HomeMy WebLinkAbout1115 EL CAMINO DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626
MECHANICAL PERMIT
Job Address:
1115 EL CAMINO DR
Suite No
92673
Vicinity:
1ST & 2ND STORY ADDITION
Parcel Number:
14161336
Applicant:
VILE, CHRIS
Address:
2932 HIERRO
Repair/Alt Cooling/Heat
SAN CLEMENTE, CA
Owner:
TING, JOAN TR
Address:
1115 EL CAMINO
Refrig Sys <100 k BTU
COSTA MESA, CA
Contractor:
CRISTOPHER MASON VILE
Address:
2932 HIERRO
Gas Piping
SAN CLEMENTE, CA
Arch / Eng :
Factory Fireplace
Address:
0
Phone: (949)498-1417
Zip: 92673
Phone:
Zip: 92626
Phone:
(949)498-1417
Zip:
92673
License:
406707
Phone:
$14.80
Zip:
Inst FAU >100 k BTU
License:
0
Status: ISSUED
Applied: 10/11/2000
Issued: 10/11/2000
ISSUED BY: fw�
SCOPE OF PERMIT
MECHANICAL PERMIT FOR NEW ADDITION TO EXISTING SINGLE FAMILY RESIDENCE. INSTALL
NEW FA.�!L E S I NG, & 2 VENT FANS
REF: B00-01135
FEE SUMMARY
Quantity
Repair/Alt Absorbtion Unit
-. $0.00
Quantity
ISSUE FEE
$23.50
0
Inst FAU <100 k BTU
$14.80
1
Inst FAU >100 k BTU
$0.00
0
Repair/Alt Cooling/Heat
$0.00
0
Inst / Rep. Recess Wall Htr
$0.00
0
Refrig Sys <100 k BTU
$0.00
0
Refrig Sys >100 k BTU
$0.00
0 ,
Gas Piping
$6.15
1
Factory Fireplace
$0.00
0
Hood w/Mech Exhaust
$0.00
0
VAV Box
$0.00
0
Vent Fan / Single Duct
$14.50
2
Appliance
$0.00
0
Fire Dampers
$0.00
0
Smoke Dampers
$0.00
0
Inst or Relocate Appl Vent
$0.00
0
Air Handlers < 10000cfm
$0.00
0
Air Handlers> 10000cfm
$0.00
0
Floor Furnace
$0.00
0
Floor or Suspend Heater
$0.00
0
FEE SUMMARY
Quantity
Repair/Alt Absorbtion Unit
-. $0.00
0
Repair/ Alt Refrigeration Unit -
$0.00
0
Ventillation'System - -
$0.00
0
Evaporative`Cooler.:,. �-
$0.00
0
Commercial lncirieratoi -. -
$0.00,
0
Domestic Incinerator
$0.00
0
Compressors /Absorption Systems
Up to 3 hp / 100 k BTU'"
x$0.00
0
3 To 15 hp 1500 k BTU
$0.00
0
15 To 30 hp / 1,000 k BTU
$0.00
0
30 To 50 hp / 1;750 k BTU -
$0.00
0
Over 50 hp / Over 1,750 BTU -
$0.00
0
Boilers
Up to 3 hp
$0.00
0
3 To 15 hp
$0.00
0
15 to 30 hp
$0.00
0
30 to 50 hp
$0.00
0
Over 50 hp
$0.00
0
Other Mechanical Fee
Investigation Fee
$0.00
Plan Check Fee
$0.00
Reinspection Fee
$0.00
TOTAL CALCULATED FEES $58.95
COMMENTS / SPECIAL CONDITIONS
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 allall
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this perrtiit.
FOR INSPECTIONS CALL: (714) 754.5626 /v/
2446.46(6/00)
DECLARATIONS n
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:
Carnet Policy Number:
(Thi o9�ec�ttio��n need not be completed it the permit is valued et one hundred dollars ($100) or less.)
_I.cerlitylhat in the performance of the rk 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 Califomia, agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these s.
ApP�etul Y- Date: I-O� I I / Ol.�
-WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P TIES D CIVIL PINES UP TO ONE HUNDRED
THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
1 hereby affirm t t.Lam.liceyp��eQp untle,r,r� p.rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the,Business�and / Professions Code, and my license is In full
force and effectrLic #-- tW �Fc�n� (�� Class #
Contractorsrs Sl :: ��� Dat �1 0% L (� O O•
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code),
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. 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.).
❑ 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. i.e. - 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 Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
.................................................................................................................._..__._.............................................................................................................__.........................................................................-...................................._......................._.
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
....._.._........... ..._.........._..........._................_..............._.............._..._._.._............................................... ....................................................... ................................... ...................... ............................................... -.........................................
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
.................................................................re'q........................................2'5'..............................................................................................................f'ull.............................................. . e. s'............................................
...................
.......................
4 If an RMPP is presently required, has Section 25534 of the California Health antl 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 aaernit 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).
...................._................................._............_............_._.......................................................................................................................................................... __....................................._.......... ........................ _..........
6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No
(if yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
......................................................._..........._............. _................................... ......................................................... ................................................... ..................................................................................................... ............ .....................................
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
...........................................................................................................................................................................................................................................................
8 (If yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
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.
lure Of Legal Owner(s) Date
by
1 ntl/Or'Authonzed Appficam_? ate---.
CODE E. INSPECTION TYPE pig INTMALS CODE INSPECTION TYPE PATE
1616 Fixed System Final Fire Prevention 206 Final Mechanical 'iTf -ni
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final BlocWRetatning 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
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 1115 EL CAMINO DR
Suite No
Vicinity: 1ST & 2ND STORY ADDITION
Parcel Nunmber: 14161336
Applicant: VILE, CHRIS
Address: 2932 HIERRO
Phone: (949)498-1417
SAN CLEMENTE, CA Zip: 92673
Owner: TING, JOAN TR
Address 1115 EL CAMINO
Phone:
COSTA MESA, CA Zip: 92626
Contractor: CRISTOPHER MASON VILE
Address: 2932 HIERRO
Phone: (949) 498-1417
SAN CLEMENTE, CA Zip: 92673
License: 406707
Status: ISSUED
Applied: 10/11/2000
Issued: 10/11/2000
ISSUED BY:
Arch / Eng : - -
Address: - - - - -
Phone:
Zip:
_ License:
SCOPE OF PERMIT "
PLUMBING PERMIT FOR NEW ADDITION TO EXISTING SINGLE FAMILY RESIDENCE. INSTALL 1
BATHTUB, UP TO 4 GAS OUTLETS, i SEWER CONNECTIONS, 2 SHOWERS, 3 WASH BASINS, & 1
WAT ET. -
REF: B00-01135 � - '
AMT
ISSUE FEE,
$23.50
Backflow irrigation -
$0.00
Backflow Preventer
$0.00
Bathtub
$9.80
Clarifier System
$0.00
Connect (Ice,Soda,etc)
$0.00
Dental Units
$0.00
Dishwasher
$0.00
Drain, Floor
$0.00
Drain, Rainwater
$0.00
Drain, Roof
$0.00
Drinking Fountain
$0.00
Expansion Tank
$0.00
Gas Earthquake Valve
$0.00
Gas (1-4 outlets)
$6.15
Gas (Over 4 outlets)
$0.00
Gas Repipe
$0.00
Gas Service
$0.00
Interceptors (Grease, Oil)
$0.00
Interceptors (Sand Auto )
$0.00
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 (6/00)
- FEE SUMMARY'
QTY
AMT
QTY-
AMT
QTY
Laundry Tub / Washer
$0.00
.
-67
Sump p6mp
$0.00
j-
0
Landscape Irrigation
$0.00
0
Swimming Pool
$0.00
0
0
P -Trap
$0.00
0
_
- Trap Primer /
$0.00
0
1 -
Pressure Regulator
-$0.00
0
Urinal /'
$0.00
0
0
Process Piping (per 10 ft)
$0.00
0
Vacuum Brkr Bkflow(i-4)
$0.00
0
0
Receptors
$0.00
0
Vacuum Brkr Bkflow(5+)
$0.00
0
0
Septic Tank
$0.00
0
Wash'Basin
$29.40
3
0 _
Sewer Cap for Demo
$0.00
0
'-Wash Basin Set
$0.00
0
0
Sewer Connect
$24.65
1
Waste and Vent System
$0.00
0
0
Sewer Private Line
$0.00
0
Water Closet (Toilet)
$9.80
1
0
Shower
$19.60
2
Water Heater / vent
$0.00
0
0
Sink, bar
$0.00
0
Water Piping (Inst or Rep.)
$0.00
0
0
Sink, commercial
$0.00
0
Water Re -pipe
$0.00
0
0
Sink, Floor
$0.00
0
Water Service
$0.00
0
1
Sink, kitchen
$0.00
0
Water Softener
$0.00
0
0
Sink, service/mop
$0.00
0
OTHER
$0.00
0
Spa (private)
$0.00
0
VIOLATION
$0.00
0
Spa (public)
$0.00
0
PLAN CHECK
$0.00
0
REINSPECTION
$0.00
0
0
TOTAL CALCULATED FEES: $122.90
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 (6/00)
DECLARATIONS F)
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' opmpensadon insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This coon �ed not be completed if the permit is valued at one hundred dollars ($100) or less.)
i
I.certify that in the performance of thew or which this permit is issued, I shell not employ any person in any manner so as to become subject to the workers'
compensation laws of California and ree that if I should become subject to the workers' compensation provisions of Section 37DO of the Labor Code, I shall forthwith
comply with Ihese.pr�ovijons.
-Appllca to Slgneturer oO
WARNING F—AI R TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TOCRIMINAL P NALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE (510000), IN ADDmON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am.license and r provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busmes Prol ssions Code, and my license Is in full
force and effect L� On ri-I Cl -q-�
Contractors'Slgnawrea: Data: _ J c7
I If
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora 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. 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:
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, California Administrative Code)
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certity a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
............................................................................................................................................................................................................................................................................................................ _.............................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
......................................_..........__..........._.............................._._...._...........__._...__...._.__.................................................................................................................................._.....................................................................................................
3 Does or will theappplicant 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 .application apernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LU Yes L-I No
(Section 65850.2 of the California Government Cade requires that the requested information be furnished on applications for non-residential building permits).
8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? []Yes ❑ No
(If 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
........................................................... ......................_.................................................................................................................................................................................
7 It 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...............................................................................................................................................................
8 (II'yes", attach cartificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all stale 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
�b/u /o.>
irAnctrOr'Authoriv Applicant Date—' ,,
CODE Y. INSPECTION TYPE QZiE IN LS CODES INSPECTION TYPE PAIS ItlTMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing'S'�
200 Final Re-Raaf 210 Final Electrical
201 Final BlocWRataining 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 Building9ccupancy
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626'
ELECTRICAL PERMIT
Job Address: 1115 EL CAMINO DR
Suite No
Vicinity: IST & 2ND STORY ADDITION -.
Parcel Nunmber: 14161336
Applicant: VILE, CHRIS
Address: 2932 HIERRO
Phone: (949) 498-1417
SAN CLEMENTE, CA Zip: 92673
ISSUED BY:
Status: ISSUED
Applied: 10/11/2000
Issued: 10/11/2000
9
Owner:
TING, JOAN TR
,
Address .
1115 EL CAMINO
Quantity
Phone:
%
"
COSTA MESA, CA
Zip:
92626
Contractor:
CRISTOPHER MASON VILE
Temp service test
$0.00
Address:
2932 HIERRO
$0.00
0'
Res. a/c package
$0.00
Phone:
(949) 498-1417
$0.00
SAN CLEMENTE, CA
Zip:
92673 -
0
Misc Electrical Equipment
License:
406707
SCOPE OF PERMIT
ELECTRICAL PERMIT FOR NEW ADDITION TO EXISTING SINGLE FAMILY RESIDENCE, INSTALL 22 '
LIG TURES, 17 RECEPTACLE OUTLETS, & 15 SWITCHES: -
REF: 000-01135
COMMENTS / SPECIAL CONDITIONS
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 11,
244646 (NW)
FEE SUMMARY
Quantity
Quantity
%
ISSUE FEE -
$23.50
Temp Dist System / Lighting
$0.00
0/
Temp service test
$0.00
Busway /100 ft
$0.00
0'
Res. a/c package
$0.00
Standing Section -
$0.00
01
New Res (1-2 units)
$0.00
0
Misc Electrical Equipment
$0.00
' ,0 -
New Res (3+units)
$0.00
0
Transformers up to 1 kva/kw
$0.00
0
Pool / Spa -
$0.00
0
.............:.yup to 10 kva/kw
$0.00-
'0
Lighting Fixts
$23.46
22
.................up to 50 kva/kw
$0.00-:
0
Recept Outlets
$18.70--,
.17-
.................up to 100 kva/kw'?.
' $0.00
0
Switches -
$16.50
--15-
..................over 100 kva/kw
$0.00
- 0 ." .
Non Res Appl , -
$0.00
0
Low Voltage Equipment
$0.00'
0 -
Res Appl -
$0.00
0
Low Volt Wiring System / Ckt ='
$0.00
0
Service to 200a
$0.00
. - 0�
Misc. Conduit . -
; - $0,00
, 0
Service to 1000a -
$0.00
0
Misc. Conductor - "
",$0.00 ,
-0
Service over 1000a
$0.00
0
Circus ( gen or ride) -
$0.00
"'o -�
Motors to 1 hp
$0.00
0
Circus (mech ride or lights)
$0.00
Motors to 10hp
$0.00
0
Christmas Tree Stand
$0.00
0
Motors to 50hp
$0.00
0
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
$0.00
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
0
Temp Pwr Pole
$0.00
0
TOTAL CALCULATED FEES
$82.16
Intermed Pole
$0.00
0
COMMENTS / SPECIAL CONDITIONS
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 11,
244646 (NW)
DECLARATIONS C)
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 Of the Labor Code. for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(this ction need not be completed if the permit is valued at one hundred dollars ($100) or less.)
` I cerYItythat in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if I Should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these pr 11S.
Applicenl Sl�gnawre 's - Dale1F DFlNES UP TO ONE HUNDRED
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHBI CIVIL
ALL SUECT AN EMPLOYER TO CRIMINAL [[
THOUSAND DOLLARE (3100,000), IN AD09ION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
hereby affirm lhat.l.am.lice Jand r rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bus i nd rofessions Code, and my license Is in full
force and effetPLic. M '� � 9�� I Class k
Contractors 6gnt�:—J� Date:
I l
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: 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 pamlit
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.).
❑ 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, 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 de 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 forth for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceplions, 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 o1
compressed gas at standard temperature end 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 Califomia 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?.....0 Yes ��❑�No_........................................_..
............................ ...... _.................... _.... _...... _.......... __.............. _.................. _._.......... _..._....... _............................................................................................. _._................... .... _............... ........_........... _............ ................. ............................... -
5 Dces or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
..............................................__..................... _........... _................ ...._................................................................... _._._.................................................................. 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
(If yes', the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
......._ ....................._.. ........ _............ _.......... __............. _....................................................................................................... _................................................................................ ........._._.................... _...................................................... _.............
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
.._.............._........._........._.........._.........._............_......................_.................. ......................... ............................... _......... ....._..._...........................................
8 (It 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,
Signature Of Legal Owner(s) gate
�— AndtOr Authorized Applicant— —D, /Data
CODE 0. INSPECTION TYPE g>,¢, INTIT19L$ CODE INSPECTION TYPE 2A11 INKS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical L�-191
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
2D4 Final Demolition 250 Final Building/Occupancy
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa. tl. )LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 1115 ELCAMINO'DR
Suite:
Vicinity: 1 ST & 2ND STORY ADDITION
Parcel Number: 14161336 ' Zoning:
Applicant:
VILE, CHRIS
Applied:
07/28/2000
Address:
2932 HIERRO
Claim Valuation: $0.00
SMIP Res:
$8.02
Phone:
(949)498-1417
SMIP Com:
SAN CLEMENTE, CA
Zip:
92673
Owner:
TING, JOAN TR
Address
1115 EL CAMINO
Phone:
(714)546-5704,
COSTA MESA, CA
Zip:
92626
Contractor:
CRISTOPHER MASON VILE
Address:
2932 HIERRO`
Phone:
(949)498-1417
SETBACKS
SAN CLEMENTE, CA
Zip:
92673
License:
406707
Arch
Address:
Phone:
Eng:
Address:
Status:
ISSUED
Applied:
07/28/2000
Issued:
10/11/2000
ISSUED BY:
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT 884 1 ST & 2ND STORY ADDITION TO EXISTING SINGLE FAMILY RESIDENCE, ADDITION TO FIRST STORY
INCLUDES NEW BATHROOM, AND ENLARGE EXISTING BEDROOM, & FAMILY ROOM. 2ND STORY ADDITION INCLUDES NEW - -
WALK IN CLOSET, AND ENLARGE EXISTING MASTER BEDROOM & BATHROOM. ALSO, CONSTRUCT NEW 40 SO FT 2ND
STORY DECK.
FEE SUMMARY
Plan Check:
$559.49
Calc Valuation: $80,146.20
Permit:
$860.75
Claim Valuation: $0.00
SMIP Res:
$8.02
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$1,428.26
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0
- Rear 0-0 Left 0-0
Right " 0-0
ACCESSORY
Front 0-0
Rear 0-0 Left 0-0
Right 0-0
PARKING
Existing: 0
Required: 0 Proposed: 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 permi> t
FOR INSPECTIONS CALL: (714) 754-5626
244646 (6/00) V
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 carrier and policy number are:
Carrier: Policy Number:
(Thi action need not be completed i/ the permit is valued at one hundred dollars ($100) or less.)
II 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'
�wmpensalion laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisl
AppSlgnaWre i� Date: tIIt [I� Cl!WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL AND ! FINES UP TO ONE HUNDRED
THOUSAND DOL-ARE ($100,000), IN ADDRION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm thattII�amm licann�$edd under proAviIwons�of Chapter 9 (commencing with Section 7000) of Division 3rt�(usillFA.3��and Professions Code, and my license is in full
force and effect. LIC. #1) it LO \ �T \ Claea�N \� )_(
Contra`ctor's.Sign� Date: 00
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: 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).):
❑ 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 work
himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to 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 Driver's 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, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or resent or future building Occupant need to file a registration form for acute) hazardous materials) Y
.......................... ...
PP P 9 P 9 Y ❑ es ❑ 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 ❑ Jo
(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 registei acutely hazardous materials with the Fire Department.
......................................................................................................................................................................................................................................................................................................................................................................I.....................
4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
............. ............... ................................................ _.............. _........................................................................................................................ ............ _._.._........................................................... _............... _......... -...... .............. _........... .._.........._.
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li 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.........................................................................................._............._...........................................
e 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 ❑ No
............................................................................................................................................................................................................................................................................................................................................................................................
B (II yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the inionration given above is correct. I agree to comply with all stale 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.
!
Si u Of Legal Owner(s) Date
(c_ a
)Arltl/Or Avtflonzed Applicant LDaley
CODE r. INSPECTIONTYPE lZTE INTITAL6 CODE I INSPECTIONTYPE gym INTRIALS
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 BlocVRetaining 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 "
NEWPORT -MESA UNIFIED SCHOOL DISTRICT
CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES
PURSUANT TO AS 1600 AND AS 181
To: City of Costa Mesa
( ) City of Newport Beach
( ) County of Orange
Applicant:
;r '
3426
District Receipt No. 1 I23
Plan Check No. F2M • b 1135
2g32 l -It t?�� 261\1 L i�IT� CA 9�'1'�
Address:
Telephone Number:
Tract/Parcel and Lot Number(s):
Location of Project:( ( ( S F t_ I NO 'Dr__ C.0`;; 7 M SSA CA
Number of Square Feet of:
Residential Space
Commercial and
Industrial Space
CommerciaVlndustrial Project is: (Check One)
Warehouse
R&D
Movie Theater
Mini -storage
Heavy Industrial
Regional Shops
Light Industrial
This project is exempt because
x $1.84
x$.30
Total 1&26_0, 5{'
Total
_ Motel
Preschool
Bank
Auto Repair
Neighborhood Shops
Hospital
_ Racquet/Health
Large Office
Hotel
Office Bldg.
_ Medical Office
Restaurant
Office Park
Fast Food
his certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections
53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction.
Checks are to be made payable to Newport -Mesa Unified School District.
By: %YEN M tLA
Authorized Representative
The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not
true, then this certificate shall automatically terminate and the appropriate City/County shall be notified.
Date:
Applicant
OCT it 2800/12:58 GM/1 1626.56
ROT4:01-0067157
112326
t
d
v
Ess aP BOILIM1c: 1 1 1 5 EL C AM I 140 DR UNIT:
O/MFA'S NIOIEIF IMOISTb TING, JOAN TR
ADDRESS' 1115 EL CAMINO
COSTAMESA
C 92626
714) 5
ADPL. MAKING ADDRESS:
.N
ARCHITECT OR ENG II MO ND,
ARCH OR ENG.'S ADDRESS: OMT:
coNmAcrars xAME: ,RECISION CONSTRUCTION (714)966-6445
CODRACTORSMMISIG 1115 EL CAMINO DR
ADDRESS; COSTA MESA CA u"'C-: 658880
. 92626 UNIT:
LICENSED CONTRACTORS DECLARATION: 1 hereby a fret under parity of perjury Met I an limed under prwieiom of Chapter 9
(commencing with Section 7000) d Divrekm 3 of the Guainww and Pichumona Code, and my coma a in full force and efface.
c uC.NO.:0593E 1.19 -et"": B LIC. NO.: 658880 EXP: 04/96
Dore' Y Contredor.� ^ JC+ •'
NER B ILDER ECLARATION: I herds, ARM under Amery of penury that I an swop from IM CoreMors License Lew for Mm
,.y+ovmp reason (Sabn ct7031.5 Guaira! errd Pmlembns Code: Any city or wuMY whichrsquirep
e a permit to oonaMucN. Ner, "unove,
noicoh, or repair any structure, prior bits cosuawe, also requires the applicant for such parom to file a signed statement that W or she
immal Wtsuanl to the pwisom d Ma Contractors License law [Chstser 9 (Wmmenia, with Section ]000) of Dol ion 3 of the
usinem and Protect.Code] or that M or the M assents therehom and the lass for Me atle9nd asampion. Any notation d Section
]031.5 by any applicant for a permit ubjeda the eppls em to a coil penalty of cwt more then two hundred ddlan (5500().
❑ 1, as owner d the propaM or my employees with wages on their ads wmpwewon, will do the work, and Or structure u not intended
or offered for men (Section7044. Bu9ases era Pmiessys Cade: Tha Contract. Lineae lee dean wt -I to an -01 pmgerty
who Wflds in irnprow a thereon, and who doee such work ter anff or harsef "rough his or her own employees, provided that much
impromare s we rut intended or offered for sale. 11, however, the building or improves rel is sold within ons year of completion, the
ownwbuildw will have the Wiles of Amwirp As or aha did not Wild or impose for Am n Noce of sale).
❑ I, as owner of the propend, am excham end wntraca'vq wits Iaamed connections lag cenwrvd the prvjed (Section ] . Business red
Proteassim Code: The Contractors Loom Law does red PPpty b an oma d wOPedy, who Wilds w calwnes themon and ods
contracts by such protects with a mmreaor(s) licensed pasua ft to the Contractors License Law).
❑ I as vamp under S Acro: G. d P.C., b this reason:
Own: Corer:
1 do hereby am* Mat I an new, d and understwa the requirements of California NeMh And Smery Cade Sections 25505, 25533. era
25530, and that I or any future building coomat will I will not (drub one) need to cwnply with maid man codes and the rsquiremenls for
a pwmF forcortewction w enodificcaushwn IImAir5 IY1Tenagemenl District. Residential conNmd'an applications we exempt from Mesa
wormlom.
Date: Applicant:
WORKER'S COMPENSATION DECLMATION: I hereby affirm under parity of perAny one of ohs following declarations:
❑ I have sea w N ma man a cen "e d consent to seffinaun br workers' wmpweation, m prwlded Ise by Sadiron 3700 d the labor
Code. for the Mdwmence d the work for which Mie palmit is cosued.
❑ I horn sea thin mai Men y is l n' wmcematonn' corm n a required by Sectors 3]00 d the lebw Code, for iha perfonnwru d the
work /or whklr this penmK is iesund. My waken' wmpenmlion ineuranee center era wlicY number we:
Caner:
Policy Number.
(iris section need not be completed f the Man is for one hundred dabn ISIMI or less.)
twe:
cenie performaa:e d thy Am in the wok for whh Mg copaewry mwesisie Mark ie ass ed. I Nal employ my an in mw ee to
subjectto the woman'wn,orma n laws d Cwilwnla, end agreeMw H 1 should bacwes ubpct to the weaen'
penmtan pmvcoona a Section 3]00 d the Labor Coda, I Nall forthwith p with thossepmvisbm.
^ U� AptsloaM:
Waming: 411.. to swum workari compensagon coverepa h u Nn m1, an• shall subfact an wnployer to cdMnal pena/tln, and
Gal flus up b we hundred thousand dollen (SfoD,aCD1. In eddldon m Ms cost of camyssaffir n, damages an pnvldsd for In
Swtloo 3706 of Ms Labor Cods, Interest, and agomoy'a fees.
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury Arm than is a construction lersis, agency ha the
performance of the work for which thin panni is cooed (Seton 3097, Civ. C).
LENDER'S NAME
LENDER'S ADDRESS:
1 cantly Anal I hew read this Wisetion as state that da abuse Information a comes. I agree Io canPNy with col city as county on irerces
end wase laws reining to building o mtrudiwr and hoary mahcr¢e representatives of thin cry to enter upon the oboe -mentioned property
for inspection purwsea.
CLIFF VON TING
Dora: ��Af0' % S
(5151d5.WP) White-Buildig 6 Swery; Grerw F* Canary -Applicant: Pink-Rwenue: GOMenmd-Assess
CITY OF COSTA MESA — BUILDING PERMIT
PERM Mcg: •R 072257
PERMIT NO; B 072257 PLAN CHECK NO; N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE; STR PURPOSE; OTH
JOB DESCRIPTION T/OFF RESTH 6 REROOF W/COMP SQ FT: 5,000
CLAIM VALUE., 5,000,00 CALC—VALUE; 5,000,00 GROUP OCC; R-3 /M-1
COMMENTS: SMOKE DETECTORS ARE REQUIRED IN EVERY VBEDROOM L HALLWAY
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING----------
FRNT; FT IN REAR- FT IN FRNT; FT IN REAR; 'FT INI
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ; PROV; PARCEL: 14161336 ZNE: REF NO;
PLANNING NOTES>
>
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
'l
ZONING APPROVED BY DATE;
BUILDING APPROVED BY DATE; p_
APPLICATION ISSUED BY; DATE:
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 72,00 ,50
SMIP/NON—RES
PLAN]
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS ---- > 72.50 0,00 0,00 72,50 72,50 .00
REVENUE DIVISION TOTALS--> COLLECTED; 72.50 OVER/SHORT; .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECY,
72,00 ,50
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 5000 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 5,000.00
END OF FEES
EXPIR
DATE /0/V 9'p e ,
01 00181594-00181597 TOT 72.50
DATE; 05/10/95 TINE: 14:00
r
CONSTRUCTION AND PLANNING:
APPROVALS Permit # Date
Inspector
PC � SQA,
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
/
i
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, Cl Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK '
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final '
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64, Plumbing System - Final .
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final I
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 #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping OGas ❑Dil
23. Gas Pipe -Rough & Test
72. Underground Flush -
-'
24. Roof Framing
73. Undergrnd. Storage Tank ❑ Gas ❑ Oil
25. Roof Sheathing
(eUj#
�c
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
:ter
28. Lathing & Siding
77. FIXED SYSTEM FINAL
n
,
29. Insulation-- -
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final,Electric
-
Notes: _ -
34. Final Heating & Air Conditioning
I ✓
5
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
-"-
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43, Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
,
51. CERTIFICATE OF OCCUPANCY
N0. Date
4`ostn MFS9
° 6�
t - e
r
fi' CITY OF COSTA MESA
NOTICE OF PERMIT EXPIRATION
TO: JOAN TING DATE: October 4, 1996
1115 El Camino
Costa Mesa, CA 92626 PERMIT: B 72257
PROJECT ADDRESS: 1115 El Camino, Costa Mesa, CA
Our records show that the listed permit(s) were obtained for property improvement or alteration at the
above address. According to our records, the permits have not had a final inspection. If you have any
information to the contrary, such as a signed off inspection card, please contact this office so that we
may correct our records.
The permits were obtained by:
(X) CONTRACTOR
( ) OWNER
Name: PRECISION CONSTRUCTION Phone: (714) 966-6445 License Number: 658880
To constructor install: REROOF
Permits are valid for 180 days from issuance or your last inspection, per Section 106.4.4 of the 1994
Uniform Building Code. If you do not contact us within 10 days, your permit(s) will expire on
October 18, 1996. Additional fees may be required to finalize the permit.
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 staff will be happy to assist you.
�w�v
C' Baca%/
ng Official (/
TCDB:ijh
CITY OF COSTA MESA, BUILDING DIVISION, POB 1200, COSTA MESA, CA 92628-1200
PHONE (714) 754-5273 • FAX (714) 754-4856
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA, CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
® ADDRESS 1115 El Camino Dr-_
COSTA MESA, CALIFORNIA
Macco Realty Co. N`,b113-4220
207343 -A -SB -1
65' x 97'
SETBACK LINE FROM
CENTER OF STREET 40
■ USE OF
Or 3-4220
N�.P .I�oB.none
DESCRIPTION OF WORK
X IIII .__
W .1
1X5016" ROOMS B STORIES
ILL wood I ROOF wood shake
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IB CORRECT 'AND AGREE TO COM.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION.
PERMITTE SIGNATUREOF E_ MaCCO R$glt4 CO pany
By:
AUTHORIZED ADEN -
FEERECEIVED
W IAV ICIWX FOR PERMIT
INAABPJ@�!(��f' - -
RECEIPT NO.
PERMIT NO;
DA EUVO�
jW42E4u IJ63
BUILDING
ADDRESS
FIRE
ZONE TYPE GROUPJV
APPROVED
BY DATE
ZONING
ZONE
NO.OF
use OFNew ing
R-1'
PLANE 2
BUILDING N gar,
I
DESCRIPTION Lot 571 Tract 5023
A. P. NO. nonp
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
SO' TO SIDE @ REAR P. L.
EAVES
ALLOWED (U. B. C. REQUIREMENT)
YARDSAPPROVED.
YARDS APPROVED
MAIN BUILDING
ACCESSORY BUILDING
(FROM C/L STREET)
FRONT FT.
FT.
R. SIDE FT..
FT.
SFT.
L. SID CJ
FT.
REAR FT.
FT.
DISTANCE BET.
BET. MAIN Q
MAIN BLDGS.
ACCESS. BLDGS.
VAR.#
DATE
C. U. P. #
APPROVED
APPROVED
nn
BY W.L.D.
DATE -22-6
Dwelling 2274 s.
.
SQ. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PURPOSE OF ESTABLISHING A PERMIT FEE .ONLY.
VALUATION
PERMIT FEE $
PLANCHECK 5
a 23,985.00
TOTAL FEE