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1010 EL CAMINO DR - Building Permits
PLUMBING PERMIT Job Address: 1010 EL CAMINO DR Suite No Vicinity: Parcel Nunmber: 14166508 Applicant: GLOVER, LORIE Address: W/ COAST ROOTER/PLUMBING Phone: 714-241-1414 Zip: Owner: ONG, TAN VINH Address " 21232 SPURNEY LN Phone: HUNTINGTONBEACH,CA Zip: 92646 Contractor: CRODDY PLUMBING & HEATING Address: 2737 S. CRODDY SUITE D Phone: 714 241-1414 SANTA ANA CA Zip: 92704 License: 529127 Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT WATER HEATER CHANGE OUT ' r r QTY FEE SUMMARY =' AMT ISSUE FEE $22.00 Backflow irrigation $0.00" Backflow Preventer $0.00 Bathtub $0.00 Clarifier System $0.00 Connect (Ice,Soda,etc) $0.00 Dental Units $0.00 Dishwasher $0.00 Drain, Floor $0.00 Drain, Rainwater $0.00 Drain, Roof $0.00 Drinking Fountain $0.00 Expansion Tank $0.00 Gas Earthquake Valve $0.00 Gas (1-4 outlets) $0.00 Gas (Over 4 outlets) $0.00 Gas Repipe $0.00 Gas Service $0.00 Interceptors (Grease, Oil) $0.00 Interceptors (Sand Auto ) $0.00 QTY FEE SUMMARY =' AMT _ QTY Laundry Tub / Washer $0.00 0 Landscape Irrigation $0.00 0 P -Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 0 Sewer Cap for Demo $0.00 0 - Sewer Connect -$0.00 0 Sewer Private Line $0.00 0 Shower $0.00 0 Sink, bar . $0.00 0 Sink, commercial $0.00 0 Sink, Floor $0.00 0 Sink, kitchen $0.00 0 Sink, service/mop $0.00 0 Spa (private) $0.00 0 Spa (public) $0.00 0 COMMENTS / SPECIAL CONDITIONS Status: ISSUED Applied: 11/10/1998 Issued: 11/10/1998 V'0 Sump Pump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(14) 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 Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT QTY $0.00 0 $0.00 0 $0.01) 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $11.00 1 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 0 TOTAL CALCULATED FEES: $33.00 EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIOMS WORKERS' COMPENSATION DECLARATION: - \ 1 hereby affirm under penalty of perjury One of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code. foi the performance of the work for which this permit is issued. 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My w/pldc�ars,'.,glomp/��ggqqsatlon I1nsur�nce Cartier and policy number are C(Tahrtisiesre. c11111�1",(�-h Policy Number: A)(--)/ R,� 44ofbd000vd )orless.) ❑ 1 certify that in the performance Of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that It I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. �� Applicant Signature: C_S Date: WARNING: FAILURE TO SECURE WORMERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MID CIVIL FINES UP TOOfNE HUNDRED THOUSAND DOLLARE (5100.000). IN ADDRRON TO THE OOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of theBusinqs and Professions Code, and my license is in full force and effect. Lic. P / Class # Contractors Signature: 9 _ Date: O CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civ,. penalty Of not more than five hundred dollars ($500).): ❑ I, as owner of the properly, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her Own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): J It'JI DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby cartlty.that no excavation five (5) or more feet In depth into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure', scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, T1tle 8, California Administrative Cade). ❑ As owner-builder, I will not employ anyone to do work which would require a penult from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building Occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ......................will ........ppli... nto......................................................................................................................................................, ............. ............................................. .......... 2 Does or will the.......*cantor present or future building occ.pant need to file a registration form for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .................................................................................bu-il.................-nt,...ad. t.................................(Ris.......................................enti.......rogr...............0tel.......................aterials.... 3 Does or will the a..P.icani or present or future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ................................................................................................................................................................................................................................................................................. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ppermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ................................................................................................................................................................................................................................................................................. 6 Will any pad of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................................................................................................................................................................................................................................................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all o1 the disclosures prescribed by California Health and Safety Code Section 42303 been made. ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... B (If'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. _ Signature: _ Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to Occupy or allow Occupancy of any building authorized by this permit until final inspection. Ts-� Date q 2 /ri—C7/J And/Or Authorized Applicant Date OD" INSPECTION TYPE 2M INTITA S CODE INSPECTION TYPE DATE INTIM 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Fina. Sign 222 Final Site _ 2G4 Final Demolition 250 Final Building/Occupancy 2"6-46 PROJECT ADDRESS: 1010 EL CAMINO DR UNIT: OWNER'S NAME: ONG, TAN VINH ADDRESS: 21232 SPUR,NEY LN HUNTINGTON BEACH,CA 92646 936-1116 ARCNIENGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE: LUC DAC TRUONG (714)444-3775 ADDRESS: 2314 HEMLOCK WY SANTA ANA CA 92704 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: EXP: Date: Signature WORKERSCOMPENSATION DECLARATION: Ihereby affirm that I have a certificate of consent to self -insure or a certificate of Workers Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C), POLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the neuritis for ane hundred ($100) offers). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compen ation Laws of California. ♦ �, �,( � K Data Signature: —�-- NOTICE: IL of er making This declaration, you shouldd eco l to the Works& Compensation provisions of the Labor / Code, you most fothwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for such permit to filo a signed statement that he/she is Licensed pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the El structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees. provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project Rection 7044, Business and Professions Code : The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: �� Dale: �-OI Owner: _ -LI "�A _- I do hereby ceridy that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will not (circle ane) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Certify Management District. Residential construction applications are exempt been these provisions. Dale: Applicant: I hereby certify that have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property forinsp(nelat'i0 purposes. Date - ��///4//1 Signature: Oliver's License or Social Security a: 1641.46 White—Building, Green—Code Enforcement: Canary—Applicant; Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA— BUILDING PERMIT PERM NO: B 07013,1 PERMIT NO: B 070134 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE; STR PURPOSE: OTH JOB DESCRIPTION . T/OFF SHEATH 5 REROOF W/COMP SHINGLES SQ FT: 4,500 CLAIM VALUE: 4,500.00 CALC—VALUE: 4,500.00 GROUP OCC: R-3 /M-1 COMMENTS: SMOKE DETECTORS REQUIRED PER 91UBC, RERO'Or'3000SF RESIDENCE ,�° �t Z O N I N G R E Q U I R E M E N OSS MICTOR MAIBUILDING S E T B A C K S ACCESSORY [I- ,IN FRNT: FT INREARCIG FT IN FRNT; TIN,REAR: FT LEFT; FT ICI RGHT; FT IN LEFT; FT IN'RGHT; FT IN .PARKING REQ: PROV: PARCEL: 14166508 ZNE: REF NO: PLANNING N TES> PLAN—CHECK TOTAL PAID DUE TOTALS ---- > D E V L O P M E N T S E R V I C E S R E Q U I R E C1'E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY DATE; APPLICATION ISSUED BY:DATE: 72.50 OVER/SHORT: ac.f-F3F iF# #f:iz #3Z?F Tf'3�'�'TF#######4c##fit ## BLDG PMT LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC .MECHANIC FIRE SHIP/RES GRADING PERMIT 72.00 50 72.00 SHIP/NON—RES PLAI C ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 72.50 0.00 .0,00 72.50 72.50 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 72.50 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/TOT GRADING PLAN—CHECK 72.00 .50 I N D I V I D U A`L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR, 4500 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 4,500,00 END OF FEES 07. 00172661-00172562 1-1 T 72,50.__ DATE: 12?02./94 TTHE : 10:.`8 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL . SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53, Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10, Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final - 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit �f 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping 0Gas 000 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing//�� 25. Roof Sheathing /7z10 -r' //=�'-�• - 73. Undergrnd.StorageTank OGas 00ii 74. Overhead Hvdro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27, Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL .30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED n 33. Final Electric 34. Final Heating & Air Conditioning Notes/"2 Z2 !� / -`P`i o a �+9ur� , dr s, , 35. Final Gas Pipe-Test�- 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING �� 3 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co - -. 51. CERTIFICATE OF OCCUPANCY No. Date IF V DECLARATION OF P,..THORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS Ick 10 EL ( A,IVIi'k) 0 )Wr Street Address Bldg. Permit # This Permit # Number 1. I (we);( declare that I am the Owner of Title � V 1 ut? 17k.� — of the above referenced real property, and that I (we) hereby authorize: 1-0 C 0XC 1-0 444 C Name Telephone No. sht"� Wy Street Address State to obtain permits in my behalf, as owner/builder, for at the above referenced property. Zip 2. Should any person become an employee engaged in the improvement of the property, I (we) shall im- mediately'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 per- son, company or corporation. 4. 1 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. 1 declare under the penalty of perjury that the foregoing is true and correct. Executed this C) cv� day of C 19 , at A�fM l_+ 4e(California. TtF til J! u K—— . 8e c o I l Printed Name - Date NOTE: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. . 077946 (Rev. 2191) NOTARIZATION REQUIRED State of CALIFORNIA Countyof ORANGE On Dec.01,94 before me, ALAIN DO, NOTARY PUBLIC (DATE) (NAME. TITLE OF OFFICER - I.E., :JANE DOE. NOTARY PUBLIC') personally appeared MR. TAN VINH ONG ONLY (NAME(S) OF SIGNER(S)) ❑ personally known to me - OR - K] proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are sub- scribed to the within instrument and acknowledged r `mow.: to me that he/she/they executed the same in �' L � � '"� Cor<un. S 1028715 � his/her/their authorized capacity(ies), and that by a:4 :aW „ N07PRYPUBLIC-CALIFORNN his/her/their signature(s) on the instrument the o- orarge Ccunty A person(s), or the entity upon behalf of which the oA , ty corm. Exp'seslDrm o 12,1998 person(s) acted, executed the instrument. Witness my h d an tial seal. (SEAL) (SIGNATURE OF NOTARY) ATTENTION NOTARY: The information requested below is OPTIONAL It could, however, prevent fraudulent attachment of THIS CERTIFICATE MUST BE ATTACHED TO THE DOCUMENT DESCRIBED AT RIGHT: CAPACITY CLAIMED BY SIGNER(S) ❑ INDIVIDUAL(S) ❑ CORPORATE his certificate to any unauthorized document Title or Type of Document DECLARATION OF AUTHORITY Number of Pages 01 Date of Document 12/01/94 Signer(s) Other Than Named Above WOLCO TS ROAM 63210—ALL PURPOSE ACKNOWLEDGMENT WITH SIGNER CAPACITY/REPRESENTATION/FINGERPRINT—Rev.12-92 01992 WOLCOTTS FORMS, INC. OFFICER(S) ❑ PARTNER(S) (TtTLE(Sp ❑ ATTORNEY IN FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER: SIGNER IS REPRESENTING: (NAME OF PERSON(S) OR ENTITY(IES)) his certificate to any unauthorized document Title or Type of Document DECLARATION OF AUTHORITY Number of Pages 01 Date of Document 12/01/94 Signer(s) Other Than Named Above WOLCO TS ROAM 63210—ALL PURPOSE ACKNOWLEDGMENT WITH SIGNER CAPACITY/REPRESENTATION/FINGERPRINT—Rev.12-92 01992 WOLCOTTS FORMS, INC. I� / ADDA53SOFEUILDING: 1010 EL CAMINO DR UNIT: A — D 0)1'4EITS NAME IF KNOWN: ONGf, TAN VINH k ADDRESS: 21252 SPURNEY LN HUNTINGTON BEACH,CA 92646 936-1116 HPL. "UNG ADDRESS: ARCHITECT OR ENGINEER: UC. NO.: ARCH. OR ENG.'S ADDRESS: UNT: CONTRACTOWSNAI LUC DAC TRUONG (714)444-3775 cow-FACTows MA1um. 2314 HEMLOCK WY ADDREss: SANTA ANA CA uc.Ni 670315 92704 UNIT: LICENSED CONTRACTORS DECLARATION: I hereby affirm under purely of perjury Chet I am Iceneed under Wovis'vre d Chadd 9 (...no, with Section 7000) d Dimion 3 d the Business and Pmfe ens, Code, and my Iceese is in lull face and effect. CITY LIC. No.: LIC. cuss: B UC. NO.: 670 315 EXP- DO.: XPP-Doe: I O - 29 _ •'I Controaor: / //V •�V ' !_ OWNER BUILDER (Section DECLARATION: 1 hereby eProf under penaty n perjury Ica I am exempt Ion a p Coniradon Haeme Lew Ia Me bawling rerson nst 7031.5 Busimsa and Proleeshao Code. Any aroity «county each which requires a p sig to construct, atlas ie or am meek, or repair any structure, Provi iris to its eConnce, neo requires its (Charmer far such permg to file a signed statement Met he or she licensed d Protectionist to the Provisions that t the she i don License few [Chaplet 9 (commencingllwith Semon 70)0) vi Division 3 d the 7031.5 by Prdeseione Code) o that M a hea is eaem t therefrom and the et more for Ian alleged dremd'on. My violation d Section 7031.5 by any applicant fa a permit wbjom IM aP0licem to a ovil penaffY d not more (hen 1'Ne hundred dellen ❑ I, as owner of the properly or my employees with wages as Ihek wile compensation, will do the want, and the st ucture Is net intended a offered I« side (Section 7044, Sustains and Prolesslons Code: The Contractors lJceme Lew does n« aptly to an owner of pai ady who Wads m improves Hereon, and who does such weak limseff or hereeff or through he or her own employees, presided (hot each pnevemems we no intended or offered for eats, ff, however, the Wieling or improvement is add within was year of completion, the owner Wider will have the When of proving M or she did not Will or impr«re la the Panniers d .cub). ❑ I. as owner of the aopem/, am eedaovely amtratlkp with licensed contractors to conetrud the mojecl (Section 7044, Business and Professions Code: The Coarmom Lcense few does real apply to an owner of prapeny who Wida or improves iMreon and who convects M sum projeda with a comrads(s) licensed pursuant to the Contractors License ❑ I am warrior under Section: B. 8 P.C.. for this reason: I do Mreby ceniry then I are aware of and understand the requirements of Celfomia Health end Safety Code Sections 25505, 25533, and 25534, and that I or any future uili irq occupant will I will not (drab one) need to comply with eek meta codes end the mcuimments fa e pe mit tworwastraolion« modifiembnh«nIM Airere y anspemenl Dmrim. Residential constructors apphddonswe eaempl from these Provisions. Dela: Applicant: WORKER'S COMPENSATION DECLARATION: I Mreby affirm under Penalty of perjury one OF the lollo tv, detlardiom: ❑ I have and nil mainlan a Mi ircele of consent to aeff-insure for wakoa'comMmulmion. as provided for by Semon 37M of the l -Asir Code, for the performance of Use work for which this permit is issued. ❑ I he. and will maintain workers' compemation insurance, as required by Section 37M of the Lobar Cade, f« the performance of the work far which this permit is isa n, My workere' compensation inwmnce owner end policy number are: Cartier: ,k Policy Number: R ')This season read real be completed y the wait is ha one hundred dollar ISlool or leew.) ❑ Deney the to Ihe pal«mance' the work f« laws (hie pamK is ended. I shall real employ any pens, in jec manner m m to become wbpct to the weaken' rompanastion lawn d CdD«na, end agree that K I shovel baconre eabpd to the woken' Data: carnrion acwa'� of Swion 3]OOyLtM �� , I shall forthwith comely nil I pmvuiphe. Wasting: Faliule ro... woken' compere ado. Mvwage 1. unlawful, and shell subpct as . player to criminal panam/w and ,. civil masa W to one hundrad thousaall downs ($100,000), In Addition ro the cwt of compwuation, densities as prodded nor In Simon 37M of Me Labor Code, Interosq and emonasy's F., CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction ending agency for the ' Md... of In. work lar which the Panni) is usual (Section 301 Civ. C). LENDER'S NAME: LENDER'S ADDRESS: I ceniry thst I have read this aidication and shone that IM above intermission is caned. I agree to comply with all city and county adineaea and stale insist rebti, to Willing construction vel hereby aulha¢e representatives of this city to enter upon the abava-mentioned propend for inspection purposes. LUC TRUONG_ P' t Neste Date: Signature of OwnedAgen /AppllcaniXonlractor (5151d6.WP) While -Buildup 8 Salary, Green -File: Canary-Appkodnt: Pink -Revenue; Goldenrad-Asaeamr CITY OF COSTA MESA — BUILDING PERMIT PERM NO: H 0747431 PERMIT NO: H 074743 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: REP JOB DESCRIPTION REPAIR CRACKED STUCCO ON STAIRWAY SQ FT: 100 CLAIM VALUE: 100.00 CALC—VALUE: 100.00 GROUP OCC: R-1 / COMMENTS: REPAIR -CRACKS ON STAIRWAY dtlydtlEdEdFdFifiFdNiEde�F+E*�E�*sFSFsr*�F�ESF�Px�E�F��Far�r��*�E*�F�FSF�*��F*�r�rsF*�Far�F�rsF**�L�F�F�r*x*�E**�F*�F�Fsr�rsr�rsr��ESF Z O N I N G R E Q U I R E M E N T S r`s S E T B A C K S ------------ MAIN BUILDING ---- _ --=--------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 14166508 ZNE: REF NO: PLANNING NOTES> 2 �] iEdFiEdtiE***dEdEiEiEiEiEiE*dEIEiEiEIEdE.IE9E****dF*dE1EiEiEdF*iEiEiEIEiEiE9E9EIE9EiFdFiFdFgEiESF***dEdEdFiEiFibiFdE**9E**1F IE IF 9E*ibiE*dEiE D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY DATE: APPLICATION ISSUED BY:%' DATE: It-,- *SP'lE iE dE iEiE SE iE if dE lE fE dE SE SE IE*fE i(iF 1E SE***iE 1E 1E SE SE HE F�FR7FiFiE dE LEGALIZATION:N F E E S U M M A R Y ,'STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTR'IC'.,MECHANIC„/ FIRE ,SMIP/RES GRADING PERMIT 15.00. y = 50 SMIP/NON—RES PLAN ISSUE FEE ' BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 15.50 0.00 0.00 1'5.50 15.50 .00 REVENUE DIVISION TOTALS--> COLLECTED, •;15:50 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC "''FIRE`'SMIP/TOT Z -GRADING PLAN—CHECK 15.00 :5'0 dF***1E SE 1E 9E 1E iE*1E 1E 1E 1E iE if iE iF dE iF iE*iE*dE 1E iE 1E*1t iE 9E iP**dE*'**dh*1E.6E iE.dE iF bE*iF 1E**1fiE*1E SEdP dE 9E**iF iF dE*6E*1E iE dP 9E RE st 9E**da I N D. I V I D U A L ',F 'E E B 'R`"E A K D%O 'W N TYPE_, QTY D E S C R I P T I O N� UNIT COST TOTAL COST SFR_ w 100. ALTER BY VALUE, RESIDENTIAL 'NOZONE 1.00 100.00 END OF FEES'' Iw t 17L ;� •3 1 � 0;;191 :-m_Ot^?5"i : i'e'p' ?i.�0 ;) r. `F•,r4;, 1,=,? 10%=�/Y` (lw� _.: �.( a �� i.' � �• r�l � lit CULY?SY!-U', 1;"S6Y2 P.J i fJ J r' A 1 17L 14 CONSTRUCTION AND PLANNING _ POC SPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -3-Electrical COnd0'y0ity-Undrgrnd. 54. Forms " 4-; ectrical Conduit?gdrgrnd. 55. Electrical Bonding n 15.• f{teel Reinforcenawt' 56. Rough Plumbing &Pressure Test �,?`glectrical UFEF�_i 1d. 57. APPROVAL TO COVER-GUNITE r ,, -5 rjpotings ;;C: 58. Electrical Conduit-Undrgrnd. ^8. Foundation r� '=' 59. Gas Pipe, 0 Undigrnd., Test g" Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 6. 10. Siructural Floor System 61. APPROVAL TO DECK, 11. Property Sewer Line,h Housex;onnection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater -& Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing. 65. Electrical -Final 15. Hough Efectrica4Coraduit "X 66. Solar System -Final 16. Rough Electric W..iriag 67. Fencing & Access Approval 17. Rough Wiring S1gn 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rou h Heatin & Air Conditioning F!#tFF [[ttEPT.REQUtREMENT 1 ^# 1 ^ Jv J (r: m n.� Cr PC;F� n * 1v Par'mit 20. ;Rough Factor F41ace +;APPgbVAL�,..� 21. Ducts; in"StrLWturF, * •' •• y '� _ a 70. 'Ondergrq'ij' Hydro t c.. - F i 22. Duc>is', Ventili(ng:� 71. Produce aping ❑bas 6 Oil 23. �as Pipe --go &Test +hM + ,T. m < Oy' ' 72. Undergro_u�d F[ti4h,- . J 24. itoof'Framin` ^' ` 9 y; -r' c" t 7k, Undergrnd.StoragmlankpOGas 00il ,, + :x tC - 25. Roof 6h;thing < ' C > iia 74: Overhead Hydra x :> 26. I-BiPCeiling (Structural) & q:t i(o�oat ;. 7 Dry Chet tical 27. Frame and Flashing r / ,G -/-- 76. Dry Star -' 28. Lathing :Sic1itt9 j�; "! 5"�'���,;%�l 77~.FIXED S.Y751NAE r-, n ;n + 29. Insulationt O, f. i_ I ; 7 FIRE PREV. F(�fJLiL 30. Drywall EJa' iliflg r.• k " y e- _-' p{'�EA LT(iyDEP. REQUIFMENT 31. Plaster Brawn-CoaY';:'S tr•t-r t' 79.E FINAL INSPECTION t_ V T • 4 32. ;Zlectricacower h;PigrGFloaI i > 'L � y t 8e� FOOD CE RTIFSATE I$ZUEEL - 33.1_sna,..)`IeWriC• ti.;;_M 6 ( + Notes: r�_ .o rr r 34. fjnallHea'$ing�!, Air Conditioning> Ct 35. �inal Gas Pipe, esto .K G. .. r �; � i= _; �,v ��,,�: l,CpQ�Y��•r,,.� y�,•s 36.ccH.00d�brQnoPY c;T, 1 ,r k8 Qny„�� �.,At8 -. 37. h,nal Factory Fireplace [•. �."� , � + I;.. C- v S E �! �^i`rf rt-4'w..q s'S > - -138. Fina PPlufAbin9 ' ' ry = r< 39. Watef'Service.Einal r, 40. Gas Service-Fidal <^ r•' c 41. Solar Domestc-Fina -- .J ''; _ L-,'-,.. Z „C4W_ 42. Backflow Preyenter « 1 x N x o9�GbfA�{yF �CLtG�agS'� 43. Backflow Irrigation '-+rn t', h, 4A. Landscape lriigation:System - Y m _: ^� L <;,,, �, w <• T5. 56und F};ien�-Wa_a yz tion;; .. . t- f ch m m i, x t6. i• lendicap•Regtrlatioris- 47. RiNA-LSTRUCTURZ&BUIL-DING 48. k1NKL PLANNING' < 49. Eleatic R ledse to E� Ison w 50. Gas Relene to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No. Date I 190 3 CCFA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 917 COSTAL MESA, CALIFORNIA For Applicant to Fill in Completely TYPE OR PRINT BUILDING amTn riv ADDRESS Let- -Pae$- 22 COSTA MESA, CALIFORNIA OWNER Dillman-Brummell Enterprises MAIL ADDRESS 12021 ]3Uaro CITY Garden Grove NE30-1160 ARCHITECT & Son TEL 3-670 1L,,x57. 1NO OF ROOMS 28 STORIEE ttucco ROOF I COVERING Shake "—NO. TEL. IZ 721 x931ON kO— LOT o BLDG[ BTREETSETBACK LINE M 301J11 REAR[[YARD [ 51 D LEFT 101 I' RIGFLT 1 DESCRIPTION OF WORK 1L,,x57. 1NO OF ROOMS 28 STORIEE ttucco ROOF I COVERING Shake ING AND WORK TO BE PERFORMED I HEREBY ACKNOWLEDGE THAT I MAV% READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PLY WITH ALL CITY ORDINANCES AND STAT E GU TING BUILDING CONSTRUCTION. SIGNATURE PERM ITTEF // ✓✓ AUTHORIZED AGENT RECEIVE© FQ�j�iA9=fOIG�It PI:WRlT BUILDING For Office Use Only BUILDING YARDSAPPROVED MAIN BUILDING RE IVSD DATEISSUED —63 MAR 1 2 Io TYPE GROUP DATE ZONING SHALL BE LESS THAN (U. B. C. REQUIREMENT YARDS APPROVED ACCESSORY BUILDING 'DISTANCE BET. I- HET. MAIN S MAIN BLDGS. ACCESS. BLDGS. VAR.# DATE Y /.Z y SQ. FT. 4 7 m THE AMOUNT SHOWN UNDER VALUATION 18 FOR THE F PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. G VALUATION PERMIT FEE S / PLAN CHECK 0 TOTAL FEE S City of Costa Mesa Building Safety Department CERTIFICATE OF OCCUPANCY N° 1930 C P. O. Box 317 Cast. Mesa, California The Building located at 'M0 ML MmlidwSidye '- UAts A to 1 — has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group ire.: Occupancy. Use of Building $ ie -- Legal Description_-`jA 36- '39M (See reverse side for Metes and Bounds) Building Permit No. Electrical Permit No—L29663—Plumbing Permit No. Floor Load Signs have been installed as Room Capacity Signs have been instaled-as required under Sec. 2308 U. B. C. required under Sec. 3301 (1) U. B. C. 17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied until 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 there is a change in: 1) Occupancy classification of a building or portion thereof 2) The number of apartments or guest rooms 3) Ownership If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California Administrative Code, Title 8, Chapter 9, Article 8. Number of apartments -4 and/or guest ISSUED TO: Building Official 'by Date v awn 2% ) This Certificate of Occupancy SHALL BE posted in a conspicuous place. on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Forra su34-1M-11-63_-s-s r i a i� ti 4l�92 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use In Only BUILDINGa' ADDRESS !!��APT /Q/Q tICRMrA/O C4riF-A—/' OWNER T�'t2. /—e a k./.Y MAIL CITY L A CONSTRUCTION LENDER BRANCH ADDRESS ARCHITECT -ADDRESS CONTRACTOR c ADORES_ _ CITY STATE LIC. NO. SIZE OF LOT 6 X USE OF EXISTING BLDG. 63! tA,I TEL. NO. CITY LIC. NO. f7. NO. OF BLDGS. - NOW ON LOT Separate permits are required for electric, plumbing and heating work. OF BUILDING AND WORK TO BE PERFORMED I hereby acknowledge that I have read this application and state that the above Information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of Parmlttee Authorized Agent lEC-?-75PrssrDO 131* *****5.50 cesr APPLICATION FOR STRUCTURAL PERMIT RECEATE RECEIVED DATE ISSU D 2 - 2-fL PERMIT NO. A.P. NO. II /6! —O( �^^cLADDRES C/iIwo vL I/0/0 TRACT -2'2.2. LOTS) BLOCK NEW 1ADDIALTER REPAIR m e SQ. FT. a _ THE AMOUNT SHOWN UNDER VALUATION IS FOR OWNER Pepe, er K15 SaLL VALUE. a FIRE ZONE TYPE GROUP APPROVED 7� BY DATE Gr PERMITFEE $ r 740 ZONE ley NO.OF PLANS 2. USE OF NEW 3fA BUILDING_ 1mtL YARDS APPROVED MAIN BUILDING YARDS APPROVED ACCESSORY BUILDING (FROM C/L STREET) FRONT O FT. FT. R. SIDE© FT. FT. L. SIDE LTi FT. FT. DISTANCE BET. BET. MAIN MAIN SLOGS: ACCESS. BL VAR.+ DATE C.U.P.# APPROVED "i - ��rr new /1 _a ,- TOTALPAID $ 1 5� N n m e SQ. FT. a _ THE AMOUNT SHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMITFEE $ r 740 n V PLAN CHECK $ 0 � $ ! O LL TAX U TOTALPAID $ 1 5�