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Home My WebLink About1966 WESTMINSTER AVE - Building Permits Co • F 9 , CITY OF COSTA MESA • ais4 BUILDING DIVISION O. : DECLARATIONS ----; 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. ❑ 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 permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (ThisjectIon need not be completed if the permit is valued et one hundred dollars($100)or less.) f —/1'eertify that in the performance of the work for which this•.rmit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of 4:lifomia,a •agree that If I sho • •ecome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these11• .� App /7e r O T FcanTS(gnet'uie:; C��`� [Date: '-`-- ,.WARMNG'FAILURE TO SE IPP""CRKERS'COMPENSATION••VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DGIARE($100,000),IN ADDITION TO THE COST OF 1.a• PENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE.INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.if Class# Contractors Signature: Date: 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 t ile 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 Iness 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 s b) is the applicant to a civil penalty of not more than five hundred dollars($500).): f 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. L.- 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 end 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 q contractor(s) L ense pursuant to the Contractors License Laws.). Business and Professions Code for this reason: Lre:+_��~�F� �L�r ['�� Explres:c.-r7 - o J Verification of Ownership by(type of docum: ,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,fatsework,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 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 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? 0 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 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 permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes LJ No (Section 65850.2 of the California 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? 0 Yes 0 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 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 penally of perjury that I have read this application and stale that the information given is correct. I agree to comply with all state laws and ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descr.%'rope y for inspection purpo .gree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /L �N� ,( . _fes ... �7 C�•, Sign=L:21,,Owner(s)_- . y_ Y, tDate_. And/Or Authorize•Applicant Date ;ODE I INSPECTIONTYPE QM INTITIALS CODE1 INSPECTION TYPE PATE iturnALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final / 208 Final Plumbing <- 200 Final Re-Roof ' _•f •_0 l4/ fa� 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 OWNER lQi,T,MEYERr MRS. BARBARA DATE 10-211-61 JOB ADDRESS 9 BUILDING PERMIT NO.15721. GENERAL CONTRACTOR o ner-bu --Aor VALUES res. Owner-buildor3; 09_.4Q AP No.118_113_2), LOT TRACT FIRE ZONE DESCRIPTION OF WORK Fnd.for move-11 1NsPECTIONS Signature DATE GROUP I TYPE V ZONE R-1 F. Gas ,_? / SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Water L Rough Com. Refrig. 0 Air Cond. 0 Rough Heating Ra _oak) ✓ Rough Plumbing /l4-/f777-1,--7Z..� J i-7 6II_ ,� Miscellaneous 4,.-n-.pR- ^ _ _i I Prop.Swr.Line [House Con. [.l-6t.Swr. 0 Jr-3 , /HyyfN .1044/ S t'it- f _rZ, �y Sprinkling System //Y' ' Construction Pole "'Underground 0 Power p _ ✓ Rough Wiring yT e p,..,,r a sc,„..,... ix- 7-‘41 '7 Id Trenches 0 Forms 0 Steel Reinf. 0 _.Ca- rI""/- 421 / ' t —11413 Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing g•-/E' :) v ^i �/ �� ,,.t et_e Lathing — In 0 Outo. 2/— 9 , A/ Plaster, brown coat Z - .' r C / In thti iris, Afar_ 12.11 </ Ref-'sw',Fl.,0 Air Cond. 0 Final ' He;; , Final / /S //• 2 $e U7 Plumbing Fixtures, Final 1/•2 * / "� p Final Gas Test JC r. )1i'- 'c' "dri. —v�JJJ--- Electric Fixtures, Final 2 .l (1 1l r , _17/ _ .0� �t� .Z Building, Final riC(i(1 r i l(,( IJi OCCUPANCY Fes" iayou. FORM BU4-5M - 7-61 HOLD FOR SPECIAL. REM IIRFMFNTS 15721 • 15721 FE RECEIVED t OCT24AI COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE/ DEPT •e P. O. BOX 317 COSTA MESA. CALIFORNIA CITY OF/COSTA MESA -,..)OR • For Applicant to Fill In Completely APPLICATION FOR PERMIT NN TYPE OR PRINT yn 5�Jj - A/ BUIL LNG, COSTA�QjMESA. CALIFORNIA For Office Use .Only VIOWNER jyr,s •{/d A'/10,I- 2 iT//�M fv/-/' I RECEIPT NO. I/ NO. • MAIL '`' / • R/EIC,g(1/NE/Gy'BY I' DATE RECEIVE DATE IODUUE/ ADDRESS PG ,y CS��E (�S�`w' ?✓C �C�✓�E y ' \ J. o-a -17� Al' .. TEL. .� BUILDING. Ni,jk/ CITY �G f. I_ /� a S cYJ V , NO. -. J` _ ADDRESS i9G� U1 �- ' ARCHITECT V TEL• c COSTA MESA. CALIFORNIA OR ENGINEER NO. --. et, ,-, 4/ • FIRE .l.- ADDRESS ->' .p _ .__ ZONE r i TYPE GROUPRO CONTRACTOR OW•Tc� 80::;/der 'APPROVED `� DATE D/, / 4 sY Y! SI.... •� i.vl :�' _ �q ADDRESS - 31• ING YI �' r0' ZO'KIII�Z,� NO.OF 2....___ USE OF NE 91 CITY `0. - I PLANE BULLPING STATE TEL. LEGAL 1 o t t 0. R 967 SIC. NO. DESCRIPTION BIZErI NO, OF BLDGB, jjj 1 OF LOT /19. ,)6.6 Y A.P.NO. I NOW ON LOT f/ 3-f33 -LAV USE OF ref;•%+c0 C7,. yc • 563,,tons YARDS EVES kEXISTING BLDG. APPROVED ALLOWEDSETBACK LINE FROM ?/ f (CENTER LINE ST.) LLCENTER OF STREET /� REAR YARD 2'. FRONT 7 B FT, 3 IN, \V1 SIDE YARD I LEFT 2 F'-3 I RIGHT (S / R.SIDE FT. IN. DESCRIPTION OF WORK 3 FT. • ,z. IN. L.SIDE • NEW I II ALTERATION I II ADDITION I REAR / / if FT. e[C /, IN. P REPAIR I II MOVING I II DEMOLISH I APPROVED t ' �I ,J/( �I DATE I U-�g-1Q l ui 'i BUILDING NO. OF 1A/v IWW� aik _ I U) SIZE ROOMS STORIES * }ply, {y A {y' / e EXTERIOR WALL IROOF V A Sp y` �y E1 'I -1 I a COVERING COVERING ddd�nL i1�1 ffi 141 SSS `V USEOFOF•BUILDING AND WORK TO BE PERFORMED Try t,0. 44 ( t�P UJt4 a �� p k w nn,R V^ w- ( �i.�--�-N.-(%L`' a. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION (�/� �L j ( /�j '! AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- �TVHEpyAMOUNT SHOWN UNDEM pVw��LUATION 11' PON THE PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING i1{FROS �F F�TABLI Obi(NPIN�,BRRIT-FEE ONLLY� CA W BUILDING CONSTRUCTION.`' �7 ^ ///�� YALU,IIUN a-.p ,' SIGNATURE 0E2 fpw //i Jv..(/ /�{' � .A�r nn__ � PERMIT FEE $�p� • PERMITTEE / 4(`Y✓�✓c�/ "n /�1�/! ' �Q p p v S �J�-j'�'—� PLAN CHECK $ o-� a AUTHORIZED AGENT ��V//v v F 'j,' N TOTAL FEE 5 /� 0 • ' ;I •. '1/4) .4,4 ‘ fr, ;7 n .:: 1.111.1 • SPECIAL REQUIREMENTS • (1) Dedication to the City of Costa Mesa of 15' spandrel at S.E. Corner of Westminster and Esther St. (2) $3500.00 bond to be posted by applicant (3) That building be comphlted 6o days after date of delivery on the property (4) All the requirements of Dept. of Building Safety. • • • • •