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HomeMy WebLinkAbout1171 EL CAMINO DR - Building Permits W . .. . • -r �. r, CITY OF COSTA MESA r BUILDING DIVISION > • ,,,�. ,I DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER �. o PERMIT - s. E06-00942 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa,ca.u_ ICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1171 EL CAMINO DR Status: ISSUED Suite No Applied: 08/25/2006 ' Vicinity: Issued: 08/25/2006 Parcel Nunmber: 14156115 • Applicant: KHADEM, ABE ' / Address: 1618 OHMS WAY • ISSUED BY: a//. Phone: 949-631-8777 /� ' - COSTA MESA,CA Zip 92627 Owner: MASUDA,-DWIGHT' Address 1171 EL CAMINO DR - _- . •Phone: • COSTA MESA,CA , Zip: 92626-5542 Contractor: NOOR,ELECTRICAL SERVICE • ' Address: , 1618 OHMS WAY . (i; Phone:-949-631-8777 COSTA MESA,CA Zip: 92627 - License:452774 .. • SCOPE OF PERMIT ' • 'RELOCATION OF AN EXISTING ELECTRICAL SERVICE. 1 SERVICE TO 200A •• NO OTHER WORK AUTHORIZED WITH THIS PERMIT. . ' FEE SUMMARY Quantity • Quantity , ISSUE FEE $23.50 Temp Dist System/,Lighting $0.00 0 Temp service test $0.00 Busway/100 ft, $0.00 0 Res,a/c package $0.00 -- ' Standing Section' - $0.00 0 . - New.Res(1-2 units), - $0.00 -0 - -_ Misc Electrical Equipment $0.00 0 ' ' . . New Res(3+units) ' •• $0.00 0 ' Transformers up to 1 kva/kw $0.00 0 ; Pool/,Spa $0.00 0 up to 10 kva/kw $0.00 0 • Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 . - Recept Outlets $0.00 ' 0 -.- up to 100 kva/kw $0.00 0 < ' Switches' ' $0.00 0 _ over 100 kva/kw $0.00 0 , . Non Res Appl, $0.00 0 • Cow Voltage Equipment $0.00 0 Res Appl - 1 ,$0.00 0 Low Volt Wiring System/Ckt $0.00 , 0 I Service to 200a $30.50 1 -Misc.Conduit $0.00,.' 0 ' Service to 1000a 40.00 0 - 'Misc.Conductor . . ,$0.00' 0 Service over,1000a '' $0 00\-, 1.74* 0�'�iF - -Circus(gen or ride) - -$0.00` 0 ---N ' Motors to lhpv 'A ,�-,$0 00'' 0; ' Circus(mech ride or lights) " ';$0.00 . 0 Motors to 10hp' $0.00'"-,,',-.:C.: ,0 •;Christr'nas Tree Stand - - $0.00 ', , 0 ' Motors to 50hp \ _' `$0.00- -:0�y •n - Fireworks Stand , _ $600 , <�0 - Motors to 100hp $0.00• - -. 0.._, \'_ _ • Other Electrical Fee - - -$0.00' A� Motors over 100hp -, , $0.00 ' ,-- ,� _0 - - - - - Communication drops ` ��:,x$0.00(' ' . 0 - - ' Investigation Fee - . $0.00 : Sub panel to 2006 `, $0.00 0- ., Plan Check Fee . $0.00. , Pole Light Pkg .`4600---. . ' 0 _ .-'Reinspection Fee 40.00 Sign Circuits $0.00' f _. o- - ' _ ' ' • - - - Temp Pwr Pole $0.00 - , • 0- . - ' TOTAL CALCULATED FEES $54.00 Intermed Pole - $0.00 -•0- . - COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) . EXPIRATION: This permit shall automatically expire and become void if work is hot 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) Encrzimmairliiiiim 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. c❑�t have and will maintain workers'compensation insurance,as required by section 3700 of the b�o�r Code,for the performance of the work for which this permit Is Issued. My workers'compensation� + � Insuran carrie and policy number a ` '� Cantere�td&i9 db'5etup , / r' ��'i% (!lf(/ / I�13/ (This sectio n t e /et�d r p4 d et hundred dl- $100)or less.) ❑ I certify that in the performance of the wo for Ich this permi ;libel'not employ any person in any manner so as to become subject to the wor " compensation laws of California,an reetht if I should a subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall fort comply with these pray' s. Appllcant.SignaWra���� TDate:-e�7 Zs— G WARNING:FAILURE T COMP TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TOORIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAR N ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: / I hereby affirm that I am licensed under provisi f Cha tar 9(commencing with ection 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.N _\ Q , CI-77 , _ , ContredoCaSigneture-� Date: / ' _ p CONSTRUCTION L --G A ❑ I hereby that t 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).): ❑ 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 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 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 Callfomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any r 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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? ❑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: X CERTIFICATE OF COMPLIANCE AND AUTH TI 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 la and " ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pr for inspect—Th s.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /fi�' gn r f -•.I Owner(s) ,�(xn1 _ Date 2-//� ,• •r'Aulhorized'ApPDcant�_ c atom n . , -a/qgpp• I'._ gAll ILS CODE? 1NSPECRON TYP. PEI WEALS • 1. • _ -Id System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final - 208 Final Plumbing 200 . Final Re-Roof 210 Final Electrical 61117 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 • CITY OF COSTA MESA ., Y, P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 • DEVELOPMENT SERVICES DEPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION May 18, 2007 Dwight Masuda 1171 El Camino Dr Costa Mesa CA 92626-5542 PERMIT NUMBERS: B06-01339. E06-00942 FOR: Re-roof, Electrical Upgrade PROJECT ADDRESS: 1171 El Camino Dr., Costa Mesa Our records indicate the above listed permits were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of your last inspection for the project. Our records do not show an inspection for these permits within the last 180 days nor •s have they had an approved final inspection. If you have a signed inspection card showing that an inspection was made within 180 days, or that the final inspection was approved, please contact this office so we may correct our records. If you do not have an approved final inspection, your permits will expire on June 4, 2007. Additional fees will be required to finalize expired permits. Requesting an inspection—If you need to request an inspection please call our Inspection Request Line at 714-754-5626. Requesting an extension—If you wish to request an extension, requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of completion. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The accuracy of records affecting your property is our goal and we appreciate your working with us to resolve this matter. Sincerely, Mary Jane Weidenkeller Office Specialist II cc: Superior Roofing Noor Electrical Service 1100 Irvine BI #701 1820 Irvine Av Tustin CA 92780 Newport Beach CA 92660 Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754-4656 • TDD(714)754-5244 • www.ci costa-mesa.ca.us i 1 • -- C in _ S:1 ., i ,d92‘.. . G, /9t/ yn, .- , - - /_ / 7/ _ea m /r) Q al • - 2.574w P7GSa, . Lam .. aIal-G.2L _ -6- - e. - - ms lis e°-e �� 8 - x/416, 7. - - - 7�0 � �f , - . _ - - . &-LA-c_, j.D-c"A-C- a a'• -. _ tr-N "'�Y r CITY OF COSTA MESA 4 BUILDING:DJVISION F • — ,) DEVELOPMENT'SERVICES DEPARTMENT PE IT NUMBER / PERMIT � �; B05-00860 ltb4roreando(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca,usNG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDIJob Address: 1171 EL CAMINO DR Status: ISSUED Suite: Applied: 05/31/2005 Vicinity: ROOF Issued: 05/31/2005 Primary Occ: R3 Type of Construction: V-N Parcel Number: 14156115 Zoning: Applicant: • DOMENIC VALVANO71.-ii.:::::::-::',77c...7:',,,,,,,,, Address: 1387 GALWAY LN •" , :; , • - _. -_ ," 7,'-, ISSUED BY: Phone 714:540-2420<-_,r- `, COSTAMESA,CA -'' t Zip 92626 / = ' _,` .' ' Owner: MASUDA;`DWIGHT 2, r _ / � Address /1171 EL CAMINO DR ,,. . : '_ `; - 'z -� t ' N i � 7 / / � Phone - ` � /� '; ,) l \ 'S ` • • ; if":-ACOSTA MESA-64%4-'22;2" Zip: 92626-5542 // A `":4/‘ Contractor: TODDALLEN•CONSTRUCTION j Address:',., 1387 GALWAY LN '��',e��'� r � ,•, ".Phone: 714-540-2420 „ j - \1 COSTA-MESA,CA I ; - \ Zi 92626 ___ .License:- 698984 - 'A{ch`: tY,,,- l' ."E ,,[ . '* .3i , ..Eng:., , Address: 'Ir; .y •-...,{. _ ' ' --':Address:. - - n „,. •_- • v'Zip: -. License: A License:, ..-.,, , "-� '').-).f /I:7i. SCOPE OF PERMIT r..' '','","\-. 1 ' ' TEAR OFF WOOD SHAKE FROM FRONT OFHOUSE ONL`Y(APPROX 22 SQUARES)/APPLY-1/2"OSB 30LBS FELTAND.INSTALL 30YEAR /COMP SHINGLES.. ' ._ - .— --.- - - - �.; .<4., i . r f _ FEE'SUMMARY -:7 rf. . ', Plan'Check: .','' . $0.00 ' ." ' • """ „ _ -�.CaIC Valuation 1 $6,000.00., . Permit: , , $125.25 Claim Valuation: If :56:00o.00 . SMIP Res: $0.60 , SMIP-Com:'. $0.00 — -. -- • Other:' $0.00' c .-- i•4,,, 1 i, �- Inspection:` $0.00 :;�':;ii �? ✓,�� l /�. r' r �/ Total: ✓ '$125 85 R:; ,M L , "".",2:04..:: '^110--)7,1V 5i/ ) ' �• � _ , I � - `.' r PLANNING &ZONING `, 1:25,,-'-'1/' �' "{';i / MAIN STRUCTURE Front 0-0: Rear 0-0-, Le_K -0:6-- Right --Al:-0 ACCESSORY Front „.:0:0.2- 'Rear 0 0:'-) Leftf'r Co \:0) Right _.,.0(0';21','"' r s !. i> ..- ice;% PARKING Existing: 0 '- \'cReouired: 0--- mac. Proposed: 0 r;,J • _ =r - %��iT- 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 isnot commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. INSPECTIONS:. In-order forthe work authorized.under this permit to be considered legal; such•work•must:compy with all applicable codes, and all requlred.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) DECLARATIONSf /^_l WORKERS'COMPENSATION DECLARATION: ' ' t ' - I hereby affirm under penalty of perjury one of the following declarations: ' ,y .Y '1*.: - • • ,• .•v., ❑ I have and will maintain a certificate of consent t0 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 dlfd 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'wtm Pens}}tion Insurance cattier and Icy number are: C ? ,r ? es /'( ',' `, POI cyNuintier://Z 4 F4- C `(Thls,session need ndt be completed i/the permit is valued at one hundred dollars($100)or less.) ❑ • I certify that in the performance of the work for "ch 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 a t If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the;e,pjovisi � ��� ApplicahCSignature: Date:. WARM ND�:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER'TO CRI• MINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOL ABE(Stm mom,IN ADDITION TO THE MCT OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby Ihat.l.a �Ifyr�ef,{�r•i,l?E O Chapter 9(commencing with Section 7000)of Division 3 of the Businesgel rQ(gssions Code,and my license is in full se forts SndleffecL.LIcrf (7 7 ?J rL rClass'#"'�all CAOtta lgnem` / / 4.-r �oat�-e sy = � -- 47 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 perjurythat 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 apermit 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 Code for this reason: Signature: Date: Owner ID verified by drivels 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 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 ❑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 Irom any other air pollution control district or agency? Yes l�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 (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? 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 properly for inspection purposes.I a• -: not to occupy or allow occupancy of any building authorized by this permit until final inspection. /Si��pr]/a�pr: c A.:. .,,- z-* • �__` t/ p�� AnmQr tli• zedrA/pp�lfCam�t- Dale `". ar,""-,;_. . CODE I INSPECTION TYPE" ' - ' 261L'" • UIIIDALS '-' CODES INSPECRON TYPE gag .I/1011,54$ 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 Fire Prevention • 202 4 Final Factory Fire Place , . - 220 , Final Planning Approval _ 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ' In yn! CITY OF COSTA MESA BUILDING DIVISION 4 04" , DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER Fi ' -^"•..-y•' PERMIT 06-01339 (714)7554-5273 • Fax(714)754-4856 • www.ci.casta-mesa.cettILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1171 EL CAMINO DR ., • Status: ISSUED Suite: Applied: 08/07/2006 Vicinity: REAR OF HOUSE Issued: 08/07/2006 Primary Occ: R3 Type of Construction: V-N'.; - Parcel Number 14156115 Zoning: Applicant: VALVANO, DOMENIC a Address: 1100 IRVINE AVE • Phone: 866-783-4400 ISSUED BY: TUSTIN,CA -- "'Zip:-92780 Owner: MASUDA, DWIGHT'7-. ;( -- = Address 1171 EL CAMINO-DR-TIC A ::--\, ': /--, � Phone, : 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. workers'corn enation Maxim..nce carrier and policy number are: p LCamer:l 5-74177r/' //'��l - -Policy Number. /4877(9 Z-- (This-action need nopleted if the permit is valued at one hundred dollars($100)or lass.) ❑ 1 certify that in the performance of the w• 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,an• . '<that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with t se provisi n ApPllcanteign, / �' ��� a � o 6 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 DOLIARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I"tensed u •er• • 'si•.s of •-pter 9(commencing with Section 7000)of Division z�3 of,the.Business' a P ions Code,and my license is In full rce.end-afleeCti�0. ttrvues5:1LT� Cgnuaaors Signefure: /'�� Dais=- -571--j2 - 46- CONSTRUCTION CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: 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:My 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 Ls 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 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,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. 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 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 ❑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 application snermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 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 Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 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 properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. "Fitist rds) DateIhonzed A plicant�c` .„a_ Date 6- CODE! UISPECTIONTYPE gdlI IEM1MLi CODEC INSPECTION TYPE gAlE MICA 1616 Fixed System Final Fire Prevention 206 Final Mechanical ' 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof (•1.- 5 It-,Co 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 _ ., CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENT SERVICES DEPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION May 18, 2007 Dwight Masuda 1171 El Camino Dr Costa Mesa CA 92626-5542 PERMIT NUMBERS: B06-01339. E06-00942 FOR: Re-roof, Electrical Upgrade PROJECT ADDRESS: 1171 El Camino Dr., Costa Mesa Our records indicate the above listed permits were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of your last inspection for the project. Our records do not show an inspection for these permits within the last 180 days nor have they had an approved final inspection. If you have a signed inspection card showing that an inspection was made within 180 days, or that the final inspection was approved, please contact this office so we may correct our records. If you do not have an approved final inspection, your permits will expire on June 4, 2007. Additional fees will be required to finalize expired permits. Requesting an inspection—If you need to request an inspection please call our Inspection Request Line at 714-754-5626. Requesting an extension—If you wish to request an extension, requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of completion. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The accuracy of records affecting your property is our goal and we appreciate your working with us to resolve this matter. Sincerely, Mary Jane Weidenkeller Office Specialist II cc: Superior Roofing Noor Electrical Service • 1100 Irvine 81 #701 1820 Irvine Av Tustin CA 92780 Newport Beach CA 92660 Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 • www.ci,cosla-mesa.ca.us W' CITY OF COSTA MESA BUILDING DIVISION ).:/. .. ..e DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER :r -.-.... 1 PERMIT �,ialn I P06-00575 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cpus . NG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 LUMBIJob Address: 1171 EL CAMINO DR Status: ISSUED Suite No Applied: 07/21/2006 • " Issued: 07/21/2006 Vicinity: POOL AND SPA Parcel Nunmber: 14156115 Applicant:ddressMASUDA, DWIGHT ISSUED • R�. Address: 1171 EL CAMINO DR _- - --- --- . .. '°� 1u\ -; i; Phone: 714-241-1434 COSTA MESA,CA '-,---2 r/, - r Zip:, 92626-5542 , _ Owner MASUDA,-DWIGHT � - - . ��--NAddress /1171-EL CAMINO PR � ry �(�7�\ \ � / Phone 714-2411434 ��� F i �_ �l %-.,-;N. Cv ..,,/,-/COSTA MESA,CA Zip. 92626-5542 _ -..,,i,..„,::..--:-.,....>...........„ / Contractor: OWNER-BUII.DER ''� \-_,:\\,,,, //q�Address:, jam!j� ,f. *\-\ Phone: AA - . ; --, V� \ + ' 7 , Zip: ,/ , - - .iLl //"/ License: -000000 . _ A.:-•pv •��. 'A:� ,v ` - J 7r'. , a -. -• ., f l A , , ,� . , SCOPE OF PERMIT --- ' i PLUMBING PERMIT TO RE-SURFACE(E)IN-GROUND SWIMMING POOL AND SPA;REPIPE PLUMBING , "N. i h//'FOR.POOL AND SPA,NEW EQUIPMENT FOR POOL AND SPA ADD PAVERS FOR:DECK AREA t �' i \ �;, cc/ \,/ > '�, \\ riTh L 11 , ,'� . ' I '.1%REF#:B06-01219 - \ \ , j ,-WORK TO INCLUDE: 1 GAS(1-4 OUTLETS), 1 GAS,REPIPE, 1,SERVICE'I LANDSCAPEs i. _1 i' , i -,. IRRIGATION, 1 PRIVATE SPA AND'1.PRIVATEPOOL. -s T=- • - .':., ; iIr i' L_ •� ` y -r'^ FEE SUMMARY ,,:,, 7� '� l I•� t ,•t ( l u ' AMT -._, it -AMT',/QTY'..., �,n AMT , QTY ISSUE FEE $23.50 'LaundryTub/Washer c '$000/ -O - - -' Sump Pump '�5/1/ L $0;00/ ��)0 Backflow irrigation ,,'/ $0.00 0 i ` Landscape-Irrigation '=--$14.80 (' 1 --- 1 Swimming Pool /)/,! %f. ,$60.75 j1 Backflow Preventer ' '.� $0.00 0 P-Trap $0 00 ! 0 Trap Primer ' r,--__`_$0.00�/0 Bathtub '-,`�', $0.00 0,2 Pressure Regulator ' $0.00' 0 ` Urinal �� % c "$0.00 0 Clarifier.System \ \ 1/4,40.00 0, Process Piping(per 10 ft) -=-.$OA0?gr.0 Vacuum Brkr Bkflow(1=4)'-..,$0.0O / 0 Conne-i'Oce,Soda,etc) \ ":. $0.00 0, Receptors $0.00 0 Vacuum Brkr Bkflow( 5+), ) $0.00/ 0 Dental Units\" ' '1$0.00 0, Septic Tank%.:-;••.:-,i'.-3.- $0.00 0 Wash Basin / c `--/ $0.00 0 Dishwasher, --$0.00 0k Sewer Cap for Demo :.$0 O0 0 Wash Basin Set 'N.,/ /$0:00 0 Dram,Floors $0.00 0 Sewer Connect $0 00 "-0 Waste;and-Vent System //$0:00 0 Drain Rainwater K/,\ $0.0a:,‘\ 0 ..Sewer Private Line $6.00 •; :0 - Water,Closet(Toilet) /1/ ,$0.00 0 Drain,Roof, ;/ ' $000""0.1 '�' '`3 ' Shower ';r - $0.00 '''0` ' ` '.% Water.Heater/vent .t//$0.00 0 Drinking Fountain, /$6.00 "-,.:_a\` , Sink•bar - _ " $0.00 0 Water Piping(Inst or Rep/.)/ $0.00 0 Expansion Tank', `. $0.00, 0 "- "Sink,commercial <; ;1 $0.00 0. - `"-,Water-Re-pipe- ) 1-/ $0.00 0 Gas Earthquake Valve =,$0.00 .0 �-'.Sink Floor - $0.00 '0 '- Water Service' ,/,',,-,/,/% $0.00 0 Gas(1-4 outlets) "�.,_ $6.15' - --0 ._ �-Sink"kitchen $0.00. .0 , Water Softener// / $0.00 0 Gas(Over 4 outlets) '$0.06,,c 0 -Sink service%mop-" :$0.00 0- - v OTHER/ ; $0.00 Gas Repipe "\--z.$9.80 ">(1. /// Spa(private)- $30.25 L� ';A:VIOLATION) / $0.00 Gas Service "$9.80 .., 1-Z/ ' _>L'_,Spa-(public) , $0.00' \'.0'\`• , PLAN.CIIECK $0.00 Interceptors(Grease,Oil) $0.00' =- -0 (-' ' v , I' . - \.;- REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00' _ -0'/`� , - - -. �' - ".TOTAL CALCULATED FEES: $155.05 COMMENTS/'SPECIAL'CONDITIONS • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned" - for a period of 180 days. •INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with:aff applicableap/ codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will resuR,�rrthe expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 {� 2446-46(WOO) 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 coal 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 if the permit is valued at one hundred dollars($100)or less.) ;S5I�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' mpensatlon laws 61C fomla,and gree ih t if I should becom subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith 4---comply with these pr Applicant Signature/ / V L 44tn D„e_. _ ..12I 10 (0 WARNING:FAILURE TO SECURE WORKERS ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000).IN O THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of DMsion 3 of the Business and Professions Code,and my license is in full force and effect.Uc.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: 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(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).): Oil,:as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractors) license pursue to the Cony:dors License Laws.). ❑ I am exempt .:r sec. I . Al',,I Business and Professions Code for this reason: Signature:—.--- I . �' A�% MeS li'1.1. �:Oate.:” - 1.2-I 1 Owner ID Verified by driver's II J se. 0 es 0 No Driver's License Nd/•- , Eipires:_ Verification of Ownership by(type of docu .nt,i.e.-property tax bill or deed): �— DIVISION OF INDUSTRIAL SAFETY PE'MIT CERTIFICATION: ❑ I hereby certify that no excavation f e(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 structu e,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,An 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to d0 work which would require a permit from the Division of Industrial Safely,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 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 r will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No will the or present occupant on o ._ _... 5 Does or the oast preor emen building o from at other for the work which isI the subject of this�eppliestion apermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control tllsidd or agency? LJ Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). —..._...._ _ _ _.._..._ _ _ —0 _ _ r. 8 Will any pan of the facility to be constructed under this permit he within 1000 feet from the outer boundaries of a school? ❑Ves ❑No— (II o (II"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely 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 stale laws and city ordinances regarding Hazardous Materials end 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 a ree to cord ly 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-d ribed prope for in tion purposes.I agree not to occupy or allow occupancy of any building authorized by this permit tptil final inspection. Signature Of. 41-6.J Legafz l Ow/ner(s).:---• - — ~111 Z) D Date And/Or Authorized Applicant Date BODE t IBSPECTON TYPE DAM RODE I INSPECTION TYPE PAIL• QUAL$ 1616 Fixed System Final Fire Prevention • 206 'Final Mechanical - 1288 .Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 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 • �.voIll.f( r•. CITY OF COSTA MESA ' BUILDING DIVISION F i 4.: A�1 DEVELOPMENT SERVICES DEPARTMENT RMIT NUMBER j . PERMIT • M06-00457 S°+•0.11160 A+� (714)754-5273 • Fax(714)754-4856 ••www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1171 EL CAMINO DR Status: FINALED Suite No Applied: 07/21/2006 Issued: • Vicinity: Parcel Number: ISSUED BY: Applicant: MASUDA, DWIGHT Address: 1171 EL CAMINO DR Phone: 714-241-1434 - COSTA MESA,CA Zip: 92626-5542 Owner: MASUDA, DWIGHT i 11 �k Address: 1171 EL CAMINO DR +1 4rJ 1 °� V• Phone: It '14is. oy: COSTA MESA,CA Zip: 92626-5542 it 4,i. `"e'.` :. t 4.,,t:, - it 4 - ' ' P Contractor OWNER-BUILDER 4 ,,. Address: $e � z!- µ'.( • 2`. Phone: +, 1. z, .. 1 ,z','t Zip: ,lug . • ! t, - 1rr to PE OF P SIT �f `+ MECHANICAL PERMIT Tfel-"+ 6t[f.'0 IN-GROU �SN/IMMING P• 1Ns PA,REPIPE ,1,41,„r '141. PLUMBING FOR POO . A E'd •MENT r POOL AND Ar3DQ.-AVERS FOR DE 'g , AREA. '• .41 ti 0g}.x '*4a- f v;` i +w 1'i y�• 4 i. l+ .4 _ Y 13 REFP:B06-01219 jr a i • aM kit • y.<. WORK TO INC, ID j„.. •, 4- - t 1 d it E etNitrk '.`•uantity A t,. Quantity IS + •-y = •••+#.� ra 1 R6.e it Af Absorbtion Unit $0.00 0 I 6 Ad` -O0i 7 "� '+° $p'•+g 0 '"•41',E, Repi`irx,,t,j�';l Refrigeration Unit $0.00 0 . tr AC k B , € + 1 0 t k Vebf�ilatidr�System $0.00 0 -e ryt Cooling t -t '•,.0. - 04‘1;70•1• Ekapordtive Cooler $0.00 0 �@'!, r/' .Recess -II Htr 1 11"0+'Y° 0 k ; coil t`p.r.gi 1 Incinerator $0.00 0 i"& gt s<100 k BTU ', ,10. r.; 0 rpo"est�i,c,y.ncinerator $0.00 0 7 Digi ys>100 k BTU +• 0 t aM C p se7rs/Absorption Systems "' • S1Pt in .+ •`+ ht: • ti, '3 hp/100 k BTU $0.00 0 - -'c7o Fireplace 0 I+�E + -.:1,X�' t)f _ 15 hp/500 k BTU $0.00 0 pbQr /Meth Exhaust '#)O�+i+ •+'•Ar ' ` - 15 To 30 hp/1,000 k BTU $0.00 0 r"41 tift n e t `(.- �' 30 To 50 h /1,750 k BTU $0.00 0 KV00 V fir •n/Single D •1it .,• O0D'* + rY• ' Over 50 hp/Over 1,750 BTU $0.00 0 • Boilers �t ,lcep)D�pers 4��e ., •• rJri• ra Up to 3 hp $0.00 0 Pampers " - W.• tei' 3 To 15 hp $0.00 0 r • =1I76 locate ,1. • $0.00 0 15 to 30 hp $0.00 0 q},1c . rr•,r• $0.00 0 30 to 50 hp $0.00 0 4 § t i>f 11• + $0.00 0 Over 50 hp $0.00 0 .•Ii - it $0.00 0 Other Mechanical Fee o H r $0.00 0 Investigation Fee $0.00 *b. •11425••:_.I . 2 $•-4,''' Plan Check Fee $0.00 Reinspection Fee $0.00 .> TOTAL CALCULATED FEES $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)754-5826 2446-46 WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of pequry 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,tor the performance of the work for which this permit is issued. ❑ I nave 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 nor be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I candy:net in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calitornia,and agree that it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code.I shall forthwith comply with mese provisions. Applicant Signature: Date: WARNING'FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 10 ONE HUNDRED THOUSAND DOLLARE f51 ,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,ANDATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: llgrP, F'sod I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code;end my license is in full force and effect.Lie.a . Class r }.Ci.arKI Contractor's Signature: Date: .-4"'j''t'}+T'k. t-ErliS'S3 • CONSTRUCTION LENDING AGENCY: " `n+ -,3..:oe ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this pernrHis issuetlyvlI(Sec 3097 Gve Code). Lender's Name: Lender's Address: w t Attgl-f,','L'�..AL's f+'f Signature: ..I,,,',Wa:t.,Y^-f^,n' e:R"Dat )4 -`=:e'"4 Tic ittlie OWNER-BUILDER DECLARATIONS: E v� Cyt! zi z6 I herooy affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS,LICENSE LAWS:nibsfollowing reason(Sec.7031.5,Business and Processions Code:Any city or county which requires a permit to construct,alter,improve,.demolish,or repair an .structurs;.pMhe�r.,rlo its issuance;afaddagllires the applicant for sucn permit to file a signed statement that he or sne is licensed pursuant to the provisionsthe Contract=License Las'(Crlepler 9(commendllg with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrojn$nd tilof e.basis for Ifia alleged exemption.Any violation of Section-7031.5 by any applicant for a permit subjects me applicant to a civil penalty of not more than five hundred datiril5500):): L'r .Ti"t h w'§�".it<:. ❑ I.as owner of the property,or my employees with wages as nse adelco s notation, o an'DOTH&WORK:end the structuram rro(hereoed or offered for sale(Sec. 7044,Business and Professions Code:The Contractors':beined Ca t sucie ndrpply loran anter:it pro ed orwho builds or improvei Etiereon,and who does such work himself or herself or through his or her own employeesrproVioed that is WktiprovemenM aielnot kdlrndedXtt offered fur sale.N;however,the building or improvement is sold within one year of completion,the owner-builder Will have die burden df proving that be or,etie did riot build or improve for of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS b construct the project(Secy7D44,Business and Professions Code:Tne contractors License Law does not apply loan owner of property who builds of mprovea thereon,and who contracts for sucn'project with a confractogs) license pursuant to the Contractors Lawskt•Tn Ref [i, �.z ^.+✓ q 4'; • i.-- [;jTy tut ` t`tit%ift ❑ am exempt under sec. •* L�'.\ c i Business •and, rotassions Coda for.this reason: - Signature: 4f.—a'f e....a Oa—:-'Y 1,-wnt t<Igi..1? Date: lir Owner ID verified Dy driver'911 fee9i ❑,Yes_ No eft FDmr6[_e License No':^( Expires: �((ype oil tri ns, rrop ny fax bill or dee .1 ttn, `y:t. Veribcalion of Ownership 's of -q 3,t i.e.Le.- ., `---TC^-.a� /-- ,.nt'.`.:Y,:,stT--.a::N Ssr..,:^e4 ..- - ..sir ,popp�7''.�. .. ..NI . . DIVISION OF INDUSTRIAL'SAFETY PERMIT CERTIFICATION: l�w'a. .� IN K4 Fax-,i At.4 4 t >.r^a ❑ I hereby certify that no,excavation five(5)or more feet In depth into whidi'e person is Tagmred to descend,will be made in connection with work authorized by this permit,and that no buildng structure.scaffolding?faisewwotk,or demdition.ix oismantlhip dfeieol,will be more than thirty-six(36)feel high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Tale 6,CaliforniaAdministrative Code). Jr+u •K•' Rf• ❑ As owner-builder jwillmot employ anyone to dorwork,`whtch Mwould require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do su�c�(h�'w�yo{r"k'from the division. 1kj}'�4.�``j.Llizy(' 43:JI IV]�i.Y-i,e' .U91:9 ctt''..3l.N .t 44..r Signature: Dale: ft N-4 1i:4-is- : ],tee-. Division of Industrial Safety Permit Numbed= - - •''^T -A HAZARDOUS MATERIALWAND EMISSIONSC ERTIFICATION: 1 Will the applicanso-Dres-"elft oIor.-ebUBding occupant need to lila and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 YesikU, 'CN'❑ '? ADDRESS CCNUM' 1171 EL CAMINO DR DMT CITY OF COSTA MESA — BUILDING PERMIT OWNERS NAME IF 10KAWE MC MILLAN JAMES W TR PERM NO: P 083955 ADDRESS: 1171 'EL CAMINO' DR COSTA MESA,CA ' 92626 PERMIT NO: P 083955 PLAN CHECK NO: N GOVT: N SUPP: N APPL.MAILING ADDRESS; CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH • ARCHITECT OR ENGINEER: ' GC.NO.: JOB DESCRIPTION : DISHWASHER CHANGE OUT SQ FT: ARCH.OR ENG.'S ADDRESS: UMT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / OONTRACTORSNAME NOCK PLUMBING ( 714 ) 895-1246 CONTRACTOR'SMANINO 11612 KNOTT ST COMMENTS: NO OTHER WORK ASSOCIATED WITH THIS PERMIT ADDRESS: GARDEN GROVE CA LiC.NO.: 707775 ********HF*+ERERE*iEatiE#atatat3F*iffFHFit#*3t*HtiERtiEHflf*******7f1(1EiEN•+E1E+E1ElEitiEAEAFat1ERF+tftat#(Eat*Ht*****RFit*atat 92841 DMT: 17 ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penaky of perjury that I am licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)d Division 3 d the Business and Professions Code,end my license is in lull forte and effect. Na' 050386 uc.cAss: C 36 uc.wNo.:` 707�75n EXP: 02/98 MAIN BUILDING ACCESSORY BUILDING • is 7l/ 710 Contractor: f ' �7�//�� sj FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN ' l sLEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN leirirR BUILDER DECLARATION:I hereby affirm under penaky d perjury that I am exempt from the Contractors License law for the f.l. ' .reason(Section 7031.5 Bnsihess and Professions Code:Any city or county which requires a permit to construct alter,improve. PARKING REQ: P RO V: PARCEL: 14156115 Z NE: REF NO: ',radish,or repair any structure,prior to is issuance,also requires the applicant for such permit to file a signed statement that he or she icensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)d pinion 3 of the PLANNING NOTES> ainsss and Professions Codel or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section > ":- ,031.5 by any applicant for a permit d suNes the applicant lo a civil penallyof notmore then five hundred dollars($500D. **********************************************,.********************************* ElI'asowner of the property or my employeeswith wages astheir sole compensation will do the work and the structure is not intended D E V E L O P M E N T S E R V I C E S%' R E U I R EM EN T S or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply than ower d property --C1''' Q who bolds or improves thereon,and who does such work Noma or herself or through his or her own employees,provided thea such improvements are not intended or offered ler sale.If,however,the building or improvement is sold within one year of completion, ZONING APPROVED BY j/ DATE: ownerrbuilder will have the burden of proving he or she did not build or improve for the purpose of sale). ❑ I.as owner of the properly.am exdimirely contracting with licensed contractors to construct the project(Section 7044,Business end Professions Code:The Contractors License Law does not apply to en owner of property who builds or improves thereon and who BUILDING APPROVED BY : - r. DATE contracts for such projects with a contractors)licensed pursuant to the Contractors License Law). <---......-61 1 ., - 7.1 es p O El B.AP.C..forthisreason: APPLICATION ISSUED BY• DATE• .1 7l Date: Owner: LEGALIZATION:N F E E SUMMAR Y STRUCTURAL. SEGMENT:N I do hereby certify that I ant aware of and understand the requirements of Celfomia Health end Safety Code Sections 25505,25533,and 25534.end that I or any future building occupant will/will not(drole one)need to campy with said stale codes and the requirements for a permit for construction or modification ty anagemm'Diadd.Residential construction mm ionappcione are exempt frothese - BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 8 ,75 Date: Applicant: 25% SM I P/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: PLAN ❑ I have and willmaintaina certificate of consent to selfiheure for workers'compensation,as provided for by Section 3700 of the Labor ISSUE FEE 22, 00 Code,for the performancedu»workforwlichthispemitisissued. BUI LE LDING—DIV—> PERMIT ISSUE PLAN CHECK TOTAL PAID DUE Q lhave andwilmantanworkers'compensal„nitsdim37 ,ance.asrequi;edbySeogdwrnted the TOTALS-- > 8 . 75 22 . 00 0 . 00 30. 75 30 . 75 . 00 work for which this permit is issued.My workers'compensation insurance carrier end policy number we: Caner: GOLDEN EAGLE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 30 . 75 OVER/SHORT: . 00 • Policy Number: 1.1WC 17114101 09/01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK • As section need not be completed 1 the peril is for one hundred dollars(5100)or less.) 30. 75 • ❑ I certify that in the pedmtence of the work for which this pent is issued.I shall not employ any person n any manner so as to become subject to the workers'compensation laws d Cafdornie that if I should become subject to the workers' ******************************************************************************* • pensation Sion,of of ion 3700 d the labor code.I forthwith those provisions. I N D I V I D U A L F E E BREAKDOWN 7 iyp 47 Applicant � lO 9:FW roertos hundreders'coompenusand anons(SI coverage , 1.ml �I.roshell aotf ormys�iu.wl danrpaiM�se Pmoyued ro.n TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Section 3706 of the Labor Code,Interest,and attorney's/au. PL 1 DISHWASHER 8 . 75 8. 75 • CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES performance of the work for which this perms ie issued(Section 3097,OW C). LENDER'S NAME: LENDER'S ADDRESS: I cents that I have read this application and date that the above information is correct.I agree to comply with all city and courtly ordinances and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. ' ROOCK . 87-30-1997/10:20 AM/$30.75 r • RCPTN:01-0005904 t Noma Dale: ,./ d/j PERMIT:083955 alr Signature of• er/Agenl/Appfi d (5151-46.WP) White-Building 8 Safety:Green-Rl my-Applicant:Pink-Revenue;Goldenrod-Assessor P 'CONSTRUCTION AND PLANNING i PQOI PA _ APPROVALS Permit# - ) Date Inspector APPROVALS Permit#: I Date. Inspector, 1. Temporary Electrical Service or Pole, . 52. Pool & Equipment Location , 2: Soil Pipe-Undrgrnd. . i 1. - - - 53: Steel Reinforcement ,'" 3...Electrical Condent.UUlity-UnilFgrnd. 54. Forms • • • . a - - 4,Electrical Conduit-Undrgrnd. , . ' 55. Electrical Bonding '1 r n r , • 5.,Steel Reinforcers entE 56: Rough Plumbing& Pressure Test = .Z6: .Electrical UFEi1=Grrdd. • 57. APPROVAL TO COVER-GUNITE.• - - 7 Footings _ _ _58. Electrical CondAiQUndrgrnd. s _ - - BF Foundation . . .59. Gas Pipe, O Undrgrnd., Test +i 1 tt9;;Water Pipe-Undrgrnd. ' : -60. Backwash Lines, P-Trap. 0 Undrgrnd. 10. Structural Floor System 'I 61. APPROVAL TO;D.ECKI. d' - 11. 'Property Sewer Line & House:Connection 62. Backwash &_Receptor-Final"i 12. Sewer Cap _ - - - - I 63: Heater & Vent-Final - 13. Roof Drains : : 64. Plumbing System -'Final ' • • - 14. Rough Plumbing'. - '65. Electrical-Final �, • 15. Rough Electrical-Conduit - - i "! ' �' 9 66. SolarSystem-Final . , 16. Rough Electric Wiring '� _ .67- Fencing & Acce approval t'- - . I 17. Rough Wiring Sign I . 68. APPROVED FO'R'PLASTERING . i. rt.-- s 18. Rough Electrical-T Bar Ceiling , i - 69. POOL/SPA SYSTEMS FINAL ,- ' 1 79. Rough-Heating'&-Air Conditioning - FIRE DEPT. REQUIREMENT .. �. r -r t .. 71 711-1^'t--, X [_ rt - 20. dough F_, .. FiF4ilace • fez': : cE -�'-i. H �A VAPe'mit# ;. _ .. " .4WO ~. J J. r 1 , 21. budsyv, in_Strucur2xa •• •• r-4S a ^± '7 70. -Undee4iounH 1-. dro - 22- Duds, VEntilating-t " ^ d.r a: 71 Produc P, m ®as 1 c- .V 1 s C .7 -t, - .f::P g. . , �J Oil 23. Gas Pipe: ou h &•Test .:t -1 .'. 04- ' t • -" .�_ ,R 9 .-. _ a; O'- �-- 72. UndergriTund F�us'h t: 24. Roof:Framin -• _, t i '- -•-.F. 1 > - Y :, -1 .". t-:-r 9 ,. m e ;. ,_,t. '`1 73 Undergrgd.Stgra'rje Tants'❑Gas ❑Oil Gt_ L i- 1. pt 1 tv a- 2:-,. -r-. .w f.,S 25. Rooheathing t �; v v t d > iJ r 74: Overhead Hydra 26. T-BarlCeiling (Structural) & IGfonacoat .j •_ - a . 7 Dry Chemical `tl `, 1-t 1 •J 27.1F,rame and Flashin 1v iw r �, ,n .0 .8 i „r.: 4: 7' >4 4., 76. Dry StanT4opet-xo ,. S_ n - 28. Lathing &'Siding�'` "'�= ` = "iii 7Z. FIXEDSY�STEb1 NAV ,- - 29. Insulation. ct-s. ` p n, � 4i 78FIRE:P•REV. FINAL ' > Pi 30. Drywall Nailing r'J '' i ) •-'' '-}iEALTQi DEPT`REOUIREMENT Il ' r. -��3 .. O T , 31. Plaster Brown-Coat,: *tit }: 1f: .-- 79. FINAL (fliSPEC_. 32.rElectricaltPoWer Meter.=Final p. ' { ji.w ;r, 801 FOOD CERTIFJ'CATE l SjJED r 1 ,-1 .... - ., -n 1 ,- i i 7 .-1L: F - 33. Fina,(.EIelGtncY t In i (K Notes: y yrt; t 17 n to -4" a 34. .F.inaf_Heating& Atr.Conditioning; ^ t lc x S i^.: + 7 -•• _ r-., ..r r-, - r '� I .t. c' , t44 I. 35. `l;inal-GarPip2!TeiT i ,,'t' _ r I '' C. r•::.. '` tr' '-' - .i i,- ; =o C. t•• m o 36. Hood or Canopy 7:A n ' •, r' , r' ' i'- r r :=;,� 1 cr .-. 77 r, -- a. t ., - :�J k -1 t17 y 37. 'Final;Factory Fireplace.., - / /- I u Y' :i' 111N 38. Finat•Plumbing Z[ �; - -. * al _- f 1 (( " e , 39. Water'Service-Final t - - t I I '/ - _ - • -"" ' X 1 ;_ Jr, 40. Gas Service-Final` , -r; Q?'-• S - •r: t P11• - u -t - . 41. Solar Domestic•Final `, ' •' I 1 ! a pi -:v "'-t ; c c r• 42.'Backflow Preventer ,. • :t u: >1-1 O 1-i 43. Backflow Irrigation ` -- - , 3. 1 r .� .t �_-, ', ;44. Landscape Ir gation System r•, - -j -1 a 7 r v w -.? , : 'V 45. ;-�ound Attenuationli -'x'F a- ' Ea r' t - - :< -t 1 T , -J .. .. 'it 111 rmr - <.`- ,-.,/ 1: 46.Handica p.Regtilatioris - . • ;. c 7` - t, t. 47. •FINAL STRUCTURE & BUILDING !- ''. S T . 48. FINAL PLANNING' • , „a ( d r Tl 49. 'Electeic Release to Edison F ii , li/7I! i. r t _50. Gas Release to Southern California-Gas Co : t. i t _ Cl. • Dr1 t • . - - --l;-, t nt • - :5T CERTIFICATE OF OCCUPANCY '-1 . t '*t% t r F 1- No- Date • m'4-„ CITY OF COSTA MESA 4 %, BUILDING DIVISION }:e. .. 4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER I. . 7s • PERMIT 'e E06-00808 bows, (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cc.� CTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1171 EL CAMINO DR Status: ISSUED Suite No Applied: 07/21/2006 Vicinity: POOL SPA - Issued: 07/21/2006 Parcel Nunmber: 14156115 Applicant: MASUDA, DWIGHT Address: 1171 EL CAMINO DR ISSUED BY: _Phone: -714-241-1434 COSTA MESA,CA - ,>�; 'Zip_IC- 92626= 5,5 ,42. . - _ .77 i - Owner MASUDA;•DWIGHT _ Address 1171EL•CAMINO,DR �‘' _ . - j ,,,; ��� i A \ / _ Phone Z14-241 1434 _ . �-.---N.\ / COSTA MESA,CA ‘ "/% = Zip - 92626-5542'=--- �� _<�_`? v ;,) ��vA 'ji ♦ .� c>- " -- -,2---‘1c.;/.2:.,"--..7-` � ' \V i'�a � '/ .�� Contrr�'r -OWN DER �1/4..c2>-..(/ C /\�-\ • /;G'Adress: ' • . _ `H\`.,ASA" �•;� ,�/; Phone: -, Zip; r.,� ,A� \ `'/-- License:000000 • __ ___ �- >H `1; - �_ r c. '. - - , SCOPE OF PERMIT- L , ' 'PERMIT TO RE-SURPACE(E)IN-GROUND SWIMMING POOLANDSPA;REPIPE PLUMBING FOR POOL _ (/7WAND SPA,NEW EQUIPMENT FOR POOL AND SPA ADD PAVERS FOR DECK'AREA!', _J a;2/ X., . , ,+` \\.7 i 1/ REF#B06-01219%�, N-2\\ + , ' i.! WORK TO INCLUDE:1 POOL/SPAT-3 OUTLETS,"4 SWITCHES, 1/SERVICE TO 200A, 1 MOTOR TO 10,- , ' ; .-HP, 1 SUB PANEL TO 200A AND 1 MISC CONDUIT:_„_' - -- ;r• i; . FEE SUMMARY- - t : , -- 11 t I L_ I I ' Quantity.v _o /2/.,,,,,\ Quantity ‘, ++ ISSUE FEE , $23.50 -• i i Temp Dist System/Ugh-tin-01:c::1 $0.00 0 ' 11'! Temp service test i $0.00 ' .. ' - ' - - Busway/100 ft', -- ' _- _ $0.00 0 / / r ,ti/ ' . 1, Res.a/c package $0.00 ._ -- Standing Section - -. 'I $0.00 0 , .// NewRes(1-2 units) , � '1 $0.00 0 Misc Electrical Equipment / /;', - `�� i $0.00 O j i New Res(3+units)\ \.ti $0.00 .' 0 Transformers-up to 1 kva/kw - -1$0.00 02 j, C. j Pool/Spa 1 -, , $49.50 , 1 up to 10 kva/kw $0.00 .0 j ' "C-'- '� ' Lighting Fixts '\ '1 V $0.00 • 0 up to 50 kva/kw $0.00 'P, r , '•rj r Recept Outlets - $3.30 3 „ �..-.; .,.�- up to 100 kva/kw $0.00 /j 0' - i- Switches ' - ' .`. $4.40 , 4 , - - `- ' over 100 kva/kw Non Res Appl -\ . N, ,$0.00 0 .r . Low Voltage Equipment $0.002 0 - / Res Appl C '. $0.00 0 . Low Volt Wiring•System/�Ckt .�.-. $0.00? o L j c' Service t200a` ` . $30:50 "1';' --> ' 'Mist:Conduit" - S' $18:20 1 '- u Service to 1000a�. $0.00 5 0'; - ' :Misc.Conductor Service over 1000a' $0.00 .c.'.0 "' , ' 'Circus(gen or ride) _ - '$0$0.00,00.5 .\o0 - / Motors to 1hp \ i $0.00. ' •0? - - -' . Circus(mach ride or lights) '. $0.00 ',0 '., Motors to 10hp $12.30 -'/ 1 ,- Christmas Tree Stand_ .$0.00-2 , 0%, ''% Motors to 50hp ` :�� $0.00 'T 0 `-� -_Fire4iorks.Stand� Vv-� .$000/ �'0-`' Motors to 100hp �, C �$0.00\7<///0 N . - Other Electrical Fee---. \1 $0!00DD Motors over 100hp C $0.00 - -0 _ - 7 Communication drops - $0.00- - -' 0 ' - - "Investigatidn Fee' • $0.00,'/ Sub panel to 200a $30.50- - 1 - , -Plan Check Fee- - - $0.00 Pole Light Pkg $0.00'- - -,-0_- ' - . - '-. Reinspection Fee , --$0.00 Sign Circuits $0.00 --0 - -, - Temp Pwr Pole $0.00 0 •- - - -' - - ,-TOTAL CALCULATED FEES $172.20 Intermed Pole $0.00 0 - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related. regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable,;codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration,ot this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(eno) DECLARATIONS (-•1 ( Th 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 win 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)or less.) I/3—Jeerer),that In,the.Derformance 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' c,,--compensatlon laws of CI mia,and ree th I I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these prow . an \t �7 -Applicant Signature—.- 1 pty ,O L(.1"4 e-�/ Dater -'. -7/2-1 11 ZI I b L WARNING:FAILURE TO SECURE WORKERS' ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL•PENALT1ES AND CML AMES UP TO ONE HUNDRED THOUSAND DOLLARS($100,O10),IN ADDM THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. UCENSED 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.Uc.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ' ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: 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 Ucense 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 cMl 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 1,=r sec. I Ir• Business and Professions Code for this reason: ' Signature: . 1....ii �S � (Date:--7IL( O - iA ' �(�'—`"'" F�cplresa- Verification of Ownership by( •a of docu .nt,i.e.-property tax bill or deed):_ DIVISION OF INDUSTRIAL SAFETY • RMIT 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(38)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? 0 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,ore 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 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 bulking 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 apenit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency! r Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). _._....__._ ___ _ _ e...._ _ _ _ _ _ __,.... 8 Will any part of the—facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If aermlt 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 agre to comply h all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descn d property f inspec' p (poses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. , 1 ,� � 21Iob Slgbature Of Legal Owner(s)._.__i___------- L __ And/Or Authorized Applicant Date ;ODE t INSPECT/NMI PATE IIIIIIIIALA CODE( JNSPECTIONTYPE PATE ____L$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical Af 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 Iii • • CITY OF-COSTA MESA I ' f 4 , @ BUILDING DIVISION ),1 ,, a DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 0 I:. _ ..L i PERMIT B06-01219 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.c¢jJJILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1171 EL CAMINO DR Status: ISSUED Suite: Applied: 07/21/2006 Vicinity: POOL AND SPA Issued: 07/21/2006 Primary Occ: R3 Type of Construction: V-N Parcel Number: 14156115 Zoning: Applicant: MASUDA, DWIGHT Address: 1171 EL CAMINO DR Phone: 714-241-1434 ISSUED BY: ' COSTA MESA,CA - -" . Zip:_ -92626-5542 Owner: MASUDA, DWIGHT II-- i.!----- : , Address 1171 EL CAMINO DR Y „ , % ' . Phone: ;714-241-1434 \� COSTA MESA,CA , A U. .1 ' Zip 92626-5542 %--. ' V� Contractor OWNER-BUILDER -'_?' v v Address i//„ \v - ����� v /- N .":� Phone: �' .,:.),N. :‘ \ 46% \N \\'/j, �% \? .:` ( \ ;\�,\ i / \ ' Zip: _ -",; ,- License: 000000 \ " \- - \, / // . ./C;/ vV,-,. �\ AAV\ /Arch :,./ ',- / )' Eng: NI VA. .i ) A Address- -5`/ - Address: _ .K„-A� 3_, - \�Av •/, ; Phone _ - Phone: (' , • A� ` • /Zip: v , /i;/ , License „ ! i, i y License:% 1V ; , , ' 1` -- SCOPE OF PERMIT ;i ;,_�,;/A� PERMIT TO RESURFACE(E)IN-GROUND SWIMMING POOL AND SPA,REPIPE PLUMBING FOR:POOL AND SPANEW EQUIPMENT FOR1POOL i t', AND'SPA ADD PAVERS FOR DECK AREA. \ ( \\\ `j\l,i i L k I I\I ( / ( I:rr'i_1 r,l ,- ..r�r t FEE SUMMARY ;"} "4�' --, V ;!c-,11:,::! y ;, / ) ,fAi. 11 ' Plan Check _ � $0.00 ' '� ✓ CPI 1.1 j',77 ids t, {- LCalc Valuation L '1:;! 1--g4,000!oo • .i ;; i Permit:,,, $97.25 — - -- - - _ — - - _ - - --- .,--- -- Claim Valuation: l "--$4,000:oo SMIP-Res 4\ ! $0.50 \ 1 Ii/j; i i i ' It SMIPOtherv.I;H`'' $0.0 _ _ Sir ':v tt f Lr � ��,�`� �� t . \yJInspectlon: „.;K, $0.00 i 3 r dill, %,� Total: v��,{ $97.75 _�._ /'/// "7 ',/'' �1 a; � 1 i` /cam ,,4r , ` `-- % ' PLANNING &ZONING ! ' / "`/ SETBACKS -vv • +f=' T /" ' /1 MAIN STRUCTURE Front\ ..9-,0 Rear 0-„,0 . Left 0 0 Right 0-0, 0 / r . V .� ` a / / /) ACCESSORY. Front, 0 Cr,.' _Rear 0 0= r Left , 0 0 Right.-j0-0 ii) PARKING. ` ,, 'Elg:',; 0 :Required ,0- Proposed 0 - �2v % /_% NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Californialstatutes 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 fora 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)7545626 ' 2446-46(6/00) DECLARATIONS f`1 tr.\ WORKERS'COMPENSATION DECLARATION: '1 I hereby affirm under enalty perjury one perjuone of the following declarations: - p -, ❑ 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: Carter: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) j I certify that inthe performance of the work for which this permit is Issued,1 shall not employ any person In any manner so as to become subject to the workers' ��''''''``.�dompensation laws of California,an gree thct JI I should be subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith L./comply with these pr Ions. , M A \ _ '�lI t7 b Applicant Signature:-.1A ands. ?Date:--- . -� / WARMNG:.FAILURE TO SECURE WORKS ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL-PENALTIES AND CML RNES UP TO ONE HUNDRED TH0t1SAND DOLLARE($100000),IN ADM 0 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.Lia 4 Class# Contractors 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 - r -subjectss the applicant to a civil penalty of not more than five hundred dollars($500).): ti -LII,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. T 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 Coptractors License Laws.). ❑ I am exempt hder sec. •4 Business and Professions Code for this reason: / Signature: . / re . l) - . .WE . ... i _ Expires:. Verification of Ownership by(type of docu ent,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFE ERMIT 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(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a permit to do such work from the division. 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? 0 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). __....r...._ 2 Doess or __....._... ..__ _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 Des will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application agermlt for such construction or modification from the South Coast Air Quality Management Mulct or from any other air pollution control district or agency? Yes LU 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 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). .—._ __..._.t... _ _...._._ __subject _ 7 If a permit from the South Coast Air QualityManagement District or other air pollution control district or agency is required for the work which IS the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 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 th all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descri d property 1 inspep 9 purp�.I agr not to occupy or allow occupancy of any building authorized by this �it ugtil final inspection. /_`y1( J /till 2100, _�Sr re Of,Legal Owner(s) j Date And/Or Authorized Applicant Date CODE t IFSPECIION TYPE DATE OfTlTt9125 CODE I REFECTION TYPE PATE Mme►$ 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 Fire Prevention 202 Final Factory Fire Place - 220 Final Planning Approval - 203 Final Sign 222 Final Site 204 Final Demolition, 250 .Final Building/Occupancy .a . . i yam ma • ea 4 &4€4 Neal- &tcidi e tiuioiotc m r ti.. T,..,..!:74 � .. OWNER-BUILDER VERIFICATION �'Addr£�,'e"ss`l 1171 E- LAM IN((t� D2 Permit#: A city or county,which is required to give notice pursuant to Section 19830,shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner- builder verification. Attention Property Owner: An `owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. /177I.personally plan to provide the major labor and materials for construction of the proposed property improvement. �J Yes ❑ No 42....1--' ihavDiave not) signed an application for a building permit for t e proposed work. 3. I have contracted with the following person (firm)to provide the proposed construction: Name Address City Phone ( ) Contractor's Lic. No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address City Phone( ) Contractor's Lic. No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work • 1042-46 (Rev.11/04) I' . .. I hereby affirm that 1 have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my personal knowledge, in compliance with this State law. fined ' /)IAT 1 1 Date > 7/21/o(� �me D6J t GUS Mt\SObik (Printed or Typed) (t• 'DL: OR S.S. # For more information call City of Costa Mesa Building Division at(714)754-5273. • • • • • 1042-46 (Rev.11/04) ca CITY OF COSTA MESA ,� l� is3ss FEE RECEIVED pi Building Safety Department FEB g 1962 Application for permit for the fabrication and erection ( � FINANCE DEPT. of awnings, advertising signs or devices. CITY OF COSTA MESA FOR OFFICE USE ONLY LOCATION ANT? Building Site Address II " I EL - r''.4/Lo7Nrl P.P/!/ . Date Issued FEB 4 1962 Permit No. Name of Leasee NLQCCC Ct9,ePoic2R7,on/ Phone NG 6o46 / Fire Zone Fo f�;•e Group Approved by Date - Contractor -C4,e PE SJT-N COMPA/VF State License No- f ZONING .- address 27/2- MA ...6-7S St City .SRN7/F A/!/4 Phone /C/ 774/ 7 Zone fk1 se of Bldgs. reon(Rc it n�_ Architect or - (A•om �- TQ, 0 J, gineer State License No. � 'D " Bldg. Site Address • - _ AM% 0 $ s' • address City Phone DESCRIPTIONt. Legal Owner Mu C 0-0 C o 1"-- ‘:=• • Description of awning, advertising sign, or device: Address 33CC a. Goa-5-'% I-1- 1 i. Awnings canvas 0 metal ❑ Width: 4$ ft. — in. Length: 6. ft. `-- in. Cityf'"n j&r.'Ala bet P1 u/\ Phone Ground Sign Cil Projection Sign ❑ Roof Sign 0 Wall Sign 0 Metal Letter Sign 0 1i"�' Yards Approved. Banner 0 Canvas Sign 0 Gas Tube Electric Sign (Sub-section 1.44, Ordinance 313) fl Large Sign in excess of 8 sq. ft- Setback from center line i Combination Sign ❑ Special Device (other) ❑ Explain: of street to front property line Oft. in. From property line to edge of sign /ft. in. Two copies of plans and specifications shall be submitted with application for permit for each sign. Plot on Side Yard Setbacks: plan sheets proposed location of sign and locations of all other signs at site. Minimum size sheets must be 18" by 24" and non-erasable. Left Side $ft- in. If within the 10-foot area of front property line, owner is to sign written agreement with the City. Right Side '"S Sit. in. Building Line Setback from S- f Sign - Thickness fT- in- Height ft- in- Length '7ft in. center line of street Sas ft. in. Wt..ynt lbs. Height above grade 4 ft. in. Projection ft- in. Area of Sign 'p4" ft. _ in. The undersigned hereby agrees to fabricate and erect awning or advertising structure within the intent and Height above Grade aft. in. meaning and in strict accordance with the provisions of Ordinance 95, Ordinance 313 (Electrical Ordinance of the City of Costa Mesa), and all amendments thereto. Projection ft. din. ALL APPLICATIONS MUST BE FILLED OUT BY THE APPLICANT. ALL FOOTING, FRAMING AND ELECTRICAL IN- SPECTIONS SHALL BE CALLED. Length ft. in. Signature of � l,v� S- The amount shown under Valuation is for the purpose of Awning Height above Grade ft. -_in. Permitee u establishing a permit fee only. Projection ft. in. Authorized Agent C ARTT R SUsW Co VALUATION Permit Fee $ — t ji 6 8 Location and sizeo r 1 ? el� $ / ,� Plan Check $ a- approved by �� • �- / I - (�� !//C_. �L'� O [DAY Recd. by Dot. Total Fee $ Date3 Form 214-1M-11-60-S-B P l �_— �..r'.- p _Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - i CfTY 0p COSTA MESA'-= - -' - '. _ .. , r L - 1,, PERMIT-NO.-. ' - - TRACT NO. LOT NO. _ BLDG.NO. r CONSiJCTION•PERMIT a I <.' 1 47B5' '.2/24/B4• '^ ' 1','3.02 : It fiEM -1/ 1{67- 4• aa 9 , 4-/0 ' • Project Address'' I —1 1 i 'I. C AcY1.1t.1 O ae • - - TYPE OF CONSTRUCTION - U. pp ,NEW ADD ALTERATION' U-REPAIR i ' - - ` ' A'pplicant's Mailing Address(, 11 ` . EL C4Cn itdO - i)R- ' v ❑ CONVERSION � DEMOLISH ❑ OTHER - 1 • - - A P # I Zone4,4...:1 - - ! I,. O_w er's Name C't'�'T V' '�A�/tnI--}fin�T' Phone �_�l1'-b•«U DE • PTION OF OR- Am * t .n- < IyI — SCO ,'+ 1 K ; /` ti - J��3����� Q N" p _ S Main Building: •� Accessory Building: Z Address 1111 .1 L.' L`�-11111.,)x: ��=" R . T�D - O TYPE ••F PERMIT III GRADING - �- FOUNDATION MSIR. TURAL Front _ i '^ N ' Arch/Eng. ' _ I - - License No. ' ' • - 0 TENANT l•ELECTRICAL ❑ PLUMBING MECHANICAL- , B Rear •�C./ / fa - - - • Address -` 1 i • '- I- ❑i OTHER .A- S •/ O/ ` .. _ Contractor's Name QWIQE-�,' '�x- ' 'Phone PROJECT DESCRIPTION .SQ. FT.' 2-�£-' S OCCUPANCY C Right 7 111/000 ' - Address, mailing) '71. - • • CONSTRUCTION TYPE VAtUATLONI$ Cc/-acpOe• $ Left 47/ 6 (• I ' E C •• ZONE ' ' ' GRADING CU.YDS. "ACRES/9, 99i 79/ Park.Fees • O • City•License No. - ' ~ ', / Ping. Ref:# •f $ ,i t. .LICENSED CONTRACTOR DECLARATION .• - - T - U Remarks: s. Parking Req./Provided _ -- - i. i 1 t lihereby,affirm that I am licensed under provisions of�Charter.9 (commencing - A " ' R with section 7000) of Division 3 of the Business and Professions Code,and , - �? /2Oesz - Use of Building: . E my license Is in full force and effect. - ' - • !!! C'. License Class License No. • PLUMBING •• FEES Planning Notes; • - M , Date Signature _- . • _ - E ""rRKE RS'COMPENSATION DECLARATION - Bar Sink Showers j - - _ N ebyaffirm that I have a certificate-of consent to self.Insure or a certificate- •• - -- -. - - . .. .. - T /orkers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer ',Service Sink ' - • ,o, Lab. C.) I ,r. Backflow Irrigation SeweriCap • j • ELECTRICAL Policy No. •'Company"1 - - BCertified copy is hereby furnished.,;"-J ' ' ' Bathtubs _ Sewer Connection 2' Automatic Washer Transformer 0 15-50.KW Certified copy is filed with the clty'Bullding Division. Co - • - • • - ' 0 50+KW:' Date Applicant Clarifiers Solar'Collectors" Constr• uction Pole Sub. .... • - _ _ .. J EXEMPTION FROM WORKERS'COMPENSATION DECLARATION I . Dishwasher ,..Cr i Solar Piping r,. Cooking (This section need not be completed lfthe permit Is for one hundred ($100) or J Unit Meter ❑Up to 100 amps less) I - DripkingFountains • I Certify that in the performance of,the work for which this permit is Issued, Solar-tank DlshWdeher Meter Dover 100 amps , shall.not employ any person in any mantle so as to become subject o the _ Workers' Cormpensytiop Laws of California Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel • Date J--after Signature NOTICE:If0after making this declaration,you sho id become subject to the Floor Sinks -- Urinal Fan •. ' Motors 00-1'HP ❑1'/a-6 Workers' Compensation provisions of the Labor Code, you must forthwith ' comply with such provisions'or this permit 'shall be-deemed revoked. • Gas Service Outlets Water Closet ' ,F.A:U. Inc.Solar 09-15 HP ❑16-15+ CONSTRUCTION LENDING AGENCY - - I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater �7� Fixtures,- Microwave Q of the work for which/this, ppr aif is Issued (Section 3097 Civ. C.) - 44 Lender's Name (.-' Kitchen Sink- Water Service '- - Device Boxes Pole Light Lender's Address Lavatories • OWNER BUILDER DECLARATION 4:•OuLlets'.� Range 080 I hereby affirm that I am exempt from the Contractor's License Law for the —P-Trap . - following reason (Section 7031.5 Business and Professional Code: Any city or 7 'Switches, Sign O 'county which requires a permit to construct,alter,Improve,demolish or repair - tin any structure, prior to its issuance, also requires the applicant for such permit Roof Drains - . ' - ( Garbage.Disposal Standing Sections to file a signed statement that he/she is licensed pursuant to the provisions of fseContractor's License Law(Chapter 9(commencing with Section 7000) of J Generato,❑0.5 KW 05-15 KW Trash Compactor 1 :•cion 3 of the Business and Professions Code) or that he/she Is exempt £ +yj¢rom and the basis for the alleged exemption. Any violation of Section •• _ - _ 45 by any applicant for a permit subjects the applicant to a civil t � { .linty of not more than five hundred dollars($500). Reinspection Fee $25 Issue Fee . $ 3 . � - I, as owner of the property or my employees with wages as their soleMECHANICAL - E m Reinspeition Fee $25 Issue Fee $ 3 compensation will do the work,and the structure is not intended or offered - FEES for sale (Section 7044, Business and Professional Code: The Contractor's — - — -m` r pUBLIC SERVICES R QUI EMENTS: License Law does not apply to an owner of a property who builds or improves Boiler Hood or Type I 0 thereon, and who does such work himself/herself or through his or her own _ Zoning'Approved By lvrt� Date.2-2�-d�'/" employees, provided that such improvements are not intended or offered for Canopy Type II 0 _- sale. If, however,the building or Improvement Is sold within one year-of com- : Duct-Under Ground • Y Building Ap-'i" .By Date q 05,4 pletlon, the owner will have the burden of proving he/she did not build or im- i „ : 2... shrove for the purpose of salIe@) ' Duct-Structural Refrigeration System Application Issued By • V d Date LJ I,as owner of the propirty, am exclusively contracting with licensed con- ❑0100,000 BTU ❑100,000 BTU ' tractors to construct the project (Section 7044,Business and Professions Code: . I Dtict-Ventilating 7 QO [7; -' -SU RY OF FEES The Contractor's License Law does not apply to an owner of property who I /•O - builds or Improves thereon, art who contracts for such projects with a con- Exhaust System 0 Multiple❑ System Repair/Alteration ',� BUILDING PERMIT $ r.�0 $MIP $ tractor(s) license pursuant to the Contractor's License Law). PLAN:CHECK $ 7/•e� PERMIT I 0 ram exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO# -1 t ' PLUMBING $ • ISSUANCE $ Date Owner ' ' Heating'System& Ducting '� PLAN CHECK 25% $ ENERGY P.C. $ - - • I hereby-certify that I have read this application and state that the above ' 00-100,000 BTU 0100,000 BTC— - - . - f(" 1/46/3 information is correct. I agree to comply with all city and county ordinances . i• ELECTRICAL $ GD GRADING '$ and state laws relating to building construction, and hereby authorize repro- MICROFILM $ sentatives of t city to enter- upon the above-mentioned property for - . '.. (PLAN CHECK 50% $ p inspection pure T _ • - „/ �/�y ` , TOTAL FEE I$ /3.OZ Signature l.. Pr ' Date ci?( 7/ MECHANICAL $ • 44.00 Drivers' License or$S / • Reinspection Fee $25 - Issue Fee - $ 3 t PLAN CHECK- 25% $ Or Zr _ . ,CMF 0865-46 rev.12/83 White-Building:Canary-Applicant;Pink-Accounting;Goldenrod-Assessor - - r.0 • - - S ili ''! RUCTIONrAND PLANNING i - - - _ POOL 'A - I- - Date Inspector - - -•Date Ins ectorr . 7 :AP. ' Permit,# APPROVALS Permit# - P„ :Temporary Electrical Service or.Pole , •52- Pool & Equipment Location- • - - 2c Soil Pipe-Undrgrnd. - 53- Steel Reinforcement 3.• Electrical.Conduit Utility-Undrgrnd. - 54.' Forms - • - F 4. Electrical Conduit-Undrgrnd: _ _ - 55.. Electrical Bonding - - . - _ ,y 5. Steel Reinforcement' . ..• ; 56. Rough Plumbing& Pressure Test 67 Electrical LIFER Gi-hd. • • -2; 3 - d 57. APPROVAL TO COVER-GUNITE 7. Footings - • I _ � - c. 58: Electrical Conduit-Undrgrnd. - ' 8. Foundation 4-SLAB - 3 .2 re ,6P - ,59. Gas Pipe, D-Undrgrnd.-,Test - 9. Water•Pipe-Undrgrnd. - :-.1 60. Backwash Lines,P-Trap, 0 Undrgrnd. , , 10. Structural Floor System 61. APPROVAL TO DECK - y 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final • . 12. Sewer;Cap • ; • • 63. Heater& Vent-Final 13. Roof Drains - 3.26-gyR 64. Plumbing System - Final - - - - 14. Rough Plumbing - 65. Electrical-Final - - • - - ! l'15. Rough Electrical-Conduit - - : , - - - - 66. -Solar System-Final - - - - -- - , - ' 16::Rough Electric Wiring _ .3/4.1/4341 / 1.1 .c,-._ - 67. Fencing &Access Approval - -,- ' _ . 17 Rough Wiring Sign - • 1 68. APPROVED•FOR PLASTERING - 1 ! = - 18. Rough•Electrical-T Bar Ceiling• - 69. POOL/SPA SYSTEMS:FINAL ' ' - • . - • ' 191-Rough Heating.& Air Conditioning. . FIRE DEPT. REQUIREMENT . - 20:.Rough-Factory Fireplace APPROVALS, Permit# ' ' 21. Ducts, in Structure ��AT AIR. ri ') ( -- a 70. Underground Hydro , 22. .Ducts, Ventilating - 71. Product Piping 0 Gas ,C Oil i 23...Gas Pipe-Rough & Test 72. Underground Flush i- • ; 24` Roof Framing '. • - • 73. Undergrnd.Storage Tank.O Gas 0 Oil . , ' ! 25. Roof'Sheathing • 3 -26 is9 14,4•p. 74. Overhead Hydro - , 26.'T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27r Frame and Flashing-W.:3 i-Ztft : ' 3 z jp 76. Dry Standpipe • - I '28.--Lathing'& Siding 41'..qv 77. FIXED SYSTEM FINAL • . , 29. Insulation Pegd-" 'COT* 04 T�9^ 78. FIRE PREY. FINAL ! .,30. Drywall Nailing i , 4.I .;i•i 4c(S ' 'HEALTH DEPT. REQUIREMENT . ; • 31. Plaster Brown Coat i.; , r."• 1 79. FINAL INSPECTION ' • 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED . 33, Final Electric • / ilioAeCaNotes: 34. Finat-Heafing & Air-conditioning: -- - rA • 35. Final Gas Pipe-Test - - - NFw TO grac•TiNG gxTFRioll L. ATH (Iwo- . 36. Hooil•or Canopy:• • LATH) Co&RPc7 4PRUCFE:p. _ ` - 37. Final'Factory Fireplace • ,- 38. FinaiPlunibi'ng' '' ' - 39. Water Service=Final -- . t 40. Gas Service-Final - I - ' 41. Solarpomestic-Final ': . . - - - - - ' , ' 42. Backflow•Preventer ' J • -'• { � 43. Backflow Irrigation . - I !.;: •.:. ...., ; ' 44. ,Landscape Irrigation System , - , • i 45. •Sound•Attenuations . . . - 46. Handicap Regulations • ' _ - • L/ 1. 47. FINAL STRUCTURE & BUILDING iz/, . let . 48. Special Requirements Completed (///�� ' • '!i • ' 49. Electric Release to Edison - , - , - - ` 1 1 ,�•. • 50. Gas Release to Southern California Gas Co -,- " - 51. CERTIFICATE•OF OCCUPANCY • • - i No. ' w 1:'.:- a a Date . 1 f • CITY OF COSTA MESA BUILDING SAFETY DEPARTMENT Registered Deputy Building Inspector — Certificate of Compliance Date of this Certificate CA / -1 9 Building Address ] 11 �C.L CPtin tto 0 Owner MC.C>osow1�ro Contractor bt.ii 1\0WV\poD\-..S Address C R.11 rc vCciet t,-i) F Vim O]S nal WG RECEIVED Permit No. q %Ltc3 O Date Issued .1- ] 40`15 CITY DEVELOPMENTF COTASERVICES DEPART AUG 6 1979 To the Director of Building Safety: AM I hereby certify that the following portions of work on the buildings at /18191 i- -. . 4. i the above address which required continuous inspection and which 'I was (i employed to inspect, were ,inspected by me and comply with the provi- sions of the Building Code applicable thereto. [ I Concrete [ ] Masonry [ ]Welding [ ] Reinforced Gypsum [ ]Special Cases O Swimming Pool Size S 7 `,[YfGunite / [ ] Hand Pack • Sacks of Cement •-.'?C Tons of Sand 6% Approximate percent of water in aggregate . Se el0 This report covers work completed during week ending 93--9 "7cl REMARKS: S t��c\ Q0 3bitJ6,SGan\‘.1- - -I Registered Deputy Building Inspector S'S SSA. C tk9.at'ck Zr Oat:k wNSA, 'SkitccFaw Namet\t. 8A2n • 1/4-4.J.lbt N6 CA "" &Q.�S bl-�S_ Address i"V?s Lfka_049 S\cyli AVt N J btkeA ‘',11.011)1\ Laboratory W%0 10C Telephone S t4— t{ it 2 CMF 0406-46 (BU 6) 5 A L • s `` �/' /' • �"�. ,' ��l Twinlnq Laboratories �,f JJUG2EZEZ Caill0Z/2Ett, L7 . ` ,- ,. 11310 ai,port Way A1,6560 antl,••Ac FO H.,. 4J Lon: 13(51,15 G:90801 ,Y,1p 426-3355 213i 63ti 2386 0111 g28-6:32 TESTING ,:;:.:.•C.:O:ftrr 15+� i,'s.,,, ..:.t,.., s....- ti.,,,., z.,. :.: 521 l3 5 : :0<5 August 14, 1979 Examination; SC79-4308 COMPRESSION TESTS ON GUNITE CYLINDERS Richard L. Hubbard 17422 Yellowstone Avenue Yorba Linda, California 92586 PROJECT SWIMMING POOL & SPA Job: D-9753 ADDRESS 1171 El Camino, Costa Mesa SAMPIE FROM Transition, Spa & Main Drains 1PCniEE:: :OMPA.h.r Anthony Pools ENGIN(tE Sb ELO!.IP>C1O: Kolodjez - Same - SPECiFIED MIX 4.2 - 1 STRENGTH 2,000 psi DATE CAST 8-1-79 CYLINDER SIZE DATE TESTED 8-11-79 8-11-79 8-11-79 CYLINDER NO. 1 2 3 COMPRESSION 10-Day 10-Day 10-Day TOTAL LOAD, LBS. 40,000 71,500 65,000 _._. POUNDS PER SO. IN. 1,683 2,753 2,503 Average: 2,313 Size: 5i" x 12" 5-3/4" x 12-3/4" 5-3/4" x 3" COMPLIANCE 10-day test complies with specifications. MADE ST OEEIVEREO B+ RECE'VED ON CYLINDERS Shannon Hubbard 8-3-79 DISTRIBUTION Richard L. Hubbard - 3 Costa Mesa Bldg. Dept. ... . .. . . ... .. _ .. —n. . .i. . . . _ • r - • ,.. T Stir 7%;16/79 ''., 11.5a,12 Tl COSTA MESA BUILDING-SAF TY DEPARTMENTAL_-..•,NSI, - -4 P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely - Use Ink Only RECEIVED BY DATE RECEIVED El•TEI S E• BUILDING ADDRESS 11 1 El Camino / l/I' J I — 6 I __ I PERM( NO. • OWNER John H. McDonald A.P.NO.BUILDING J"'1 MAIL ADDRESS 1171 El Camino ADDRESS 1171 El Camino 714 - • er 7911 CITY Costa Mesa -X751 -7099 TRACTI,1,2O4 1 LOT1 OO BLOCK CONSTRUCTION • NEW (APD ALTER REPAIR (MOVING DEMO(ISH LENDER 1)nknr11.it1 BRANCH owNER J1q{ohn.H. McDonald ADDRESS 213 pViv13LC "I''' p00 VALUE / �^ef/ _, ARCHITECT TE USE and spa $/�z0 ORENGINEERRJ . • Kolodziel N0$67-2703 J. FIRE ADDRESS 5871 E. Firestone Blvd. ZONE / T PE GROUP`. CONTRACTOR Anthony Pools APPROVED / DATE ••••• ADDRESSJr S71 E. Firestone Blvd. 2131 ZONE J� ((( NO.OF USE OF NEW anceI-. r CITY Sputh Gate NOO67-2703 I PLANS Z BUILDING ..reel. STATE CITY YARDS APPROVED YARDS APPROVED gF LIC. NO. 190179 LIC.NO.006083 MAIN BUILDING ACCESSORY BUILDING L SIZE OF LOT . I x I�O NO.OF BLDGS.1 (FROMM C/LST%EE7)L � NOW ON LOT FRONT 19 FT. • Y FT. Q USE OF I / V) EXISTING BLDG. private residence R,5IQE IO FT. FT. FSeparate permits are required for L.SIDE d-I / FT. FT. electric,plumbing and heating work. A REAR 10 I FT. FT. IQ USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& QQ AMAIN BLDGS. ACCESS.BLDGS. private swim pool and spa VAR. u P# APPROVEDDA/T 7 APPROVED a 4& [ — >.. _BY /`"'fes , DATE — ..I IYi 0 I hereby acknowledge that I have read this application and state n Ce that the above information is correct and agree to comply with m Z. all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of the State of California. I1 I hereby certify that I am properly licensed as a contractor under 574 SQ. FT. cmi the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the •revisions of the State of California Business VALUATION PERMIT FEE $ may/) v and Professions C••• , Division 3,Chapter 9. �6i!(/V m Signature of as PLAN CHECK $a m Permittee !d', .y '$ thong Pools _ s/6/00r ��d� TAX $ 4y?_i U..2 Authorize• • sent David M. James II Y ,, 7./...• U TOTAL PAID �' • Plan Parcel AR • FEE RECEIVED �►'` �7 a93 D COSTA MESA BUILDING-SAFETY DEPARTMENT I JAN 15 lya'c P. O. BOX 917 COSTA MESA. CALIFORNIAFINANCE DEPT. 0 cif P For Applicant to Fill In Completely APPLiEE2 TIsNCIA ru ART TYPE OR PRINT� BUILDING )) 7/ �� Co..sru,I:ci7,(O BUILDING ADDRESSt. COSTA MESA. CALIFORNIA For Office Use Only OWNER RECEIPT NO. I PE MIT ,,,;13y- - I . 4-. D= " . .Me • _ //GG MAIL ,may, RECEIVED BY /yATE ECEIVED,, •ATS 168/ycyt¢_ ADDRESS 3800 E. Coast Highway � I ! ---/5--4. -l' /`' -g-D" CITY Corona Del Mar, Calif. NOLOR. 3-14220 pDDREIN ARC CT Cliff Olsten TEI'IL�,,-�_ COSTA MESA. CALIFORNIA OR r, EER R. ARgnn. NO ] ADOE 90252 E. Florence Ave., (Focal ilt° ZONE TYPE GROUP l�� CONTRACTOR Macco Corporation APPROVED BY DATE . ADDRESS 3800 E. Coast Highway ZONING CITY Corona Del Mar, Calif. ZONE? —1 I ND'GP - BU LD NG E OF e4,441 p /�p OfE TEL. /t PUNS LLIC.TNO. 98808 -i NO. OR - 1-112ZO LEGAL '�/( '�i 2a\ti �Hj� /�,n ? pSIZE 1 $$�� DESCRIPTION 1� l v `.i# V OF LOT 8085 S.F. NOW ON LOT A. s I A.P.NO. GB4I //q I6L USE OF YARDS EVES EXISTING BLDG. None APPROVED ALLOWED SETBACK LINE FROM r J��, (CENTER LINE ST.) CENTER OP STREET SOI REAR YARI4J9I-211 FRONT _ O FT. —/- IN. SIDE YARD I LEFT 6' .. I-RIGHT 71-6R- - R.SIDE • 7 FT. - `� IN. DESCRIPTION OF WORK L.SIDE /� FT. -- - IN. NEW I X II ALTERATION I II ADDITION I REAR I/ 7 FT. E IN. REPAIR �+r I -- IMOVING I DEMOLISH I APPROVED BYVAi°T tR DATE ///fl" SZ ()�x-}OI1nt1 NO. OF ROOMS 7�a}- STORIES 1 EXTERIOR WALL ROOF wood Shakes COVERING • - COVERING & Shingles USE OF BUILDING AND WORK TO BE PERFORMED Single Family Residence Living Area 1739 S.F. W/attached garage , Garage It 460 S.F. - Covered Porch 141 S.F. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OE ESTABLISHING A PERMIT PEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION ✓IGNAROFMesa Deihl- Development Co. PERMIT FEE $ PERM tti By $ 18,768.00 PLAN CHECK $ /? 4 AUTHORIZED 1 I+ TOTAL FEE $ 57.00 0