HomeMy WebLinkAbout1601 WHITE OAK ST - Building Permits CIO
CITY OF COSTA MESA
o4. BUILDING DIVISION
F 1 I '1ggEg 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
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9 FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: B09-00166
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 13921408 DATE ISSUED: 08/2012009
ISSUED BY: BJK
JOB ADDRESS: 1601 WHITE OAK ST CM Suite/Unit:
Vicinity: REROOF SFD AND ATTACHED GARAGE
Squares: 2800 Valuation: $5,000.00
SCOPE OF WORK: REROOF RESIDENCE AND ATTACHED GARAGE: NEW ROOF TO GO OVER 1 LAYER OF EXISTING COMP SHINGLES,
1 LAYER 15#FELT,APPLY NEW 30-YEAR COMP SHINGLES.PITCH 4:12 2800 SO FT
OWNER: MICHAEL,DORIS BRANDLER Address: TR Unit: COSTA
MESA,CA
PHONE: City/State/Zip: 1601 WHITE OAK ST
APPLICANT: KENNEDY, BILLY Address: 660 S JEFFERSON Unit: :UNIT C
PHONE: 714-993-9715 City/State/Zip: PLACENTIA,CA
CONTRACTOR: ROOFING STANDARDS License No. 741302
Address: 660 S JEFFERSON Unit: UNIT C PHONE: 714-993-9715 •
City/State/Zip: PLACENTIA,CA 92870 CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $111.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES $112.25
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE R. INSPECTION TYPE DATE INI1TIALS CODER INSPECTION TYPE DATENTmALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final / / 208 Final Plumbing
200 Final Re-Roof a 'I/`- 07 fO cvli 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
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-properly tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
ormance 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compgnsalion Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: L '(�/J person is required to descend,will be made in connection with work authorized
/� h by this permit,and that no building structure,scaffolding,falsework,or demolition
rti
Caer: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm
(This sectioncar be completed permit is valued al one1hunM`ea�dloears(S100)or ress) 2,M2 Sec.341,Title B,California Administrative Code).
•
Policy umber: Go�S ZZ S ' 2".f7 •'
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any pers. in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' c•mpensatio la of Cl ifornia, and agree that if I should
becomes : -c o he work= s' ompeni=tion provisions of Section 3700 of Applicant's Signature Date
the La•• •od , ,•.Il forth it comply th these provisions. ��
• z/ i S ' cr'2 Division of Industrial Safety Permit Number:
Ap.ecam's Sig :wre HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO S CURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑ No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons.or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is inn full force and effect. (� 14 L31 a registration form for acutely hazardous materials? ❑Yes 0 No
<Lic.#x L2 l 0 Class# ' `-��/ I (Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
A Z� "l each business which at any one time has on hand a quantity of acutely
Contra-.r's rt.! Date -- 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
CONSTRUCTION L DING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safely Code provides that the
Lender's Address: _ 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
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 8. (If"yes", attach certificate of compliance from the appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to o cu•y or allow occupancy of any building
authorized by this permi until final pa ion.
5i• -t TI;�I•_al Ownar
Da a a_J/Q
Signature Date �� ll /
3057-46131071 - _U
And/or A themed •nnLcant n•,e v
4,a` 9 CITY OF COSTA MESA
4 BUILDING DIVISION
.• ' 4I a DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER
G. Ira 1
6C' PERMIT
%bro naS. P06-00516
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
- PLUMBING PERMIT
Job Address: 1601 WHITE OAK ST Status: ISSUED
Suite No Applied: 06/28/2006
Issued: 06/28/2006
Vicinity: - .
Parcel Nunmber: 13921408 /
It
Applicant: NOCK, CANDY ISSUED BY:
Address: 11612 KNOTT ST
SUITE 217 - Phone: 714-895-1246
GARDEN GROVE,CA ' Zip: 92841
Owner: MICHAEL, DORIS BRANDLER
Address TR
COSTA MESA,CA Phone: -
1601 WHITE OAK ST - Zip: 92626-3724 .
Contractor: NOCK PLUMBING '
Address: 11612 KNOTT ST
SUITE 217 Phone: 714-895-1246
GARDEN GROVE,CA Zip: 92841 ,
License: 707775
SCOPE OF PERMIT
CHANGE OUT WATER HEATER.
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 $0:00 0 Wash Basin Set $0.00 0
Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower - $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink,Floor '$0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 -.0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 - , `Sink;service/mop $0.00 • 0 .. C OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service - $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0 •
TOTAL CALCULATED FEES: $35.80
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomfa 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
fora 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
2448.46(6'ea) .
DECLARATIONS 1 • I
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 hay
(��rq�n will aintain�"tare
compensationer r rrnilln��ds��Durr rice.as requir by section 3700 of the Labor Code,for the performance oo�ftpowoo for which
^this���jjj it' issu
My vl e -VtV,�sL PSri:e carty� r� Policy LI�A� I
Carrier:
l Number:
(This secu not be completed if the permit I valu d t one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for-which-this.•-•••' is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,-et • :• :- . s ou•become •'-ct to the workers'compensation provisions of do 3700 of the Labor Code,I shall forthwith
comply with these-provi '•- _ S.apy,/f
Applirig
�ISignat rue - Date: / /LI
. .. AILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licens:: on.: • s. hapter 9(commencing with Section 7000)of Division 3 of the Business fe ions Code,and my license is in full
force and effect.Lic.# ! .� _ Class# t
Contractor's Signature: _% Date: - c7
_/S - _ n
CO . -UCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a 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 en 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.).
O 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.).
O l am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date: _
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes 0 No
(Section 25505 of the 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 0 No
(Section 25533 of the Califomia 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? Li Yes Li No
(Section 65850.2 of the California Govemment Code requires that the requested Information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If ryes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,end authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
--
�--m-- ..--"Te Of a ne
A •I Authorized Applican Date
CODE#. tNSPECTIQNTYPE ' - 2AIE INTRIALE CODE( INSPECTION TYPE 291E 1NTIDAL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical Q J T,/
1266 Pool Spa Final 208 Final Plumbing 8 15'o ., ZW
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 SAFETY DEPARTMENT
CERTIFICATION
As the undersigned, I am fully aware of the responsibilities as
amer builder. I hereby certify that the personnel listedsbelow,�J
who are presently performing work at /i't / 12'tA cter.LO i( (1,1
are employed by me. I will withhold Social Security deductions,
State and Federal income taxes. They are also covered by Workmen's
Compensation Insurance as prescribed by the State laws of California.
NAME & ADDRESS OCCUPATION
i&tvity ,te: c
Date ; L� / /976
Sigaed: 0 �J
Address: 1110 \
es 4a Al #44z
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
- CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT'NO. LOT NO. UNIT NO.
Project Address /1 0 I w 1\\ 6' IS P t (o (9 (O 1 2069 11 /13/84 5.00 TL
TYPE OF CONSTRUCTION LI NEW LJ ADD ❑ ALTERATION N REPAIR
Applicant's Mailing Address 7ft-h`i ^e..„ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
Owner's Name 17 ptIS1C 4e' L PhoneS'l& - hi'I A.P.# Zone
DESCRIPTION OF WORK/USE OF BLDG. •
Address 1 6 0 1 IAD 1'11 1 1'. 0 Z IC S Main Building: Accessory Building:
Z
Arch/Eng. 'License No. TYPE OF PERMIT El GRADING FOUNDATION ❑ STRUCTURAL T Front O
❑ TENANT ❑ ELECTRICAL I�PLUMBING ❑ MECHANICAL B N
Address D Rear _
sP Contractor's Name j"s-
I 1 L1� Ill^-A Phone 646'4441 ❑ 'OTHER C Right N
r MD ,' PROJECT DESCRIPTION SQ. FT. OCCUPANCY K g
G
'— Address(mailing) CONSTRUCTION TYPE VALUATION $ S Left •
( City License No. I 0 q 3 ZONE . GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided' - - E
a LICENSED CONTRACTOR DECLARATION O
---- I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: • Planning Notes: •- M
with section 7000) of Division 3 of the Business and Professions Code, and T
my license is in full fore nd effect. - • S.
Licenie Class G -3 L dense No?- L
Date /" ) 5 -81 Signator. AMF,MIP L . ' , PLUMBING FEES
IN
WORKERS'COMPENSATION DECLARATION 1 Bar Sink • Showers
hereby affirm that I have a certificate of consent to self-in ure or a certificate ELECTRICAL : FEES
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
� Automatic Washer Transformer ❑ 15-50 KW
3800,-Lab. C.�j -yam -
Policy No. ilp. (-hcaC Company NUl `Tr' St Backflow Irrigation Sewer Ca - 0 50+KW
Lis P Construction Pole Sub.
Certifiecopy is hereby furnished. •
Certifiedeg
copy is filed with the city 'Wing D" ton. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date 11 . Applican /Iv '
EXEMPTION FROM WORKERS'COMPENSATION DECL ATION Clarifiers Solar Collectors Dishwasher -Meter Dover 100 amps _ . '
(This section need not be completed if-the permit is for one h ndred ($100) or -
less). Dishwasher ' Solar Piping Dryers ❑Gas. ❑Electric Sub Panel
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 Drinking Fountains Solar Tank • - Fan
Workers' Compensation Laws of California. , - Motors❑0-1 HP ❑1%-8 -
.,Date Signature ' Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09.15 HP 016-15+
NOTICE: If,after making this declaration,you should become subject to the - - —
Workers' Compensation provisions of the Labor Code, you must forthwith 4 Floor Sinks ' Urinal - - - '
comply with such provisions or this permit shall be deemed revoked. Fixtures Microwave
CONSTRUCTION LENDING-AGENCY 1 Gas Service Outlets Water Closet Device Boxes •
'
I hereby affirm that there is a construction lending agency for the performance -/ L Z( Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range
Lender's Name - 9
Lender's Address - Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION •
-
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal ;Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays - Generator ❑O-5 KW❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - ,
the Contractor's License Law(Chapter 9(commencing with Section 7000) of - - ' -
Division 3 of the Business and Professions Code) or that he/she is exempt .
therefrom and the basis for the alleged exemption. Any violation of Section • , ,
7031.5 by any applicant for a permit subjects the applicant to a civil ' , _
•
penalty of not more than five hundred dollars ($500). 3
❑ I, as owner of the:property or my employees with wages as their sole Reinspection Fee i$15 Issue Fee $
compensation, will do the work, and the.structure is not intended or offered _ - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL . FEES
License Law does not apply to an owner of a property who builds or improves _ _
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ •
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By _ Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
prove for the purpose of sale). - ,
❑ I, as owner of the property, am exclusively contracting with licensed con- • Duct-Structural Refrigeration System Application Issued ByC2M43
Date 1 1
tractors to construct the project (Section 7044,Business and Professions Code: -
The Contractor's License Law does not apply to an owner of property who • Duct-Ventilating 0o-100,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con- -
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System D Multiple D System Repair/Alteration BUILDING PERMIT $ - SMIP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
❑ 1 am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers' PLUMBING $ ` 'ISSUANCE $
r a7
Date owner ' Heating System& Ducting , Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify.that I have read this application and state that the above 00-100,000 BTU 0100,000 BTL _ ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre-- PLAN CHECK 50% $ MICROFILM $
sentatives of this city o ent• upon t. ovey.-ntioned property for
inspection purpos-s TOTAL FEE $ J�"
w �lS.�. MECHANICAL $ CO
Signature ✓ i. Date t✓/ SI - /-
Drivers' License or Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
' CONSTRUCTION AND PLANNING PL._ & SPA
APPROVALS - Permit# - Date Inspector APPROVALS Permit# Date Inspector
•
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location •
• 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement
.3C Electrical Conduit Utility-Undrgrnd. 54. Forms •
4. EIectlical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough'Plumbing & Pressure Test
6..Electrical UF ER,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, 0 Undrgrnd.
10.',Structural Floor System ' 61. APPROVAL TO DECK
11. Property Sewer Line & House Connections 62. Backwash & Receptor-Final '
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains . • 64. Plumbing System - Final •
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66: Solar System-Final • •
16.,Rough Electric Wiring • 67. Fencing & Access Approval
17.-Rough Wiring Sign • 68. APPROVED FOR PLASTERING
18.,Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough'Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS. Permit# •
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank-D Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro •
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80: FOOD CERTIFICATE ISSUED
33. Final Electric Notes:,- mate ea. c.ca imit(/r
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test .4-II/;y/1t1 C-I0
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. Special Requirements Completed
49. Electric Release to Edison • ' - •
50-.Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY . -
No. Date •
I'II% fl\CL , ULU IS L)MIL
10B ADDRESS 1601 White Oak Street BUILDING PERMIT NO. 41064
N GENERAL CONTRACTOR Owner/Bl dr. DESCRIPTION of WORK Enlarge Bathrooms
J AP No.I 39-214-0B LOT TRACT FIRE ZONE VALUE $2,000.00
--.-.-
1 1CTIONS Sinature Dote TYPE V GROUP ZONE
R-1
sL.- 3" /i—�2^ SUBCONTRACTOR PE,RMITS ISSUED
GAS . .../.........a., Crel„a/ 3- n. Date I Number I Signature
WATER Plumbin
ROUGH PLUMBINGr-� f4-S 3-a, 7�Qw-x44 / �, /-/A-t 6,8/6 Q_-
LJ
PROP. SWR. LINE HOUSE CON. ❑ ��'��_��_''�''
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER 0 yy yy
ROUGH WIRING m `..i y"+y74 Heating and Vent.
TRENCHES 0 FORMS 0 STEEL REINF. 6.1/ %.-. 3 - y• 6
FLOOR SYSTEM
BOND BEAM [l STEEL REINFORCE in
SHEATHING 3 .• .a-j'2-4
FRAME AND FLASHING <3 '26
LATHING — IN Fri OUT f -Lf —.Zi%2
PLASTER. BROWN COAT o— r' b
ST"'ICTURAL, FINAL Electri y
I NG, VENT., REFRIG. AND A.C.. FINAL Pi-
O'trvi.e(•/ J-fid' • /I aisyy
PLUMBING, FINAL AND GAS TEST E_�______________ `i !' -_
ELECTRIC, FINAL N,, lfr•)-C ,
BUILDING. FINAL N 7 1F 7C.
I
. ,r : . g 1064 /AN 1?-76PAID00 287* ****30.50
A • f.Mc
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
REC IV D BY DATE RECEIVED DATE/ IIISS�SSUED
ADDRESS ILO I w14 17e OAK COCA. MI'S BUILDING /— �'��p ` "'•}'ter �e
OWNER bORI ]''1MAIL M I♦ I-1 Pie(._ A.P. NO.l3r�—ZtI4'— 08///���PFfifl/ 000/
ADDRESSySIIVOI me-ski
ITe /iO�t4 1/s�/j_it ADIDRIESSI DS f, h, rye SrC2
CITYCOS/A C'4 NOYp' 7 TRACTt "`�^^`���111"'ttt LOT`I,(J`2.!^BLOCK
CONSTRUCTION C Y NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER ) ,
BRANCH xe• , /
OWNER (12 i
ADDRESS I /
_ VALUE It
ARCHITECT KAP A ye TEL. USE , ( . - •$ f
OR ENGINEER V�/ NO
FIRE
ADDRESS ZONE / rT P GROUP r*( 7�
//J APPROVED /� /r ll�—/�
CONTRACTOR / BV DATE
ADDRESS .s1�,s1��� ��++
TEL. ZflLtp PLANS USE OF NEW fej�7 / .�D'-1
CITY NO. I< 1 PLANS C__ BUILDINC�I E.aac�1•1
F' STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
LLI SIZE NO.OF BLDGS. (FROM C/L,s�STREET)'
u. OF LOT NOW ON LOT / FRONTA/A FT. FT.
'CUSE OF
p
US EXISTING BLDG. p es / /,CAJC ' R,SIDE t, FT. FT.
cn
IE—.
Separate permits are required for L.SIDE10 FT. FT.
electric,plumbing and heating work. 33 f r
G REAR FT. FT.
I • USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET. BET.MAIN&
GMAIN BLDGS. ACCESS. BLOCS.
`�� d, VAR.vis DATE
R E5 Lp&NC if — /•tnwA Sl n 4/ CJs+ C.U.P. APPROVED
ut
UA APPROVEy,/t•/t.'y/��sj '�' _�
.}..l
IY V BATH I? D O M -1 BY lam/" �/ DATE
14
0 I hereby acknowledge that I have read this application and state N.
Ln
CC that the above information is correct and agree to comply with m
A. all laws regulating building construction, and I shall not employ
Z any person in violation of the workmen's compensation laws of F.
S ILI the State of California. m
3 I hereby certify that I am properly licensed as a contractor under SQ. FT. 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 era In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: —
us
am exempt from the provisions of the State of California BusinessVA ATION Owe PERMIT FEE $ ^ e
and Professions Code, Division 3,Chapter 9. .. sZ('f 8....40 Jt
0 0 m
_� PLAN CHECK $ ` �� 'n
Signature of �/ / Q o
Permittee !/ r✓t- le-e S //j:" TAX y
U.
So 6
D
Authorized Agent TOTAL PAID S 39sift)
10064 AUG 7 1959
COSTA MESA BUILDING-SAFETY DEPARTMENT -. it • , nr 1-.:D
P.O.BOX 317 COSTA MESA. CALIFORNIA `
FOR APPLICANT TO TILL /N COMPLETELY APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING 1601 White Oak St.
ADDRESS
COSTA MESA, CALIFORNIA TOR OFFICE USE ONLY
Land
I RECEIPT NO. I �`-' F(1B�
OWNER Rosslane Land Co. `U'
ADDRESSILRECEIVED BY--AT- .DATE RECEIVED ATE ISSUED
419 E. 17th St. I -�7I AUu J�9
CITY Costa Mesa TNo Jgu59 BUILDING0 ppp �� //-tee
ADDRESS /CO o/ fU L __ // .•��
AR' .ECT Carlson & LIC. • COSTA MESA• CALIFORNIA
OR INEER NO.
• FIRE
ADDRESS Garden Grove ZONE TYPE .11 - GROUP / 1%9—,n
^\
Dike & Colegrove, Inc.STATE 167293 APPROVED
CONTRACTOR LIC.NO. BY DATE
ADDRESS 419 E. 17th St., Costa MesapZONING
LEGAL r� 2822 ZONE NO.OF USE OF NEW j��� �
DESCRIPTION (NO. 19L. I BLOCK 1 I TRACT _ ,/ I PLANS//�� I BUILDING IJ // —`-^
A.P.NO. _ BYAPPROVED / yam)
DATE !� /.6 /j
SIZE 67! x 951 I NO.OF BLDG80ne YARDS 4 EVES
OF LOT rvow. ory LOTH _ REQUIRED ALLOWED
USE OF (CENTER LINE ST.)
EXISTING BLDG. FRONT CV FT. IN. -
SETBACK LINE FROM
CENTER OF STREET 501 REAR YARD 331 R.SIDE ,!ll_
FT. IN.
SIDE YARD I LEFT 101 I RIGHT 61 L.SIDE FT. IN.
DESCRIPTION OF WORK - REAR c120• 4i FT. IN.
NE I X II ALTERATION I II ADDITION •
REPAIR I II MOVING I I DEMOLISH I
SIZE
BUILDING 1601 NO.OF
ROOMS 6 STORIES 1
EXTERIOR WALL ,_ ROOF
COVERING SUCOO (COVERING Rock .
USE OF BUILDING AND WORK TO BE PERFORMED
Sinele family residence with
attached garage.
Plan 750BR
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM-
' PLY WITH ALL CITY ORDINANCES AND ST: WS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRU TIOVALUATION
SIGNATURE OF ` '/ PERMIT FEE $ 35.00
PERMITTEE -Ard A . . t—
lar $ 15,928 PLAN CHECK $ 17.50
Dike & Colegrove, Inc.
AUTHORIZED AGENT
TOTAL FEE $ 52.50
OWNER SOUKUP, Kenneth DATE 2-27-62
JOB ADDRESS 1601 White Oak BUILDING PERMIT NO. 16)493
GENERAL CONTRACTOR Frank C. Palmer VALUE $ 190.00
AP No. 113-5911-08 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Block Wall
INSPECTIONS Signature DATE GROUP B1kWa11rYPE ZONE R-1
G+„ ISSUED
SUBCONTRACTOR DAT�R� II'PSNUMBER
Water
Rough Corn. Refrig. 0 Air Cond. 0
Rough Heating
Rough Plumbing
Miscellaneous
Prop.Swr.Line 0 House Con. ❑ St.Swr. 0
Sprinkling System
onion Pole
Underground 0 Power D
Rough Wiring
Trenches IW Forms ❑ Steel Reinf'll] OWE* ,,-yg�Gle-
Floor System Oft'
Bond Beam ❑ Steel Reinforce S �'Q1 34—c-2
SheathingSheathing :!
Frame and Flashing
Lathing — In 0 Out 0
Plaster, brown coat
. 0 Air Cond. ❑ Final
Final
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final
Building, Final r P1 73-1-‘2.
OCCUPANCY
rnpM PIIG.SM _ 1.Rl i Mfg{
I8493 FES RECEIVED
�'' FEB 271962
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 917 COSTA.MESA. CALIFORNIA
• CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT
/ -/ ) �(�J aj� /,/p) `f /yam r c BUILDING
ADDRESS �(L C � 1 (,/n t�/�L _ C/ /f. ' I-lnl)YU
COSTA MESA. CALIFORNIA ----
I
`VVV""""' For Office Use Only
T NO.
OWNER t�Jnh , . Q RECEIPT NO. I/ pE�l9e
^ y L EO /p O
MAIL / 1/l l � ' - I CJ.i(L RE Dp ST I��7/ &Ec I�f?7/�it
ADDRESS
01.040.-,
/fir i,,� 3l �qr /n /, jjj //�/j
CITY( '11d ty / /L KL NO�IAs (/ ADDRESS/(/`•i /, U'a- -
AR' ECT TEL. COSTA MESA. CALIFORNIA .
OR INEER NO.
FIRE
ADDRESS ; ZONE TYPE CARO .
i 1
CONTRACTO- ) „CL./ I 0
/ , ( Did APPROVED
BY DATE
ADDRESS /5$q y mx'wcn> . ZONING �)�
�/� ' ZONE NO.OP JJ USE OF NEW aiOCKwa(
CITY /fitQyµi 11QQ r7 R�' 1 PLANS L� , BUILDING p
LIC.TNO. a O�O� 6 9 TNO. Ls- (�S� DESCRIPTION L Ot i 9L 7-Al Z V 2 z
SIZE I NO. OF BLOCS. y C
OF LOT NOW ON LOT A.P. NO // 3 -� S -� S o
USE OF YARDS EVES
EXISTING BLDG -_ _ APPROVED ALLOWED
SETBACK LINO FROM (CENTER LINE ST.) on ��� O4N
FRONT
•
CENTER OF STREET REAR YARD / FT.
SIDE YARD I LEFT I RIGHT R.SIDE FT. IN.
DESCRIPTION OF WORK
L.SIDE 0 FT. N.
II
NE I ALTERATION I II ADDITION I REAR FT. IN. -
REPAIR I II MOVING I II DEMOLISH I BYPROVEDi /'l 0' +✓(1�M� DATE 2/L7 4 .
BUILDING NO. OF � Y
SIZE ROOMS STORIES
EXTERIOR WALL I ROOF
COVERING COVERING
USESEOF BUILDINGl(DAND� �( WORK TO BE PERFORMED )A ��
57;71.- . �! L r.l. ZY.CA-- ,i AT^I - 7Ce \
, r / /
se
•
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. 1.1 VALUATION .,
aQ
SIGNATURE OP \\ NNNMkJ PERMIT FEE $
PERMRTEF
,'1
$ /y(/. PLAN CHECK $ i^
AUTHORIZED AGENT / e-0
E
TOTAL FEE