HomeMy WebLinkAbout2629 WESTMINSTER PL - Building Permits CITY OF COSTA MESA
49 • BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
FIF 1i.� PERMIT
J `� PO4-00811
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2629 WESTMINSTER PL Status: ISSUED
Suite No Applied: 12/01/2004
Issued: 12/01/2004
Vicinity:
Parcel Nunmber: 43920108 ISSUED BY:
Applicant: FLECK, DAVID JR& MARIE
Address: 2629 WESTMINSTER PL
Phone: 949-290-5891
COSTA MESA,CA Zip: 92627-4643
Owner: FLECK, DAVID JR & MARIE
Address 2629 WESTMINSTER PL
Phone:
COSTA MESA,CA Zip: 92627-4643 all
t1S
Contractor: OWNER-BUILDER b
Address:
Phone:
Zip:
License: 000000
Arch / Eng :
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
1 SEWER CAP IN CONJUNCTION WITH THE DEMOLITION OF A 1190 SF SFD.
REF:804-02029 AND B04-01912
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 Preventer $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 ft) $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 $9.80 1 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
•
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
2448-48(8m0)
I
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have end 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:
(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 whit this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
/ compensation laws of Califom d agr that' sho become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisio
ii Applicant Signature: )�� Date: /2-i 0
WARNING:FAILURE TO SE URE RKERS'WM NS COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARS(5100,000),IN ADDITION TO THE T 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.IJc.If Class*
Contractor's 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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
su •� s the applicant to a civil penalty of not more than five hundred dollars($500).):
.�(b//I�epI,,,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.).
e„, sold
• 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• er of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Co• : •rs Licens. La .).
❑ I am exempt under s• - lusiness and Professions Code for this reason:
Signature: Date: eeZ/-0Y"
Owner ID verified•y driver'-•icense. 0 Yes/L No Driver's License No. ,' /.? Expires: far
Verification of Ownership by(type of document,i -property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 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 at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ora 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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes L I 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 California Health and Safety Code).
7 If a permit from the South Coast Air Ouality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 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 II state laws and ci rdinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described propertyfor i pection/mses e not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature egpruwner(s) Date
And/Or Authorized Applicant Date
CODE I UISPFCTION TYPE DATE INITIAL$ CODE It INSPECTION TYPE DAA. IDEA
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing /120
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
•
CITY OF COSTA MESA • •
BUILDING DIVISION
lirAe .
> • , a DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F t •1 II
VPERMIT
• I►
B04-02029
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2629 WESTMINSTER PL Status: ISSUED
Suite: Applied: 12/01/2004
Vicinity: Issued: 12/01/2004
Parcel Number: 43920108 Zoning:
Applicant: FLECK, DAVID JR ISSUED BY: L�
Address: 2629 WESTMINSTER PL
Phone: 949-290-5891
COSTA MESA,CA Zip: 92627-4643
Owner: FLECK, DAVID JR & MARIE
Address 2629 WESTMINSTER PL , 111
a�F,
Phone: a
COSTA MESA,CA Zip: 92627-4643 taiI
I l*
Contractor: OWNER-BUILDER DP
Address:
Phone:
Zip: License: 000000
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
DEMOLITION OF AN 1190 SF SFD IN PREPARATION OF FOR THE CONSTRUCTION OF A NEW 4412 SF TWO-STORY SFD.
PROPERTY OWNER HAS BEEN NOTIFIED TO CONTACT AQMD.
REF: B04-01912
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,000.00
Permit: $83.25 Claim Valuation: $3,000.00
SMIP Res: $0.00
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.25
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
•
•
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 It 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 . . At
WORKERS'COMPENSATION DECLARATION: r '
I hereby affirm under penalty of perjury one of the following declarations:. -
❑ I have and will maintain a cehificate of consent to sell-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 end 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 pdllcy number are:
Carrier: Policy Number:
i(T action need not be completed if the permit is valued at one hundred dollars($1 00)or less.)
I certify that in the performance o work or which t.s permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
/ compensation laws of Califo •,an• agr that If I - •.d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions. ,�/
Applicant Signature: Date: /7-r-Or
WARNING:FAILURE TO S CURE W•RKERS'COMPEN ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100,000),IN ADDITION TO TH'••JT 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.a Class#
Contractor's 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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
sub' cts the applicant to a civil penalty of not more than five hundred dollars($500).):
as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
64
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 properly,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 th= C• ctor 'cense . •s.).
❑ I am exempt un.. / / Business and Professions Code for this reason:
Signature: — `�J _ Date: /7-/-"/
Owner ID verified by dri Br's license. 0 '. 0 No Driver's License No. Expires: - 0)
Verification of Ownership by(type of doc -.•n4 i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
• permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 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 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? U Yes U No
(Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California 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 penalty of perjury that I have read this application and state that the information given Is
correct. I agree to comply with-al tate laws a city ordi nces relating toe building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for ins ction pu e" agr n occupy or allow occupancy of any building authorized by this permit until fiinnal inspection.
/7 /-`Y
Signature Of Legal w (s) Date
And/Or Authorized pplicant Date
CODE I, INSPECTION TYPE PATE ILL$ CODE( INSPECTION TYPE PATE ILLS
1816 Fixed System Final Fire Prevention 206 Final Mechanical
1266 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 I'' 7S -A(t 250 Final Building/Occupancy
��3�E' , CITY OF COSTA MESA
A � BUILDING DIVISION
F �.,,, ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT B04-01912
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa:BtLD NO P`E•1l IT R DRIVE,COSTA MESA,CA 92626
Job Address: 2629 WESTMINSTER P rt Status: ISSUED
Suite: • ' Applied: 11/10/2004
Vicinity: Issued: 03/22/2005
Primary Occ: R-3 Dwellings/Gong Res<10 Type of Construction: V-N
Parcel Number: 43920108 Zoning:
Applicant: FLECK, DAVID JR
Address: 2629 WESTMINSTER PL _��
Phone: 949-290-5891 ISSUED BY:
COSTA MESA,CA Zip: 92627-4643
Owner: FLECK, DAVID JR AND MARIE
Address 2629 WESTMINSTER PL
Phone:
COSTA MESA,CA • Zip: 92627-4643 X . . El)
EContractor: OWNER-BUILDER a r
Address: DATE /D •,
Phone:
Zip: License: 000000
Arch : Eng: PHONG V LE
Address: Address:
Phone: Phone:
• 4
Zip: '' License: ' License: S4726
SCOPE OF PERMIT
REVISED 11/13/06:ADD 168 SF FOR NEW WALK IN CLOSET.
CONSTRUCT NEW 4425 SF TWO-STORY SFD(2316 SF 1ST FLOOR AND 2109 SF 2ND FLOOR)WITH 841 SF ATTACHED 3-CAR GARAGE.NEW
HOME WILL CONSISTS OF 5 BEDROOMS AND 1 OFFICE WITH 4-1/2 BATHROOMS.
A 390 SF PATIO COVER WILL BE ADDED TO THE REAR OF THE STRUCTURE WITH A 110 SF COVERED PORCH AT THE FRONT.
REF:ZA-04-067 . .
FEE SUMMARY
Plan Check: $1,876.26 Calc Valuation: $437,366.30
Permit: $2,886.55 Claim Valuation: $0.00
SMIP Res: $43.74
SMIP Corn: $0.00 -
Other: $0.00
•
Inspection: $0.00
Total: $4,806.55
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 20-0 - Rear 25-11 Left 5-0 Right 10-0 •
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 4 Proposed: 6
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(WOO)
DECLARATIONS rJ t . . ,
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.
❑ 1 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:
�za tion need not be completed if the permit is valued at one hundred dollars($100)or less.)
•v W-0 certify that in the performance of which this pe ' s 2-ued,I shall not employ any person in any manner so as to become subject to the workers'
y A'II compensation laws of Califomi: •at if/. ould• b�•-subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provision /
�PPIicanTSigneture, /� ✓— Date; . //-lam—moo
WARNING:FAILURE TO SEM- WORK COMPENS- ION•• �-•GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S1@,0110),IN •• ION TO THE•• T+' *'•PENSATION,DAMAGES AS PROVIDED FOR IN SECTION 31060E THE LABOR CO DE,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.Llc.IS Class 0
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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
"cts the applicant to a civil penalty of not more than five hundred dollars($500).):
-:xa,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
C - 044,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.).
le I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
C . i Code:The contractors(ken . . s :•ply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
icense pursuant to the • tractors c aws.).
am exempt under 'c. Business and Professions Code for this reason:
• igneture: costa ,�rryy''�
Owner ID verified•y drivers I¢et -. .- 0 No , Drivers license No. . _Expires: ��"/3 Tiye'
Verification of Ownership by -of docu :nt,i.e.-property tax bit or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation live(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,faisework,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? 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 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—._Doesrwilll h fit
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 aggermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 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 pari 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 California 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? ❑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.. ••.•RIZATION 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 wlih'ell state laws : d c'••-•rdinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection pu ••..- agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
7/—/ —e6 j
c-. :tura0 eget Owner(s) Date
And/. Authorized Applicant Date
CODE 4 INSPECTION TYPE MEI INTITIAL5 LODE 4 INSPECTION TYPE PATE INTmMLM
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 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 - MID 451 6/9
,
CITY OF COSTA MESA
BUILDING DIVISION
CY DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT B04-01912
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2629 WESTMINSTER PL Status: ISSUED
Suite: Applied: 11/10/2004
Vicinity: Issued: 03/22/2005
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 43920108 Zoning:
Applicant: FLECK, DAVID JR ISSUED BY: 4226)/(----
Address: 2629 WESTMINSTER PL
Phone: 949-290-5891
COSTA MESA,CA Zip: 92627-4643
Owner: FLECK, DAVID JR & MARIE '
Address 2629 WESTMINSTER PL
Phone:
COSTA MESA,CA Zip: 92627-4643
Contractor: OWNER-BUILDER .
Address: -
Phone:
Zip: License: 000000
Arch : Eng: PHONG V LE
Address: Address:
•
Phone: Phone:
Zip: License: License: S4726
SCOPE OF PERMIT
CONSTRUCT NEW 4425 SF TWO-STORY SFD(2316 SF 1ST FLOOR AND 2109 SF 2ND FLOOR)WITH 841 SF ATTACHED 3-CAR GARAGE.
NEW HOME WILL CONSISTS OF 5 BEDROOMS AND 1 OFFICE WITH 4-1/2BATHROOMS.
A 390 SF PATIO COVER WILL BE ADDED TO THE REAR OF THE STRUCTURE WITH A 110 SF COVERED PORCH AT THE FRONT.
REF:ZA-04-067
FEE SUMMARY
Plan Check: $1,876.26 Calc Valuation: $437,366.30
Permit: $2,886.55 • Claim Valuation: $o.00
SMIP Res: $43.74 -
SMIP Corn: $0.00 _
Other: $0.00
Inspection: $0.00 .
•
Total: $4,806.55
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 20-0 Rear 25-11 Left 5-0 Right 10-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 4 Proposed: 6
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.
j
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes-and-al
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of n�nit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(600)
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:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑r..l.certify that in the performance of e work f.r whic . Is permit is Issued,I shell not employ any person in any manner so as to become subject to the workers'
—compensation laws of Califo ' ,a agr :et - ouid become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisi pkppli
cant Signature
.WARNINFAILURE TO SECURE WORKERS'COMPEN2. ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLierER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO TH-...T OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.4 Class a
Contractor's 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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve.demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Busin 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
su ' is the applicant to a civil penalty of not more than five hundred dollars($500).):
I,gs owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an er of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the t actor License L s.).
wait m•exempt under a Business and Professions Code for this reason:
V -
Signature: ( l Date'
Owner ID verified by driver's nse. ❑Y No _r$ rs'Ci6 i / EVQ'lley^67d�
Verification of Ownership by(type of documen,i.e. property tax bill or deed
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341.Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑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? ❑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 ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 8 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? ❑Yes ❑No
(If"yes',the facility must meet the requirement of Sections 25534 and 42303 of the California 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? ❑Yes ❑No
r(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: Dale:
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,wittralrsta laws end It ordina • relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described propsiptilor inspec" purpo1--`• '0. 'Occupy or allow occupancy of any building authorized by this ppprmit until final inspection.
•
/ 7 js rC
SigneNre Of�l`: • s)y�,7.;��F._ D r
And/Or Authorized A.plicant Datta
ODE 0 ANSPECBONTYPE gdIE INMIALS (NTITLALS
1616 Fixed System Fi I Fire Pre,ention / 20 'nal Mechanical
1288 Pool Spa Final ' 20 Fine Bing
200 Final Re-Roof x_ 21 Final Eleclri I
201 Final Block/Retaining Wall 21 Final Fire Pre entio /
202 Final Factory Fire Place 111
22 Final Planing Appr val I
203 Final Sign 222 Final Site
•
204 Final Demolition 250 Final Building/Occupancy
NEWPORT-MESA UNIFIED SCHOOL DISTRICT N° 5428
CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 AND AB 181
To: iCity of Costa Mesa District Receipt No.
City of Newport Beach �//
( ) County of Orange Plan Check No...e0 19-0I2
it aqW (/J il
Applicant: '€(.1--
Address: 21472q Lt) •4.ti,A/a7-r'R—
Telephone Number: ). SLI°/ /G b –5tyct j
Tract/Parcel and Lot Number(s):
Location of Project: \ Gf`'~'e
Number of Square Feet of: a CD
Residential Space 3 0&5x $1.84 Total
(ggk2-5 * - 11704 - 325541
Commercial and
Industrial Space x S .30 Total
Commercial/Industrial Project is: (Check One)
Warehouse _ Motel _ Preschool
_ R & D _ Bank _ Auto Repair
Movie Theater _ Neighborhood Shops _ Hospital
Mini-storage RacquetHealth _ Large Office
Heavy Industrial _ Hotel _ Office Bldg.
Regional Shops _ Medical Office _ Restaurant
Light Industrial _ Office Park _ Fast Food
This project is exempt because
This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections
53080 and 65995. The Building Perrrits for this square footage in this proposed development may now be' sued by your jurisdiction.
Checks are to be made payable to Newport-Mesa Unified School District. 1
.tel
By: ,w./
Authori=al Representative 61H71 2 J 2005
The above representation as to square footage is true. Applicant agrees that if it is later detemined that s • tai r not
true,they this certificate shall automatically terminate and the appropriate C • • hall bbeeeootified. 5. r� ryl
•
Date: 5 (95 '' `•�'
nt
NEWPORT-MESA UNIFIED SCHOOL DISTRICT N2 5687
CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 AND AB 181
To: ?,City of Costa Mesa District Receipt No.
City of Newport Beach
( ) County of Orange Plan Check No./5%O/!q
/L
Applicant: )4 . Ql-1=CJL J 2
Address: 2-‘12—°I vt✓ ,t
r] V FS & T5)& - pl ,
Telephone Number: vl4 G I — C9`577 ^ copse —7
Tract/Parcel and Lot Number(s): / 9 39 - 2 C) 0 A>
Location of Project: / l� Zq Ge! �=1 / Ai /)4 c71i c. All
Number of Square Feet of:
Residential Space __Z x $1.84 Total #-3e)2,I. SCA D %s* 7-s-? 7
/1)1_6
Commercial and
Industrial Space x $ .30 Total
Commercial/Industrial Project is: (Check One)
Warehouse Motel Preschool
_ R & 0 Bank Auto Repair
Movie Theater _ Neighborhood Shops _ Hospital
Mini-storage Racquet/Health Large Office
Heavy Industrial _ Hotel _ Office Bldg.
Regional Shops _ Medical Office _ Restaurant
Light Industrial Office Park Fast Food
This project is exempt because
This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections
53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction.
Checks are to be made payable to Newport-Mesa Unified School District. �j �j�-
By: di / rt.--'ilei / `C-
Authorrrr����ad Representative
The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not
true,then this certificate shall automatically terminate and the appropriate City/County shall be notified.
Date: _
Applicant/� z9 0� � �
f
- .. . • • _ 11-11 ?CDS 101 Fri ; _
USER:LE
001- O- 6458
•
NEWPORT-MESA UNIFIED SCHOOL DISTRICT N2 6318
CERTIFICATE OF COMPLWNCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 AND AB 181
To: (/C) City of Costa Mesa District Receipt No.
/( ) City of Newport Beach
( ) County of Orange Plan Check NotraOIl 12
Applicant: )( TIJ i c. uc
Z&tC) f
Address: 1- t �1 •
Telephone Number: k 9y`l Z949- Sc8Q
Tract/Parcel and Lot Number(s):
Location of Project: ic 2en-9 (_ieg-r4 ud7-A-& P( -
Number of Square Feet of: i Z
I
Residential Space 1 (0(e) x $1.84 Total
Commercial and
Industrial Space x S .30 Total
CommerciaUlndustrial Project is: (Check One)
_ Warehouse _ Motel _ Preschool
_ R 8 D _ Bank _ Auto Repair
_ Movie Theater _ Neighborhood Shops _ Hospital
Mini-storage Racquet/Health _ Large Office
Heavy Industrial _ Hotel _ Office Bldg.
Regional Shops Medical Office Restaurant
Light Industrial Office Park Fast Food
This project is exempt because
This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections
53080 and 65995. The Building Permits for this square footage in this proposed de ,lopment ma now . , issued by your jurisdiction.
Checks are to be made payable to Newport-Mesa Unified School District. 9/,11
O
By:
1 i.!
Authorized Representative5y 0na
0,
The above representation as to square footage is true. Applicant agrees that If it is later determined that such representations ate not
true,then this certificate shall automatically terminate and the appropriate City/Co • : notified. .:a n .I.
LI III C 1
k7 CJI
_n
Date:
//- /3- 7 r„ :::
Applicant x .
�Y _� CITY OF COSTA MESA
4 '� BUILDING DIVISION
C rl" ' ,1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F I : :: .: 1
4 � PERMIT
44* E05-00227
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2629 WESTMINSTER PL Status: ISSUED
Suite No Applied: 03/22/2005
Vicinity: Issued: 03/22/2005
Parcel Nunmber: 43920108
Applicant: FLECK, DAVID JR & MARIE ISSUED BY:
Address: 2629 WESTMINSTER PL
Phone: 949-290-5891
COSTA MESA,CA Zip 92627-4643
Owner: FLECK, DAVID JR& MARIE ��
Address 2629 WESTMINSTER PL '(\ • a
Phone: is .+ A I
COSTA MESA,CA Zip: 92627-4643 / I ) 1
��SI
Contractor: OWNER-BUILDER
Address: -
Phone:
Zip:
License:000000
SCOPE OF PERMIT
CONSTRUCT NEW 4425 SF TWO-STORY SFD(2316 SF 1ST,FLOOR AND 2109 SF 2ND FLOOR)WITH
841 SF ATTACHED 3-CAR GARAGE.NEW HOME WILL CONSISTS OF 5 BEDROOMS AND 1 OFFICE WITH
4-1/2 BATHROOMS.
A 390 SF PATIO COVER WILL BE ADDED TO THE REAR OF THE STRUCTURE WITH A 110 SF
COVERED PORCH AT THE FRONT. REF.:B04-01912
ELECTRICAL TO INCLUDE:4425 S.F.S.F.D.,2 LIGHT FIXTURES,2 OUTLETS AND 2 SWITCHES . •
FOR THE GARAGE. 1 SERVICE TO 200 AMPS
FEE SUMMARY
Quantity - . . Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 - 0
Temp service test $0.00 Busway/100 ft - $0.00 0
Res.a/c package $0.00 - Standing Section ' _ $0.00 0
New Res(1-2 units) $247.80 4425 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00, 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $2.20 2 . up to 50 kva/kw $0.00 0
Recept Outlets $2.20 2 up to 100 kva/kw $0.00 0
Switches $2.20 2 over 100 kva/kw $0.00 0
Non Res Appl $0.00 ' 0 Low Voltage Equipment $0.00 ' 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $30.50 1 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 _ 0 Circus(gen or ride) $0.00 0
Motors to 1 hp $0.00 0 Circus(meth ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
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 th/is p/ermit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00) 010*
DECLARATIONS •
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have end 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 end policy number are:
Cartier: Policy Number:
(TMs s tion need not be completed if the permit is valued al one hundred dollars($100)or less.)
T• .•- ceitly 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'
t compensation laws of Califomia,a e that If should b••• e subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
of
with these provisions. /
can;;Slgn.alure'v, ,��/ Date; 3—«o�
r__- .
W :FAILURE TO SECUR WORSE"Si CCMPENSATI• 4 •r GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND OOI.LARE(5100,000),IN ADDITION TO THE COS yo F C+ PENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.R Class a
Contractor's 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 end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
fsu ' the applicant to a civil penalty of not more than five hundred dollars($500).):
Jeri 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 Lew does not:••y to an owner of property who builds or Improves thereon,and who contracts for such protect with a contractor(s)
license pursuant t. r•ntrect.' License •.ws.).
.- --'i amn mpt / -� / Business and Professions Code for this reason:
O teLIDvenfied by'river's license./,■ i 0 No Ddva?5'G6erise No:y: - '�" • , G85'= ///off-
Verification of Ownership by(type
ad,
ocu .n6 i.e.-property tax bill or deeded
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,faisework,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 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 ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes 0 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 California Health and Safety Code).
7 II 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 penalty of perjury that I have read this application and state that the information given is
correct.I agree to comp) all state law end city ord a • relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described r y for i pectioo s .• of :occupy or allow occupancy of any building authorized by this permit until final inspection.
?— —off
umoLLegal,. 1;r(s)..c .«.•,•, , l Date`..—�:._.
And/Or Autho' :d Applicant Date
CODE f INSPECTION TYPE DAIL 1/TRIALS OaQE1 INSPECTION TYPE DAIS INTMAta
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 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
„�1 CITY OF COSTA MESA --
t BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
rirla PERMIT
M05-00803
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 2629 WESTMINSTER PL Status: ISSUED
Suite No Applied: 12/29/2005
Issued: 12/29/2005
Vicinity:
Parcel Number: 43920108
ISSUED BY:
Applicant: FLECK, DAVID
Address: 2629 WESTMINSTER PL
Phone: 949-290-5891
COSTA MESA,CA Zip: 926274643
Owner: FLECK, DAVID JR & MARIE
Address: 2629 WESTMINSTER PL
Phone:
COSTA MESA,CA Zip: 926274643 12114
Contractor: OWNER-BUILDER
Address: DR +
Phone:
Zip:
License:000000
SCOPE OF PERMIT
CONSTRUCT NEW 4425 SF TWO-STORY SFD.
REF:B04-01912
2 INST FAU<100K BTU,2 VENT FANS/SINGLE DUCT,2 FACTORY FIREPLACES
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $29.60 2 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep.Recess Wall Htr $0.00 ' 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $21.30 2 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $14.50 2 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000dm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm - $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $88.90
COMMENTS/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 carrier and policy number are:
Cartier: Policy Number:
's action need not be completed if the permit is valued at one hundred dollars($100)or less.)
1I certify that In the performance of the w•• - hich this permit is' ued,I shall not employ any person in any manner so as to become subject to the workers'
" . compensation laws of California,a.' :. : .t If I s•nultj bac/•.( eject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Vi Date: /7-2' �O S
WARNING:FAILURE TO SECURE WORKERS'••MPENSATION •VE-•• IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100,000),IN ADDITION TO THE COST OF COM- NSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F 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#
Contractor's 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).
Lender's 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
scts the applicant to a civil penalty of not more than five hundred dollars($500).):
I?as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
/ 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law--..s 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 •_C. tracto .ricense Laws.).
❑ I am exempt •:et sec Business and Professions Code for this reason:
C Signature: � CDator'1/2-7S-c'S f
Owner ID verified by d wars se. ❑Yes ❑No Drivers License.No. Expir—es� `
P
Verification of Ownership• ype of document,i.e.-property tax bill or deed):CC-..,_____—_-J
DIVISION OF INDUS -IAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 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 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
Does wl.t....
5 or will the applicant or present or future building occupantm other
for the work which is the subject age of this p estion aIQ Nnit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑Yes 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? ❑Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California 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- D 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 corn y with all ate la and ' ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-describ -property for ins ction agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
/?- zgoC
Signature Of gal Owner(s) H.Date^
And/Or uthorized Applicant Date
CODE I INSPECTION TYPE DATE INTITIAL$ DDDEn INSPECTION TYPE USE EMU
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 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
•
CITY OF COSTA MESA
< 9 BUILDING DIVISION
F at. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
t. 1111 PERMIT P05-00206
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2629 WESTMINSTER PL Status: ISSUED
Suite No Applied: 03/22/2005
Issued: 03/22/2005
Vicinity:
Parcel Nunmber: 43920108 ISSUED BY:
Applicant: FLECK, DAVID JR& MARIE
Address: 2629 WESTMINSTER PL
Phone: 949-290-5891
COSTA MESA,CA Zip: 92627-4643
Owner: FLECK, DAVID JR& MARIE ,
Address 2629 WESTMINSTER PL
Phone: C 111��`
COSTA MESA,CA Zip: 92627-4643 L
OAat •
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 000000
•
SCOPE OF PERMIT
CONSTRUCT NEW 4425 SF TWO-STORY SFD(2316 SF 1ST FLOOR AND 2109 SF 2ND FLOOR)WITH
841 SF ATTACHED 3-CAR GARAGE.NEW HOME WILL CONSISTS OF 5 BEDROOMS AND 1 OFFICE WITH
4-1/2 BATHROOMS.
A 390 SF PATIO COVER WILL BE ADDED TO THE REAR OF THE STRUCTURE WITH A 110 SF
COVERED PORCH AT THE FRONT,REF.:604-01912
PLUMBING TO INCLUDE:2 BATHTUBS, 1 LAUNDRY T_UB/WASHER,2 SHOWERS, 1 KITCHEN SINK,5
WASH BASINS AND 5 WATER CLOSETS.
FEE SUMMARY :.
AMT QTY - - AMT QTY _ AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 ' 'Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $19.60 2 Pressure Regulator $0.00 0 Urinal - $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $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 $49.00 5
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) $49.00 5
Drain,Roof $0.00 0 Shower $19.60 2 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
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,deY'IL
FOR INSPECTIONS CALL: (714)754-5626
244646(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 carrier and policy number are:
Cartier: 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 theyy •r which this ermit is issued,I shall not employ any person in any manner so as to become subject to the workers'
E:; compensation laws of California and agree at if I s b,-„'e subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall Iorthwith
ly with these pmvis'•
{`'Applicant Signature:?« '.Data: .
' 7...".$7—d�—
W NIN�G::FAILURE TO SECURE WORSE•- COMPENSATION ea;'••GE IS UNLAWFUL AND SHALL SUBJECT AN EMPCOVER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($l00,000),IN ADDITION TO THE COST OF• PENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.4 Class e
Contractor's 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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any thy 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 o1 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
sub' he applicant to a civil penalty of not more than five hundred dollars($500).):
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.
.'3044,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 tho 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 aws.).
S �vi
'`7„--- exempt under se Business and Professions Code for this reason:
Slaneturay �
/Expires:` "7--•
Verification of Ownership by(type o• ument,i.e.-property tax bit or deed)` "
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2.Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 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 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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes 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
Of'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Coda).
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
B (if"yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penally 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 COMP QE 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 co y with all St a laws 'ty o i nces relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-describe? d p,openy for Inspe ion pu r not to occupy or allow occupancy of any building authorized by this+permitpuntil final inspection.
igne@re. 'tag ner(s) 1_Date £
And/Or Au rized Applicant Date
CODE/ INSPECTION Type DAIS INTITIAts CODE If INSPECTION TYPE DAIS INIBIAL4
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wail 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
•
WEIDENKELLER, MARY JANE
From: NICHOLS, DAWN
Sent: Wednesday, January 04, 2006 1:24 PM
To: WEIDENKELLER, MARY JANE
Subject: FW: PERMIT# B04-01912 2629 WESTMINSTER PL
FYI
Original Message
From: FORD, MARTHA
Sent: Wednesday,January 04, 2006 12:56 PM
To: PETROS, EDWARD; NICHOLS, DAWN
Subject: PERMIT#804-01912 2629 WESTMINSTER PL
Please be advised that Khanh has directed me to approve the plan revision known as delta 3 for this project with its own
set of plans (because this engineer will only stamp the plans for delta 3). The previously approved plans are then still valid
for all other work on this project. This has been duly noted on each sheet of the approved plan revisions.
For inspections and record keeping purposes (i.e. microfilming)there will be two different sets of plans with two different
dates that we need to reference and keep.
Thank you.
Martha
1
•
NICHOLS, DAWN
To: WEIDENKELLER, MARY JANE
Subject: FW: PERMIT# B04-01912 2629 WESTMINSTER PL
FYI
Original Message
From: FORD,MARTHA
Sent: Wednesday,January 04, 2006 12:56 PM
To: PETROS, EDWARD; NICHOLS, DAWN
Subject: PERMIT# B04-01912 2629 WESTMINSTER PL
Please be advised that Khanh has directed me to approve the plan revision known as delta 3 for this project with its own
set of plans (because this engineer will only stamp the plans for delta 3). The previously approved plans are then still valid
for all other work on this project. This has been duly noted on each sheet of the approved plan revisions.
For inspections and record keeping purposes (i.e. microfilming)there will be two different sets of plans with two different
dates that we need to reference and keep.
Thank you.
Martha
1
. 1 J
•
=ott, CITY OF COSTA MESA
ePO. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
*
9-4:-;:t 4
`• Fill
Str DEVELOPMENT SERVICES DEPARTMENT
•
October 7, 2004
David Fleck
2629 Westminster Place
Costa Mesa, CA 92627
RE: MINOR DESIGN REVIEW ZA-04-67
2629 WESTMINTER PLACE, COSTA MESA
Dear Mr. Fleck:
The minor design review for the above-referenced property has been completed.
The application has been approved, based on the following project description and
findings:
PROJECT DESCRIPTION
The property is developed with a single-story, single-family residence. The
applicant proposes to demolish the residence and construct a 5,253 sq.ft.
(including three-car garage), two-story residence in its place.
A minor design review is required for a two-story addition that results in a second-
story floor area that exceeds 50% of the first-story floor area and that does not
comply with all residential design guidelines. The review is to ensure proper design
consideration and compatibility with surrounding properties.
The proposed construction conforms to all residential development standards and
the intent of the design guidelines. The second floor to first floor area ratio is
approximately 66% (2,096 sq.ft./3,157 sq.ft.), which is well within the 80% ratio
recommended by the residential design guidelines. The design guidelines also
recommend 10 ft. average side setbacks for the second floor. The left side
proposes an average of 9.4 ft. It is staff's opinion that the proposed deviation from
the average side setback guideline is minimal and the structure still meets the intent
of the design guidelines. Specifically, the overall structure, including the left side
elevation, incorporates multiple building planes and variable rooflines for visual relief
and interest. Privacy impacts are also minimal because the second floor provides
Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245
FAX(714)7544856 • TDD(714)754-5244 • www.ci.costa-mesa.ca.us
�)
ZA-04-67
October 7, 2004
Page 2
20 ft. to 30 ft. setbacks from right and rear property lines while the left side
elevation has only staircase, laundry room, and bathroom windows.
FINDINGS
1 . The information presented substantially complies with Section 13-29(e) and
13-29(g)(14) of the Costa Mesa Municipal Code in that:
a. The proposed development and use is compatible and harmonious with
uses on-site as well as those on the surrounding properties. The
project meets or exceeds all residential development standards and the
intent of the design guidelines.
b. The project is consistent with the General Plan.
c. The planning application is for a project-specific case and does not
establish a precedent for future development.
d. The information presented substantially complies with Costa Mesa
Municipal Code Section 13-29(g)(14) in that the project complies with
the City of Costa mesa Zoning Code and meets the purpose and intent
of the Residential Design Guidelines, which are intended to promote
design excellence in new residential construction, with consideration
being given to compatibility with the established residential community.
This minor design review includes site planning, preservation of overall
open space, landscaping, appearance, mass and scale of structures, •
location of windows, varied roof forms and roof plane breaks, and any
other applicable design features.
2. The project has been reviewed for compliance with the California
Environmental Quality Act (CEQA), the CEQA Guidelines, and the City
environmental procedures, and has been found to be exempt from CEQA.
3. The project is exempt from Chapter XII, Article 3 Transportation System
Management, of Title 13 of the Costa Mesa Municipal Code.
CONDITIONS OF APPROVAL
Ping. 1 . Street address shall be displayed on the fascia adjacent to the main
entrance or front door in a manner visible from the public street.
Numerals shall be a minimum 6" in height with not less than 'h "
stroke and shall contrast sharply with the background.
2. All new and existing construction shall be architecturally compatible
with regard to building materials, style, colors, etc. Plans submitted
for plan check shall indicate how this will be accomplished.
3. The conditions of approval and ordinance or code provisions of minor
design review ZA-04-67 shall be blueprinted on the face of the site
plan as part of the plan check submittal package.
4. The applicant shall contact the Planning Division to arrange for a
Planning inspection of the site prior to the release of
ZA-04-67
October 7, 2004
Page 3
occupancy/utilities. This inspection is to confirm that the conditions
of approval and code requirements have been satisfied.
5. Grading, materials delivery, equipment operation, and other
construction-related activity shall be limited to between the hours of
7 a.m. and 8 p.m., Monday through Friday, and 8 a.m. to 6 p.m.
Saturday. Construction is prohibited on Sundays and federal
holidays. Exceptions may be made for activities that will not
generate noise audible from off-site, such as painting and other quiet
interior work.
Eng. 6. Maintain the public Right-of-Way in a "wet-down" condition to
prevent excessive dust and remove any spillage from the public
Right-of-Way by sweeping or sprinkling.
CODE REQUIREMENTS
The following list of federal, state and local laws applicable to the project has been
compiled by staff for the applicant's reference. Any reference to "City" pertains to
the City of Costa Mesa.
PIng. 1 . Approval of the Zoning Action is valid for one (1 ) year and will
expire at the end of that period unless building permits are obtained
or the applicant applies for and is granted an extension of time.
2. All contractors and subcontractors must have valid business licenses
to do business in the City of Costa Mesa. Final inspections will not
be granted until all such licenses have been obtained.
Bldg. 3. Comply with the requirements of the California Code of Regulations,
Title 24, also known as the California Building Standards Code, as
amended by the City of Costa Mesa.
4. Prior to or concurrent with the submittal of plans for grading/building/
plan check/submittal of final subdivision map for engineering plan
check, the applicant shall prepare and submit documentation for
compliance with the State Water Resources Control Board (SWRCB)
Water Quality Order 99-08-DWQ; National Pollutant Discharge
Elimination System (NPDES) Permit No. CAS000002 for Storm Water
Discharges Associated with Construction Activity (General Permit);
the California Regional Water Quality Control Board (RWQCB) Santa
Ana Region Order No. R8-2002-0010 and NPDES Permit No.
CAS618030; and, the City of Costa Mesa Ordinance No. 97-20 for
compliance with NPDES Permit for the City of Costa Mesa. Such
documentation shall include a Storm Water Pollution Prevention Plan
if over 1 acre (if over 5 acres if submitted prior to March 10, 2003)
and a Water Quality Management Plan (WQMP) identifying and
detailing the implementation of the applicable Best Management
Practices (BMPs).
5. Submit soils report for this project.
ZA-04-67
October 7, 2004
Page 4
6. Submit grading and drainage plan for this project.
Parks 7. Street trees in the front setback shall meet with the approval of the
parks and parkways division. Street trees shall be Liquidambar
Styraciflua, 15-gallon minimum size, spaced at 30' on center.
Eng. 8. At the time of development submit for approval an off-site plan to the
Engineering Division and grading plan to the Building Division that
shows sewer, water, existing parkway improvements and the limits
of work on the site, both prepared by a civil engineer or architect.
Construction access approval must be obtained prior to building or
engineering permits being issued by the City of Costa Mesa. Pay
offsite plan check fee to the Engineering Division. An approved
offsite plan and fee shall be required prior to engineering/utility
permits being issued by the City.
9. A site access permit and deposit of $500 for street sweeping will be
required by the Engineering Division prior to the start of any on- or
off-site work.
10. Submit required cash deposit or surety bond to guarantee
construction of offsite street improvements at time of permit per
Costa Mesa Municipal Code Section 15-32, and as approved by City
engineer. Cash deposit or surety bond amount to be determined by
the City engineer.
11 . Obtain a permit from the Engineering Division, at the time of
development and then construct P.C.C. residential sidewalk per City
of Costa Mesa standards as shown on the offsite plan, including four
(4) feet clear around obstructions in the sidewalk.
12. Obtain a permit from the Engineering Division at the time of
development and then construct P.C.C. residential driveway approach
per City of Costa Mesa standards as shown on the offsite plan.
Location and dimensions are subject to the approval of the
Transportation Services Manager. A.D.A. compliance is required for
all driveway approaches.
13. Obtain a permit from the Engineering Division, at the time of
development and then remove any existing driveways and/or curb
depressions that will not be used and replace with full height curb
and sidewalk at applicant's expense.
SPECIAL DISTRICT REQUIREMENTS
The requirements of the following special districts are hereby forwarded to the
applicant:
Sani. 1 . Developer shall contact the Costa Mesa Sanitary District at (949)
631-1731 for current district requirements.
AQMD 2. Applicant shall contact the Air Quality Management District (AQMD)
at (800) 288-7664 for potential additional conditions of
ZA-04-67
October 7, 2004
Page 5
development or for additional permits required by AQMD.
CDFA 3. Comply with the requirements of the California Department of Food
and Agriculture (CDFA) to determine if red imported fire ants exist
on the property prior to any soil movement or excavation. Call
CDFA at (714) 708-1910 for information.
Upon receipt of this letter, your project has been approved. The decision will
become final at 5 p.m. on October 14, 2004, unless appealed by an affected party
(including filing of the necessary application and payment of the appropriate fee) or
by a member of the Planning Commission or City Council.
If you have any questions regarding this letter, please feel free to contact the
project planner, Wendy Shih, at (714) 754-5136, between 1 p.m. and 5 p.m.
Sincerely,
Pit PERRLAA`NTINNEE
Zoning Administrator
cc: Engineering
Fire Protection Analyst
Water District
Building Division
Jean Rudenski
2624 Westminster Place
Costa Mesa, CA 92627
eta-
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BUILDING DIVISION •
F w ,' DEVELOPMENIJ SERVICES DEPARTMENT •i'CRMI1INUMBER
�,. PERMIT
yrE04-01304
1
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2629 WESTMINSTER PL Status: ISSUED
Suite No Applied: 12/15/2004
Vicinity: Issued: 12/15/2004
Parcel Nunmber: 43920108
Applicant: FLECK, DAVID JR & MARIE ISSUED BY: ___C
__
Address: 2629 WESTMINSTER PL
Phone: 949-290-5851
COSTA MESA,CA Zip: 92627-4643
Owner: FLECK, DAVID JR & MARIE
Address 2629 WESTMINSTER PL
Phone:
COSTA MESA,CA Zip: 926274643
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 000000
SCOPE OF PERMIT
TEMPORARY POWER POLE.
•
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3-i-units) $0.00 0 Transformers up to 1 kva/kw ' $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 . up to 100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee - $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
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%nder pipcyty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to self-Insure for workers'compensation,as pmvidLd 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:
Cartier: Policy Number: M
(This section need not be completed li 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 fdrthwlth
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 CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLIARE($100,OW),IN ADDmON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS 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#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
in I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the properly,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 .5 o ner of .e pro.:••, . - XC VELY •- - • ' W)Ty ICENSkCONT CTORS to construct the project(Sec.7044,Business and Professions
•nir. •rs License Law does not apply to an owner of erty h6 BuWfrrim eon,an w o contracts for such project with a contractor(s)
JJ license pursuant to the •• -ctors L••.. a La .).
_l.]exempt er'sec. / Business and Professions Code for this reason: — (�-
atUre:
Expires:_ (t—OS
Verification of Ownership by(type of tl ,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,'Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS MID 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 9 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑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? ❑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? 0 Yes LI 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? ❑Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California 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? ❑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 al state laws :nd city . di..nces relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for in action p..••' s. .. ..-not to occupy or allow occupancy of any building authorized by this permit until final inspection.
/ /2-75=OK,
( Signature I e•_ • ner(s) \ Date
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE QAIE INTITIALI CODE INSPECTIONTYPE PATE gfT10AL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final _ 208 Final Plumbing �/
200 Final Re-Roof 210 Final Electrical aid/DW ,pp��/J/--
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
OWNER ROYALTY SERVICE CORP. Y DATE 5-20-54
JOB ADDRESS 2629 Westmina _Jr Place BUILDING PERMIT NO. 253
GENFERAL CONTRACTOR Jy. !• Doverspike VALUE $ 8,800.00
LO - � 119-161-'1 BLOCK TRACT Dwelling & Garage ft
GROUP I TYPE V ZONE R-4 FIRE DISTRICT #257
INSPECTIONS •LTE SUBCONTRACTOR PERM ITS ISSUED
DATE NUMBER
'Footing Trench )t64 r� ty J
Foundation Forms and Grade to GaraglN / (i'fl J
• Rough Framing )«-. - ) I i
Plumbing,Rough to Slab 7LG`j. /x, stl, Z. a. tu.-, m_�P --ill_
Plumbing,Rough Complete >C-C, 1/y
' Temporary Pole //
Wiring,Rough lig IL 4 atic /�/O JXt` rd' - Z ,r _ r/
Heating,Rough •GC-c._i / 13-A'ai - - •-•.c' '
Heating, Final -26_e...---"5.- 18/. /y/
Sewer C i"�/��)11 U E.
Septic Tank or Cesspool 66 Fri- .' "ii.' Zr�.. - miry i69
Lathing /ilf . L4-t-tr / ;
„Plastering 7'vt--
Plumbing,Final,Fixtures Comlep. t' A/ 1. /
Plumbing,Final Gas Test /f 'FA., ,-t� • v- f✓ G6l
Wiring,Final / Tfj//�'( l /
t
Occupancy �'Gr/ i' /� j O'I 6` c-�, -73^571 tiP4 - L!� Jli
Forn, 210 G-11 1M 12-53 / `L 0
INSPECTION RE EST /
TO: Building Inspector Date.. la, 7 , 1957 Hour
Asst. Buildin78/'�'speetor p7 p�'-f2-�_ O2
Plumbing /spectoa/.)�' 1 �._../_//`O�.,-/^���/) /�/t,
Job: Name: .,. r SIA. ... .../ Address ../.r 'aYF.:.CtiJ{..l4
Contractor '. ... 2 --, i Permit No tin
Type otlnspection
, Rough or Final O.K.'d by Date
i 0 TRENCH ft/.
i 0 FOUNDATIONNrS GRADE TO jjG��ARAGE �/j�� ,lin",..,fi+sJi file 7 5#& �c
/}❑ PLUMBING...!-.. •-,. d[\ ........... /1 M1.1-.`i✓ 'L.,+i l.fl/�` ot
PD SEWER i� 3 T ,/r,,�
❑ HgATING go
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LATHING (/
4I4ASTERING..._ .D:.-g g _ �....- L._
'BLDG.FINAL 6' T
SCELLANEOUS
Signed
Form p13 G-H 10M 12-53
Costa Mesa Building Department APPLICATION FOR PERM I,� .
111 EAST 20th STREET 257BUILDING_. _
COSTA MESA, C FORNIA -
FOR APPLICANT TO FILL IN ' FOR O_ACE USE ONLY .y
.. Receipt No. PermitNo.
Building //��/J� / f ////, �/ ,-.5-1", 3 j
Address !+c'ti� ,7 .__a. i y%4/`r
sta Mesa, California Received by a Rec' Date Issued
7(e 6.---. 9 gZ�r 7�-Z =sem
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Cross SQ �� ,�/' �/Ji--(� Building 77� Gs - ,
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Owner
dy iii rj�//��)��_ /_ Costa Mesa, California
Address ` C--0 i�C(. I Nearest /,f1/� )7'�'�y. I 1
Tel. Cross St. Ott
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City No. Zone No.of L- Type I Group
Architect or Lic. • Plans I
• Engineer ' No. Approved' 1 '
by Dale l
• Address eaCORRECTIONS
City Li '
Contracto
C/5a.,4 ! . / No. , /
• Attar.ss C.J I'Mtil e
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LegalLo . I t.
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Description No. Block Tract I-7;"C, I \o, ���
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(Attach Metes and Bounds) /i " '
f/ o.of Bldgs. • t,l� ` -..,
Size of Lot a.A27Q I Now on Lot _. .. • __ . t.,_-- o
Use oT • /J No.of No.of • r IT .. s
Existing Bldg.-1%r-
ldg. / I Families I Rooms F' . a
Setback Line from / Rear Yard • - - - -- -- -- -- -
Center '- - '- Z
Center of Street ah!1 Side Yardp�,, � 2.
DESCRIPTION OF WORK C!T Y .U�- -V'� ' ^_ frit:3A
- New I"I Alteration I - I Addition I•
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Repair I I Moving I I Demolish I
e
BuildingNo.of
Siz "_,e G Rooms - Stories /
Exterior Wall �i I Roof �' APPROVALS
;; _Covering L Covering lig
Use of New
Foundation Location Inspector Date
Building /
, Forms,Materials,
♦ Under-Pinning
are Frame: Fire Stops,
Bracing,Bolts
• I hereby acknowled.- r have read this Application Lath. Int.
and state that the . ,.�! .rrect and agree to comply
with all City O . % . d State Laws r•gulating Lath. Ext.
building cone• J
Plaster, Int.
Signature of , -
Permittee i�iia.e�at fr / _ . A • plaster,Ext.
Autho iz.• /
Masonry Reinforced
Valva ion O Permit Fee $ 2 Y—
6 ..' Plan Check $ 3 Bond Beam
' $ �-� ' Feeal S 2-A 00 FINAL
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PLOT PLAN
Show location and distances from ..
property line and between buildings. 4
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