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HomeMy WebLinkAbout2551 WESTMINSTER AVE - Building Permitsr> p CITY OF COSTA MESA 4t• BUILDING DIVISION - > ,t , DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER F 1 2� r PERMIT %Paws °* a P01-00571 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2551 WESTMINSTER AV Status: ISSUED Suite No Applied: 09/21/2001 Issued: 09/21/2001 Vicinity: FRONT YARD ISSUED BY: Parcel Nunmber: 43919112 Applicant: OLSEN, BETTY A Address: 2551 WESTMINSTER AVE Phone: 949-645-4424 COSTA MESA, CA Zip: 92627 Owner: OLSEN, BETTY A , Address 2551 WESTMINSTER AVE Phone: COSTA MESA, CA Zip: 92627 Contractor: OWNER BUILDER Address: Phone: Zip: License: 000000 Arch / Eng : Address: Phone: Zip: License: SCOPE OF PERMIT REPLACE GAS LINE FROM METER TO RESIDENCE. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 - . Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Prevent& $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 k) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $9.80 1 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $33.30 COMMENTS I SPECIAL CONDITIONS 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(6/00) 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 carder and policy number are: Carrier: Policy Number. (This 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 in any manner so as to become subject to the workers' compensation laws 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 comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1(6,(100),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF 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.# 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: 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 pens' subjects the applicant to a clvil 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 I,old 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.). 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 en 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 em exerlyt under sec. Business and Professions Code for this reason: /�/ /U r Signature: A ' . 0l. - (= Date: 9 / Owner ID verified by driver's license. Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of docume t,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feel 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 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 division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑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). s o. ill e applicant .r. 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre 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 appplication agRermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes Ll 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 whiac Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this errllt until fine'innsspection, TA x Signature Of Legal Owner(s) /0�1 Date And/Or Authorized Applicant Date CODE S. INSPECTION TYPE PATE IIIIDAL$ CODE t INSPECTION TYPE WE .rruw.s 1616 Pool Final 208 Final Plumbing Fixed oo Final Fire Prevention Mechanical 1266 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 JECT ADDRESS: 2551 WESTMINSTER AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 061895 SNAME:O:,SEN BETTY A L . •_ ADDRESS: 2551 {IESTMINSTER AVE PERMIT NO: E 061895 PLAN CHECK NO: N GOVT: N SUPP: N r COSTA MESA, CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE: OTH ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : ELECTRICAL SERVICE UPGRADE ( 100AM.P SERV) SQFT: ADDRESS: UNIT: - PERMITTEE: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / ADDRESS: BETTY OLSEN ( 714 ) 645-4424 La.2551 WESTMINSTER AV COMMENTS: ELEC WORK ONLY / THIS PERMIT NOT ACCESSORY TO A BLDG PERMIT COSTA MESA CA 92627 ***+ ***+6**+E*x± ******tE***************x***yE***** E#+e****************************** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. r SETBACKS CITY LIC.: STATE LIC.: CLASS: Cate'. signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self.insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3000. Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ• PROV: PARCEL : 43919112 ZNE: REF NO: ❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > t: Applicant: ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($100)or less). DEVELOPMENT - SERVICES REQUIREMENTS I certify that in the erformance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Wo ors'Co ensation Laws of California. isiZONING APPROVED BY - DATE: .�^ Date: /277 3 Signature:X T e l i4•�t.� _ NOTICE: after making this d€claralion.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : / 4 / 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 lendingagency for the performance of the work for 7 which lois permit is issued(section 3097.Civ.C). ° y APPLICATION Z S SUED BY: a • a, ��. � DATE: ********************** - '!t > xF*lCx •lt I.le • Rite ' • 'Pr-'ittit W**********it It :itR" . . 1F'** LENDER: ********************************************* '******************************** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC 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 50 repair 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 the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 50% SMIP/NON—RES 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 15,00 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 PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered tor sale(Section 7044,Business and Professional Coder The Contractors'State License Law TOTALS----> 18 . 50 15 . 00 0 . 00 3 3 . 50 33 . 50 . 0 0 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 improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED: 33. 50 OVER/SHORT: ,00 for the purpose of 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 ,k_J and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such protects with a contractor(s)license pursuant to the Contractors'State License Law). l am aware *.**j(.*..x.**.*.***********************************lk*************************ie*****.*** that proof of their Worker's Compensation insurance should be provided to me. ❑ lam exempt under Section: B. &P.C. INDIVIDUAL F E E BREAKDOWN for this reason: '� k k, � �/ TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date:Y/27193 Owner/—'F'['xF. /v I do hereb certify that l am aware of and understand the requirements of California Health and Safely Code Sections 25505.25533.and ELE 1 SERVICES BELOW 600 `,7 6 BELOW 2 01 AMP 18 . 50 1 8 , 5 0 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Date: _ - Applicant: I hereby certify that I have read This application and state that the above information is correct.I agree to comply with all city and county ordinances and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above.mentioned property for , A i speclion purposes. T�(. • ' S Date: 1L7/9 7 Signature:_v/� 01 00137993-00137993 TOT 33.50 Driver's License or Social Security of: ' DATE: 04/27/93 TIME: 12:02 t64i-46 White—Building.Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor lirNND PLANNINGPOOL A 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. Emctrical Conduit Utlrty-Undrgrnd. - 54. Forms - 4. Electrical Conduit•Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test -j 6. Elcctricc! LIFERG-rd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. r 8ourdat_on 59. Gas Pipe, Undrgrnd.,Test I 9. Water P.p:Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. I • � 10. Structural Floor System .I 61. APPROVAL TO DECK = I 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final • ---I-� '1 1-27-S:wer Cap 63. Heater& Vent-Final • - { I _ i 4 Post :rains 64. Plumbing System • Final hough Plumbing -�--_- - T o g 65. Electrical-Final . 1:. Rough Etectricel-Conduit 66. Solar System-Final 16, Rough Electric Wiring 67. Fencing & Access Approval I 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1 18. Ro.gh Electric'-T Bar Ceiling __ 69. POOL/SPA SYSTEMS FINAL 19. Rough ;.eating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rot ;:: Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure • � 70. Underground Hydro --h i I 21 22. Ducrs_Vant•iat,ng 71. Product P'ping E Gas L-.10L-.1011O 23. Ga. 7.pt.•Rough & Test 72. Underground Flush 24. Roof Fram,ng 73. Undergrnd.Storage Tank ^Gas C'0 25; Root 5nazth:ng 74. Overhead Hydro 2F. T Ear Calling (Structural) & Monccoat 75. Dry Chemical r?7. Fre s d l ia=n,ng 76. Dry Standpipe - - i 28. Lain ng C4 S.dL19 _ 77. FIXED SYSTEM FINAL I-_ 29. Inswa'icn 78. FIRE PREY. FINAL _ ___i 30. Drywall Nailing 1 HEALTH DEPT. REQUIRE'.',EJT 31. Plattrr Rronn Coat 79. FINAL INSPECTION 32. Electrics Poser Meter-Final _____,5,/,7/93 7 � " 80. FOOD CERTIFICATE ISSUED - - 33. F^al E'cctr.c � Notes: 4. F;(1:1Fii.abng g( Air Conditioning - --- - -- --- - - _ ---- - 35. Final Gas Pipe-Test _.y - ------ .-_.... ----'- ----I 36. Hood or Canopy 37. Fina: Fitt:try Fireplace 38. F•nal Plumbing • ;l' i I -t 39. Water Service-Final ' 40, Gas Service-Final - 41. Solar Domestic-Fina! '12. Backf toy. Preventer - 43. 8actdloe: irr,gztion 44. Landscape Irrigation System 45. Sound Attenuation 48. Handicap Regulations -r 47. F!NAL STRUCTURE & BUILDING 46 FINAL PLANNING i 49. Electric Release to Edison I` t. ' 50 Gas s Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT AOORE55: 2551 WESTMINSTER AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 061896 OWNER'S NAME:OLSEN, BETTY A ADDRESS: 255-.. ES_MINSTER AVE - ' PERMIT NO: M 061896 PLAN CHECK NO: N GOVT: N SUPP : N COSTA MESA,CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: NEC PURPOSE: OTH ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL NEW FORCED AIR UNIT SQ FT: ADDRESS: UNIT: ( PERMITTEE:BETTY OLSEN ( 714 ) 645-4424 CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 / ADDREss: 2551 WESTMINSTER AV COMMENTS: MECH WORK ONLY / THIS PERMIT NOT ACCESSORY TO A BLDG PERMIT COSTA MESA CA 92627 ***************tree** *********ar, * ****************** 6**DF************* t•**>Fi ****** LICENSED CONTRACTOR DECLARATION: I hereby affirm That I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in lull force and eflect. 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 self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN Compensation Insurance.or a certified 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: 43919112 ZNE: REF NO: 17 Certified copy is hereby furnished. 0 Certified copy is tiled with the city Building Division. PLANNING N TES> date: `.., Applicant: Y'**'k1-*************3E***iE***********iE***it*************iE*IE***!e**iE*Ik*******ie******fE* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify that in 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 the orkers' mpensation Laws of California. k. _`1' ZONING APPROVED BY - DATE; Dale: �7/ y3 Signature a {y NOT II,after akmg this declaration,you sho d owe 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 E APPLICATION ISSUED BY; .h-'-\ DATE: .3 which this permit is issued(Section 3097,Civ,C). *************************r wit it**Y R9t i.n•**-!R - **' t*it**-'**************** 'l.,. ' ' *x*' R** LENDER: ******************************************* Q********************************** ADDRESS: LEGALIZATION:N F E E SUMNARY STRUCTURAL SEGMENT: N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC 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 p ERM I T 9,00 repair any structure,prior to its issuance.also requires the applicant for such permit to lite a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 2 5 t SMIP/,NON—RES and Professions Code)or that lie/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031,5 by PLAN any applicant tot a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE 15. 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 PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 9 . 00 15 . 0 0 0. 00 24 . 00 24 , 00 . 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 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED; 24 . 00 OVER/SHORT; 00 for the purposeol 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 protect(Section 7044.Business 24 . 00 and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to theContractors'State License Law).t am aware **********IE***************)E****************iE*********************************** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: 8.&P.C. for this rreeason: ^FK� ��/) Eq TYPE QTY DESCEIPTIO N UNIT COST TOTAL COST Date: (_? �y3 Owner y\ . �T �.C7{r�►E?� f / NEC 1 INST FORC—AIR/GRAN FURN <= 100 K BTU 9 . 00 9 . 00 I do hereby ce bfy that I a aware of and understand the requirements 01 California Health and Safety Code Sections 25505,25533.and END OF FEES 25534 and that I or any future building occupant IMI!not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby Pettily that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspe tion purposes. Date: 0i7493 signature ( r N. cn 5E YV D01 00137992-00137992 12 T01 24.00 Driver's License or Social Security M: 1641-46 While—Budding:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor ----- --- - -- ------- . POOL PA r -- - -- 1 --CONSTRUCTION AND PLANNING ,,� Date Intpector r I Date I Inspector I APPROVALS Permit -.,- _ APPROI ALS P.rmit to I I - --I 1,-1. Temporary Electrical Service or Pole 52. Pcol Cr Equ "m_rt '_ucat o-' 1 2. Soil Pin Ltdrg'nd. 53. Steel Reinfora'^-e'-t ---1 3 E'P^tri Gil Conduit U+P.ty-U-d•ernd _ 154, Forms r-- - 4 Electrical Candwt.Undrgrnd. I 55. Electrical Bonding I i 5. S:ael Reinforcement -I 56. Rough Plumbing & Pressure Test II - --1 Ill u. Electrical UF ER Grnd 57. APPROVAL TO COVER GUN•TE r 7. Footings I - 58. ciectr,:al Corr u t .i..ti•:ra - n. l � -� I 8. 2-au-dationH.- `l� 59. Gas P.Ce. Ur u• 1 , 'fist l 9. :'rater Pipe Undrgrnd 1--- L',17.. Y.!60. Back '•cshh l' --. P•7-an, U .. u tr• ; 10. Structure! Floor System III61. APPROVAL TO 'JE::K--- - .� I -- - - 11. Property Sewer Line & House Cnnract,on Ii- 62. 3aeks'.asn u ReceP!' F'; ' - -- - *- ---'------ - 12. Sever Cap 63. Heater & Vent-E;nal 1 13. Roof Dta.nl, --- I 64. Plumbing S/ "m F-1.11 _ _ _-I_ ` 14. Rough Plumbing65. Electrical-F ira' 15. Rough Eiectncal•Condui 1 I ---_- 66. Solar Syd.i_, r -- `---_ _-I --- _ 16. Rough ElectricWiring - fi 9 1_ 67. Fenrng & Ace An;'_`. _T ___ --- -. 17, Rough Wrirg Sign 1- 63. APPROVPD FOR PLASTERING ' 1i Rough Electrical•T Bar Ce•I.ng 69. POOL/SPA SVSLE'1S FINAL _--- --- --- - t 19. Rcugh Hc,:t,ng & Air Cordrnen;r.g1- -- ---i FIRE DEPT. REDUIFENIE('T - - - - 20. Routh Factory F''rep•ace APPROVA_S 21-Duct, in Structure - -1- `- 70. Und;:rgrG.41.._ _�_- - _II 22 Ducts, Vent Latina 71. Pruduc' d 1:ni; ,Cur GE: 23, Grs Pipe-Rough & Test I 72. Underrro--- I- 'SI- 24. Roof Framing 1 1 73. Undargrnd St'•,•.•. .T.-Ir ' ' Gri = I 75. Root Sheathingr -I --- I 74. O.e read -lo y • - -- --- --I -- - - 26. T•Bar Ceiling IS! ucc..ral, & : U'orocat - -- - j 75. Dry Cheer - • ' 27. F .ur-r and F.ash,n.9 __ _ - ------ - --- - --- 76. Dry Stn.:..iv: - ----- I I '3 -at1 ..g ?• S•dn 177. FIXED SYS' LI- '.AL -T --- - ' !- ---- --- -- --i--- - -- -- , 29. Insulator. i 78. FIRE ;RLV. F `,A_ I i. I37. D-;-..a1! \'1.I:ng HEALTH DEPT REQUIRE`":V' - -^ -� -� -- - - - - -. - - 31 Plestr 6rar:n Coat 79. FINAL ?! .r CT.O\ I I I 32. Electr'ta'. Poorer Meter Fru J SO. FOOD Ci nTlFrl:A1 E. l',',UFD I I 33. Final Eleztric 1 ,' Notes: 34. F n,l Hect,tic & :. Cor-vt c=• _ rbi.4 IC -T-- - - - - - --- - - - ; 35. F.nal Gas Rpe-?r.t 35. Hoot cr Crimpy, I 1-.;`. -1. 37. I'.-J nectar F•,cpErr 1 -1- - � - -- - -- - 39. Final Plumbu•9 39. tNater Service Final t 40. Gas Sermea•Frnal 41. Solar Dorneatie-Fina. -f- I 42. BdGcflo:•r Preventer I ---------- I 43. Reekt ow ;rt gat.on r-- - -� ---- -- - -- -- --- ---- -- _------ Y-. La rd.a Ct I••.cuac-. S.strn 1 4SSound Artcnu_tiar ---- - �- - ---I- -- -- --- ---- -- . ---- -' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ' i -- - - 48. FINAL PLANNING ---- -- - _----- - - - 49. Electric Release to Edison l 50. Gas Release to Southern California Gas II 51. CERTIFICATE OF OCCUPANCY -- -- ---- "- No. Date • i PROJECT ADDRESS: 2551 WESTMINSTER AV UNFO: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 059844 OWNER'S NAME: OLSEN BETTY A ADDRESS: 2551 WESTMINSTER AVE PERMIT NO; B 059844 PLAN CHECK NO: N GOVT: N SUPP : N COSTA MESA,CA 92627 645-4424 CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ALT ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION ; REROOF W/COMPOSITION SHINGLES SQ FT: 1 , 900 ADDRESS: UNIT: CLAIM VALUE; 1 , 900 . 00 CALC-VALUE; 1, 900 , 00 GROUP OCC:; R-3 /M-1 PERMITTEE: PERFECT COVER ROOFING ( 714 ) 434-1566 ADDRESS: 3303 HARBOR BL D-5 COMMENTS ; REROOF 1700SF RESID & GARAGE C.M. CA 92626 *****x******-pvX**********X** t****** *-**x****'*- XXiX* )(3 )Ou'XKiE 0r• ,E•r •• Kury a . rL..- TK:.. T} T LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING R E Q U I R E M E N T S SMO1 E 1,..�{.._� f O 7000)of Division 3 of the Business and Professions Code d my li -nse is in fullfort- elf' t. SETBACKS CITY LIC.: Q54 5CC��5 STATE LIC.:622_r` CLASS: 4 REQUIRED Date:_6-'(4-y ?� Signature..0 MAIN BUILDING • ACCESSORY, _BULL 1v ft /- FRNT; FT IN REAR : FT IN FRNT; FT IN•1lEAR; FT IN WORKERS'COMPENSA ION DECLARATION: I hereby -am that I have a certificate of consent to self-insure or a certificate of Workers' Compensation Insurance,or a certified copy thereof lection 3800.Lab.C). LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN POLICY NO.: 1263623-92 EXP.DATE: 07/01 /93 coMPANY: STATE FUND PARKING REQ: PROV; PARCEL: 43919112 ZNE: REF NO: ❑ Certified copy is hereby lumisned. © Certified cr Vic:. '' the city Buil..'. . PLANNING N TE S> Date: V Applicant: v illill".""*---- --- EXEMPTION FROM WORKERS'COMPENSATION DECLARATIO.IQhis section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES R E Q U I R E N E N-a S I certify that in the performance of the work for which Mi permit is issued,I shall not employ any person in any manner so as to become - sublect to the Workers'Compensation Laws of California. ZONING APPROVED BY •• DATE: Date: Signature: NOTICE:If,after 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 APPLICATION ISSUED B Y• DATE; I( LE (S I-- which this permit is issued(Section 3097,Civ.C). **********************************ie**Rxfl'***x*itxxle**x!1'**re************x'**at***x x** LENDER: ************************************************1E****************************** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC 'MECHANIC FIRE SM I P/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 43, 00 , 50 repair 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 the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN SM I P/NON-13ES and Professions Code)or That he/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). ISSUE FEE '. 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 PLAN-CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 43 . 50 0, 00 0 . 00 43 , 50 43 . 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: 43. 50 OVER/SHORT: , 00 orimprovemento is soldf le)hin one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK for the entis of sale). I.as owner of the property,am exclusively contracting with liyensed contractors to construct the project(Section 7044,Business 43 00 , 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ******x********************************************i£*-*****************Y*****l() * that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL - F,E E BREAKDOWN o I am exempt under Section: B.8 P.C. for this reason: TYPE QTY DESCRIPTI 0 N UNIT COST TOTAL COST • Date: Owner: SFR 1900 • REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 1 , 900 , 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from these provisions Date: Applicant: • ' I hereby certify that I have read this application and state that the above information is correct.I a.ee to comply with all city and county .' ordinances and slate laws relating to building construction and hereby adthori • epresentativeso�tEdcily I. mer upon the above-mentioned property f{or inspection purposes. 4/ Date: C —/ /4 Signature: - — ._' • .r - , 7 Driver's License or Social Security N_ - 1641.46 White—Building:Green—Code Enlorcement:Canary—Applicant Pink—Revenue:Goldenrod—Assessor 015NSTRUCTION AND PLANNING POOL 'A 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-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. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd, 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 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 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 OH 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 - I 78. FIRE PREV. FINAL 30. Drywall Nailing I HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ( 1 ( 79. FINAL INSPECTION 32. Electrical Power Meter-Final80. FOOD CERTIFICATE ISSUED � I 33. Final Electric I Notes: 34. Final Heating & Air Conditioning I if O 9 7 i . dl� 35. Final Gas Pipe-Test l I r ; • 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing ( ( ( 39. Water Service-Final I i i 40. Gas Service-Final I ! I 41. Solar Domestic-Final ' I f � 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations ; 47. FINAL STRUCTURE & BUILDINGC rf `6 - 48. FINAL PLANNING 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date