HomeMy WebLinkAbout3186 MADEIRA AVE - Building Permitsr� � • - ; � y�: .
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CITY OF COSTA MESA
t �pMFq BIIILDING DIVISION �
i , . � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ra.us
� FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER; M09-00057
PERMIT TYPE MECH
APN: 13913201
JOB ADDRESS: 3186 MADEIRA AV CM
Vicinity: SIDE SFD -
SQ. FT: 0
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
0 711 4/2 0 0 9
BJK
SCOPE OF WORK: CHANG�-OUT OF A FAU W ITH THE ADDITION OF A/C AT AN EXISTING SFD. 1 FAU < 100K BTU, 1
CONDENSER UP TO 3 HP
OWNER: KEMP, EDLETRAUT � - Address:
PHONE: . � - City/State/Zip:
APPLICAN7: DE ANGELIS, MA7T Address:
PHONE: 949-521-3226 City/Stale/zZip:
CONTRACTOR: A C XPERTS HEATING AND AIR CONDITIONING
Address: 19185 ECHO PASS ROADUnit: � �
City/State: TRABUCO CANYON, CA ZipCode: 92679
MECHANICAL PERM17 FEE SUMMARY
MECH ITEM FEE: � $53.00
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: . $0.00
TOTAL FEES: $53.00
3186 MADEIRA AV Unit:
COSTA MESA, CA
19185 ECHO PASS ROAD �Unit:
TRABUCO CANYON, CA
License No. 915801
PHONE: 949-521-3226
-� CELL: 949-709-4849 OFFICE
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1. 12-21-g2)
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 fnal approval will result in the expiration of this permit.
GOOE 0. INSPEC710NTYiE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
DRTE INTITIALS CO�E� INSPEGTIONTVPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 FinalBuiidinglOccupancy
�ATE IN77i1R15
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WORKERS' COMPENSATION DECLARATION:
I hereby affirm untler penalry ot perjury one of �he following declarations:
❑ I have and will maintain a certificate o( cOnsent to self-Insure for workers'
compensacion, as provided tor by section 3700 of Ihe Labor Code, tor the
pedormance of the work for which this permit is issued.
❑ I have and will maintain workers' compensa�ion insurance, as required by
section 3700 of the Labor Code, for the peAormance of the work fw which this
permit is issued. My wnrkers' compensation Insurance carrier and policy
number are:
Carrier.
(This sectwr neea not De wmdetetl A lne permn is vaWetl et one nvnaietl tlollars (SIDO) w IessJ
Polic umDer:
� I ceAi(y t�at in the pertortnance o( Ne ��k lor which ihis permit is
issued, I shall not employ any person in any n�anner so as to become subject
to the workers' compensation laws of Califomia, and agree thal if 1 should
become subjecl to Ihe workers' compensation provisions of Secfion 3700 0(
the Labor Code, I shall lorthwith comply with tdese provision
� 7� � 7 � -�
Applica/�i s naWre ' 9
WARNING: FAILURE O SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(3100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE IABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION;
I hereby aHirm lhat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Busin�ss and Professions Code, ana
my license is in full force and eflect. ,/,
�lic..# �/ai�� Class #� L � `Z/
J � `
cad ignaWre ,D e�
CONSTRUCTION LENDING A .
❑ I hereby a(fum Ihat there is a constNctbn lending agency fw the
per(ormance of Ihe work for wfiich this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Date
OWNER-BUILDER DECLARATIONS:
I hereby affirm ihat under penalry of perjury ihat I am E%EMPT FROM THE
CONTRAC70RS LICENSE LAW for the f0��owing reason (Sec. 7037.5.
Business and Professions Code: Any city or couniy which requires a permit to
construct, alter, improve, tlemolish, or repair any sVucNre, prior to its
issuance, also requires the applicaN for such permit to fle a signed statement
lhat he or She is licen5ed pursUant to lhe provi5i0ns of lhe COnlrector5
License Law (Chapter 9(commencing with Section 7000) o( Division 3 of the
Business antl Professions Coae) or t�at he or she is ezempt there(rom and
the basis for the allegetl exemption. Any viola�ion of Section 7031.5 by any
applicant tor a permit subjects the applicant to a civil penalty of not more than
fve hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and tpe structure is not intended or
oRered (or sale (Sec. 7044, Business antl Professions Code: The Contractors
License Law tloes 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 ovm
employees, provided that such improvements are not intended or oftered tor
sale. If, however, the building or improvement is sold within one year of
completion, the ovmer-builtler will have the bUrden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUS�VELY CON7RACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl
Professbns Code: The contractors License Law dces not apply to an owner of
pmpetly who builds or improves Ihereon, and vMo con[racts (or such project with
a contractor(s) license pursuant to the Contractors Ucense Lavrs.).
❑ I am exempt under sec.
Business and Professions Code for Ihis reason:
Sgnawre
JOS]-<6(3I0'!)
� , , 1
,
� Owner ID verifed by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Venfication of Ownership by (type of tlocument, i.e. - propeny taa bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I �ereby certdy that no excavation frve (5) or more (eet in depth into wfiich a
person is requiretl to descend, will De made in connection with v.ork authonzetl
by ihis pertnit, and that no building strucWre, scaHdtling, falsewvrk, or demolition
or dismantling thereof, will be more than Ihitly-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title B, Califomia Adminisl2tive Code).
❑ As owner-builder, I will not employ anyone to tlo vrork which would
require a permit from the Division o( Intlustrial Salety, as no�ed above, unless
such person has a permit lo do such work from Ihe division.
Aoolicanl's SignaWre oale
Division of Industrial Safety Permit Numbec
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant neetl to fle and
certify a Business Plan (or emergency response to release or threatenetl
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Salety Code requires, with some
exceptions, that a Business Plan be filetl with the Costa Mesa Fire
Department by every business which has at any one time during a repoRetl
year a quantity of hazardous materials equal to or greater than a weight o(
500 pounds, or a volume of 55 gallons, or 200 cubic feet o! compressed gas
at s[andard temperaWre antl pressure).
2. Does or will the applicant or present or future building occupant neetl [o file
a registration form (or acutely hazardous materials? ❑ Yes ❑ No
(Sec�ion 25533 of the Califomia Health and Sale[y Code, with some
exceptions, requires registration with ihe Costa Mesa Fire Deparlment by
each business which at any one time has on hantl a quantity of aculely
hazardous materials equal to or greater than a weight of 500 pounds. or a
volume ot 55 gallons, or 2Q0 cuhic teel of compressetl gas at standard
remperature and pressure).
3. Does or will the applicant or preseN or tuture building occupant need ro
prepare an RMPP (Risk Management antl Prevention Program (or acutely
hazardous matenals)? � Ves ❑ No
(Section 25534 of the Califomia Health and Safery Cotle provides that the
Costa Mesa Fire Depariment may require the preparation, certifiwtion antl
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazartlous materials with the Fire Department.
4. If an RMPP is presently require4 has Seclion 25534 of the Califomia
Health and Safety Code been (ully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuNre builtling occupanl require for
the work which is lhe subject of Ihis application a permit for such construction
or modifcation from the South Coast Air Qualiry Management Districl or fmm
any other air pollution control district or agency? ❑ Ves ❑ No
(Section 65850.2 of the Califomia Govemment Cotle requires that ihe requestetl
infortnation be fumishetl on applications (a non-residential building pertnits).
6. Will any patl of the laciliry to be constructed untler Ihis permi� be within
1000 (eet from the outer bountlaries of a school? ❑ Yes ❑ No
Qf'yes", the facilily must meet the requirement of Sections 25534 and 42303
of the Califomia Health and Safery Code).
7. If a permit from the South Coast Air Quality Management DisMct or oiher
air polWtion control disMct or agency is required for ihe vrork which is the
subjecl of this application, have all of ihe disclosures prescribed by California
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
S. (If yes", attach certifcate of wmpliance fmm Ihe appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
informalion given above is conect. I agree to comply with all state laws antl
city ordinances regartling Hazardous Materials antl Emissions.
Signawre
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have reatl this application antl s[a[e ihat
the information given is correcL I a9ree to comply with all state laws and city
ordinances relating to building consWction, antl authorize representatives of
the City o! Costa Mesa to enrer upon the above-described O�oPerty for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by Ihis permit until fnal inspection.
SiBnalure o1 Lep�l s ale
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••"•�^ llOWNS Ms'. •& Mz's. B.
JOBADDRESS 3186 Madiera Aveni
� GENERAL CONTRACTOR Blue Ribbo�
AP No1 -1 2-Ol LOT 1 T
IN 'CTIONS '
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ROUGN PLUMBING
PROP. SWR. LINE [] MOUSE CON.
SPRINKLING SYSTEM
MISCEILANE0U5
ROUGH HEATING AND rIIN CONDITIONING
TEMPORRHY SEPVICE OP POLE
UNOERGROUNO � POWEA �
ROUGN WIRING
TRENCNES FORMS STEEL REINF.
FLOOR SVSTEM
BONO BEAM STEEI REINFORCE
SHEATHING
FRRME RN� FLASHING I�
LRTHING — IN OUT
PLASTER. BROWN COPT
STRUCTURAL, FINAL
HEI" ', VENT., REFRIG. AND A.C., FINRL
PLL IG, FIN/l r1N0 GAS TEST
ELECTRIC, FINAL
BUILDING. FINAL
cocriei ocnuiocucurc
vA i � ].2-b-
BUILDiNG PERMIT N
SUBGONTRACTOR
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COSTA MESA BUILDING-SAFETV DEPAHTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant ro Fill in Completely
BUILOING �/!). �iAA. J., il�ir
O W N E R /��' �„"/NS � 2S
ADDflESS .�/�O � /v/iijYJ �C
CITv [ /�4.,yT� /���/f'
BRANCH
ARCHITECT
OR ENGINEER
ADDRESS
CONTRACTOF
ADDRESS �L
CITY S
$TATE �
LIC. NO.
SIZE
OF LOT
VSE Of
EXISTING BIDG.
512E Of
NEVJ BLDG.
EXTERIOR WAII
COVERING '
VSE OF BUIIDING AND WORK TO 8E PERFORMED
Tidr� � �e-Tl
TEI.
No. 7bl-
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LIC. NO.
NO.OF Bl
NOW ON �OT
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PP C TION FOR BUILDING PERMIT
PE V D �E}�I R D T�1�5 ED
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A.P. NO. �:J �c� —�
ADDRIES�I� /��� �e •
TRACT �� LOT � BLOCK
W P
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OWNE r /�/ S • � • � /
V LUE
S 00/1� %g $
FIRE I I I /� T
VARDS APPROVED
MAIN BUILDING
FROM C/L STBEET),-
VAR. �F'+
E OF NEW
ILDING�Od� �n
VARDSAPPROVE�
FT.
BEf. MAIN &
ACCE�. BLOGS.
DATE
APPROVED
...__ %_i i - ��
I hereby acknowletlge [ha[ I have reatl this ap0�ication antl sta�a
that the abova informetion is corract antl apree to eomply wI[h
ell laws .aa�iau�a builtlin8 �onstr�ttion, entl I shnll no[ employ /1
eny parson in viola[lon of tha workmen's compenselion lawa ot ✓
the State of Celifornie. � m
e
I hereby certity Nat I am properly licensatl as a convactor untler ZS Q. FT. o
the State of California Busina ntl P�ofe ions Co Dlvlsicn 3, THE AMOUNT SHOWN UNDER VAIUATION �S FOR
Chapter 9, end thot s�ch ' ens ere in II forc on effac[, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m
am enempt irom U e p visi s of tha ta of C' omlo Buslae ¢
antl Professions Cnua �'' ion 3, C i 9. � VALUATION y
PERMIT FEE $ �
7
Slg^otura of . / . �%� ��Q� � ✓ m
Permli[ee 0�� r 5��y//a P�qN CHECK $ E
� V V � Z Q
Authorizetl ABent LL
TOTAL FEE $
OWNER LINCOLDI SAVINGS & LOAAI „
sa
INSPECTIONS ��_i?./.J I DATE
^�
OCCUPANCY
SUBCONTRACTOR
DATE 7-2%-EO
Form 210—SM-11-59 S-B P . 12>C3Z
. 2
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COBTA MEBA. GALIFORNIA
For Appiieanf fo fill In Completely
TYPE OR PRINT
BUIIDING /
ADORE69 �O
COS7A MESA. CALIFORNIA
� MAIL
� SIZE
■ BeTBACK LINe PROM
TEL. �/ nD� �.
NO. 7
Cy'l. I I NO. OF BLDGB.
DESCRIPTION OF WORK
BUILOING
81ZE
CXTERIOR WALL
WORK TO BE
FEE RECEIIIED
��JUI 1 � i96�
FINANCE DEPT.
APPLICATIOZy7QQ$FP�B4���[ MESA
BUILDING
For Office Use Only
flECE1PT NO. PgRMIT j{O.
COSTA MESA. CALIFORNIA
FIRE //
ZONE TYPE
BYPROVED C� �A
� NING
ZONEn 1 NO.OF �911{9�E} �O�P!
—� � f I PLAN9 � �i-�'• w.
LecAL � //���T
DBBGRIPTION �
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A. P. NO. �,71T_�.{1��G1
YARDS EVES
APPROVED ALLOWI
(CENTHR LINE BTJ
FRONT /�SFT.
R GII']� �FT
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P/L �N I •
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I HERBBY ACKNOWLEPOB THAT I NAV6 READ THI9 MPLIGTION THg AMOUNT BHOWN UNOER VALUATION IB FOR TH!
AND BTATE THAT TH6 �BOV6 �8 CORRECi AND AGflEE TO COM-
PUliP08E OP E8TAB418HING A PBRMIT FEH ONLY.
PLY WITH ALL CITY O��NANC89 AND 8TI1TH LAWB PeOYLATINO
BUII.DINO CONBTRUC'f�0 VALUATION Q �
81GNATURE OF
PERMIT FEE $ pi��
PERMITfE )/ Y
' S/�/ �/(O/ PLAN CHECK S V' —
AIITHORIZED AGENY TOTAL FEE � / ��
. COSTA MESA BUILDING-SAFETY DEPAHTMENT
P.O. BOX 1200
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Coata Mesa, Calitornia
. �.�.. ,.�� -5-77�aro00 169 �*�,ra;:7 GG
� � � � I I � I PERMIT NO.
/,,/ TRACT N0. REC'D BV_r ^ � �]���
Con[rec[o , /% i/� �j 7) /YIJ" LOT N0. J
Add�C55 (& SU Ck�NTRRL 4�19�f?l BUILDINGVSE ATEISSUE�
c��v i� h.f� r� r��: 7�va-9 9 9 &S -�
$[e[e Litense No� a 1 d� C1855.1. �� �! BUILOING �
City Licenu No. � p ` �DDnEss ���/p � f{Q �� / e-
N0. ITEM EACM FEES COST� MESA, CALIFONNI� �l�
NEAREST � ��J
FAU, Wall, or Grav. Cno55 si.
Furn. Incl. Ductsand � �� u`h k '� 'J\"�� s�'�
, VBnlS OWNER � � vylN
to 100 000 BTU �
MAIL 7 (�/ �� � �q
•DORE55 �,7 /Op �'���� �'\ � �
over 100,000 BTU �('�
CITV ' �� Y TEL. N0. '/ '/<'
Vent (if not incl. abovel �d �.l'� C;LS I� S —7 7 Q
(1 �Y
t hereby aclinowledge [het 1 have rend this applicetion
Sus ended Heater v • �.
and state�that the above is correct and agree to comply
Alter or Replace � ��.
A liance �w�th u1lyCity Ordinnnces and State Lows regulating Hena
PP
ver eet o �� (�ng; Ventiiating, Re(rigcration end AirvConditioning.
9es piping •L
BOILERS OR � :' I certify that 1 possess the ebove valid Sta[e o( Calit-
COMPFiESSORS '� .� omia classification or 1 am the Icgal owner of the single
'� j\ � family residcntial property describcd above.
3 H.P. or less 'Y
Over 3 H.P. to `\ Signaturc of
15 H.P. �� 1�� Pe(mi«te 9
Veni Fan—Sin le Duct,
(�'��( y-' R ARKS:
Ventilating,Hood
,-. � .o � ')'�)
�
M isc?\.
b'
APPROVRLS INSPECTOR OATE
Ducts Underground
Ducts in Stmcture
Ducts Vmtilating
Heating — Rough
Hoods
Refrigeration Lines
Pressure Tcst
Air-Cond. Final
Ventilating Final
Sub-Total Heating Final � r- i-
Permit Fee 3 �� Refrigcration Final
Final Gas Test
TOTAL FEES , D O
Utiliry Co. Notified
•���•�,: BLDG. PERMIT NO.