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Home My WebLink About1090 EL CAMINO DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1090 EL CAMINO DR Suite: Vicinity: ROOF FOR 2ND STORY & GARAGE Parcel Number: 14162112 Applicant: RUBRIGHT, JOHN Address: 1090 EL CAMINO Zip: Arch Address: - \ Phone: Zip: License: Zoning: COSTA MESA, CA Owner: RUBRIGHT, JOHN Address /1.090 EL CAMINO Phone: (714)444-4262 Zip: COSTA MESA, CA' Contractor: OWNER -BUILDER 'Address '0 Zip: Arch Address: - \ Phone: Zip: License: Zoning: ISSUED Phone: (714)444-4262 Zip: 92626 Phone: (714)444-4262 Zip: 92626 Phone: MAIN STRUCTURE Front License: '0 Eng: Address: Status: ISSUED Applied: 04/05/2001 Issued: 04/05/2001 ISSUED BY: ,Phone: license: SGUPE OF PERMIT' REROOF. PORTION OF EXISTING SINGLE FAMILY RESIDENCE & ATTACHED GARAGE (2ND STORY & OVER GARAGE) _8j SQ. TEAR OFF EXISTING, ROOFING & RESHEATH WITH 1/2" CDX PLYWOOD. INSTALL 30# FELT, UNDERLAYMENT & REROOF;WITH 25 YEAR ASPHALT SHINGLES:` / i PLANNING:&ZONING- Plan Check: $0.00 Permit: $69.25 SMIP-Res:'. `, ,$0.50 MAIN STRUCTURE Front SMIP Com: ` ` $0.00 1- - �� Right,, = 0- O=/ "Other: $0.00 0-0 Left 0-0 Inspection: _ PARKING Existing: Total: $69.75 Calc Valuation: /1" Claim Valuation:/� / rl .� NOTICE: by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work 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 2446.46 (6/0) PLANNING:&ZONING- SETBACKS MAIN STRUCTURE Front 0-0 ` _ _ Rear - 0-0 Left 0-0 1- - �� Right,, = 0- O=/ ACCESSORY Front 0-0 ��' Rear. 0-0 Left 0-0 =, Right -,0 _ PARKING Existing: 0 Required:- -0 Proposed: ' 0 NOTES: NOTICE: by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work 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 2446.46 (6/0) J DECLARATIONS C") 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. ❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the pertonnance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 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 if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML PINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37W 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. d Class a Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the fallowing 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, -es 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. —X7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License law d es 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 e C ctor ense Laws.). ❑ 1 am exemplA r se Business and Professions Code for this reason: Sig`oalure:_ - !'Date:- �' -,of,' Owner ID died by dove 5 wen e. ❑Yes ❑ No rDnLicense No: - �� Expires: . Verilic n cf Ownership by (type of document, i.e. - property tax bill or deed): �— DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B. California Administrative Code) ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....._.........._............_........._..............—....... ....... _................... _.......................................................................................................................................................... .................................... ............................................. ............................... 2 Does or will the applicant or present or future building Occupant need to file a registration loan for acutely hazardous materials ? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................... .............. _............................................................................................................................................................................................................................ ...................... ....................................................... .................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and tiling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ............................................................................_.....................................alif.. r'ni.....................................................................imll............,pli.......................................................................................... ............. ...................... d If an RMPP is resent required, has Section 2553a of the Celilornia Health end Safe Code been full com lietl with? p ly q h Y p ❑Yes ❑No 5 Does or will the applicant or present or futurebuilding occupant require for the work which is the subject this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control distract 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 par of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (it yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ........................................................._........................................._.....,................_..____.........._.._.......................................................................................... ........................ ............._............. ................ ...... ........................ ............. ....... ........... 7 II 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 Califomia 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. 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 tocymply tri all stat laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-descri peforiplapeK purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final map ec ion. l nature.OLLegal Owner(s)- - . ' (/Date And/Or Authorized Applicant Date CODE 1. INSPECTION TYPE UR INTMALS CODE INSPECTION TYPE INTITIALCS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Finales 208 Final Plumbing 200 Final Re -Roof Pte_ 210 Final Electrical 201 Final Biock/Relaining Wait 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1090 EL CAMINO DR Status: ISSUED Suite: Applied: 09/26/2001 Vicinity: 1 ST STORY ONLY Issued: 09/26/2001 Parcel Number: 14162112 Zoning: Applicant: RUBRIGHT, JOHN ISSUED BY: Address: 1090 EL CAMINO DR - Phone: (714)444-4262 - COSTA MESA'CA• ,-- - Zip: 92626 Owner: RUBRIGHT, JOHN' Address .1090/EC CAMINO DR - - _ Phone: (714)444-4262 /COSTA MESA; CA' - Zip: 92626 Contractor: `OWNER -BUILDER Address: Phone:.. , Zip: Arch Address: Zip: License:- 0 - - - Eng Address: - Phone: - - - - Phone: License: License: SCOPE OF PERMIT- REROOF IST STORY OF EXISTING 2 -STORY SINGLE'FAMILY RESIDENCE. TEAR OFF EXISTING ROOFING & RESHEATH WITH 1/2" OSB. INSTALL 30# FELT UNDERLAYMENT & REROOF WITH 25 YEAR ASPHALT SHINGLES. - FEE SUMMARY Plan Check: $0.00 — -- - - - - Calc Valuation: $1,500.00' Permit: $54.00 Claim Valuation: $1,500.06 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $54.50 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 NOTES: Rear 0-0 Rear 0-0 Required: 0 PLANNING & ZONING Left 0-0 Left 0-0 Proposed: 0 Right 0-0 Right 0-0 - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required 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 244646 (6100) DECLARATIONS C) WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. My workers' compepsation Insurance carrier and policy number are: Carder: v Policy Number: (This section need not be completed if the Permit is valued atone hundred dollars ($100) or less.) ❑ 1 cartity 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 became subject to the workers' compensation provisions of Section 3700 of the labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (SID0.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect. Lic. # Class # Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 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: 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 01 the Business and Professions Cade) 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 perr+' subjects the applicant to a cMI penalty of not more than five hundred dollars ($500).): ®W�V 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. I. 044, Business and Professions Cade: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to e C acto s U nse Laws.). ❑ 1 am exam p n r se Bus ss a d Prof �ns ode for this reason: �Signdture:- %Dater — Ow D nfietl by drive ra i e. ❑Yes ❑ No Drives License No✓� r Expires_ Verili on of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby cadity 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, Tlile 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a Permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or200 cubic feet of compressed gas at stand . and ._._........................................................................................................................................................................_.............................................._.........._............_............... 2 Does or will the applicant or present or future building occupant need to file a registration forth 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 SSection 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 apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..................._........_........_........__.......__..............._........._...__........................................................................................................................................._......................................................_..............._............................................................. 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ..................................................................................................._......................................_...................................._.._..................................................................................................................................._........................................_................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a mit 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 Califomia Health and Safety Code). ..................................._........_.......__.........__............_.........................................................................................................................__..._-_.................................._........................_...................._.......-...................................................... 7 It a permit from the Souih 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 Califomla Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ..........._............................. ................................................... ._............................ _... __............ ......................_... _................................................................................................................... ....._........................................ _........ _............................ 8 (If yes', attach cartificate 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 cc Iy 'D II at ws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above -describe 1 e, for' p rposes. I agree not to occupy or allow occupancy of any building authorized by thiTX_ Permit until final ins action. rX-�% Signature 01 Legal Owner(s) - Date And/Or Authorized Applicant Date CODE I. INSPECTION TYPE prig INTITALS CODE INSPECTION TYPE PAIL ILLS 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 B1ock/Retaming Well 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 PROJECT ADDRESS: 1090 EL CAM ENO;,QR OWNERSNAME: JACKSON, ROBERT E ADDRESS: JACKSON, CATHERINE 1090 EL CAMINO DR COSTA MESA,CA ARCNIENGINEER: ADDRESS: ZI ) UNIT: 92626 (� REG.NO.: UNIT: PERMITTEE: NOCK PLUMBING (714)895-1246 ADDRESS: 11610 SEABOARD CIR STANTON CA 90680 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. ctrruc.: OS 386 STATELIc.:5119713fi V LASS: C—\ [pa�te1,� Signature: w� ` tom"—� WDNRERS' C MPEN SATION DECLARATION: I hereby affirm that I have a certificate of consent to self insure or a certificate of Workers' Compensation Insuranye oJ,a ce,(ified coyy thereof (Section 3800. Lab. C. POLICY NO.: 1167791-99 EXP. DATE: 63/01/95 COMPANY: STATE nullified copy is hereby furnished. EX Conduct copy is fill,"Ih the city Building D�nsion. !Date: Applicant: Y _I'— \ )_ ._ \E7 PTION FROMWORKERS' COMPENSATION DECLARATION: (This section need Pat be completed if the permit is for one hundred ($1W)or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California, Date: Signature: NOTICE: If. after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Cade. 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 structure. prior 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 ContractorsSlate 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 (S500). 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 properly 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. 11, 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 (Section 7044, Business ❑ and Professions Code. The Contractors' State License Law does not apply to an owner of propene who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' Slate License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section. B. & P. C. for this reason: Dale: Owner I do hereby canny 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 Quality Management District. Residential construction applications are exempt from these provisions. Dare: I hereby can ordinances a property for that Applicant this application and stale that 9 t building construction and is correct. I agree to comply with all city and county nerves of this city to enter upon the above mentioned Date: Signature: / U^ �� E mer's License Of Socia Security x: 1641-46 While—Building. Green—Code Enforcement; Canary—Applicant: Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 066701 PERMIT NO: P 066701 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH JOB DESCRIPTION INSTALL WATER HEATER SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT aE 1E****1E**iE*1EiE it*fE iE ie if iFiE iE iElE iE fEff aE*iE IE fE iE if iE iElF*iE iE ititxit iE lP iP it*1F*it*1E iE 4E**1P 1E fE iF iE iE iE iF fE *iE iE iE iE iE**iP iE 1E* Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FKNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING RE&(� PROV: PARCEL: 14162112 ZNE: REF NO: PLANNING NOTES> > 1E * * 4E!! 1f !l' 1E iE 1E lE lE lE 1E 1E 7E iF 1E 1F It i! k iE iE it iE Bt 7f it k iE tE * iE tE ff iE iP iE * 1E 1f it 1f i! iE iP if iE Be iE iE iE k iE iE iE it lE iE iE 1E iE iE iE iE iE it * if 1E 1E is 1E iE it 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: 1E of lF if iE iF**4*****iF aE 7F iE *iE 1E iE it 1E iE 1E 1F 41f If 1f iE �� iF if if iE iE 1E lE 1E 1E 1F fE iF 1F 1F iF iF If iE iE fE of 1E 9E if 1F aE 1E 1E 1f aE 18 iE iE iE aE iE iE iE 1E iE i! iE * it %* iE 1E * * iE k * iE it iE 1E it k iE iE * iE iE * iE it it iP 7E iE ie iE iE 1E!! iF iE if LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N PERMIT BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/AES GRADING .00 25Y SMIP/NON—RES PLAN ISSUE FEE 20,00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 7,00 20.00 0.00 27.00 27.00 ,00 ,f REVENUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 27.00 iE 1E 1Elf iE iE iE * 1E iFlE 1E fElE fE * 1E 7F 1E 7E 1t iklE ¢E 1E fF * * iE iE k 1E 1E ie BElE iE 1E 1E * ft iE i! * iE eE iE k i! iE fE iE 1F if iFlf * iF 1f 4E k 9E iE iE iE ielE * iE fE'7h if 1E iE et rt * 1Eli 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 PLU 1 WATER HEATER AND/OR VENT 7.00 7.00 END/OF FEES 01 00158488-00158488 TOT 27.00 DATE: 04/06/94 TIME: 09:10 CONSTRUCTION AND PLANNING ; POO' ,PA APPROVALS Permit # Date Inspector APPROVALS Permit ?k Date Inspector 1. Temporary Electrical Service or Pole 52. -Pool & Equipment Location 7J 2. Soil Pipe-Undrgrnd. rq 53. Steel Reinforcement ' 3.;E}Attrical Condtrit.Utility-lyndrgrnd,,i.n 54. Forms 4.rLEreo ical Conrruit,10'ndrgrnd. 55. Electrical Bonding .� 5` -Steel Reinforcerheiit' - 56. Rough Plumbing & Pressure Test i= y .• 6.,..Eleciricat OF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7E0. Footings s< 58. Electrical Conduit-Undrgrnd. $,.. Foundation " 59. Gas Pipe, ❑ Undrgrnd., Test -Ii9,9Vater Pipe-Undrgfnd. - 60. Backwash Lines, P -Trap, tC3 Undrgrnd, - 10, Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor Final 12, Sewer CapT _ 63. Heater & Vent -Final 13. Roof Drains `u 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electrie.Wiring 67. Fencing & Access Approval U 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOLiSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT lAPPRO.VAIS:DZPermit= 20. ,Rough FactorH Ff✓eplace _ 27.-Du6�;, in $tructur ; r t,70. Linde giepPd Hy_. ro r' „ 22.'Dutti, Ventilating- j tJ S' '� � :iz �=:' �Produc(�Ptfii ng QQ"G'Ss O'Dil ✓ ♦ . r 23. Gas Pipe kojh &'Test �_ -; 72, Underg�o�ny Flus' J, Y ' 24. -Roof Framing -= r F. r: :• j _ f , -73 7Undergrnd' Storank FIGas 000 25. Roof Sheathing ' '74. =overhead Hydro; 26. _T -Bar Ceiling (Structura0 &;g+lonocoat -+ ^ �: f -• 75 7?Jry Chemical 27. -Frame and Flashing 76. -Dry Stand�ip Latkiing_ Siding" .LL2. rn "=S '� UL • 77 c""FIXED Sl"STEA1'-E=JNAL` 29. Insulati�t`I ' 1, ; 78."rFIRE PREY. FAf ,' , 30. Drywall Nailing t c •HEALTHDEPT: REQWRBMENT Plaster Blown Coat; , G, i 79.'fi VALiNPECTIQ;N .37. rr .32. ::EIectrieaj!Pov er MatefjPinal i t •80. -.FOOD CERTIFICATE ISSUED =Final Electric - _33. 34. Finaf Heating.& AurConditionirig, 6- i 4 4• - _+ /• 35. Final Gas_Pipe-Test -;36.'Iiood or Canopy y _ - - -37,'FinaLFactory Fireplace p S 38. Final Plumbing ?� i •• _: -LO I -+ ., --- "39. Water Service -Final * _ - + ' h >t • • ?t -- . N .40. Gas Service -Final i41. Solar Domestic -Final- -42. -Backflow Preventer, 43. Backflow Irrigation- � :r: ' r ;44. Landscape Irrigation System In T y r :1 rj J; ,i; 45. Sound Attenuation-' lust- ;,; _ -46. Handicap Regulation;'s ..' , :•, cc ;- t� � r, _ 47. -FINAL STRUCTURE & BUILDING ro J 48. FINAL PLANNING, F'.F J _ 49. Electric Release to Edison < x 50. Gas Release to Southern California,Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 917 COSTA MESA, CALIFORNIA' For Applicant to Fill In Completely TYPE OR PRINT - COSTA MESA, CALIFORNIA Co. E MAIL :SS TT,,//a5S. 1'NOvP 'RACTOR Masco Realty Co. NO. OF USE OF EXISTING BLDG. SETBACK LINE FROM EFT RIGHT DESCRIPTION OF WORK IE. A I" II MOVING I' II IU ILDING541 RNO. OF OOMS IIX7501618�qq :XTERIOR WALLWood & ROOF i :OVERING '1'.i)onn COVERING ISE OF BUILDING AND WORK TO BE PEI Single £anvil dwelling w garage. OT nan. 600 DR 1 2, IBB 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CON. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION, SIGNATUREOF A AUTHORIZED FEE R ECEINti� 5 1963 �LAPFPfATI LD("TPERMIT h =� Cltpr(Af�S�IUs�J1tb/YY ' RICE, PY NO. / pEd T e.csry Br DAJE Eecery DATEeD ,owre IeeueD BUILDING ADDRESS FIRE ZONE TYPE GROU APPROVED BY DATE ZONING ZONE NO. OP USX OF NEW fLull PLANS L• BUILDING W att gar LEGAL DE CRIFIION A. P. NO. none NOTE: NO EAVE OVERHANG SHALL BE LESS THAN 30' TO SIDE 8 REAR P. L. EAVES ALLOWED (U. B. C. REQUIREMENT) YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET) FRONT FT. FT. R. SIDE FT. L. SIDE FT. FT. REAR FT.f FT. DISTANCE BET. BET. MAIN B MAIN BLDGS. ACCESS. SLOGS. VAR.* DATE C.U.P.# APPROVED APPROVED BY L DATE -22-6 .11ing 227)1 F S F SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION C PERMIT FEE $ �� S 233985.00 PLA CHECK /J , //N TOTAFEE $ L E