HomeMy WebLinkAbout1047 WESTWARD WAY - Building Permits ADDRESS OFB"LOM: 1097 WESTWARD LN WIT: CITY OF COSTA MESA — BUILDING PERMIT
OWNERS NAME IF DOWN: ATFSTBLUFF HOMEOWNERS PERM NO: H 072331
ADDR : 7400 CENTER AV
.4
HUNTINGTON BEACH PERMIT NO: B 072331 PLAN CHECK NO; N GOVT; N SUPP : N
APDL."AMINO ADDRESS: CONSTRUCTION TYPE; 5—N PERMIT TYPE: STR PURPOSE; 0TH
ARCHITECT OR ENGINEER: UC NO.: JOB DESCRIPTION : T/OFF , REROOF W/TORCH—ON BUILT—UP ROOF SQ FT: 8, 400
ARQL OR ENG.'S ADDRESS: WIT:
CLAIM VALUE; 8 , 400 , 00 CALC—VALUE; 8, 400 , 00 GROUP OCC; R-1 /
CONTRACTWSNANE EVERGREEN ROOFING ( 714 ) 529-7427
caRRAcrofMuuNc 1175 ORANGEWOOD DR COMMENTS ; SMOKE DETECTORS REQUIRED PER 91 UBC, REROOF 3700cr— (7h1I1 I P P`�' E
ADDRESS: BREA CA LIC-f4°2 679865 ******+F*N-************->FaF�F*ssr�E�t*�c*+F�:ics�F*+gain**�F*FF+e****** Fac**�F �c.T�,a'.�,..�.x.�l; "writ3r 4rI►
9 2 621 UMT: Z O N I N G R E Q U I R E M E N T S
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I am I sed under pravelans of Chapter 9 SETBACKS �7- E p'
(commencing with Section 7000)of Division 3 d the Business and Professions Code,end my lice'-; in lull force and effect. U U Ire Il YU a ui j_•J Y
CITY LIC.No.: 7 WC.CUSS: LIC.NO.: ty r4<<�.., I RE-^r��,"y !!! S.I
060 , 41 C39 8 EXP : 11 /95 MAIN BUILDING ACCESSORl gtILDING
Dene: S/(S 2,-1-- Contractor. A _ FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
/� LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
`Wm,NER BUILDER DECLARATION:I hereby affirm under penally• perjury that I a /pxempt from the Contractors license Law for the
Away reason(Sedfon 7031.5 Business and Professions Code:Any oily or county whr/1 requires a pecan to construct,ager.improve.
uemdish,or repair any structure,prior to is issuance,abo requires the applicant for such permit to file a signed statement that he PARKING R E Q: PROV: PARCEL; 93523006 ZNE; REF NO:
is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES>
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 fora permit wblede the applicant to ecivil penalty dnot more than fxa hundred dollars 1$50011. *************************************APOia*****************if*N********Mgc*******14
❑ I.as owner of the property or my employees with wages as their sole compensation,will do the work.end the structure is not intended
or offered for sale(Section 7044,Business and Professions Code:The Contractors orange Law does not apply to an owner of property D E V EL O P M E N T S E R V I C E R E Q U I R E M E N T S
who bolds or improves thereon, such and who does 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 ZONING APPROVED B Y
owner-builder ova have the burden of proving he or she did not build or improve for the puscee d vio). DATE;
o I.as owner of the properly.am exd s ely contracting with licensed contractors to consmd the project(Section 7044,Business and
Professions Coda:The Contractors License Law does not apply to an owner of property who builds C.improves thereon end who BUILDING APPROVED BY . DATE:
contracts for slash projects with a contractor(s)licensed pursuant to the Contractors License Law). `•
❑ I am exempt under Section: B.AP.C..forthis reason: APPLICATION ISSUED BY : } DATE: CIt 1 r
(Ct•C
Data:
Owner: ***************************4***************4.**************.*******4040***x*x******
I do hereby certify that that I eaware of and understand the requirements of California Health end Safety C Sections 25505,Para',and LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT; Y
25534,end that I or any future building occupant*ll/wilt not(circle one)need to compl9wkh said stat d the requirements for
a permit for construction or modification from the ArQuTy agement District Residential construdb ' ions are exempt health BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/RES GRADING
provisions. / PERMIT 108 , 00 . 84
yDate .S'/S'1,� Applicant: SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of d the one following ded.retloos: PLAN
0 I have and l min aintaa certificate of consent to seiico
rsure for workers' mpensation,as provided for by Section 3700 of the Labor ISSUE F E E
MI
Code,for the pedm
orarceorthewrktorwihthispermiisissued. BUILDING—DIC > PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ I have and soil maintain workers'ampenwicn insurance,as required by Soman 3100 of the Labor corea b the performance of the TOTALS----> 108 . 84 0 . 00 0 . 00 108 . 84 108 . 84 . 00
work for which this permit is issued.My workers'compensation insurance rant end policy number are:
Carrier REVENUE DIVISION TOTALS--> COLLECTED; 108 . 84 OVER/SHORT; . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP /TOT GRADING PLAN—CHECK
(This section need nor be completed d the permit is for one hundred dollars/$l00)or less) 108 , 00 . 84
El 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 d Calilamia, and agree that N I should became subject to the wakes' ******************-lair***********.***#'#****
compensation provisions of SedWn 3700 of the Labor Code,I shall forthwith commpy with those provisions. dF**********-**********A'-*******er**********
Date: Applicant: I N D I V I D U A .L F E E B R E A K D ON N
Warning:Aaiun,to secure workers'Gorrwaneatlon Coverage Is unlawful,end shall eub/ecr an e'ployer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars(3100,000A in addition to the cost of compensation,damages as provided for In
sxdon370spfthe Labor Code,Interest, roandaayef»a. SFR 8400 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 8 , 400 . 00
4 CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency for the • END OF FEES
performance of the work for which this permit is issued(Section 3097.Cir.C).
LENDER'SNAMEADDRESS INCLUDES
LENDER'S ADDRESS:1047-1057 WESTWARD LN
I certify that I have read this application and state that the above information is correct.I agree to comply with all oily and county ordinances r'
and state laws relating to buildup construction and hereby authorise representatives of this city to enter upon the above'mentioned properly
for inspection purposes.
/L / c�(//c DATE 0 0,,/Pym Nlemo� I .
'70
Date.
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LI
reg. dpwnsrlA9enL/Ap hat« OI E!059.5, 5ig+I42 13 1.3ICS.8-,
DpFE: 65'25y4`� iIrE: 1?•sa".
'5151-46 WP) White-Buildng A Safely:Green-File:Canaoy-Apphcent:Pink-Revenue:Goldenrod-Assessor
F. _ & SPA
CONSTRUCTION AND PLANNING
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pod! & Equipment Location •
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER.GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Badkwash & Receptor-Final
12. Sewer Cap '63. HeAter & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing •65. Electrical-Final
15. Rough Electrical-Conduit 66. Sohar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 7 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT •. •
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED `•�
33. Final Electric Notes:3 LT "5 A„.enre9liJ� ... .
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test 00% .. . i c6lar9r
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
1
ADOREssaSLiuul 1042 WESTWARD WY WIT: CITY OF COSTA MESA - BUILDING PERMIT
an,ERsw.6IEQPa WESTBLUFF HOMEOWNERS ASSO PERM NO: B 071693
/ ADDRESS: 1042 WESTWARD WY
/ COSTA MESA, CAggi-I toS • PERMIT NO: B 071693 PLAN CHECK NO: N GOVT; N SUPP: N
•
ATFL.NAILING ADDRESS: O CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: OTH
Mama OR ENGINEER: Ldcp.: JOB DESCRIPTION : T/OFF ,REROOF W/TORCH-ON BUILT-UP ROOF SQ FT: 5, 600 . '
ARMC OR ENC.'S ADDRESS: UMC
CLAIM VALUE: 5, 600 , 00 CALC=VALU 3T 5, 600 .00 GROUP OCC: R-1 /
cannawsNMI EVERGREEN ROOFING ( 714 ) 529-7427 � '� / '
OWITIMTDITSIIMLSKh 1175 ORANGEWOOD DR COMMENTS; ADDRESS INCLUDES 1042-1048 STWAR6, REROOF 25005F-4 UNIT APARTME
ADDRESS: BREA CA mom.: 679865 ***+r+E********if+E****if+EiE***{f **-** ***************************0* iE****,.fit*rtf**cif**+E*
92621 LMT: ZONING REQUIREMENTS ,..:1)!.. ., `'` F` t ;i -'1T
LICENSED CONTRACTORS DECLARATWN:I hereby dfnm wider pewlfy of perjury that I am(tensed •- provbbns of Cheater P SETBACKS
(commencing with Section 7000)d Divsbn 3 d the Business and Professions Code,end my lioans 'Joroe and effect �: ;
GmL1c.ND.:060741 UQOLASS: C39 uaNO.: '865 XP: 11 /95 MAIN BUILDING ACCESSORY BUILDING-: i--; 3
'• 3.6 Dae: 3- �� sorry. �-y,/ FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury the I ea exempt horn the Cactwors License Law la the
b9uw.preason(Sedibn 7031.5 Bvsiwse end Professions Code:Any city wcounty which esquires a permit to cowman eller,EVA ,. PARKING REQ; PROV: PARCEL; 93523039 ZNE: REF NO:
derndwh.or repel any sneer`s,pro ton issuance.also repulse the applicant la anic such pto Nee signed elewnat Uwe he a end
M kceneed pursuant to the provisions d the Cwuradds License Law(Chapter 9(commendrp with Section 7000)d Dbeion 3 of the PLANNING NOTES>
Business and Professions Code)or the hew she is Bump lit rdrom and Ihe beds for the dbged aemption.My vdetion of Swion ' >
T031.5byanyappLrent to•°amts meds the indican toadwi penalty not more than five haled doAen)S50OD. *******************************************************************************
0 I,as owner d the property or my employees with males as their*de compensation,will do the wok end Ne ehumtre is net needed
or offeredka sale(Section 7044.Business and P,desMas Code:The Cavadcn License Law does not apply to an byword properly D E V E -L O P M E N T SERVICES REQUIREMENTS
who Widmer improves thereon.and who does such work himself or herself a through Ns or her own employee,provided that such
improvements are not intended or offered for safe.Lhowever,the building or Uncrowned s sod within one year d completion, ZONING APPROVED BY DATE: -
°wrw-0uida will have the Baden d proving he or the did rot build or insane for the purpose d sale). . _ _-
❑ I,es owner of the property,son exclusively contrwng with licensed contractors to construct the p jed(Sed'on 7344,Business ed
Professions Code:The Conned=License Lew does not awry to en owner dproPMyWho bolds or impend thereon ard ello BUILDING APPROVED BY : DATE:
contracts kit such projects with a todrada(s)licensed pursued to the Cwl'radora License Law). )
0 Iamexempt under Secw B.8P.C..for thsreason: APPLICATION ISSUED BY: 5 DATE: 3130 (`Lk •
�a LEGALIZATION;N F E E SUMMARY - STRUCTURAL SEGMENT:Y
1 do hereby certify that I am aware of end understand the requirements of Cdiomte lleahh and Safely Code Sections 25505,25533,and
25534,and that I a any Mum building owupent will/will rot(Ode one)need to campy with said Mae codes and the requirements for
exempt modification from Residential BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING ;
• prDalma. PERMIT 81 . 00 . 56
Dale, Applicant: SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby alum under penalty dSowing perjury one of the owin g declarations: P LAN
ISSUE FEE
0 Maws and wit meinlein a certificate dconsent b sell-insure for workers'coperaeins,prodded for by Semon 3700 d the tabor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code,for the performance d to work la which this permit s issued.
p !have and roiimdm
maiden insuSectionrance. performance of
3700dtheLaborCods.fortheperfonetM TOTALS----> 81 . 56 0 . 00 0 .00 81 . 56 81 . 56 . 00
work to whim this permits issued.My workers'compensation insurance caand poky y number are:
Cartier: REVENUE DIVISION TOTALS--> COLLECTED: 81 . 56 OVER/SHORT: . 00
PdicyNumber: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be compered F the pert s ter w hundred dollars(s1av or base) 81 . 00 . 56
C3 I coney that in the performance of the work for whits this pawn is saved.I MSU ploy .. • nary manner so es to -
become subjedl°the workers'cemperaeion laws of Ceomia.and I rs' ***
saint thew°M1e * ***************************************************************
compensation provisionsprovisionsdw
San 3700 d the Labor Code,I.hell Iwtnmh won+ -.• ************I N D I V I D U A L F E E BREAKDOWN
. 4 Da30 c�- / APWsed: •'L/
7 e:
Wam/ng:Failure t secure workeicomp*asd0n comps N unwM,and shall stoat an*aglow to crhdrldbanshee and TYPE QTY DESCRIPTIO N. UNIT COST TOTAL COST
Chili Una!up to as hundred thousand dollars(sI0g000),In addition to alfa cwt of comminution.derspse b provided for In
Section 3708 ofthe Labor Cods,Interest,and attorney's toss. SFR 5600 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 5, 600 . 00
CONSTRUCTION LENDING AGENCY;I hereby aNion oder penalty of perj y that there is a construction lending agency for the END OF FEES •
performance ci the work for which the perm s issued(Swan 3097,Cir.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify the I have read this application end Mee that the above nIcaaiion'Ti coned.I agree to comply with all thy and county ordinances ��e ppb �..0
and stele laws relating to building conmwwion ad hereby saho¢e repnaentemes d this thy to over upon the above.mediaed property Ex'), J r`-• ,'
Ai inspection. rposas. -iNilYlw� ay
— �' Print �j -So '110'
LLSe L-. I� - iS" ti a:_I _n. j^y i 1177 its
Sig at d• nVAppicenktontndo it I' .•r,i
,ecce.*WD, Whe..n.idk.,A Slaw hnv.-Al t Cxwuv-Annient•Pink-Revenue:Godmrod-Aas.w
�'CY CITY OF COSTA MESA
44411* BUILDING DIVISION
F•
-
R r..%I DEVELOPMENT SERVICES RTMENT PERMIT NUMBER
P IT B05-01502
mf
(714)754-5273 • Fax(714)754-4856 ; a-mesa.43U1LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1047 WESTWARD WY Status: ISSUED
Suite: Applied: 09/06/2005
Vicinity: UNITS 1047-1057 Issued: 09/06/2005
Primary Occ: R Type of Construction: V-N
Parcel Number: TPN99015 Zoning:
Applicant: RON SELL
Address: 18032 LEMON
Phone: (714)528-1758 ISSUED BY:
YORBA LINDA,CA Zip: 92686
Owner: WESTBLUFF VILLAGE HOA
Address MIKE BERRY
COSTA MESA,CPhone: EXPIRED
1024 SEA BLUFF DR Zip: 92626 • LYii�J
Contractor SELL ROOFING COMPANY DAT13rJ14a
Address: 18032 LEMON -
Phone: (714)528-1758
YORBA LINDA,CA
Zip: 92686 License: 323842
Arch : • Eng:
Address: Address:
Phone: - Phone:
Zip: License: License:
SCOPE OF PERMIT
INSTALL 4 PLY BUILT UP ROOF OVER EXISTING BUILT UP ROOF.(REROOF OVER EXISTING SHALL BE APPROVED BY BLDG INSPECTOR-PER
SHA)FOR UNITS 1047-1057 WESTWARD WY
FEE SUMMARY •
Plan Check: $0.00 Calc Valuation: $6,900.00
Permit: $139.25 Claim Valuation: $6,900.00
( SMIP Res: $0.69
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $139.94
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 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)
OP "S
DECLARATIONS • - c
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 incur e,as req ,,,,,,bbbbbb������se���ction 3 tof the • x ,r,for the performance of the work for which this permit Is ued.
My workers'comp s ce r and p number erd t -v y /6 (�
/
Carrier: t Polio ur•; : S
(This section need no a mple ed lb permit is vale d et one hundred dollars($1 'or less.) r 'Jfi'.
❑ I certify that in the performance of the w•• or 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,an• _, hat if I s Id be ubject to the workers'compensation provisions of Section 3700 of the bor C e,I shall forthwith
comply with these provisions. /p 6 S
Applicant Signature: Date: (`
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES D CIVIL NES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATrORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed_under•rovisions o Chapter 9(commencing with Section 7000)of Division 3 of the Business anti"rofes s pope,and my license Is in full
force and effect.Lic.# A Class# �L
Contractor's Signature: `�a�� Date: 6.
/ r
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 Cale).
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 property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I em exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes D No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,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 Safely,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,ore volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application 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? LI Yes 10 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 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 COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is
correct.I agree to comply with all stets and city Ivan s !sting to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for insp:$P rposes.la e n t cupy or allow occupancy of any building authorized by this permit until
fiinnyvinspect' n.
Signature Of Owner(s) ate
And/Or
And/Or Authorized Applicant Date
CODE I gl$PECTON TYPE DAIS INTITIALS CODFE INSPECTION TYPE QATh ISL$
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
/'' 4`oc- Gfp 20-76E;.-foo 909', *t•25Q.:1
• - -
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
�l . APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely —Use I
_ _ _ RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING J� r
ADDRESS V ft /14-r I��-
/.¢ // i PER r�•"L' J
OWNER /Il
art, /,/,/ (/. A' A.P.NO.
MAIL �j //+� BUILDING p� /� _ ��'(1tYat.°
ADDRES Z(,r/OU ,/�L�>�(/, /fe � JAy/ ADDRESS�L•��"7..,5�-� '7
G ! e Witte
TEL - / /� TRACT LOT BLOCK
CITY 7 NO.
CONSTRUCTIO NEW ADD ALT-R liffern, •• s • ••.I
IIMM
LENDER
BRANCH OWNER AlatiftPeld /V-r
k.TheR,
ADDRESS .J _ •L E
ARCHITECT / f j TEL. S_ (J • • a {L'
OR ENGINES' // " ... NO.
FIRE
ADDRESS ZONE TYPE ( GROUP • •
APPROVED
CONTRACTOR 2,5BY DATE
ADDRESS
TEL. ZONE NO.OF USE OF NEW
CITY I NO. PLANS BUILDING
F
STATE / CITY YARDS APPROVED YARDS APPROVED
j4LIC. NO. yj 23 LIC.NO. I MAIN BUILDING ACCESSORY BUILDING
u SIZE ��pp NO.OF BLDGS. (FROM C/L STREET)
P. OF LOT ,rz` I NOW ON LOT FRONT FT. FT.
Q USE OF
v). EXISTING BLDG. R-S112E FT. FT.
to
F Separate permits are required for L.SIDE FT. FT.
G electric,plumbing and heating work. REAR FT. FT.
#. USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. BET.MAIN&
QMAIN BLDGS. ACCESS. BLDGS.
otaS FL//Tf/ C.LI GAQnec3SRP DATE
APPROVED
-C
APPROVED
>• - DATE
GC . 'Antwin1-/J7. ` 5,too4%.1.ft,0el �.
w l
O I hereby acknowledge that I have read this application and state AJ13f1 aAYI`j .-7--17 df._4130 /42j
ix that the above information is correct and agree to comply with dd J ��Q s'm1�.
A. all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of 1 yqr �( n r m (rt
•1yT. the State of California. '}/t •�/I SQ. FT.QI sap �/ & /I ! i"m V
I hereby certify that I am Properly license• as a contractor under �^ O Y '�^^ �'`� w N
the State California s and Prof dons Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
g.
Chapter 9, and at uc; license-are i I for = antl effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m
am exempt • t - •/•visions •f 'e e of alifornia Business VALUATION PERMIT FEE $ e
and Professions •.I rvii on �_• I „`
ro
(CJI //�A PLAN CHECK $ Za a o�.t
Signatureemof /{ y;//��• ti , F// � LL
,Permittee rujL/' ./ $ `�3 SQ 0 TAX $ (�
Authorized Agent TOTAL PAID S2,9 7/ U
J / 13 JAN 31-77P.v- OO
/� 1�323�y�/d>*'38 .25
"' COSTA MESA BUILDING-SAFETY DEPARTMENT .-e ,�Q fs X¢y�-„-?/
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
- JJ ,,,sU`/�y/�� �l�s�./ RECEIVED BY DATE RECEIVED DATE ISSUED
ADDRE L/ 4SI`7r5-'7 n432:'02il ss'A]
` /- PERMIT NO.
OWNER /np�J//s�WrQQO A.P. NO.
MAIL •,•V /// YYY___ - BUILDING �j_Q �r3_c fz�s�r�
ADDRESS ADDRED /-f'/ / J/�/
TEL. TRACT LOT BLOCK
CITY NO.
CONSTRUCTION NEWS ADD ALTER REPAIR MOVING DFMOLISH
LENDER f,V,(`/ �t �r/� /�� 4 ,s/��s
BRANCH OWNERS KV�-LetlIYP fenyiP"W"�[l
ADDRESS —�,CJ.d_ VALUE
ARCHITECT TEL.
imiWW -$
OR ENGINEER NO.
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS ZONE INO.OF USE OF NEW
TEL. PLANS BUILDING
CITY NO.
F' STATE CITY YARDS APPROVED YARDS APPROVED
j LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
I+4 (FROM OIL STREET)
SIZE NO.OF BLDGS.
OW., OF LOT NOW ON LOT FRONT FT. FT.
a USE OF
Ch EXISTING BLDG. R.SIDE FT. FT.
to
F_2' Separate permits are required for L.SIDE FT. FT.
d electric,plumbing and heating work. REAR FT. FT. -
r.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
OMAIN BLDGS. ACCESS. BLDGS.
VAR.* DATE
QC. U.P.qW APPROVED
APPROVED
} BY DATE
CO
A. .
A.
I hereby acknowledge that I have reed this application end state n
C that the above Information is correct and agree to comply with m
0. all laws regulating building construction, and I shall not employ i
Z any person In violation of the workman's compensation laws of _ m
W the State of California.
2 m
I hereby certify that I am properly licensed as a contractor under SO. FT. elf
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
43
am exempt from the provisions of the State of California Business VALUATIONv
and Professions Code,Division 3,Chapter 9. PERMIT FEE E � �� ,�
n
PLAN CHECK Si m
Signature of b.
Permittee S --4(9"'n-- 2
TAX S U
b.U
�s
Authorized Agent TOTAL PAID $ Art 1'.5.
1AAq .-
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Comple ly —U• Ink Only
RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING 1 /ti /
ADDRESS (�/F{� L_
//��/�— - , ,�—/ / / , • PERMIT NO.
OWNER.//"�Slrear a O. r .
BUILDING Y
MAIL �-a ��ra ADDRESS "(� /' y'
ADDRESS 2. ,& �. [ Z �/ ,/X� IDf7 VL/Y/J I�f '.j
CITY 9'/ /`9 NoTELL4-5=44/: TRACT t6Q0T I B'[ICIOCK
LENDENUCr,IO/N`P_L-Jjl // v NEW ADD ALTER REPAIR MOV ItAJG'VDEMOI ISH
LENDER L/.[�/I)�.Q '.o_Jf/ X
BRANCH .aS 1{-F �,,f s t' /• //, aL'Q� .
ADDRESS
/ Fi/d— / r.,4a.L., OWNER -�nf:/JI-C..I'� VALUE LO
V
ARCHITECT / TEL SE:--�..�' r4Al I $
OR ENGINEER AqA��� ��� ��� _/y'. / ���'}J�'��//y
�.O4-3 Wan • t2 a
FIRE
ADDRESS ZONE TYPE / _ GROUP
APPROVED J
CONTRACTOR deft BY DATE
ADDRESS
TEL. ' PLANS USEOF NE�
PLANS Pi
BUILDING
CITY NO. A
F' STATE CITY YARDS APPROVED YARDS APP ED
LIC. NO.2I 8823 LIC. NO. MAIN BUILDING ACCESSORY ILDIN_
izl SIZE /1 NO.OF BLDGS./ (FROM C/L Tg E r
. OF LOT , ',4 .,, NOW ON LOT e"....-
ReNT s I - a FT. ,
Q USE OF
EXISTING BLDG. fl_SIDE At .i . FT.
CO
F Separate permits are required for L.SIDE BFT. FT.
electric,plumbing and heating work.
CiREAR _S�gj'F A l. FT.
I., USE OF BUI LOIN AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& -
Q (� MAIN BLDGS. ACCESS.BLDGS.
(//e^T_ �I VAR.# DATE
< (j(�Ls� C.U.P. / 0 i APPROVED
Q
.'.7 1 /{ �YROVED /� - ' D DATE 1-�L.1- / !
CC GU I
-E J HOID—Fbn�R`[S�PyEC! I REQU!RE't1AEJNl '
a.
0 I hereby acknowledge that I have read this application and state 'n
N.
CC that the above information is correct and agree to comply with
m
a
all laws regulating building construction, and I shall not employ i
Z any person In violation of the workman's compensation laws of u
LO the State of California. I��/ ,'�1 a ✓�%fit
I hereby certify that I am properly licensed as a contractor under /V SO. FT. V 4 3o�' s 4z7 a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
ta
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ a
and Professions Code,Division 3,Chapter 9. J,
co
Signature of2I 'I PLAN CHECK 5 0
Permittee A ' 1 TAX $ LL
2
U
Authorized Agent TOTAL PAID $