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HomeMy WebLinkAbout1167 EL CAMINO DR - Building Permits I . . } CITY OF COSTA MESA 4 BUILDING DIVISION • Fi ."IIA. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER b PERMIT ''+roamal le • • Mfld_D0577 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca,us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1167 EL CAMINO DR Status: ISSUED Suite No Applied: 10/05/2004 Issued: 10/05/2004 Vicinity: ATTIC Parcel Number 14156119 ISSUED BY: Applicant: KATHY PUIG .. -_ - _ Address: 1523 W STRUCK .- SUITE E • • ' . " , • Phone: 714-633-8892 - - ORANGE,CA - • Zip: 92867 • . , Owner /,DOMMELEERS„JOSEPH-C H Address:• 1167 EL CAMINODR- - V`1� ` _ , . Phone: COSTA MESA;CA Zip: 92626 'Contractor ALPS AIR CONDITIONING & HEATING Address: 1523WSTRUCK - SUITE E • - Phone: 714-633-8892 • ORANGE, CA , _ •--Zip;'. 92867 ' - • - - License:667953 - - ” \ ~ - SCOPE OF PERMIT CHANGE OUT A/C UNIT AND RELOCATE FURNACE INTO ATTIC. N, N-' , , r •�! . i • MECHANICAL TO INCLUDE:-1 INSLFAU-<'100K-BTU, 1 REPAIR/AL`T.000LING/HEATING,AND, (,- • - I r,', ' ' -1 GAS PIPING. �- ./` • ' t ,'�, FEE SUMMARY . _ • . -Quantity'_,,: " -- ' 'i L- ;Quantity; t ISSUE FEE $23.50 " —Repair/Alt Absorbtion Unit I Inst FAU<100 k BTU $14.80 1 • ` Repair/Alt Refrigeration Unit 2: ' `$0:00 - -0 , , Inst FAU>100 k BTU $0.00 0 - Ventillation System .,,/ $0.00 ,,-0 - Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler .. , "-:',/, $0.00 >0 :'I- -1 Inst/Rep.Recess Wall HV $0.00 0 Commercial Incinerator /"/ :$0.00. ' 0 ' /J Refrig Sys<100 k,BTU $0.00 0Domestic IncineratorI/ GasRefrig'Sys->100k BTU •`• • $0.00 0 tom;%"�"rte Compressors/Absorption Systems /</,' -- / ,' l r Gas Piping, ' '' $6.15 1 *f P Up to•3•hp/100 k BTU //// $0:00 / 0 j Factory Fireplace '-, $0.00 0 • 3-To 15 hp%2500 k BTU_ "'21,7"-r/ /. $0.00' 0. Hood w/Mech Exhaust ' '.10.00_22-0 • -- 15 To 30,h0f 1,000'k'BTU ' • $0.00 0 VAV Box `� K`2-,‘ /� -•-- $0.00 .,0 • • 30_To 50 hp/1,750 k BTU - . $0.00�/ 0 / Vent Fan/Single Duct /1,-;,/,'" $0:00 ..0 - - ." Over 50 hp/Over 1,750 BTU-- •/' • ,$0.00" 0 Appliance . -' ' $0 00 0, , - - - Boilers ' "� I / Fire Dampers �� '- �',$0 00 0',". • - ;Up to 30hp r '� ' $0.00 0 Smoke Dampers $0.00' 0 - • . - _ -. ..-3 To 15 hp-' • ' ' "/ "'$0.00 0 Inst or Relocate Appl Vent' $0.00 ' 0- • - • 15 t630-hp - $0.00 0 Air Handlers< 10000cfm`‘1, $0.00 ''0 .-. , - 30 to 50 hp-' • $0.00 0 Air Handlers> 10000cfm '- ' $0.00 : 0 - • ' - - Over 50 hp" •0 $0.00 0 Floor Furnace ' �.' $0.00" 0 ' ' " ' Other Mechanical Fee Floor or Suspend Heater '$0.00- 0 - , •`\\., " "Investigation Fee . -- $0.00 - - Plan Check-Fee $0.00 - ;,Reinspection Fee $0.00 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) DECLARATIONS ' `) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 0 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. . r 0 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. workers'compensation Insurance carTJ nand policy number are: ) �y� C riar� � �, LC9lyLQ 12/14.-.( �R�4'c N der.- /73ra-ds—, c i— (lLleTeect on need not be completed if ate petal is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the w.J•• 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 Ca'fomia,and at a that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr-vi '.ns. Applicant si.gLIRET_ WORKS' EMPLOYER TO P ^T""z. • URE TO SECURE WORKS"S'COMPE.�g`I; TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALPES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S1 W,CCO),IN ADD'ION TO I • T OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: IheTEby a xtrm;IheFhemlicensed under.provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full 5terce and effect.Llc.# (&O? r OrCle`es''rre'�C Fm C C Ssaiguraf_ -.y-- ! zk �) to e. O/c/0 y CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: 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 penaltyof 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 wit have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 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: 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? 0 Yes 0 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? 0 Yes ❑No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Calif omia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ul Yes LJ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-resIdenlial building permits). B Will any part of the facilityto be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 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? 0 Yes 0 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 atur: 0 egal Own.; D e Q tWJ - f C (Amt. -;4'P,F6'.',A:.Iica`tr,— r.�., r e5 CODE I INSPECTION TYPE DISE 1NTriALS ; CODE( INSPECTION TYPE DAli I[�ALfl 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 _ . 212 Final Fke Prevention 202 Final Factory Fire Place - - 220 Final Planning Approval 203 Final Sign 222 Final Site • 204' • Final Demolition ' - .. ' ". ` '250• Final Building/Occupancy - • . • ir CITY OF COSTA MESA BUILDING DIVISION 4 ,,,• tI . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT fi. E04-00816 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT ' Job Address: 1177 EL CAMINO DR Status: ISSUED Suite No Applied: 07/16/2004 Vicinity: SFD Issued: 07/16/2004 Parcel Nunmber: 14156114 Applicant PIERPONT, JOHN KENNETH- - -_ - ISSUED BY: Alli S r Address: 1177 EL CAMINO DR- - , _ r - . _ . - - Phone: 714-979-6139 - COSTA MESA,CA'' • - Zip: 92626-5542 , i.' Owner: <-LPIERPONT, JOHN"KENNETH �� % , �,.� Address, 1177 EL CAMINO DR-_ N Phone: N COSTA MESA,OAZip: 92626-5542 • �' i IIn Contractor: OWNER-BUILDER .- . � \ ' Address: - ' . 'i - - d. - Phone: _ ` Zip: - . . License: 000000 •/ - -r-- / SCOPE OF-PERMIT % --, .- ,. \ - , CHANGE-OUT OF 9 ELECTRICAL OUTLETS AND ADDITION OF SLIGHT FIXTURES IN AN EXISTING SFD. NO OTHER WORK AUTHORIZED WITH THIS PERMIT. - ! • ., '� - --FEE SUMMARY . - - ' Quantity Quantity ' - ' 'ISSUE FEE . $23.50 Temp Dist System/Lighting ' -$0.00 02,.// -.. , ' Temp service test '? N $0.00 1 Busway/100 ft' : '$0.00 ,0/'/ j ._ r , Res:-a/c package ' ''1 - $0.00 . Standing Section New Res(1-2'units)' ` $0.00 0 ...y , - 'Misc Electrical Equipment $0.00 - '0 // ( New Res(3+units) ' $0.00 0 4 c 0,r? -.- Transformers up to 1 kva/kw $0.00!-G'/0 Pool/Spa.> "- $0.00 0 , . . - up to'10,kva/kw $0.00/' 0. ,- '' •� Lighting Fixts�'. $5.50 -.5 - 'up to°50 kva/kw.-N.- -- $0.00 0 _ ,` / / f Recept Outlets:. -- $9.90 9 up to 100 kva/kw - $0:00 0 ` Switches - ,.//,/ - $0.00 0 - ,v - ' - over 100 kva/kw ,--:,;"/$0.00_,,2 0 /' Non Res Appl -', $0:00 - 0, `'_ Low Voltage Equipment :-...„--7$.0.0'0. („„/,,,& v / Res Appl ' ' $0:00" N0 `� - -'Low Volt Wiring System/Ckt $0.00,i 0 Service to 200a - N - $0.00 - 0 _ < Misc.Condud -= �- ! ;$0'00'! 0'1, Service to 1000a - $0.00 -0 - _ Misc.Conductor - -$0.00/ 0> Service over 1000a N. ' ' $0.00 - '' 0- ', --' . Circus(gen or ride),A A',',$0.00% 0 Motors to 1 hp $0.00 0 -�/ -\ ' Circus(meth ride orJights) $0.00 ,•�0 Motors to 10hp $0.00 _ 0, •, - Christmas•Tree Stand !'x$0.00' 0 Motors to 50hp $0.00 - • - - 0 :Fireworks Stand - _ :27'140.00 0 Motors to 100hp $0.00 Other Electrical Feel.-/7� $0.00 Motors over 100hp $0.00 0 '-N 7 _.c��%ci.-�,� '-'" Communication drops $0.00 0 ------ Investigation Fee $0.00 Sub panel to 200a $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(6/00) 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. ❑ 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.) \YI 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 Calif•'end agree that 11 I should become subject to the workers'compensation provisions of action 370 of the Labor Code,I shall forthwith comply with the':�•.,-�. .,.,_! 1`� Applicant Signature: \ Date:t 16 a WARNING:FAILURE TO SECU' • ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PE TIE AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S1C0,000),IN ADDrnON 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.Llc.it Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: 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).): ilia 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 em Business and Professions Code for this reason: ^I��'� Signature: 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: 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? 0 Yes 0 No (Section 25505 of the Califomla 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? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this gppplication apermit 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 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? 0 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 Califomla Health and Safety Code Section 42303 been made? 0 Yes 0 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 ly with all- : : laws and city ordinances relating to building construction,and authorize representatives of the ity o Costa Mesa to enter upon the above-described prrtte ; •n purposes.I agree not to occupy or allow occupancy of any building authorized by this r i Tod final nspection. a re Of Legal Owner(s) � ate V And/Or Authorized Applicant Date CODE L INSPECTION TYPE DATE (MALI CODE S INSPECTION TYPE ghIL INIRIAL5 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/Retalning 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 `,' CITY OF COSTA MESA BUILWNC DIVISION .If:�. ..,. ",, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER '. PERMIT E04-01066 Ng (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1167 EL CAMINO DR • Status: ISSUED Suite No Applied: 10/05/2004 Vicinity: Issued: 10/05/2004 Parcel Nunmber: 14156119 Applicant: KATHY PUIG ISSUED BY: Address: 1523 W STRUCK SUITE E ` - Phone: 714-633-8892 ORANGE,CA ,/ Zip: 92867 Owner ;DOMMELEERS, JOSEPH C,H - - . , ' / •.. Address' - 1167 EL'CAMINO DR . �, \, \ Phone: ' ' \\ COSTA MESA;CA ' Zip: 92626 Contractor: ALPS AIR CONDITIONING & HEATING- " Address: 1523 W STRUCK ' . WS SUITE E - Phone: 714-633-8892 ORANGE,CA -. . - _' Zip: 92867 license: 667953 - ` ' • SCOPE OF PERMIT CHANGE OUT A/C UNIT.AND RELOCATE FURNACE,INTO ATTIC.. r,. ' ' ELECTRICAL TO INCLUDE: 1 LIGHT-FIXTURE, 1 OUTLET, 1 SWITCH,AND 1 MOTOR TO 1 HP. , , ; — '''.1 FEE SUMMARY --- _ - Quantity - -- Quantity ,'," ' r'' r ISSUE FEE - ' $23.50 Temp Dist System/Lighting , $0.00 0 „-', -, 1 ' Temp service test. • $0.00 Busway f100-ft' -.,$0.00 0,7 i ' ' " Res:a/c package $0.00 Standing Section/ $0.00 0/;?,/ '" -. • �' i New Res:(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 (.0'/ ,') ' / / New Res(3+units) , $0.00 0 '>Transformers up to 1 kva/kw $0.00 ,C 0/ C./ / I / Pool/Spar H. '�i -$0.00 0 :�''�, ' -_up to 10 kva/kw $0.00/j"//0 _r ,'l) Lighting Fixts: $1.10 1 '`Y" ' _ up4o 50 kva/kw // 0 Recept Outlets •- : $1'.10 _ 1 - - up to 100 kva/kw,.. -_ ,$0.00'- 0 , 1.1 Switches ' - $1.10 - '1:,- ' � ' over 100 kva/kw �''. -$0.00 0 /� Non Res Apph," /!.$0.00; ; '0 . � _ ' Low Voltage Equipment ,,$0:00, /\-0 Res Appl v /=/ $0.00' ''-0 ' ,Low Volt Wiring System/Ckt,Y:' 0.00, /,0, /If./ / Service to 200a A ;;, - $0,00, -0':' - , - . Misc.Conduit - --2.,--2.,- $0.00- , (,0 ' / - . Service to 1000a \-'' „$0.00` . 6,1? Misc:Conductor _ = . $0.00> 0 ' Service over 1000a , $0:00 . 0 - . ' Circus(gen-or ride) $0.00"/ , 0, Motors to 1hp :-$4.75 1 Circus(mech ride or lights) , . $0.00 /0 Motors to 10hp "..," .$0.00 ,0 _ - Christmas Tree Stand $0.00 -'0 Motors to 50hp �N$0,00' - 0. - Fireworks Stand , _; $0.00. 0 Motors to 100hp $0.00 --.0 ' - -Other Electrical Fee` ' ''' $0:00 Motors over 100hp $0.00 �' 0 ' Communication drops $0.000- Investigation Fee ' - $0.00 Sub panel to 200a $0.00 0 -- - - '- Plan heck'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 uter 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 1 2446-66(6/00) ° . 1 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - . ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. •�' 1 have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workecompensation Inssyrance carrier an cy nu er are: _ ( (YLT/) Po ,Number.J� r —aa)� acrt(on need not be campletSJif the pon flit is valued at o e hundred dollars($100)or less.) • ❑ I certify that in the performance'of the work for whic this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia,and agree that if - ould become subject to the workers'compensation provisions of Section 3700•f the Labor Code,I shall forthwith comply with these provisions. //� Ap,'•- ignature: --•` i �L_, .-1.4 (�Da �+ l 3-- 19/ ;a. . AILURE TO SECURE 'ORKERS'COMP NSATION CO 'GE IS UNLAWFUL AND SHALL SUBJECT AN EYaLowe fJ_CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO D1E COST OF 4 PENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I he b a I em license u9der•revisions of Chapter 9(commencing with Section 7000)of Divisio he.Business and Profen igys Code•and my license is in full Conic ctols.5ignawre:_ Rigete:. /OC 0`7 CONSTRUCTION LENDING AGENCY: ❑ t hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097•Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ 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 Code for this reason: Signature: • Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,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? 0 Yes 0 No r (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 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aRPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 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? 0 Yes 0 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 occup or allow occupancy of any building authorized by this permit until final inspection. Signature Of Le•.I.. D t ,_ai//ct, (.4 U AnN• ._,. ... .••ilcant=%w?i--/ /' ODE E INSPECTION TYPE PAIL Rama CODE! INSPECTION TYPE PAI! INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing • 200 Final Re-Roof 210 Final Electrical '201 . Final Block/Retaining Well . 212 • Final Fire 7evention 202 Final Factory Fire Place • 220 Final Planning Approval • 203 Final Sign 222 Final Site 204' Final Demolition - . ' 250 Final Building/Occupancy i Us$ / IPS .,. ,a.,,,,,,,,„„„„. Air Conditioning & Heating Co. a til Nesting , . ALPS PLOT PLAN RJT:14!.IR. YAJ.It) P!LI S 1 ��\.,1 I D. f\\CJ E � � ' E HI° YY A A ItSINGLE FAMILY DWELLING R D D p P LI1PPROTY OF VEDC / MESA L PLANNING DIVISION 8J ���2 SUBJECT TO BLDG. DEPT.REG. 0 WER NAME 1 i , . � , WOe C GUSH DRESS c'tint✓\4- C)f. NOTE: ADDITIONS, DELETIONS, P NE 4 eil 14)Scj(�_1 ocf? /Yl0A, OR CORRECTIONS SHALL BF. \ i Cl APPROVED BY THE PLANNING DIV. / . E: p2(.5.14 imcyaftit ALPS Mr Conditioning&Halting 747 W.Katella Ave. Suite 2O 3 Orange,CA 92867 (800)994-2577 1 ' 4`„401 sD CITY OF COSTA MESA i, BUILDING DIVISION F I DEVELOPMENT SERVICES DEPARTMENT PE NUMBER fl • PERMIT ` oq,rEo d B05-00224 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1167 EL CAMINO DR Status: ISSUED Suite: Applied: 02/04/2005 Vicinity: ROOF Issued: 02/04/2005 Parcel Number: 14156119 Zoning: Applicant: KIM, DANIEL ISSUED BY: irb,1_ Address: 968 S.NEW HAMPSHIRE AVE.#6 Phone: 213-210-1125 LOS ANGELES,CA Zip: 90670 Owner: LOTTY, ELIZABETH Address 1167 EL CAMINO DR Phone: 714-546-8043 COSTA MESA,CA Zip: 92626 Contractor: JEUN'S ROOFING & PAINTING INC Address: 968 S. NEW HAMPSHIRE AVE.#6 Phone: 213-210-1125 LOS ANGELES, CA Zip: 90670 License: 830895 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT - TEAR OFF EXISTING WOOD SHAKE ROOF, INSTALL 1/2"CDX PLYWOOD,'1-LAYER OF 30#FELT UNDERLAYMENT,AND REROOF WITH 30 YEAR ASPHALT SHINGLES(20 SQ). FEE SUMMARY Plan Check: $0.00 - - - - - - Calc Valuation: - $5,000.00 Permit: $111.25 Claim Valuation: $5,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $111.75 PLANNING &ZONING SETBACKS ' - . • MAIN STRUCTURE Front 0-0 - Rear 0-0 - Left 0-0 " - Right' . 0-'0 ACCESSORY Front 0-0 Rear 0-0 Left . 0-0 Right 0-0' PARKING Existing: 0 • Required: 0 Proposed:. 6 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(WOO) DECLARATIONS ) f WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O 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. a 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: o T-tc - 1 Policy Number: 11&4-35 — —a—CV cr— (This section be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation 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 fdrthwith comply with these provisions. -,27 / O Applicant Signature: �G Date: ( �/ 5 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARE(5100,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37050F 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.x 0 -S Class It C.73 G39 r'3 Contractor's Signature: Date: -7 T CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any stricture,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 end Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): O 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. 70.44,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.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,end 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). O 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 0 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? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit 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 U 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 0 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 Duality 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? 0 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 abov - ribed property f inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. it ( aS Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date COM I INSPECTION TYPE RAIl INTmALS CODE INSPECTION TYPE RATE IIMAS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing 200 Final Re-Roof d1/4210 Final Electrical 201 Final Block/Retaining Wall 212 Final Flre Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy EEE., RECEIVED 210 ! 4 NOV 1 5 1863 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING ADDRESS 1167 El Camino Drive COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. I �{ERA]I,T BO. OWNER Mesa Del Mar Development On_ _ "(J. rtif MAIL • RECEI BY DA 171E43I IInitlITU9 aADDREss3800 East Coast HiFhwaY !/ // ( mbv TEL. BUILDING CITY Corona Del Mar NO. ADDRESS ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER Mecca Realty Co. NO. ORI-499( ADDRESS 3800 East Coast Highway, CDM FIRE v1: P[ _ ZONE TYPE / GROUP CONTRACTOR MUGC° Realty CO. APPROVED /'� �L DATE/ Y/ -/ ADDRESS 3800 Fast Coast Highway (E NTNG , _ ZO�/��, OF USE O CITY Corona Del Mar LhC - I NO. v USE UJ Q�l„ LIC.NO. 207343-SBI - TEL 0R3-4220 LEGVALI V DESCRIPTION Parcel E tact /4204 SIZE I NO. OP BLOTS. LOT 7030 i n NOW ON LOT None A.P.NO. USE OF None YARDS EVES EXISTING BLDG, _ APPROVED ALLOWED SETBACK LINE FROM (CENTER LINE ST.) //�� •. CENTER OF STREET 601 REAR YARD 39 I FRONT catIN. SIDE YARD I LEFT 51 1 RIGHT 5' R.SIDE 5 FFT. IN. DESCRIPTION OF WORK L.SIDE { pT IN. . - JJJ��1( NEW I X VI ALTERATION I II ADDITION I REAR Y \ Ft IN.N REPAIR I VMOVING II DEMOLISH BYPROVEFN^`' 1 DATE I I- / ` 1 BUILDING DING 601 x51' RNO. OF OOMS B STORIES 1 DATE' J EXTERIOR WALL1,� II ROOF COVERINGWOOc&StUCCd COVERINGCedRT chakaa USE OF BUILDING AND WORK TO BE PERFORMED Single Family Residence w/attached Garage PLAN 450-B J� ;fee `I ' 5160 lir I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHO'aR UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE or ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION SIGNATURE OF PERMIT FEE $ a o PERMITTEE MESA DEL MAR DEITFT:nPMENT en N -�/2, ,i�� $ 18,801.06 PLAN CHECK $ 2 v'-' F AUTHORIZED AGENT i% / 1,(J/„✓/.; E TOTAL FEE $ 9 O--- i X