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HomeMy WebLinkAbout1177 EL CAMINO DR - Building Permits t:L?F " A CITY OF COSTA MESA BUILDING DIVISION F ,1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ralk PERMIT % 7raefr E04-00816 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1177 EL CAMINO DR COP' Status: FINALED Suite No Applied: 07/16/2004 Vicinity: SFD Issued: 07/16/2004 Parcel Nunmber: 14156114 q-{ Applicant: PIERPONT, JOHN KENNETH ISSUED BY: �1V Address: 1177 EL CAMINO DR • Phbne: 714-979-6139 COSTA MESA,CA Zip , 92626-5542 " Owner PIERPONT, JOHN KENNETH �p Address '1.177 EL CAMINO 614)'' Phone: COSTA MESA, CA Zip: 92626-5542 Contractor: OWNER-BUILDER Address: - - Phone:.. ... Zip: License:000000 - - SCOPEOFPERMIT • CHANGE-OUT OF 9 ELECTRICAL OUTLETS AND ADDITION OF 5 LIGHT FIXTURES IN ANEXISTING SFD. - . ,. 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 • ' 2 Res.a/c package $0.00 • Standing Section 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 $5.50 5 up to 50 kva/kw -$0.00 •0 Recept Outlets $9.90 . 9 - up tb 100.kva/kw - $0:00 0 • Switches "a $0.00 -0 - -over 100 kva/kw: "" -$0.00 '0 Non Res Appl $0.00 "0' - Low Voltage Equipment $0.00-" 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(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 will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carder and policy number are: Carder: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of thq; hi his 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 • r•u: • -•me.._'act to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: ' ,+ _�• Date: WARNING:FAILURE TO SECURE WORKERS'CONPENSATI• •; :JFy AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMP AT• "-PT GES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lie.# 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 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 driver's 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 ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight,of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aapernit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and 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',attachch 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 stale that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date yODE r INSPECTION TYPE 1A_TE INTRIALS CODE II INSPECTION TYPE PAM IDOLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1286 Pool Spa Final 208 Final Plumbing i1 Q�� 200 Final Re-Roof 210 Final Electrical Va& IY (,t 201 Final Block/Retaining Wall 212 Final Fire Prevention V` 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy A • : - Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $38.90 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS t 1 CITY OF COSTA MESA 1 , BUILDING DIVISION e,jr DEVELOPMENT SERVICES DEPARTMENT PERMIT NUM ER 4 PERMIT y woo PO4-00492 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us • 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1177 EL CAMINO DR . Status: ISSUED Suite No Applied: 07/16/2004 Issued: 07/16/2014 Vicinity: GARAGE ... - ISSUED BY: /+ 4 Parcel Nunmber: 14156114 _ ,, -M1 - - - S/> Pr Applicant: PIERPONT,,JOHNIKENNETH / Address: 1177 EL CAMINO DR -, . . . , - Phone 714-979-6139 • COSTA MESA,CA . • •• Zip _92626-5542 • ' / --\\ Owner' PIERPONT, JOHN'KENNETH Address 1177 EL CAMINO DR �\„ / - Phone: - 'N.' ; ,✓ , - COSTA MESA,CA Zip:. 92626-5542 i • Contractor: .OWNER-BUILDER i ' ' . Address: by - - / - - Phone: - 1 Zip: ) / License: 000000 'Arch / Eng : _ . . ." .. . _ � .. ._- . . ' • Address:, ` _ . . ' Phone: . - . '. / ' -- - - ` - - _ _--Zip' - • _ - _. a „ r - - - . . License: • 4... - , . - ' , - i • /;/ , SCOPE OF PERMIT " \\ CHANGE-OUT OF A WATER HEATER AND INSTALLATION OF A TANKLESS WATER HEATER'.IN THE, LARGE OF AN EXISTING SFD.A SERVICE.SINK'.W_ AS ADDED NEXT TO THE UNIT. 4/%; ; //' l `. '�.,. _ 1 SERVICE/MOP SINK, 1 WATER HEATER/VENT "`i ,/,''%- � _ p'// 'V A,' .NO OTHER WORK AUTHORIZED-WITH THIS PERMIT _ - •%:/ i �-/ A'V r = // ' / r, / FEE SUMMARY - , ,,, AMT QTY -� ,- . - S I = ' i�C/�/.� .1. AMT QTY ISSJE FEE v �, $23.50 -, Laundry Tub/Washer $0.00 0 j; Sump Pump:2 -, / $0.00 0 Backlow irrigation ' ,v$0 00 0 Landscape"Irngation'_ _ -.$0.00_ i0- _ / Swimming Pool: $0.00 0 Backfhw Preventer N 1 .$0.00, - 0 P Trap -- •- `M ` $6:001. 0'- "`, Trap Pdmer%J/ $0.00 0 Bathtut, \N$0.00 0 I,',.Pressure Regulator - $0.00 0--`h \`Unnal „/ $0.00 0 CladfierSystem $0.00 0 Process Piping(per_10 ft) . .,$0.00 .-,0�'1',. • -Vacuum!Brkr Bkflow(1-4) $0.00 0 Connect\tce,Soda,etc) $0.00 • 0- •-/ \'Receptors ' `; 'r $0:00`x: 0` J Vacuum Brkr Bkflow(5+) 50.00 0 Dental Units, $0.00 - 0 •- Septic Tank-, . - •$0.00. _ 0 - ;-JWash•Basin $0.00 0 Dishwasher , $0.00 6 - - - -Sewer Cap r Demo- '$0.00 0 j Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect _ - _ .$0.00; -0- _ Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 SewerPrivate'Line----"--'----2$0.00.----0" Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 • Shower - $0.00 0 Water Heater/vent $12.30 1 \ r NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS ` • 1 ( ) I- )• 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. ❑ 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: Carder: Policy Number: (This section need not be completed/l the permit is valued at one hundred dollars($100)or less.) 4 I certify that in the performance ie 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 law .__Cal, --ir•agree that if I should become subject to the workers'compensation provisions of Sectin 37of H1e Labor Code,I shall forthwith comply with these prop' 4 Date: 'Applicant Signature: NAL WARNING:FAILURE TO SECURE W-•• RBJ S'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3716 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# 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). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): X '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) licen pursue the Contractors License Laws.). ❑ I am ex r sec. Business and Professions Code for this reason: Signature:verified by �1 Owner ID1`\ I P driver's license. Yes 0 No Drivers License No. Expires: ‘ � � Verification of Ownership by(type of doc ,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 B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 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 thprire 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 mrdification 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 Govemment Code requires that the requested information be furnished on applications for non-residential building permits).it 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). • 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is Pe subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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 • comply with all state laws and city ordinances relating to building construction,and authorize representatives f the ity of Costa Mesa to enter upon the above-described• -,• _ Irny tion purposes.I agree not to occupy or allow occupancy of any building authorized by this per t inti f I i spection. .lgnature Of Le ner(s) Ib ate , And/Or Authorized Applicant Date CODE t INSPECTION TYPE DATE 1NTRIAL$ CODEC INSPECTIONTYPE DATE LiPLAL£ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �NJ 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 01 L\ c_Avd, vANIQ, SAN ,► 1l\ rA 4\\U \C ,Ai r . , a i C 1 1 �. !' eneet Nom a, I 'lilt:, OWNER-BUILDER I VERIFICATION 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 he issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. V Yes ❑ No 2. I (h u e oq 11 VL signed an application for a building permit for the proposed work. 3. I have conte 'ted 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 a provide the major work: Name Address City_ Phone ( ) Contractor's Lic. No. 5. I will provide some of t to work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work J 1042 46 (REV.9/98) - 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. • \ )0141 Signed: \11111111111\ Date: Name: v o v11\1 �`i V 5 ( ntcd or Typed) C.D.L. # For more information call City of Costa Mesa Building Division at(714)754-5273. • 1042-46 (REV.WM) 4 • l �s.r. CITY OF COSTA MESA 4 BUILDING DIVISION 1 ,r - DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1• t ...1,a .4. i PERMIT .e" B01-01402 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1177 EL CAMINO DR Status: ISSUED Suite: Applied: 09/10/2001 Vicinity: KITCHEN 8 BATHROOM REMODEL Issued: 09/10/2001 Parcel Number: 14156114 Zoning: Applicant: PIERPONT, JOHN ISSUED BY: Address: 1177 EL CAMINO DR - , - Phone: (714)979-6139 - COSTA MESA;CA'" - Zip: 92626-5542 - Owner: PIERPONT,'JOHN`K& MEGAN C. Address /1177EL CAMINO DR - - - -, . ` / �N • . -Phone: (714)979-6139` - . -- '�•\ -COSTA MESA;CA"' Zip: 92626-5542 Contractor: 'OWNER-BUILDER Address: ' - • - Phone: ' Zip:. -License: 0 - - - Arch : - - -- - Eng: .• r • Address: Address: - - . Phone: Phone: Zip: - - -License: \ License: _ SCOPE OF PERMIT MINOR BATHROOM&KITCHEN REMODEL/INSTALL-NEW ISLAND.IN KITCHEN.. FEE SUMMARY : Plan Check: • '• $0.00 - ' - Calc Valuation: •sl,000.00- Permit: $38.75 • - - - - Claim Valuation: A. 81,000.00i SMIP Res: • ' $0.50 "' - i SMIP Corn: $0.00 ' Other: $0.00 Inspection: - •$0.00 i - ' /, ` - i Total: $39:25 ' PLANNING & ZONING SETBACKS. . MAIN STRUCTURE Front 0-0 . - Rear -,0-0 Left 0-0 . Right ;0-0 - ACCESSORY Front' 0-6' •- 'Rear 0-0 Left 0-0 . Right" 0-0 - PARKING Existig n : .0 ' - Required: - 0 • . . Proposed: 0 ,' NOTES: l' - 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 ail / required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. • FOR INSPECTIONS CALL: (714)754-5626 /� 2446-46(6/00) / i 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. ❑ 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'compensption Insurance carter and policy number are: Carder: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars(SI 00)or less.) ❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.# Class# 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 pert' subjects the applicant to a civil penalty of not more than five hundred dollars($500).): V'-I,-as Winer 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.ex sec. Business and Professions Code for this reason: p fel gnature: - ,Expires:-'� Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. 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 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 agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Di Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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 prop for ins ctlon purposes.I agree not to occupy or allow occupancy of any building authorized by this peit until final inspection. ) la�g nature Of Legal Owner(s) . a atee ---�, And/Or Authorized Applicant Date coos I INSPECTION TYPE PAIL INTIDALS CODE! INSPECTION TYPE PATE INTITIALQQ 1818 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 /Oa j c — eGtt "b" eZdt Nara Deuiaaa j..... f`T m OWNER-BUILDER VERIFICATION 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. I. I personally plan to provide the major labor and materials for construction of the proposed property improvement.' Yes ❑ No 2. I (have/have not) f ^ ).l ( signed an application for a building permit for the 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.9/98) I hereby affirm that I 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. • Signed: - Date: I 16101 Name: \J6V1'Ni lQ?QDn For more information call City of Costa Mesa Building Division at(714)754-5273. 1042-46 (REV.9/98) W CITY OF COSTA MESA ' 4401 9.Ilia_ BUILDING DIVISION r ''"^' DEVELOPMENT SERVICES DEPARTMENT • PER NUMBER v !! PERMIT 99-01978 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1177 EL CAMINO DR Status: ISSUED Suite: Applied: 12/17/1999 Vicinity: HOUSE&GARAGE Issued: 12/17/1999 Parcel Number 14156114 Zoning: Applicant: DUNNING, PATRICK ISSUED BY: Address: 1177 EL CAMINO DR . Phone: (714)556-2039 - COSTA MESA,CA • • Zip: 92626 Owner DUNNING, PATRICK ' Address 1.177,EL CAMINO DR - ' . Phone: • `COSTA MESA, CA Zip: 92626 • - Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 • Arch : ` - . - • Eng: Address: Address: . Phone: Phone: Zip: License: License: SCOPE OF PERMIT • ' REROOF-T/O, REPLACE SHTG AS REQUIRED, INSTALL 2 LAYERS OF 15#FELT AND 30 YEAR COMPOSITION SHINGLES. ' FEE SUMMARY . Plan Check: , $0.00 - -Calc Valuation: $5,000.00 Permit: $111.25 Claim Valuation: $5,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 ' Other: $0.00 Inspection: $0.00 Total: • $111.75 PLANNING&ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0, PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • L ( WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one Of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) O I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,004 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 am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: 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).): O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 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 goes not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) lice e pu uant to the Contractors License Laws.). ❑ I am exe t un r s• . ` r Business and Professions Code for this reason: Signature: / Date: / 2— f 7- y 9 Owner ID verified by driver's license. q Ye 0 No - Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division, Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (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? I:Yes No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required-has Section 25534 of the 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 epermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? PI Yes 0 No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 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 6 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penally 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 comet agre o corn 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- scri e prop f• Inspec •n purposes.I .< -:not too.cupy or allow occupancy of any building authorized by this permit until final inspection. — (7 99 Signature Of Legal Owner Date And/Or Authorized Applicant Date OPE I INSPECTION TYPE DATE INTITIALS CODE I INSPECTION TYPEQAC, INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof /-17—a2 &444-- 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 2446-46 eta, exiles Itteaa &a b, Dada:on st- OWNER-BUILDER VERIFICATION 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. I. 1 personally plan to provtd the major labor and materials for construction of the proposed property improvement. E Yes ❑ No 2. 1 (hava/itRTitt) signed an application for a building permit for the pro..fid work. 3. I have contracted with the following person (firm)to provide the proposed construction: R.'•-'6-‘1‘ � Name 1""-'''rS ��++ � Address 1(77 `E ( vv`:vW i/ City lcS Phone(-7i ) SSS — X39 Contractor's Lic. No. 4. 1 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. 1 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.9198) I hereby affirm that I 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. Sign Date: iZ- /7 — 9 9 Name s CSC COLI- 'vr¢, (Printed or Typed)/ C.D.L. #OR S.S.# For more information call City of Costa Mesa Building Division at(714)754-5273. • 104268 (REV.9/98) ' CITY OF COSTA MESA o,f �. BUILDING DIVISION F I ',Jaw/ 1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER a �aa PERMIT *-'Fero aTo sem �E01-00781 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1177 EL CAMINO DR Status: ISSUED Suite No Applied: 09/10/2001 Vicinity: KITCHEN Issued: 09/10/2001 Parcel Nunmber: 14156114 Applicant: PIERPONT, JOHN - ISSUED BY: Address: 1177 EL CAMINO DR > - - -" -Phone: (714)979-6139 COSTA MESA;CA<-- ' Zip: 92626-5542 / - - Owner � T.PIERPONJOHN K& MEGAN"C - .' Address /1177 EL CAMINO DR . /, , Phone: (714)979-6139 .. . COSTA MESA,-CA Zip: 92626-5542 , • i , Contractor: -OWNER-BUILDER �` Address: - . - - � - -Phone: i _ Zip: - /;• License: 0 - - • _. SCOPE OF PERMIT . ' . • / ELECTRICAL PERMIT FOR MINOR KITCHEN REMODEL..INSTALL 4 RECEPTACLE OUTLETS&1. SUB-PANEL. -" - . .. - " " --. __ . - - REF: B01-01402 - . - - • - ' r , 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 i /0 Pool/Spa $0.00 - 0 . up to 10.kva/kw.. , , $0.00 ' " 0 , Lighting Fixts - / $0.00' I-"-i a:`- . up to 50 kva/ki'N $0.00" 0 - Recept Outlets $4.40 4 ' ' 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 - , . Low Voltage Equipment $0.00 0 Res Appl . $0.00 , 0 Low Volt Wiring System/Ckt $0.00 0 . Service to 200a $0.00 0 Misc.Conduit - $0.00 0. Service to 1000a - $0.00 " . 0 Misc.Conductor . $0.00 0 Service over 1000a $0.00 - ' 0 Circus(gen or,ride) $0.00 !- -0 Motors to 1 hp $0.00 0 ' Circus(mech ride.or lights) , $0.00.' 0 Motors to 10hp $0.00 - 0 • Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 `` 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 -- 0 - Other Electrical Fee $0.00 Motors over 100hp $0.00 0 - Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $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 $58.40 Intermed Pole $0.00 0 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: in order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all' required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit�. , FOR INSPECTIONS CALL: (714)754-5626 2446-48(WOO) DECLARATIONS ( ) ; -j 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 i«led. . 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.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOU.ARE($1110,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.tic.# Class 4 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). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a penny. sub'ects the applicant to a civil penalty of not more than five hundred dollars($500).): ( s 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. subtle e 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) licen e pursu t to the Contractors License Laws.). ❑ I a der sec. Business and Professions Code for this reason: / Signature:— �te. ♦,Empires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the 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 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 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 ❑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 penally 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 pro•- i$-a,ion purposes.I agree not to occupy or allow occupancy of any building authorized by this permit til fi al inspection. re gal Ownet(s) And/Or Authorized Applicant Date ji CODE I INSPECTION TYPE PATE MALS CODE z )NSPECTION TYPE PAM Its 1616 Fixed pa Final Fire Prevention 206 Final Mechanicalmbi 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical _/Q / 4--'' 201 Final Block/Retaining Wall 212 Final Fire Prevention ?02 Final Factory Fire Place 220 Final Planning Approval 103 Final Sign 222 Final Site 04 Final Demolition _ 250 Final Building/Occupancy 1�' CITY OF COSTA MESA BUILDING DIVISION >, ,,,•. s DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t "4a• . PERMIT o IP01-00543 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1177 EL CAMINO DR Status: ISSUED Suite No Applied: 09/10/2001 Issued: 09/10/2001 Vicinity: OWNER ISSUED BY: Parcel Nunmber: 14156114 _ Applicant: PIERPONT, JOHN'%-/. ,- `i Address: 1177 EL CAMINO DR- - • - Phone: (714)979-6139"/ "-.w COSTA MESA,CA ' - Zip: 92626-5542 _ 4 •/ ' / - - _ Owner., PIERPONT, JOHN K& MEGAN C ( Address "1177 EL CAMINO DR Phone: (714)979-6139 . " COSTA MESA,CA Zip: - 92626-5542 ' , Contractof: ,'OWNER-BUILDER - - - - - • Address: • - - - . . Phone: . , Zip: - License: 0 "N Arch / En Address: - - -• - - • . Phone: . ' . - Zip:, .. - - -� License:'. i'�f _ _ / ' SCOPE OF PERMIT PLUMBING PERMIT FOR MINOR KITCHEN&BATHROOM REMODEL. INSTALL 1 BATHTUB, DISHWASHER, 1 KITCHEN SINK, 1 WASH BASIN, &1 WATER CLOSET. REF:-B01-01402 FEE SUMMARY "AMTi 'QTY : AMT QTY - AMT QTY ISSUE FEE $23.50= ' - ,- Laundry Tub/Washer $0.00 0 - Sump Purnp"" - - $0.00 0 Backflow irrigation $0.00 0 -Landscape Irrigation $0.00 0 - Swimming Pool . $0.00 0 Backflow Preventer $0.00 ' 0 P-Trap $0.00 . 0 . Trap'Primer . , $0.00 0 Bathtub ' . $9.80 . 1 . Pressure Regulator $0.00 0Urinal $0.00 0 Clarifier System $0:00 0 ' . Process Piping(per 10 ft) $0.00 . 0 . Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00. " 0 .. Receptors • $0.00 ' 0 ' Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00'- • 0 ' -Septic Tank $0.00 0 Wash.Basin $9 .80 1 Dishwasher $9.80 1 , . - . Sewer Cap for Demo, .$0.00 0 .. "Wash Basin Set $0.00 0 Drain, Floor $0.00 0 - - _ Sewer Connect $0.00 0 " - Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private-Line , ,$0.00 - ' 0 Water Closet(Toilet) $9.80 1 Drain,Roof $0.00 0 Shower - $0.00 0 Water-Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $72.50 NOTICE: The work authorized by this permit sjmmEttnigt Apitchiki2 t'o1(R9n4FJF,9 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, anthill I required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.' FOR INSPECTIONS CALL: (714)754-5626 . 2446-46(WOO) DECLARATIONS (f n WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have end 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' compensationrerinsurance,oli us required by section 3700 of the Labor Code,for the performance of the work for which this permit is I«ued. My workers'compensation Insurance carder and policy number are: Carder: / Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SI-ALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,0011),IN ADDrI1ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.tic.4 Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code), Lenders Name: Lender's Address: 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 objects 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. d —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 purs ant to the Contractors License Laws.). ❑_I.e m Business and Professions Code for this reason: Signature: 1 j.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,ora 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? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 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 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 corn., 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-desc'= < .-:0'.r Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this pe t untifinal inspection. r 9 10 al Signature Of Legal Owner(s)..... Date ' J And/Or Authorized Applicant Date CODE it INSPECTION7'Ft PATE INTITIALQ CODE r PISPECT1ON TYPE PATE ur.. 11616 Fixed System Final Fire Prevention 206 Final Mechanical 12668 Pool Spa Final 208 Final Plumbing lir 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 ?03 Final Sign 222 Final Site 1.04 Final Demolition 250 Final Building/Occupancy I :mr - CITY OF COSTA MESAJP FEE RECEIVED Building Safety Department I ` , 16386 FEB 8 198 JJ �j FINANCE DEPT. Application for permit for the fabrication and erection CITY OF COSTA MESA of awnings, advertising signs or devices. LOCATION FOR OFFICE USE ONLY Building Site Address l/ 77 EL roma/A/oDiQ/G/ ' rw Date Issued FEB 1 4 1962 Permit No. 43♦ Name of Leasee 4/I19CCA CORP DEADoN Phone /YE [n o y 6 / Fire Zone pe Group Approved by Date Contractor CAQTP_,Q S/GN CO , State License No. ZONIN��', � �- address 1.7/ 1- w ct sr City SAKI/TA /9N.9 Phone KC / 77 � ) Zone. I Use of Bldgs 46 iv Engineer State License No. A. P. No. Bldg. Site Address )/ -27 L izeia-0 address City Phone _ - L(. ii DESCRIPTION Legal Owner" ` -7 = -�-� 2 Description of awning, advertising sign, or device: Awnings canvas D metal u Width: 49 ft. — in. Length: �' ft. in. Address City Phone Ground Sign S Projection Sign fl Roof Sign 0 Wall Sign fl Metal Letter Sign n Yards Approved. Banner D Canvas Sign fl Gas Tube Electric Sign (Sub-section 1.44, Ordinance 313) jJ Large Sign in excess of 8 sq. ft. Setback from center line Combination Sign fl Special Device (other) fl Explain: of street to front property line . -4/Uft. in. From property line to edge of sign eft. 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 ‘11-5--ft. in. ,�(If within the 10-foot area of front property line, owner is to sign written agreement with the City. Right Side 3 Oft. in. r se of Sign - Thickness ft. in. Height 6 ft. in. Length ' ft. in, Building Line Setback from center line of street 2'ft. in. Weight lbs. Height above grade ‘ ft. — in. Projection ft. in. Area of Signs. ft. in. The undersigned hereby agrees to fabricate and erect awning or advertising structure within the intent and Height above Gradelift. 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- Awning Size-Width ft. in. SPECTIONS SHALL BE CALLED. Length ft. in. Signature o .""�'r te The amount shown under Valuation is for the purpose of Awning Height above Grade ft. in. Permitee r establishing a permit fee only. _ Authorized Agent CAWT Sl6N CO Projection ft. in. 9 VALUATION Permit Fee $ '� /`Location and size / n /� 71,2---- J $ Plan Check $ e-- approved by � . Cy Recd. by Data J` ��� ro / Total Fee $ _ Date �-3o —C � Form 214—:M-11-60.-4-B P Plan FEE RECEIVED ` -• 0 6.192 _ � Parceli C C COSTA MESA BUILDING-SAFETY DEPARTMENT ,FINANCE JANE1 5 19621 P. O. BOX 317 COSTA MESA. CALIFORNIA FINANCE YEP I. 0 ftr— if For Applicant to Fill In Completely APPLICATIONFFORRPERMITT.. TYPE / OR PRINT BUILDING BUILDING / 7 / `_MN1Wa1 ADDRESS , COSTA MESA. CALIFORNIA For Office Use Only OWNER Mesa Del Mar Development Co. RECEIPT NO. :/..7 7.. yo.y MAIL RECEQeBY IDATE RE IVSD/d. IYE SSUUED . ADDRESS 3800 E. Coast Highway L / —/1=� - 46 -- / TEL t BUILDING CITY Coruna Del Mar, Calif. NOOR 9-112 ADDRESS ARCHITECT 'Cliff Olsten OR ENGINEER & Aggro TELL,��� NOA 3-122] COSTA MESA. CALIFORNIA Downey, FIRE / q/ ADDRESS9O2a E. Florence Ave..Cali .. ZONE TYPE Y GROUP-- I CONTRACTOR MaccopCorporation APPROVED DATE ADDRESS 3800 E. Coast Highway 'ZONING . : . Calif. ZONE/J NO.OF USE OP NEW ^f 4/_ /J CITY Corona Del Mar, Clif ^ -I I PLANS I SBUILDING .y/ -dah STA [� LEEGAL \ , ;Tat W LIC.TNO. 98808-SB-1 NO. OR 3-h220 DESCRIPTION�p• / fp/7, I. 4.,Iy�/�� 1/4/:- ' C- SIZE 825n S.F. I NO. OF BLDG'S.one A.P.NO. ((Let- IO�,{ • //9/4 2- OF LOT NOW ON LOT USE OF YARDS EVES EXISTING BLDG.- ' None APPROVED ALLOWED SETBACK LINE FROM 6Z1 1 REAR YARD 381 FRONTR LINE ST.) / FT. IN. CENTER OP STREET [ [ Va. SIDE YARD I LEFT 7'=6" I RIGHT 71-,11 R.SIDE 7 FT. 6 IN. DESCRIPTION OF WORK - G L.SIDE ^� 7 FT. IN. NEW I % II ALTERATION I II ADDITION I REAR J V FT. '— IN. REPAIR (MOVING IIIDEMOLISH I APBYPROVED dA 6K DATE //1-5-1/41 BUILDING [ NO. OF SIZE 601 7C $01 ROOMS 7 STORIES 1 EXTERIOR XVALLWOOd, ILI`ROOF Wood-Shakes COVERING$LUCCO,BT]( OVERING Rr Shi rel en USE OF BUILDING AND WORK TO BE PERFORMED Single Family Residence Living Area 164 S.F. •W/attached garage. Garage R 443 S.F. - Covered Porch 38 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 ANO AGREE TO COM- PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE Or ESTABLISHING A PERMIT PEE ONLY. BUILDING CONSTRUCTION. VALUATION 3 /7 SIGNATURE 0 PERMIT FEE $ / — PERMITTEF 9a TIP( T PP.4P]jlrjnet]'f COO Mw BY / $17,333.00 PLAN CHECK $ r/rry/ri 5-0 B AUTHORIZED `�` TOTAL FEE $ 77.70 0