all laws ragulating building constr�ction, end 1 shall not employ � any person in violation of the workman's compensetion laws of the Stata of Calitornia. �,.p1� i hereby certify that I am properly licensetl as a cont�actor untler �T SQ. F. the Stete of California Businass and Professions Cotle, Divisicn 3, THE A T SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in f�ll torce and effect, or I THE PUFPO6E OF ESTABLISHING A PERMIT FEE ONLV: am ezempt from tha,provisions of the State of Calitornia Businass VALUATION �� ''- antl Protessions Code, pivisibn 3, Chapter 9. �', {1' ��, PERMIT FEE -$` � ' Signeture of A' �� /7 /'/ ///) . Pe�mittee dN � l rq .i _ $ / �-� `� PLAN CHECK $ �_ V ' � I Authorized Agent / TOTAL FEE $ �� ._�- ! 9�,F� COSTA MESA BUILDINGSAF�_�f , DEPARTMENT � P. O. BOX 97] COSTA M6BA. CALIFORNIA For Applicant fo Fill In Complefely TYPE OR PRIN7� ��oirvc ��.no 1� oaess Lot 45, Tract 5011 ' COSTA MESA, CALIFORNIA I IiLIa1N �� R. Hi1lerNo'PR 52007 �, N�. Euclid, Anh. � v��i � I NO. OF BLD6p. 9ETBTCK LINB FROM 1� <ENTEP OF BTREeT 4O � REAR YARO 27'' BI�EYARDI LEFT 22�� 'RIpHT S� DESCRIPTION OF WORK NEW X I MOVINGTION — AEMOLISH REPAIR 512�EOIN6 CC I X'�3 � ROOMS � 8TpR1E9 � ll GOVER NGWA StLiCCO I COVOERIN S�1P+�iB USE OF BUIlDIN6 AND WORKTO BE Pfi�ORMBD i � HEPEBY ACKNOWLEO08 TX�T 1 XAVH REAO TXIB APPLICATION AND 6TRTE THAT THH ABOVC IB COqRECT qNU AOREB TO COM. PLY WITH ALL CITY ORDINANCEB ANO HiAT� y�Wg fl6GULATING � BUILOINO CONBTppCTION.. � SIGNATUREOF HYCROFT TERRACE, 1NC. PERMITTE /] � • � � � i AUTHORI2ED AGHNT� 9C FEE RE��eVED i!U N 7. � ,,,,� FINANCE DEPT. CId�IPL�FAFA�Sj%��S�RMR BUILDING For Offiee Use Only BUILDIN6 NO. OF! / I U9E OF LEOAt NOTE: NO YAROSAPPROVED MAIN BUILOINO DISTANCE BET MAIN BLDG9. VAR. � SHALL BE LESS THAN � i' (U.B.C.REQUIREMENT) � YARDSAPPROYEO '� ACGESSORY BUILDIN(d w � FT. � a W �. � .] �. � V � r, W BET. MAIN @ 4 � ACCE55. BLDG3. a DATE Q APPROVED �+ DATE �S�/'I�-�� O � � y�/�, /1,'l �so. �. � 1 /Sl �-° HE A'Y MOUNT 9MOWN UNDER VALUATION 19 FOR TX8 PUFP08E OF [9iABL18HIN6 A PERMIT FE8 ONLY. VALUATION �J PERMITFEE $ /^O/� s�t/y�6 0. / TOTAL FEE �� City of Cosfa Mesa Building Safefy Department P. O. eox 3t7 Cosfo Mesv, California CERTIFICATE OF OCCUPANCY N� IS9O C 7he Building located at �0 A Cemi� i7�ive _ has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Gro�p � P'� J Occupancy. Use of Building fiour�Lex ReaRdence t�lth attached G�rzae Legal Description LUt 1}5. �.�'i1A� 5021 (See reverse side for Mafes and Bounds) Building Permit No. i��% Elecirical Permit No. 2Z1� Plumbing Permit No._ �� _ ��oor Load Signs have been installed as Room Capacify Signs have been instaled as required under Sec. 2308 U. B. C. _ . required under Sec. 3301 (7) U. B. C. � 17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied �ntil the owner or operator has been issued a valid certificate of occupancy by the enforcement agency. (b) A new certificate of occupancy shall be obtained whenever ihere is a change in: 1) Occupancy classification of a building or portion thereof 2) The number of apartments or guest rooms 3j Ownership If Group H Occ�pancy, number of apartments and/or guest rooms as required under Sec, 17050.1 (d), California Administrative Code, Title 8, Chapter 9, ArTicle 8. Num6er of apartments �u' andfor guesT rooms ISSUED TO: B�ilding Of i ial � iLv�crof't 2'errnre Ineoraoratecl by��s��i!%j%r�� Date ��h �s Z7� This Certificnte of Occupancy SHALL Bf posfed in a conspicuous place on the premises and SHALL NOT 8E removed excepT by the Building Official of fhe City of Costa Mesa under Sec. 306 (e) U.B.C. Fo�,�, avsa—iM—ii_s�-s-s r �