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Home My WebLink About200 WAKE FOREST RD - Building Permits • 41"44. CITY OF COSTA MESA 46�g BUILDING DIVISION > :J,,,,' ,sr S DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER ti ° PERMIT 07-00106 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.r..-- 0 PERMIT77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 200 WAKE FOREST Rb Status: ISSUED Suite: Applied: 01/31/2007 Vicinity: Issued: 01/31/2007 Primary Occ: R3 Type of Construction: V-N Parcel Number: 14146512 Zoning: Applicant: KEVIN-CROWLEY Address: �l SANTA NA _,_Phone: _ 714-836-1966 1580 E EDINGER AV#F . - 2. - /<.-' ' Zip: 92705- ISSUED BY: Owner: KISSLAN, MICHAEL A Address PO B0X2178%, ''`• - - //i"i/,'.-.A A t • Phone: . -, .r ORANGE;CA \'--" ' `_ Zip: - 92859. - Contractor GREATER'PACIFIC'ROOFING - Address rV�' - ` , , , ,/� SANTA NA 7.-",/'-/-i % Phone: 714-836-1966 '. 1580 E-EDINGER AV#F - , �� //,-./ Zip: 92705-� %� License: 621368 , Arch :,/, c, b7/ Eng: ' Address: - Address: ' ' • ;/ - —-- Phone: Phone: - 'License: _ License: - - - • , �� 7- t SCOPE OF PERMIT ..TEAR OFF INS TALL'2-15LB FELT AND 20 YEAR 3 TAB COMP.SHINGLES ` / - ./ - , - - - FEE .•_ SUMMARY Plan Check:; $0.007 /: _ _ • 2 ," cCalc Valuation: , , $5,550.00 Permit ` '$125.25 _ ' -- . ' • '` . .. Claim Valuation: $5,550.00 SMIP Res:. $0.56 ' SMIP Corn: $0.00 �,, .. Other: ' $0.00 -- Inspection:, , ... $0.00 ''Total: ':`r, $125.81 . ' -. PLANNING &ZONING SETBACKS-- v`,.,. �s , .,i. . . MAIN STRUCTURE,Front.-0 ;Rear-- 0-0-�-, ' , Left 0 '6-0Right 0-0 ; ' , ACCESSORY Front- 0-.0.�;.-, -: --.i -Rear '0.0- ; Leff '0-0' "Right 0-0 "t :. jj� '- c , PARKING Existing:'j 0 - -Required: 0 ' Proposed:' =0 , \ - J - - - • 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 160 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) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. . have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Cod performance of the work for which this permit is issued. y workers'compensation Insurance carder and policy number are: At.)a,tJ S • er: `f6 G10/So%n/-crz _ (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the perform a of t work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' of C 'omia d me that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith omply with these• • • Ions. 'oilcan'Slgnatur-. 'eer-sLi/f Dat / — 1Y/—o7 •••••• : -AILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND fn t ARE(S100,CO3),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSE• •NTRACTORS DECLARATION: I h; . '• at I am licensed under provisions of Chapter 9(commencing with Section 7000)of•'•ision 3 of the B siness and Professions Code,and my license is in full 6 .rect.Lic.• 7/ a Class• — r35i • actors Sine . _ 1_ _, •a-. C.- ,. CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code: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.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly 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,talsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gip 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. . Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 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 al 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 Califomia 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_oermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes L-(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 Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described propert • inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Jr ure 01 Lege ner(s) Date _ i G��i. An. •r ..horized .go,(cant e\ _ ,,ODE I INSPECTION : E INiRIALS BODE INSPECTION TYPE _.7 AT INTMAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final I 208 Final Plumbing 200 Final Re-Roof O ��1 210 Final Electrical i 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 _ 6302 . COSTA MESA BUILDING DEPARTMENT � TA• gya **roam P.O.BOX 317 JAN 20-58?fl A COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT ADDRESSD200 Wake Forest Road BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. 6R•)P2 ' OWNER Princeton, Inc. ��''�u MAIL- RECEIVED RECEIVED BY DATE RECEIVED DATE ISSUED ADDRESS 419 E. 17thI Street n --r---1/47e1 /— ?iG -YJAN 2.0 1958 CITY Costa Mesa TNO1a 0"1159 ADD RENG ARCHITECT Carlson a4nd LIC. OR ENGINEER ladieorook NO. COSTA MESA. CALIFORNIA ADDRESS Garden Grove FIRE ZONE ZONE�/�/ / NO.OF TYPE GROV CONTRACTOR Dike & ColegroveG,I YID:. .7333' II-\ / PLANS / Pte ADDRESS 419 E. 17th St. rmii 8-1159 APBVPRVOV,ED DATE LEGAL LOT 27CORRECTIONS DESCRIPTION NO. BLOCK TRACT 2955 A.P.NO. SIZE 75 'Y 100 Avg NO.OF SLOGS. OF LOT NOW ON LOT none USE OFr EXISTING BLDG. none . SETBACK LINE FRO • M CENTER OF STREET 55t REAR YARD 22' _ lot 51 SIDE YARD RIGHT LEFT DESCRIPTION OF WORK ' NEW X ALTERATION ADDITION REPAIR MOVING DEMOLISH SZIEDING 1514 sq. ft•ROOOMS 7 STORIES 1 EXTERIOR WALL Stuco� ROOF COVERING J COVERING Comp♦ _ USE OF NEW Single gle family residence and garage1 . PI HEREBY ACKNOWLEDGE 740A E I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND 5 TE LAWS REGULATING BUILDING CONSTRUC TION. VALUATION nr� SIGNATURE PERMITTEE OF / M '/ PERMIT FEE $ 32.00 _..# PLAN CHECK $ 16.00 $ 13,072.00 44 AUTHORIZED AGENT Dike & Colegrove, Inc. TOTAL FEE $ 48.00 '�, OWNER PRINCETON, INC. DATE 1-2058 JOB ADDRESS 200 Wake Forest Road BUILDING PERMIT NO. #6302 GENERAL CONTRACTOR Dike & Colegrove VALUE $ 132072.00. AP. No. LOT 27 TRACT2955 FIRE ZONE DESCRIPTION OF WORK Single res. Watt. gar. GROUP I & J TYPE V ZONE R1 PLAN NO. 6302 ', PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Trenche Forms Steel .4 J1".2-/0-.5.7 Floor Sy m Steel Reinforce Chimney Re-Rod v Bond Beam • Frame and Flashing J5 td////mc" Lathing, InCDys Out et44. /V/'_'F/rk • Plaster, browh'coat " 1l - S7K,r d Underground soil M/4 S W/G Pipe Test(//{{2-�4-s-P" Top Out i,24-51( Furnace /1IN'S 3-4/S Y 7e'9aA i../41) '. FEB 2 0 19.ei`t 12 91 . Gas Vents RoughJ „ JAN 2 3 195E 12471 Plumbing 4.04.c =/�2-$'% ��:C.G,t� �-. Cesspool Septic Tank Prop. Swr. Line House Coa,d/I/ 4t. Swr. 2-y0 2 —a1-1 (tea., ?-ia- ar. Sprinkling System _ Heating Final ,. �• �q Plumbing Fixtures, Final ...mi /.. 3 Li /`d Final Gas Test l•s4• /mg. (n •a,•3Q• . Construction Pole Underground Power ''�{ J Rough Wiring T U-1l-t�'/ ✓W I.�/�,;;,c,pTh�_ AAR 1 1 1938 61i).� A) —01 '! 7 Fixtures, Final tsi.__C./C(.Z$ / l I A --OCCUPANCY Mil -23-6-r t rG +l Form 2IO-5M—I-57 ' OWNER LENNERT, EUGENE DATE 5-20-59 JOB ADDRESS 200 Wake Forest BUILDING PERMIT NO. �--Stl GENERAL CONTRACTOR Byron E. Dangler VALUE $ 120.00 AP. No. LOT 275 TRACT 2y5S FIRE ZONE DESCRIPTION OF WORK Block Wall INSPECTIONS DATE I GROUP TYPE ZONE Underground Soil U.G. Water — SUBCONTRACTOR PERMITS ISSUED Underground Gas DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole _ Underground Power Rough Wiring Trenches Forms Steel :::1_,S___Akzyy Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing Frame and Flashing Lathing, In Out • Plaster, brown coat Plumbing Fixtures, Final • Electric Fixtures, 'gal rn Building, Final ,ingl ' 2 /T► OCCUPANCY f Form 210-3M-4-59 -- __ ' 9370 935 0 EE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT G _ (2.-0 -Ser v'A P.O.BOX 317. COSTA'MESA, CALIFORNIA `- FINANCE DEPT. FOR APPLICANT TO TILL IN COMPLETELY APPLICATIONS FOR',PERMIT TYPE OR PRINT BUILDING BUILDING ADDRESS D /) #2..in ty , ty>II�)f FOR MESA. CALIFORNIA FOR OFF/Lp E USE ONLY /J/ I-III RECEIPT NO. I RM SC OWNER AtK 9 ._A� , 0�,-,�P/j 7.3 MAIL ,f--wed \ R IVSD BY (RATE B CE WE(-D�q `DATE ISSUED ADDRESS -II.:),4110.4 yr ed c -�Genitd. J Cn --c/ I ,) - >79•-•...” ' '�- ,/,, TEL. -- AD RESS BUI DING CITY Ca-� i�ip-,.c. NO. . ARCHITECT l LIC. COSTA MESA. CALIFORNIA OR ENGINEER NO. ADDRESS • FIRE ZONE Type Group- CONTRACTOR//////((77,,'' ATE APPROVED s.(.:a+l 7 . 7i Qgfizi.pol3Ws BYDATEADDRESS 777), �1,�C -- 4?: ZONING LEGAL LOT Qiii��J//��• ZONE / I NO.OF USE OF-NEW�/ DESCRIPTION I NO. ,r 7 BLOCK • IR^�� yF/LANDS/�/7,„..--- BUILDING W4/]%(///\_/ A.P.NO. BYPR j�/�l lJ' Ed s— SIZE �J �/ NO.OF SLOGS. YARDS EVES OF LOT • / S-yL�OO NOW ON LOT REQUIRED ALLOWED USE OF (CENTER LINE ST.) EXISTING BLDG. II< FRONT _.- FT. IN, SETBACK LINE FROM ` /I CENTER OF STREET REAR YARD U R.SIDE IN. SIDE YARD I LEFT •-•-.-- RIGHT L.SIDE FT. IN. DESCRIPTION OF WORK REAR FT. IN. NEW I II ALTERATION I I ADDITION REPAIR I II MOVING . I II DEMOLISH I BUILDING NO.OF SIZE ROOMS STORIES • EXTERIOR WALL IROOF . COVERING COVERING USOF BUILDING AND y I(TO BE,PE E` RMtJR--77 , I HEREBY ACKNOWLEDGE THAT I HAVE R THIS APPLICATION AND STATE THAT THE ABOVE IS CORRE ND AGREE TO COM. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND TAT LAWS REGU TING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTION. VALUATIGN SIGNATURE OFa ye„ ,... > / (PERMIT FEE $ �- PERMITTEE $ /2 D•` PLAN CHECK $ AUTHORIZED AGENT TOTAL FEES , �- r,