HomeMy WebLinkAbout2127 WALLACE AVE - Building Permits CITY OF COSTA MESA
osis FS BUILDING DIVISION
t p
F -tI I 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL:(714)754-5626
Jam" " PERMIT NUMBER: BC11-00076
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES ALT DATE ISSUED: 03/09/2011
ISSUED BY: RMD
JOB ADDRESS: 2127 WALLACE AV CM Suite/Unit:
APN: 42246113 Zoning: , ,
Vicinity: FRONT ENTRY Primary Occ:
Const Type: V-B SQ. FT: 51 Valuation: $16,500.00
SCOPE OF WORK: 51 SF FRONT ENTRY EXTENSION OF A 1-STORY SFD. EXTEND FRONT ENTRY WITH 4 LIGHT FIXTS, 2
OUTLETS, 2 SWITCHES, EXTEND GAS LINE FOR NEW PREFAB FIREPLACE.
OWNER: GROSSO JEFFREY B AND VANESSA N Address: 2120 PLACENTIA AVE Unit:
Phone: 949-231-9424 City/State/Zip: COSTA MESA,CA
APPLICANT: LUISI, HENRY Address: Unit: :
Phone: 626-485-4419 City/State/zZip:
CONTRACTOR: LUISI CONSTRUCTION License No. 675251
Phone: 626-401-9152 Address: 11212 MILOANNUnit:
Cell: City/State: ARCADIA,CA ZipCode 91006
ARCHITECT: License No. PHONE:
ENGINEER: DAVID LI AND ASSOCIATES License No.0058075 PHONE:626-288-1216
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: $181.51
Building Fees: $279.25
Electrical Fees: $32.30
Mechanical Fees: $0.00
Plumbing Fees: $29.65
SMIP Residential: $1.65
SMIP Commercial: $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES: $525.36
"Refer to fee receipts for all fees paid for project
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010- PER CMMC Sec. 13-279
Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibited all hours-Sundays and the following Federal holidays:
New Years Day,Memorial Day,Independence Day,Labor Day,Thanksgiving Day and Christmas Day
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 S, INSPECTION TYPE DATE, INTITIALS CODES INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing A )
I L` I S •/I PIP
200 Final Re-Roof 210 Final Electrical k • I`yijj
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 . Y C ` I l
WORKERS'COMPENSATION DECLARATION Owner ID verified by drive tcense. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. ' 1 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 carrier and policy ❑ 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
by this permit,and that no building structure,scaffolding,falsework,or demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm
(This section need not be completed the permrtis valued at onehundreddollars($100)or less) 2 Art 2Sec.341,Title 8.California Administrative Code).
PolisNumber:
❑ As owner-builder, I will not employ anyone to do work which would
�� 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
become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Dale
the Labor e.I shall forth •h comply with these provisions._
7_ // Division of Industrial Safety Permit Number:
�Mpl rd'kSsgnawre LDale.j> 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 ❑ No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the Califomia 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
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard 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//isinfull forteandeffect. TZ a registration form for acutely hazardous materials? 0 Yes 0 No
LLc#� ( �.) J Gla ss #_i l� (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
conr�Rol s'sienawre pate—.--- 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ 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 ❑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.
Sighalure 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? 0 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 (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred 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 Safely Code Section 42303 been made? 0 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
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
❑ I. as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
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
❑ 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
Business and Professions Code for this reason: 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.
ature of Legal er(s) Dale
Signature Date - -.3— --
305T.4e(3/071 — - /•�
rA for valorized Applicant' L.-Date-,
Z)Z - WzI,L,ZeQ
QC V"l coo 6 }Z P. I. Deputy Inspections, nc. (949) 291-3912
Fax(949) 481-5866
www.deputyinspector.com Email: rpaquette4@cox.net
1903 Via Pimpollo
San Clemente, CA 92673
REGISTERED ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL WELDING
INSPECTOR'S ❑REINFORCED STEEL 0 EPDXY
REPORT OF: ❑POST TENSION CONCRETE ❑ FINAL REPORT
❑ REINFORCED MASONRY ❑ BOLTING ❑ OTHER
JOB NAME BLDG.PERMIT N CITY OF PERMIT
Grosso BC11-00076 Costa Mesa
JOB ADDRESS CONTRACTOR
2127 Wallace Ave. Owner
ARCHITECT SUB CONTRACTOR
Arias Same
ENGINEER LAB TESTING SAMPLES
Dachenq Li
Observed epoxy placement for dowels and HDU2 ,existing to new.Remodel at front entry and
rear walls. As per 2/S-3 and S-3 note on holdowns.
(2) 5/8" HDU2
(4) 5/8" AB's
(21) #4 rebar dowels
Simpson XP ICC ESR 2508 in clean holes.
I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK,UNLESS OTHERWISE NOTED,AND TO THE BEST OF MY
ABILITY,I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS,SPECIFICATIONS&APPLICABLE BUILDING LAWS.
MATERIAL INFORMATION: CONCRETE❑ GROUT MORTAR WELDER CERT.
SUPPLIER: MIX NO.: ADMIX: SAMPLES CAST:
SPEC.P.S.I: TYPE: SLUMP: YDS.PLACED:
AIR-TEMP: CONC TEMP: MIXING TIME:
DATE START STOP REG. HOURS 0.T. HOURS
03/30/11 AM AM 4
1,K2rir
Allimpeak,n bawd onamhdmwn all ham aadorm/haws-Bdwr minimum, our uopedim 6:2
Wending past noon hour ill he on l hour minimum.All Me orwums nfl he thawed Me highest legd rase d SIGNATURE OF REGISTERED INSPECTOR
interest,including eladkaion mC anda0mer lea All retumedd.ch.AlMsubject so a VOW fee.
03/30/11 1080 O.C.
Approved By DATE OF REPORT REGISTER NUMBER
2►.z3 t,crewzc e
6c.1 t oo0-7-Q
.,ITY OF COSTA MESA, BUILDING DIVISL..
'SPECIAL INSPECTOR REGISTRATION x
Job Address c2Ir -2 LAD ALLACe fUC___ C r\ Permit# sett b007c
Inspector's Name g Com- PP. Q Littre-
Residence Address 14 T) 3 0 A ?Win pb 1 (0 Phone#
Number&Street
SA-) Ctennee..te_ CA Qn2G 73
City State Zip
Laboratory
Address
Street City Zip
All licenses listed below must be currently valid and legible copy(s)and must be attached to this registration. t C. ,`
DISCIPLINE L.A. COUNTY L.A. CITY ORANGE COUNTY OTHER
Concrete i o s o i ( 0 cCc S c- ti ct
Ductile Moment Resisting Frame
Reinforcing Steel,Prestressing Steel
Welding
High Strength Bolting 1 0 S 0
Structural Masonry
Reinforced Gypsum Concrete
Insulating Concrete Fill
Sprayed on Fire Proofing
Pilings,Drilled Piers,Caissons
Special Grading,Excavation or Filling
Special Cases Unusual Hazards
I hereby certify that I am qualified by training and experience to perform the inspections for which I hold the above listed Special
Inspectors licenses, and will provide all certifications required by the City of Costa Mesa.
I will inspect and certify the following procedures and locations: is pos-'-1 g.4._t r a
I will certify not only to the job conditions but that they are in conformance with the approved plans. If at any time, progress occurs
on the above mentioned job relating to my area(s) of responsibility, without my knowledge or approval, I will stop the jobs process
immediately with notification in writing to the job superintendent and notify the Building Division of the situation.A record of my tests and/or
inspections as agreed to above will be available upon request by the Building Division. U on quest I will submit a complete package of
testing and inspection results.A letter certifying satisfactory completion will be, rovid d me u on teflon
Cs, nature3 - 30 —( (
Date
This registration is accepted and approved by: g 1 /
141
(Plan Check Engineer) (Build Official (Date) .
1068-46 (rev.6109)White—Building Division:Canary—special Inspector:Pink-Developer
CITY OF COSTA MESA
0.'`"MFBUILDING DIVISION
,t; ‘l p 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
. g FOR INSPECTIONS CALL: (714)754-5626
fro;,su Ap
PERMIT NUMBER: E10-00170
PERMIT TYPE ELEC STATUS: ISSUED
APN: 42246113 DATE ISSUED: 07/13/2010
ISSUED BY: BE
JOB ADDRESS: 2127 WALLACE AV CM Suite/Unit:
Vicinity:
SCOPE OF WORK: UPGRADE ELECTRICAL SERVICE TO 200 AMP.
OWNER: INGARDIA,SAMUEL P TR Address: 2120 PLACENTIA AVE Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: GREG MARTIN Address: 622 N HALLOCK AVE Unit:CA
PHONE: City/State/zZip: SAN DIMAS
CONTRACTOR: GREG MARTIN License No. 867320
Address: 622 N HALLOCK AVEUnit: CA • PHONE:
City/State: SAN DIMAS ZipCode: 91773 , CELL:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL FEES $54.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: 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 1 INSPECTION TYPE DATE INnnALS CODER INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1286 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
•
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. ❑Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
/ 0 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
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 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
by this permit,and that no building structure,scaffolding,falsework,or demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp
(This sedan need not be mmPleted 4the perm4 is valued at one hundred dollars($100)or less.)
2,Art 2Sec.341,Title 8,California Administrative Code).
Policy Number:
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
ued, 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.
is .
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
Applicant's Signature Dale
the Labor Code •. • - • •• with these provisions.
• -112 116 Division of Industrial Safety Permit Number:Bppliram'sSignamfe 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
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard 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 force and effect. a registration form for acutely hazardous materials? IDYes ❑No
�
X Lic.# cpUJ7 O Glassery— CA6 (Section 25533 of the California Health and Safety Code, with some
—� __ x 13 r 1� exceptions, requires registration with the Costa Mesa Fire Department by
X-e1 each business which at any one time has on hand a quantity of acutely
Contractors Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and 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 ❑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 Dale
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 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 (Section 65850.2 of the Califomia Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safely 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,Businesr 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 8 (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
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
❑ I. as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
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
Business and Professions Code for this reason: 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.
Dote
Signature Date �y • tlilligilir �/' ^"7 I121I6
305 ]-a6(310]) - ✓\ / ( e-J
Motor Authorized Apdirvnl Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
N TRACT NO. LOT NO. UNIT NO.
CITWOA COSTA yMESnA CONSTRUCTION PERMIT/ PERS—t'. CO
• ,f Ptoject Address rY ld"/ //JLC/�C/� qg(��QL O S Main Building: Accessory Building:
Applicant's Mailing Address �I '5C33 /lJ /mifinz&J q•� TYPE OF CONSTRUCTION If J NEW U f ADD LI ALTERATION IJ REPAIR E Z
Owner's Name ,0 . 5AMCFE? i-r PhohO7olj ❑ CONVERSION ❑ DEMOLISH ❑ OTHER i T Front O
DESCRIPTION OF WORK/USE OF BLDG. i A Rear N
Address
N
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING�❑�FOUNDATION ❑ STRUCTURAL ' C Right i G
❑ TENANT ❑ ELECTRICAL L7 PLUMBING ❑ MECHANICAL ' $ Left 1111111 R
Address n
Contractor's Name •7S �'L Phone/ x - ❑ OTHER �Ping. Ref.# Parkin Req./Provided E
PROJECT DESCRIPTION SQ. FT. OCCUPANCY nila
Address(mailing) l �,•-. �"/, l Planning Notes: M
/s err
eh r CONSTRUCTION TYPE _ - VALUATION$ • T
City License No. `,'- 9 ZONE GRADING CU.YDS. ACRES - S.
LICENSED CONTRACTOR DECLARATION n /. //y-,-� -v--�/� `. d��/ .1�,l t.i,1_i p 72t Id U �llf1�
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: /)IJ.57 L�%O (,(//-f/G� �L�,G..•( S 1 tit:tall YGSJ a/Nle J Js7
with section 7000) of Division 3 of the Business and Professions Code,and
my license is in full for a•• •ffect. ELECTRICAL FEES
A License C . C L e e Np. / /A
Date 1- a laSignature i�i__. /•- ii. . PLUMBING FEES Automatic Washer Transformer 0 15-50 KW
�. WORKERS' OMPENSATION DECLARATIONConstruction Pole Sub. •
050+KW
\ I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers
Workers' Compensation Insurance, or a cern d copy thereof (Section Cooking Unit Meter pup to 100 amps
,0, Lab. D.) Backflow Preventer Service Sink
�fyd�� Dishwasher Meter Dover 100 amps
Policy Company SUE/" Backflow Irrigation Sewer Capp
rtifieied copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel
Cert Lji¢�gp /isfriled with the city BpliR•Divteion` /j Bathtubs Sewer Connection
Date SCC/o7 FROM Applicant /-'�1 [L.& 4d-J Fan Motors❑0.1HP ❑1X-8
EXEM P'f ION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors
(This section need not be completed if the permit Is for one hundred ($100) or - F.A.U. Inc.Solar 09-15 HP 016.15+
less). Dishwasher Solar Piping -
I certify that in the performance of the work for which this permit is issued, I — Fixtures
shall not employ any person in any manner so as to become subject to te Drinking Fountains Solar Tank Microwave
Workers' Compensation Laws of California. -
Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE: If,after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Cade, you must forthwith Floor Sinks Urinal Outlets Range
comply with such provisions or this permit shall be deemed revoked. - -
CONSTRUCTION LENDING AGENCY Switches Sign
Gas Service Outlets Water Closet 9
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is Issued (Section 3097 Civ. C.) nn • .. Garbage Disposal Standing Sections
Lender's Name Interceptors i Water Heater pQw
Lender's Address Kitchen Sink Water Service .l Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash '
following reason (Section 7031.5 Business and Professional Code: Any city or -
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Tfays
any structure, prior to Its Issuance, also requires the applicant for such permit - -
•to file a signed statement that he/she is licensed pursuant to the provisions of
Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt • Reinspection Fee $15 Issue Fee $ 3
1
refrom and the basis for the alleged exemption. Any violation of Section
�'`,.^',31.5 by any applicant for a permit subjects the applicant to a civil
$' -
`nalty of not more than five hundred dollars ($500). DEVELOPMENT SERVICES REQUIREMENTS:
•❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 4c' Zoning Approved By Date
compensation, will do the work,and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES i Building Approved By DateT�q_�
License Law does not apply to en owner of a property who builds or improves m . e_--G-// FAY �1'
thereon, and who does such work himself/herself or through his or her own Application Issued By cieDat 4
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 •
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground. _ SUMMARY OF FEES
s(_rove for the purpose of sale). - - _ BUILDING PERMIT $ SMIP $
LJ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK
tractors to construct the project (Section 7044,Business and Professions Code: $ /,/t PERMIT
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0.100,000 BTU 0100,000 BTU PLUMBING $ J OO ISSUANCE $
builds'or Improves thereon. and who contracts for such oroiects with a con-. _
tractors license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple ❑ System Repair/Alteration - PLAN CHECK 25% $ ENERGY P.C. $
proof of their Worker's Compensation insurance should be provided to me. - ELECTRICAL $ GRADING $
0 I am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers MICROFILM $
• PLAN CHECK 50% $
Date Owner Heating System& Ducting Registers MECHANICAL $ __ TOTAL FEE $ J-06)I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,00OBT
•
information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $
and state laws relating'to building construction, and hereby authorize repre-
sentatives of this �c/ity t0J,�1ter upon the above-mentioned/'pry per y;�for
Signattion urre pu sl,(:J/� Date.- - 01 00052733-00052733 TOT 5.00
'Drivers' License or SS# . Reinspection Fee $15 Issue Fee $ 3 n DATE: 01/24/90 TINE: 16:14
0865-46,rev. 5/88 White - Building; Canary -Applicant; Pink -Accounting; 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
• 4. Electrical Conduit-Unclrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test •
.6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
-9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK •
11. Property Sewer Line Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater& Vent-Final
13. Roof Drains -1
64. Plumbing System - Final
14. Rough Plumbing.• - 65. Electrical-Final
' 15. Rough Electrical-Conduit 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. POOL/SPA SYSTEMS FINAL
r r
,1.9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
O. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
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 PREV. 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: $f'/0/90 6/0 ON€ Atotn-t.&Ac e-4a . C•i t
34. Final Heating& Air Conditioning (o/(fie 2Cefz,yn l t-- RIC Pied-b Q$ part_ 2o, 3
35. Final Gas Pipe-Test f_,PG -
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing .
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final 47
42. Backflow Preventer '
43. Backflow Irrigation 1'1
44. Landscape Irrigation System ,•'>•
45. Sound Attenuation •-•:
1'
-
46. Handicap Regulations •
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison �.
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY (J.
No. Date
C-
OWNER TOBIAS & CRR - 2 ✓ DATE 1-26-55
JOB ADDRESS 2127 WallaceAvenue BUILDING PERMIT NO. 855
GENERAL CONTRACTOR Dike & Colegrove VALUE $ 8,500.00
Lc. it BLOCK TRACT 188101Single Family Residence
R14
GROUP I TYPE V ZONE FIRE DISTRICT 870
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
• DATE NUMBER
Footing Trench )-0,-44-
Foundation Forms and Grade to Garagel • '
Rough Framing 8-f G' 6 5-76-1,`1
Plumbing,Rough to Slab (.(� ,� ,2.--Z '.7♦�
L'
Plumbing, Rough Complete A1C- 3 '24- A t.5tnw rail ,,A..,6 . 0) -/6 -Cr /y/9 -
Temporary Pole ,,[[ rr z U U y
Wiring,Rough 4-frr4 3�757tP4r--a...-, e ee, • J-/,e-(S F. 6
Heating, Rough
yr.rtat
�) n 'Heating, Final 1 7 y%�} Y�•,-/gcy, , ,1' /Sewer -. _ 2L S lu /Y L,fC w' � .ECe �,,� c i
Sr^c Tank or Cesspool �'•��9 O �• yL-. -S(- /e.c6
L. .,g Gta,.t-- /� / /-c_3-/G-53
Plastering sa Len n' 7 rJ
Plumbing,Final,Fixtures CompJletatIS , 3')/ „ /, ' .
Fifiumbing, Final Gas Test 7�,fj• ?a/' -V.-alit( .f
y ,!d
firing,Final r7 6'6 ______(1
Occupancy ��� J
Form 210 GH 1M 12-68
Costa Mesa Building Department 8/0 APPLICATION FOR PERMIT
111 EAST 20th STREET BUILDING 1
COSTA MESA, CALIFORNIA
tar FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN I .Receipt No. I Permit No:
Building J 99/ d Sys-
Address 2127 Wallace Ave. , Costa Mesa
Costa Mesa, California Received by Date Recd. Date Issued
i-? ' 'Sr
Cr ss reS. Hamilton to Victoria Building
TobiasAddress
Owner & Orr Costa Mesa, California
Mail
Address 419 E. 17th. St. Nearest
CrosCosta Mesa Tel' Li.8-1159
City No. Zone ZoneJ No.of Type I Group
Architect or Lie. 1.� T Plans v ..{..
Engineer Hugh Gibbs No. Approved
by Date
Address Long Beach CORRECTIONS
City Li
,tractor Dike & Colegrove No. c1.301
Address 419 E. 17th. St., Costa Mesa
Legal Lot
Description I No. h. I Block I Tract1881
(Attach Metes and Bounds) ] !LSlIII'{f1
i1
N
lit
Size of Lot 60 x 130 Io.Nowof onBldgsLot.
None
o
Use of No.of No.of a_
Existing Bldg. I Families I Ro1ms J�I� 6 iyCC 2/-
Setback
Setback Line from Rear Vard 0 plus 55 Z
Center of Street 551 Side Vard 51 patio y
DESCRIPTION OF WORK r
New I X I Alteration I I Addition I CITY OF COSTA MESA
Repair I I Moving I I Demolish I
Building No.of
Size 12001 Rooms 6 Stories 1
•erior Wall I Roof
! ering Stucco Covering Compo. APPROVALS
use of New
Building Single Family Res. Foundation Location Inspector Date
Forms,Materials,
•
Under-Pinning
Frame: Fire Stops,
Bracing,Bolts
I hereby acknowledge that I have read this Application Lath. Int.
and state that the above is correct and agree to comply Lath. Ext.
with all City Ordinances and State Laws regulating
building construction.
Signature of Plaster,Int.
Permittee
Plaster, Ext.
Authorized Agt2/42e.1rta•
Masonry Reinforced
Valuation Permit Fee $ C .W
Plan Check $ 3.00 Bond Beam
$ 8,500 Total
Fee $ 25.00 FINAL
FORM 204 0-H 2M 5-54
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PLOTPLAN,
Show location and distances from
property line and between buildings. - . - -