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HomeMy WebLinkAbout1103 EL CAMINO DR - Building Permits(714) 754-5273 • Fax (714) 754.4856 • www.ci.costa-mesa.EL&TRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1103 EL CAMINO DR Status: ISSUED Suite No Applied: 09/30/2005 Vicinity: R P ' Issued: 09/30/2005 Parcel Nunmber: 14162310 R Applicant: RUVALCABA, GILBERT Address: 1103 EL CAMINO DR ISSUED BY: Phoria `,;714-444-4230 COSTA MESA, CA r:Zip y,_ 92626 - Owner: RUVALCABA, GILBERT AND AUDREY Address 1103 EL CAMINO DR Phone: - - C(1RTA UFRA GA din- 09R9R 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(600) FEE SUMMARY n = Quantity. r , ':Quantity ii { ISSUE FEE �:� _ i-$23.50, _ Temp Dist System (Lightirig ' $l).00 0 .: {t •'- -- - Temp service test �. $0.00 Busway /100 ft $0.00 _ -0 - -- , k' Res.a/c package - $0.00 Standing Section $0.00 - 0- -` Ne Res;(.1=2 units) -- - $0.00 0 t - _ Misc Electrical Equipment `r $0.00 ;, 0 Ne`w Res':(3+units) -. $0 00 " -0 Transformers up tot kva/kw. ,$0 OO•: 0 p ,� "ll Pool Spa $0 00 " 0.. ; .. '-� - .. up to 10 kva/kw ' $0 00 -- - 0 ing Fixis - Lighting g <. $0.00 0 -- = up to 50 kva/kw ',-SO 00 ..- 0 > , Recept Outlets --. $0.00 - _ . up to 100 kva/kw $0.00 - Switches - ' y , $0.00 - f 0 ............over 100 kva/kw $0.00 �'$0.00- 0'. ' , •" " Non Res Appl ,ti $0.00,;<.; 0 Low Voltage Equipment 10 Res Appl `- $0.00 0 Low Volt Wiring System / Ckt $0.00--- 0 Service to 200a -. $30.50;.,. 1 Misc. Conduit .$0.00 0- Serviceto•1000a $0 00 • 0 i Misc:. Conductor $0.00 - 0 Service over.1000a $0.00 - 0 - _ - Circus ( gen or ride) $0.00., ;- 0 Motors to 1 hp - $0.00. 0 Circus (meth ride or lights) $0.00 ,- 0 ... Motors to 10hp - $0.00 ,' _ 0-- _ Christmas Tree Stand . - $0.00- 0 Motors to 50hp_ $0.00- =-`0 R1"` , -Fireworks Stand -; - _`„ $0.00 - 0 , Motors to 100hp ,. $0 00 - - 0'. _ Other Electrical Fee $0 00 - - Motors over 100hp, $0.00 0 • -' " Communication drops ,"$0.00 -0: -Investigation Fee -� $000'_x., Sub panel to 200a _ $0.00 0 Plan Check Fee; $0.00-` Pole Light Pkg $0.00 - -0 "-Reinspection Fee- $0.00 Sign Circuits - $0.00`t 0 `-'- Temp Pwr Pole $0.00 0 " TOTAL CALCULATED FEES ' $54.00 Intermed Pole '$0.00' 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(600) DECLARATIONS 0 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 carrier and policy number are: Carder: Policy Number: (This section need not be completed i/ the perm/t is valued at one hundred dollars ($100) or less.) j�l certify that in the pertorma 1 thew c for vhich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of C o , and a ee t t If I shoultl became subject to the workers compensation provisions of Section 3700 of the Labor Code, I snail forthwith comply with these pro si Applicant Signature: Date: — /y/ /� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL MINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000). IN ADDITION TO THE COST.OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I.$ 4 ¢f.. 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing viithSection 7000) of,Division 3 of the Business and Professions Code, and my license is In full force and effect. Lic. x Class It Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the periortmance 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 requites the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): . ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not appy 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 Iw purpose of safe.). ❑ 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 purs to the Co rs License s.). ❑ 1 am e p der sec. Business and Professions Code for this reason: Signature: /Date: Owner I verified by drivers license. Yes ❑ No Driver's License No. 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 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 Wil 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 torn 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 appplicant 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 en RMPP is presenly requiretl, has Section 25534 of the Califomia Heelth and Safety Code been fully complied with? [1 -Yes. ❑.No 5 Does or will the applicant Or present or future building occupant require for the work which is the subject this a plication apertnit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agencc y? 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). ....._..... ...._........... _.......................... _............................. _................. _...................... ........... _......... ______..... ............................................................................................... ... y...................... ❑ .................................................................. 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves 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 California Health and Safety Code Section 42303 been made? ❑ Yes [I No ........................................................................................................................................................................................................................................................................................................................................................................................... 8 (If fires", 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: CE CATE 0 COMPLI E AND AUTHORfZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is cor ct. I afire o comply, e laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the a ve-desc ed property f Ins a n puryoses. I agree not to occupy or allow Occupancy of any building authorized by this permit until final inspect Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE 0. INSPECTION TYPE PdLF INTMALS CODE# INSPECTIONTYPE p9IE jNIMIAL� 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical �a k� 201 Final BlocWRetaining Well 212 Final Fire Prevention Ph 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - 250 Final Building/Occupancy ma (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1103 EL CAMINO DR Suite: Vicinity: RESIDENCE AND ATTACHED GARAGE Parcel Number: 14162310 Zoning: Applicant:ZA-IOA.1, •`^' „''"`"t Address: 2016 WALLACE AV - UNIT B Phone: 949-642-7057 COSTA MESA ;,CA Zip: 92627 Owner: RUVALCABA, GILBERT AND AUDREY Address 1103 EL CAMINO DR Phone: - - i Status: ISSUED Applied: 08/19/2004 Issued: 08/19/2004 ISSUED BY: 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 2446.46 (6/00) COSTA MESA, CA - Zip: 92626 - - Contractor: 'LEMUS ROOFING Address: 2016 WALLACE AV UNIT B, Phone: 949-642-7057 - " COSTA MESA, CA Zip: 92627 ,License: 826813 Arch :. Eng: - Address: - - _ Address: - • Phone: Phone: ' '-Zip: - License: License:, SCOPE OF PERMIT_ _ TEAR OFF WOOD SHAKES, INSTALL SHEATHING,�COVER WITH FELT AND 50YEARCOMP SHINGLES. INCLUDES ATTACHED GARAGE: FEE SUMMARY Plan Check:. $0.00 Calc Valuation: $10,000.00 Permit: $181.25 = = Claim Valuation: $10,000.00' SMTP Res: $1.00 ,SMIP Corn: $0.00 i' r Other: i $0.00 Inspection: � $0.00 \ $182.25 ,Total: • � ��/ / - �.-i—= ci PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0- 'Rear Z., 0 0 Leff' 0-0. ,"Right, 0'0,-� �, ACCESSORY�F.ront'- 0-0 �e Rear• 0-0 Left 0-0" Righty :'0-'0 ,J PARKING Existing:. o Required: oProposed:', 0 NOTES: 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 2446.46 (6/00) 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 he" and will maintain workers' compensation insurtance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. My workers' cor to ce mer d II rare: Carrier: J I. Policy Number: (Thi se need not be corn I ted i! a permit I 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 Celifo//rnii(iff,, ann/dddn agreee� that I I should become subject to the workers' compensation provisions of Bach n 3700 of t e Labor Code, 1 shall forthwith comply th Applicant i Slgnature:e� ^-yy//�� Date: WARNING: FAILURE TO SECURE EN WORKERS' COMPSAAON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTIES GVIL FlN S UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3m6 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. Llc. NClass p Contractors Signature: fLh 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 afliml 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 at Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Cade 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: ❑ 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 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, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................ ..................................................... _.......................... ........................................................................................................................... __...................................... _....... -...... _............................ ......... _........ 2 Dces 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 Mese 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 Oces or will theaGplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes 11No (Section 25534 of the Califomla 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 en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No 5 0099 Or will the applicant Or present or ferur0 building oceupant require for the work which is the subject of this a plication a E_ NC for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control dlsMct or agency? U Yee u No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ...................................... ............ ............................................................. _... _._............................................... _....... ................................................................. .............-........... _.................................. .......................................... ............ I..................... 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 (it'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 El 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. / gn ure Of Le al Owner(s) D T An ' r Authorized Applicant Date CODE 0. INSPECTION TYPE gdlE INMALS CODES INSPECTION TYPE psg INTITdLi 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Relaining 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 C PROJECT ADDRESS: 1103 EL CAMINO DR OWNER'SNAME: BATH,AM, ERNA�pA ADDRESS: 1103 EL CAMI.A.IP, COSTA MESA,CA ARCN/ENGINEER: ADDRESS: Z 1 /, UNIT: 92626 REG.NO.: UNIT: PERMITTEE: WATER NETWORK (714)528-2760 ADDRESS: 3350 E BIRCH 245 BREA CA 92621 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 Pmfe;siaLn�Cotl� ypit my license is in fu)L �rCe and effect. CITY LIC.: ST�E LIC,: JJ fill 77 V� L1A55. C b�� Date: _�/2 0� Signatures WORKERS' CONIPEN ATION DECLARATION: I hereb affirm that I have a coordinate of consent to self -insure or a cendicale of Workers' Compensation Insurance. or a certified copy thereof (Section 3800. Lab. C). POLICY NO.: EXP. DATE: COMPANY: ❑ Climbed copy is hereby furnished. ❑ Cemtied copy is filed with the city Building Division. date. Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued I shall no employ any per in any manner so as to become subject to a Worker Comrpe%% to Laws of Carleton �,/ / Oat e ii, N ICE: If, of er making this declaration, you should became subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shalt 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 ContractorsState 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 Contractors' Stale License Law (Chapter 9(commencing with Section 7000) of Division 3 ofthe 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 penally of not more than five hundred dollars ($500). I, as owner of the properly Of 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. It, 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). L as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Section 7044. Business E) no Professions Code : The Contractors' $late License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractods) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. S P. C. for this reason: Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505. 25533, and 25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modificalion from the Air Coolly Management District. Residential construction applications are exempt from these provisions. Date'. Applicant: I hereby certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and stale laws relating to building Construction and hereby authorlie replesenlatr,3 off this city to enter upon the above mentioned property for in fiction purposes Dale: L U 764 t 46 White—Building, Green—Code Enforcement, Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: P 065779 PLAN CHECK NO: N CONSTRUCTION TYPE: PERMIT TYPE: PLU JOB DESCRIPTION : REPLACE BROKEN WATER PIPE CLAIM VALUE: CALL—VALUE: PURPOSE: OTH SQ FT: GROUP OCC: / COMMENTS:,NO OTHER WORK AUTHORIZED BY THIS PERMIT 1E if 9E 9E Jt BE iP iE iF if fE iE BE eE iE * * iF it iE if !E 9E 4 it ie Bf ie if if iE iE iE Bf iE eE 1E of iE if * 9E fE BE BE TE iE * if 1E BF * BE BF aE 9E iF 9E fE iE i¢ iE Bf * 9E BE if fF iE iF+t 9f ie iF 1E if BF it a4 - Z O N I N GS E R T E B Q A U C I K R S E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 14162310 ZNE: REF NO: PLANNING NOTES> > Bf ii ii iE%Bf ie ik if * 1k iP is 9E iE BE it iE iE BE iE iE ie it 1E if fE iE iF ik 1!!E * at iE i! fF 1P Bk BE if * iE BE iE it if BE if BE BF iE 9E BF if iE * iF if ik 1E iE BE iE JE iE 1E as 9E 9E iE BE JE * Be fE it * iE 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 DATE: BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: DATE: Be B! Bf Bf %it Bf if if BE * BE BE BE iE * * k f! 9E 1E 1f3E�iFiFTiFiFiF�iF�F3FTF'{FiFiF�iF'iFiF 3FiFiPlP3FTF3F3F9f3F iE iE BE iE lE if iE le iE BE ik ft i(- i( -BE 9E * * iE 1E BE 9E iE iE BE BE iF iE if IE iE iP if iE BE if if k it ik ie Bk BE iE ie if 1k * BE * * * iE iF 4E BE iE ik 1E iE ak BE iE * iF dE BE iElE iE iE 9E'1E iE fF )E if !f BF iE if BE * iE eE 9E i( -9E dE 9E 1E LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 7,00 25% 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 REVENUE DIVISION TOTALS--> COLLECTED: 27,00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 27.00 if ie 1E ik BE ie BE of ik ie BE iE 1E 1E 1E lP 1! 1E iE iE iE iE BE iE Bf iE * iP iE iE 1E BF iE it JE iE BE iE * * fE * 9E iE BE BP if ie * iF if iE if iE iE iE if ie iF iE * * 4F iE JE BF iF if BF iE 9f BE 9f 1E iE 1E iE lE dE I N D I V I D U A Lj ,,,IF 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 RE—PIPE 7.00 7.00 END•OF FEES 11. 00154)66-00154056 Till 27.00 unTE: 01.120/04 TIME: 10:30 CONSTRUCTION AND PLANNING APPROVALS Permit # Date F--or POOL .PA APPROVALS Permit # Date i\ Inspector 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms �4. Electrical Condua-Undrgrnd. 55. Electrical Bonding ! 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd 57. APPROVAL TO COVER-GUNITE { 7� Footings 58. Electrical Conduit-Undrgrnd. • Q: Foundation - 59. Gas Pipe, O Undrgrnd., Test 9`. Water P pe-Undrgrnd. 60. Backwash Lines, P-Trap, C Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor Final 12. Sewer Cap 63. Heater & Vent-Final , 13. Roof Drains y 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final } 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ~ 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit-T ! ! 20: Rough-Factory Fireplace 21. Ducts, in Structure 70. UnderVound Hydro 22. Ducts, Ventilating - .' r `, 71. Product Piping '-Gas COiI 23- Gas Pipe-Rough &Test -- 72, Underground Flush 24 Roof Framing _ 73, Undergind. StolDge Tank ❑Gas Coll 25. Roof Sheathing 74. Overhead Hydro- , 26. T•Bar Ceiling (StTUCtUrall & MOnOCOat 75, Dry Chemical 27. Frame and Flashing _ 76. Dry Stane:pipe 28. Lathmn & Siding 77. FIXED SYSTEP-0 FINAL 29. Insulation '• 78. FIRE FREV. FINAL - 30. Dry-.;l,' Nailing - HEALTH DEPT. REQUIREMENT 31. Plast^,.$rown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33, Final Electric 34. Final Heating & Air Conditioning 35, Final Gas Pipe-Telt Notes: ( ( ( I 36. Hood or Canopy 37i F,naI Fectory Fireplace 38. Final Plumbing o 39. hater Service-Final 40. Gas Serv,ce-Final. 41, Solar Domestic-Final 42, Backflow Preventer _ ! 43. Backflow Irrigation --i - . 44. Landscape irrigation System,.- 1 - 1 45. Sound Attenuation ' 46, Handicap Regulations - 1 47. FINAL STRUCTURE & BUILDING --- 48. FINAL PLANNING 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _ 0 a7� -30 ^73s-ta jl© 3 �E� OWNER NOONAN GREGORY DATE 9-2-77, 108 ADDRESS 1103 El Oa�mtno Drive BUILDING PERMIT N0. 57 GENERAL CONTRACTOR Owner -Building DESCRIPTION of WORK Add Maacter B F 0486-46 (BU 4) edroom & Raath P No141-62 -10 LOT TRACT FIRE ZONE VALUE f IN �t^)CTIONS Si nature Dats jj— TYPE GRDUP ZONE SUBCONTRACTOR _ c� Data Number Si nature WATER Pimmbina PLUMBING^ - J;OUGH PROP: SWR. LINE lJ HOUSE CON. F] ySPRINKLING SYSTEM .MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONINGA TEMPORARY SERVICE OR POLE UNDERGROUND POWER I_A AF— ROUGH WIRING _ G A,'vY Illectipa'd. TRENCHES FORMS STEEL REINF. i2 I FLOOR SYSTEM BOND BEAM 'STEEL REINFORCE SHEATHING TTE-jL=p--::n FRAME AND FLASHING LATHING — IN OUT C`If -7'— '— PLASTER, BROWN COAT STRUCTURAL, FINAL AF -'NG, VENT., REFRIG. AND A.C., FINAL .�j• I -/- n F !NG, FINAL AND GAS TEST ELECTRIC, FINAL •�� BUILDING, FINAL SPECIAL REQUIREMENTS UTILITY NOTIFIED, GAS ELECT. OCCUPANCY F 0486-46 (BU 4) /a'vA+ 4 1 PeRm'T '9'`frPro fig., 4 iV COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 FCITY 7S51)3� n Completely — Use Ink Only BUILDING �_'i— C/� 1/J U rpt Q%IQ /AA 'MAIL yt�G` '`� M, IW/ (] �t'jh&E?,4' NOI. 7_ jG- BRANCH ADDRESS ARCHITECT Dr ow --A CONTRACTOR TE BUILDING ADDRESS OWNER 631 o USE FIRE ,Sr9 ZONE APPROV SEP-1-77PAIBCMSA00 002* ***115.09 .TION FOR STRUCTURAL PERMIT BY I DATE RrCEIVEDF nnrc iccncn P KO VALUE OATEi"/ —/' ADDRESS NO.OF CITY TEL. PLANS 2 STATE NO. LIC. NO. w SIZE CITY OF LOT �� TE BUILDING ADDRESS OWNER 631 o USE FIRE ,Sr9 ZONE APPROV SEP-1-77PAIBCMSA00 002* ***115.09 .TION FOR STRUCTURAL PERMIT BY I DATE RrCEIVEDF nnrc iccncn P KO VALUE OATEi"/ —/' a' ZONEfZ� NO.OF USE OF NEW �p14C TEL. PLANS 2 BUILDING NO. r � Separate permits are required for L. SIDE CITY YARDS APPROVED YARDS APPROVED LIC. NO. MAIN BUILDING ACCESSORY BUILDI (FROM C/LSTREET REAR NO. OF BL Gs. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. NOW ON LOT I RONT - FT. a' I hereby acknowledge that I have read this application and state USE OF rte. EXISTING BLDG. B, SIQE r � Separate permits are required for L. SIDE N the State of California.23 ./ 3 electric, plumbing and heating work. 1 the State of California Business and Professions Code, Division 3, REAR w F USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. Q� am exempt from the provisions of the State of California Business MAIN BLDGS. TAX $ and Professions Code, Division 3, Chapter 9. QC.U.P. Signature VAR. $ 9101 �1 APPROVED �,(i r i V v a x w a Q I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with ow all laws regulating building construction, and I shall not employ m m ,Z any person in violation of the workman's compensation laws of N the State of California.23 ./ 3 I hereby certify that I am properly licensed as a contractor under V(' SO' the State of California Business and Professions Code, Division 3, THE AMOUN' PLAN CHECK $ Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE 0 am exempt from the provisions of the State of California Business VALUATION TAX $ and Professions Code, Division 3, Chapter 9. U Signature Perml Authorized X] DATE APPROVED ia.I.- TOTALPAID $ m m m N VN UNDER VALUATION IS FOR m 'ABLISHING A PERMIT FEE ON Y: PERMIT FEE $ �� < v� PLAN CHECK $ n '^ 0 LL TAX $ f U TOTALPAID $ ?0268 fCOST# MESA BUILDING -SAFETY DEPARTMENT P. O. BOX S1] COSTA MESA, CALIFORNIA For Applicant to Fill In .Completely TYPE OR PRINT 1103 E1 Camino Drive COSTA MESA, CALIFORNIA MILTAIII [ARCHITECT - ' TEL.INEHR Mecca Realty Co T 0113-4220 ;SS same as above ADDRESS same as above CITY same as above STATE 207343 -A -SB -1 No • OR 3-4220 SIZE1 1 OF LOT 72 X 97 NO. OF BLDGe. I Now oN LOT nOifE USEOF none EXISTING BLDG. BUILDING SETBACK LINE FROM CENTER OF STREET 5O1 1 n REAR YARD 26 6 SIDS YARD I LEFT 101 ZONE TYPE GROUP I RIGHT 81 DESCRIPTION OF WORK ZONE xII ----------- R-1 L PLANH 2 -------- �. REvA1R 1 Il MOVING I 'II DEMOLISH BUILDING54'x50'6" NO. OF 8 2 SIZE . ROOMS ST RIES EXTERIOR WALL, WOO ROOF WOO 8 a Ce COVERING and atUCC 'COVERING USE OF BUILDING AND WORK TO BE PERFORMED Plan 600-B 1 HEREBY ACKNOWLEDGE THAT IIHAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IH CORRECT AND AGREE TO COM. PLY WITH ALL CITY ORDINANCES AND -STATE LAWS REGULATING BUILDING CONSTRUCTION. SIGNATUREOF -1 r.. ® AUTHORIZED AGENT FEE - RECEIVED 69 APrWAIT N'F,FO f.ERMR . r BklliDMl C1f9r (QFf Theub* k RECEIPT NO. PS OAT R8C81V DATEIBSUED BUILDING ADDRESS FIRE y ZONE TYPE GROUP APPROVED BY DATE ZONING ZONE NO. OF UBH OPN ' - � R-1 L PLANH 2 BYILDINO W a•t•t gar LEGAL DESCRIPTION Lot 59- Tract 5021 A. P. NO. none NOTE: NO EAVE OVERHANG SHALL BE LESS THAN HO" TO SIDE B REAR P. L. EAVES ALLOWED - (U. B. C. REQUIREMENT) - YARDSAPPROVED YARDSAPPROVED MAIN BUILDING ACCESSORY BUILDING I FROMC/ STREET) FRONT FT. FT. R. SIDE U FT. FT. 0FT. L. SIDE FT. REAR FT. b FT. DISTANCE BET. .BET. MAIN d MAIN BLDGS. ACCESS. BLDGS. VAR.* _ DATE C.U.P.# APPROVED PROVED BY _6 2- a 'Piling 2274O arae 453 J. SQ. FT. THE AMOUNT SHOWN UNDERVALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION PERMIT FEE S +� 37,55—a $ 23,985.00 PLAN CHECK $ TOTAL FEE 21