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Home My WebLink About1126 EL CAMINO DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.c9L1CTRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1126 EL CAMINO DR Suite No Vicinity: Parcel Nunmber: 14161214 Applicant: VILE, CHRISTOPHER M FEE SUMMARY Address: 2932 HIERRO Quantity Quantity $23.50 Phone: (949)498-1417 $0.00 SAN CLEMENTE, CA Zip: 92673 Owner: 'PAUL, BEN E TR ' 0 $0.00 Address -1126 EL CAMINO DR $0.00 0 $0.00 0 Phone: $0.00 0 COSTA MESA, CA Zip: 92626-5529 Contractor: CRISTOPHER MASON VILE $0.00 0 Address: 2932 HIERRO 0 $11.00 10 .................up to 50 kva/kw Phone: (949)498-1417 $18.70 SAN CLEMENTE, CA Zip: 92673 0 $15.40 License: 406707 ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to the Motors to 10hp Motors to 50hp Motors to 100hp Motors over 1 00h Communication drops Sub panel to 200a Status: ISSUED Applied: 08/08/2003 Issued: 08/08/2003 ISSUED BY: SCOPE OF PERMIT REF: B03-00674:486 SQ. FT. ROOM ADDITION/REMODEL. ELECTRICAL TO INCLUDE: 10 LIGHT FIXTURES, 17 OUTLETS AND 14 SWITCHES. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446.46 (&00) FEE SUMMARY Quantity Quantity $23.50 - Temp Dist System / Lighting $0.00 0 $0.00 Busway /100 ft $0.00 0 $0.00 Standing Section $0.00 0 $0.00 0 Misc Electrical Equipment $0.00 0 $0.00 0 •. Transformers up to 1 kva/kw $0.00 0 $0.00 0 -' .. ................up to 10 kva/kw $0.00 0 $11.00 10 .................up to 50 kva/kw $0.00 0 $18.70 17 .................up to 100 kva/kw $0.00 0 $15.40 - . 14 - ..................over 100 kva/kw $0.00 0 $0.00 0 Low Voltage Equipment $0.00 0 $0.00 0 Low Volt Wiring System / Ckt $0.00 0 $0.00 0 Misc. Conduit $0.00 0 $0.00 0 Misc. Conductor $0.00 0 $0.00 0 Circus ( gen or ride) $0.00 0 $0.00 0 Circus (mech ride or lights) $0.00 0 $0.00 0 Christmas Tree Stand $0.00 0 $0.00 0 Fireworks Stand $0.00 0 $0.00 0 Other Electrical Fee $0.00 $0.00 0 $0.00 0 Investigation Fee $0.00 $0.00 0 Plan Check Fee $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 2446.46 (&00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. ❑ 1 have and will maintain workers' compensation insuran e, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.. My workers' compenatio s r F ter and i amf�are: Cartier: Policy Number: - (This section need not be completed if the permit is t uad of one hundred dollars ($100) or less.) - 1 certify that in the performance of the work for ich this permit is issued, I shall not employ any person in any manner so es to ecbme subject to the workers' compensa8on laws of California, and agree that if should become subject to the workers' compensation provislons of Sectidn W 9Yhe Labor Code, I shall forthwith comply with these provisio Appllca'm Signature: w(�� Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMIAPEIE AND CUU.IiII&S UP TO ONE HUNDRED THOUSAND DOLIARE (5100,000), 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 Iicen nde provisio s of Chapter 9 (commencing with Section 7000) of Division 3 of the Bus nd P otessions Code, and my license is In full force and effect. Lic. If �1 ('�� Class M Contractors Signatur.: — Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that mere is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Cade 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 dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth Into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia 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). .......................................................... _........................................ .................. ......................................................................................................................................................................................... .................................. .............. 11............ 11............ 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. .............ff..................................................................................................................................................................................................................................................................................................................................................................... 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 thisa plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Byes 8 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). . . . .................................................................................................................................................................................................................................................................................................................._.................................._................... .... e will any pert 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 Distinct 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? El Yes ❑ No ..... ......................................................................._.............._....................................................................................................................................... __.._......................... __._................. .__........... _....................... _.......... _.......... _............... B (If yes', arach 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. Si ature Of Legal Owners) And/Or Authorized Applicant A Dat CODE 1, INSPECTION TYPE fIAIE '-INImeLS CODEC INSPEC71ONTYPE - RM INTITIALS 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 Bloc /Retaming 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 ELECTRICAL PERMIT Job Address: 1126 EL CAMINO DR Suite No Vicinity: Parcel Nunmber: 14161214 Applicant: CRISTOPHER MASON VILE Address: 2932 HIERRO s - - Phone: (949)498-1417 - - SAN CLEMENTE. CA Zip: 92673 " Owner: PAUL, BEN E TR Address 1126 EL CAMINO DR Phone: COSTA MESA, CA Zip: 92626-5529 Contractor: CRISTOPHER MASON VILE Address: 2932 HIERRO Phone: (949)498-1417 SAN CLEMENTE, CA Zip: 92673 License: 406707 SCOPE OF PERMIT UPGRADE ELECTRICAL SERVICE TO 200 AMPS. - Quantity ISSUE FEE $23.50 Temp service test $0.00 Res. a/c package $0.00 New Res (1-2 units) $0.00 New Res (3+units) $0.00 Pool / Spa $0.00 Lighting Fixts $0.00 Recept Outlets $0.00 Switches $0.00 Non Res Appl .. $0.00 Res Appl $0.00 Service to 200a $30.50 Service to 1000a $0.00 Service over 1000a $0.00 Motors to 1hp $0.00 Motors to 10hp $0.00 Motors to 50hp $0.00 Motors to 1 00h $0.00 Motors over 100hp $0.00 Communication drops $0.00 Sub panel to 200a $0.00 Pole Light Pkg $0.00 Sign Circuits $0.00 Status: ISSUED Applied: 10/28/2003 Issued: 10/28/2003 ISSUED BY: 0 ; Busway/100 It $0.00 FEE SUMMARY - - - Quantity Temp Dist System / Lighting $0.00 0 ; Busway/100 It $0.00 0 Standing Section $0.00 0 Misc Electrical Equipment $0.00 .0,. Transformers up to 1 kva/kw $0.00 0 . -,"'x"•...:..:.........up to 10 kva/kw $0.00„0 ,, ",•." < ...............::up to 50 kva/kw $0.00. "' . 0 .................up to"100 kva/kw $0.00, 0 - ......:...........over 100_kvaNw;�• $0.00 0: ' - Low Voltage Equipment $0.00 0 Low Volt Wiring System / Ckt, "$0.00 0 Misc. Conduit $0.00 " '0 " Misc. Conductor - $0.00 0 Circus ( gen or ride) $0.00 0 " Circus (mech ride or lights) $0.00 0 Christmas Tree Stand $0.00 0 Fireworks Stand $0.00 ." 0 Other Electrical Fee $0.00' - Investigation Fee $0.00 Plan Check Fee, $0.00 Reinspection Fee $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 2446.46(6/00) DECLARATIONS C-) WORKERS' COMPENSATION DECLARATION: I hereby offimt under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars ($100) Orissa.) ❑ 1 certity 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 It I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisl Applicant Signature: Date: 1o4,4243 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000), 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 that I am licensed under rcvisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business�9d Professions Code, and my license Is in full force and effect. Uc. a MQ L Class a IS "1 Contraclors Signature: �" Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Cade). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I Bert 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 (commenting 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 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 o1 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-slx (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Cade). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..._........................_......._............................._....................._.................._........................................................................................................................................................................................_......................__............._..........._.........__........ 2 Does or will the applicant or present or future building Occupant need to file a registration 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 appplicant or present or future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes 11No (Section 25534 of the California Health and Safety Code provides that the Costa Mess 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. ................._................_............._..........._.................._................_....................._____Cali___.........._............................................._.._......................................_...._............ ..._..............._..................................._.................................. 4 II en RMPP is presently required, has Section 25534 of the California Healihantl Safety Code been fully complied with? El 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,ppplication aggernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? u Yes LJ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). ..................................................................._....................................-.................................................................................................................. _..__.____......................._.......... ...._................................................... _.........._............... e Will any per of the laciltry to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (II 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? [:]Ves ❑ No ......................................... ............. ................ _..................... _......... _._................................................................................................................................. ___...................... _._........... _............. _..................... _........ _......... _.......... _.. 8 (If yes', attach corgilcate 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. Signatur gal Owner(s) Date, ,-777� 1 � /a/a:2/B d/Or Authorized Applicant -- ao CODE E. INSPECTION TYPE ATF INTITIALS CODE INSPECTION TYPE PATE gig 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pod Spa Final 208 Final Plumbing i 200 Final RB-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 1126 EL CAMINO DR Suite No Vicinity: Parcel Nunmber: 14161214 Applicant: VILE, CHRISTOPHER M Address: 2932 HIERRO SAN CLEMENTE, CA Owner: PAUL, BEN E TR Address 1126 EL CAMINO DR COSTA MESA, CA Contractor: CRISTOPHER MASON VILE ; Phone: (949) 498-1417 Zip: 92673 Phone: Zip: 92626-5529 Address: 2932 HIERRO . - Phone: (949) 498-1417 SAN CLEMENTE, CA Zip: 92673 License: 406707 , Arch / Eng Address: - - - - - - - Phone: Zip: License: ISSUED BY: Status: ISSUED Applied: 08/08/2003 Issued: 08/08/2003 SCOPE OF PERMIT REF: F303-00674.486 SQ. FT. ROOM ADDITION/REMODEL. PLUMBING TO INCLUDE: 1 BATHTUB, 1 SEWER CONNECT, 2 SINKS, 1 TOILET. - 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: V14)754-5626 2446-46(800) "'FEE SUMMARY AMT .,QTY AMT OTY AMT QTY ISSUE FEE - $23.50 - Laundry Tub / Washer $0.00 0 - Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backfiow Preventer $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80' 1 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect (Ice,Soda,etc) $0.00 _ ' 0 Receptors ' $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 `0 Septic Tank - $0.00 0 Wash Basin $19.60 2 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 , 0 Sewer Connect $24.65 1 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 - Sewer Private Line $0.00 0 Water Closet (Toilet) $9.80 1 Drain, Roof $0.00 0 Shower $9.80 1 Water Heater / vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: V14)754-5626 2446-46(800) C DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, is rNMimd by section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. My workers' compens r are: Carrer: mJ Policy Number: his section need not be completed if the permit is vat d of a hundred dollars ($100) or less.) 1 certity thaj in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to b me su ject to the workers' compensation laws of California. and agree that if hold become subject to the workers' compensation provisions of Section 37 0 of th or Code, I shall forthwith comply with these provisions Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENATES ANKCIVIL FIN TO ONE HUNDRED THOUSAND DOLLARE ($100,OD0), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M 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 Busine d ass ons C e, and my license IS in full farce and effect_Lic. If -YDS �Z Class k 1 Contractors Signature:��// — Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby of irn 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 not apply to an owner of property who builds or improves thereon, and who does such work himself or herself of through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement i5 sold within One year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to 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: I 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). ........_............._........_.......—..........__........._...................._...........uildi___._.__.___....._......__....istr.................._....._..._......................................_._..._................................................................................................ 2 Does or will the applicant or present or future building occupant need to file a registration Corm for acutely hazardous metenal57 Yes ONO (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. ......._ ................_........._... .... __.......... _................ __............... __.................................................... ..................... .............................................. -......... ........... ................. ........................... .................. ............................ ................ I....................... 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ........... ....................................... _............ _................__................_..................................................................................._............................ .......................... _............................ __................................................. ................. _................................. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aPPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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). ..........................................._........_............._..................._._......._..........__...............................................................................................................................__......................... ...................... 8 Will an ty p .... ...... ...... .._.. ............. y part of the facili to be constructed under this permit De 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? [3 Yes [I No ....... .................................................................................................................................................................................................................................... _.................................. __._.................. __..................................... _.......... _........... _............ 0 (Ii'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 Penni nt final inspection. Si re f Legal Owner(s) t AndfOr Authorized Applicant 10ate CODE E. INSPECTION TYPE PATE I[UIDELS CODEC INSPECTIONTYPE - .- 2AM 1616 Fixed System Final Fire Prevention '206 Final Mechanical C 1266 Pod Spa Final 208 Final Plumbing 200 Final Re-Rcof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval ' 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ' (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 1126 EL CAMINO DR Suite No ISSUE FEE Vicinity: Quantity Parcel Number: 14161214 Applicant: VILE, CHRISTOPHER M Address: 2932 HIERRO Repair/ Alt Cooling/Heat SAN CLEMENTE„CA Own@r: PAUL, BEN. E TR Address: 1126 EL CAMINO DR Refrig Sys <100 k BTU COSTA MESA, CA Contractor: CRISTOPHER MASON VILE Address: 2932 HIERRO Gas Piping SAN CLEMENTE, CA Phone: (949)498-1417 Zip: 92673 Phone: Zip: 92626-5529 Phone: (949) 498-1417 Zip: 92673 License: 406707 ISSUED BY: SCOPE OF PERMIT REF: B03-00674.486 SQ. FT, ROOM ADDITION/REMODEL. MECHANICAL TO INCLUDE: 1 REPAIR/ALT TO EXISTING SYSTEM (DUCT WORK ONLY), 1 VENT FAN/ SINGLE DUCT. Status: ISSUED Applied: 08/08/2003 Issued: 08/08/2003 FEE SUMMARY Quantity ISSUE FEE $23.50 Quantity Inst FAU <100 k BTU $0.00 0 Inst FAU >100 k BTU $0.00 0 Repair/ Alt Cooling/Heat $13.70 1 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 $0.00 0 Factory Fireplace $0.00 0 Hood w/Mech Exhaust $0.00 0 VAV Box -$0.00. 0 Vent Fan / Single Duct $7.25' -1 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 Status: ISSUED Applied: 08/08/2003 Issued: 08/08/2003 FEE SUMMARY Quantity Repair / Alt Absorbtion Unit $0.00 0 Repair / Alt Refrigeration Unit $0.00 0 Ventilation System $0.00 0 Evaporative Cooler $0.00 0 Commercial Incinerator $0.00 0 Domestic Incinerator $0.00 0 Compressors / Absorption Systems _ Up to 3 hp / 100 k BTU $0.00 0 3 To 15 hp / 500 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 $44.45 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 264646 (6100) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insure as Ired by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensatio s e carrier and bar are: Carder: Policy Number: (rh/s s ton need not be mmplefed if the permit is slued at one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall notemployany person in any manner so as s become subject to the workers' compensation laws of California, and agree that It 1 should become subject to the workers' compensation provisions of Sectio 3700 the Labor Code, I shall forthwith ,-`comply with these pro" .sioryy_� Applicant Signature:_ - Date: WARNING: FAILURE TO SECURE WORKERS' O M1PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE ALTIE AND GVIL F ES UP TO ONE HUNDRED THOUSAND OOLLARE ($100,000), IN ADDRION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE, INTE D ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busine nd Professi s Cade, and my license is in full force and effect. Lic. N Class x Contractors Slgnature<; 1 — Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). 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 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 driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in Connection with work authorized by this permit, and that no building structure, scaffolding, lalsework, 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 Cade 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 appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .............._......_.........._......................._..........................................._.................o*`f..........................................................................................................................................................e's................................................. ......... ......_............_...... 4 If an RMPP is presently required, has Section 25534 of the California Health antl Salary Cotle been fully complied with? ❑Yes O'N' o ......................._......___......._.....ican......_......__....................._.......................................................................................... hi..-h.I....tha...........................................lca.........................................................................................cid-iicrt.......... 5 Does or will she applicant u present or future building occupant require for the work which is she subject c This a plication appernit for such construction or motlification from the South Coast Air Quality Management District or from any other air pollution control tlisinci or agency? � Yes L_1 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 Cade). _............_..........._........._........._.......__.........._...................._...................... ..............................................................._......................................................................................................................................................................................... 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. ,Sig Of Legal Owner(s) c nd/Or Authorized Applicant - D e CODE E. INSPECn0NTYPE PATE ' INTrIALS' ` ` CODE# INSPECTION TYPE PdIE 1616 Fixed System Final Fire Prevention - 206 Final Mechanical ,'Z 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 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 ' (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.%Vj, WING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1126 EL CAMINO DR Suite: Vicinity: Parcel Number: 14161214 Zoning: Applicant: VILE, CHRIS Address: 2932 HIERRO Phone: 714-545-2210 SAN CLEMENTE„CA Zip: 92673 Owner: PAUL, BEN E TR Address 1126 EL CAMINO DR Phone: COSTA MESA; CA - Zip: 92626-5529 Contractor: CRISTOPHER MASON VILE Address: 2932 HIERRO Arch : Address: Phone: (949)498-1417 SAN CLEMENTE, CA Zip: 92673 License: 406707 Phone: Zip: License: Eng: Address: ISSUED BY: Status: ISSUED Applied: 04/23/2003 Issued: 08/08/2003 Phone: License: SCOPE OF PERMIT 486 SQ. FT. FIRST FLOOR ADDITION TO INCLUDE EXPANSION OF TWO ROOMS ON THE FIRST FLOOR AND CONVERSION OF AN EXISTING BEDROOM TO A BATHROOM. ONE EXISTING BEDROOM WILL BECOME ADEN. HOUSE IS CURRENTLY A 5 BEDROOM - 3 BATH DWELLING AND WILL BECOME A 5 BEDROOM - 4 BATH - DWELLING. AREA OF REMODEL OF EXISTING HOUSE IS 314SF. BECAUSE THE HOME IS NOT INCREASING_ THE NUMBER OF BEDROOMS, THE NONCONFORMING GARAGE WIDTH DOES NOT REQUIRE A MINOR DESIGN REVIEW. REAR LOT COVERAGE OK— 104 SF PROPOSED- 325 SF ALLOWED. ' FEE SUMMARY Plan Check: $422.99 Permit: $650.75 SMIP Res: $5.02 ` SMIP Com: $0.00 Other: $0.00 Inspection: $6.00 Total: $1,078.76 PLANNING & ZONING SETBACKS Calc Valuation: $50,154.72 Claim Valuation: $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 it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446-06 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as providedfor 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 in lance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Nlyworkers'compensiulon Ifisre Garner mber are: Carder: %AJ Policy Number: F ection need not be com I/ Ne permit valued of one hundred dollars ($100) or less.) 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' mpensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 37 of th Labor Code, I shall forthwith mply with these provisions. /^' Applicant Signature: IEEI" r/ Date: WARNING: FAILURE TO SECURE WORKERS• OOMPENS TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AID CIVIL 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 E, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm thatam licensed der provisions of.Cfhapter 9 (commencing with Section 7000) of Division 3 of the Business rot ions Code, and my license is in full force and effed Lic: M'-` '�\ m (_ \ (Class #. Contractors Signature: /� 6 Date: X fig 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 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.). ❑ 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 dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _........._............._.........._..........—.........._..._......................_.._............................................................................................................................uie-.....-h-a...........................................................................0................................................ 2 Does or will the applicant or present or future building ocoupant need to file a registration torn for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................_.............._................_............................................................................................................................................._........._......................._..................._..............._..._...__........._.................................. 3 ❑ es or will th❑e applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? (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 II en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No 5 Does or will the applicant orpresent or future building occupant require for the work which is the subject this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? y? Ves L-I No (Section 65850.2 of the California Government Code requires that the requested intonation be furnished on applications for non-residential building permits). ........._.........._..... ..... _............._..........__............___................_...............................................................-................._........_............I--...-................................ ..................... .................................................................................................. 8 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (II yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................ ..................................... ..................................................... I..................... _... _................................... ................................................. _......................... _ 7 If a permit from the South Caast Air Ouality 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 ...................................... _......................._...........-_................... __............................_....._------ ........._....__._.____....................................................................__._....................._............._.............__...................._............................ S (II yes', attach cenificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cer ity 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 certity 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. Sign5kr6pf Legal Owner(s) 'IV" --And/Or Authorized Applicant ) D CODE t. INSPECTONTYPE ' ' DATE INTITIALS CODE -INSPECTION TYPE Dom. INTITAy@ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 , Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site p ` 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1126 EL CAMINO DR Suite: Vicinity: Parcel Number: 14161214 Zoning: Applicant: BILL,EDMONDSON Address: - Phone: 714-557-4520 Zip. Owner: PAUL, BEN E TR Address 254 SEMPLE CROSSING Contractor: Address: Phone: BENICIA, CA Zip: 94510 Phone: Zip: License: Arch - Eng: Address: - Address: Phone: Zip: License: ISSUED BY: Status: ISSUED Applied: 05/07/2001 Issued: 05/07/2001 Phone: License: SCOPE OF PERMIT 501-F OF BLOCK WALL. REF VOIDED B01-00609POR PLANNING APPROVAL. FEE SUMMARY; Plan Check: $25.19 -- --- - - Calc Valuation: $1,000.00 Permit: $38.75 - - Claim Valuation: so.00 SMIP Res: $0.50 fr SMIP Com: $0.00 Other: $0.00 %! _ Inspection:: $0.00 Total: $64.44 SETBACKS MAIN STRUCTURE'Front 0'0 Rear '0-0 ACCESSORY Front ,0-0-�:;-Rear. 0 -0 - PARKING Existing: =0- Required: 0. NOTES: ANNING & ZONING Left 0=0 1.'��-� Right X0,0.= Left - 0-0 , Right 0-0,', 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 (6,00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. My workers' compensation Insurance carder and policy number are: Carder: Policy Number:' (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND QVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATON, DAMAGES AS PROVIDED FOR IN SECTION WOa OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 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. Uc. a Class a Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: - ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: n oe� I hereby affirm that under, penalty/otperjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professlons Code: Any city or county whlehrequires 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:ehe Is,licenged 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�slie 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 morelhaii 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:.Tlib Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professiona for this re so ig at re: at ID verified by drivers license. ❑ lies ❑ No Driv Nom xplres: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or200 cubic feet .. standard and _.........I.............. . _......................................................................................... .......................................................................................... .......................... ................................................................... 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 standardtemperature 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 Ii en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ........................ ................................................................... _......................................................................................_............................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..................................................................................................................................................................................................................................................__................................... .......................................................................................... fi Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ..................... .............. _.......... _.......... _.......... _.................... _._._.................. _......._.................. ...................................._.._...._..........-............ .... ........ ............ .............. -................ .... ......................... ............... ................................... ...................... 7 If a permit from the South Coast Air Quality Management Distdct 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: 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. ,! Ignature Of Legal Owner(s) ^� Day{.�,..� a Da CODE 1. INSPECTION TYPE INTRIAL CODE I INSPECTION TYPE 2MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall �- y� 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..uUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1126 EL CAMINO DR Status: ISSUED Suite: CUSTODIA TORRES Applied: 10/01/2003 Vicinity: ROOF Issued: 10/01/2003 Parcel Number: 14161214 Zoning: $0.00 Applicant: CUSTODIA TORRES SMIP Res: $0.80 Address: 103 W ESCALONES Other: $0.00 Inspection: SUITE A ,. - Phone: 949-498-2274 SAN CLEMENTE, CA Zip: 92672 Owner: PAUL, BEN ETR Address 1126 EL CAMINO DR Phone: COSTA MESA, CA Zip: 92626-5529 Contractor: J.L. RAY COMPANY, INC Address: 103 W ESCALONES SUITE A Phone: 949-498-2274 SAN CLEMENTE, CA Zip: 92672 License: 567238 Arch : Address: Phone: Eng: Address: Phone: Zip: License: License SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 1/2" OSB, 1 LAYER OF 30# FELT, AND 40 -YEAR ELK COMPOSITION SHINGLES. 2,014 S.F. INCLUDES RESIDENCE WITHOUT ROOM ADDITION. SEE B03-00674 FOR ADDITION (ROOF INCLUDED).. Total: $154.05 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 PARKING Existing: 0 Required: 0 Proposed:, ,0 Calc Valuation: $7,995.00 Claim Valuation: $7,995.00 Right 0-0 Right 0-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) - EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 daA. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 2446.46 (&00) FEE SUMMARY Plan Check: $0.00 Permit: $153.25 SMIP Res: $0.80 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $154.05 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 PARKING Existing: 0 Required: 0 Proposed:, ,0 Calc Valuation: $7,995.00 Claim Valuation: $7,995.00 Right 0-0 Right 0-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) - EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 daA. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 2446.46 (&00) I ECLARATIONS WORKERS' COMPEN5ATION DECLARATION: r I hereby affirm under penalty of perjury one of the following declarations: ❑ I hav well 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 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 work�s{s' mpe salion Insdrenca carder a tl policy number are: rCartfer^• �_'�P� r __`-F'1.1 Policy Number.? (Ihls section need not be complete d the loomnit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work f 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 Celifomi rid a to at if hould become su 'act to the workers' compensation provisions of Section 3700 the or Code, I shall forthwith comply with these provision Applicam-Slgnature: �.//i✓/ , b � Date: O 3 ARNJND: FAILURE TO SECUR ORKERS' COMPENSATION COVERAGW UNLAWFUL AND SHALL SUBJECT AN Fb1PLOYER TO CRIMINAL P ALTI AND CAVIL FINES UP TO ONE HUNDRED T)kZSAND DOUARE 1Stc0,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEOT10N 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby.af irn.that.Lam 1_1c_ens un r eerovisions of C a ter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my lice a is in full f cro a and effect, Lic. # � /� Class If ,6 /moi 3 -Conuactof�: _moo•)' _ _pate*,__ 4a 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 Coda). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirn that under penalty of perjury that 1 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 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 driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property lax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .._.........................................._....................... ......._.................................................................................................................................................. .... .............. ............................. I .............. .................................. _.............. _............ _............. _... 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 theapDlicant 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 II an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ NO ._.........._.........._ ........... 11 .............................................. .... .... ................................................................................................................................................................ ......-..................... _.............. ........ ................. _........................ _... 5 Does or will the applicant or present or future building Occupant require for the work which is the subject of thisapplication aEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 8 Yes t,,1 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? ❑ Yes ❑ No (It yes', the facility must most the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ........................................................................................................................................................................................................................................................................................__.................—............._........_........._..........._..........__. 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ......._..........._........__........._............_............_.................. _................ _._......................................................................................................................................................... ...................... ............. ............................ .... ........... I .............. ..... 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: 1 certify under penalty of perjury that I have read this application and state that the infOrnati0n 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. natur f lrageF6wlT�r(Sr—� ! d Date (— nd/Or Authorized plicant r Date CODE 1. INSPEcnoN TYPE PSIF INTMLALS CODEI INSPECTION TYPE ga¢, ISL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BuildinglOccupancy CITY64 CO3TA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRI, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1126 EL CAMINO DR Status: ISSUED Suite: Applied: 05/02/2001 Vicinity: Issued: 05/02/2001 Parcel Number: 14161214 Zoning: Applicant: EDMONDSON,BILL ISSUED Address: - - Phone: 714-5574520 - Zip: Owner: PAUL, BEN E TR Address 254 SEMPLE CROSSING Phone: BENICIA, CA Zip: 94510 Contractor: Address: Phone: t� Zip: 'Li e: vVN- Arch Eng: Address: _ Address:" Phone: _ Phone: Zip: License: License: _C0_ OF PERMIT. CONSTRUCT 50 LIN. FEET OF BLOCK WALL 6 FEET IN HEIGHT FEE SUMMARY Plan Check: $72.31 Calc Valuation: $4,275.00` Permit: $111.25 - Claim Valuation: ', $0.00 SMIP.Rds: $0.50 SMIP Com: $0.00 Other:. $0.00 X, « , Inspection: $0.00 w Total: $184 O6 1 PLANNING & ZONING SETBACKS, MAIN STRUCTURE- Front 0/�O"� Rear---0-0 - Left 0�0 Right 0-0, � �\ACCESSORY Front-1Rear. 0-0 Left0-0 =�0 Righty" 0-0:% PARKING Existing:'Required: ,0- Proposed:, j: NOTES: NOTICE: The wor authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. 0.92-28, § 1, 12-21-92) EXPIRATION: T is 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 1 days. INSPECTION : In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required ins ctions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSP CTIONS CALL: (714) 754.5626 244646(6' NO DECLARATIOMS 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 N 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: Policy Number. (This section need not be completed it the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML 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. q Class q Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). 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 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 EXCLySIVE Y CON ACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors U e Lg1a(w.�oes a cac�nnss ppty I an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pur to aCoctrect Lic Laws.) ❑ 1 am ex r sea Business Professions Code for this reason: ature: �� - Da —� verified by drivers license. Yes No - Verification of Ownership by (type of document-I.e. - property tax bill or de 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 fila a registration form for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................................................................................................................................................................................................................................................................................................................... 3 Does or will theapplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ po (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is 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 a plication ayemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency! LJ Yes L7 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 (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. Sig e'O legal Owner Date An " onzed AD nt - CODE 1. INSPECTION TYPCQL1¢, INTITIA65 CODE E INSPECITO TYPE JIM INTITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Rcof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • THE SKETCH LS FOR.INFORMATIONAL PURPOSES • SOLID WALLS/FENCES BETWEEN 2'6• k 6' IN iIDG7iT9HALL ONLY. APPLICANT IS RESPONSIBLE FOR PROVIDING BE SETBACK AT LEAST IV FROM FRONT PROPERTY LINE AN ACCURATE REPRESENTATION OF THEIR PROPERTY IN CASE THE SHAPE AND SIZE DO NOT CORRESPOND • 9OEM WALLS/FENCES SHALL NOT ECCEED Y 6- IN FLIGHT WITH THE INFORMATION PROVIDED ON THIS SHEET WITHIN IV OF THE FRONT PROPERTY LINE (NOT CURB LINE). DIViSION OF BUILDING SAFET.�gYDLSTANCEFROMCURBTOPROPEMUNE CITY OF COSTA MESA ANDSHOWONPLAN. VERIFICATION FROM THECIY5 APPROVED ENGINEERING DIVSION S REQUIRED. CALL (714) 7545311 FOR IJFpRMATtoN. fis wt d plans hnd opcc,dwtitme mus, oe kept on thb)ob U ed than end d k uw" to moka dtw*ddo6r4'itfown on who VA"o w ftport k" t omdreDwbn WWft G Pr BLOCK WALL LAYOUT FOR BUILDING PERMIT Cjuz-G00 PLANNING DIVISION TYPICAL 611 CONCRETE -BLOCK FENCE Cement Coping Optional Channel Block With 1-3/8 9 ! Horizontal Top of all Fences For Fences 5' or Less Ven. Bars 3/8"0 at 4' 0" O.C. For Fences Higher;Than 5' Ven. Ban 3/8"0 at 32" O.C. Fill Cells Solid WithGrout Where Steel Occu is' Reminrcing Sfeel;Shall. Conform to Sec'4-.15-39 A.S. T.M. All Steel to be LdQOed,_ 24" or to Code " NATURAL -GRADE -�`- :i g/ate . TWO 3/a"O BARS L CONTINUOUS TOP 6 BOTTOM L HaFTiSTEEL MUST BE TIED IN , PLACE AT TIME OF TRENCH' INSPECTION. P 4 ,A- � N_ DTI 1--�wIDTF SEE CHI t• -= BE Low FOOTING REQUIREMENTS CHART GENERAL- NOTES MORTAR: One Part Plastic Cement, and Three Parts Sand GROUT: One Part Cement Three and One Half Ports gond COPING: One Port Cement, Three Parts Sand CONCRETE: Well Mixed 1:2-1/2:3-1/2 Mat of 7-1/2 Gol:ons of Water Per Sock of Cement GROUT MAY BE POURED FROM THE TOP OF THE FENCE IN CELLS WHERE STEEL OCCURS. CE LLS AND AREAS OF HORIZONTAL REIN FORCEMENT SHALL BE CLEAR, CLEAN 6 FREE OF ALL MORTAR DEBRIS, ETC. H (.F EARTHTCOTH ik/ TrIE HEIGTH or FENCE LOW BOTTOM OF FOOTING SCALE: 1/2n= I' WIDTH 14" 14" 12". 12" THICKNESS . . 10 . 10" a B" DEPTH OF EARTHTOOTH 24' 20 16" 12" SPACING OF EARTHTOOTH 12' 14' 16' 16* BUILDING DIVISION CITY OF COSTA MESA REFUND REQUEST FORM From:rFnce Vendor#: ing Safety Permit#: B0r'— no(g)!ning Amount: ❑ Public Services ❑ Community Services Date v t ❑ Other Department Signature Account Fund Organization Program Project/Grant Amount - 3o 01 g3cro o?0Lf/0 Name and address of applicant: 1121 EI (2Q/rVt n o be;y4F-- Phone: V jq—) ✓S / / 5�� 61-2101 Appfi i ur Date— gna REASON FOR REFUND: a� n :PparY,� ISSI eat ?tea12 . !D r12R%u.�aC . il2C¢ Eo. ll APPROVALS: Finance: City Manager: _ 2,101-22 MW ONLINE PROJECT ADDRESS: PAUL, BEN E TR UNIT: OWNER'S NAME: 15712 E CRESTRIDGE CIR ADDRESS: AURORA,CO 80015 ARCHIENGINEER: REG.11I ADDRESS: UNIT: A.H.C. HEATING 6 A/C (714)540-0972 PERMITTEE: 2951 GRACE LANE ADDRESS: COSTA MESA CA 92626 LICENSED Cpp ZIR99C]]0yy gpCLARATION: hyreyy�t f�r t1gl I am licensed underyrevisions of Chapter 9 (commencing with Section 7900) of Di14ilAd 19 A91fkBusiness and Pr it �d my license is in fl(If ItQ Qhd effect. CITY LIC.: STATE LIC.: LAS — aI� c�Lt)M14�e Signature POLICYBNO 0�1" TcopX thereofb(Section 3800, F affirm that I have aAy.Jfi5Attcfc rri)o self- insure or ace certificate of Workers' =COMPANY: �) 1 Coll copy is hereby furnished. ❑ Certified cobigiiis filed with thi Building Division. J* EXEMPTION FROM WORKERS' COMPENSATION DECLARATPN: (This section need not be cp d if the permit is for one hundred (51W1 or less). I certify that in the performance of the work for which this permit is issued. shall not toy any person in any manner so as to became subject to the WorkersCompensation Laws of California. Dale: Signature: NOTICE: If, after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor 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: ADDRESS: OWNER BUILDER DECLARATION: t hereby affirm that I am exempt from the Contractors' Slate License Law for the following reason (Section 7031 5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State 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 tar 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 (65DI I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a 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 completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). 1. as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law),I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: 8, 8 P. C. for this reason: Date: _ Owner I do hereby county that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from these provisions. Date: Applicant I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and slate laws relating to building construction and I author¢e representatives of this city to enter up the above mentioned property for inspection purposes. License or Social Security 4. 1641-46 White—Building: Green—Code Enforcement: Canary—Applicant. Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: M 065836 PLAN CHECK NO: N CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE; OTH JOB DESCRIPTION : REPLACE FAU SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT iE * 1E iE eE fE fE fE iF'7E 1f iE eE eE iE * 1E fE iE iE iE iE iE aE aE iE iE iE * iE iE 1f iE iE iE iE * 1E iF * iF iE if iE 9E iE iE iE * aE fE eE IE iE iE iF 1E iF iE * iE 1E iF XF TE iE if iE iE eE iE jt 1f aF JF IE iE'aF iE Z O N I N GK9 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 IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 13916108 ZNE: REF NO: PLANNING NOTES> > 9t 1f iE it 1f 1E iE iE fE RE iE iE iE')f * 1E 1E iE iE * fE iE 1E 1E iF iE * k fE iE * iE iE XE iE fE if fE RE 1E 1E * iE iE * * iE aE 9E iE if aE iE'aE 9E of it iE iE iE 1E iE * * fE iE if iE 3f iE iE 1E iE iE of 1E iE iE 1f D E V E L O P M E N T S E R --V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY: DATE: APPLICATION ISSUED BY: ^1 DATE: 210 1E iE fE iEk*1E RE iE 1E iE iE XE iF iF iE eE 1E *RE iEif 1E 9E iE if if iE iE iE iE iE iE iE iE iE RE fE iE iE fE*iE iE 1E iE 1E RE 1flElE iE 1E iF 1ElE iE iE iE lE iE iE 1E IE IElE fE eE iE iE eE IE ik XE iE lE iE eE aE iF if lE TE iE iE iE*lEXE%if iE iE iE iE ff fF ie lE if 3f lE iE if iEfE 1f fE iE iE LEGALIZATION:N F E E'=_S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 9.00 255 SMIP/NON—RES PLAN ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 9.00 15,00 0.00 24.00 24.00 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 24.00 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 24.00 fE fF fE fE iE iE iE iE iE iE lE iE iE iE XE iE iE 1f 3E iE it fE iF iE iE iE iE iE if if if * fE iE iF 9E iE iE,iE iE iE XE * * * * 1E iE aE iE 9E RE 1E if iE XE * * iE iE if eE fE aE * iE jE aF of iE iE iE iE 9E 1E iF iF XE iE I N D I V I D U A L f- F E E B R E A K D O W N TYPE QTY D E S C R I P T I O Nj UNIT COST TOTAL COST MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9.00 9.00 ENDIOF FEES 01 00157360-0015§360 T O T 24.,00 itATE: 01/26/94 TIME: 08:16 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector FOS t SPA APPROVALS Permit Date Inspector 1. Temporary Electrical Service or Pule 52. Pool & Equipment Location 2. Sod Pipe-Undrgrnd. - 53. Steel Reinforcement ' 3, Electrical Conduit Utility-Undryrnd, ' ,. 54. Forms 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrlca:UFERGrnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. water Pipe-Undrgrnd. ', 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor•Ftnal 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 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 2..1. Ducts, in,Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping OGas OOd 23. Gas ,°_ipe-Rough & Test - 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 001! 25 Roof Steathirg 74. Overhead Hydro 26 iBar Ceiling (Structural! & Monocoat 75. Dry Chemical 27. Frame and Hashing - - 76. Dry Stetrdpipe -, 28. Lathing & Sid;ng 77. FIXED SVSTEAA FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing _HEALTH DEPT. REQU[RENIENT 31, Plaster Bra,.-in Cont 79. FINAL INSPECTION 32. Electrical Power `.Teter-F,ral 80. FOOD CERTIFICATE ISSUED 33. Final Electric _ 34. Final Heating & Air Conditioning-- %- Notes: _ 35. Final Gas Pipe-Test, 36. Hood or Canopy 37. Final Factory Fdepiace 1 38, Final Plumbing. 39. 'later Service-Final ; 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Prevente.r -• 43. Backflow !rrtgation , 44. Landscape Irrigation System- - 45. Sound Attenuation 4$. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ' 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Ca 51. CERTIFICATE OF OCCUPANCY No. Date • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - _ _ CITYOF*_rA SA 'CONSTRUCTIONPERMIT PE MI7 NO. ,TRACT NO. jLOTAO: UNIT NO trojCt"Address -i 12-CoE� �ti f 5(a ' I ' 9447 50 ;TL Applirpht's Mailin Address J. TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR 1 _28'. � ❑'CONVEft510N❑ DEMOLISH ❑ 0 Fy�R '_ L Owner's Name l�_�f RLt '••� Phone cp=4l[L/' --^/ Zl SrJ� �!l/f4- (til-2"F __ A.P.-#_ �. t__ _ _ _'__ l •. Zone_ .- , Address. ]_)7(O r-- (�/J!% 1A;C2 DESCRIPTION OF WORK/USE OF BLDG. E 'UM S %{moi' I Main Building: ory tP�.1/106- Arch/Eng. I License No. TYPE OF PERMIT GRADING ❑ FOUNDATION STRUCTURAL E T i Front' I I O El TENANT ❑ ELECTRICAL{ ❑PLUMBING ❑ MECHANICAL R N Address Q d 1 /n/r' 1 1 ❑ OTHER-; _ - r + 'A Rear - - _ _ _ t - _ _,.+ _ 1 _ __ - I 'N' Contractor's Name' Phone PROJECT C- Right t -- .^- - np�pp 'L�- V • �'y7< Address (mailing) L C H• DESCRIPTION SQ. FT. OCCUPANCY ,K - G ''�L/f'+� CONSTRUCTION TYPE - VALUATION$ �i-�i G,-S S Left f City'License No.-]-rte! r ' ZONE- •GRADING CU.YDS: ACRES' - a - Ping. Ref: # ' Parking Req./Provided j i R E LICENSEO CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under proBlslons of Charter 9 (commencing Remarks: Planning NOl¢$[ i f y 1 M with section 7000) of Division 3'of the Business and Professions Code, and my license is in full force'and effect. ' / - _ j t j - C T Licens Class C - Li N ! $ _ Date 'f - Signature + 'PLUMBING 1 - I _-FEES f - r + WORKERS' COMPENSATION DECLARATION Bar Sink Showers, - ereby affirm that I have a certificate of consent to self-insure ora certificate 1 - ELECTRICAL FEES o, Workers' Compensation Insurance, or a certified copy, thereof (Section .,800, Lab. C.) Backflow Preventer - -- Service Sink Automatic Washer 1 Transformer'=❑ 15-50 KW , ' Policy No. Company 1 Backflow Irrigation Sewer Ca -� .' - p - Construction Pole Sub.. -- �❑ 50+KW, ; 1 e Certified co furnished. copy _ - ;- - Is filed w th Certified copy Is filed with the city Building Division. 'Bathtubs Sewer Connection 1 _ ' Cooking-Unit I Meter El up to 100 amps I its Applicant- EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers - Solar Coll¢c1Ors7 t ,.- -- _ ` - Dishwasher Y u ' :-, Meter El over, 100 amps ` (Thissection need not be completed if the permit is for one hundred ($100) or less). Dishwaslier -' Solar Piping Dryers ❑Gas C❑Electric - ' less). that in the performance of the work for which this permit is issued, I - - - Sub Panel - shall not employ any person in any manner so as to bet a lett to the Drinking' Fountains Solar Tank_ Fan Motors ❑0-1,HP ❑1 Worker Co mpesgs�tton Laws of California/ yp/rA /y.)p _ - /x- 8 Date Cs-'�-!o_—Signature L,.....�r1�r� / /iL.C.�.r% Floor Drains Swimming Pool w/Spa ` F.A.0 I ' Ina Solar ❑9-15 HP ❑18-15+. _NOTICE: If, after making this decli rationyyou shoultl b come subjectto the. .J Workers' Compensation. ,provisions of the Labor Code, you must forthwith _ FIOOr Sinks Urinal t ' T^s I I . _- 1 Fixtures ( Microwave. comply with such prvisions or this p y permit shall , be deemed revoked. ( CONSTRUCTION LENDING AGENCY GasService 'Outlets Wat¢i Closet 1 Device Boxes 1 Pole + i I hereby affirm that there is a construction lending agency for the performance - Li 9 Light, of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors ' Wate'r- HeaterLentler's Outlets Name _ Range -Lender's Address i_ Kitchen Sink -.1.- .).. Water Service-- r - Switches -r--- - - Sign f- - - - - - - I " - OWNER BUILDER DECLARATION I hereby affirm that'I'am'exempt from the Contractor's License Law for the Lavatories Auto-Wash � Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or � i county which require5'a permit to construct, alter, improve, demolish or repair P-Trap t Laundiy'Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor any structure, prior to,its•issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of i Roof Drains , , 'he Contractor's License Law (Chapter 9 (commencing with Section 7000) of s . 1 vision -3 of the Business -and Professions Code) or-,that he/she is exempt- - ' :refrom and the basis for the alleged exemption. Any violation of Section • , '� j31.5 by any applicant for a permit subjects the applicant to a civil ' {malty of not more than five hundred dollars ($500). '! 1 3 $ - LJ 1, as owner of the property or my employees with wages as their sole Reinspection' Fee $15 , Issue Fe a compensation, will ado the work, and the structure is not intended or offered Reinspection Fee - $15 Issue Fee + 1 i ', $ 3 for ;sale (Section-7044, Business and Professional Code::The Contractor's MECHANICAL "FEES 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 i Hood or Type I ❑ 'DEVELOPMENT SERVICES REQUIREMENTS:. 1 ` , employees, provided that such improvements are not Intended or offered for 'sale. improvement is within Boiler ._ I - Zoning Approved By _ Date If, however, the building or sold one year of Com- ,. Canopy Type '❑ • pletlon, the owner will have the burden of proving he/she did not build or im- ' .' Duct - Under Ground - Buildin A roved 8 9 pP y - 'Data rove for the purpose of sale). ' f d; as owner,of the property, am exclusively contracting with licensed con- I - Duct -Structural Refrigeration System 'Application Issued By tractors td construct the project (Section 7044, Business and Professions Code; The Contractor's License Law does-not apply So an owner of property-who - Duct - Ventilating _ ❑0-100,000 BTU- BTU : _ , SUM E, ARY (�F FEES • - builds or improves thereon, and who contracts for such projects with a con- tractor(s license to the Contractors,Llcensii Law). I that - - _ - - _ _- I BUILDING PERMIT _ _ ' �$' 5:D- pursuant am aware their Exhaust System ❑ Multiple ❑_ System Repair/Alteration $ SMIP proof of Worker's Compensation' insurance should be provided to me: ❑tl am exempt under Section :B. & P. C. for this reason Firepl/Fact. Bit..ICBO # _ Fire Dampers PLAN CHECK $� - =.PERMIT. t - _ - I ' P.LU MBING $- -' ISSUANCE .$ T _ Date - ;Owner -- - Heating System&Ducting Registers - �. - ' PLAN'CHECK '_25% ENERGVP.C: $', I hereby cert icy I have read this application and state that the above ❑0-100,000 BTU ❑100,000 BT _ _ ,$ ^ + GRADING' $ correct. Information is correctg agree comply with all city and county ordinances ELECTRICAL $: and state laws relating to di buil ding, construction, hereby authorize , - 1 1 1 _ PLAN. CHECK $ ' MICROFILM- '$ ' aband of this city toren teL on the above-mentioned Property for - t yfor' _ _ _ , f -50% - _ + inspection inspection pur A ..-7 /Al/ MECHANICAL $ FEE Signature' Date' Drivers' Licens or SS �:'1 ^ , Reinspectian'Fee , - $15 Issue Fee $ 3 - PLAN CHECK - 25% :$-. ,TOTAL ,$' 1 J CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS 'Permit # _ Date Inspector POOL & SPA - APPROVALS Permit # can Date. c^t p Inspector m 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 l i 7. Footings - - 58. Electrical Conduit-Undrgrnd.- r_T n m 8. Foundation - 59: Gas Pipe, ❑ Undrgrnd., Test " 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ 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 16. Rough Electric Wiring - 67. Fencing&'Access Approval " 17. Rough Wiring Sign- 68. APPROVED FOR PLASTERING ' 18. Rough Electrical -T Bar Ceiling - 69. POOUSPA 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 ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing _ 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 7 �� 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 Coat 79. FINAL INSPECTION 32. Electrical,Power.Meter-Final 80. FOOD CERTIFICATE ISSUED ' 33. Final Electric Notes: 34. Final Heating & Air Conditioning 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 - 144. Landscape Irrigation System 45. Sound Attenuation' - - - - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ;r 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATEOF OCCUPANCY I- No. Date - Lucen /CII r Date I Signature r Z \i "ORKERS' COMPENSATION DECLARATION , (tjJcp Iereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance,'or a certified copy thereof (Section 1 3800, LabNo. I fl I n �' f n^ J 1 Policy No. co VI�r'1 /t f Company n 1 �rtifietl copy is hereby turn lshed. Cer 'fled o y� s filed with the city it i Di isi n. Date - Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). 1 certify that in the performance of the,work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration,.you.should become subject to the - Workers' Compensation(provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY s i I hereby affirm thahthere is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name I. ..Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt4rom the Contractor's License Law for the followings. 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 is licensed pursuant to the provisions of 'he Contractor's License Law (Chapter 9 (commencing with Section 7000) of ivision 3 of the Business and Professions Code) or that he/she is exempt erefromand the basis for the alleged exemption. Any violation of,Section '031.5, by any applicant for a ,permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). ' 1 I; as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business•and Professional Code: The Contractor's License Law does notapply to an owner of a property who builds or improves thereon, and who does suchlwork himself/herself or through his or her own i employees, provided that such improvements are'not intended or offered for sale. If,.however, the building or improvement is sold within one.year of com- _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. -, Showers P IT O. 'TRACT NO. - LOT NO. UNIT NO. r I F' 7S/ CITY OF MESA CO IST UCTION' PERMIT 1 + ' Backflow Irrigation Project Address ' Sewer Connection Applicant's Mailing8' ddress TYPE OF CONSTRUCTION 'NEw ADO ALTERATION REPAIR Dishwasher - - /� �� ' �, - ❑ CONVERSION ❑ DEMOLISH ❑ OTHER P # Solar Tank Owrier'S Name r' Q—r{1n/� Phone _A DESCRIPTION OF WORK/USE OF BLDG. Floor Sinks Address �i.JT r r �/ i i I I'S Main Building: Water Closet . Arch/Eng. License No. TYPE OF PERMIT GRADING Q4 FOUNDATION El STRUCTURAL �T Front -]TENANT' Kitchen Sink Address 1 ❑ ELECTRICAL /PLUMBING ❑ MECHANICAL r 'B Rear Auto -Wash ' I 1 ❑;OTHER , Laundry Trays , Roof Drains Contractor's Name Phb e vWi. 'C Right; i - Goldenrod fit _:.L' ��J� PROJECT DESCRIPTION ' SQ. FT. i OCCUPANCY r ,K PLAN•CHECK -25% Address (m�l'nnl LI�Y'f' frs� 'r CONSTRUCTION TYPE VALUATION$ S Left City License No / ' ZONE - GRADING CU.YDS. ACRES pRef. # Ping. EN LICENSED CONTRACTOR DECLARATION Remarks: i Planning Notes: 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 I my license is int rCe and effect. 10 /1 Lucen /CII r Date I Signature r Z \i "ORKERS' COMPENSATION DECLARATION , (tjJcp Iereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance,'or a certified copy thereof (Section 1 3800, LabNo. I fl I n �' f n^ J 1 Policy No. co VI�r'1 /t f Company n 1 �rtifietl copy is hereby turn lshed. Cer 'fled o y� s filed with the city it i Di isi n. Date - Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). 1 certify that in the performance of the,work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration,.you.should become subject to the - Workers' Compensation(provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY s i I hereby affirm thahthere is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name I. ..Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt4rom the Contractor's License Law for the followings. 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 is licensed pursuant to the provisions of 'he Contractor's License Law (Chapter 9 (commencing with Section 7000) of ivision 3 of the Business and Professions Code) or that he/she is exempt erefromand the basis for the alleged exemption. Any violation of,Section '031.5, by any applicant for a ,permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). ' 1 I; as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business•and Professional Code: The Contractor's License Law does notapply to an owner of a property who builds or improves thereon, and who does suchlwork himself/herself or through his or her own i 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- Reinspection Fee 1 $151 1 ' Issue Fee pletion, theowner will have the burden of proving he/she did not build or im- 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 . Interceptors Water Heater, Kitchen Sink Water Service - Lavatories Auto -Wash ' P -Trap Laundry Trays , Roof Drains 1 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod Reinspection Fee 1 $151 1 ' Issue Fee pletion, theowner will have the burden of proving he/she did not build or im- - Duct - Under Ground prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- Transformer'❑ 15-50 KW - 50+KW; Duct -Structural tractors to construct the project (Section 7044, Business and ProfessionsCode: Dishwasher I Duct - Ventilating ' - The Contractor's' License Law does not apply,to an owner of property who builds or improves thereon, and who contracts for such projects with a con- Sub Panel s 1 - / Exhaust System ❑ Multiple ❑ tractoi(s)'Ilcense pursuant to the Contractor's License Law). I am aware that proof their Worker's Compensation' insurance should be p p provided to me. Cl I'am exempt under Section - _ B. & P. C. for this reason, Ince. Solar 09-15 HP'1116-15+. Firepl/Fact. Bit. ICBG # ' DateOwner Device Boxes Heating System & Ducting I hereby certify that' I have read this application and state that the above ❑0-100;000 Range BTU 11.100,00013Tinformation is correct. I agree to comply with'all,city and county ordinances and state laws relating to building construction, and hereby authorize repre- Garbage Disposal Standing Sections Generator ❑0-5 KW 05-15 KW , sentat ives of his it to en r upon the hove -mentioned- property for inspection p n � � Q Signature - Date . Drivers' Li nse or SS - -� _ - ' - - Reinspection Fee '$15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Typel '❑ Canopy Type II❑ I Refrigeration System ❑0-100,000BTU 1:1100,00013T System Repair/Alteration Fire Dampers Registers Iwue�Fee $, 3 $ 3 l' 3058 2127/,87 5001 TL Zone Accessory Building: Z O r N I G R Parking Req./Provided E _ G i RECEIVO f EB i2 M T $ Zoning Approved By • ELECTRICAL FEES Automatic Washer Construction Pole Sub: - Transformer'❑ 15-50 KW - 50+KW; Cooking Unit I Meter []up to 100 amps. - Dishwasher I Meter El over 100 amps - Dryers ❑Gas ❑Electric - Sub Panel s 1 - / Fan Motors 1-10-1. HP-❑ 1 % - 8 - F.A.U.* Ince. Solar 09-15 HP'1116-15+. Fixtures - Microwave ' Device Boxes Pole Light 1 Outlets ' Range Switches " Sign Garbage Disposal Standing Sections Generator ❑0-5 KW 05-15 KW Trash Compactor PLAN CHECK 60% - MICROFILM'*'$ '- ) I. 1 Reinspection Fee $15 Issue Fee - $ 3 dELOPMENT SERVICES REQUIREMENTS: "' 1 Zoning Approved By Date Building Approved By Date i+ Application Issued By__'_ - Dat '. - SUMMARY OF FEES- _ ' BUILDING PERMIT $ �SMIP $: PLAN CHECK - $ . PERMIT -. Apt, ' PLUMBING: _ $ -. ISSUANCE $ PLAN CHECK 25% $ ` ENERGY P.C. I$- . I 'ELECTRICAL +$ - GRADING, $ PLAN CHECK 60% - MICROFILM'*'$ '- • MECHANICAL ' $ - TOTAL FE,E .$ PLAN•CHECK -25% $ - CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA - APPROVALS Permit # n . - Date Inspector 1,. Temporary, Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd: 53. Steel Reinforcement y, 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 1- 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ^-f 5.. Steel Reinforcement. 56. Rough Plumbing & Pressu'ejTest 6. Electrical LIFER Grnd. 57. APPROVAL TO COVE R;�BINITE 7. Footings 58. Electrical Conduit-Undr468. ' 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 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. Etectrical-Final 15. Rough Electrical -Conduit - 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling' 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 20. Rough Factory Fireplace 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. Storage Tank 0 Gas 0 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 PREY. 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 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing #-Z747 LV) 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. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co - -, 51. CERTIFICATE OF OCCUPANCY No. Date COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 817 COSTA MESA, CALIFORNIA I tp11t 7� J 9w For Applicant to Fill In Completely. APPLICgIT�ON f gg PERMIT TYPE OR PRINT I.N.qRGc' BUILDING CI IF�F�W� NEOi,ly ADDRESS 1126 El Camino Drive RBCHIPT NO. PPHNlj $O. COSTA MESA, CALIFORNIA �'I1)� RECEIVED BY OA RECEIVHD GATE I66UED OWNER Mesa Del Mar Development Co. ~aa- I tttt BUILDING MAIL ADDRESS 8 E Coast Hi hWa ADDRERE SS �- TEL. Ori___ FI TYPE /� fRO11P / ADDRESS Jame as above ONING t NO. OF PLANS /] 2 I KOFNEWO'1161 fa BUILDING S� ,ayy a li li CONTRACTOR M� MaCCo Realty Company1. DESCRIPTION L Tract 2 ADDRESS - - nmg abwre NO. none CITY Same Gag above : NO EAVE OVERHANG SHALL BE LESS THAN SIDE @REAR P. L. ' SSIZE (U. B. C. REQUIREMENT LSD 1, LIEN.STATE. 2 -A-S �1 NO,TILOle 3-µ22CO 6C 1 OF LOT 77 q _; 91 I I NO. of BLDGdOneWED NOW ON LGT ARDSAPPROVED MAIN BUILDING YARDS APPROVED ACCESSORY BUILDING USE OF EXISTING BLDG. None LINE FROM[^T OF STREET II REAR YARD ( 11. M C/L STREET)SETBACK FT. FTCENTER FT. v FT. SIDEYARDI LEFT 1611 I r�- RIGHT 7161, -DE E _ U, FT_ _ FT. DESCRIPTION OF WORK - SIZE -M, x 411611 ROOMS 7 STORIES 1 C.U.P.# APPROVED EXTERIOR COVERING COVERING Thr0001- ROOF AP COVVERING Shake Shing BYPRDYEt.- L. D. DATE -22-6 USE OF BUIL1 ORK TO BE PERFORMED v R + ara e DwellingS t Plan 0-,E Garage 60 S N SQ. FT. P I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURP09E OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION' (Ib m BUILDING CONSTRUCTION. N SIGNATURE OF PERMITFEE S j. PERMITTE T f� B 57 AUTHORy 231 �2�P"� A CHECKS 4 TOTAL FEE $