HomeMy WebLinkAbout2513 LEHIGH PL - Building Permits CITY OF COSTA MESA
o�""'_. BUILDING DIVISION
F a ,Al 77 FAIR DRIVE,COSTA MESA,CA 9262(( w
6 • (1 154-5273 • Fax(714)754-4856 • ww.costamesaca.gov
v. fl - FOR IN$PECTI S CALL:(714)754.5626
* ®� PERMIT NUMBER: BC12-00560
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES ALT DATE ISSUED: 10/03/2012
ISSUED BY: KJB
JOB ADDRESS: 2513 LEHIGH PL CM Suite/Unit:
APN: 14142418 Zoning: , , .
Vicinity: DEN , Primary Occ:•
ConstType:V-B SQ. FT: 0 Valuation: $1,200.00
SCOPE OF WORK:REPLACE 1 WINDOW IN THE DEN AND REPLACE THE DRYWALL. ELECTRICAL TO INCLUDE: 1 LIGHT
FIXTURE, 6 OUTLETS, 2 SWITCHES,
OWNER: WEBER,TODD Address: 2513 LEHIGH PL Unit:
Phone: City/State/Zip: COSTA MESA,CA
APPLICANT: WEBER,TODD - Address: 2513 LEHIGH PLUnit::
Phone: 714-276-7955 City/State/Zip: COSTA MESA,CA
CONTRACTOR: License No:
Phone: Address: Unit:
Cell: City/State: ZipCode
St
ARCHITECT: License No. PHONE:
ENGINEER: License No. - PHONE:
.i
COMBINATION PERMIT.FEE SUMMARY
Building Plan Check: $0.00
Building Fees: $44.85
Electrical Fees: $33.40
Mechanical Fees: • $0.00
Plumbing Fees: $0.00
SMIP Residential: - $0.50
SMIP Commercial: $0.00
Bldg Std Admin Fund - $1.00
TOTAL FEES: . - $79.75
"Refer to fee receipts for all fees paid for project -
?.I�, HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010- PER CMMC Sec. 13-279
;!Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibited all hours-Sundays and the following Federal holidays:
New Years Day,Memorial Day,Independence Day, Labor Day,Thanksgiving Day and Christmas Day
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41OTICE: 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)
FEXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
Lrc
rINSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
irpquired inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CvDF I INSPECTIONTYPE DAZE INImAIS ;ODE/ INSPECTIONTYPE PANE INTTAIJ
jf.
6116 Fixed System Final Fire Prevention 206 Final Mechanical
7 Z.66 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical c/h/2l9L3
4'
177i201 Final Block/Retaining Wall 212 Final Fire Prevention
[202 ' Final Factory Fire Place 220 Final Planning Approval
.'203 Final Sign 222 Final Site
cit,A90-3(204 Final Demolition 250 Final Building/Occupancy
. a
WORKERS'COMPENSATION DECLARATION: Owner ID verified by dnvelicense. ❑Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: ' Drivers License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
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 DIV SION 0f1INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carder and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: 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
Carrier: or dismantlingthereof,will be more than thirty-six
(This section need not be completedd a rtjs vat lone hundred doll or/ass) (36)feet high.(Chap.3.2,Grp
�/%—. 2,Art 2,Sec.341,Title 8,Califomia Administrative Code).
olicy Number:
0 As owner-builder, I will not employ anyone to do work which would
ify that in the performance of the work for wiich this permit is require a permit from the Division of Industrial Safety,as noted above, unless
tss ed, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should•
become subject to a workers' ompensation provisions of Section 3700 of Applicants Signature Date
the Labor C s rt ith pl with these plj s.
I3 1 Division of Industrial Safety Permit Number:
Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes El No
(5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the Califomia Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes 0 No
Lic.# Class# (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
Contractor's Signature Date hazardous materials equal to or greater than a weigh( of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lenders Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lenders Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑ No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
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 (Section n befu5850.2 of the onCnlifomlic Govemment Code requiresbuilding thnt the requested
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
information furnished applications for non-residential permits).
•
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
ve hundr d dollars($500).): of the California Health and Safety Code).
, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
co ensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to en owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No
thereon,and who does such work himself or herself or through his or her own 8 (If"yes', attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
property,
❑ I, as owner of the
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
am exempt under sec. the information given is correct. I agree to comply with all state laws and city
Iordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of C to Mesa to enter upon the above-described property for
inspection oses. I agree of to occupy or allow occu ncy any building
�'`��� a rmi un ayingPection. 11 3
110/.34 Signature of Legal Owner(s) („J ate
Signature e
305746(3/07) And/or Authorized Applicant Date
City of 'osta �12e sa Building Division. .
•
C ¢ /� 71 air Drive, Costa Mesa, CA 92626
®S E Mesa 714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION •
Permit # ele9- TO40-b
Disclosures & Forms for Owner- Builders Applying for Construction Permits - •
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner: • •
An application for a building permit has been submitted in your nam lisurs
ting yoe the builder of the
property improvements specified at &S(
O7 property D I
• •We are providing you with an Owner-Builder Acknowledgment and Informal Verification Form to make you . •
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you.have read, initialed your understanding of
each provision,'signed, and returned this form to us atour official address indicated. An.agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior.approval of the permitting
authority. .
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
'rut. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
-n,J 2. I understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
'r W 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
'T1„3 4. I understand Contractors are required by law to be licensed and bonded in California and to list their
license numbers on permits and contracts.
1'LJ 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
MA 6. I understand if I am considered an "employer" under state and federal law, I must register with the state
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
TLJ 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan 1,2009 OB Packet template 1 of 2
M..) 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
71,) 9. I understand I may obtain more information regarding'my obligations as an "employer"from the Internal
Revenue Service; the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
i Lf 10. I am aware of and consent to an Owner-Builder building permit applied for in my name,and.understand
' that I am the party legally and financially responsible for proposed construction activity at the following address:
71411. I agree that, as the party legally and financially responsible for this proposed construction activity, I will •
abide by all applicable laws.and requirements that govern Owner-Builders as well as employers. .
113 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any.of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license; the Contractors' State License Board may be
unable to assist you with.any financial loss you may sustain as a result of a complaint. Your only remedy against .
unlicensed Contractors may-be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner •
and returned 'to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notarization, or other verification acceptable to the agency is required to be
presented when the permit is 'ssued verify th property owner's signature.
Signature of property owner Date: 1013/1 2.
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work):
.Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature: Date:
•
•
3148-30 CALBO Jan 1, 2009 OB Packet template 2 of 2 •
---f ' CITY OF COSTA MESA •
4, . BUILDING DIVISION �.
• • �. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F ttb ' i PERMIT
E04-01077
masa
(714)754-5273 • Fax(714)754-4856 • www,cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2513 LEHIGH PL Status: ISSUED
Suite No Applied: 10/11/2004
Vicinity: Issued: 10/11/2004
Parcel Nunmber: 14142418
Applicant: WEBER, TODD ISSUED BY:
Address: 2513 LEHIGH PL
Phone: 714 435-9035
COSTA MESA,CA Zip: 92626-6121
Owner: WEBER, TODD
Address 2513 LEHIGH PL
Phone:
COSTA MESA,CA Zip: 92626-6121
Contractor:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
REF: B04-01742: INSTALL DRYWALL @ GARAGE INTERIOR UNFINISHED WALLS&2 EXTERIOR
GARAGE LIGHTS,8 INTERIOR GARAGE OUTLETS&3 INTERIOR GARAGE SWITCHES.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 ,
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(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $2.20 2 - up to 50 kva/kw $0.00 0 -
Recept Outlets $8.80 8 up to 100 kva/kw $0.00 0 .
Switches $3.30 3 over 100 kva/kw - $0.00 0 .
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl - $0.00 0 Low Volt Wring System/Ckt $0.00 0
Service to 200a $0.00 ,0 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 $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
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 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
2446-48(WOO)
L
DECLARATIONS
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: Policy Number:
(This section need 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 provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FiNES UP TO ONE HUNDRED
THOUSAND COMARE($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#
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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that Under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
%' . 7044,Business and Professions Code:The Contractors license Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant the Contractors License Laws.).
ged5c, 1 ode a Business and Professions Code for this reason:
signatu t> �F/ {Yrs.oa�e:-6' 10 r f I-n-1 O
'Owner ID verified by driver's license. • e 0 No rv �'Ucense'No. >i' _,Eipl s: '3—p
Verification of Ownership by(type of doc ment,i.e.-property tax bill or deed
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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 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 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 California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this as plication a 2ermit for such construction or modification
from the South Coast Alr Quality Management District or from any other air pollution control district or agency? 0 Yes IJ No
(Section 65850.2 of the Califomia 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? 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 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 slate 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 afire' 6 comply with :ll state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
a•• •-••A•e• pros arty f•r i•s•e'tion purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
( '$Signaliie50flLe"gil,Oiv"ner(e) `rirDatS_
And/Or Authorized Applicant Date
CODE ii g15PEOT10NTYPE RAIL INTRIALS CODE II INSPECTIONTYPfy RATF RALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing �,n
200 Final Re-Roof 210 Final Electrical ® V�j`r'�J'`�—
C
201 Final BlockURetaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place • 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy -
• ' CITY OF COSTA MESA •
c .. BUILDING DIVISION
N DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1. 1 r-r .- PERMIT
J �
b14%este no e 04-01742
(714)754-5273 • Fax(714)754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2513 LEHIGH PL Status: ISSUED
Suite: Applied: 10/11/2004
Vicinity: Issued: 10/11/2004
Parcel Number: 14142418 Zoning:
Applicant: WEBER, TODD ISSUED BY:
Address: 2513 LEHIGH PL
Phone: 714 435-9035
COSTA MESA,CA Zip: 92626-6121
Owner: WEBER, TODD
Address 2513 LEHIGH PL
Phone:
COSTA MESA,CA Zip: 92626-6121
Contractor:
Address:
Phone:
Zip: License:
Arch : • Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
INSTALL DRYWALL @ GARAGE INTERIOR UNFINISHED WALLS&2 EXTERIOR GARAGE LIGHTS,8 INTERIOR GARAGE OUTLETS&3
INTERIOR GARAGE SWITCHES. •
•
FEE SUMMARY
Plan Check: • $0.00 Calc Valuation: $500.00
Permit: $23.50 - - - Claim Valuation: $500.00
SMIP Res: $0.50
SMIP Com: $0.00 •
Other: $0.00 _ •
•
Inspection: $0.00
•
Total: $24.00
•
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(6/001
DECLARATIONS I '
WORKERS'COMPENSATION DECLARATION: • .
I hereby affirm under penalty of perjury one of the following declarations: '
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
O 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: Policy Number:
(This section need 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 provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOI I ARE($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 P
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).
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
subjicts the applicant to a civil penalty of not more than five hundred dollars($500).):
407I,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.
V" 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.). •
O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to he C tractors Ligense Laws.).
❑_l.e er / I Business and Professions Code for this reason:
X59 eat i %/ I/��Q .,rya,r>r r., - -.
-•Expires,- 3
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 be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the 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$2ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U 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 a state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
ab ve-.E' i•e•;•ror'rty f in ectio purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until l inspection.
(4 final
' 4 . to-Mr-cot -�—.
SignatUre,'Of Le'gal'Ownet(]_J 1/4165 "'''. Date4
And/Or Authorized Applicant Date
CODE r INSPECTION TYPE . DATE =BID CODE INSPECTION TYPE PAIS INTITIALB
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 '_/442f'
el MF 9 CITY OF COSTA MESA
4`
BUILDING DIVISION
F• , ;MUM ca,,'�'.�1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
J. 1111.14
%%bo ,d'° • /P02-00495
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
.Job Address: 2513 LEHIGH PL Status: ISSUED
Suite No Applied: 07/31/2002
Issued: 07/31/2002
•
Vicinity:
Parcel Nunmber: 14142418 - - /
ISSUED BY: %
Applicant: WEBER, TODD '
Address: 2513 LEHIGH PL
Phone: 714435-9037 - . "
COSTA MESA,CA Zip: 92626-6121 -
Owner: WEBER, TODD
Address 2513 LEHIGH PL . _ -
Phone:
COSTA MESA,CA Zip: 92626-6121
Contractor: OWNER-BUILDER
��" '
' Address: • '
Phone: - , -
Zip:
License: 0 ,
Arch / Eng: . - -. l .. ,
Address:
Phone:
Zip:
License: - " _ ..
• . SCOPE OF PERMIT
PLUMBING PERMIT TO REPLACE PLUMBING FIXURES IN AN EXISTING SFD. 1 BATHUB,1 WASH
BASIN,1 WATER CLOSET, 1 WATER PIPING,(INST OR REP)FOR WASH BASIN.REF:602-00776 .
FEE SUMMARY ' ,
AMT QTY. AMT. QTY" - AMT QTY
ISSUE FEE . $23.50' - • Laundry Tub/Washer - $0.00 0 • • Sump Pump .,$0.00 0
Backflow irrigation , $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 ' 0- P-Trap $0.00 0 -Trap Primer , , / $0.00 0
Bathtub '$9.80 . 1 Pressure Regulator $0.00 0 Urinal - $0.00 0
Clarifier System $0.00 0 " . Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin , $9.80 1
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 . -Sewer Connect $0.00 0 -Waste and Vent System $0.00 0
Drain, Rainwater $0.000. Sewer Private Line . , $0.00 0 ," Water Closet(Toilet) $9.80 1
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 - Sink,bar -,$0.00 0 Water Piping(Inst or Rep.) $9.80 1
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 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: $62.70
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 perrnit•shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
fora period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(aroo)
DECLARATIONS
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 tfjs 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: I Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
O 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 provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($1 X,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.4 Class$
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).
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).):
;tg, 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.).
O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exe u e Business and Professions Code for this reason:
:sigoaturet—' / A
cf2spires:3////a 3
Verification of Ownership by(type of document,i.e..property tax bill or deed):
I
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).
ul.i g o ....t.need
fie a registration
for.. o
2 Does or will the applicant or present or future building occupant need to file a registration Corm 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 apermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? LL]]Yes LJ 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(Duality 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 ❑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 ajjII state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-de ' r pe tw insIpc on purposes.I agree not to occupy or allow occupancy of any building authorized by this
thpg� u� fl inspection.
is( ilna
LgnnatureO1.LegalOwnerts7 cOete-7
And/Or Authorized Applicant Date
COVE* INSPECTION TYPE PATE INTmALS CODFf INSPECTION TY PE PAM At-
1616 Fixed System Final Fire Prevention 206 Final Mechanical Al
_ Z 2
1266 Pool Spa Final 208 Final Plumbing or
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
F CITY OF COSTA MESA
4 . 9 BUILDING DIVISION
>:J194 trl Tbriani 1 DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER
4 PERMIT E02-00451
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2513 LEHIGH PL Status: ISSUED
Suite No Applied: 06/04/2002
Vicinity: BEDROOMS AND BATHROOM Issued: 06/04/2002
Parcel Nunmber: 14142418
Applicant: WEBER, TODD ISSUED BY:
Address: 2513 LEHIGH PL
Phone: 714-435-9037
COSTA MESA;CA Zip: 92626-6121 -
Owner: WEBER, TODD
•
•
Address 2513 LEHIGH PL
Phone:
COSTA MESA,CA Zip: 92626-6121
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
. License: 0
SCOPE OF PERMIT
REPLACE 2 WIRES WITH 3 WIRES(1 IN GROUND),CHANGE OUT 8 LIGHTING FIXTURES, 13
OUTLETS,AND 9 SWITCHES IN ALL THREE BEDROOMS AND BATHROOM.REF: B02-00776
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
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(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $8.80 8 up to 50 kva/kw $0.00 0
Recept Outlets $14.30 13 up to 100 kva/kw $0.00 0
Switches $9.90 9 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 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 $0.00 0 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 $56.50
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
fora period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00) dddYYY
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 sell-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: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
:121 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
h
tt,{II shquld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these r r i./72/ �/v \ t /'
Applic�rrt'Slgnetur� / !/// /6 Date: (-/y/0 2
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,MID 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.a Class N
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).
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,end 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)
�.l—license pursuant to the Contractors License Laws.).
:f-'1 arri exloo^t-uader Business and Professions Code for this reason:
Signatures 1/�/fi(7 (l /� CData:�. ((LI/ O Z
Owner ID verified by driver's license. Yes 0 No ,Drivers:License•No. Expires:-. -))-O
Verification of Ownership by(type of docum i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT ERTIFICATION:
❑ 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: Dale:
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 ❑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 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 an hand a quantity of acutely hazardous materials equal to or greater then 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 Calif omia 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 en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? UI Yes L,f 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 El 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? ❑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 c mply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
a aid Er party1orrIrISp
{a tion purposes.I agree not to occupy or allow occupancy of any building authorized by
tthi per it until final inspection.
jgnature Ofa-sgaFOwner(s) N-Date-1
And/Or Authorized Applicant Date
CODE t INSPECTION TYPE gZIE 1NTIRALS MU INSPECTION TYPE Pea INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical 7-0223 -sedO)
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
Z5t3 LE-ti Q.-‘ PL.
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CITY OF COSTA MESA
ir
BUILDING DIVISION
F4L«• 4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
°, I /B02-00776
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2513 LEHIGH PL Status: ISSUED
Suite: Applied: 06/04/2002
Vicinity: BEDROOMS AND BATHROOM Issued: 06/04/2002
Parcel Number: 14142418 Zoning:
Applicant: WEBER, TODD ISSUED BY:
Address: 2513 LEHIGH PL
Phone: 714-435-9037
COSTA MESA,CA Zip: 92626-6121
Owner WEBER, TODD
Address 2513 LEHIGH PL
•
Phone:
COSTA MESA,CA Zip: 92626-6121
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: " 0
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REPLACE DRYWALL IN ALL OF THE WALLS IN ALL 3 BEDROOMS AND 1 BATHROOM.
CHANGE OUT 2 WINDOWS IN FRONT BEDROOM, 1 WINDOW IN EACH REAR BEDROOM AND 1 WINDOW IN THE BATHROOM
TO REPLACE WITH DOUBLE PANE GLASS AND MEET 1997 BUILDING CODE REQUIREMENTS. DIMENSIONS WILL REMAIN
THE SAME.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $2,550.00
Permit: $83.25 Claim Valuation: $2,550.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
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
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
244646(6/00)
DECLARATIONS 1.
•
WORKERS'CO/APENSATION 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 maintajn 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 carder and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
I2_..1 certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so es to become subject to the workers'
compensation laws of California, d 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
AppIf nt S19neture y /1/jfA Dat> 6/70
2-
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION 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 37060F 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.N Class R
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).
Lender's Nam& 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.).
c :, :l.am.exe g de( c r Business and Professions Code for this reason:
`lgnature� 75�`GT/
fit r—
/ Expic res: 3-41—0 3
Verification of Ownership by(type of doc m t,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY P:RMIT 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? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ 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 ❑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 California Health and Safety Code Section 42303 been made? 0 Yes ❑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
a�mA�tle ' arty for igsp do urposes.I agree not to occupy or allow occupancy of any building authorized by this a m/Lunti final inspection.
5 / 'SLignature bf'CegafOwner(s)—" F 'CDe e�
And/Or Authorized Applicant Date
CODE! INSPECTION TYPE DATE INTRIALS CODE I INSPECTION TYPE DATE jNTmALS
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 �7
204 Final Demolition 250 Final Building/Occupancy ` 2 f-6,1 (y6#
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MF CITY OF COSTA MESA
F4y :l BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER
—._:_-•k PERMIT
00-01035
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
•
Job Address: 2513 LEHIGH PL Status: ISSUED
Suite: Applied: 07/11/2000
Vicinity: RESIDENCE&ATTACHED GARAGE Issued: 07/11/2000
Parcel Number: 14142418 Zoning: •� p •
ISSUED BY: ..."._
Applicant: ROBERTS, WALT
Address: 1653 SUPERIOR AV
Phone: (949)642-7222
COSTA MESA,CA Zip: 92627
Owner: SUYDAM, LOTTIE L TR
Address 2513 LEHIGH PL
Phone:
COSTA MESA,CA Zip: 92626
Contractor LEE ROOFING OF COSTA MESA
Address: 1653 SUPERIOR AV
Phone: (949)642-7222
• COSTA MESA, CA
Zip: 92627 License: 349686
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF:T/0, INSP SHEATHING, 2/15#FELT,25 YR DIM. SHINGLES-TIMBERLINE, RIDGE&NEW FLASHINGS.
2800 SQ FT.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $4,800.00
Permit: $111.25 Claim Valuation: $4,800.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $111.75
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
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
WORKERS'COMPENSATION DECLARATION:
Phereby 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 carne and policy number are:
Carrier: es rn r,'c ,Ll-'-YI/10 • Policy Number:
(This section need 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... that if should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisionss.
ApplicanfSignature: C?). e • Date: '7-/, --g7.9'
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(4100,000),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 provisi•. 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.It / Class N
ConkacIrignatuie: Alk
/4/• /'fl _ Date:. '7— / / '077
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 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.-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,Ttle 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? ❑Yes ❑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).
2fe-_ wh an..or occupant -..ito-file. ation cute materials?
No
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous mYes ❑
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akJermit 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 ❑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).
ir..Quage.-_ co hs is
7 If a permit from the South CoastlosAir Quality Management is at or dother air pollution control district agency is l 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? El Yes ❑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 for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
f Legal Owner(s) Date
� 7-/t'—�'/)
r nd/Or'A orizedA'pp(Icant. Date
CODE• INSPECTION TYPE PBM RITITIALS CODE I( INSPECTIONTYPE WArg INTITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa FinalC, tyre rpt 208 Final Plumbing
�^
200 Final Re-Roof 7•I /•� �w}I L?j ` 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
OWNER DEATS, MARVIN DATE 4-5-63
JOB ADDRESS 2513 Lehigh P1.— BUILDING PERMIT NO. 19.256
GENERAL CONTRACTOR Owner-Bldr. VALUE S 1,056.00
AP No. 141-424-18 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Patio-Roof
INSPECTIONS Signature DATE GROUP J TYPE V ZONE R-1
Soil PERMITS ISSUED
Gas SUBCONTRACTOR DATE NUMI3ER
Water
Rough Corn. Ref rig. 0 Air Cond. 0
Rough Heating
Rough Plumbing _
Miscellaneous
Prop.Swr.Line 0 House Con. ❑ St.Swr. 0
Sprinkling System
onstructioiFPo1e
Underground 0 Power ❑
Rough Wiring
Trenches U Forms U Steel Heint. U 7 71 1-11-6, 9
Floor System
Bond Beam ❑ Steel Reinforce 0
Sheathing EY/4 11-17-6a_
Frame and Flashing ry-74
Lathing — In ❑ Out 0
Plaster, brown coat
Rettig. ❑ Air Cond. 0 Final •
Heating, Final
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final
Building, Final F 9-at.;
OCCUPANCY
FORM BU4-514 - 7.61
19256
FERECEIVED
CA
MESA BUILDING-SAFETY DEPARTMENT APO 5 1963
J} P.O.BOX 317 COSTA MESA,CALIFORNIA
\ FINANCE DEPT.
For Applicant to Fill In Completely APPLICATIOaI?iDOPE TA MESA
TYPETORLE- 14 PRINT BUILDING
BUILDING a �/ .l3 /�j JT fie. Office Use Only
ADDRESS VI J.
RECEIPT NO.
COSTA MES
A, CALIFORNIA YRECEI/D BY Dwc - /
OWNER Al nl? /V// 1 Tl ye,- 1
T ISS 1
BUILDING
MAIL
ADDRESS V AM A ADDRESS /
M s ---i.
( M` FIRE
CITY (DA 0 -r/�l / {1=ieNO. ZONE ��// /TTYP GROU'UPP
-
APPROVED /'y . . DATE/ l/�'
ARCHITECT TEL. �� BY b //.j// .
OR ENGINEER NO.
ZONING
ADDRESS
� ( ZON I NO.OF /� USE OF NE�j��
D, _ I/I/ 1 I PLANS {._ BUILDING/�/A
CONTRACTOR ` r/ (J GV���J�"
•
LEGAL /a 3 n ' /
ADDRESS DESCRIrt1O J/ �/' I ` Q
CITY A.P.NO. / - /_ i] e:3-el.- / O
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE - TEL. 90'TO SIDE&REAR P.L.
LIG.NO. NO.
/ EAV
SIZE /_ O I NO.OF ELOGe. . ALLOES
WED (U.B.C.REQUIREMENT)
OF LOT N� Now ON LOT
U/}J //�'+L 1" YARDS APPROVED YARDS APPROVED
EX STO NG BLDG. l PV4+ ' /!t'/ MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STpRE/ET).. ��nn
SETBACK LINE FROM //yy , FRONT /.�Y.l F(a .�• FT.
CENTER OF STREET REAR YAR/Dtf•� /
SIDE YARD I LEFT L / I RIGHT 'b ' R.SIDE (OFT. FT.
DESCRIPTION OF WORK FT.
NEW _ ALTERATION _ ADDITION
DISTANCE BET. BET.MAIN&
MAIN SLOGS. ACCESS.SLOGS.
REPAIR MOVING DEMOLISH
l DATE
BUILDING/6/.,/ NO.OF J /
SIZE T ROOMS STORIES P. APPROVED
EXTERIOR WAIS,______, ROOF ///��� q - / ) /'
COVERING I ROOF
j//yJ BTW• L, DATE 1'(' �S—b�
6.727
USE OF BUILDWG AND WORK TO BE P ORMED�
N
SQ.FT. G
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION a 4r(7 ca BUILDING CONSTRUCTION.
.() PERMIT FEE $
SIGNATURE OP(�/y cit, . +v O O
PERMITTEE /' L✓""1 •'�` �'� / L,I S'O D
$/C� PLAN CHECK $ / p
AUTHORIZED AGENT TOTAL FEE $ /� Co• n
OWNER GRAHAM, JOHN N. JR. DATE 5-6-59 •
JOB ADDRESS 2513 Lehi•h Plaoe BUILDING PERMIT NO. 92n1
GENERAL CONTRACTOR Owner-Bldg, VALUE $ 244.00
AP. No. 113-344-07 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Block Wall
INSPECTIONS DATE GROUP TYPE 3 ZONE R 1
Underground Soil U.G. water PERMITS ISSUED
Underground Gas — SUBCONTRACTOR DATE NUMBER
Overhead Water and Gas
Rough Heating _
Rough Plumbing
Miscellaneous
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating, Final _
Plumbing Fixtures
Final Gas Test
Construction Pole
Underground Power
Rough Wiring
Trenches rForms Steel( lyes SrJ- 5.9,
Floor System
Steel Reinforce Chimney Re-Rodjr
-)�-:��"
Bond Beam
Sheathing
Frame and Flashing
Lathing, In Out
Plaster, brown coat
Plumbing Fixtures, Final
Electric Fixtures, Final
Building, Final
OCCUPANCY
Form 210-3M-4-59 9d01
9201EE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT ( , ; ,.MAY 5 195$
P.O.BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT.
FOR APPLICANT TO FILL IN COMPLETELY APPLICATIONFFORAPERMIT
TYPE OR PRINT
'A BUILDING
ADIDRESSG 2-5-73I3 W,+G# PK�GE r/�
COSTA -M`ESA,CALIFORNIA� /p.� T FOR OFFICE USE ONLY
OWNER ffI� ry Vitel4 *44 M. I RECEIPT NO. �' NMI} NO.
MAIL RECEIVED BY DATE RECEIVEE-DGS DATE IBS
ADDRESS smwr �s J I ,5--5--� / I J - -;S'!:::7,
CITY 1- .&..��• €STT /`ttM TNO. NsNF. BUILDING
ADDRESS
ARCHITECT .I LIC.
OR ENGINEER /L/ V Td1M
}SG1JSJM NO. COSTA MESA. CALIFORNIA
A,A(DDRE✓SS -2 57 • _ DL 8}/ PL/9CI ZONE Type Group
UGoP L/?-J�}f'' STATE ,_ APPROVED DATE
CONTRACTOR Wei
.. ' it . • I
/
ADDRESS ZONING
LEGAL LOT J )) I Z 7 S0 ZONE NO.OF USE OF NEW 1
DESCRIPTION NO. / JJ BLOCK TRACT . R / I PLANS / .I BUILDING IA/�'V/✓A\.
QQ (/! � y
A.P.NO. '13 — .3 41 U - O /1' BYPROVED.1" O 91/n _ DATE ..c-") �S_F/
SIZE 7 1 1 X / Z S 1 I NO.OF NOW ON LOTS /
YARDS EVES
REQUIRED YV�S-del YN1N ALLOWED
OF LOT
USE OF EXISTING
2.24-••
(CENTER LINE ST.) 1
BLDG. FRONT ,w FT. IN.
SETBACK LINE FROM 0
CENTER OF STREET 3 o REAR YARD R.SIDE FT. IN.
SIDE YARD I LEFT SPL IT The Ip,RIGH L.SIDE ff FT. I IN.
• N.
DESCRIPTION OF WORK REAR 0 FT. U IN.
�/
NEW I II ALTERATION II ADDITION I/� •
REPAIR I II MOVING I II DEMOLISH I
BUILDING NO.OF
SIZE ROOMS STORIES
EXTERIOR WALL I ROOF
COVERING COVERING
USE O BUILDI WO K TO BE PERFORMED
I3 biD s r- c64474
Cl dDert BLDtK WALL
i IV
I HEREBY ACK NOWLE GGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONS CTIOH. VALUATION
SIGNATURE OF Q ` / G' PERMIT FEE $ .�. Z�7
PERMITTEE (F IY, ✓K� .1� �`� �/
PLAN CHECK $
$
iii/✓//���` r J J(/
AUTHORIZED AGENT TOTAL FEE $ 4', 0'Z-,
OWNER Costa Mesa Estates DATE 4-12-56
JOB ADDRESS 2513 Lehigh Place BUILDING PERMIT NO. 2733
GENERAL CONTRACTOR Roven-Spiegal Co VALUE $ 11,200.00
LOT 133 BLOCK TRACT 2750 Single Res. w/att gar
GROUP 1 & J TYPE V ZONE Rh FIRE DISTRICT 2755
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
DATE NUMBER
Footing Trench $> y:13,—.1
Foundation Forms and Grade to Garageft 7 /8- t
Rough Framing /0�-...241:46
Plumbing,Rough to Slab Safi 4 S f s -_ P o
Plumbing,Rough Complete Vm Q.S 0 j Ste- /,/214.4...:•ce.-1,-E': ( r�, ^ -,71P-r Gag a 6 "-
Temporary
Temporary Pole
Wiring, Rough 491 /0' Z'J't 4%OnnAl222_?1t c.' • /0-//'7-�,r/4 a 30 / — _
Heating,Rough P7) - 5 //D t.419_4,,27,-,. S�n ilrl1,t.rt, /0-/Q-7 V —
Heating, Final Nn es ) -})s7
sewer, Housei✓a.k. Sewer,St. {yt £-S V3 ...rt. p , A ,k . err . 4 - / , SA , < —
Septic Tank or Cesspool
Lathing, In Out 1 ' /1- 8 -s,
Plastering .tom- 6 - 0.--Z1fr 6
Plumbing,Final,Fixtures Complete fP1 • -y
Plumbing,Final Gas Test J3%1�`vvAn
ve.5 -a -s' ' -V-xc7 .- -c-.
4 .fc�
Wiring,Final v0Z--- ) ,..2e,t
v Ga
•
Occupancy izo t.
FORM 210 3M 10005
Costa Mesa Building Department . - APPLICATION FOR PERMIT
• f COSTA MESA,111 EAST gCAL FORNIA th STREET 1�y 55 BUILDING
®•
FOR OFFICE USE ONLY
FOR APPLICANT TO F L IN
G Receipt No. Permit No.
Building 13
Addre ✓
S 3 C sta Mesa, ' a ornia R-e-c7e�iivve,d by //Date Recd. Date Issued /
Nearest A/ y/�/� ! T /a-J V'/�-S-6,
Cross St. "/' 6 `"' Building
/j, Address
Owner �- /2Oc�
Mail --ffes� Costa Mesa, California
Address -SL tD. G/✓, Nearest
`c /I_ � `s Te �t�-� Cross St.
City 3�"�" No..v4j _ 7 Zone// I No.of I Type / Grouft ,
Architect or Lic. J c Plans -hf�(,/�
Engineer �V/GC" /LIG- No. Approved
Address S�I/,Pl>Car4 cin r by CORRECTIONS Date
Contractor,aaiL,) /Ezr,=r c;N29/Y/3 CL9
Address co. 6 ?/s3 �p,10 e--'E/S --
Legal Lot 3 /I t li?.1 � I U 1 �
Description I No. / 3 I Block ' I Tract G%' I • { n
1 II
(Attach Metes and
Bounds) pc---- ) .��
Size of Lot 72411/1.-0 I Now oNo.of n Lots PP.'? j J �Q.riri
0
Use of I No.of I No.of 7s
Existing Bldg. Families Rooms n
Setback Line from /_ Rear Yard Z6 L�TY fir nnn-r. -_\`..II'' c�
Center of Street ;�G Side Yard /4 F6 Vf VUC. in wi J4
DESCRIPTION OF WORK
•
New -Alteration I I Addition I
Repair I I Moving I I Demolish I
BuildingNo.of
Size ��� Rooms Stories
Exterior Wall ies///_ Roof :0°
Covering L%r/ I Covering 5 /,4/�C-G APPROVALS
Use of New 2,,/ --.4/;07.,
Building `j/4/GI's c.',- i�lt -y>Sn Foundation Location Inspector Date
P // � n' Forms,Materials,
//y�l% /�//If(/�j�jl1 yUnder-Pinning
Frame: Fire Stops,
Bracing,Bolts
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply Lath.Int.
with all City Ordinances and State Laws regulating
building construction. Lath.Ext.
Signature of �5i //�� �/��-.
Permittee %2�1i- —�-Tl Plaster, Int.
Authorized Agt. (� • Plaster,Ext.
p \
Valuation "Permit Fee $ J-O Masonry Reinforced
gee, Plan Check $ / _ Bond Beam
$ Z019? Total .� ---Fee $ / FINAL
FARM 206 S-RP 2M R-55
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Lo
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a.
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•
Street
PLOT PLAN
Show location and distances from
property line and between buildings.