HomeMy WebLinkAbout1022 EL CAMINO DR - Building PermitsCITY OF COSTA MESA
�y1Tr MF't9 BUILDING DIVISION
(a77 FAIR DRIVE, COSTA MESA, CA 92621 • (714754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
s 8 FOR INSPECTIONS CALL: (714) 754-5626
°'"""`°fi PERMIT NUMBER: M11-00041
PERMITTYPE MECH
APN: 14166510
STATUS: ISSUED
DATE ISSUED: 03/08/2011
ISSUED BY: KJB
JOB ADDRESS: E1j022•EL.CAMINg R{CMj Suite/Unit:
Vicinity:
SQ. FT: 0
SCOPE OF WORK: UNIT A. CHANGE OUT FAU. 80K BTU. SAME LOCATION.
OWNER:
WHELAN, JOHN F TR
PHONE:
$0.00
APPLICANT:
BAKER, COREY
PHONE:
714.444.1243
CONTRACTOR: MECHANIC REFRIGIRATION COMPANY
Address: 14770 FIRESTONE BLVDUnit: -
City/State: LA MIRADA ZipCode: 90638
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE:
$38.30
PLAN CHECK FEE:
$0.00
INVESTIGATION FEE:
$0.00
REINSPECTION FEE:
$0.00
TOTAL FEES: $38.30
Address:
1055 EL CAMINO #E Unit:
City/State/Zip:
COSTA MESA, CA
Address:
14770 FIRESTONE BLVD Unit:
City/State/zZip:
LA MIRADA
License No. 697664
PHONE: 714-444.1243
CELL:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE 0. INSPELnON TYPE DATE INRMALS CODE 0 INSPECTION TYPE DATE IN s
1616 Fixed System Final Fire Prevention 206 Final Mechanical 3-7-9 - it %3/J
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
0
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are{'- L I 1 n
Carrier:
i7ht5 Section neea�not he canpreted A the peenruf u,vva3bed at one hunted"as t00)miew)
Policy Number:
❑ I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the L r Code, I sh forthwith comply with [hese pr�ove14,
ons.
`C� =4t )
Aarlic3rits Signature Date
WARNING.NF4&URE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force anieffect.
Lic. # VJ 1d� Class #
�C \ ugr's Signature Data 1
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued. (Sec. 3097, Gvil Code).
Lender's Name:
Lender's Address:
Signature
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner -builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for such project with
a contractor(s) license pursuant to the Contractors License Laws.).
❑ lam exempt under sec.
Business and Professions Code for this reason:
Signature
3057-46(3/07)
Date
Owner ID verified by drive�ense. ❑ Yes ❑ No
Driver's License No. Expires:
Verification jof Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a
person is required to descend, will be made in connection vnth work authorized
by this permit, and that no building structure. scaffolding, falsework, or demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above. unless
such person has a permit to do such work from the division.
I Applicants Signature Date
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
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 Safely 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 application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(if "yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", attach certificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
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.
ignature of L Ovmer(s) Date
An hon Applicant Data
tpliiied Prescriptive Certifica',' '�onopliauce: 2008 Xevitlential HVA CAlte. Is CF -1H -ALT -11 VAC
low Zones' I and 3 - 7
M(
Site Address': l�IV1 �f ty
m 1 Ti
L•'u/orcclu eul fJgeucl':
Dole
Pet Pe'rmrr N:
Conditioned
Loci insulauo/
EauitimcN Tvoc'
List Minimum Efficiencv'
Floor Area
renuiremeyrf I
Thertuoram
O packaged unit
.9.Furnace
p
FUE O CO),
Over 40 fyof due s
etbac4:
❑ indoor Coil
5-ry by system
OSELrit O HSPP 1`1 sf
adder) /re la¢gin
% .
nr ndiaa te.
(/(rem alrcodp pr csem. nurvi be,,
❑ Condensing Unit
O EER _ 11 Resistauee
pace
It G (C7. 1, ;-5)
installed, .
❑ Other
1, Equipment Type: Choose the equipment being installed; if more than one system, use enothcr CT-IR-ALT-}1VAC for each system.
2. Minimum Equipment Efficiencies: -13 SEER, 78h AFUE, 7.71-ISIT for typical residential systems -
Contractor (Documentation Author's lkesponsible Designer's becturation Statement)
• 1 certify that this Certificate of Compliance documentation is accurate and complete,
• I am oh&le under Division 1 of tlu: California Business. and professions Code to accept responsibility for the demirrn identified on this
Certificate of Compliance.
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts band 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms, worksheets, calculations, plans and specifieations submitted to the enforcement agency for approval with the.permil
application.
Name . r} .. -
LSignamre: -
Company.- Date:
� t
Address: �D �n^^n 1 -
License: Cao
City/State)Zip: C {� C
"hone -11
eJ
1006'Residential Compliance Forms March 1010
(ENFORCEkE, NT A GL`N.CY
CANIC�--ro--M(ZE (WITH LEYMU--1EAD/SL'f1L)
2008'BUHdine Energy Efficiency Standards R€sidd14ia1 HVAC .Alterations
Climate Zones 7 and 3 throuGh 7
BUSINESS ANI) PROFESSIONS CODE, SECTION 7110
Willful odeliberate disregard and violation of the building laws, including the California Building Code. and
local permit requirements constitutes a cause fm disciplinary action from the Contractors State License Board
working in conjunction with the local building department. This action may consist of foes up to $5.000 per
violation or suspension/revocation of a conuactor's license.
NAUEN IS A PERNUT REODU:EM
A written construction permit shall be obtained from the enforcement agency prig to the erection, construction,
reconstruction, installation, relocation, or alteration of any mechanical system, except as permitted in Appendix
Chapter 1, Section 112.2 of the 2007 California Mechanical Code. Projects requiring permits include, but are not
limited to:
• New HVAC installation
HVAC Changeout
• Replacement of furnace, coil, FAU, or condenser -
• Relocation of an existing HVAC unit _
Adding or replacing more than40fi ducting in unconditioned space.
2008 BUILDING ENERG)' EFFICIENCN' STANDARDS (Title 24. Part 6) RE, OUMEMENTS INCLUDE:
L Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor fumaces; room heaters).
2. Central air conditioners & heat pumps less than 65.000 Btu/iu must have a minimum 13 SEER,
3. Newly installed or replaced ducts must have a minimum insulation value of R-41.
4. A setback type thermostat (24 In clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory reouirements of Section 150(m):
All joints and openings in the in the BVAC system must be sealed.
• Only UL 181, UL 181A, o' UL 181B approved tapes. or mastic shall be used to seal duct openings.
Connections of metals ducts and the inner core of flex ducts shall be mechanically fastened. Flex ducts
must be connected using a metal sleeve/coupling.
• Flcx ducts that are suspended must be supported every Oft. max for horizontal runs with no more than 2"
of sag between supports and 6 fi. max for vertical runs.
6. The CF-6R-MECB-04 must be completed and signed by the installing contractor. The Inspector will collect
this form and verify that the model numbers are the same as the installed equipment.
as
CITY OF COSTA MESA
Sia MFq BUILDING DIVISION
t
> ,. .. 77 FAIR DRIVE, COSTA MESA, CA,y0j2626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
�. F(iR INSPECTIONS CALL: (714) 754.5626
�'^b°°u�ca� PERMIT NUMBER: M11-00024
PERMIT TYPE MECH
APN: 14166510
JOB ADDRESS: 1022 EL CAMINO DR CM
Vicinity: UNIT B
SQ. FT: 0
STATUS:
ISSUED
DATE ISSUED:
02/09/2011
ISSUED BY:
���j
Suite/Unit:
SCOPE OF WORK: CHANGE OUT FURNACE. 80K BTU. SAME LOCATION
OWNER:
WHELAN, JOHN F TR..
Address:
PHONE:
714.549-5231
City/State/Zip:
APPLICANT:
BAKER, COREY -
Address:
PHONE:
_
714444.1243
City/State/zZip:
CONTRACTOR: MECHANIC REFRIGIRATION COMPANY
Address: 14770 FIRESTONE BLVDUnit:
City/State: LA MIRADA ZipCode:, 90638
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE:
$38.30
PLAN CHECK FEE: -
$0.00
INVESTIGATION FEE:
$0.00
REINSPECTION FEE:
$0.00
TOTAL FEES: $38.30
1022ELCAMINO Unit:
COSTA MESA; CA
14770 FIRESTONE BLVD Unit:
LA MIRADA
License No. 697664
PHONE: 714-444-1243
CELL:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this
permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.
Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE O. INSPECTION TYPE DATE
INTITIALS CODES INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention
206 Final Mechanical
1266 Pool Spa Final
208 Final Plumbing
200 Final Re -Roof
210 Final Electrical
201 Final Block/Retaining Wall
212 Final Fire Prevention
202 Final Factory Fire Place
220 Final Planning Approval
203 Final Sign
222 Final Site
204 Final Demolition
250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARA.—C
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier: T�y 11�1VGhCQ CC�1(1� ('t{�
(This sec ion need/hot aaaunpletGert dthe permRisvaluetl at one hun r tars(S I00) orless
GI )
Policy Number: O Iii J2� H9
❑ I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code, I shall fort >fvith comply wi.th these provisions.
pli nature D to
WAR G: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. # `f D Class # 70
/-217
on dors ignaWre to
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Signature Date
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner -builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for such project with
a contractor(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signature Date
3057<6 (X07)
Owner ID verified bense. ❑ Yes ❑ No
Driver's License No.
Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDJSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a
person is required to descend, will be made in connection with work authorized
by this permit, and that no building structure, scaffolding, falsework, or demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Applicant s Signature
Division of Industrial Safety Permit Number:
Date
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 fled with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, Min some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safely 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 application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(if "yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", attach certificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state lam and
city ordinances regarding Hazardous Materials and Emissions.
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.
ignature a Owmer(s)
dlor Authorized Apphrant
t-, ate
G
at
Climate Zmtes 1 and
CeriiGcate0' tpliwtcc:2908RcsidentwlllVACA[teowt. Cr'-M-ALT-IIYAC
silo Address:
Linfn enrent AAeacl,:
Dare
1'eruri/ P.
wL ��
e
�.
i
Condhimted Duct insulatic
Eduioment 9-y e'
Lisl Iv{inimum Efficiency'
Plom Area I rcouiremeR� ,
I Thermostat
C Packaged Unit
'><Umacc
,�.,,6,j
❑ AFU! - C Col'`
Over 40 }��.of duc s
Setback
C ]ndoor Coil
❑SEER_ ❑ HSPT
Served b), system
�� _(), cf
added (re laa;l it
% p'
nc Ilam, toy ace
p
/ rmralreadr presenr, nmsr be
C Condensing Unit
❑ EER ` ❑ Resistance
insmlleQl
❑ Other
!. Equipment'I ypc Choose the equipment being installed; if more than one. system, use -another CP -1 R -ALT -BV AC for each system.
2. Minimum Equipment Efficiencies 13 SEER, 78% AFUE, 7.7HSPF for typical residential svmms.
Comractor (Documentation Anther's lltesponsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate Intl complete. "
• I am eligible under Division 3 of the California Business and 1'mi-stounc Code to accept responsibility for the design identified on this
Certificate of Compliance.
• 1 certify that the cnerg), features and pedom nice specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, farts I and G of the California Code of Regulations.
• The design features identified on this Certificate of Compliance arc consistent with the information documented oil other applicable
compliance forms, worksheets, calculations, plans and specifications submitted to the enforeemen! gency for approval with the permit
aooiication. "
Name: 0 -
I Signature: "
Company: - Datc: .-
Address'. r L n ��
/J
I Licen
Ciry/StateiZin: e -i% ,.yr�rlj �l C
Yhone:7/,e-/
I ; _, 7
2008 /tesidential Compliance Forms Nlm'ch 2010
(ENFORCL'AvfENT AGDVCY
CAxCUST0AVZE YT'ITHLETTERFIEf1D/SzAL)
2(1(18 Building �nerg}' Efficienep Standards Residential HVAC Alterations
Climate Zones 1 and 3 thxough�7
BUSINESS AND PROFESSIONS CODE. SECTION 7110
Willful or deliberate disregard and violation of the building laws, including the California Building Code, and
local permit requirements constitutes a cause for disciplinary action from the Contractors State License Board
wortdng in conjunction with the local building department. This action may consist of fines up to $5,000 per
violation or suspension/revocation of a contractor's license.
WHEN IS A PERNUT REQUIRED?
A written construction permit,shall be obtained from the enforcemerit'agency prior to the erection, construction,
reconstruction, installation, relocation, or alteration of any mechanical system,. except as nermitted do Appendix
Chapter 1, Section 112.2 of the 2007 California Mechanical Code. Projects requiring permits include, but are not
limited to: "
• New HVAC installation
• HVAC Changeout
• Replacement of furnace, coil, FAU, or condenser
• Relocation of an existing HVAC unit
Adding or replacing more than,40h ducting in unconditioned space
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title. 24 Part 6) REOVIRENMNTS INCLUDE
1. Heating equipment must have a minimum 78% AFUE (Exception: Wall &, floor furnaces; room heaters).
2. Central an conditioners & heat pumps less than 65,000 Btu/m must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of k-4.2.
4. A setback type thermostat (24 In clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirements of Section 150(m):
All joints and openings in the in the HVAC system must be seated.
Only UL 181, UL 181A, or UL 1813 approved tapes. or mastic shall be used to seat duct openings.
Connections of metals ducts and the inner core of flex. ducts shall be mechanically fastened. Flex ducts
must be connected using a metal sleevc/coupling.
• Flex ducts that are suspended must be supported every 4ft. max for horizontal tuns with no more than 2"
of sag between supports and 6 ft. max for vertical runs.
6. The CF -6P -ME CEI -04 must be completed and signed by the installing contractor. The Inspector will collect
this form and verify that the model numbers are the same as the installed equipment.
November 25, 2008
To:
CITY OF COSTA MESA
P.O. BOX 1200 - 77 FAIR DRIVE • CALIFORNIA 92628-1200
DEVELOPMENT SERVICES DEPARTMENT
Building Safety Division
Code Enforcement
Communications
County Clerk
County Planning and Dev. Services
County Registrar of Voters
County Tax Assessor
Engineering Division (2)
ESRI
Fire Admin. - Training Officer
Fire Admin. - Mark Brown (Station 6)
Fire Prevention
Irvine Ranch Water District
Mesa Consolidated Water District
AT&T Broadband
Newport -Mesa Unified School. Dist.(2)
Pacific Bell
Police Dept. - Planning & Research
Sanitary District Engineer
Sanitation Division Office
So California Edison Company
Southern California Gas
State Board of Equalization
U. S. Post Office - AIS
U. S. Post Office, Adams
Thomas Brothers
Time Warner
File (2)
The City of Costa Mesa would like to inform you of the following address change:
OLD ADDRESSES NEW ADDRESSES
1011 EI Camino Dr.
1031 EI Camino Dr. See Attached Project Site Map
1013 EI Camino Dr.
1033 EI Camino Dr.
1015 EI Camino Dr.
1035 EI Camino Dr.
1017 EI Camino Dr.
1037 EI Camino Dr.
1021 EI Camino Dr.
1041 EI Camino Dr.
1025 EI Camino Dr.
1045 EI Camino Dr.
1029 EI Camino Dr.
Your cooperation in this matter is appreciated.
Sincerely,
0%%/
MEL LEE, AICP
Senior Planner
Attachment: Project Site Map
cc: Vi Pham, Administrative Services/MIS
Reve Pacific
Attn: Kirstin Emershaw, Partner
230 Newport Center Drive, Ste 210
Newport Beach, CA 92660
Budding Division (714) 754-5273 - Code Enforcement (714) 754.5623 • Planning Division (714) 754-5245
FAX (714) 754-0856 • TDD (714) 754-5244 • w N.crcoso-mesa.ca.os
A.P. NOS
141-671-07
141-671-17
City of Costa Mesa -
Building Safety Department CERTIFICATE OF OCCUPANCY N? 2316 C
P. O. Sox 317 _
Costa Mese, California
The Building located at W • 10M IM CSO 1KV6
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group V"Z Occupancy.
Use of Building 22 illi$ C/fyllse-'LiBi"
Legal Description 143,6n 11
(See reverse side for Metes and Bounds)
Building Permit No, 220& Electrical Permit No. 2M Plumbing Permit No. 4307
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 8s Chapter 9, Article 8.
Number of apartments and/or guest rooms
ISSUED TO: Building Offi
Ili Six Co.0 M. by
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 Meso under Sec. 306 (e) U.B.C. Form W3+—IM-11-e3--s-a F
154.
EVE
?L9Y 4 !961
=?` nuILDING-SAFETY DEPARTMENT LANCE DEPT.
04SO x317 OpR4 MESA. CALIFORNIA
Lrl. IY OF COSTA MESA
D: A''F%Applicant }o Fill ►n complete �j .- APPLICATION FOR PERMIT
="i TYPE OR PRINT BUILDING
/c For Office Use Only
BUILDING `
ADDRESS 1011- E1 Camino Drive .RECEIPT No. PyIMI .
COSTA MESA, CALIFORNIA oO</
RECEIVED BY DATE RI IVHD OAT ISSUED
OWNER Triple D Ince -r
MAIL - BUILDING
ADDRESS 1598 Monrovia Avenue ADDRESS
FIRE /(V
7E ZONE TYPE /� GROUP
CITY Newport Beach NO`846-3958
APPROVED
ARCHITECT G NEER Ray Levanas No'673-7010 BY Dw7EG
ADDRESS 3432 Via Oporto, N.B.
ONING
ZONi._/ PLANS
rN USED 8W `
PLANS //" BUILD
CONTRACTOR Don Koll Co. Inc• /1 �
LEGAL VWT a L7 ,_ t_-+''YI/✓%1 ^
:RIOR WALL
ERING
OF BUILDIN
JRMED
VA R.# 4 I DATE
l
IHCREBY ACKNOWLEDGE THAT 1 HAVE RE! O THIS APPLICATIO
ANO STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COM
PLY WITH ALL CITY OR ANCBB ANO BTA IB LAWS R80ULATIN
BUILDING CONSTRU ON.�
SIGN ATURE OF/'Ly✓�L��� / /
PERMITTEE
AUTHORIZED AGENT
ry
G
A. P. NO. b0 J-! s-SiG•
Newport Beach ( Ili•
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
BY �
221764 Nc - 646-3958
30" TO SIDE S REAR P. L.
EAVES
ISR C,i�1..f 1I't`^M
2
NO. OF BLDGB.
NOW ON LOT -0-
ALLOWED (U. B. C. REQUIREMENT:
YARDS APPROVED
YARDS APPROVED
N
G BLDG.
MAIN BUILDING
ACCESSORY BUILDING
THS AMOUNT SHOWN UNDER VALUATION IB FOR THE
(FROM C/L TREE
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
LINE FROM
F STREET REAR YARD
FRON O :FT.
Ff.
/S�
PLAN CHECK 5/ ¢O
RDI LEFT
I RIGHT
R. SIDE FT.
Fr.
�0
DESCRIPTION OF WORK
L. SIDE" Fr.
FT.
:RIOR WALL
ERING
OF BUILDIN
JRMED
VA R.# 4 I DATE
l
IHCREBY ACKNOWLEDGE THAT 1 HAVE RE! O THIS APPLICATIO
ANO STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COM
PLY WITH ALL CITY OR ANCBB ANO BTA IB LAWS R80ULATIN
BUILDING CONSTRU ON.�
SIGN ATURE OF/'Ly✓�L��� / /
PERMITTEE
AUTHORIZED AGENT
ry
G
APP E
L� G
B
BY �
DATE J
ISR C,i�1..f 1I't`^M
(/, - �o
1. @LLV
/
N
q. FT.
THS AMOUNT SHOWN UNDER VALUATION IB FOR THE
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
VALUATION
// _ m
PERMITFEE
PLAN CHECK 5/ ¢O
j 4
TOTAI FPF s 3 976. -2.
CITY OF COSTA MESA
2317P Building Safety Department
Application for permit for the fabrication and erection of classified signs.
Building Site Address
Nome
Contrc
Location
l n
�J C7
Tag No. .—
Type of Sign
Non-Elec. /
Address ??L -r city'
Ar,kitect or
ineer
Phone
to License No.,
Address City Phone
Description: �_I Tract Sign Roof Sign
Appurtenant and Incidental Advertising Sign ❑ Gas Tube, Elec. Sign
❑ Off-site Advertising Copy Sign Sec. 1.37, 1.44
Two copies of plans and specifications shall be submitted with application for permit for each sign. Plot on plan
sheets proposed location of sign .and locations of all other signs at site. Minimum size sheets SHALL be 18" x
24" and non-eresable.
If between property line and established setback line, owner is to sign written agreement with the City.
Signature of Property Owner
Date
I,- undersigned hereby agrees to fabricate and erect the advertising structure within the intent and meaning and
in strict accordance with the provisions of Ordinance 63-13, Ordinance 344, the Electrical Ordinance of the City
of Costa Mesa, and all amendments thereto.
ALL APPLICATIONS MUST BE FILLED OUT BY THE APPLICANT. ALL FOOTING, FRAMING, ELECTRICAL
AND FINAL INSPECTIONS SHALL -.BE CALLED.
NOV 4 i9o4 1
FINANCE DEP-1.5�A1
Gfiv, OF GOSIA NiLSA
FOR OFFICE USE ONLY
Date Issued / �� Permit NoZ
Fire Zone Type Group
Approved bye
PLANNING DE TMENTD
Zone r A. P. No. �j L
Bldg_Site Address h'
Legal Owner �i� /[Q/ (.%�� z
Address ^�ZI % �n �71j�1�'iZ.-�1-r✓-
City ?1 l� 1,14
Area of Sign: ft.
Required Bldg. Setback to
Center line of Street
in. X ft. in. -
Location of Sign:
Behind Bldg. Setback Line
Between Property Line and
Bldg. Setback Line
Front ir Feet
Right / Feet
Left / Feet
Projection 1*- 1- Feet
Ground Clearance Feet
Signature of IC. U. P. C. Date Approved
Permittee i G The amount shown under Valuation is for the purpose of
establishing a permit fee only
Clearance Chap. VIII, Art. 5. Sec *on 8504 (b)
-i
Authorized Ag VALUATION Permit Fee $/ (
Signature (Planning gff )
Y $ �
Plan CheckS_�_"
- Signature (Dept. of Public Works) �)
;ecd. by /� Date//' -) S-. / / --
DR. eu-ao-1..-716 Total Fee $ / 7 • Date: L ! �,
PROJECT ADDRESS: 1022 EL CAM 1 NO DR
OWNER'S NAME: WHELAN JOIN
ADDRESS: 3_ 40 RtD HILL AVE 4150
COSTA MESA,CA 92626
ARCH(E NCIN EE R: 540-3666 flEG.NO.:
ADDRESS:
UNIT:
UNIT:
PERMITTEE: JOHN WHELAN (714)540-3666
ADDRESS: 3140 BEAR ST
CM CA 92626
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 farce and effect.
CITY LIC.: STATE LIC.: CLASS:
Date: Signature:
WORKERS' COMPENSATION DECLARATION: I hereby 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:
7 Certified copy is hereby furnished. ❑ Certified copy is bled with the city Building Division.
Dale: Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(SlDO) or less).
nify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as t0 become
sublect to the WorkersCompensation Laws of California. A / �•"
Date: S— 20 X 43 Signature: •I/ /'T 04 J Gti
NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor
Code. you must forthwith 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 structureprior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors' State 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
❑ 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 awn 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 propeny, am exclusively contracting with licensed contractors to construct the project (Section 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 contractors) license pursuant to the Contractors' State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
1 am exempt under Section
for this reason BP7044
A L WORK BY OWNER ��
Dale: `� 'A3 Owner: {rtip�
I do hereby certify 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 one) need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from
j these provisions.
Date. Applicant:
I hereby certify that I have read this application and state that the above information is correct I agree to comply with all city and county
;romances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes. I
r
Date: 5'—Zo 3 Signature:
Driver's License or Social Security Y: )_
1641-46 While—Building, Green—Code Enforcement. Canary—Applicant: Pink—Revenue', Goldenrod—Assessor
CITY OF COSTA MESA - BUILDING PERMIT PERM NO; S 062273
PERMIT NO: B 062273 PLAN CHECK NO; 01786-93 S GOVT: N SUPP; N
CONSTRUCT -TON TYPE: PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : CITY STD BLOCK WALL SQ FT; 44
CLAIM VALUE: CALC-VALUE: 880.00 GROUP OCC: M-1 /
COMMENTS: CITY STD BLOCK WALL
##############Y#f###:fiF###iE###dc•x#####?f##i%##########df##x.#######i.'####•x##kY########
Z O N I N G S E T B A C K S R E Q U I R E M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ------
FRNT: FT IN REAR: FT IN FRNT: 20 FT IN REAR: 20 FT IN
LEFT: FT IN RIGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REO: PROV: PARCEL: 14166510 ZNE: R3 REF NO:
PLANNING NOTES> TWO 18 LINEAL FT. 6' HIGH BLOCK WALLS NEAR FRONT AND REAR
> OF EX. RES. PROP. WITH A 4' GATE AT EACH.
D E V E L O P M E N T S E R V I C E S R E Q U T- R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY 7?BAN-CHECK DAT£:
APPLICATION ISSUED BY• DATE:...,cit sicx###Y.Jfi:LEGALIZATION:N F EA R Y STRUCTURAL SEGMENT:Y
HLDG FMT_ PLUMBING EANIC FIRE SMIP/RES GRADING
PERMIT 23.00 •50
SMIP/NON-RES
PLAN 14.95
ISSUE Flt
BUILDING -DIV-> PERMIT ISSUE TOTAL PAID DUE
TOTALS ---- > 23.50 0.00 14.95 38.45 38.45 .00
REVENUE DIVISION TOTALS--> COLLECTED: 38,45 OVER/SHORT: .00
BLDG PMT PLUXBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK
23.00 .50 14.95
#?F#?E#Ri###?E##?E#?E#E##?f#<##?f#ie iE ie#?F##/#+�tif#1?##'F-if#i'#-3E#3E#•###3(##ii#########fe 3F###IF##1E is is }; #:•f
I N D I V I D U A L F E E B R E A K D O W N
.1
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 44 RES -CONCRETE BLOCK ,WALL / FT. 20.00 880,00
EIND OF FEES
4 _
A
EXPIRED t
Incoo�m tete Inspections
Date l'
Xt
01 00139534-00139536 TOT 38.45
DATE: 05/20/93 TIME: 11:57
CGEJSTRUCTION AND PLANNING ; r
� PO( SPA
Dafe
APPROVALS Permit #
Inspector
,
APPROVALS Permit
Date
Inspector
1: Temporary Electrical Service or Pole
52. Pool & Equipment Location
'
2. Soil Pipe-Undrgrrid.
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 COVE R -G UNITE
I
7. Footings
58, Electrical Conduit Undrgrnd.
8. Foundation
59. Gas Pipe, El Undrgrnd., Test,"
-
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 17 Undrgrnd,
I
10. Structural Floor System
61. APPROVAL TO DECK
f
11. Property Sever Line & House Connection
62. Backwash & Receptor -Final
-
12. Sewer Cap
'. f
53. Heater & Vent -Final
13. Roof Drains
n
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 =,sL
20, Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping ❑ Gas O Oil
23. Gas Pipe -Rough & Test
-
72. Underground Flush
24. Roof Framing -
73. Undergrnd. Storage Tank CGas 0 Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Mono -oat
75. Dry Chernical
{I
I
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
'�y4,
77. FIXED SYSTEM FINAL
Al •�
__
_
29. Insulation
'„
11 �.1
i(�
78_ FIRE PREY. FINAL
30. Drywall Nailing
I,
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat1
+ tI'l
79. FINAL INSPECTION
32. Electrical Power Meter -Final
f
�.;�t
80. FOOD CERTIFICATE ISSUED
33. Final Electric
34. Final Heating &Air Conditioning
i(
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
A
' I
44. Landscape Irrigation Systeme„�-
��
.
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
t
49. Electric Release to Edison
r
'
50. Gas Release to Southern California Gas Go
51. CERTIFICATE OF OCCUPANCY
No. Date
u
STATE OF CALIFORNIA
County of
On IV d:%z q / 9 9 3 before me, the undersigned, a Notary Public In
and for said State, personally appeared a A/ 2_ A
Aj
personally known to me or proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)
is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same In
hieftwAheir authorized repecily(les), and that by hla/her/their
signature(s) on the Instrument the persoo(s), or the entity upon
behalf of which the person(s) acted, executed the instrument.
OFFICIAL SEAL
LYNN SUTTER
mg' NOTARY PUBLIC -CALIFORNIA
PRINCIPAL OFFICE IN
ORANGE COUNTY
I4YCMMjUi0n E1.AugW4, 1995
r,
LIMITED STATEMENT OF RESPONSIBILITY
TO WHOM IT MAY CONCERN:
Zo�,Z Z_,l 6Aw.'d o
Street Address
Bldg. Permit # (362 Z?3
This Permit #
/511- GG-S=m
AP Number
as Owner in Title of the above referenced
property, o hereby authorize:
0J
Name Telephone No.
Street Address
to obtain permits in my behalf, as owner/builder, for Zk f !>Z
at the above referenced property.
Should any raon become an Pmpinype engaged in the improvement of the property, I 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.
As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per-
son, company or corporation.
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.
077946, rev. 6/67
6144J 4 L�,3
Printed Name Dale
NOTARIZATION
REQUIRED
TYPICAL -6'.'CONCRETE BLOCK FENCE
Cement Coping Optional
Channel Block With 1-3/8S
,
Horizontal Top of all
Fences
For Fences 5' or Less _
--'
r
Vert. Bars 3/8" ¢ at 4' -0" O.C.
o
¢
x
For Fences Higher Than 5'
I - +"
0
Vert. Bars 3/8-0 at 32" O.C.
Fill Cells Solid With Grout
>
Z
Where Steel Occurs
a
-
- Reinforcing Steel Shall
•' i
i0
Conform to Sec.A'15=39 , -
w
0
A.S.T.M.
Z
2
r
All Steel to be Lapped .... _.
•-
24" or to Code
NATURALGR4DE--,7I_.
TWO 3/8"4 BARSrl
CONTINUOUS TOPBOTTOMWIDTH
E CH/
HoraZSTEEL MUST-BE;TIED INLOW
IPLACE-AT TIME OF TRENCH
INSPECTION. 1,
FOOTING REQUIREMENTS CHART
GENERAL- NOTES
MORTAR: One Part Plastic Cement, and
Three Parts Sand
GROUT: •,One PartTCemenf Three and
One Half Parts-'$dnd
COPING: One Port Cement; Three
Parts Sand.- ,
CONCRETE: Well Mixed 1:2-t/2:3-1/2
"Max. of 7-1/2 Gollons of
Wafer Per Sack of Cement
GROUT MAY BE POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
CELLS AND AREAS OF HORIZONTAL REIN-
FORCEMENT SHALL BE CLEAR, CLEAN &
FREE OF ALL MORTAR DEBRIS, ETC.
H OF EARTHTCOTH
1/3 THE HEIGTH OF FENCE
BrLOW BOTTOM OF FOOTING.
SCALE: 1/2n = II
WIDTH . . 14" . . . . . . . . . . .14' 12 12"
THICKNESS . . . . .10° 10° 8 °. 8 "
DEPTH OF EARTHTOOTH - 24" . 2011 . . . 16 12"
-- - - --SPACING OF EARTHTOOTH. . 12' 141 16'. 16'
.-City of Costa Mesa, California J
Building Department
}.=v15ao Nov. 8:.
I
r.1
102 -2 -
RESIDENCE "EsIDIENCE
0-1
Lai
Lu
E- � Cim',rig
STREET
RESIDENCE
6
NOTE
ADDITIONS, DELETIONS, OR CORRECTIONS SHALL
BE APPROVED By THE PLANNING DEPARTMENT
/PAVI:F. ,
WOF COSTA'
PLANNIN EFT. W/
mm
UM—�[ :1 �':S
Or Kamm
RESIDENCE
Uf(VE'f OF LOT LINE
MAY 4E REQUIRED
.61
I Pprm*
THIS NIJ:,n1j1 I%P"isr
ALL INSPECTION
10.)NIPANY
)Uz.STS
APPROVED
City of cc;cta iilesa P -Wiling Dept.
BY CJE 6 y"3ei co)
t11NO
ALL TIU�� WKE
CHIANC�E� W'd,)J. t�,EPT,
NO 11c I � �-
MESA
lcffy or COSTA
FANNING DEPT-
SWC TO UDO. DEPT. Sao.�l
C13
111L
PLAW:z ml!) ;.w1 : ti; '419t.k 0 f10 Ill' A
Ulrl.. 'I Ad �N OF A!'Y oli
-r, 11 0 CAVI:
AUT4GNif
DATE- n4---76—
M :4 c�
CO1 I.;! WL-1),K'W`. 131',L-
-(� mcma Of PLAWINW-
via
WHICHMAUTW'
W,31S, gWro.'
'IT R',' 0 UI ,ANS AND
THE IVIIJ,WX 01 t I'- .'�'
SPECIFICtOlDNti SIALI W11 41-+; 111% fN-jClAj'
SAID PIAN5 1,115 C4T10112 I ' ill 1111111F1111:11:111111
81J:LD1N1,', OPFkAtIONS III CARIAICIION 1ltr.l!(-lJlhWr(Wll1'N
NV!Q;.!dICP: OF *1111", 013DIi 0FiQ1- ANY UTI ICH OWOINMKi lt Ot!
I
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102 -2 -
RESIDENCE "EsIDIENCE
0-1
Lai
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STREET
RESIDENCE
6
NOTE
ADDITIONS, DELETIONS, OR CORRECTIONS SHALL
BE APPROVED By THE PLANNING DEPARTMENT
/PAVI:F. ,
WOF COSTA'
PLANNIN EFT. W/
mm
UM—�[ :1 �':S
Or Kamm
RESIDENCE
Uf(VE'f OF LOT LINE
MAY 4E REQUIRED
.61
I Pprm*
THIS NIJ:,n1j1 I%P"isr
ALL INSPECTION
10.)NIPANY
)Uz.STS
19021
COSTA MESA BUILDING-SAFL. I DEPARTMENT
P. O. BOX 917 COSTA MESA, CALIFORNIA
For Applicant to Fill In Completely
TYPE OR .PRINT
t022 Et com nu Dltve
BUILDING
ADDRESS 1.8t /.i
COSTA MESA, CALIFORNIA
1MAIL
ADDRESS 12081 Buaro
CITY Garden Grove No530-1160
ARCHITECT
OR ENGINEERWalter5 & Son NobR 3=6700
ADDRESS 436 Heliotrope. Corona del Mar
CONTRACTOR Self
ADDRESS
CITY —�
STATE - TEL.
LIC. NO. NO.
SIZE NO. OF BLDGS'
OFLOT 7J1XI%3T NOW ON LOT 0
[SETBACK LINE FROM51
CENTER OF STREET 0 / it REAR YARD
SIDEYARDI LEFT 101 I RIGHT 51
DESCRIPTION OF WORK
rare= I X II el rwweTlnM I 11ennlnnM I
BUILDING NO. OF
SIZE 44lx 1 ROOMS
EXTERIOR WALLStllCCO ROOF
nn..rwrran ..
[I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
AND 6TATE THAT THE ABOVE IS CORRECT AND IS
PLT WITH ALL CITY ORDINANCES ANO 6TATEf.M/f
BUILDING CONSTRUCTION.
N AUTHORIZED AGENT
F E r ECE1VED
APP% A%iFO�2IP�ERMIT
B611lDIN'E nvu T,
For CW#,,,e L"',GZ'a4 MESA
BUILDING
ADDRESS
FIRE
ZONING
ZOI ` `/ NO. OF
n I USE
PIANS I//Y BUII
LEGAL - �O [�3
DESCRIPTION (J
SHALL BE LESS THAN
i
YARDS APPROVED
MAIN BUILDING
YARDS APPROVED
ACCESSORY BUILDING
(FROM 7STREE )
FRONT FT.
R. SIDE FT.
FT.
L. SIDE I0 FT.
FT.
REARPT.
DISTANCE BET.
MAIN SLOGS.
ET. MAIN 8
ACCESS. BLDGS.
VAR.# _.
DATE
THE AMOUNT SHOWN UNDER VALUATION IG FOR THE'
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION _
G,y/ n PERMIT FEE $
Vr
City of Costa Mesa
Building Safety Department CERTIFICATE OF OCCUPANCY N? 1973 C.
P. O. Box 317
Costa Mesa, California
The Building located at 1022 El Cadn0 Drive - Mats A. B " DIIt7. D
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group EW Occupancy.
Use of Building_. UrP1-e3C 1C' rlft' 1C@ 47j-th 121M .OhOac—X'- ;Q
Legal Description ht 53, Tr l-t"t 39=
(See reverse side for Metes and Bounds)
W-3 -
3
Building Permit No. 19021 Electrical Permit No. 19u�.966 '�C 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 rooms
ISSUED TO: Building Offici I
Dil,•s a- ;ill Enterpriwa by—
Date gprU 30, lg6b
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. Form Bu34-ate-11-61-s-B r