HomeMy WebLinkAbout224 MAGNOLIA ST - Building Permits -crilatir
4 CITY OF COSTA MESA •
,4r' . BUILDING DIVISION
.........,,i:' ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
o. PERMIT J
M99-00314
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 224 MAGNOLIA ST Status: ISSUED
Suite No Applied: 07/06/1999
Issued: 07/06/1999
Vicinity: FAMILY ROOM&NEW GARAGE
Parcel Number: 42540206 ISSUED BY: •
-7119
Applicant: NELSON, GREGORY C
Address: 224 MAGNOLIA ST '
Phone: -
COSTA MESA,CA Zip: 92627 '
Owner:„NELSON, GREGORY C
Address:'! 224 MAGNOLIA ST "
/ r,i / /
Phone: '
/ \COSTA MESA,CA Zip: 92627
Contractor SEAN:GRATTAN
. ' Address: 33671 BAYPORT WAY ` ,
. . . Phone: (949)240-1222 ••
•
, DANA POINT,CA Zip: 92629
• . . License: 656020
Arch/Eng: • .
- Address: `a
Phone:
Zip:
' License: .`
SCOPE OF PERMIT
1 REPAIR/ALT COOLING/HTG, 1 FACCTORY FIREPLACE& 1 APPL VENT.
' 'REF:B99-00181. • . ' .
a
FEE SUMMARY "•
•
Quantity - Quantity
ISSUE FEE - $22.00 Repair/Alt Absorbtion Unit $0.00-S 0
Inst"FAU<100 k BTU - ' $0.00 0 Repair/Alt Refrigeration Unit - . $0.00 0' '
Inst FAU->100 k BTU $0.00' 0 Ventillation System '$0.00 0 ,
Repair/Alt'Cooling/Heat $12.25 1 Evaporative Cooler $0.00 ,0
Inst/Rep'Recess Wall Htr , $0.00 0 - Commercial Incinerator , - _ $0.00, 0
Refrig Sys<100 k BTU • . $0.00 -0 - Domestic Incinerator $0.00 '0
Refrig Sys>100 k BTU $0.00 - 0 - Compressors/Absorption Systems ,
Gas Piping - $0.00 . 0' -Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace - $9.50 1 3 To 15 hp/500 k BTU ' - $0:00 0
Hood w/Mech Exhaust . $0.00 0 • 15 To 30 hp/1,000 k BTU " - $0.00 0
VAV Box - $0.00 0 30 To 50 hp/1,750 k BTU / $0.00 0
Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $9.50 1 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $53.25
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
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 end 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
r
•
DECLARATIONS n n
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: -
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: 5)--,-4 c � ,,. Policy Number: -7.7 C r tot rn r-z.
(This sect/on need not be completed if the permit Is valued at one hundred dollars($100)or less.)
I certify that In the performance of the ork'fo 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,a • .gree t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: 1 Date: 6/1i r
WARNING:FAILURE TO SECURE WORKERS'COMP NSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES 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 ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed un P rovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect'Lic.# I SCO to Class#
Contractor's Signature: Date: ?
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code).
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 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 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-properly 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:
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 Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the 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 end 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 Califomia Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ 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 yofficer).
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 inspe ion purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
/C/-'i/iLegal Owner(s) 1'L 1 Date
And/Or Authorized Applicant Date
CODE II INSPECTIONTYPE POPE I INSPECTION TYPE •
gag -
1616 Fixed System Final Fire Prevention 206 Final Mechanical 1,)-13-99 v's/V
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
2446.46
,z0rJ CITY OF COSTA MESA
F ws. `I, BUILDING DIVISION PERMIT NUMBER
DEVELOPMENT SERVICES DEPARTMENTTe. grICIL
v
so
PERMIT
P99-00380
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
•
PLUMBING PERMIT
Job Address: 224 MAGNOLIA ST Status: ISSUED
Suite No Applied: 07/06/1999
Issued: 07/06/1999 •
Vicinity: FAMILY ROOM&NEW GARAGE ...Q ,,/y�
Parcel Nunmber: 42540206 ISSUED BY: c'} D r I
Applicant NELSON, GREGORY C
Address: 224 MAGNOLIA'ST ,
Phone: -
COSTA`MESA,'CA_ • Zip: 92627 • / - _
/ .
Owner/,'NELSON, GREGORY C
Address‘ 224 MAGNOLIA'ST "
Phone:
COSTA'MESA,CA Zip: 92627 ,,
4'Contractor:' SEAN GRATTAN
'Address: ,33671 BAYPORT WAY ,
' , • Phone: (949)240-1222 ' -
'DANA POINT,CA . Zip: 92629
' +' j License: 656020 - i•,'
61 f - •
1
Ar ,
h/Eng.: , - `
\ /Addre55: •
V \
Phone:
t\' • • Zip:
Z License:
SCOPE OF PERMIT.' •
,' - ' '` 1 BATHTUB, 1 DISHWASHER, 1 FLOOR DRAIN, 1 1-4 GAS OUTLETS, 1 LAUNDRY TUB, 1 SHOWER, , T '
- "KITCHEN SINK, 1 SERRVICE SINK, 1 WASH BASIN& 1 WATER CLOSET. - ‘
'REF:1399-00181.
FEE SUMMARY
V AMT ' QTY AMT QTY iAMT QTY
•ISSUE FEE'�`' • ' $22.00 ' ,. '':.Laundry Tub/Washer $8.75 1 Sump Pump - '',$0.00 0
Backflow irrigation $0.00 0 '�'' Landscape Irrigation $0.00 0 r Swimming Pool - $0.00 0
Backflow Preventer. ,-/$0.00 0 • P-Trap $0.00 0 ' Trap Primer , , ' .. / $0.00 0
Bathtub ,$8.75 1 .Pressure Regulator $0.00 0 Urinal / $0.00 0
Clarifier System $0.00 0 Process Piping p g(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 $8.75 1
Dishwasher $8.75 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $8.75 1 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) $8.75 1
Drain, Roof $0.00 0 Shower $8.75 1 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00, 0 Water Service $0.00 0
Gas(1-4 outlets) $5.50 1 Sink,kitchen $8.75 1 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $8.75 1 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: $106.25
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
•
INSPECTIONS: In order for the work authorized.under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
DECLARATIONS n
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation!''++ Insurance carrier and policy number are:
Carrier: 3' .-4-r 4-un Policy Number: 7,2_1 q1 C/r+,%J-llu-.-7 0017
(This section need not be completd if the permit is s' ad at one hundred dollars($100)or less.)
❑ I certify that in the performance of •- work this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califo ' d agree y.•if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these prov' s
Applicant Signature: Date: % G 4'1
WARNING:FAILURE TO SEC••E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PE ALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE m'T OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
hereby affirm that I am licensed under provisions h ter mmencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# G t6 o z 0 Class# 7
Contractors Signature: ®� Date: '7
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore 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 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑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,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the Calif omia 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 Califomia 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 Califomia Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit 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 L]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 SafetyCode Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with 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 inspecti urposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
/I���grn reO gal Owners) �5 Date
zed Applicant / Date
CODE 4 INSPECTION TYPE DAT& tNTITIAL5 CODE/ INSPECTION TYPE PALE iNTmAL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical n
1266 Pool Spa Final 208 Final Plumbing ). . l3'9d, n f't
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
2446-46
1
1:1
CITY OF COSTA MESA
;yA, BUILDING DIVISION
) DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
t' !
PERMIT
V‘lnnigi
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 224 MAGNOLIA ST Status: ISSUED
Suite: Applied: 02/08/1999
Vicinity: FAMILY ROOM&GARAGE AREAS Issued: 07/06/1999
Parcel Nunmber: 42540206 Zoning:
•
ISSUED BY: g!
Applicant: CHAMBERLAIN, JULIEl , - - _ .
Address: , , -
Phone: 949 631-0811
Zip:
Owner: / NELSON, GREGORY C
Address's 224 MAGNOLIA ST
�� - Phone:
/ / COSTA MESA,CA1 Zip: 92627 ��\
// _ v�_V.
Contractor: . /'�_ , �� / :,„,'. .
i nA i ; A�Z
+Addres"s:, - -
Phone: ,,
L
. Zip: License: ,
' Arch : . JULIE CHAMBERLAIN , • Eng:
' Address: , 2647 WESTMINSTER AV I Address: ,
Phone: 949-631-0811 ,'Phone: •
COSTA MESA,CA . - '
/
Zip 92626- License: C22332 Zip: License: : _ `
SCOPE OF PERMIT
, , REMODEL APPRX 351 INTERIOR OF SFR;ADD 385 SF FAMILY/BATH/ENTRY,DEMO EX GARAGE,CONSTRUCT 450 SF
DET GAR WITH LAUNDRY ROOM+420 SF ATT WORKSHOP.AREAS ADDED WERE ALTERED BEFORE PERMIT IS ISSUED,
PER ARCH REQUEST, PLANS REVISED TO SHOW ALTERATION ON 5/13/99.BY SA.
N. - ..
**ALL CONSTRUCTION WORK - '
WILL BE DONE AT THE SAME TIME**
-
, a', FEE SUMMARY —
Plan Check:, $123.86 Calc Valuation: . i$79,500.00
- '' Permit: , $762.25 Claim Valuation: • $79,50o.00
SMIP‘Res: '$7,95 .
SMTP Com: - $0:00 .
Other. - $0.00
Inspection: $0.00
Total: - $894.06 . . . .
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 23-0 Rear 14-6 Left 12-6 Right 5-0
ACCESSORY Front 14-6 Rear 5-0 Left 5-0 Right 5-0
PARKING Existing: 2 Required: 2 Proposed: 2
NOTES:
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 A•- .: :
rr
1
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.
QJ 1 I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensa ion Insurance carrier and policy number are:
Carrier: i, 1a - al IN a( Policy Number: 0 n q - 49 - Unh-nA zorOG2
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
P•' I certify that in the performance of the work- . 'hich this permit is Issued, I shall not employ any,persoaiD_any manner so as to become subject to the workers'
compensation laws of California,and agtr' . Al-should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: — Date: 7/6 t
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE TMST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION: '
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full
force and effect.Lic.# 1.5 6�.(' - Class#
Contractor's Signature: /c '— Date: 7/6.' x/"e
CONSTRUCTION LENDING AGENCY: '
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
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.).
❑ 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 en 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 0 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,talsework,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 be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ora volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LU No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE 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!•:ture OIL:•- •4.ner(s) Date
/7
i.':Or Authorized Applicant
4Date
ODE t RISPECTION TYPE ' PATE *TRIALS CODE II INSPECTION TYPE . PAN - jNTITIALS
1816 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site tit.
204 Final Demolition _ 250 Final BuildingiOccupancy m#• VC-. r'y-{it.
244646 (�
w
4CITY OF COSTA MESA J
.�� BUILDING DIVISION
�. ""-i'_ : DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
se
E99-00626
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 224 MAGNOLIA ST Status: ISSUED
Suite No Applied: 07/06/1999
Vicinity: FAMILY ROOM 7 NEW GARAGE Issued: 07/06/1999 •
Parcel Nunmber: 42540206
ISSUED BY:
Applicant: NELSON, GREGORY C . - -
Address: 224 MAGNOLIA ST , : i
Phone:
• COSTA MESA, CAZip: 92627 _ ,
.
Owner:Y NELSON; GREGORY-C - -
Address X224 MAGNOLIA'ST o '\_��
/,/ , ' •x, Phone:
/",/ -COSTA-MESA,CA Zip: 92627
i 7.��
- Contractor:, SEAN-GRATTAN
.' Address:/ $3671•BAYPORT WAY . '
' Phone: (949)240-1222
' DANA POINT, CA Zip: 92629 ,
License: 656020 . '
`;\ �
SCOPE OF PERMIT
t / ` - 37 LIGHTS, 30 OUTLETS, 17 SWITCHES, 1 200 AMP SERVICE PANEL, 1 200 AMP SUB
PANEL ,
Y , .
•" � REF:1399-00181.
t . ,
FEE SUMMARY
Quantity Quantity• % <
ISSUE FEE - $22.00 Temp Dist System/Lighting $0.00 0 t
-.Temp service,test $0.00 Busway/100 ft - $0.00 0
Res:-a/c package $0.00 Standing Section $0.00 , 0 - ,
New Res(1-2 units) $0.00 0 Misc Electrical Equipment ' $0.00 - 0 ,
New Res(31units)-' - $0.00 0 Transformers up to 1 kva/kw " $0.00"" - 0 • "
Pool/Spa,t\ . $0.00 0 ' up to 10 kva/kw $0.00 0 . '
Lighting Fizts`v . - v$31(.05 37 .- • up to 50 kva/kw
Recept Outlets' $26.50 30, up to 100 kva/kw •,- . $0.00 0•
Switches " $17.00 17• over 100 kva/kw $0.00 . 0
Non Res Appl't - $0.00 0 • Low Voltage Equipment' - - $0.00 - 0
Res Appl - v "' ' $0.00 0 Low Volt Wiring System/Ckt $0.00 /-0 /
Service to 200a . $27.25 1 . . Misc. Conduit $0.00 0'" '
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 " 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 " 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $27.25 1 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $151.05
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
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.
Isy I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier �-i- 4-.. �..n.( Policy Number: 22 S- c'i S Gn,t zee.6 i
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
re I certify that in the performance of the •rk '•r 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,a . ea at if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: / Date: 6 rirl
WARNING:FAILURE TO SECURE W•- ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI P NALTIES AND CIVIL FINES 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 ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# -. . . /_ Class N
Contractor's Signature: / Date:_7/67/r7/
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
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 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers 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 B,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes in 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? 0 Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
8 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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
B (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under 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 fpection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection.
/may to : •• • ner(s) Date
• d/o r Authorized Applicant ! Date
pODE L INSPECTIONTYPE PATE IIQQIALS CODE! INSPECTION TYPE puff, INTRIAI
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
244ade