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HomeMy WebLinkAbout1102 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 MECHANICAL PERMIT Job Address: 1102 EL CAMINO DR Suite No Vicinity: Parcel Number: 14162109 Applicant: DEANGELIS, DON " Address: 14 SANTA CATRINA Phone: (949)589-6592 RANCHO SANTA MARGARITA, CA Zip: 92688 _ Quantity - Owner `,"HAILSTONE,N LANCE ISSUE FEE $23.50 Address: 1102 EL CAMINO DR , $0.00 0 Inst FAU <100 k BTU $14.80. Phone: - -,;� Repair / Alt Refrigeration Unit $0.00 COSTA MESA;" CA Zip: 92626 Contractor: COAST AIRE $0.00 0' Address: 14 SANTA CATRINA 0 - Evaporative Cooler $0.00 -0 Phone: -Zip: (949) 589-6592 0 RANCHO SANTA MARGARITA, CA � $0.00 92688 _ " $0.00 License: 355425 SCOPE OF PERMIT Status: ISSUED Applied: 04/06/2004 Issued: 04/06/2004 ISSUED BY: ' R. 8 R. FAU < 10K BTU. " FEE SUMMARY _ Quantity - Quantity". ISSUE FEE $23.50 Repair/ Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $14.80. - 1- " - -,;� Repair / Alt Refrigeration Unit $0.00 0' Inst FAU >100 k BTU $0.00--0- _ Ve'ntillatidri System $0.00 0' Repair/ Alt Cooling/Heat $0.00 0 - Evaporative Cooler $0.00 -0 Inst /,Rep. Recess Wall Htr $0.00 0 Commercial Incinerator % � $0.00 0 . Refrig Sys <100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys >�100 k'BTU ". $0.00 0 Compressors / Absorption Systems . Gas Piping `, $0.00 0..,.Up to 3 hp / 100 k BTU ;', `- $0.00. 0. Factory Fireplace $0.00 0 ' 3 To 15 hp / 500 k BTU �/ .$0.00 0 Hood w/Mech Exhaust .. $0.00 0 .r, � ? 15 To 30 hp / 1,000 k BTU $0.00 -0 VAV Boxy " • a $0.00 0 - 30 To 50 tip /1,750 k BTU�� $0.00" 0 Vent Fan / Single Duct x$0.00 _�.0 " Over 50 hp / Over 1,756 BTU,!, '"�" $0.00 0 Appliance - '$0.00 0 = - - Boilers -I I I I I ' Fire Dampers $0.00 0 -"' Up to 3 hp - - - .$0.00 0 Smoke Dampers $0.00 0 3 To 15 hp - $0.00 0 Inst or Relocate Appl Vent $0.00 0 - 15 to 30 hp_ .' $0.00 0 Air Handlers < 10000cfm $0.00-_0 . 30 to 50 hp - - '- x$0.00 0 Air Handlers > 10000cfm �'� _ $0.00 '0 - - _ - - Over. 50 hp . ,� j $0.00 0 Floor Furnace _ $0.00 0.. Other Mechanical Fee Floor or Suspend Heater`, $0.00 ..0 " Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 .. TOTAL CALCULATED FEES $38.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 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 (6/00) J 1 DECLARATIONS 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 Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carder and policy number are: Carder: Policy Number: I sect/on need not be completed it t permit is valued at one hundred dollars ($100) or less.) em rtorme that in the pencethe w for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' co pens n laws of Celifom' e d e e that If I should become subject to the workers' compensation provisions of Section 3 of he Labor Code, I shall forthwith ase provisi, qs. 011 Applicant Sign e: Date: _ ` /ao� "I LURE TO SECUR O RS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMP O CRIMINALkENA61ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I he I am licensed der provisions of Chapter 9 (commencing with Section 7000) of Division Business and Protssions Code, and my license is in full fort c M CI Contra rs Si ure: 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 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 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 contractors) 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 Drivers License No. Expires: Verification of 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 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 6, 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). ............................................................................................_.........................._........................................_......_._Y..........._....._...._.....................................__................................_..... ........_.................................................................. 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 theapplicant 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. ........_........_......................_......... _..................... .._............... _................. ...... _.............. ............................................................................................................................. ............... .... .................. .............................................._... I......................... 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 WIII the applicant or present or future building occupant require for the work which is the subject of this a plication aPPermII for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yee L_I No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). B Will any part of the facility t0 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 ..........._........_............. ........... _........... _.............. .............. -... _..__...... .............. __...... _..._.... ................. ....................... ... ........ ............................... ........................................................ .................... -................ ............................... I............. 6 (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 ATj ORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. 1 agree to comply with all stet aws and ci ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property fo inspec n osea agree not to occupy or allow Occupancy of any building authorized by this permit until final inspection. i u t wner(5) I� e And/Of Authorized ABOftt le CODE Jr. INSPECTION TYPE PAIF. IIffIDALS COOED INSPECTION TYPE INTITAk6 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 BIOcWRelaining 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 Al CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENT SERVICES DEPARTMENT January 10, 2005 BUILDING DIVISION NOTICE OF PERMIT EXPIRATION Lance N. Hailstone 1102 EI Camino Dr. Costa Mesa, CA 92626-5529 PERMIT NUMBER (S) FOR: PROJECT ADDRESS: M04-00163 Replace FAU 1102 EI Camino Dr., Costa Mesa This is to advise you that the above permit is about to expire. Per Ed Petros, Chief of Inspections, you have 10 days in which to complete the job and have an approved final inspection. If you do not complete work and have an approved final inspection, your permits will expire on January 25, 2005. Additional fees will be required to finalize expired permits. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will assist you. We appreciate your working with us to resolve this matter. Sincerely, t &MJane Weidenkeller Office Specialist II Building Division (714) 754-5273 • Code Enforcement (714) 754-5623 • Planning Division (714) 754-5245 FAX (714) 7544856 • TDD (714) 754-5244 • v .ci.costa-mesa.ca.us i, e CITY OF COSTA MESA �/ ' BUILDING DIVISION _ DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER B98-01056 (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1102 EL CAMINO DR Status: ISSUED Suite: Applied: 06/16/1998 Vicinity: Issued: 07/20/1998 Parcel Nunmber: 14162109 Zoning: Applicant: MEIR, GERARD Address: -- i' Phone:' "_ 714-9207270 r f Zip: r_ Owner: HAILSTONE; N:LANCE Address THOMPSONr'JEAN Ems.- i Tri �� - COSTAESA CA� ., -:one P.h h � L102ELCAMINODR Zip 92626 _ contractor:' ;A MIER.CONSTRUCTION CO. .wr Add/i.,' d ess: 11792 DEQ -LNC Phone: 714-534-3105 ,, v,yv /v � - (�GARDEN:GROVE Zip�,i 92840 ���A� 'j, P ; �jA License: l 394335 /Aroh /Eng Ti, Address i/,i = : _ �/'"' ,.T:'",,,.� '� it , Zip: License: SCOPE OF PERMIT 'JCONST 116SF ROOM ADDITION TO REAR OF�HOUSE AND SECOND FLOOR MASTER BATH � REMODEL "CREATE CLOSET J = / FEE SUMMARY: —r4 Plan Checki $,186.71 r �_ lCalc Valuation g19454.00 h `'� -Permit,�,\'x$287.25 - _ Claim Valuation �go.00 � MIP Res i�,',)$1.9511 SMIP Com:, �` x$0.00 �\'$0.00 �� Other-, �A \ \ Inspection:' $0:00, \Total: ',$475:91A\ PLANNING & ZONING SETBACKS MAIN STRUCTURE Front _ 0`0_ i %' Rear 22-6 -: _ Left 51-0 Right = -1l_,0, ACCESSORY Front �0 0:--` "Rear 0 - 'Left 0- 0 i, � F Right - /.'0; 0 PARKING Existing: 0 `Required: 0 Proposed: 0 _ NOTES: 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) 764-5626 0 DECLARATIONS 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, 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 carver and policy number are: Cartier: F P © j'USV k -w « �7-0l(.ScR '� Policy Number�f �`% _/.2 016, (This section need not be completed ff the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certity that in the p dormance 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' compensatlon laws Celli la, an 1gres, that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cafe, I shall forthwith r io C, plicant S Da* ' L/1 p- eo WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLO4�NAL P NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOUARE ($100,)00), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES A$ PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby att' m licensdd under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full _Joride .eon ssIf 1 Date: 'Z-- 49� CONSTRUCTION LENDING AGENCY: ❑ 1 hereby atfirn that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lentlers 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 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 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. It, 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 Drivers License No. Expires: Verification of 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 descand, 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 Cafe). ❑ 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 WIII 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). ............................................ n.t'..................r"lu".............................................................................................*a'g ...en.. nd'P........enti.... Pr..........................aterials? 3 Does or will the applicant or present or future building occupant neetl to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Cade 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 ........................................................................................ I........................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes a 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 Dart of the facility to be constructed under this permit be within 1000 teat 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 II a Permit from the South Coast Alr Quality Management Distdcl or other air pollution control district or agency is reQwired 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? ❑ 9es ❑ 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 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. ligniature Qj4gal Owners) Date 42 Or Authodze Applicant D CQQL. INSPECTION TYPE OAiF INTIMAS CODE INSPECTIONTYPE OATS iNim9{S 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1286 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 Final Sign 222 Final Site 204 Final Demolition 250 Final BuildingtOccupancy_ 244646 CITY OF COSTA MESA r` BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMI UMBER E98-00769 (714) 754-5273 • Fax (714) 754-4656 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: 14162109 MIER, GERARDO 714-534-3105 Owner: HAIL'ST.ONE; N LANC Address THOMPSON, JEAN.E/, Status: ISSUED Applied: 07/20/1998 Issued: 07/20/1998 �-Phone:I' -- - - Zip: Phone Zip: 92626 vvvr� yr rcnnn � fS, 8 SWITCHES, 3 MOTORS UP TO 1 HP & UPGRADE SERVICE UP TO 201 Quantity, „ .'`.`,, ..--� T�� I:>s�,.'_ f� - QuantitY .rn- r _ -Temp Dist System / Lighting= $0.00 0 � - _ Busway,/100 (t/ $0.00 0i' ..,`a c, pac age ,,. a•1 $ New Res'1(1-2.units) \\ $0.00 0 New Res,(3+units) V E FEE $22.00 i service test \',,p / k' $0.00 000 Status: ISSUED Applied: 07/20/1998 Issued: 07/20/1998 �-Phone:I' -- - - Zip: Phone Zip: 92626 vvvr� yr rcnnn � fS, 8 SWITCHES, 3 MOTORS UP TO 1 HP & UPGRADE SERVICE UP TO 201 Quantity, „ .'`.`,, ..--� T�� I:>s�,.'_ f� - QuantitY .rn- r _ -Temp Dist System / Lighting= $0.00 0 � - _ Busway,/100 (t/ $0.00 0i' ..,`a c, pac age ,,. a•1 $ New Res'1(1-2.units) \\ $0.00 0 New Res,(3+units) V `� N, $0.00 (� 0 Pool /Spa,\ Lighting Fiids�$10.00 $0.00 { \v\'� 0 10 Recept Outlets \� i "o ......... up to 50 kva/kw $7 00 7 Switches �V ��$8 00 8 N\ Non ResAppliv�A$000 - $000 '� 0 Res Appl $0.00 0 Service to 200a \A //$27 25��+� �0 1 Service to 1000aA �� �/ $0.00 -�0 Service over 1000a\\- so oo' 0 Motors to 1 h C<�. x$0.00 ,� _ 0 Motors to 10hp _. $0:00, ;� `, 0 Motors to 50hp - $0.00 ', -_�� �- 0 Motors to 100hp �$Q.w ` �;; .0 Motors over 100hp $0.00 \, 0 Communication drops $0.00 0 Sub panel to 200a $0.00 0 Pole Light Pkg $0.00 0 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 Intermed Pole $0.00 0 Standing,Section $0.00 0; - t Misc Electrical Equipment "- , $0.00 i0� Transformers:up to 1 kva/kw $0.00 /o/ ....:..`..._.....up to 10 kva/kw $0.00 "o ......... up to 50 kva/kw +$0.00j�'0 up to 100 kva/kw $0.00j- 0 over 100 kva/kw - $000 '� 0/ �Atf- Low, Voltage.Equipment $0.00 0 ,Low Volt Wiring System / Ckt, - -$0.00 0 `Misc: Conduit ;.�� $O OOi -�0 '�,� Misc; Conductor. % $000 %� 0 Circus ( gen or ride) $0 00` `� 0i ;Circus (mechriiie or lights) ., 0 - Chhstmas�Tree Stand -. _$0.00' $o.001, / 0 _ - Fireworks Stand., - -- $0.00I '0 Other Electrical Fee - . $0.00 ' .� Investigation Fee $0.00 --, Plan Check Fee , $0.00 Reinspection'Fe $0.00 TOTAL CALCULATED FEES $87.00 COMMENTS / SPECIAL CONDITIONS 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 ►I DECLARATIONS 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 ���'0rk for which this peril 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 worlrk�aq'rs' compensation Irns�ur�a�nce rarrierppen��d pofiicny number are: Cartier; 'h R0 (Q�sUQ%uc� 01Gm L242S Policy Number: g( (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) -- ❑ 1 cartify 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' wmpe do of California, and, gree that If I should become subject to the workers' compensation provisions of 5 tion 37 of the Labor Cade, I shall forthwith Uese sil(,'��y� T�I Mgr" c. /gcZQ 4B A cantS ature: m\'M UO 'V�c�N�' Date: W :FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN OV CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED SAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONT�RS DECLARATION: I hereby affi eF Iam li ensetl untler provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the s and Profes ions Code, and my license is in full force act. Uc. p '2a 3Y� A s K Cpdrticjs Sign e: L y^ 'x Date: 'L dig 0 coNsTiRiLi 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: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: 1 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).): ❑ 1, 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 WON 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 Loonies 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 driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, Le. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby comfy, 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 6, 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 petit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII 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 neetl 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). ....................................................................................'1'd'i..........u.p.a.................pro-...................p'(,.............n-'a,g................................................... ,o.r.a............................................... 3 Does or will the applicant or present or future bung=ltliupant 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, cerlification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................................................................................................................................................................................................................................................................................... d 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ll Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ...........................................................................................................................0'0.................................................................................................................................................... e Will any pen of the facility to De canstrucletl untler Ihis 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 .................................................................................................................................................................................................................................................................................... 6 (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. Ig lure Of 1 Ow r(a) Date And/ r dzed Ap5' nl Date COp" INSPECTION TYPE RAN INTMA CODE INSPECTIONTYPE DAM INITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re -Root 210 Final Electrical Liz.- yy 201 Final Block/Retaining 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 2"6-46 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT - PERMIT PERMIT NUMBER A M98-00312 (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 1102 EL CAMINO DR Suite No Vicinity: Parcel Nunmber: 14162109 Status: ISSUED Applied: 07/20/1998 Issued: 07/20/1998 Applicant: MIER, GERARDO Address:- /, Phone: ... .. zip:Y Owner: HAILSTONE, N'LANCE\ Address: iAi��i THOMPSON, JEAN COSTA MESA;CA� : j -r �i1102 Phone EL CAIvll R''i' '� Zi 92626 License: ontractor. , /w i� A MIER-CONSTRUCTION CO. AW\\\ r ,l �{ �Alrcli /.Eng Address f;F � I, -,FEE i Phone: Zip: License: SCOPE OFRERMIT, �i ALTER HEATIN&DUCT & 3 VENTELATION FANS REF1398-1056 \ Y ',7 � ' �y 11792.DELLA LN- ���� Phone:' 714-534-3105 ",y\\,, JGARDEN GROVE Z{p ^ 92840 ,I, L{cense > 3943.35 -4 SUMMARY.,` --I,/ ..-Quantity quantity $22.00, Repair / Qlt Absorbtion Unit $0.00 ' 0 � ti Inst FAU;� 100 k BTU $0.00 Re'pavd.Alt Refrigeration Unit y --$0 00 OV, Inst F' U11100 k BTU ��`-.� $0.00 Ventillation.System , � $0.00 +0' � Repair' Alti Cooling/Hea$1225 1 Evaporative Cooler$000 .i0/ Inst / Rep:.Recess.Wall:Htr\ 4` $0.00 0 Commercial Incinerator '= � $0 00,'i 10' Refng Sys'c100 k BTU V $0.00 0>n'Dpmestic Incinerator$6.0 � -0 Refng Sys 100 k BTU � A�,\ $0.00 0 Compress... / Absorption Svstemsi Gas Piping ll�\ $0.00 0 , Up to 3 hp / 100 k BTU $0 OOa 0 Factory F{replace�V ��$0 00 , .0 "-�� 3 ToI, k BTU ,:$0.00 0 Hood w/Meth Exhaust$0 00, 0 ;%',15 To 30 hip 11 000 k BTU , $0.00 0 VAV Box /$19.50 0.00110,,�- '130To50 hp71450,k BTU /,/ '/ �-$0.00 0 Vent Fan /Single Duct, _- / $19 50 310ver.50hip %- Over ,1;750 BTU $0.00 0 Appliance%x$0.00_ , 0 � � Boilers Fire Dampers -0 Up to 3 hp $0.00 0 Smoke Dampers -$OAO %%0 3 To 15 hp,' $0.00 0 Inst or Relocate Appl Vent $0.00 � ,0 � - 15 to 30 h r �i P'.' � $0.00 0 Air Handlers < 10000cfm � $0.00 -, 0 30 to 50 hp ; $0.00 0 Air Hantllers > 10000cfm $0.00- -0- \� Over 50 hp - $0.00 0 Floor Furnace $0.00 ' 0 - ,Other Mechanical Fee Floor or Suspend Heater $0.00 0.Investigation Fee $0.00 Plan Check Fee $0.00 Reinspect TOTAL CALCULATED FEES $53.75 COMMENTS /SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 100 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 appro val will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 ion Fee $0.00 TOTAL CALCULATED FEES $53.75 COMMENTS /SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 100 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 appro val will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIONS 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 performance of the work for which this permit is issued. Myw �y wmpenj�tion l`nsu�a����Mer endppoli�cy�numb�er�ere�:1 +, p Carder: nyK f`Nw�V K1WlL '<�F4T3�Yi1�� Policy Number. OI NY��� Z�9k (This section need not be completed if the permit Is valued at one hundred dollars ($100) 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 Is of C domia, a agree that if I should become subject to the workers' compensation provisions of S ction 3700 of the Labor Code, I shall forthwith comply with thas w I s. PY c Applicant Slgnature: o, E4.L Date: —%�2a' ��91 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMIItAL 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 3106 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. p Class P Contractor's Signature:D j` � Date: 7 -2 �f Y 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 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).): ❑ 1, as owner of the property, or my,employses with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended of offered fol 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: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, Le. - property in 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, 71t1e 6, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safely, 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). .............................t..................................................................................................................................................................................................................................................... 2 Does or will the ei Piiwnt or present ar 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 hes on hand a quantity of acutely hazardous materials equal to or greater than a weight of SDO 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 apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ............................... - .....................................................................................................................................................................................I................. 4 If en RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No ...................................appl..............................futu....buil..........................quir..........................hich.................ject..f thi.......plic.tion.a.....nnit...................nstructi .............diff ...tion. 5 Does or will the applicant u present or future building occupant require for the work which is the subject c this LJ Yes apertnit for such construction or modification from the South Coast Air Quality Management District or from any Omer air pollution control district or agency? LJ Yes LJ No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ............................................................................................................................................................................................................................................................... 8 Will any pan 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 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is regqwired for the work which is the subject of this application, have all 01 the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Vas ❑ No .................................................................................................................................................................................................................................................................................... 6 (If'yea*, attach certificate of compliance from the appropriate air pollution control officer). CERTIFICAT OF COMPLIANCE: I codify that under penalty of perjury the information given above is correct. I agre to comply with all state laws and city ordinances regarding Hez /o�u�sf.Tdl aterials d Emissions. Signature: VOII C. L + dC _ Date: Z� 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. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE L I �ESPECTIONTY� PE 2ATE ILiilm CODE 1 INSPECTION TYPE ge¢ 1616 Fixed System Final Fire Prevention 206 Final Mechanical t I Z -99 MW 1266 Pool Spa Final 206 Final Plumbing 200 Final Re-Rcof 210 Final Electrical 201 Final Block/Retaining 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 2"646 CITY OF COSTA MESA ;4 BUILDING DIVISION _ DEVELOPMENT SERVICES DEPARTMENT J •���; PERMIT (714) 754-5273 • Fax (714) 754-4856 PLUMBING PERMIT Job Address: 1102 EL CAMINO DR Suite No Vicinity: Parcel Nunmber: 14162109 Applicant: MIER, GERARDO -- r PEROT NUMBER P98-00578 ✓ 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 07/20/1998 Issued: 07/20/1998 Address: Phone, , /f Zip: Owner: HAILSTONE\N LANCE- Address' (rTHOMPSON,1JEAN E�?��, �/ 'i /COSTA MESA;CA i% Phone: � � i > I ,,, { '1102 EL CAMINOiDR Zip: 92626 VAVA;�/ Contractor:: A MIER,CONSTRUCTION CO. 1j..: 1U /�Address:,114792.DELLA LN -, �• -,I,. - �� Phone,, 4-5343105 GARDEN GROVE a ��Zip,"_92840 i , License` 394335 It I '', Arch I Eng ,rte 4 A . i Address Phone ,i ),,i iii ♦ ��'. �'- �\ license: - SCOPE-OF,PERMITy BATHTUB, SHOWER, WASHBASINWATER CLOSET REF 98-1056 _ - V'�All� FEE SUMMARY--L- UMMY---..-�- AR - i v "'0 0"�fXMT QT.Y AMT QTY ' AMT QTY ISSUE FEE\ ���' $22700 Laundry Tub/ Washer r $0.00 0 Sump Pump' $0.00 0 Backflow irrigation ,i� $0;00 0 Landscape Irrigation; �$0.00 0 Swimming:Pool "'.$GAO 0 Backflow Preventer $O.00gV 0 P Trap I, 0.00 0 Trap Primer t/ $0.00 $0.00 0 Bathtub -� �� Clarifier _( $8 75 �X�t Pressure Regulator f , $0 00: 0 Urinal - $0.00 0 Systeme $0 00�V1'0•, - Process Piping (per 10,ft)�.$0 00':' 0 :.'Vacuum Brkr Bkflow(14) $0.00 0 Connect (Ice,Soda etc) $000v `0��� .*Receptor`s-r"` ', $000•.10 Vacuum Brkr Bkflow(5.)' $0.00 0 Dental Units <$0.00 0 _;Septic Tank'0 �1; $0.00 _-0 - Wash Basin: $8.75 1 Dishwasher �.,-,� $0.00 j,0 :`Sewer Caprfor Demo - X$0.00'-"-0 Wash Basin Set ii $0.00 0 Drain, Floor ���c$0.00' �/ 0 j ;_ � -Sewer Connect; ��'� �� -.$0.00- '0 _ 'Waste and Verit".System $0.00 0 Drain, Rainwater -` $0:00\ I0 % - Sewer Private Line - - $0.00"' 0 Water Closet (Toilet) $8.75 1 Drain, Roof "$0:00,- 0, 'Shower $8.75 '1 'Water Heater/vent $0.00 0 Drinking Fountain $0.00,_'_ 0 .'� Sink, bar` - - '. $0.00 0 - Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00", Sink; commercial$0.00 - .,0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 '0 - Sink, Floor - $0.00 0 Water Service $0.00 0 Gas It outlets) $0.00 0 Sink, kitchen.,..,. , „ ,$0.00 0 Water Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, service/mop a -- $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $57.00 COMMENTS / SPECIAL CONDITIONS IEXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned I 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 I 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) 7545626 0 DECLAMT16NS 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 ttc��� work for which this permit is issued. h, 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. 1 My workers' compensation Insuran cam er and poli nummbbeer�arre: o p, C/ Cartier. 7_4 P'�.�Ci) �� P'FL�.f �i{� Policy Number. •> 'i 0%�vC7ZQ% � LO (This section need not be co�p/eted i/ the permit Is valued at one hun red dollars ($100) 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' compensatbn I s of Ilfomia, and a that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with lIn ovl I Applicant Signature )'CTC E �� Date: -0 WARNING: WARNING: FAILURE TO SECURE WORKERSCOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENALTIES ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION W06 OF THE LABOR CODE, INTEREST. AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am 111ii:anseJ under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license is In full force and effect. Lia x 5 3C a. Class q �- Contractors Signature: > Date: 20 P 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). Lenders 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 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.). ❑ 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 Lew 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: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, Le. - property tax bill or dead): 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 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 Cade). ❑ 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 torte 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 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 aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ................................................................................................................................................................................................................................................................................... e Will any pan of the facility to be conslnlcled untler this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes-, the facility must most the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................. .............................................................................................................................................................................................................................. I........ 7 If apermit from the South Coast Air Quality Management District or other air pollution control district or agenis required for the work which Is the subject of this applicatlon, have all of the disclosures prescnbed by Califomia Health and Safety Code Section 42303 been madecy ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... 8 (If yes-, attech 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. ne(gre Of Legal Owner(s)/,6;y- And/Or 9 r' And/Or Authorized Applicant Date CODE 0 INSPECTION TYPE DATE INTITIAIS CODE M INSPECTIONTYPE DATE INTITI� 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pwl 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 2448-46 w I 90212 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 917 COSTA MESA, CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT FBIJILDING ADDRESS 1102 E1 Camino Drive COSTA MESA, CALIFORNIA . OWNER Masa Del Mar Development Co. MAI RESS -3800 E Coast Highway TEL. Oriole R KIM r 21 X 971 I No.or BLoae,.One NOW ON LOTNG. jROM/'ET 5Ot REARYARD1611 EFT $1 RIGHT lOI DESCRIPTION OF WORK BUILDING NO. OF SIZE I7 1611 ROOMS 7 STORIES 2 EXTERIOR WALL WC Od PY ROOF Shake COVERING ,^itlirm COVERING Rhing1p USE OF BUILDING AND WORK TO BE PERFORMED Single famij,,� dwelling: w attached garages FEE RECEIVED iIOC 2 5 ��qq APPDCATION F R PERMIT FINANULII"Wih CI[yFpA qq&-MW®Spnly, 1 - I RECEIPT NO. PEgpIG I L RECEIVED it 1, DATE RKWAUD �L DATE ISSUED ZONING ZONE xoFNXTpIng.L Ian R-1 Puna 2 B ILDING0 att g LEGAL DESCRIPTION Tnt, 9 Trani, 5021 A. P. NO. none NOTE: NO EAVE OVERHANG SHALL BE LESS THAN 90• TO SIDE & REAR P. L EAVES ALLOWED (U. B.C. REQUIREMENT YARDS APPROVED YARDSAPPROVED MAIN BUILDING ACCESSORY BUILDING VAR.# DATE C. U. P. # APPR APPROVED Plan 500 -AR SO. FT. 1 HEREBY ACKNOWLEDOS THAT I HAVE READ THIS APPLICATII THE AMOUNT SHOWN UNDER VALUATION IS FOR THE F' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CPURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATILUAT10N ODB UILOINO CONSTRUCTION, SIGNATURE OFPERMITFEEPERMITTE 23,925100 PLAN CHECK $ 7 a AUTHOR DAG NT— �J� L ' TOTAL FEE //EA• Q U Z< Q W D: a l+l J ZO M J 2 W w Z _ Z I— w0 In = Z)O F 39418 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 13—oo �3, 1 �ia.5a c �<<i., APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RE IV BY DATER C I D T IS ✓ BUILDING / /J �2' ADDRESS C. d K —667 PE A OWNER �7if,� A.P. NO. MAIL �/ BUILDING ADDRESS ( ADDRESS 116, pz7 1/1 �/ CITY er Qj NOL�y�i-�% TRAC LOT BLOCK. NEW IADDIAL FPAIF1 CONSTRUCTION LENDER BRANCH jj NER ADDRESS ALOE LY(J $ ARCHITECTT EL. OR ENGINEER D z— N0. FFRE ADDRESS ZONE TYPE :ItGROUP APPROVED CONTRACTOR BY DATE ADDRESS TEL. 20 NO. OF USE OF N CITY NO. I PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING CCESSORY BUILDING SIZE NO.OF SLOGS. IF ROM C/L S EET) OF LOT NOW ON LOT RONi FT. USE OF yy II ! EXISTING BLDG. R. SIDE FT SIZE OF NO. OF NEW BLDG. ROOMS STORIES L. SIDE T. FT. EXTERIOR WALL ROOF COVERING COVERING REAR FT. FT. SE BUILD1.7 AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN SLOGS. ACCESS. SLOGS. VAR.*y. DATE ! O C.U.P.+ APPROVED APPROVED 6,j - 3- 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 TqX the State of California. 1 hereby certify that 1 am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business and Professions Co a Division 3, Chapter 9. `/ VALUATION PERMIT FEE $ Signature of �r♦f vy Permittee /%f�Z�rjl��N "- $ ^,/ • n (� PLAN CHECK $ Authorized Agent � TOTAL FEE $