HomeMy WebLinkAbout2524 LAUREL LN - Building Permits of/ CITY OF CTA MESA REQUEST FOR OCCUPANCY
TRACT NO. /6097 DATE: /— /K—�O
DOT NO. 3
ADDRESS 02T2 I t40.L.ec O Q-n€E / Co c7--)4 t-7n3-4-, c
Z7
The develrpPr of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
By executing this agreement, the undersigned ackno. ledges that he/she/they
was/were advised that this tract has not been given final inspection nor has
it been accepted by the City of Costa Mesa as having complied with the conditions
of approval which were inpcsed by the City at the time the Final Tract Map was
approved.
The City assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted conditio I ). /
// /� }��12�22
BY �
ature .f Purchaser)
RECEIVED
CITY OF 07ITA .cSiv. • BY
'
•-;1 ( i. a s e o veloper and/or
JAN 1 A. 1980 - authorized representative
CALIFORN FEDERAL SAVINGS & LOAN ASSOCIATION
1
1819,1Uilli12i1i2i3i4i5P6 BY r q )� l
! - Richard A$1Ganaatu Aof L.eanntrVicePre .;. ti:,,A.W
COMO FM
4/79
ADDRESS OF BUILDING: UNT: —
OWNER'S NAME 2524 LAUREL LN CITY OF COSTA MESA — BUILDING PERMIT •
ADDRESS: JACOBSON, DONALD A PERM NO: P 07565€
2109 E BALBOA BLVD
BALBOA CA 92661 PERMIT NO: P 075656 PLAN CHECK NO: N GOVT: N SUPP: N •
APDL.MMUNG ADDRESS:
631 0 3`3 8 •
OTIi
• CONSTRUCTION TYPE: V—N • - - PERMIT TYPE: PLU . PURPOSE:
ARCHITECT OR ENIgNEER: UC.NO.: JOB DESCRIPTION : C/O DISHWASHER SQ FT:
ARCH.OR ENG.'S ADDRESS: WIT: ,,
CONTRACTORS NAME CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 / •
PACIFIC COAST APPL INSTAL ( 310 ) 324-8476
CONTRACTORS MAJORS
139 WEST VICTORIA ST DG No. COMMENTS: CHANGE OUT DISHWASHER
"DRESS' GARDENA CA 362642 . ###########################################################################*###
• 90248 UPC: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 SETBACKS .
(commendng with Section 7000)of Division 3 of the Business and Prof signs Code,and my license is in full force and eller!.
CITY LIQ NO.: LIC.CLASS: LIC NO: .
/J� q ]�/ C 10 62 XP: 11 /96 MAIN BUILDING ACCESSORY BUILDING '--
Dele:j l OP, Ig ri c°ntnanr� � � � /�11 I/� FRNT: FT IN REAR: FT IN . FRNT: FT IN REAR: FT IN
OWNER BUILDER DECLARATION:I herebyaffirm underr shatters exLEFT: FT • , IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
penaky of Wry pt from the Contractors License Law for the
ilklowing reason(Section 7031.5 Business and Professions Code:Any city or county whi requires a permit to construct,alter,improve, '
modish,or repair any siturtma,prim to its issuance,also requires the hpdi°amtor such 'to me a signed statement mm he or she PARKING REQ: PROV: . PARCEL: 43917254 INE: REF NO: .
licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of DNeion 3 of the PLANNING 'NOTES>1
Business and Professions Code)or Thal he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section . '
7031.5 by any applicant fore permit subject the applicant toe civil penalty of not more than five hundred dollars 15500(1. - ####
❑ I,asGwrordthe progeny or very employees wlth wages asthe�sole compensation,will do the work,end the evucure®runt intended *'##################################################################Hf#######
or offered for sale(Section 7044,Business and ProfessionsCode:The Contractors License Law does not apply to en owner of property DEVELOPMENT S E R V I C E 'S REQUIREMENTS
who buids or improves thereon,end who does such work timsef or hersea or through his or her own employees,provided that such
improvements are rot intended or offered for sale.5,however,the building or improvement is sold within one year of completion,the '
ownerbuider will have the burden of proving he or she did not build or improve for the purpose of sale). ZONING APPROVED BY _ DATE:
❑ I.as OW1113(of
• Professions Crhe ede:The ontracors License Law does am exclusively no licensed an tractors to construct the owner of properly wlto builds orimprovesSeclim therBusiness end .
eon and who •
contracts for such projects with a comractogs)licensed pursuant to the Contractors license taw). BUILDING APPROVED BY DATE: n
10Iamexemprundrsectio : B.APc..forthtereason: APPLICATION ISSUED BY: �� DATE: -I -9s •
Date: Owner • ############################################# s ############## ##
Ido hereby certify that I am aware of and understand the requirements of Celfomia Health and Safely Code Sections 25505;25533,and LEGALIZATION:N •
F E •E SUMMAY STRUCTURAL SEGMENT:N
25534.and that I or any future building occupant will/wnl not(circle one)need to comply with said stale codes and the requirements for •
a permit forconsructionor modification from the Air�- tyty enagementDistria.Residentialconstruciorneppkwinsareexemptfromthese •
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
• provisions.
PERMIT 7 .0 0 •
Date: Applicant:_ • _ 2 5% SMIP/NON—RES
. WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declarations: PLAN ,
IDI have and will maintain a ceniricale of consent to sef:nsure for workers'compensation,all provided for by Sectionof 3700 the Labor ISSUE FEE • 20.,0 0 .
Code,forthepedoanncedthewontforwmchthispermiti°issued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ I have and wit maintain workers'compensation insurance,as umpired by Section 3700 of the labor Code,for the pedormance of the TOTALS---—> 7 . 00 '20 .00 0 . 00 27 . 00 27 .00 , 00
I work for which this permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier: CO?^BN i'_ CLE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 27 . 00 OVER/SHORT: 00
Policy Number: PItI O74Q4. . 08/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not be . plated athe permk is for one bun r. pilars(S1r.1 or kiss.) 27, 00
❑ I may • a the•:dormance o the work for which this permit is iss .I I shall not employ Renton in any manner so as to .
beco s blest to he woo. compensation laws d California. and that a 1.3hou subject lot workers'• #####################################RF#################!(r###############dE#######
Section 3700 of the Labor Code,I shall forth 1 1 • with at
Dae: r APptat it ,I J �1 e, I N• D I V . I D U A L F .E E BREAKDOWN
i r
Warning:Failure to secure workers'compensation coverage Is unlawful,a shelf subject ean ns yr to criminal penalties and TYPE QTY D E S C R I P T I. 0 N UNIT COST TOTAL COS T •
civil fines up to one hundred thousand dollars(5/00,000),In addition to a cost of compliant•n,damages as provided for In
Section 3706 of the Labor Code,Interest,and attorney's fees. '
• CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury Ihal them u a construction lending agency for the PLU J. DISHWASHER • 7 .�00 7 . 00
pedormanceof he work for which this permit isisued(Secion3097,Cir.C). END. OF FEES
LENDER'S NAME: -
LENDER'S ADDRESS: - F .1. I
.
I certify that I have read this application and state that the above information is correct.I agree to comply with all dry and county ordinances
and stale laws rel ting to building construction end hereby authorize representatives of this city to enter upon the above'rnentined property
. for inspection pa ,
JAMIE PAICHTA _ •
p �1 D P� f� 'a�/�J �� — 01 00196821-00196321 TOT:44 27.00
( MA I Da : v/ DATE: 12/19/95 TIME: 12:46
\_/ ..ignal're of Owner/ enVAhltan on r — .
(5151 6.WP) L White-Building A Se{liety:Green-File Canary-APPYcanl:Pink-Revenue:Goldenrod-Assessor '
$ BUIL
UNT:MEIFIDIOYIN: 2524 LAUREL LN CITY OF COSTA MESA — BUILDING PERMIT
ADDREss. JACOB SON, DONALD A •
PERM NO: P 075656
2109 E BALBOA BLVD
BALBOA CA 92661 PERMIT NO: P 075656 PLAN CHECK NO: N GOVT: N SUPP : N
Ain MAILING ADDRESS: 631-0338
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
ARCHITECT OR ENtlNEER: UC.NO.: JOB DESCRIPTION : C/O DISHWASHER SQ FT:
MEN.OR WS ADDRESS: WIT:
coxmACTarsxAME: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
PACIFIC COAST APPL INSTAL ( 310 ) 324-8476
CaIIRACTORS MAILING 139 WEST VICTORIA ST COMMENTS: CHANGE OUT DISHWASHER
ADDRESS: GARDENA CA UC.NO.: 362642 *+t*at*at***stat***it'*****it*sEatFtstie+tit****at***ititstuit'*** (*rt***aster*at***x*x'atat* it+t**** **rt***
90248 U"T' ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I ant licensed under provisions of Chapter 9 SETBACK S
(commencing with Section 1000)of Division 3 of the Business and Prof cions Code,and my license is in full force and effect.
CITY LI .NO.: L C.CLASS: LI °A
�Q�Q 7741 C 10 I T3(6� ret y P: 11 /96 MAIN BUILDING ACCESSORY BUILDING
Date: II�"'tt !l���l Conlredo� y�� ((� �� FRNT: FT IN REAR: FT IN FRNT: •
FT IN REAR: FT IN
VER BUILDER DECLARATION:I hereby affirm under penal) of LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
YMY that I am ex pl from the Contractors License Law for the
Ong reason(Section 7035.5 Bushes!and Professions Code:Anyjay or county veil requires a permit to construct,alter,improve,
olnh,or repair any structure,prior to its issuance,also requires the pliaant la such permit to file a signed statement that he or she PARKING REQ: PROV: PARCEL : 43917254 ZNE: REF NO:
is licensed pursuant to the provisions of the Contractors License Law[Chale 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES>
Business and Professions Cade]or that he or she is rxempl therefrom and the basis for the alleged exemption.My violation of Section >
7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than We hundred dollars[mow
❑ I.uowner ache norm sea with wagestheir sole cam *******************************************************************************
or offered fon sale(3endn 704a Business and Professions Code:The ContractorsLicense Law does not the
to an Sewerofaopeed
property
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
who builds or improvesthereon,end who does such work himself or herself through herown employees. that such
improvements are not itoffered sale. however.the building or improvement is soldwithin one year of completion,theowner'baimerwillnaveheburdanofpraninghearanedidaWiloimprovef«rthepumaseaftsan).
ZONING APPROVED BY DATE:
o
I,as of the
Thee C Contractors Licam ense law does not with licensed
appy toancontracto construct the tors
property who buildsion thereonendness and
end who BUILDING APPROVED BY : DATE:
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law).
❑ Iemexempt under Section: B.8.P.C_for this reason: APPLICATION ISSUED BY: ��y DATE: r Qs
i
Date: Owner ********************** •: ************** �**** ******
I do hereby certify that lam aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.wird LEGALIZATION:N F E E SUMMAY STRUCTURAL SEGMENT : N
25534,and that tor any future building occupant will/will not(circle one)need to comply wih said stale codes and the requirements ler
a permit forcolaWddn or modifirationfrom the Av ue iy ananegemenidstrict.Residential construction applications are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 7.00
Date: _ Applicant: 25% SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following dada:atia s: PLAN
❑ self-insureIhave and wit mailman acertificate of consent toSection
for workers'compensation,as provided for by 3700dthe Labor ISSUE FEE 20 . 00
Code,for the perarmenceof the worfor which this pemtflscsued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
'err]
, Ihave el
ndwmsimaitworkers'compensatoWOO 4the Labor Codea
for TOTALS----> 7 . 00 20 . 00 0 .00 27 . 00 27 . 00 . 00
- ,6 work for which this permit is issued.My workers'compensation insurance carrier and policy number are: '
A Carrier GOLDEN EAGLE EXPIRES
NWC3� REVENUE DIVISION TOTALS > COLLECTED: 27 .00 OVER/SHORT: . 00
Po Nabi: 07404 08 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This sectionneed not be ompleted A the permit is for one hun ullars(S1••j or less) 27. 00
❑ I cents I in the ormance of the work for which this permit a ras :I I shall not em any man r ea as to
co .•- • bird t Ih: •. . • compensation laws of California. and 1. : that d 14ho wbl•• to I woMara' *******************************************************************************
be •. . ' cmpgathe labor Co de IoFdl Tann M1
Dale. # / I Applicant. Jli , A I i��i,Lie • IND I VID UAL F E E BR EAKDOWN
Warning:Failure to secure waren'compensation coverage/s unlawful,a.d shall subject an •foyer to criminal penalties end TYPE QTY DESCRIPTIO N UNIT COSTTOTAL COST
civil cines up to one hundred thousand dollars($1011,000),In addition to s coal of convents-,n,damages as provided for In
Section 3706 of the Labor Cods,Interest,and attorney,leu.
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency for the PLU 1 DISHWASHER 7 . 00 7 . 00
performance«the work for which this permit'a issued(Section 3097.Civ.C). END OF FEES
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that hay e fled phis apple onst end nate ThatIha above information is mrreu.t agree ago campypon hl dry end . rayed ropcea L
and state laws u to Wiring construction wird hereby aahorUa representatives d It city lo ante upon iha above .
tunel ropery
for inspection pis
a cyh, JAMIE P ICHTA f
IUnUd1 P IN I / DATEE__ N__ 07.± Old 001bs L-!!',i%A;.:' TOT
LiK.
Date: •
ign e• / ant/ 'Han
(5151.46.WP) White-Building d S ety;Gre n-Rle;Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
1
I.
I - CONst RUCTION AND PLANNING _ ' P( & SPP' .
'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:Elect-rice! Conduite.Utility-Undrgrnd. 54. Forms "' . !•
-
rl
•
'4. Electrical Conduit�l'3n igrnd. 55. Electrical Bonding ,
• :Steel Reinforcement•K 56. Rough Plumbing & Pressure Test
-1.4 - -
- 6. 'Electrical UFERtrnd. 57. APPROVAL TO COVER-GUNITE
` 7. Footings _ - 58. Electrical Conduit:Undrgrnd. _ '
a. Foundation C c ^ 59. Gas Pipe, 0 Und? d.,Test =
- -, , 4 -. _ - - rn
._Water Pipe-Undrgind. - " 60. Backwash Lines[RSrap, 0 Undrgrnd. ,
10. Structural Floor Sys-tem 61. APPROVAL TO_D€CK. - .
11. P,'operty Sewer G-12(4'& House Connection 62. Backwash & Receptor-Final
12. Sewer Cap - • 63. Heater & Vent-Final i
13. Roof Drains 64. Plumbing System - Final -
14. Rough Plumbing_. - - 65. Electrical-Final
15. Rough Electrical Conduit ^ - I66. Solar System-Final - . •
16. Rough Electric Nliring?„ _.. 67. Fencing & AccescApproval ' - - 1
17. Rough Wiring Sign i 68. APPROVED FdAtLASTERING .
c.
18. Rough ElectricalhT Bar Ceiling`-"' 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning_ FIRE DEPT. REQUIREMENT -•
20. fa'ciugh Fa¢iory„Firyp(<ace -.1-1n: tr. '- ' " �,4. I-APPROVAL'St- er.'in it# ' r
-
•
21. Ducts, in Structure.-„T •• •• _ ' r' . 70. 3ndergF6&na�Hydro r
22. Ducts.Ventilating ' tr • -.' Co r, , :71. Product-Piping O'G_as OiOil _
23. Gas P�Pe-Rough & Test FE ,•1 r w: :. -72. Undergrou .: sh7
24. Roof raining4 " ' ; = r :.•73.,Undergrnd'.Storage,Tank OGas ❑Oil ✓1 1
25. Roof Sheathing P n�•741 Overhead Hydro: S.
26. T Bar"Ceiling (Struett7rall & Moriocoat - '
.. .. .. , -. r. ^.. 75.-Dry Chemical a ` r yri +
t l.. • 4- .. �' ""��'
27. Frame and Flashing r _ - r r t 76. Dry Standpipe Y -- !�
-28. Lathing &=Siding _ ' , •',$ 77.'FIXED SYSTEM FINAL„ r }
29. Insulation r F' 78'.--1:FIRE RAEV. FINAL * _
30. Drywall Nailing v+ I`
_, �:�' QHEALTFPT RDEPEQUIREMENT
r31. Plaster Brrt own Coat-•-- -- _.c_ - i 11 T'79. FINAL INSPECTION
:-32. Electrical Powe).1 Meter-Final 'Tik - '80"FOOD CERTIFICATE ISSUED_
* 1
•-33. Final:Electric ;„ tc. L .+ Notes: . . n,, * .' ?
f
r 34. Final-Heating at- Conditionin<y'Z f 4- t .• �, S F • . C'
35. Final Gas Pi e• est Y ^ .. •r ' •-
36. Hood.or Canopy -
_37. Final Factory Fireplace' ' '-'__ 1 - ,.- ` +• •
38. Final Plumbing - .rt i' Jr - �; z ;
1
'39. Water-Service-Final i "• r-,, 'C: t ..' 4.
. '
:40. Gas Service-Final . . a:--• •' .. 'T1 , 'i• • ?'t..- -k
=41. Solar Domestic-Final ' •• a,j t' `
42. Backflow Preventer ; _ n . -- i rr. -i
43. Backflow Irrigation 1, - - . -; A
ti
44. Landscape Irrigation. System ;t 't: x -r 7 s= ^t .; _ +i "':o v - -
4 c e. `i r 1j.' r
45. Sound At4enuation , , it, - ',' - tt`. r
I
46. Handicap Regulations. - 2 = .
_ - . - = F
-i
47- FINAL STRUCTURE""& BUILDING ''
48. FINAL PLANNING r I ? .� -r
_ . r - '
49. Electric Release to Edison 'f
51. Gas Release to Southern California Gas Co , i :.. . •
51. CERTIFICATE OF OCCUPANCY - T o
No Date
•
r • 01 MFsq CITY OF COSTA MESA ,
qA) BUILDING DIVISION •
PER T NUMBER
F """ ' ' DEVELOPMENT SERVICES DEPARTMENT
• PERMIT
'�`'4,,, ,rF 00-00406
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2524 LAUREL LN Status: ISSUED
Suite: Applied: 03/29/2000
Vicinity: Issued: 03/29/2000
Parcel Number: 43917254 Zoning:
Applicant: LYLE COONER ISSUED BY:
Address: 2109 E BALBOA BLVD , '
Phone:
BALBOA, CA • Zip: 92661
Owner: LAUREL POINTE HOA
Address 2109'E BALBOA BLVD .. _ •
- - - Phone: .
BALBOA,CA' Zip: 92661 ,
Contractor PRO-TECH,WEATHERPROOFING
Address: 23015 DEL:LAGO
- Phone: (714)583-1858
LAGUNA HILLS CA
' Zip: ' 92653 License: 620476
Arch : - Eng:
Address: — ' _ Address: .
' Phone: Phone:
• .
'. Zip: License: License: ,
•
SCOPEOF PERMIT
' TEAR OFF INSTALL COMP SHINGLES. FOR BUILDING 2.
•
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,400.00
Permit: , $97.25 ,' Claim Valuation: , $3,400.00
•
SMIP Res: $0.50
•SMIP Corn: $0.00
Other: , $0.00
Inspection: $0.00
' Total: $97.75 •
_ , 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
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
•
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'compeInsurancensation carrier and policy number are:
Carrier: V/(-LAI" OjA Policy Number: IA)C 3'0. 't/771
(This section need not be completed it 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'
• n 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 ese provisions.
App --sure: � Date: 2 9
vv-• FAILURE TO SECURE WORKERS'COM NSATION COVERAGE IS UNLAWFUL AND SHALL SUBJE N EMPLOY t •CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOI!I ARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTt N 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONT ORS DECLARA ON:
I here. . that I am4icensed un• provisions of Chapter 9(commencing with Section 7000)-ofU Ion 3 of the siness and Professions Code,and my license is in full
- e effect.Lic.# •'4 7 6 Class# y
Co (actors Signatur- "-j _"24 ....ora _
•
• TRUCTION 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).):
o I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No 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:
O 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 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 0 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 a,permit 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 ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Ow r(s) Date
And/ ' Dar
=as INSPECTIONTYP( DATE INTmALS CODEC INSPECTIONTYPE RAN fNTITIAt4
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final / / (/ 208 Final Plumbing
�
200 Final Re-Roof !q-Q® CD/A�' 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
MMIIIPIIMIMMIIII
IIVIS P 4E a 25 26
`y 46 6 3 "- i Ini 7806 I 0/27/78 I-1.1.96 -Thi
COSTA MESA BUILDING-SAFETY DEPARTMENT7806 10/27/78 lite
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 •;w 7806 00004469 66 I e - '
AP' ATIONFOR+STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
BUILDING..�•�^I/r �1 �t RECEIVED BY �i E ECEIVED ��= ISSUE 7:
,
AODRESS_rNf��(#Wc I - �e. L.t ,... ,. ..r.-�.. ilit Z�^TTjj
O
,� OGR '44 PERMIT NO.
OWNER - A.P. NO. a, -O.& 'd ';D.3D A. z A _ ,
1) • 1 < • . 1 1 • II- .. a ,
MAIL BUILDING r ,^'/ --,6-,26
2` /•,U fe, LA.J
ADDRESO01 Doye St . #225 ADDRESS 7Y /V' (��(f'
CITY NO.'752-507 ��• 0.O BLOCK
Newport Beach
CONSTRUCTION .111111111 ADD AL R - PAI- • • u•
LENDER v
BRANCH ?< Wallin'
/^ [[�� ��� �
OWNE- - �/(, alli`7 '�1•ILV
ADDRESS
ALOE
ARCHITECT TEL 45-5854 SE,_..1,, ,,,,.._&...„...__ r S ( 7 D'/
OR ENGINEER Br; on ,Ten nnet tP RO.Aq COP '.. -""'. �;, .•�-
µgq04 N. Newport Blvd . #202 FIRE CI
ADORESSyewpor I3e C ? ZONE YPE GROUP 1 '
Alf ` APPROVED, nom/
CONTRACTOR ✓;,,La _// �n� _ BY I�� DATF`O -27-7p
ADDRESS / NO.OF USE OF NEW
TEL. PLANS BUILDING
CITY NO.
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
fay SIZE I NO.OF BLDGS. FROM C/L S9BEET)
o. OF LOT NOW ON LOT FRONT C FT. FT.
Q USE OF
.N-i EXISTING BLDG. ? R,SIDE FT. FT.
F Separate permits are required for L.SIDE 5-FT. FT.
electric,plumbing and heating work.
FT.
[W., USE OF BUILDING AND WORK TO BE PERFORMED ' DISTANCE BET. BET.MAIN&
•••1
New�Tyo�wnhomes YPro i ect MAIN BLOCS.OC. �y /� ACCESS. BLDGS.
L MPc4g1 /��v C URP.##Z L'/J 21) AP ROVED /2-.27-9'7
•CG - ` •LD FOR SPECIAL 'EOUIREMENT5
0 I hereby acknowledge that I have read this application and state n
w
Cg that the above information is correct and agree to comply with
m
0+ all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of Li
the State of California. �^_� i -
I hereby certify that I am properly licensed as a contractor under /'•'r SO. FT. +/`� � NFa
the State of I nia Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Q
Chapter 9, .n• such licenses ere In full force and effect,or I THE FURPCSE OF ESTABLISHING A PERMIT FEE ONLY: Q
am exemp� fr•4 rovisions of the State of California Business v
and Proles �• VALUATION PERMIT FEE $
'vision 3, - 9.
n
` PLAN CHECK $ / "�
Signature o 'J ,/t4 7 ( ' � i0
Permittee /,Mira $ (Q 0 TAX $ O ��j�•//� v.R • r U
Authorized Agmt TOTAL PAID $ llit 9,
liNI •=11
�/i -
46"rei .1 7935 _0 . __ 215.00 TI
COSTA MESA BUILDING-SAFETY DEPARTMENT - 7935 10/30/78 21'5.000_KT_5_
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 7�9t1�3q5 ❑❑n/❑30� pp qq ��qq
APPLICATION FOK'S7RUCTUR�L6PEI NIIT "-
For Applicant to Fill in Completely — Use Ink Only
RECEIVED BY DATE RECEIVED DATE ISSUED
ABUILDIN275-xl C �7 e6.2 / f /q -oir 7-
�,,(� rj--s-.I._ �I PERMIT NO.
OWN (/�//V I rJ W-TQ1-aK� A.P.NO.
//
MAIL BUILDING `�r qqAD DR ESsJ 2 ' 2.6
ADDRESS
TEL, TRACT I LOT BLOCK
CITY NO.
CONSTRUCTION NEW ADD ALTER REPAIR (MOVING DEMO(ISH
LENDER
BRANCH - C Jt�
OWNE J
ADDRESS ailt ,r t
ARCHITECT TEL. USE "�`/'74'l^6`:r..`"
OR ENGINEER NO.
FIRE
ADDRESS • ZONE TYPE GROUP
APPROVED
CONTRACTOR
ie."
BY DATE
ADDRESS
TEL, ZONE INO.OF USE OF NEW
CITY NO. PLANS ' BUILDING
STATE CITY YARDS APPROVED YARDS APPROVED
gLIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE INO.OFBLDGS. (FROM C/L STREET)
0. OF LOT NOW ON LOT FRONT FT. FT.
a USE OF
r EXISTING BLDG. R.SIDE FT. FT.
U)
FSeparate permits are required for L.SIDE FT. FT.
G electric,plumbing and heating work. REAR FT. FT.
W USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCEBLD BET. BET.MAIN&
Q� MAIN BLDGS. ACCESS.BLDGS.
% VAR.# DATE
Q _MI
C.U.P.# APPROVED
I�,� APPROVED
›•1
�Y HATE
IX
0 I hereby acknowledge that I have read this application and state ' r,
(:‘ that the above Information is correct and agree to comply with m
W all laws regulating building construction, and I shall not employ i
Z any person In violation of the workman's compensation laws of
iil the State of California. .e.:
I hereby certify that I am properly licensed as a contractor under
SQ. FT. c)J
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business $ / a
(.0
and Professions Code,Division 3,Chapter 9. VALUATION PERMIT FEE n
PLAN CHECK $ o \
Signature of
Permittee $ y1 TAX $ 2
Authorized Agent
,e ^ II
I V TOTAL PAID $49-.15—°5:15) /`/
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