HomeMy WebLinkAbout3062 MADISON AVE - Building Permits jTilSl r �C74Y OF COSTA MESA
4
BUILDING DIVISION
q-Vq- • DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER
1. 1
i PERMIT
IP
606-00142
4.1.
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.9I, tLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 3062 MADISON AV Status: ISSUED
Suite: Applied: 01/31/2006
Vicinity: ROOF Issued: 01/31/2006
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number 14159315 Zoning: R1
Applicant: CHURCHILL CTION
Address: 4425 FOREST GLEN RD
Phone: 714-974-0456 ISSUED
ANAHEIM,CA Zip: 92807
Owner: SUGIYAMA, HITOSHI
Address 3062 MADISON AVE
Phone:
COSTA MESA,CA Zip: 92626
Contractor CHURCHILL CONTRUCTION
Address: 4425 FOREST GLEN RD
Phone: 714-974-0456
ANAHEIM,CA
Zip: 92807 License: 660990
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: .License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF.INSTALL 1 LAYER 30#FELT,30 YEAR COMPOSITION SHINGLES,AND REPAIR/REPLACE SHEETING AS NEEDED.
30 SQUARES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $7,420.00
Permit: $153.25 Claim Valuation: $7,420.00
SMIP Res: $0.74
SMIP Corn: $0.00 .
Other $0.00
Inspection: $0.00
Total: $153.99
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)
WORKERS'COMPENSATION DECLARATION: ' 1
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
wo f•or which this permit is issued.
I hav 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.
y ., rs'cc pensation Insur ce carrier and policy number are:A - �u Policy Number.;: 3 T S/ g3
ti _CTh s:section'ne'ed not be completed if the permit is valued at one hundred dollars($100)or less.) -
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwIth
comply with these•roov+issi
hp, ions.
wta)Signaiure iF 'e .;:.. Date s. E / —3 /-0 6
WARNING 466E1'0 SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT ANE C PLOYER-TOCRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
-111:-AND DCC ARE($100,(x10),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTTi X3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
1 h b affirm that I am.11icensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of a Business and Professions Code,and my license is in full
orce end effect.Lic.N -(c"040 g/91 O ClassM' Q
Contractor's r Date:_ / -3/-OL
,____
—
CONSTRUCTION LENDING AGENCY:
O 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 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 sate.). •
❑ 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 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes ❑No Driver's 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 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:
I 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 De tiled 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? ❑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? DI Yes U 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 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 ❑No
a (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
/ Si_gnome Of Le I Owner( /-3 G ate
arAildiet` /(/ze Ap�ilrCantlt� /k Date ... .=�i"is+r
�
goes INSPECTION TYPE U gAI E INTmALSCODEN INSPECTION TYPE PAIS INTmALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
•
200 Final Re-Roof S \ Ur 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
PROJECT ADDRESS: 3062 MADISON AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 048343
OWNER'S NAME: SUGIRAMA
ADDRESS: 3062 MADISON AV PERMIT NO: P 048343 PLAN CHECK NO: N GOVT: N SUPP : N
COSTA MESA
CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE; PLU PURPOSE: OTH
(714 ) 530-2440
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL 40 GAL . WATER HEATER SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /
PERMITTEE: A—AMES PLUMBING 6 HEATING ( 714 ) 530-2440
ADDRESS: 10422 TRASK AVENUE COMMENTS: *
GARDEN GROVE CA 92642 ****************+e***************+F***+e*******aE**********+F***********************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect. SETBACKS
max.: 006664 sun uc.:250307 CUSS: C-36
Date: 7—.7/• el Q4 Signature:` 4,ec_ s ( MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DFr,C�LA)RAnci 9u Wept
InrLeeo�ereM affirm that��l have acertifraU of consent to self-insure oracertiTrcLEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
ate of workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation lgswance,gtAMPANcetlieyt(Section 3800,Lab. 3/01 /91
PCT
OY: NATCON
IONWIDE PARKING REQ: PROV: PARCEL: 14159315 ZNE: REF NO:
—3 Certified copy is hereby furnished. IN Certified copy is filed with the city Building Division. PLANNING NOTES>
�7 ( >
E"
Date: 3 I— 4 0 14pplicant 7 ,a . .� *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Ibis section need
not be completed it the permit is for one hundred($100)or less). DEVELOPMENT SERVICESREQUIREMENTS
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. ZONING APPROVED BY DATE: •
Date: Signature' BUILDING APPROVED BY : 4 DATE:
NOTICE:II.after nuking this declaration.you should become subject to the Workers'Compensation provisions of the Labor
Code,you must forthwith comply with such provisions Or Urs permit shall be deemed revoked. ( c'
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: \ _ DATE: -1 --Ito,
which this permit is issued(Section 3097,Ch.C). ******************************************************************** *** ****
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: My shy of county which requires a permit to construct,alter,Improve,demolish,or PERMIT 2 . 00
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 2 5% SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business P LAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 3 . 00
I, as owner o1 the property or my emplogees with ova7es as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors State License Law TOTALS--——> 2 . 00 3 . 00 0 . 00 $ .00 5 . 00 , QQ
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 empblm,provided that such improvements are not Mended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 5 . 00 OVER/SHORT• . 00
improvement is sold within one year of completion,the owner will nave the burden of proving tre/she did not build or improve for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 5 . 00
❑ and Professions Code: The Contractors'State License Law does not apply loan owner of property who builds or Improves thereon
and who contracts for such projects with a contractor(s)License pursuant to the Contractors'Stale License Law).l am aware *******************************************************************************
that proof of their Workers Compensation insurance should be provided to me. IND IVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.S P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner; PLU 1 WATER HEATER AND/OR VENT 2 . 00 2 . 00
I do hereby certify that I am aware of and understand the requirements of Cabtomia Health and Safety Code Sections 25505,25533.and END OF FEES
25531 and that I or any future building occupant wilt/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby certify that I have read this application and state that the above Information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes. ��i
�`3 /-1 0 ( signature:—�L��•�•L _� 01 00066551-00066551 TOT 3.UJ
date: P DATE: 07/31/90 TINE: 14:21
Driver's License or Social Security It:
1641-48 White—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—A.co.ear ,
CONSTRUCTION AND PLANNING - POO. SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole s - 52. Pool & Equipment Location
-2 Soil Pipe-Undrgrnd:, - 3`-
r.
,.. 53. Steel Reinforcement
ElectricaI Conduit;U;ility-Undrgrnd?-7 54. Forms
'4-Electrical CondJit-Undrgrnd.. 7,,„t, 55. Electrical Bonding
-*Sr-Steel'Reinforcetnee-ri: ,r, 56. Rough Plumbing & Pressure Test
6:1Elect ical UFER:Grnd. 57. APPROVAL TO COVER-GUNITE v
7.tootings -.< - 58. Electrical Conduit-Undrgrnd. _
82 Foundation --r , 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undigi-nd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
-
10. Structural Flopi System 61. APPROVAL TO DECK
11. Property Sewec.Lirie:& House Connection 62. Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final
13, Roof Drains .- 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric:Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19, Rough Heating &Air Conditioning ,� FIR DEPT. REQUIREMENT
20:�Ro-. Factory Fireplace z t x c •-..:4 -
-, . .; ,
; . ,-:- ALS:.+- -Perm t # ^
21:Ducts, irc5elStrticti.lr^yer " " H ^ K '70. Old erg'ro}ind Hydro y
. 22-Ducts, VJenti1etirgt .u. ic p C 0 :',c C71. ProductrPtping OGas DOil
23 yGasPiperRough & Test rs.,,r, iin , M x < 5* x ^72. Underground Flt
cr.
24. Roof Framing x `'' r,, "• j w - V. -73j.Undergrnd.Storage:ank O Gas ❑Oil
- r
25._Roof Sheathing c < V ' '" ri 7 . 7490verhead Hydroc.i, 4
26.- T-Bir Ceiling (Structural) &'Nlonocoat : .0 y K . 75-.Dry Chemical :.j .. _ <
27:-Frame and Flashing. c:^ _ " -' -s =t+• * 76. DryStandIpe c.` - " ' .a
c r
--,r”n T% >,* .- .. r(.-I • 1. C .J 1.
x,"28. Lathing& t. rn -�.�'; ^ .-,� ICy�_•
'
Siding r x .ti. 77:; FIXED SYSTENtX;INAL• :� r. ral
_29. Insulatioli • SX '. "Lt. 78 FIRE PREV. FINAL 1. > ..---- p`,
C r , .. f r K -. rr
r.30. DrywalhNailing ..A „, > F. r Do.v o HEALTI--DEPTf;REQUIREMENT
a
L31. Plaster B•rown•Coati. S y'r v > -'79.-FINAL I4 ECTI N r :, , .1
32cElectrica! Power Meter-Fjnal, .• I. �
„ 80,400D CERTIFICATE ISSLL•ED ... ^
5.33 Finai Electric x R7 < ' Notes: "7 'i•"' 4` "a 0
34 Final Heating•& Air Conditioning ,-,t v s '+ S `•r_ " T`
35. Final Gas Pipe•Testrr -y i• * - t; _ x " F-•^
?36SHood o�Cano P x - ty_ . * .^y :77O * -_
.i.
-37. Final Factory Fireplace.: .-F v -x •• ��
.38. Fida`I Plumbing - 71"; = g 'i7w t O
-39. Water Service-Finale ^ S x * > ''.. * `
_,40. Gas Service-Final m r C'--^ S t ' * - ;, ._ orlc
:,41. Solar Domestic-Final' •• * •. v C r a r. 5
42 Backflow Preventer" -3 ` •" ;' C 4µ i
x V oI-I -E v: - * t:C: Y.
43. Backflow Irrigation. 7•-• r. .:t * * '; « .--. •
• 44._Landscape ITripation ;.:
System_ t'T < J •rr * t 017 Y _
•"45-Sound Attenuation •- • •• . . -* > t; r• -C7 •
-46- .'Handicap Regulations " '` ' Z. _ - r -
-47'FINAL STRUCTURE & BUILDING y a
48=FINAL PLANNING' " "• ; -.1 _
-.49.1 Electric Release to Edison . ;: c r
-50.- --.Gas ouSouthern Release to StheCalifornia Gas Co t ' rt; -
' 51. CERTIFICATE OF OCCUPANCY " `
No. Date
PROJECT ADDRESS: 3062 MADISON AV UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 061770
• OWNER'S NAME:SUGIYAMA, HITOSHI
ADDRESS:
3062 MADISON AVE PERMIT NO: B 061770 PLAN CHECK NO: N GOVT; N SUPP: N
• COSTA MESA, CA 92626 •
CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ALT
flit_ ARCHIENGINEER: REG.ND.: JOB DESCRIPTION : REROOF W/COMPO 0/COMPO SQ FT: 2, 000
All ADDRESS: UNIT:
CLAIM VALUE: 2, 000 . 00 CALC-VALUE: 2, 000. 00 GROUP OCC: R-3 /M-1
PERMITTEE:
ACTION 1ST ROOF CARE ( 714 ) 841 -7663 �. ••
ADORES5: 18352 GOTHARD COMMENTS: SMOKE DETECTORS REQUIRED PER THE 1991 EDITION OF THE rB
HUNTINGTON BEACH CA 92647 **�E+ ****' **+�**********�F*�E*�r+E �F+E*****�r�E�F�r***grit#�Fir�E*****r�F�E*�t�A�E�Fc , >F . iE . „ v
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS `"' �� bETECTO
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS REQUIRED
CITY LIC.:04.5¶ 3 5 STATE LIC.5 02900 CLASSS�:C—3 •
r 4 Date: (rb/9—\ Signature:�'f'��—LZ� MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICYNO.:1042000-92 EXP.DATE: 09/01 /93
cOMPANr:STATE FUND PARKING REO: PROV: PARCEL : 14159315 ZNE: REF NO:
Certified copy is hereby furnished. Z1 Certified copy is filed with the city Building Division. PLANNING NOTES>
E L ^� �• > .!
�
Date' 1 / 6 1 �7/�3 Applicant: �� 9r &t **************************)k********************************i1-********4v*********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred(5100)or less). DEVELOPMENT SERVICES REQUIREMENSTS
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
sublet:to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: . .
Date: Signature:
NOTICE:If,atter making this declaration,you should become subject to the Workers'Compensation provisions of the tabor BUILDING APPROVED EY : DATE; I r,
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. •
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for ' o
APPLICATION ISSUED BY: DATE: .9.16
which this permit is issued(Section 3097.Civ.C). ************************21* .x xi�** *• *3r *****,r*x**x***********' • - x ' **
LENDER: ******************************************* ***********************?F,**********
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL\ S`EGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter,improve,demolish.or PERMIT 45 . 00 . 5 0
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed .
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON-RE S
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN •
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN—CHECK TOTAL PAID ,` DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 45 . 50 0 . 00 0 . 00 45. 50 45 . 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through .
his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or
improvement
sold
) LDGPMT PLUMB NG ELECTRICMECHANFIRESMIP/TOOT GRADIN
within one year of completion.the owner will have the burden of proving he/she did not build ar improve REVENU BDIVISION
T __ ODIC 45 . 50
G:
for tepurpose ofsalePLAN-CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 45 . 00 r . 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Slate License Law).lam aware *.µ**************if-*******'E****)f**************************************%X*1l-*******
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL, FEE BREAKDOWN - '
❑ I am exempt under Section: B. &P.C.
•
br this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date-. Owner. SFR 2000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 000 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533.and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from .
these provisions. ;l
Dale: Applicant
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state lours relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned {
property for inspectionti[ purposes.
` �'/ 1--X- Date: y r i 0/�/ 1 Signature: ea_CO— .p
4 DAT00134315-0013780: 10TOT
6 45.50
Driver's License or Social 7
1641-46 white—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldonrod—Assessor
\".111111
CONSTRUCTION AND PLANNING POO' 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
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit•Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. E,ectrica' 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, C Undrgrnd.
10. Structural Floor System • • 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Bac wash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains ; 64. Plumbing System • Final
14. Rough Plumbing 65. Electrical-Final I
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Accrss Approval li
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 C Gas S. Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank '.J Gas C a;-
25. Roo` Sheathing 74. Overhead Hydro
26. T-Saf Ceiling(Structural) & ivtonocoat 75. Dr; Chem`cal
27. Frame a-d Flashi'g
76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
� I
29. Insuiat,on 78. FIRE PREY. FINAL
sir EPT. REQUIREMENT
31. Piaster N32. Electricci Power Meter•FinaI E ISSUED
33. Final Eleztric g/�".)34. Final Heating& Air Conditioning
35. Final Gas
36. Hood or Canopv
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service•FMal
40. Gas Serve-Final
41. Solar Domestic-Final '
42. Backflow Preventer J •��
43. Backflow Irrigation -�
44. Landscape Irrigation System •
45. Sound Attenuation
46. Handicap Regulation 11
47. FINAL STRUCTU4E 82:WILDING y ,� S ,4 da t
48. FINAL PLANNING •
i
49. Electric Release to Edisoa '.
60. Gas Release to Southern•£alifornia Gas Co
51. CERTIFICATE OF QCQIJPANCY
No. Date
• 17060 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT V (MAY 17 1981
P. O. BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT.
For Applicant to FBI In Completely APPLICATION FOR COSTA MESA
TYPE OR PRINT
6 a �acis BUILDING
BUILDING 3o
ADDRESS 0''t �K
COSTA MESA. CALIFORNIA For Office Use Only
1 RECEIPT NO. I P7I 71to
OWNER Occidental Loan C9moany
MAIL j� y RECEIVED BY I RHhIVHD I �E3BBG176a
ADDRESS 2;901 Benedict Canyon Dr. (///J�� 2 1
CITY Beverly Hills Ho`:CR' -6- BUILDING
ADDRESS 3062 Madison Avenue
6y4<,
ARCHITECT TEL. COSTA MESA. CALIFORNIA
OR ENGINEER -- NO. ////����
FIRE
ADDRESS -- ZONE TYPE GROUP
CONTRACTOR Alfred A. FJielsohn APBYPROVED DATE
ADDRESS 2901 Benedict Canyon Dr. ZONING
CITY BeverlyeHills , California °"X—/ IPRO.
LANO:
Z' I BULD°F INGNEW
/ •r-L h
LIC.NO. 1413 5 NO. CR. -o-O 4O LEGALI Pr1oN ��(( 33 ��``!!
STATE TEL. 9 Lot TT TR-4607
SIZEOF LOT 62x100 I NO. OF BLOCS.,/
NOW ON LOT A.P.NO.
USE OF -- YARDS EVES
EXISTING BLDG. CZ _ APPROVED ALLOWED
(CENTE
CENTER
SETBACK
OP STREET /O I REAR YARD 31' FRONTR LINE BT.1 5-00
FT. .---- IN.
SIDE YARD I LEFT 51 I RIGHT J1 R.SIDE --Sr FT. IN.
DESCRIPTION OF WORK L.SIDE FT. IN.
NEW I X 1 ALTERATION I 1 ADDITION 1 REAR 3( FT. D IN.
REPAIR I II MOVING I II DEMOLISH I APPROVED
BY `-(/</ 4,4,1E DATE '�/o/CL
SIZEBUIL
9 ROOMS NO. OF 7 STORIES 1
EXTERIORItL ROOF
COVERING bL UCCO I COVERING Wood & Rock
USE OF BUILDING AND WORK TO BE PERFORMED
1 - Fam. Res. w/attached Gar.
9 /9.30
/976aj GoP ,PG-)V
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 CON- PURPOSE OF ESTABLISHING A PERMIT PEE ONLY.
PLY WITH ALL CIT' ORDINANCES AND STATE S REG LATINO
BUILDING COMM CTION. VALUATION
PERMIT FEE $ /—
SIGNATURE O/
PERMITTE' ' _ .J_, L 1,024.00 w l ,SORV
AUTHORIZED A•'NT
N. TOTAL FEE $ .%7.e.ISo 0 r