HomeMy WebLinkAbout2202 WALLACE AVE - Building Permits CITY OF COSTA MESA
BUILDING DIVISION
>. ..t,•
DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBE
F t •�% : PERMIT
ittobi, ,+ B04-0 45
i
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2202 WALLACE AV Status: ISSUED
Suite: Applied: 09/02/2004
Vicinity: Issued: 09/02/2004
Parcel Number: 42241110 Zoning:
Applicant: MCCLAIN, KIM ISSUED BY:
Address: 12812 VALLEY VIEW ST
STE 33 Phone: (714)897-1780
GARDEN GROVE CA Zip: 92845
Owner: MYERS, KATHRYN
Address 2202 WALLACE AVE
Phone:
COSTA MESA.CA Zip: 92627-2913
1
Contractor MCCLAIN ROOFING INC
Address: 12812 VALLEY VIEW ST
STE 33 Phone: (714)897-1780
GARDEN GROVE CA
Zip: 92845 License: 625013
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF AND INSTALL 30 LB FELT UNDER NEW 30 YEAR COMP.SHINGLES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $4,500.00
Permit: $111.25 Claim Valuation: $4,500.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $111.75
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446.46(0/00)
•
r •x l
DECLARATIONS U -
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 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
ork for which this permit is issued.
d will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for •: •erformance of the work for which this permit Is Issued.
ers'compensation Insurance carrier and policy number are:
; 5ednot f 11A11balp bar. / % 1 �lJ 7670 -20ole
is section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person n any manner so as to become subject to the workers'
comm• x: on :' : of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
I t :se•r0yi$i60e. °C- — Dal . L?/2l vY
A.+Dant Signature' Tons.
2
r•E TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUM AN EMPLOYER RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
••SAND DOLLARE(5100,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
LICENSED ACTORS DECLARATION:
1 he affirm that m licensed under f r Ions of Chapter 9(commencing with Section 7000)of Divlsl Business anzd Professions Code,end my license Is in fug
force ' .4 Ob.!-�9 1 s a C:3 7
co c rs sig ure: 7Y1 Lr L---. .s.Pete: a/ti OI{
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(5500).):
❑ 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 drivers license. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,I.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,An 2,Sec.
341,Title B,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the dMslon.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
materiel? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has et 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 California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aaermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Govemment 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 pedal 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).
_. pollution
_ __-
7 If a permit fromn the South Coast s Quality ed by gement District or other airpollution ooncontrol-district agency is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (if"yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,end authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
/ SI o tura Of Legal Owner(s) Q /2 ate
And/Or thodzed$ant �'�Date
CODE r i$SPECTIONTYPF f\ gATF UtIMO CODElt INSPECTIONTYP( \ PAIL NEW
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
• 1266 Pool Spa Final �/ 208 Final Plumbing
200 Final Re-Roof Z/7 d'r 210 Final Electrical
201 Final Block/Retaining Well 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
_ _Applicant to fill in all_spaces except those within heavy border lines and sign all appropriate declarations. _ _ ___ f_-,---_______ _ _ ____
STAMESAI CONSTRUCT.I N-P._ ..,. TI 1 1 - 'P.ERMIT O. ' ' TRACT NO. LOT NO. I I • 1� I I I ( 6 Ell Ir
rtt a r r. c- _ - - UNIT N0. I _ •J a a s a. �G� a (� }� �+ ) 1'x':4 IIS
I - , W J '�'J v f W f`J co ,. I G: '3 Y ✓ .x It CTi'
,eject Address i :l— as O 2 l (A)-I- I ' . l dZ � - 1r I I I I _
TYPE OF CONSTRUCTION LI NEW U ADD LI ALTERATION -UN •
---. ; a..... 1 ()-:. t, ni �„ T ' ) m min 1
Applicant's Mailinre• -dress - ❑ REPAIR
6114.--
I 1 - 4, •�.7 _❑FCONVERSION, ❑,DEMOLISH IT! OTHER I AP # _ ' .: 1 -E ' • z I 2 I lone L I i I`— ;
Owner's Name i`= _Phone L.. I - -
DESCRIPTION O,F WORK/USE OF BLDG
Address g 144 e - _ I ' _ '17- -$I Main Buildin - 1 '_ I I O - �- I'r
- g. - j ;AceessoCy Building: 1 ,.r I
.TYPE OF PERMIT ❑'.GRADING ❑ FOUNDATION [C. ! - ' _
Arch/Eng. License No. r T DSTRUCTURAL • T Front- I cI L. m ' ' I . . -' ' a. _ . o - I.1 O
Address r CI- ❑;ELECTRICAL.- 'PLUMBING 111 MECHANICAL - B 1 Rear= i T I ra I - r I _ r - I ? 1 ' n - J, .,, I n 'R; N
Contractor's Nam' 6a I. r..., __ Phone t 75 ❑"OTHER" �•' fie A ; , _ N
-
Address(mailing) LS6l LI AMP PROJECT DESCRIPTION SQ. F• yb0 OCCUPANCY •:K' Right , r I - •1 r *r - , • G
g / - CONSTRUCTION TYPE VALUATION$ arD-0fil /00 , Left I I I N I " 1 r�_ 1 'C 7 jU
CityLicense No. DiCk .. - :R
ZONE GRADING'CU.NDS. ACRES Ping. Ref.# ' I Parking Req./Provided •�c C • n 1^ E
LICENSED CONTRACTOR DECLARATION - I 0
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: i 1 I 1 _ + lar M
with section 7000) of Division 3 of the Business and Professions Code,and -
my license is in full force ...d effect. ^, �• 1 I ` I I O ;
License Cla - `A� ice. o. - I - - $
l"\ Date -.,••••!. Signature �/ __ �/ PLUMBING FEES a I ^ 1 ,-' 1 I
.S Y WORKERS'COMPENSATION D RATIONBar Sink ' Showers I ELECTRICAL I ' I FEES I
t1j I hereby affirm that I have a certif . e of consent to self-insure or a certificate I I I 1 •'
Workers' Compensationnsurance, or a certified copy thereof (Section Service Sink '--'1•— - -- - -'� i
00, Lab. p C/ �'''/.- /J Automatic Washer - -Trnsformer 1❑ 15-50'KW '— Y
I olicy No. 43Ss /02�ompany Cis& FLln+.•,�� Backflow Irrigation Sewer Cap10 50+KW I
Construction Pole Sub.. I I -
]-Certified copy is hereby furnished.
Y Certi ie =l� led with the cit (j,Drnq Ijy'�Qn.s/J / Sewer Connection Cooking Unit I i i Meter '❑up io 100 amps � 1
Date_ t Applicant (y.(:rjC.w.�� - - '
EXEMPTION FROM WORKERS'Ceor NSATION DECLARATIONClarifiers Solar Collectors Dishwasher I I Meter Dover 100 amps I 1 _
(This section need not be completed e permit is for one hundred ($100) or - ---- - - - -- -- --- --
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I I �!
I certify that In the performance of the work for which this permit is issued, 1 • _
shall not employ any person in any manner so as to become subject to the • Solar Tank Fan 1
Motors❑0.1 HP ❑1%,-8
Workers' Compensation Laws of California. • 1 _
—
Date Signature • SwimmingPool vv/Spa a -
'NOTICE: If,after making this declaration, you should become subject to the p F.A.U. ' Inc.Solar 09-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures -- - - - - - - -- - - ---
comply with such provisions or this permit shall be deemed revoked. - I
"Miaowave'r' - -�-
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes ' POIe Light
I hereby affirm that there is a construction lending agency for the performance 1
of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets I I
Lenders Name Range , I •
Lender's Address Kitchen Sink Water Service Switches Sign '
OWNER BUILDER DECLARATION - -
I hereby affirm that I am exempt from the Contractor's License Law for the Auto-Wash Garbage Disposal ;Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or . I 1
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator ❑0-5 KW❑5-15 KW Trash Com actor! •
any structure, prior to its issuance, also requires the applicant for such permit 1 P i ,
-- - —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 I , 1 I 1
Division 3 of the Business and Professions Code) or that he/she is exempt 1 I
therefrom and the basis for the alleged exemption. Any violation of Section ' I 1 ;
„t.71,V031 5 by any applicant for a permit subjects the applicant to a civil •
I 1 1
'enalty of not more than five hundred dollars($500). I
Reinspection Fee I $15 • Issue Fee $ 3 I I I i I I I I 1
❑ I, n owner of toe work, my employeestctwith wages d their sole Pe ,
• compensation, will do the work,and the structure is not intended etl or tl - - Reinspection Fee j I $15 j Issue Fee I 1 1 1 $13
for sale (Section 7044, Business and Professional Code: The Contractor's - , MECHANICAL FEES •
License Law does not apply to an owner of a property who builds or improves I 1
thereon, and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS: I
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 I I I 1
sale- If, however, the building or Improvement is sold within one year of corn- Canopy Type II ❑ Zoning Approved By 1 - Date'
pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground I I 1 1
prove for the purpose of sale). - Building Approved By I Date 1,, 1�
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By' I I I I i Date I I Ip-k(&
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating • 00-100,000 BTU ❑100,000 BTU I I SUM A FEES I I I I II
builds or improves thereon,and who contracts for such projects with a con- �)pX��1pt/
tractor(sl1 license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PER $I 1.4 nu
1 SMTP 1 $ e. J
proof of their worker's Compensation insurance should be provided to me. t
• PLAN CHECK $i 1 I PERMIT1
❑ I am exempt under Section B.& P.C.for this reason . Firepl/Fact.Blt. ICBG# Fire Dampers i
' _ PLUMBING $1 I I - ISSUANCE $ ,
Date Owner Heating System&Ducting Registers I 1 ENERGY PCI $
PLAN CHECK 25% $
I hereby certify that I have read this application and state that the above 00.100,000 BTU 0100,000 BTL I . 1 GRADING $
information Js correct. I agree to comply with all city and county ordinances ELECTRICAL $1 I 1 1
and state laws relating to building construction,and hereby authorize repre- I 1 I MICROFILM $ 1
sentatives of this city to en er^upon t.• above-mentioned proper y fyr - PLAN CHECK 50% $ 1 1 J
inspection rime- _ '_(!{� • MECHANICAL. 1 $ 1 I I 1 TOTAL FEET $ ('I• 1
Signature .. ■ ' D.te I
Drivers' Alr se or SS Reinspection Fee $15 Issue Fee • $ 3 PLAN CHECK 25% $ I I 1 , I 1
CMF 0865-46,rev. 10/84 White • Building; Canary - Applicant; Pink -Accounting: Goldenrod - Assessor
i •
NSTRUCTION AND PLANNINGIllPOOL 'A
PPROVALS Permit# _ Date Inspector APPROVALS Permit Date Inspector
kel
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-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test
6. •Electrical UFER Grnd. 57. APPROVAL TO COVE R-GUNITE
7. Footings - ' • 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Wafer Pipe-Undrgrnd. -- 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System • 1 61. APPROVAL TO DECK
11. Property Sewer Line,& House Connection 62. Backwash & Receptor-Final
12. Sewer Cap _ 63. Heater & Vent-Final
13. Roof-Drains - - • 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
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. 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 (FRJca A3 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:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final •
41. Solar Domestic-Final ,
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System t
45. Sound Attenuation
46. Handicap Regulations .
47. FINAL STRUCTURE & BUILDING tAiitc. D s
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY
No _ Date
:PROJECT EINEM
r OWNEnsNAME:lig2O2 WALLACE AV
NTENOT, WESLEY J UNIT: CITY r COSTA MESA — BUILDING PERMIT PERM NO: E 054315
AL4RESS: FONTENOTPATRICIA M PERMIT NO: E 054315 PLAN CHECK NO: N GOVT: N SUPP: N
2202 WALLACE AVE
COSTA MESA,CA 92627 CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: OTH
960-1578 '
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : SERVICE UPGRADE SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /
PERMITTEE: FONTENOT ( 714 )960-1578
ADDRESS: 1610 MINORCA COMMENTS: SERVICE UPGRADE
CM CA 92626 ***+FBF**+E•4***********************TF*>E*****+F****3E****+E***Tt*********3FaE*******3E**+a**
LICENSED CONTRACTOR DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)al Division 3 01 the Business and Professions Code.and my license is in lull force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Date: signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a sendied copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ• PROV: PARCEL: 42241110 ZNE: REF NO:
, ❑ Certified copy is hereby furnished. 0 Cemlied copy is fled with the city Building Division. PLANNING NOTES>
>
Date: Applicant: *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This se[fon need not be completed it IM penin i5 for one hundred(5100)or hiss). , ,,DEVELOPMENT - SERVICES REQUIREMENTS
I certify that 1n 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 theWorkers'Compensation Laws of California. ZONING APPROVED BY DATE;
Dale: Signature:
NOTICE:If.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : 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 APPL I CAT I ON ISSUED B Y __ ` __ �_�_� DATE• / U U P3 1
which this permit is issued(Section 3097.Civ.C). **********************• • _ - • *********.* ***.*, * **
LENDER: ************************* ' ********** . *************************************
•
ADDRESS: LEGALIZATION:N F E E S HMA R Y STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for following reason BLDG PMT PLUMBING EL ECTR 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 18 0
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 'O= SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
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 of not more than five hundred dollars(S500). ISSUE FEE 1 .. 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 PL ' —CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS---—> 18 , 50 15. 00 r 0 . 00 33 . 50 33. 50 . 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 REVENUE DIVISION TOTALS--> COLLECTED: 33 . 50 OVER/SHORT: . 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
r for the purpose ol sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 33 . 50
i ❑ and Professions Code: The Contractors'State License Law does not apply to an o r rr of property who builds or improves thereon 7
and who contracts for such projects with a contractor(s)license pursuant to th ammeters'Slate License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to m: INDIVIDUAL F E E BREAKDOWN
ix lam exempt under Ilion: B P 70 4 4 B.S P.C.
for this rc.yo WORK BY •OWNER TYPE QTY DESCRIPTIO N UNIT COST. TOTAL COST
—gale: /6Omer: �.1 Alle;LIS ELE 1 •
SERVICES BELOW 600 V & BELOW 201 AMP 18 , 50 18 . 50
Ido herebyerMC dy mat I am aware of and understand the requirements of California Health and Safety Code Sectio 25505,25533,and -END OF FEES
25534 and that I or any future building occupant wiNwiI not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification tram the Air Duality Management District.Residential construction applications are exempt from •
these provisions
Date: Applicant: • //(e•_OO
I hereby certify that I have read this application and state that the a information R correct.I agree to comply all city and county / 7(/ _
ordinances and slate vs telarng to building construction and he by (horde r4^• natives 01 this city l enter u the above-mentioned �% : .f;;:.. -'
property for/
Fur r/ // /^ --;)°'g• /0 �:, ..
—Date Signature: ((/(//(—/A .• /`
Driver's ' ense or Social Security n: (l
1641-46 White—Budding:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor r \
-- CONSTRUCTIONANDPLANNING POOL ,PA ,
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
H l4Temporary Electrical Service or Pole 52. Pool & Equipment Location
�y2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
!iT '
.3:;Electrieal ConduiLtltility-Undrgrnd. 54. Forms
-4. Electrical Conduit:Undrgrnd. 55. Electrical Bonding
`5. SteellReinforceme`nt 56. Rough Plumbing & Pressure Test_
:67 Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNI�E
.-7. Footings - 58. Electrical Conduit-Undrgrnd.
8: ropndation 59. Gas Pipe, 0 Undrgrnd., Test '
9. Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, 0 Und[grnd.
10.-.Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains .t. 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
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20.-Rough Factory Fireplace - : 3 . . • - APPROVALS:. :Permit# - -
21 SDucis, in-Structtrie': „ „ .T. _ "y, h r.70. IJAder)rpuild,Hydro v ''
22. Ducts, Ventilating-" Y _ -tor , -91. Product-Pfping 0-Gas Deil
23:-•,Gas'Pipe-Rough &'Test - _ •y 72. Underground Flusfc -
. 24..Rool Friming. tr' • .� _ - - - 73!nUndergrnd:Storage&Tank O Gas 0Oil
r
I' 25. Roof Sheathing ->y £ • '74,.Overhead Hydro
• 26.=`f-Bar Ceiling (Structural) &_Monocoat : to - r 75.:Dry Chemical -
27,-Frame and Flash`ny: - T r �yt 76'Dry Stand ipe -
r .28.-Latfting& Siding-e, .. - I. : _ .+ ,• - 77.: FIXED SYSTEM..
a
-
'29. Insulation ;; , - •- .. 5 - ' I, L 78.;FIRE PREY. FINAL -
30. Drywall Nailing i r 9 r HEALTH.DEPT".. REQUIREMENT
_31. Plaster Brown Coat' _ I , I 79::FINAL INSe,ECTI9,N. • -
32yElectric 1 Power Mater:Final- - I/ �r80..,FOOD CERTIFICATE ISSUED n.
/s ,,
33. Final EI'ectr'
5 c _ ! K ' Not@s,/Z=o./ 7-?:-
�-- % .lC /Lore•
,34.-Fin Heating:& Air;Conditioni�g •t k i, •r._ .� , t;
35:;,Final Gas Piga-Test' _ r x I - '; • ' C
• .. -< . :no r-r-
•
,36. Hood or Canopy ` .x, - I
•,-37CFinal Factory Fireplace ' S r ' 'r I I : " - `M
38. Final Plumbing , .. .. . : . , p
L139. Water Service-Final t .:C, . -
n I . , 'C
:40. Gas Service-Final ` r r, _. . n z ' •
- . {x td
T
?91. Solar Domestic-Final 5 - 7
- 42.'Backf low Preventers - '' 'IL ' I ' �' ; -
43. Backflow Irrigations - =s 5 -•..J - _
7_44. Landscape h'?igation Systeme rz ti. - . c ,1 • S - O
,45ZSound Attenuation. r - - . 5. - - 7-.e
346.•Handicap;Regulations - f
'47.-FIh1AL STRUCTURE & BUILDING " '' ! :
, ' - -` r.. c t
48.`FINAL PLANNING I '' ,y -,
.249.`.-ElectricRelease to-Edison -, t I • s, . J
Sp..Gas.Release to Southern California Gas Co ' - ! I. , _
Cr
_
`51. CERTIFICATE OF OCCUPANCY .r -- -
No. Date
OWNER KOLL CONSTRTTTTON CO., INC. DATE 3-6-57
JOB ADDRESS 29O2-Wallace Ave. BUILDING PERMIT NO. #1527
GENERAL CONTRACTOR Owner Bldr, VALUE $ 11,1400.00
L 11 BLOCK TRACT 3065 Res. w/det. gar.
GROUP I & J TYPE V ZONE FIRE DISTRICT 111179
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER
Footing Trench S/76,
Foundation Forms and Grade to Garag:
Rough Framing ter p /�
Plumbing, Rough to Slab „0/ ..��i =rr X7.7 to pa. p n.,. AGNe � _ c-, _,S7 (Q O (; 7
Plumbing, Rough Complete • • Via/C9
Temporary Pole
Wiring, Rough APR 7 VCB ' Mr,
. _• .. . '.Q-S -57 X1.2 y
Heating, Rough ----- T -/.' 1y�Mr, � 1. .. 3-a-)--s7 _ _8 -'6
Heating, Final / {�'(.; s
`isewer, HouseS &/S)Sewer,st4ff c 6-6-T7 _ �• (�.�_ a , ' - 77 2-
Septic Tank or Cesspool ,,,,��.)))
1 ng, In Out � 1 ' /d r,
P1..0tering /� A-3O - _
Plumbing,Final,Fixtures Complete/NIIP/S G-9-32 J S
Plumbing,Final Gas Test/S /NWS - -S., ' �� ece<-'� 7 ��2
Wiring,Final JUN ' 1951 VC; L-c----- _ •
Occupancy N#3- , -o - " .
roRM 210 3M 10-55
Costa Mesa Biking Department 111 EAST 20th STREETq ryn APPLICATION FOR PERMIT
1''' COSTA MEA, CALIFORNIA 441 .7 BUILDING
i FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN 1 Receipt No. 1 Permit No.
Building 2202 Wallace ' 0,..z._ • 4527
Costa Mesa, California Received by Date Recd. I Date Issued
Nearest j: $=S7MAR 6 1957
Cross St. Wilson Bucidln
Address
Owner K.w,Koll Construction Co., Inc. Costa Mesa, California
Mail
Address 2826 Newport Blvd. , Nearest
Tel. Cross St.
City Newport Beach, Cal. No. HA5201 ZoneNo.of Grou
Architect or Lib. I Type Plans I !� C. vi
Engineer Carlson and MicidlNd:rook Approval ( o
by Date
'dress Garden Grove, Calif. CORRECTIONS
City Llc.
Contractor Owner No.
Address Same
LegalLot I
Description I No. 2.1 I Block I Tract 3065 /
(Attach Metes and'Bodnds) "�� d
Size of Lot 60 x 100 I NbwoBLots none per- /
Use of I No.of I No.of p / z
Existing Bldg. Families Rooms /e,
J /v 5
Setback Line from Rear Yard J`
Center of Street 50 Side Yard I�� / D
DESCRIPTION OF WORK , r
New I X I Alteration I I Addition I (/)
T
Repair I I Moving I I Demolish I
mest
Building No.of U
size 1325 Rooms 5 Stories 1
xterior Wall I Roof —
Covering stucco Covering roc; APPROVALS I'
Use of New �
Building residence 6"-re
Foundation Location Inspector Date
Forms,Materials,
'J` Under-Pinning a
Frame: Fire Stops, is,
Bracing,Bolts C
I hereby acknowledge that I have read this Application O
and state that the above is correct and agree to comply Lath. Int A
with all City Ordinan and State Law 'regulating regi
building constructs . Lath. Ext
Signature of
Permittee Plaster,Int
Authorized Agt. w / - t/+ Plaster,Ext. CO'
N
Valuation Permit Fee $ 4/- Masonry Reinforced V
$ //l, (/OD Total Plan Check $ /54 -- Bond Beam
`f� `s
( _ �1 Fee $ /a -- FINAL o
FORM 204 S-BP 2M 6-55
c o
1 c
d
•
al
J
a
a e
• a
Street
PLOT PLAN
Show location and distances from
rt-
property line and between buildings.
0
l/
t/:
•
O
in
ty .
co
V