HomeMy WebLinkAbout1954 WALLACE AVE - Building Permits . :IR a
CP 6 CITY OF COSTA MESA
BUILDING DIVISION
> • „,,. i DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
4 Pk. • PERMIT P07-00158
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1954 WALLACE AV Status: ISSUED
Suite No • Applied: 03/14/2007
Issued: 03/14/2007
Vicinity: SEWER MAIN
Parcel Nunmber: 42226211
Applicant EZELL, BRENT
Address: ST WARNER AV - . . 3 77.7� - _ ISSUED BY:
SUITE 104 . < Phone.' 714-377-752T
HUNTINGTON,BEACH CA-" - - 'I Zip: 92649 _
Owner PLASCENCIA,'HENRY TR _ - :_ _ --- "-,�
Address '1950WAAVE#F - _ ' -
'� - " _ A- �y
Phone:
`,COSTA MESA,CA - Zip: 92627 ".� AA
/ , \\ \J f\\\\
N'vv - ��
Contractor: TECHONE PLUMBING �\\���/ \�
/ (Address: 4952 WARNER AV - V�2N' Z A \,\-\
N SUITE104 Phone:`.714-377-7527 vy .t .--A.1 ' �`\
• HUNTINGTON BEACH,CA i Zip '92649 - _ - - - ,� 1 •�l
- - , 'incense: - 823413,'- - , •
\-,
- SCOPE OF PERMIT - -.- , 2 , '.!,''',I \ ,,
'-SEWER MAIN REPLACEMENT. (,\ - ' (��t
- \ - - V - v :ht 1 _ A1
FEE SUMMARY v-
AMT QTY. J AMT • QTY
•
ISSUE FEE $23.50 _ _ Laundryjub/;Washer,- - ,_$0.00;. 0, i '`.Sump Pump -$0.00 CO';
Backflow irrigation $0.00 0. - . Landscape Irrigation - --$0.00 -0 -- ,Swimming Pool t , x--$0.00 ,;0,
Backflow Preventer : • $0.00 0 , P-Trap $0.00 '07-' 'Trap Primer • - /,? i ! $0.00 ' Oi
Bathtub $0.00 0 '. Pressure Regulator $0.00 j6,� Urinal ;,,, -' $0.00 10
Clarifier System $0.00 0 - - Process'Piping- -
(per 10ft),- $0.00' 0 � 7--- --- Vacuum Brkr Bkflow(1'4)/;---$0.00 , l'0
Connect(Ice,Soda,etc) ' $0.00 0 - - Receptors-- - - ---$0.u0/,'0 - - Vacuum Brkr Bkflow(5+) - $0.00 t 0
Dental Units $0.00 0 -' Septic Tank . ' <. _-.$0.00 ,) 0` ' - - ' Wash Basin 1/ '' $0:00 1 0
Dishwasher - � $0.00 0 , Sewer Cap for Demo $000 „' 0 Wash Basin Set?/G/ +`'-$0.0011'/0
Drain,Floor $0.00 0 , Sewer Connect `$0.00/_ 0 Waste and Vent System-'C=$0.00'N'/ 0
Drain;Rainwater ,- $0.00 0- Sewer Private Line _`,$24:65- " ,
1 Water Closet(Toilet) . $0.00 / 0
Drain,Roof _"' . $0.00 0 Shower $0.00 0 Water Heater/vent,;, '1 $0:00/ 0
Drinking Fountain' -,,50.00 0- Sink,bar L..,,,�1; •., . $0.00 0 Water Piping/(Inst or Rep:) .' $0;00' 0
Expansion Tank -'$0.00 0 Sink,commercial'‘ ., -$0.00 0 Water Re-pipe / 50.00 0
Gas Earthquake Valve $0.00 0 Sink,-FloorW; - $0.00.. 0 Water Service �' 4$000 0
Gas(1-4 outlets) $0.00-; 0 . Sink;kitchen 50.00
- "0 WateISoftener, C '$0.00 0
Gas(Over 4 outlets) 1 $0.00 \.0 - - Sink,service/mop - � $0.00- :- 0 '+;',.:2-OTHER' ;(,, 7$0.00
Gas Repipe - -- $0:00 -' 0 Spa(private); '$0.00 0 -VIOLATION- 7 / 50.00
Gas Service ' $0.00 . -0 ` Spa(public),y $000 '0 ,-,--PLAN.CHECK, y , $0.00
Interceptors(Grease,Oil)'($0.00
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.
S sl have and.w•ill maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work fo wFi��is rmi ispsued,
ywork rs'compensation In ranee carrier and policy number are: L l C -V
CCarrier: '9pr con r Po4y umber.,
(This section head noibe completeat he permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the perform.• - • he work for which this permit is issued,I shall not employ any person in any manner so as to become bject to the workers'
compensation laws of C omia,a •agree that if I should beco..subject to the workers'compensation provisions of Sectio 700 of, Labor Code,I shall forthwith
comply with these pro Bions. ,G1
,Appflcant.Slgnature:
a �' Date:.----• 0 7
CZ WH`:FAILURE TO SE URE WORKERS'•PENSA .' GE IS UNLAWFUL AND SHALL SUBJECT AN EMFER'TD ORI- ENALTIES D CIVIL FlNES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITI• O THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE R CODE,I EREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby_affirrtthat I am licensed under•rovisi..s of Chapter 9(commencing with Section 7000)of Division 3 of the.Businessao¢Orefions Code,and my license Is In full
for a and effect Lic:11 a �ess N—$CC�— -47
Con
tract0 ,Signature: - — a, Dile:
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).):
❑ 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. ❑Yes ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,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? ❑Yes ❑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? ❑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 Califomia 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 a plication 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? j�Yes D 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? ❑Yes ❑No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia 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 property for inspection pu .oses.I agree not to occupy or allow occupancy of any building authorized by this permit until f..I inspection.
a 7
.gnature , T . - I�j 'r c) rate q/,7/
r OA ��i
tr d/Or- +..ur _ •,.2- ' , Date,--�_
4
CODE• 81SPECTION TYPE OR fNTRIAL$ C00E• INSPECTION TYPE DATE MALE
1616 Fixed System Fin. . -revention 206 Final Mechanical r .
1266 Pool Spa Final 208 Final Plumbing 1/16/0
200 Final Re-Roof 210 Final Electrical . $o.
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
OWNER PLASCENCIA, HENRY DATE 5_28_57
JOB ADDRESS 195li Wal l acre BUILDING PERMIT NO. #5148
A° kE•�__.tNTRACTOR .. S _ - d VALUE $ 6,280.00
•P. No. LOT 9 TRACT 612 FIRE ZONE DESCRIPTION OF WORK Res. Watt. gar.
GRnUP I & J TYPE V ZONE R4 PLAN NO. 5234
- 11 .CTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel e„/F•�c- A -1/-3'7-
Floor
1/:'7-
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam ^ / .
Frame and Flas 'ng �, s `/7i/S./
Lathing, In Out //VS /
Plaster, bro coat p a egirr •
Underground soil Afi SW/G Pipe Test/M'S 4_s--5-7
Top Out /. &-S7- 2, - s-7 y
Furnace PJ nt s -7-- --s7 �c.n4re ..,/' Ect-,i- ... s--3/- 57 9 9 t'rP) I/Gas Vents *Ns 7 YO-4 7
Rough Plumbing f, '.1 . A'Itn ems, S- 31-67 9v%?
Cesspool Septic Tank
Prop. Swr. Line -ouse Cont/ St. Swr. ogr �/f 7 A1/4",, V/ex IN.C1 9 Fie
Sprinkling System �J ��YY
Heating Final ,41/4-1' -/0-3-7 I rye.// ]r.,,.+ 'HQ r:"...
Plu-nbing Fixtures, Final /11/-5 9-70-4-7 k.. _ - `
F Sas Test /5- /L1f4S 7-/b- 7 I et- l-tr(' _-r-.Th et- // -_)7- )l( �j
't... .ruction Pole
_Underground Power - _
Rough Wiring. p9T4 7//-J Wm.. /f. ,- '&. 7-to -S7_ 5-jt-4. V.--
Fixtures,
Fixtures, Final ,t %r 9.&<4r e�r�C'C�'e/_t-, l" 7l- i/ �<C4
-OCCUPANCY 4/1725 Y-in, 5148
Form 210-5M-1-57
5234
FEE RECEIVED
COSTA MESA BUILDING DEPARTMENT Z3 /q
P.O. BOX 317 / / 7r L-+
COSTA MESA. CALIFORNIA FINAN E DEPT.
FOR APPLICANT TO FILL IN AFelhtleFAeI@. JMESAOR PERMIT .
BUILDING /954 1 /et.P. o-a-e— BUILDING
ADDRESS
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. PERMIT NO.
OWNER 71 � J�7 4� 7
MAIL /) ( / .,�- O A RECEIVED BY DATE RECEIVED DATE IS DEO_
ADDRESS (//l--r'`i--`/��py(iGL(./l., //vy a, ���� 0:.?3-s-� �-aY,� ;�
q TEL. BUILDING
CITY K NO. ADDRESS
ARCHITECT LIC.
OR F "IEER NO. COSTA MESA. CALIFORNIA
' FIRE
ADEC�iJtJg./Y n w ZONE
CONTRACTOR�,.,[�//4(� //J CITY �I CO. )^ / / ZONE i� pOe N$ iv PE / GROUP K
�^/t " — J.1 AMTE'L (�'/ 6 APPROVED (/// `{//J
y'
A DDR E553(/R G /fj/. [- '•rvj. BY DATE
LEGAL CR LOT //2 CORRECTIONS
DESCRIPTION jNNO. BLOCK p TRACT (J Lj� ,MT ''�(z ,t
A.P. NO. /IBJ .34c2 _ 4/ l pp P fl LS D
OF LOT 1;. X a 90 NO. OF SLOGS.
NOW ON LOT � -- CITY OP CnSTA MESA
USE OF PLAN r G DEPT.
EXISTING BLDG.
• • i a . UCP' .
SETBACK LINE FROM , 'j
CENTER OF STREET 60 REAR YARD , 3 3
SIDE YARD RIGHT / 1 LEFT T BYLJ6* DAT. . 3SJ
DESCRIPTION OF WORK :::29/6-/ 1 LC
S—
NEW X I ALTERATION ADDITION
I
REPAIR MOVING DEMOLISH
•
BUILDING NO.OF
SIZE /� ROOMS STORIES
EXTERIOR WALLA�� ROOF
COVERING Wt.
COVERING
USE OF NBUILDING 29
- _L.,--C.GG✓4 (.iI/a . /1 /Oy S—
Gy ,og *O
•
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC'
TION. //�/� �}�f (�/J�� VALUATION
SIGNATURE OFee f. f�+"^'� •�.)i .11 PERMIT FEE S /A
PERMITTEE � / _
OPLAN CHECK $ b /
$ /
/(O 6,20
AUTHORIZED AGENT
TOTAL FEE $ vise
SEP 1 5 1964
OWNER PLACENCIA, MIRY r DATE {
JOB ADDRESS 1954 Wallace Ave. BUILDING PERMIT NO. 22868
GENERAL CONTRACTOR John Marshall & Assoc. VALUE $ 14,432.00
j AP No.115-342-52 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK Res W/att.Ger.
1 F ;CTIONS Signature DATE GROUP I & J TYPE V ZONE R2
S. D(/-Git_ PERMITS ISSUED
Gas 1 �� SUBCONTRACTOR DATE NUMBER
Water
Rough Corn. Refrig. 0 Air Cond. ❑
Rough Heating /414-5- /O -(may :is_c:ado" yC 7/ti/G7 3 S-S-V
Rough Plumbing /J*5 /- f iy � 1_ 1. � ,ten si—e /9/2,94 K 54.1/
Miscellaneous / c/ Ha:/
Prop. Swr. Line ❑ House Con. 0 St. Swr. 0\-22/,/,_1., //J/k.0 29 ,,. ,,f..-e- //74Y 4//e e\h/-�'l
Sprinkling System .1�..,
Construction Pole
Underground 0 Power 0 ,t,/.''
—Rough-Wiring 7l/(Aj !(p O-Ltl 4t tZ71.4 rlbtem. • /i/to% 3 7K 1—
Trenches Q Forms Ea' Steel Reinf. 0 Q ole le ,f/�ey
Floor System _
Bond Beam 0 Steel Reinforce 0 r�+ o
Sheathing /"fil - /e) /1.2(0-i41-
/..t0/6SY•
Frame and Flashing Rny/- ii/f/6v
Lathing — In GFI, Out.a L 0 ir /&/
P1•Mr, brown coat ,R 3,?. /24Y/cc/
R . 0 Air Con. ❑ Final
Tie.Ling, Final ,v* -2 -rW
Plumbing Fixtures, Final S ._-.={^_5_1„.
Final Gas Test/,i �1fS_i - —6LC.
Electric Fixtures, Final /rig_= /-//-45
Building, Final /eI- //-6,5
OCCUPANCY
Form BU4-5M� --
-63S-B P 22868
r 22868 FEE RECEIVED .
',COSTA MESA BUILDING-SAFETY DEPARTMENT ,
• P.O.BOX 517 COSTA MESA.CALIFORNIA FINANCE DAP 4. 1964
For Applicant to Fill In Completely APPWATIc1FIOaf/fI
TYPE OR PRINT BUILDING
BUILDING 1/ _,l ,, /rs �� For Office Use Only
ADDRESS / 2 • s/ ,6' / '-' (!�[/`- RECEIPT NO. PERMIT NO.
COSTA MESA, CALIFORNIA as Ss-6$'
�J ,,} ,,
RI BY c/Rci c D7 / j4
OWNER // em,-..7 ?Ari O7 G�l4,-.47•MAIL 1!(,N (! /
/ BUILDING 7 L' ) , D V ,
ADDRESS /fa/ e//Dt r ..g.14
ADDRESS ' 7 �/�l
p%elr /
_CITY en 74 TEL. ZONE TY-E GROUP....--
ROUFIRE
P,`��
NO.
C APPROVED 1/r
ARCHITECT fs/,a� Cr Y�`/We/TEL.
L BY DATE? L -Vat
OR RVG/NEER /� GAr • '
,/ /� ZONING Oei
A SS en Y a` .f7 O..$"V ' ' �y IIY/
/ ZQ1�x .^� I HO.OP UBEOFNEW /� /`,'/
V N PLANE y- BUILDING
CONTRACTOR Ae�,4/ /Jd..� �l grifi oe ' ci �r/n//J�SI. wen
63+� 9 `' ,I �/ DEDAL l � 6 `K j t 6 i 1
oa qP r en.74,4 sr-zee" - DeacBlPTlon[� LK d/
ADDRESS /� ra ,ly/
CITY
/r a Mi, ` .!are.eX . A.P.NO. I L S I 3 ` a ~ B
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE .�.77 4 �.p n TEL. j 90'TO SIDE Et REAR P.L.
LIC.NO. .,,!4 '!' NO. {}r. .'a4j%yi
EAVES
SIZE / / NO.OF BLDGS. J ALLOWED' (U.B.C.REQUIREMENT/
OF LOT .6_ A 177 NOW ON LOT / YARDS APPROVED YARDS APPROVED
USE OFt MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. iA e.'F/t1//v',-e -
(FROM C/L STREET) -{
SETBACK LINE FROM ' `` )J / F'A, •
CENTER OF STREET REAR YASD./9•7 FRONT I FT/ PT
SIDE YARD I LEFT .S - I RIGHT a j + R.SIDE a 7Fr. FT. •
DESCRIPTION OF WORK L.SIDE 3, FT. Fr.
NEV ALTERATION ADDITION REAR O FT.
DISTANCE BET. BET.MAIN It
' MAIN
REPM.n MOVING DEMOLISH jjn.
ACCESS.BLDGS.
BUILDING e' NO.OP / DATE
SIZE fOf WO ROOMS STORIES /Af..2.74EXTERIOR WALL I ROOF .t4 ---EOVERING .n>`l .Y+- ROOFRING -Q�J� ATE
USE OF BUILDING AND WORK TO BE PERF RMED
5 i,rp,C e /-7eAli&
f/T f.5///r ,ce'rt
��a PrVt IkU,'s ' IIM77-124, %323 SQ.FT. �4 3 7 J
001 . N
I HEREBY KNOWLEDGE THAT I HAVE READ THIS APPLICATION' THE AMOUNT SHOWN UNDER VALUATION IS FOR THE i',
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH
CONSTRU IO IN. CES AND STATE LAWS N. REGULATING VALUATION C/ C(j m
BUI . ERMIT FEE $ 4/J
SIGNATURE OF /j ZrZ CC:.
PERM ITTE c '� 11�/ (�p/ G
• S. • Co "/ �0 PLAN CHECK $ 2, F
C
AUTHORIZED ENT . 72 0.0 E
a TOTAL FEE $