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HomeMy WebLinkAbout1121 EL CAMINO DR - Building PermitsCITY OF COSTA MESA u RMF BUILDING DIVISION i 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 • www.ci.costa-mesa.ca.us f FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BC10-00320 PERMITTYPE: B_COMBO STATUS: ISSUED Sub Type: RES_ALT DATE ISSUED: 10/06/2010 ISSUED BY: JOB ADDRESS: 1121 EL CAMINO DR CM - '`Suite/Unit: APN: 14161335 -Zoning: Vicinity: - Primary Occ: Const Type: SQ. FT:. 0 Valuation: $0.00 SCOPE OF WORK: 2 HR INSPECTION FEE TO FINALIZE EXPIRED PERMITS FOR 360 SQ FT GAME ROOM ADDITION. REF: PERMIT NO. G15185. FINALIZE GAS, FIREPLACE AND ELECTRICAL FOR GAME ROOM ADDITION. REF: PERMIT NO. PME 15554 I OWNER: EDMONDSON, JOHN BAddress: 1121 EL CAMINO.DR - Unit: Phone: City/State/Zip: .COSTA MESA, CA APPLICANT: DIRK HERZOG - - Address: - ,. Unit: Phone: 949-756-1702 - City/State/zZip: CONTRACTOR: Phone: Cell: ARCHITECT: ENGINEER: COMBINATION PERMIT FEE SUMMARY Building Plan Check: Building Fees: Electrical Fees: Mechanical Fees: Plumbing Fees: SMIP Residential: SMIP Commercial: Bldg Std Admin Fund TOTAL FEES: License No. Address: Unit: City/State: License No. License No. $0.00 $0.00 $0.00 $0.00 $0.00 - $0.00 $0.00 $0.00 . . $94.00 ZipCode PHONE: PHONE: 'Refer to fee receipts for all fees paid for project - - HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/1812010 - PER CMMC Sec. 13-279 Monday thru Friday -7:00 am thru 7:00 pm. Saturdays -9:00 am thru 6:00 part. Prohibited all hours - Sundays and the following Federal holidays: New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE tl. INSPECTION TYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re -Roof 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition DAIS INnTIALS CODE INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy DATE INTITIALS � ro-r5-lo �E_y K 1y-15- it7 mp by aa -7- >< /O -15-10 MQ bI W�— ) j0 -/s i0 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: (Thu tart in need not be nxndeted ✓the perrrM is valued al one hundred dollars (Sfo)) a less ) Policy Number: ❑ I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant's Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # Class # Contractor'S Signature Date CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the ovmer-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 3057-46(]107) Owner ID verified by driver s license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax dill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, a demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Califomia 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. AppliWnt's Signature Division of Industrial Safety Permit Number: Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be 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 Califomia 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 might 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 Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and fling 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 a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be conshucted under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for it tion purposes. I agree not to occupy or allow occupancy of any building au oriz is permit until final inspection. ignat rog f I Owmer(s) Dat Q. And1n, ALIftforizedApph.i. It.te 08/$!1I2019- 1112V F.ax 71d' 44856 -. Costas ,mesa ,r , €/ t h i. r % City of Costa 5Wesa l uildirW Drms-ion Tl Fair Drive, Ccsta Mesa, CA 92628 714-754-5273 l Fax 714-7544858 a Permit 9 BC/0'003 Disclosures & Forms for Owner- Builders Applying for Construction Permits IMPOR7,4tdTf NOTICE TO PROPERTY OWNER Decir Property Owner. An aputicaiion for a building wroit has b aen submit, d in your name fisting youtself as the builder of the aroperty trnpwvr3ments.spcciRed 2t A -,Y1 f'nv Q -a-Ccx f, A i 1 . 5# Gl ` ?a Zoo We are providing you with all own-Bridder Aanoutlydgment me lnf;xnb*Jon verification Form to mare you aware of your rusponsmititios and possible risk you may incur by lir=ring this rmrmi? rue f in your name as the O net- uiider. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official addrosrr indicated, An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting ,%au0torny. sia ertwW nater to 5rgrrrfy you undorstarxi or verity this infomo6ori. {¢ i . I understand a frequent ora^3ice at unl;consed persons is to have tate Property owner obtain an oowmir- tA -tA- 3e"' building permit that erroneously implies that the property ower Is providing I*r. or her axn lator and material Personally. I, as an Owner-Dulider, may be held liable and subject to xeriovs financial risk far any injuries sustained by an unikensed person and his or her employees whila working on my property. My hnmeowWfi insurance may not pmvtde coverage for those injuries I am vvillfulty acting as an Ovmar-Builder and ant aware at the limits of my insurance otwerage for injuries to workers ort my property. I 66I understand building permits ara not required to be is n -d by prmrerty v-vivir5 unless they an: 11rastVe for the crmstruction and are n t hiring a licensed Contractcr a assume ihis retponsibtfity. jr{ understand as an'Owner-r3uildat' I am the responsible party of recoro an the permit- I anderstaro th8t ( may protect mys-elf from pulantlal llnarrc�al risk by inning a licansed Contractor and having the. permit fled in his or her n_eme-lnstoad of my nem. s_ I urroerst:nd Cc.rtractors a� n quired by law ts be Been l and bonded in CaNfointa and to Int rhoir sa nurnbers cn permits and con'Xacts. f 5. i understand It I employ or odterwiso engaga any persons, atria' than CrOornia toned Contractors, the total value of my construction is at least five hundred dollars (.t.; atl), inoludirtg laborano ntataiiats. I may, he considered an 'cmptoyer' under state and fe4eral fav:, eunderstand if I :.'n considered an "employer' under state and federal law, I muo ragister with the rate edeial government, withhold payroll saxes. provide woekers' compensation dmabfilly insurance, and conrriouto to unemployment compensation for carp `amploycc' I a'.so un6erstand my fa4lurc o abide by biosis i-ws may subjaax utr: lei serious fin2reciai rlsk. ,Ick �. t understand un1er California Conkn_c'.01W State License Lair, an Oviner-Sunder Y.-hoDuCds single-family 'itis v I at 5tuctu€s ruinnot malty build then{ with the intent to after aiem for sake, unless ail lvork is parformed by Licensed wbcontractoiti and the numbat of siructures does no; exc-d four %614fn any calendar year, or all of the work is performed under contract with a iteensal yanaral building CDntra«or. si4ii-30 CAL60 Jan 1, 2C+:'4 Ca F acYet iernpts!e 1 of 2 0/2:3l2ata ir. `ts rA,x tss75 d11 <<t; V'002100'2 6i understand as an Cywver-RvLdcrlf 11,011 Lha property fair %v ich the; po: rnfi is if.tur;ri, I may no Fold fiau?o ,:i�ny Nntrnri<,t ur pt~nrrnal injures sustained by any subse:Sarent rnvrler(s) tisi resufi from any talon. cot +u tI rnr defects in the vrvArnaabhlp or materials Ali `; 8. b a ScrstanG 1 may al aln mole information regarding my cbt-£ga3�n;: as an'emplayof' frcun'he Internal 16 !vnut) Service, the United Slates Sfrnall Business Administration, the California Departnuant of Benefit v Nyrnrnls_ and the Cafifornta pivfsbn of Industrial Acrrdents, i also underidt,a I may contact the Co!itrnia Contractors' State J-kwise Eoaid (CSLB) at 1.800-321-CSLI3 (3752) o; vtmv,cstb.ea.gcv for nioro Informaton aboutAcursed rxmtractoss. J0: I ams aware of and consent to an Cnvrtt r -Bu oder buildirtc parmit applied for In my name, end urderai:and am ibe Dar y legally and flnalcis ty responsible for proper ed construction activity at the following address: 7ty 11. I agree 01st, as the party legally and f=,nancl3Uy ce�sporrs b;e for this pro�ei censtrac`•icin actM� q, I will ole by al; appil:2 lir taws end regutruments that govern OweerBuifde:s as wolf as employrrrs. ikX 12_ i agree to no'I-/ the issuer of this form Immediately of any edditlsns, deletions, or changes to any of the m a©cn f have providrrd oir, itii5 Aorn, Licensed contractors are regulated by lays designed to protect the pttbtic, If You contiact wilts someone rrno.does not have a license. the Contractors State L€comae Board may be unable to assist you with any ftnandar loss you rnay sustain as a result of a cmtaa';nt Your Drily rensedy against unlicerLwd Contractors may be In cMi court It is else <'mpoivutrt for yet to understand that If an unicepsed Contractor or employee of thol individual or fmn Is €njwe,d w tae working on your property, you may be herd Rabe for damages, If you ob:atn a permil as Owner -Builder and shish to hire Contractors, you will be respoasfblo for verfl-ying r+netner or net those Contractors are am ly ticsnsed and the eteatus of utak worlters' cgmper ivation insurance cin -i ay'le. 84fore a building permit can be Istsuad, this form must be comploud and signed by the property owner and returned to the agency m9parr;ible tar issuing the pertnit New A copy of rte property owner`s driver"s license, form notarization, at aa�rre rstlon acceptilbte, to the agency is required to be presented when via permiAr' ed rS verifthe property owner`s signaiute, Signatur8 cl prrpert`,s'acunec � �' tate: r Note; The kBowirrg Autfrcdzstion Form is rogVWd to be completed by the proptrty owner only when designating &I agent of th= property ownarto apply for a constnrction permjl for the Ower-Bugder. Ewclu4ing the Notice to Property Ower, the execution of which 1 understand Is my pevsoaral responsfaelity, t herby ouf1wrfze this faltor lag parsmi(a) to act as my agent(s) to apply for, sign, and file the docurnerds ne emsafy to obtain an Owner -Builder permit for fny ptoject. , .r� tt Scope of Consuuct,'on Protect for Description of Work).- P- I+.1,r�. X � hc9j t Y rj Prosect Location or Address: I) Z I Name of Authorized Agent: s Addrsaa of Autitorked 4�r>'L Tel NO e) rt et _ _ 7 j to - / 1'] s ..j «rf 0A 1'j I decIare under penattyr of perjury that I am the preperty owner for the address Lsted above and 1 persnona£ly filled out the above information and certify its a+cc,-urscy. Notal, Acopy ortho ovjror's elffveraticense, fom, notartzaficia or e her imrifh:ation acceptable to the agency is required ro Ha presented rshen fete permit is Issued 0o re. Ny Etre property miner's sig tF jP �,�. }} f rooperfy Owners S , urer' Dole: tri 31"&30 CAI 60 Jah 1, 2009 03 Packet teMpiate 2 d 2 21 CI F 66STA MESA CONSTRUCTION PERMIT Project Address 1121 .1 amino Dr. C/M Applicant's Mailin9'Addres.s oma - - Owner'sName—T—Tn =317—H-,—LpillJnPS Phone S-7-401.1 Address 1�2� El.'Carn=Q Dr,, CAM. Arch/Eng. E!rank Drake 'License No. (146-56 - Address 2202 4tJj S+i,.f-� R.ri r),N ign Contractor's Name, -- flLuNE/Z -Phone Address (mailing) City License No. _ LICENSED CONTRACTOR DECLARATION ]-hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3, of theusi ness and Professions Code, and my license is in full force and. effect. _ I License Class O ]cense No. Date ' Signature I WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified, copy thereof (Section Policy No. - Company - ®Certified copy is hereby furnished. - Certified copy is filed with the city Building Division.. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hu retl.(5100).or less). -. certify that in the performance oI the k for wh' h this rmit is issued, I shall not el ploy any person inanr so a bed a subject to the Worker' a Laws of Calif n" , Date Signature i NOTIC f, aft r making this decla t yo kI ome subject to the Workers'. Compensation provisions the bor C , you must forthwith comply with such provisions or this p mites all -bedeemed revoked. CONSTRUCTION LENDING AGENCY, I- 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's Name Lender's Address OWNER BUILDER DECLARATION - _ _ I hereby affirm that I am exempt from the Contractor's License Law forthe following reason (Section: 7031.5 Business and Professional 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/she JS licensed pursuant to the provisions of I the Contractor's License Law (Chapter.9 (commencing with Section 7000) of. ',vision' 3 of the. Business and Professions Code) or that he/she is exempt irefrom and the basis for -the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects' the applicant- to a civil nalty of not more than five hundred dollars ($500). i7 I, as owner of the property will do the work, and the'structure isnot intended or offered r sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or.her 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 com- pletion, -the owner, will have the burden of proving he/she did not build or im- rove for the purpose of sale). , i.; I I , as owner of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to anowner of ,property who builds or improves thereon, and who contracts for -such projects with a.con- tractor(s1 license pursuant to the. Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. I am exempt under Section 7 0.44 B. & P. C. for this reason I Date9/� Owner j3arrj A 'TPVI•llP I hereby certify that 1 have read this application and State that the above information is correct. I agree to comply with alt' city and county ordinances and state laws relating to building construgtion and hereby authorize repre- sentatives of this city 16 enter upon inspection purposes. Signature Drivers' License o SS CMF 0865-46, rev. 4/94 - White'- Building-, plicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations PERMIT NO/,S-- TRACT NO. LOT NO. UNIT NO. 6T – /J t— /-re.r 5023 56 TYPE OF CONSTRUCTION• NEW LX ADD LJ ALTERATION 0 REPAIR ❑ CONVERSION ❑ DEMOLISH � OTHER A.P. # 14 DESCRIPTIONOFWO RK/USE OF BLDG. Game/'Rec Room S Main Build, TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL E . EXTENANT ® ELECTRICAL PLUMBING ❑ MECHANICAL B 1 ❑OTHER' 1 ' C PROJECT DESCRIPTION. SQ.F7. 36W OCCUPANCY Req K 'CONSTRUCTION TYPE 6406173 = VALUATION $: S, c - ZONE. T I GRADING CU..YDS. ACRES ping. Ref. # Remarks: Planning Notes: ' - - PLUMBING Bar Sink Showers ' Backflow Preventer _ Service Sink _ Backflow Irrigation Sewer Cap Bathtubs Sewer Connection ) ' Clarifiers Solar Collectors ' Dishwasher - - Solar Piping - Drinking Fountains _Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks _ Urinal Gas Service -Outlets -Water Closet' . •t, Interceptors Water Heater Kitchen Sink Water Service Lavatories r•• P—Trap Roof Drains`.,- - ReinspectiontFee_ I ' $15 ler :t; Under Ground i Ventilating Exhaust System Ll Multiple L_ Firepl/Fact. BIL ICBG # 114 Heating System & Ducting ❑0-100,000 BTU ❑ 100,0006T Reinspection Fee I $15 Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee I $ 3 1ANICAL FEES Hood or, Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU 13100,000 BTU System Repair/Alteration Issue Fee 1 $ 3 Automatic Washer - Construction Pole S Cooking Unit 1 Dishwasher Dryers ❑Gas -CIE Fan F.A. U. Fixtures Device Boxes I Outlets, , 8076 9/13/8a = 4.1 Zone A cM o t I u N N t R Parking Req./Provided ' - E O M T Jr S. ELECTRICAL FEES _ Transformer _❑ 15-50 KW _ ❑ 50+KW Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors 1-10-1 HP El % -8 Inc. Solar 09-15 HP 016-15+ Microwave Pole Light 2 Range - Switches, 3 I Sign -.- Garbage Disposal I Standing Sections-• Gerierator ❑05 KW ❑5-15 KW Trash Compactor-' f $ ENERGY P.C. $ ' y $ Reinspection Fee $15 Issue Fee DEVEL'OPMENTSER I SR Zoning Approved By. G Building Approved Byy QUIREMENTS: - _VA _.BUILDING PER I {I$' . PLAN CHECK 71 PLUMBING $ PLANCHECK 25/% $ ELECTRICAL {D.9 PLAN CHECK -50J.71 MECHANICAL $ PLAN CHECK ,25%, $ FEES I r,. �� 5.s.- SMIP -- $ PERMIT'' ISSUANCE $ ENERGY P.C. $ ' GRADING $ IMICROFILM $ -TOTAL-FEE $ 1_ - CONSTRUCTION AND PLANNING APPROVALS Permit # 7Dt,Inspector - POL SPA, i APPROVALS Permit # •{4 Date ' Inspector 1. Temporary Electrical Service or Pole y . 52. Pool & Equipment Location 2. Spit Pipe-Undrgrnd: - 53. Steel,Reinforcement - 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ~ 5. Steel Reinforcement c( 56. Rough Plumbing & Pressure Test - 6. Electrical UFER'Grnd. '57. APPROVAL TOCOVER•GUNITE 't i. . 7. Footings gzk A)41 . 58. Electrical Conduit-Undrgrnd. ' 8. Foundation ,- y $ �' 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60.. Backwash Lines, P-Trap, O Undrgrnd.: 10. Structural Floor. System %7 61. APPROVAL TO DECK 'Y 11. Property Sewer Line & House Connection 62. Backwash & Receptor; Final 12. Sewer Cap 63. Heater & Vent-Final - .1 13. Roof Drains 64.. Plumbing System - Final -' 14. Rough Plumbing 65. Electrical=Final 15. Rough Electrical-Conduit 66. Solar System-Final, - -• - - 1,6. Rough Electric Wiring • - �a )� 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 0Gas 00il 23. Gas Pipe-Rough & Test -. 72. Underground Flush ` 24. Roof Framing r����&N '1 11u? 73. Undergrnd. Storage Tank 0 Gas, 0Oil 25. Roof Sheathing ro/rad ro����cvtx. 1 74. Overhead Hydro 26. 7-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical _ 27. Frame and Flashing c 76. Dry Standpipe , 28. Lathing &'Siding 77. -FI D SYSTEM FINAL 29. Insulation N/ B ro ro 78. FIRE.P.REV. FINAL 30. Drywall Nailing .t _ 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 13-3•��Ne 64e,, 35. Final, Gas Pipe-Test ' . J2h• L 36. Hood or Canopy _ -�� 37. Final Factory Fireplace -• 38. Final Plumbing i _ - 39. Water Service-Final ' l• _ .. 40. Gas Service-Final 41. Solar Domestic-Final - T. 42. Backflow Preventer _ 43. Backflow Irrigation �• . 't' 44..Landscape Irrigation System •' ' - ' 45. Sound' Attenuation ' 46. Handicap Regulations ap^ 11 U6C }9{{ 47. FINAL STRUCTURE & BUILDING ., 48. Special:Requirements Completed , 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co - )' 51. CERTIFICATE OF.000OPANCY No Date E—m APPlice nt to fill in aI paces ex� tNase within heavy border lines antl sign all appropriate declarations. COSTA WES CQNS1FjUC ON P€RMIT Project Address �� fj ,/t{{ Alayo 4poc . Applicant's Mailing,rd/peess Owner's Name y�!9"/ /Phone Address SA 67 Arch/Eng. 60A ,y%j!License No. �/ Address feasrL��} b>`/s%' lia/J Li/#r(f ,Contractor's Name ALV A) eltP Phone -1401J Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter,9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. "` License Class L ense No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate if Workers' Compensation Insurance, ora certified copy thereof (Section 3800, Lab. C.) i Policy No. Company HCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the won for which this gger isissued, I shall not employ any person in any m r so as to be me bject jo the Workers' mp ; do Laws of Calif i Date ignature NOTICE: i, after mak ng this declar ,you ou m sublect to the Workers' Compensation provisions of the Lab r Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit -is issued (Section 3097 Civ. C.) Lender's Name Lender's Address Q OWNER BUILDER DE RATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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 Jo file a signed statement that he/she' is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 -of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation -of Section 7031.5 by any applicant for a permitsubjects the applicant to'a civil J(_e nalty of not more than five hundred dollars ($500). ' L� I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure isnot intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her 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 com- pletion, the owner will have the burden of proving he/she did not build or im- ITve for the purpose of sale). , 1,'as owner of the property, am exclusively contracting with licensed con- . tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Lawdoesnot apply to an owner of property who. builds or improves thereon, and,who contracts for such projects with a con- tractor(s1 license pursuant to the Contractor's License Law). I am aware that. proof off their Worker's Compensation insurance should be provided to me., ❑ I am exempt untler�ction B. & P. tl. for this reason / Date - '� / v Owner n hereby certify that 'have rea t is applicati an state that the above information is correct. I agree to comply with city and county ordinances and state laws relating o uilding constructi9K.And hereby authorize repre- sentatives of this ci enter up n the ve-mentioned propert for inspection purposes. p i Drivers'. Licens S CMF 0865-46, rev. 4/TT-White - Building; Canary -Applicant; Pink - Account =J OL,S PE OF CONSTRUCTION NEw DO ❑"CONVERSION ❑DEMOLISH ❑OTHER DESCRIPTION OF WORK/USE OF BLDG. — ALTERATION LJ REPAIR TYPE OF PERMIT *LJ GRADING FOUNDATION LJ STRUCTURAL '❑ TENANT *ELECTRICAL PLUMBING ❑ MECHANICAL ❑ OTHER A 4-.rI PROJECT DESCRIPTION SQ. FT.' ZEOO 1V - OCCUPANCY CONSTRUC ON TYPER10 ,VALUATION S ZONE GRADI NG CU. YDS. IAC RES_ Remarks: , Bar Sink Backflow Preventer - Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service it Outlets Kitchen Sink - "- Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct -Structural i Duct - Ventilating -_- Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO #O Heating System & Ducting 00100,000 BTU ❑ 100,000 BTI Reinspection Fee I $15 Goldenrod - Assessor SI'b PLUMBING; ' Showers Service Sink' Sewer Cap Sewer Connections Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet ' -Water Heater Water Service . Issue Fee Hood or Type ❑ Canopy Type I I ❑ 110100,000 BTU ❑100,000 BT System Repair/Alteration - Issue Fee 9480 10/04/84 38.70 TLI A.P. # �� �,3 3t Zone S Main Building: Accessory Building: E Z T Front - - O A Rear N C Right N 8 Left G R• Ping. Ref. # Parking Req.' /Provided _ E Planning Notes: Q M T S. $ 3 rn 9 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENTrSERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date _ • l BUILDING PERMIT' ELECTRICAL I FEES ' SMIP Automatic Washer •- -- Transformer 0-15.50 KW Construction Pole Sub. ❑ 50 + KIN Cooking Unit - Meter ❑up to 100 amps ' Dishwasher Meter Dover 100 amps PLAN CHECK Dryers ❑Gas ❑Electric Sub Panel ' PERMIT Fan Motors 110-1 HP ❑ 1'/: - 8 F.A.U. - Inc. Solar 09-15 HP 1-116-15+ Fixtures;.- - Microwave' 2- 21 Device Boxes' Pole Light $ S,00 $ IS -6 $ 1 f' $ %f -i (� • Outlets i Range $ $ $ $ 6L Switches Signic 11 Garbage Disposal Standing Sections v ,Generator ❑0.5 Kw 05.15 KW Trash Compactor $ 3 rn 9 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENTrSERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date _ • l BUILDING PERMIT' SUMMARY OF FEES $ SMIP - $ PLAN CHECK $ PERMIT Y r �. �ePLUMBING /PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% $ S,00 $ IS -6 $ 1 f' $ %f -i (� ISSUANCE ENERGY P.C. GRADING MICROFILM $ $ $ $ f MECHANICAL $ 10C) TOTALFEE $ 3IE)'7D $ 3 PLAN CHECK 25% $ • 00 CONSTRUCTION AND PLANNING APPROVALS Permit.# Date Inspector POO'Ll''"�`P.A 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 Y• 4. Electr`ical`"Conduit-Undrgrnd. 55. Electrical Bonding 5.,Steel Reinforcement _ 56. Rough Plumbing & Pressure Test - 6. Electrical 'UFERGrnd. 57. APPROVAL TO COVER-GUNITE r •�� 7. Footings 58.' Electrical Conduit-Undrgrnd. V_ 8. Foundation YS ". ". 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water,Pioe-Undrgrnd. %� 60. Backwash Lines, P -Trap, 0 Undrgrnd. i 10. Structural Floor System 61. APPROVAL TO DECK •' 11. Property Sewer. Line & House Connection,' s.. 62. Backwash &Receptor -Final 12. Sewer Cap j `rte: -Y ` 63. Heater & Vent -Final - 13. Roof Drains , r, „ - 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 Hearin Air Air Coriaitioning 20. Rough Factory Fireplace, A.; FIRE DEPT. REQUIREMENT APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro .� 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23? Gas Pipe -Rough & Test - 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank 0Gas IJ oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27: Frame and Flashing 76. Dry Standpipe . 28. Lathing & Siding .77: , FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing. - _HEALTH DEPT. REQUIREMENT 31. Plaster Brown Chat! 79. FINAL INSPECTION 32. Electrical Power Meier -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes:' S d t 34. Final Heating & Air Conditionings 35. Final Gas Pipe -Test 36. Hood or Canopy' 37. Final'FactorY Fireplace 38. Final Plumbing 39. Water, Service -Final ,Service 40. Gas -Final 41. Solar Domestic -Final - 42. Backflow Preventer 43. Backflow. Irrigation i 44..Landscape Irrigation System, -. 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co •51. CERTI F ICATE OF OCCUPANCY No. Date r - CITY OF COSTA MESA BUILDING DIVISION > 77 FAIR DRIVE, COSTA MESA, CA 92626 - (714) 754-5273 - Fax (714) 754-4856 • www.ci.costa-mesa.ca.0 FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER EO$ -00350 PERMIT TYPE ELEC STATUS: ISSUED APN: 14161335 DATE ISSUED: 08/28/2008 ISSUED BY: CAC JOB ADDRESS: 1121 EL CAMINObR CM` Suite/Unit ,.7-. Vicinity: SCOPE OF WORK: 1 SWITCH AND 1 TRANSFORMER 10 KVA 1 GAS 1-4 OUTLETS CODE CASE C08-1388 OWNER: EDMONDSON, JOHN B'- ' =. Address: , 1.EL CAMINO DRQ, Unit:. PHONE: 714-557-4011` ,- .' COSTA MESACA121 -; , :_ ' - -- -City/State/Zip:,-- , ', - APPLICANT: EDMONDS'ON '-JOHN B Address: 1121 EL CAMINO DR Unit: PHONE: 7145574011 :'13_ ........City/State/zzip:..... COSTA MESA, CA' � -' CONTRACTOR: OWNER BUILDER License No. `' 000000 Address: Unit. c=:I PHONE: City/State: ZipCode ' _ - ---CELL:. ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $36.90 ' Reinspection Fee $0 00 TOTAL FEES $36.90. E NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODES. INSPECTION TYPE DATE IN71TIAL5 CODEC INSPECTION TYPE DATE INTITALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof - 210 Final Electrical 9 i 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 204 Final Demolition 222 Final Site 250 Final Building/Occupancy Or '\ WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code. for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: (This sedixr need tel be m'np'etedxlhepermd is valued at one hundred dollars ($100) a fm,) Policy Number: ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applimnt's Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # Class # Contractor's Signature CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: 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).): n❑� 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. IL however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of pioving 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 appy 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 taws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Date - 3057 6 (3107) 1_ef`- G Owner ID verified by drriiiv /nse. ❑' -Yes ❑ Not e U / Drivs License� 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. Applicant's Signature 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 fling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safely Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No B. (If 'yes", attach certificate of compliance from .the appropriate aiipollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjuryrthe 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 uiltling construction, an authorize representatives of the City of Co esa to enter upon the ove-described property for inspection p o s. [Area no!,4.p9cupy or a ow occupancy of any building L - V CITY OF COSTA MESA toBUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 7544856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBERYP08-00193 PERMITTYPE PLUM STATUS: ISSUED APN: 14161335 DATE ISSUED: 08/28/2008 ISSUED BY: CAC JOB ADDRESS: 1121 EL CAMINO DR CM -Suite/Unit Vicinity: SCOPE OF WORK: 1 GAS 1-4;OUTLETS, , CODE CASE C08-1388 s ; OWNER: EDMONDSON'JOHN B . ,;.Address: '11121 EL CAMINO DR PHONE: 714-5574011_City/State/Zip:,... COSTA MESA CA zT APPLICANT: EDMONDSON JOHN B•""r, # _ Address: 1121-EL CAMINO DR, PHONE: 714.5574011 -? i City/State/zZip: COSTA MESACA • '. CONTRACTOR: OWNER-BUILDER License No. 000000 Address: PHONE:.. City/State: ZipCode:- - CELL: - ARCHITECT: Licerise No.'--_; .. - ..r PHONE:I,-' ENGINEER; License No. - PHONEa`r,.� y PLUMBING .;PERMIT:FEE' SUMMARY PLAN CHECK FEE.,;,, $0.0v PERMIT FEE " TOTAL FEES: $29.65 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. ODEt I115PEC110N TYPE DATE INTMALS CODE INSPECTION TYPE DATE IN/7 i�1�RL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical g 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roo( 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 204 Final Demolition 222 Final Site 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATION* I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code. for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: (This sectio need "Ce mmplelad tithe pend is valued at we hundred "am ($100) Or law) Policy Number: ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant's Signature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # Class # Contractor's Signature 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: 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).): 0<—I, as owner o1 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 -47 yyy SI ria — — Coate— W5746 I3I0 i Expi� res: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: .v ❑ 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, Califomia Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicant's Signature Division of Industrial Safety Permit Number: 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 Califomia 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 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 Califomia 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 a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if "yes', the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7. 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 Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If'yes", attach certificate of compliance from the appropriate air polhition control officer). - . CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury+the information given above is correct. l,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 corect. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City o Costa Mesa to enter upon the above-described property, for inspec urp ses. I not to cupy or allow occupancy of any building au nz bys pe u)xfil final ilpeclion. _ SrgnitIGre'oTLegar OwnerTs) C�� Date„ / / 2--,( ' �C L ' 6q-kr\,t',kl)o c� 6--�fA eta, � P- APPROVED C CITY OF COSTA MESA PLANNING DIVISION SUBJECT TO BLDG. DEPT. REG. NOTE: ADDITIONS, DELETIONS, OR CORRECTIONS SHALL BE APPROVED BY THE PLANNING DIV. E I BY:DATE: SSS 1 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.n9]MLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1121 EL CAMINO DR Suite: Vicinity: HOUSE & ATTACHED GARAGE Parcel Number: 14161335 Applicant: ZAIDI, SYED Address: 1115 EL CAMINO COSTA MESA, CA Owner: EDMONDSON, JOHN B Address 1121 EL CAMINO DR Zoning: Phone: (714)404-9752 Zip: 92626 Phone: COSTA MESA, CA Zip: 92626 contractor: PRECISION CONST & ROOFING Address: 1115 EL CAMINO COSTA MESA, CA Zip: 92626 Arch : Address: Phone: (714)404-9752 License: 658880 Eng: Address: Status: ISSUED Applied: 10/16/2000 Issued: 10/16/2000 ISSUED BY: Total: $125.75 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 NOTES: PLANNING & ZONING . Rear 0-0 Left 0-0 Right 0-0 Rear 0-0 Left 0-'0 Right 0-0 Required: 0 Proposed: 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 ?44646 (woo) Phone: Phone: - Zip: License: License: SCOPE OF PERMIT REROOF EXISTING SINGLE FAMILY RESIDENCE WITH ATTACHED GARAGE (28 SO). TEAR OFF EXISTING ROOFING & RESHEATH WITH 1/2' CDX PLYWOOD. INSTALL 30# FELT UNDERLAYMENT & REROOF WITH 25 YEAR COMPOSITION - - SHINGLES. - FEESUMMARY- Plan Check: $0.00 Calc Valuation: $5,035.00 Permit: $125.25 Claim Valuation: $5,035.00 SMIP Res: $0.50 SMIP Com: $0.00 - Other: $0.00 Inspection: $0.00 Total: $125.75 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 NOTES: PLANNING & ZONING . Rear 0-0 Left 0-0 Right 0-0 Rear 0-0 Left 0-'0 Right 0-0 Required: 0 Proposed: 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 ?44646 (woo) l WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. _❑_I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: -Carrier:-__STAI6 CO P-Ny 114 T16A/ /n/ VrCl?AJcE 1: iIIV /"—Policy Number: (-.i LN a 0� C -(This section need not be completed i/ the permit is valued atone hundred dollars ($100) or less.) ` - ❑ 1 cenify 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 Calif mia, and agree that it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisio -Applicant Signature:b bo L% -WARNIND-FAILURE TO SECUR ORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES 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 ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect Lic-N— 5.45 iS O Class b L C ntractoes Signature: )Date: 1 D Ifo O O CONSTRUCTION LENDING AGENCY: t ❑ 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 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 riot 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 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 certity 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 WIII 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 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 registei acutely hazardous materials with the Fire Department. ................................_................._......lyr'.....................................................'34'.................................................................................................'n-i.................................._............... ............................................................................................. 4 If en RMPP is ... ..tty requiretl, has Section 25534 0l the California Health and Safety Cada been fully complied with? ❑Ves ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject this a plication a p_J No for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agencc y? LJ Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ._..................................................................................................................................................................................................................................................................................... ........_............. ........... ._..........._....... 8 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (I1 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 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: 1 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 1 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-Owner(s)Dat§ - - ID�16 /6 0 And/or Autfibinz pplicant-"— (_Date_ CODE .. INSPECTION TYPE PdIE INTITIALS CODE I INSPECTION TYPE )PAN NITTIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �,q 208 Final Plumbing 200 Final Re -Roof •tip 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 217 COSTA MESA, CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT COSTA MESA, CALIFORNIA OWNER Mesa del Mar Development C;. AI AnnREBs 3800 E. Coast Highway FA.RCHITECT MacRealty Co P "':INFER y CO ee ,S same as above ADDRESS same as above ,T same as above SIZE- -,AS 1 n0, OP BLDGH^ ,.Q7 _... __ ,...e i� 4. FEE .RECEIVED p�� 2 5 1963 11PPL�CATION FOR PERMIT BUILDING ZONING ZNO. OP USE OP R-1 PLANS 2 BUILDII R- LEGAL - -. r NO, none 7E: NO EAVE OVERHANG SHALL BE LESS THAN TO SIDE 9 REAR P. L. ES .OWED (U. B. C. REQUIREMENT'. YARDSAPPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING SETBACK LINE FROM I -' CENTER OF STREET �" D RHAR YASIDEYARDi FRONT FT. PT. 61 SR BIDE FT. 1� FT. LEFT - RIGHT DESCRIPTION. OF WORKL. BID Fr. FT.'NR ALTERATION ADDITIREAR ]6" FT. FT. DISTANCE BET. BET. MAIN 8 R,. .A OVING DEMOLBUILDING541X411611 MAIN BLOCS. ACCESS.BLDGS. NO.OF %.VAR.* DATE SIZE ROOMS ST C: .P. APPROVED EXTERIOR WALL, wQGd I ROOF wood sAPPROVED USE OF BUILDING AND WORK TO BE PERFORMED IN Single familyres. w att. ar Dwelling Plan 500-B Garage 460.sf' N 64. FT. B I HEREBY ACKNOWLEDGE THAT -I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IH FOR THE F AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AND STATE LAWS gtGULAT(NG' yALUATION m BUILDING CONSTRUCTION• PERMITTEESIGN PERMAITTEEOF Maa C-C�o Realty Co parry ^/ m By $ 23,925. 00 PLAN CHECK $ 3 / 5b 0 AUTHORIZED AGE TOTAL FEE J