HomeMy WebLinkAbout1068 VISALIA DR - Building Permits CITY OF COSTA MESA
BUILDING DIVISION
Aµ ) 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.costamesaca.gov
A. Mika FOR INSPECTIONS CALL:(714)754-5626
Ita"° °.** PERMIT NUMBER: E13-00007
PERMIT TYPE ELEC STATUS: ISSUED
APN: 41210516 DATE ISSUED: 01/15/2013
47,_. -ISSUED BY: KJB
JOB ADDRESS: 1068 VISALIA DRCM Suite/Unity,
vicinity:
SCOPE OF WORK:CHANGE OUT A/C UNIT. SAME,LOCATION. ,
NOTE: FINAL APPROVAL OF PERMIT SHALLNOT1BE GRANTED UNTIL ACCESS TO DWELLING-UNIT(S)IS PROVIDED FOR VERIFICATION
OF SMOKE AND CARBON MONOXIDE ALARMS.BY THE CITY INSPECTOR.SEE ATTACHMENT.WIINSPECTION CARD(RESDENTIAL ONLY)
OWNER: ARMANTROUT,,HENRY-W,TR i 'Address: . 1068 VISALIA DR'.Unit:
PHONE: r r •,y -'City/State/Zip: COSTA MESA,,CA
APPLICANT: ESTRADA,•RICARDO :r I t - Address Unit:. •'
PHONE: 3104384666 rr �, - City/State/Zip:
CONTRACTOR: VENVEST BALLARD - - License No. 878533' •
Address:
78533'Address: 2712 LA CADENA DRUnit: _ _"" /- . L PHONE: 310-838-6.666,
City/State: RIVERSIDE,CA ZipCode: 92507 . - CELL:
ELECTRICAL PERMIT FEESI
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: -� , ' ..;',, $411.70 . "-
Reinspection Fee $0.00
TOTAL FEES $41.70 � ,�d
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE N. INSPECTION TYPE DATE INTIMLS CODE It INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site /��J /�p
204 Final Demolition 250 Final Building/Occupancy gig M(3 T f
WORKERS'COMPENSATION DECLARATIC Owner ID verified by c. ;license. ❑Yes ❑No
I hereby affirm under penalty of perjury one of toe rollowing declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carder and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
W[9 ST by this permit,and that no building structure,scaffolding,falsework,or demolition
Carrier: or dismantlingthereof,will be more than thirty-six
(This secfion need rat be mmP/ste0 the permit is valued at one hundred dollars($1
00)or/ess.) iCode). high. (Chap.3.2,Grp
• V / 5 O Z?4 / /u D 2,Art 2,Sec.341,Title 8,Califomia Administrative Code).
Policy Number. G f•'
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
beco ' subject t• the workers' comp-nation provisions of Section 3700 of
Applicant's Signature Date
the ...r Code,I .hall h th • with these provisions
4` G 3 D-0//3 Division of Industrial Safety Permit Number:
Applicant's SignatureDate•
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions,that a Business Plan be filed with the Costa Mesa Fire Department
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: volume of 55 gallons, or 200 cubic feet of compressed gas at standard
I hereby affirm that I am licensed under provisions of Chapter 9(commencing temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full forcercand effect. a registration form for acutely hazardous materials? ❑Yes ❑No
&7U//C'��l Class tr. C_C� (Section 25533 of the California Health and Safety Code, with some
4_,,-�/ i%1��L o_.3,72 eh, exceptions,requires registration with the Costa Mesa Fire Department by each
ir/ business which at any one time has on hand a quantity of acutely hazardous
Contractor's Signature Date _ 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
CONSTRUCTION LENDING AGENCY: pressure).
O I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
Signature Date
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
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 (Section 65850.2 of the Califomia Govemment Code requires that the requested
Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business information be furnished on applications for non-residential building permits).
and Professions Code)or that he or she is exempt therefrom and the basis for 6. Will any part of the facility to be constructed under this permit be within
the alleged exemption.Any violation of Section 7031.5 by any applicant for a 1000 feet from the outer boundaries of a school? 0 Yes 0 No
permit subjects the applicant to a civil penalty of not more than five hundred (If"yes", the facility must meet the requirement of Sections 25534 and 42303
dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
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 8. (If"yes", attach certificate of compliance from the appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
property,
❑ I, as owner of the
LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. 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
Business and Professions Code for this reason: inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Signa re L er(s) Date
G3/2U//�
•
Signature Date trAnd/or Authorized Applicant (fDate--
3057.46 13/07)
CITY OF COSTA MESA
BUILDING DIVISION
0 Ota
jai,
F ) 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.costamesaca.gov
'. �. FOR INSPECTIONS CALL:(714)754-5626
.�orn. PERMIT NUMBER: E13-00007
PERMIT TYPE ELEC STATUS: ISSUED
APN: 41210516 DATE ISSUED: 01/15/2013
- - _x,-- �ISSUEDBY: KJB
v"r.
JOB ADDRESS: 1068 VISALIA DR,CM 7 I Suite/Unit:`
Vicinity: <' 1- ' •
SCOPE OF WORK:CHANGE OUT FURNACE AND A/C UNIT:SAME LOCATION r ' ' N'_'
NOTE: FINAL APPROVAL OF PERMIT SHALL NOT BE GRANTED UNTIL ACCESS TO DWELLING UNIT(S)IS PROVIDED FOR VERIFICATION
OF SMOKE AND CARBON MONOXIDE.ALARMS`BY THE CITY INSPECTOR.SEE ATTACHMENT W/INSPECTION'CARD(RESIDENTIAL ONLY)
OWNER: ARMANTROUT HENRY W' R
TIS I Address;l- •1068 VISALIA DR Unit:'.
PHONE: - '•;c-City/State/Zip: COSTA MESA,CA. -. .l
y
APPLICANT: ESTRADA, RICARDO ,;•;,`-:•••, (,I _• - 1 Address Unit.
PHONE: 310-838.6666 r •I ! City/State/Zip: •""
CONTRACTOR: VENVEST BALLARD - License No. 878533 .
Address: 2712 LA,CADENA DRUnit: ' ,_ "_,,. ' _,',--:•_,-. ,-PHONE: 310+838-6666 '
City/State: RIVERSIDE,CA ZipCode: 92507 CELL: _
ELECTRICAL PERMIT FEES) I 7f'�'
Electrical Plan Check Fee:, •... " $0.00 r
ectrical Permit Fee: A ) $41.70
Reinspection Fee
TOTAL„FEES
C _ .
r ,
S. n
til.
IA^i
1r1'
'prL.
r-i,NOTICE: The work authorized by this permit shall comply with all applicable handicapaccess requirements under California statutes and related
5, regulations.(Ord.No.92-28,§1, 12-21-92) p y PP g
yF,EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
Tyi-•'1N5PECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and z
(required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
,CODE O. INSPECTION TYPE DATE INTITIALS CODE* INSPECTION TYPE SATE INTIM
�_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
6q 202 Final Factory Fire Place 220 Final Planning Approval _
P203 Final Sign 222 Final Site
(1.204• Final Demolition 250 Final Building/Occupancy
•
`1.
v
WORKERS'COMPENSATION DECLARATIC Owner ID verified by c ;license. 0 Yes 0 No
I hereby affirm under penalty of perjury one of bre following declarations: Driver's License No. Expires:
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' com ensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: //�)In�// G A `� person is required to descend,will be made in connection with work authorized
Carrier: Cj.Jg zc 1 u' �f 'C— by this permit,and that no building structure,scaffolding,falsework,or demolition
pe uva/uee et one hundred dollars(stoo wkss.) or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp
(This section nese nd�ee/wrjw�etedCnure�•-� /' /� P� 2,Art 2,Sec.341,Title 8,Califomia Administrative Code).
Policy Number: w V LSO 2Z &C to V
0 As owner-builder, I will not employ anyone to do work which would
O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of C.lifomia, and agree that if I should
become subject to the worke ' compe,sation provisions of S ction 37 0 of - Applicants Signature Date
the L r Codehal h h p -with these provisions.
��e /..5- 4.:_ , Division of Industrial Safety Permit Number:
Applicants signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions,that a Business Plan be filed with the Costa Mesa Fire Department
ATTORNEYS FEES. 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
LICENSED CONTRACTORS DECLARATION: volume of 55 gallons, or 200 cubic feet of compressed gas at standard
I hereby affirm that I am licensed under provisions of Chapter 9(commencing temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is---infull force and effect. t- 7i0 a registration form for acutely hazardous materials? El Yes ❑No
Lic SSS------7777774-C� Class# / (Section 25533 of the California Health and Safety Code, with some
1/ exceptions,requires registration with the Costa Mesa Fire Department by each
d l business which at any one time has on hand a quantity of acutely hazardous
Contractors Signature Oat 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
CONSTRUCTION LENDING AGENCY: pressure).
O I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
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 (Section 65850.2 of the California Government Code requires that the requested
Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business information be furnished on applications for non-residential building permits).
and Professions Code)or that he or she is exempt therefrom and the basis for 6. Will any part of the facility to be constructed under this permit be within
the alleged exemption.My violation of Section 7031.5 by any applicant for a 1000 feet from the outer boundaries of a school? ❑Yes ❑No
permit subjects the applicant to a civil penalty of not more than five hundred (If"yes',the facility.must meet the requirement of Sections 25534 and 42303
dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by Califomia
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
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 8. (If"yes", attach certificate of compliance from the appropriate air pollution
ale. If, however, the building or improvement is sold within one year of control officer).
ompletion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
d not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
TENSED CONTRACTORS to construct the project(Sec. 7044, Business and
fessions Code: The contractors License Law does not apply to an owner of signature Date
)arry who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
ntractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
I am exempt under sec. 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
ess and Professions Code for this reason: inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection. /
Signator al e - / f1St� /---
Sgnature Date And/or Authorized Applicant Date
/07)
PROJECT AOORESS: 1068 VISALIA DR ' UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 066155
OWNER'S NAME: ARMANTROUT, HENRY W
ADDRESS: 1068 VISALIA DR PERMIT NO; P 066155 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA, CA 92626
CONSTRUCTION 'TYPE; V—N PERMIT TYPE: PLU PURPOSE: OTH
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : WATER HEATER REPLACEMENT SQFT:
ADDRESS: UNIT:
CLAIM VALUE; CALC—VALUE : GROUP OCC: R-3 /
PERMITTEE: NOCK PLUMBING ( 714 ) 895-1246
ADDRESS: 11610 SEABOARD CIR COMMENTS : NO OTHER WORK AUTHORIZED BY THIS PERMIT
STANTON CA 90680 #+r####ir###,r+r######io-##################ir#+tx########+t###########ic-############+s###+r-
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING R EQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. S E T BA C K S
9N`cic.' 0 E 38 , STATE LIC.: 5 1 1 9 7 CLASS: C—. 6
Z5�Q Signature: 1 C+��� MAIN BUILDING ACCESSORY BUILDING
WORKERS'C((IIMPENSA ION DECLARATION: I hereby affirm that l have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT; FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab. C). LEFT; FT - IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
POLICY ND.: 1167992-93 EXP.DATE: 03 /01 /94
COMPANY: STATE PARKING REQ• PROV; PARCEL: 93506117 ZNE; REF NO:
• Certified cc y is hereby furnished la Certified copy • with the city B 'ring Division. PLANNING NOTES>
��tEJ --ff : �- _ >
!i� Applicant BtifiE#iE1ElEiE'yElElfifitiE#feiFiEiflE1E)E****iEiFiE3E****#)EitiEiEiE±FiEiEiEifiFiEiliElfiPlfiEiE****i6if3ElFiEiEltifiEifikiEiEiEjEiFiEi ***
EXEMPTION FROM WORKERS'COMP NSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES — REQUIREMENTS
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 ZONING APPROVED BY ''
•• DATE:
Date: Signature:
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : ...1, DATE :
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. _
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: ` --.DAT E
which this permit is issued(Section 3097,Civ.C).
•
LENDER: iF if iF BE if of iF iE#iE jE if iF iF if#iF Bf BF iE aF it,eE BF it iF#if iF*if 1E aE iF ie iE if iF iE#1f aE if#1E iF ie iF BF iF iE#*je iE if iE ik BF#9F}E#ie iE iF iF dF iP 96.Fie 3F is k iF#ie it,
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 7,00
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 5 SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 71X10)of Division 3 of the Business i
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN .
any applicant for a permit subjects the applicant to a civil penalty 01 not more than five hundred dollars($500). ISSUE FEE 20,00
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 7 . 00 20 , 00 0 . 00 27 , 00 ' 27 . 00 , 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees, provided that such improvements are not intended or offered for sale.If,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 27 . 00 OVER/SHORT : . 00
lor the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the properly.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 27 , 00 •
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon '
and who contracts for such projects with a contractor(s)license pursuant to theContractors'State License Law). l am aware #####################################################+Eif-#+F####iE#####1e+fdl#It#i(###lEi(-
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C. M- 1
for this reason: TYPE DESCRIPTIOI O N� UNIT COST TOTAL COST
Date: owner: PLU 1 WATER HEATER AND/OR VENT 7 , 00 7
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and0 0
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END 'OF FEES
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from • •
these provisions.
Date' Applicant:
I hereby cerlily that I have read this application and state that the above information is correct.I agree to comply with all city and county " \
ordinances and state laws relating to building construction and h' uthorize representatives of this City 10 enter upon the above-mentioned
erty for ins lion pur•oses. )4-7
1 ' 01 00155845-00155845 T Q T
�D e: Signature. �. DATE: 02/23/94 TIME: 09:59 27.00
Driver's License or Social Securi y 4:
1641-46 White—Bmlding:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL . ,,PA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms iI
4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding - I
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE I{
• 7. Footings 58. Electrical Conduit-Uncirgrnd.
8. Foundation I - I 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House connection, 62. Backwash & Receptor-Final
12. Sewer Cap I 63. Heater & Vent-Final
1,3. Roof Drains 64. Plumbing System - Final jI
14. Rough Plumbing 65. Electrical-Final •
15. Rough Electrical-Conduit -6 66. Solar System-Final
• 16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOLiSPA SYSTEMS FINAL
19, Rough Heating & Air Conditibning FIRE DEPT. REQUIREMENT
, 20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating - • 71. Product Piping 0 Gas 0Oil
_
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73.'Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar.Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding - 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing • HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33, Final Electric Notes: „.
34. Final Heating & Air Conditioning • 3_) GIa �C� � -
( /)Ems%-- 4 .v
35. Final Gas Pipe-Test
36. Hood or Canopy
37, Final Factory Fireplace
38. Final Plumbing 3 4
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
r
-S
42. Backflow Preventer ',n
43. Backflow Irrigation .r
44. Landscape Irrigation System -
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48: FINAL PLANNING
49'. Electric Release to Edison
, 50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY •
No. Date
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT N0. G .&L{ r DATE
LOT NO. 19
ADDRESS /O G n y,�.�Le2_ 9_n
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he-she-they)
,-Pet (was or were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition.
B J.J r l A44
RECEIVED Pu.caser
CTY Of COSTA ESA BY ii
V eloper ./or aut OM/ad
-presentative
JUL 1 G 1973
AM PM
71819;1QJ11112Z2i2I3!4,516 BY
`, Lender
OWNER HELTZER ENTERPRISES DATE 8-28-72
JOB ADDRESS �T;sal"
s .Ie BUILDING PERMIT NO. 3528
GENERAL CONTRAC Seltzer DESCRIPTION of WORK Res. w/ att. gar.
' '0. LOT 39 TRACT 6245 FIRE ZONE VALUE $ 23,600.00
ACTIONS Signature Date GROUP I & J TYPE 5 ZONE RI
SOIL /`/57d-lD'77-- SUBCONTRACTOR PERMITS ISSUED
GAS Dare Number Signature
W AT ERNIM 5AO-7 r- - Plumbing,
ROUGH PLUMBING - �� 7a �,�{/I/,n '��,eJ'��`' �p/�.��illi
PROP. SWR. LINE HOUSE CON. ✓�j'/'^'�//. jfL�fl.�/io4L'�J�7/ ?--9-73 A- 55V
SPRINKLING SYSTEM ZZZ /Ja7P ���/�«CC�C���"
MISCELLANEOUS n
ROUGH HEATING AND AIR-CONDITIONING 61,,A" 97J '7'9
TEMPORARY SERVICE OR POLE
UNDERGROUND D POWER 0
ROUGH WIRING j��' i Heating and ent. �j
TRENCHES FORMS STEEL REINF. ,1C 0-/[• J `' 'Ndr Or A/C— ," /
FLOOR SYSTEM ,e-Z fl ,c G/ x,� �4.- YYJ9�y
BOND BEAM 7 STEEL REINFORCE pi r�
SHEATHING 'Y /.'j�'/I/�
FRAME AND FLASHING /;
1
LATHING — IN V OUT F/tr- 3 _
pt ASTER, BROWN COAT IZ� 2-IQ3
TURAL, FINAL Electric�/ 1
, .NG, VENT., REFRIG. AND A.C..,, FINAL 7,2..73 A&&C�t '1�P1. ,;“1/3 <5� 'r --
PLUMBING,
PLUMBING, FINAL AND GAS TEST pyo .,Cr S }I, ELECTRIC, `f-' ,g
NAL iiArio
BUILDING FIINAL \ � C,,-75
11111)
• • .in2C,.3 AUG 30-72Pn19OO2074n ***133\x.
. cnsA.
•
COSTA MESA BUILDING-SAFETY DEPARTMENT ,
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 - '
• APPLICATION FOR BUILDING PERMIT-
For Applicant to Fill in Completely •
RECE ED/���N D/��/TE RECEIVEDED TE ISSUED
BUILDING 6 4/ I / n ,� , d '-a,[,"7 �� 7,-
ADDRESS
1 Q YJ ((�) I/ lS a1 l LL V'—.t .
_ • PERMIT-Ne
OWNER Meltzer Enterprises-Costa Mesa A.P. NO. .joe193
BUILDING MAIL ADDRESS I-QSy / 5a L c �l QR' •
2ADORESS74O No. La Brea Avenue (
o-O CITY Los Angeles 90038 NO.w La 937-2171 TRACT6245 LOT' 39 BLOCK
ZQ CONSTRUCTIONNEW ADD ALTER_REPAIR MOVING DFMOI ISH
-N LENDER United California Bank • ✓-'
J j BRANCH Main Office
m W ADDREss600 So. Spring St. , Los Angeles OWNER ��`T� e �JALuLE �T—i
-CO ARCHITECT
TEL 213) S e J- i '$ s
J Q OR ENGINEER David Freedman NO. 653-3859 - - ,t
U Q FIRE T Wri.
W B �
ADDRESS113 N. San Vicente, everly Hills ZONE _ TYPE (L GROUP "'v'
d W APPROVED .
mZ CONTRACTOR George J. Heltzers BY • DATE'
:I ¢ ADDRESS 740 No. La Brea Avenue
W W ZONE NO.OF USE OF NEW S(au Fol-pm 7JV
O= TEL 3(7-2) PLANS BUILDING i'/'y`'/J[TL
Z N CITY Los Angeles 90038 No.937-2171 �� t -r r
LIT 0 STATE CITY YARDS APPROVED YARDS APPROVED
co CC LIG.NO. 3144 LIC.NO. 1900 MAIN BUILDING ACCESSORY BUILDING
• 00 SIZE - NO.OF BLDGS. (FROM C/L STREET)
OF LOT _ NOW ON LOT FROM S O FT. , FT.
USE OF •• - _
EXISTING BLDG. R.SIDE S FT. FT.
•
I- SIZE OF NO.OF /,,,aZ. NEW BLDG. ROOMS STORIES L.SIDE .( •MPT. FT.
EXTERIOR WALL ROOF ' /� pp
✓_ COVERING Plaster COVERING REAR 39.60.FT. - FT.
-I USE OF BUILDING AND WORK TO BE PERFORMED . DISTANCE BET, BET. MAIN&
O. MAIN BLOC'S. ACCESS.BLDGS. •
1 VAR.# ' ' DATE •
Q O Single Residence Plan 411C - C.U.P.# APPROVED •
P
CB
(.02Z-722.4(../
� �f �
ADP,: .. �pQ DATE V123/I L
Z alAlt
O p HO I Ert, sr,„
:^
UI hereby acknowledge that have read this application and state /.6,5-. ' -_ -_ `?1rE1 EINT j
✓ that the above information is correct and agree to comply with ,\\
CC all laws regulating building construction, and I shall not employ. TAX �C
F, any person in violation of the workman's compensation laws of" ,. .
V) the State of California. / •� I o '/ _ y./z� co
Z /6d0 SO. FT.b'�- �j�S S'" to
I hereby certify that I am properly licensed as a contractor under a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m -
rc
am exempt from the provisions of the State of California Business
and Professions Code, Divisi ,Chapter 9. VALUATION O�o(ra� QD ro
PERMIT FEE $ N
0
Signature ofL. a of
Permittee S_l 6QD - PLAN CHECK $ �'� E
•Authorized Agent ril✓ 9 •
LL
TOTAL FEE $ /5•2"