HomeMy WebLinkAbout2531 LEHIGH PL - Building Permits 0a5/11e
si9 CITY OF COSTA MESA t
4 BUILDING DIVISION
>%j r.,,,. , DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
1. 1 . PERMIT
�, o44.11411 . 007-00334
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa€tfTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2531 LEHIGH PL • Status: ISSUED
Suite No Applied: 04/18/2007
Vicinity: GARAGE REAR WALL Issued: 04/18/2007
Parcel Nunmber: 14142415
Applicant: BIZZELL, JIM
Address: 817 17TH ST
UNIT 19 Phone: 714-404-8377 ISSUED
COSTA MESA,CA Zip 92627
• Owner: WELLS, IRENE V TRUST, ,
Address 2531 LEHIGH PL
Phone: 714-540-6206
COSTA MESA,CA Zip: 92626
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License:000000
•
SCOPE OF PERMIT
ELECTRICAL PERMIT TO REMOVE(E)ROMEX AND REPLACE WITH FLEX CONDUIT AT REAR WALL OF
GARAGE FOR A SFD.
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 $18.20 1
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 $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0
Switches $0.00 0 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 i -. 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 Pian 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 $41.70
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and,related
regulations.(Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all a able codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2448-48(8/00)
r ,
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.
❑ 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 carder and policy number are:
Cartier: 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 I: s of California,a d a that it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with the .provisions.
Applicant Signature: Tva a I (1 (Date: - Li- J(1-OR
WARNING:FAILURE TO-- URE WORKERS'COM SA COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE('I%•,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3700 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.0 Class a
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: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business end Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
! I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does mol apply to en owner of progeny 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)
license pursuant to the Contractors License Laws.).
❑ I am a pt undeypl Business and Professions Code for this reason:
Signature: .,•..n-,lKv,"_�/1 --
- Eaplres: //,'.9 =-
,T O G
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,Scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑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 0 N
(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 en 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 apernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Wit 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 end 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 end 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 at 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.
likt\ _ _ ._ a
�� . ' '`egal Owner �� -�� �syte
( i 'Or.Authorized Applicant , rDate_
CODE r I/157ECTiON TYPE — MLLE EMU CODE! INSPECTION TYPE QAIF. IN11T1A1.;
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
s.
---n_ &tit 4 emea, neda &St, Devaist
Intmom
"• OWNER-BUILDER
.taxi
uu , _
VERIFICATION E 0 2" ob 33-)
t q
poi- CO 3S
LAddress: 9f �e�+g I� l4�` Permit#:
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as
a condition precedent to issuing a building permit, require the completion and require the return of, an owner-
builder verification.
Attention Property Owner:
An `owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building permit will be issued until this
verification is received.
C 1. Lpersonally plan to provide the majo labor and materials for construction of the proposed
property improvement. ❑ Yes No
OT---I (have/have not) c�/te�uJ JhZlPsigned an application for a building permit for
the proposed work.
_1.have contracted with the following person(firm)-to-provide-the proposed construction:
Name) In. efgl fs
Address 1 City 6AA 1me35
Phone(lly ) \(bt i —83.7 Contractor's Lic. No. �� n.?
4. I plan to provide portions of the work,but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address City
Phone( ) Contractor's Lic. No.
5. I will provide some of the work but I have contracted (hired) the following persons to
provide the work indicated:
Name Address Phone Type of Work
1042-46 (Rev.11/04)
1
DECLARATION OF AUTHORITY Bldg. Permit#
FOR AGENTS OF PROPERTY OWNER '00 3�7
TO APPLY FOR PERMITS This Permit# - oft;-257
treefAddress: d�SV1 '� 1i [ I Le AP Number:
1.—l-(we),r J' t�r..'_2-exJi , declare that I am the Owner of Title of the above
L---
referenced real property,
,()and that I (we)hereby authorize: L
Name: n on L1f_ 4)rfS �1 Telephone Number:/\ � C
/7 Vr7' - 0.377
Street Address( 3 67 r 1. / .Jf.
City: Qcs k .. ,rf'aP State: Zip2ccn
to obtain permits in my behalf,as owner/builder,for
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I (we) shall immediately provide Worker's
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa
Mesa,as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this day of 20 , at ,California.
Print Name: - T/PF,-NE' . V \/I\I E l IS
agnature:
Date:—-- / 7- .2GG,
Note: This authorization does not grant authorization to perform the work as owner,
it solely provides for limited power of attorney to secure this permit in any behalf.
0779-46(rev.11/00)
44Ai
011 It,. CITY OF COSTA MESA
BUILDING DIVISION
> • 0„ ..A. $ DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER
F I .�.t... I PERMIT
� ilirra� P07-00237
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.Pti MBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2531 'LEHIGH PL status: ISSUED
Suite No Applied: ,04/18/2007
Issued: 04/18/2007
Vicinity: REAR OF HOUSE .
Parcel Nunmber: 14142415
Applicant: BIZZELL, JIM
Address: 817 17TH ST ISSUED BY:
UNIT 19 Phone: 714-4044377
COSTA MESA,CA Zip: 92627
Owner: WELLS, IRENE V TRUST,
Address 2531 LEHIGH PL
Phone: 714-540-6206
COSTA MESA,CA Zip: 92626
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 000000 ••
•
SCOPE OF PERMIT
PLUBMING PERMIT TO CHANGE OUT(E)WATER HEATER(SAME LOCATION,REAR OF HOUSE).
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow Irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 '0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 H) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 • Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo 50.00 0 Wash Basin Set $0.00 0
Drain,Floor $0.00 0 Sewer Connect 30.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0- 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 30.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $35.80
COMMENTS/SPECIAL CONDITIONS
•
NO110E: 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 WOO)
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 a 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 s 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 th rovislon,�///� kr-67
Applicant Signature: 1Wf K Date: —/
WARNING:FAILURE ECURE WORKS PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLAR 100,000),IN ADDTON 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.# Class If
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: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
titan ursuant to the Contractors License Laws.).
❑ I am mpt and Business and Professions Code for this reason: _
Signature: `yb
) (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,faisework,or demolition or dismantling thereof,will be more than thirty-slx(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Tule 8,California Administrative Code).
❑ As owner-builder, I wit 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? 0 Yes 0 No
(Section 25533 of the California Health and Safely 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 0 N
(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 Celitomia 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 appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes u No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above Is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
' • ature Of Legal Owner(s) Date
•% ya, � ( • ,e[0 �( �I if
/ •--:1•rr Authorized Applicant' (Date '2
CODE INSPECTION TYPE VATF KMT1ALS CODE INSPECTION TYPF gM. INTIDALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical A
208 Final Plumbing £$ 14-o7 3—
1266 Pool Spa Final
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Flre Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition _ 250 Final Building/Occupancy
PROJECT ADDRESS: 2531 .LEHIGH PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 05798;
OWNER'S NAME: WELLS DEAN E
ADDRESS: 2531 LEHIGH PL PERMIT NO: M 057987 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: OTH
5406206
ARCH/ENGINEER: REG,NO.: JOB DESCRIPTION : FORC—AIR C/O SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: 1 , 100. 00 CALL—VALUE: GROUP OCC: /
PERMITTEE: GRAHAM BROS INC. ( 714 ) 546-1653
ADDRESS: 2952 CENTURY Pb COMMENTS; REPAIR/ALT HEATING UNIT&INST FORC—AIR
COSTA MESA CA 92626 ********4** *********+E******* *+r aE+E+6**+E******+F*TE****+ETr***T6*****+F***************
• LICENSED CONTRACTOR DECLARATION: I hereby attirm that I am licensed under provisions 01 Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)at Division 3 of the Business and Professions Code.and my license is in full torte and effect. SETBACKS
CITY LIC.: 005963 STATE LIC.: 2486 Cuss: C,v
Date. 7' l '-"IZ. Signaler MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby attirm that I have a ceniticate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance,or a cenuied copy thereof(Section 3800.Lab.C). LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY ND.: WC 71610 3 0 2 2 6 01 1 mom 08/01 /92
COMPANY: LIBERTY MUTUAL PARKING REO: PROV: PARCEL : 14142415 ZNE: REF NO:
I Certified copy is hereby furnished. CR Certified co.. 1•,with the city Buitdim Division. PLANNING NOTES>
c >
IDate: 1 ' I - '9Z Applican — ' A. 2 *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permt is for one hundred(SICO)or less). DEVELOPMENT SERVICES REQUIREMENTS
I cenity that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY . DATE:
Dale: Signature:
NOTICE:If.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: _ _
Code.you must tonhwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby attirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: ...air DATE: —7-- /—
which this permit is issued(Section 3097.Civ.CI. ********************** - ********4********t4-**
LENDER: *************************************•******************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the fallowing reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 1 8. 00
repair any structure.prior to its issuance.also requires the applicant for such permit to life a signed statement that he/she is licensed 2 5 Z SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN +'
any applicant for a permit subjects the applicant to a civil penalty al not more than five hundred dollars(5500). ISSUE FEE 1 5. 00 m
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 18 . 00 15 . 00 0 . 00 33. 00 33 . 00 ei. . 00
does not apply to an owner ot a property who builds or improves thereon,and who does such work himself/herself or through L
his or her own employees,provided that such improvements are not intended or offered tor sale.If,however the building or '
improvement is sold within one year of completion .00
,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 3 3 .0 0 OVER/SHORT•
torthepurposeotsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING. PLAN—CHECK
I.as owner ot the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 33 . 00 1
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of proper y who builds or improves Thereon ^
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).lam aware ********************************************************************:4** ********
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.A P.C.
for tills reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9 . 00 9 . 00
I do hereby cenity that I am aware ot and understand the requirements of California Health and Safety Code Sections 25505,25533,and MEC 1 REPAIR/ALT HEATING UNIT/SYS W/CNTLS 9 . 00 9 . 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from END OF FEES
these provisions.
Dale: Applicant: Q —
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ........--.0---" SI$ ! 'l�
Ordinances and state laws relating to building construction and here auihor¢e representatives of this city to enter upon the above-mentioned
property for inspection purposes. / \ '�yBt jL1J
�Q, .dutho t ol20009E1-1 suoll�adsui a?,E�Idwoo+.EI
Dale: ' 411-Z— Signature. •
�� 0009E1-1Q 3 8 1 d X 3 rl 7., :-. _ .l . .: 1 --
Driver's License or Social Security a: C •T:; r: :'.L ' -
1641.46 White—Budding,Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING POI, SPA
APPROVALS Permit# Date Inspector APPROVALS- Permit _ Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. - 54. Forms •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
•
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-I Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing j HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test _
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final -
41. Solar Domestic-Final
42. Backflow Preventer
43. Backf low Irrigation
44. Landscape Irrigation System .
45. Sound Attenuation EXPIREI)
46. Handicap Regulations 'morn lete tiWoirticuts
47. FINAL STRUCTURE & BUILDING 'NO -X} .$7g
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. _ Date
OWNER Costa Mesa Estates DATE 1I-12-56 _
JOBADDRESS 2531 Lehigh Place BUILDING PERMIT NO. 2736
GENERAL CONTRACTOR Roven-Spiegel CoVALUE $ 11,200.00
LOT 136 BLOCK TRACT27SO Single Res. w/att gar
VRh
GROUP I & J TYPE ZONE FIRE DISTRICT 2758
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
DATE NUMBER
Footing Trench '�: 8MBER
Footi •
ng TrForms and Grade to Garage, 7-4-s- .-4„/
Rough Framing _ (r16i6 to- -2 C v
Plumbing, Rough to Slab 3 g e-S ,(-' �n �
Plumbing, Rough Complete ?2e 5 S .. a...e - ...,4.,- tilrw��,. X-,./pQ-,re; e ,J,
f --
Temporary Pole et
Wiring, Rough4fr- d'17'J'a �v2A.r3 ./.L �.: ._lPQneiiA. to -n, -C 33 o 9
Heating, Rough '2i�pFr - '+-CPOntA Sb, )lt'tP 0 -/t-4- 7/ 7/ ----
Heating,
Heating, Final f/ P71 C.5 -a-8'.(r
t/ �+ b
$ewer, Housei✓a& Sewer,stfflCS a-3'S?i K.)34 . &o—w, . 9•/ S•Si, Sa38 —
Septic Tank or Cesspool y C V
Lathing, In Out ft G / f-- Si` _ _
Plastering > 12-.2$- - -
Plumbing,Final,Fixtures Complete PIC-S.,
2' 8'S a l LL ,. <. _
Plumbing,Final Gas Test 1$g me3 a.-;_ -Sb � _- — '\ ��v •-
Wiring,Final 7-c4 t. ` w•
Occupancy TJ') et'+'+»Z Il--p. '46 i- 4-----
FORM 310 3M 10.55
. Costa Mesa Building Department APPLICATION FOR PERMIT
` •• 275
,� 111 EAST 20th STREET BUILDING 1
i COSTA MESA, CALIFORNIA
NW FOR OFFICE USE ONLY
FOR APPLICAN TO I , IN Receipt No. Permit No.
AAddress. r > rXGiCe/ 7 3
Received by Date Rec'd. I Date Issued
CostaM� % aifornia
( V—/
� -, u -/, -J
Nearest ��Vii/ °(i
Cross St. Building
Address
Owner e05779- /&F -6S' ' - Costa Mesa, California
Mall G(/ 3
Address `/.' Nearest
// __ TeL,,//��^� Cross St.
City �L2'47 ' /vl�� No.r"---`" -V/ lair I No.of I Type v G I
Architect ora ��� Lie. Plans �/"
Engineer F1'�-F �l"i No. • Approved
b Date
Address --<,...21,62-4/4"....k;s3rt-?,,WL CORRECTIONS -
Contractor,-JdF-Nj/Ffiyt!- NCity
o. I2,jy�
i.
Address ....57-A:57/1/2 gic, ei '/ l67---6 -- ^—� ^--
Legal I Lot /C I / I 7 y i : P . 1 ��
Description No./ Block I Tract 27-lt.' I c a ' s _ i ' ,t
! 1
(Attach Metes and Bounds) i c--t t .J
La
i No.of Bldgs. ��� 9CC
Size of Lot 9 7x /aw I
Now on Lot F'• 1 �SJ•�
Use of No.of No.of 0
Existing Bldg. I Families I Rooms • I)
Setback Line from ` ,, /y.� Rear Yard .37 11IT/ nr nnnr n nn.-el ,
Center of Street �� CCS' Side Yard /2 E.� vi t I V! V V i.I/1 i„ _JH >
DESCRIPTIONIOF WORK r
New I -NJ Alteration I I Addition I
Repair I I Moving I I Demolish
Building 274-3)c-1-0
/,-3X /-0 No. _
Size �f- 6' Roomsof Stories /
Exterior WallA. Roof -
Covering j%G f'•- D I 54y��Covering $4J Avn.,(=- •" APPROVALS
Use of New l'
Building - "6Z€5' fl-7.5.927,1‘,74,./c..:„.27./.;' Foundation Location Inspector Date
1 Forms,Materials,
V //TTBI�e/) '4' W-fi-7- Under-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 oft ..
Permittee > T Fh�( ot/e Plaster, Int.
Authorized Agt. fJ1liie--- •-l-e--te--6l-7 Plaster,Ext.
Valuation rmit
Fee $ 0,2-/--- Masonry Reinforced
�G$0 n Check $ / T -- Bond Beam
$ 2(1'7' al
/ $ fro? FINAL
WnRM 204 S-PP 2114 a-55
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Street
PLOT PLAN
Show location and distances from
property line and between buildings.