HomeMy WebLinkAbout2144 THURIN ST - Building Permits CITY OF COSTA MESA • •
BUILDING DIVISION
'41.1>Y .1, 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
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.'. FOR INSPECTIONS CALL: (714)754-5626
4 ��
PERMIT NUMBER. B07-01005
PERMIT TYPE B_ROOF2 STATUS: ISSUED
DATE ISSUED: 10/31/2007
ISSUED BY: RMD
JOB ADDRESS: 2144 THURIN ST CM Suite/Unit: •
Vicinity: GARAGE ROOF ONLY
Squares: 400 � - - Valuation: $1,200.00
SCOPE OF WORK: REROOF DETACHED GARAGE ONLY AT"COSTA MESA GRANGE.TEAR OFF(E)ROOF MATERIALS, INSTALL 1
LAYER OF 30#FELT ON A 5:12 PITCHED ROOF AND REROOF WITH 25 YEAR 3 TAB SHINGLES.ON GARAGE,
APPROX 400 SF. REPAIR AND REPLACE SHEATHING AS NEEDED.
OWNER: COSTA MESA GRANGE#612 Address: 408 ST LOUIS AVEUnit: UNIT 600
PHONE: • City/State/Zip: LONG BEACH, CA -
APPLICANT: POCIALIK,MICHAEL Address: . . • Unit: :
PHONE: 949-947-8049 City/State/Zip:
CONTRACTOR: OWNER-BUILDER ' - - License No. 000000
Address: Unit: PHONE:
City/State/Zip: CELL:
ARCHITECT: License No. PHONE:
ENGINEER: - License No. PHONE:
FEE SUMMARY
Reroof Plan Check: .$0.00 .
Reroof Permit Fee: $44.85 • . _
Reinspection Fee: $0.00 _ .
TOTAL FEES $44.85
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE A, INSPECTION TYPE DATE IN1111ALC5 CODEA INSPECTION TYPE DATE IN111IAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final208 Final Plumbing
200 Final Re-Roof 12---6"
-4:21 Q 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
•
WORKERS'COMPENSATION DECLARATION. Owner ID verified by driv '
Yes
r-Ezpiies: 3J�"J 06
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-propenitax 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. •
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
• permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation Me(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,scaffdding,falsework,or demolition
Cartier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(Mssednn need not be completed✓the peand 6 valued at one hundrecl dolars(atgo)or ss.)
2,M2 Sec.341,Title 8,California Administrative Code).
Policy Number:
❑ As owner-builder, I will not employ anyone to do work which would
(]_,certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued,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 the workers'compensation provisions of Section 3700 of
Applicant's Signature Date
the Labo Code,I shall forthwith comply with these provisions.
(n. P o LA JAL 10/3 //31 Division of Industrial Safety Permit Number:
rApplicant•s Signature rrDa10- t 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 CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material'? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California 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? 0 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 weight 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
Lender's 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? 0 Yes 0 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? ❑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
infor(Section 65850.2 of the California Government Code requires that the requested
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the nformation be furnished on applications for non-residential building 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 0 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
five hundred dollars($500).): of the California Health and Safety Code).
CL.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
compensation, 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 an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 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
property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
❑ 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
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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
authon e by thi ermit until jfinal inspection.
mini ppf/& 4AG )P13,hi
fWr/G P B G atik 16)3 LI e 7 Signature of Legal Owner(s) Date_
Signature l Dates �'— L----'3057-46(3/07) __ Ancor Authorized Applicant Date
r
4 CITY OF COSTA MESA �'
x ," BUILDING DIVISION
. ,
i r .1DEVELOPMENT SERVICES DEPARTMENT
PERMIT PER NUMBER
(714)764-5273 •
:05-01660
Fax(714)754-4856 • www.ci.costa-mesa.MOILDING PERMIT
77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2144 THURIN ST
Suite:
Vicinity: COSTA MESA GRANGE Status: ISSUED
Primary Occ: Applied: 09/21/2005
Parcel Number: 41902127 Type of Construction: V-N
Issued: 09/21/2005
Zoning:
Applicant: BOLTON, DOROTHY
Address: 15415 GOLDEN LANTERN LN
LA MIRADA,CA - Phone: 562-947-8049
Zip90638 ISSUED BY:
Owner: COSTA MESA GRANGE#612 �j
_
Address 408 ST LOUIS AVE-t .
UNIT 800. �.� � �-
LONGBEACH,CA - Phone:
- ZSR 90814"1033
Contractor" .OWNER- BUILDERc
Address/ .a
Phone:
License; 000000
Arch
Address:
Eng:
-
Address:
Phone: ,
Zip:
License: - Phone:..
INSTALLATION OF CERTAINTEED PREMIUM VINYL SIDING ON THE EXISTING -
License: ' '
#ER 1478 SCOPE OF PERMIT
OSTA MESA GRANGE#612".ONE-STORY BUILDING.fCBO
FEE SUMMARY
•
Plan Check x$0.00 "
Permit $377.25,
SMIP Res ;$0.00 Calc Valuation
SMIP Com. .p, , $4.86 Claim Valuation: $23;t5o.00
Other. $0.00 $z3n5o.00;
%Inspection: $0.00
Total: 7, $382,11 •
SETQACKS PLANNING$ZONING
MAIN STRUCTURE O_�RE Front o-o
Rear o-o Left
ACCESSORY 0 0 Right 0-0.
Front 0.0 - - "
Rear 0-0
PARKING
Left o-o Right o-o
Exi in 0
Re wired; 0 Pro osed: 0 . .
NOTICE: The work 92-28 § 1, 1by2 this permit shall comply NOTICE: (Ord. 92-28,§ d 1y.this p A y with all applicable handicap access requirements under California statutes
EXPIRATION: 2)
This permit shall y p
for a perioof 1 days.
automatically expire and become void if work Is not commenced within 180 days, and doerelated
INSPECTIONS: order for the work a or if work Is suspended or
required IONS: Inmo and thfinal e authorized under this abandoned
approval must be obtained.Failure obtain e o inspections dered such workpal will comply
FOR INSPECTIONS CALL: (714)754.5626 and final approval result in the expil ration olt this parmnd all
244838(NOM
D. CLARAIIONS I 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 carrier and policy number are:
Carrier: Policy Number: •
(T is section need not be completed if the permit is valued at one hundred dollars($100)or less.) .
( ~ 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 it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these prov Ions. �/ Q—
AppRcan1SiLe-- // ('bN- rDate) l.)---3- /—QC
WARNING:FAILURE TO SECURE WORKERS' MPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPCOYERTO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed 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 it
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.). •
• 1 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/n tt uJ nder sec. }—�-.� Business and Professions Code for this reason:
rSignature:N_' - �P/ A.2-a.( -'� �-Dater 0 R ( "� -5
Owner IrDverified by drivers lic nse. ❑Yes ❑No (Drivers'Gcense'No: ( Ek fires`//z`O1—as
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,talsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
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 Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the 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 wit the applicant or present or future building occupant require for the work which is the subject of this application a_aPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by 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.
M "vg1ature Lwner(s) Date
'r )c 9—c..t/ —ate
Anp(O(Authorized Appllcant- L ate
CODE 11. fNSPFCTION TYPE DATE INTITIALS OPE it INSPECTION TYPE PAM INTITIALS
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 (0'2- "'-'�
l
CITY OF COSTA MESA
�tt. BUILDING DIVISION
,, DEVELOPMENT SERVICES DEPARTMENT
reiPERMIT PERMIT NUMBER
441boititiol';14"
B98-01761
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIV ,COSTA MESA,CA 92626
• BUILDING PERMIT
Job Address: 2144 THURIN ST Status: ISSUED guy
Suite: Applied: 09/29/1998
Vicinity: Issued: 09/29/1998
Parcel Nunmber: 41902127 Zoning:
Applicant: RAY, ROSS
Address:
Phone:
Zip:
Owner COSTA MESA GRANGE#612
Address 2617 N LINWOOD
Phone:
SANTA ANA,CA Zip: 92705
•
Contractor: ALL WEATHER ROOFIGN
Address: 2192 AMERICAN AV
#A Phone: 714 646-8694
COSTA MESA, CA Zip:• 92626
License: -739271
Arch/Eng: • •
Address: • -
Phone:_
• Zip:
License:
SCOPE OF PERMIT
'T/O EXISTING AND REROOF THE HOUSE ONLY WITH COMP. SHINGLE, ROOF CERT.ATTACHED TO
.' PERMIT.
• FEE SUMMARY
Plan Check: ' $0.00 • Calc Valuation: ' $2,500.00
Permit: $74.75 - - ,' ` Claim Valuation: $2,500.00
SMIP Res: $0.50 /
SMIP Com: $0.00 -
Other: $0.00 •
Inspection: $0.00
Total: $75.25 -
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:
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
WORKERS'COMPENSATION DECLARATION.
I hereby affirm under penalty of perjury one of the following declarations: Y
-•
❑ I have and will this
erm 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:
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 laws of .Tornio,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shell forthwith
comply with these pro ision �
Applicant Signature: / 0-10-^l Gl.( Date: 9-2 �i ' 9
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000).IN ADDITION TO THE COST OF PENSATION,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#
Contractors Signature: 1/S0-1/' Date: ✓ ''�-2 x-9 St
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. __ _ Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 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 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 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65650.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'Yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 es 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.
J Si azure Of gal Owner(s) ate
J ' And/Or thorized Applicant Date
CODE L I65PFRTION TYPE DATE D6IIIAU CODFJ INSPFCI1O11TYPF DATE IIIMIAL$
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
244646 •
1
July 22 , 2003
Costa mesa Building Department
Costa mesa City Hall
77 Fair Drive
Costa Mesa , California 92628
Gentlemen ,
This letter is prompted by the notion that so!ieone
other than the proper persons might try to obtain permits
for Costa Mesa Grange #612 , 2144 Thurin , Costa Mesa ,
California .
We are part of a national non-profit organization
with state and national officers and many subordinate
groups called " Granges" located in as many communities .
While we belong to the sane group , each Grange is a
separate entity And any real property belongs to the
entitynamed on the grant deed - not the state or national
organization . California State Grange or their representative
may try to say they are the agent for Costa Mesa Grange
#612 or that they have control of the property . This is
an untruth . Our grant deed clearly states "Costa ilesa
Grange #612" and we have no agents .
The only persons authorized to sign a release for permits
are : Dorothy N . Bolton Dewey Lamb
15415 Golden Lantern Lane 8591 Bird Ave .
La Mirada , California 90638 Midway City , California 92655
562-947-8049 714-897-5141
If anyone appears with either of these signatures ,
please verify their authenticity by a phone call . In fact
we will probably come to your building department our-
selves when we want a permit .
Yours Truly ,
Dorothy � � .
o
Bolton
Master , Costa mesa Grange #612
OWNER COSTA MRSA GRANGE MAY 1 3 1957 b DATE 12-31-56
JOB ADDRESS 211111- Thurin BUILDING PERMIT NO. #4168
GENERAL CONTRACTOR Owner Bldr. VALUE $ 512.00
AP115-220-10
LOT 17 BLOCK 21144 TRACT 9 Storage Garage AS PER U. E :.
GROUP ,1 TYPE V ZONE R4 FIRE DISTRICT 4213
PERMITS ISSUED
INSPECTIONS 1 DATE SUBCONTRACTOR DATE NUMBER
Footing Trench e —Jy
Foundation Forms and Grade to Garage 7-
Rough Framing IJY otirs2
Plumbing,Rough to Slab (J "
Plumbing,Rough Complete
Temporary Pole
Wiring, Rough
Heating,Rough _
Heating, Final
Sewer, House Sewer, St.
Septic Tank or Cesspool
Lathing, In Out AA
Plastering IP71/ it- %Ia-'n
Plumbing,Final,Fixtures Complete
Plumbing,Final Gas Test
Wiring,Final ,,,,, �/
Occupancy
FORM 210 3M 10.35 ll 41.68
Costa Mesa Building Department APPLICATION FOR PERMIT
V P. O. Box 317 A21BUILDING 1
. COSTA MESA, CALIFORNIA
FOR OFFICE USE ONLY
.- FOR APPLICANT TO FILL IN Receipt No. I Btrmit No.
Buildingre2/j7 / � Ill:a ///jjj777
Address a I �J`'� 6 AW
Costa Mesa, California 7eceiv y D e Re Da Iss d
Nearest � /y /
Cross St. l)l C-D \(I \(C) il /
AB du essding ca/7 — u 2/ /(/
Owner Costa,, M(2Sci CtraHIT,e 'Pi 6/t, Costa Mesa, California
Mail /, �
Address i 7 Y -'H a.M 14 Sit Nearest ?...I I `q
Tel. Cross St. If ( L
City 0 �/�(/ l.4.—er No. Zone_ I No.of I Typ, .. Group
Architect or Lic. T Plans / / }
Engineer No. APpr'�'_ �r> ne i / 6
by `- ��13 Date 3/..Ol
Address Ctll£ZCIA.TIONS
'attic. City Lic.
C �.J;I) � ,' 0Vt
Contractor No. [P s e.l �t v a
Address CITY OF C.jST.• s:r.c4
Lot J
De cription I No. f I I Block -/97j Tract 9' PLA'd'r;C.!(. DEPT. i
/ SUBJECT TO BLDG. DEPT. REG.
(Attach Metes and Bounds) i/5—: aaa--/U
No.of Bldgs. �
Size of Lot / )( �-/)- I Now on Lot � By CO - g24 DATE //-7 ...--3 /_
Use of yy�� No.of No.of i G1
PLAN TEC ...-77k_Existing Bldg. /Tan I Families I Rooms / — A
Setback Line from Rear Yard % •
Center of Street .�, 2 Side Yard /�{,J yi D
DESCRIPI'iON OF WORK/ ,c--- Afr/ r
New I I Alteration I I Addition I l) /3 e 2—(.4Pag ir
Repair I I Moving I I Demolish I
Building X /4 • No.of
Size !e Rooms / Stories / id
Exterior Wall Rod Wood I Roof —
Covering 'eld.tuc Covering APPROVALS I
Use of New
Building XJ �,i Foundation Location Inspector Date
Forms,Materials,
Under-Pinning
Frame: Fire Stops, a
Bracing,Bolts C
I hereby acknowledge that I have read this Application C
and state that the above is correct and agree to comply Lath. Int. _
with all City Ordinances and State Laws regulating Al
building construction. Lath.Ext.
Signature of 2' .-T yf14/�
Permittee m �� Plaster, Int
Authorized Agt.C.-1 4. • �9 �/ Plaster,Ext. Q
Valuation pC Permit Fee $ 4- 0 0 Masonry Reinforced
lan Check $ /U 0 Bond Beam o
$ � Total
I Fee $ 4 ' G' FINAL a
see. IIIII
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PLOT PLAN
Show location and distances. from
c::..7
19 . property line and between buildings.
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30969OCT —a-e9—Cf/SA'°00 350* ****30.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely RECEI V D BY DATE RECEIVED DATE SU
BUILDING 2144 cfHv.efiv s r L /O-g" X6/7
ADDRESS/'_ /, /I rJf/�
OWNER L-L�STfJ / ?`'S S/] GQniyc2 6 I2 A.P. DO./� -a 3'�!Lig �- -a�+'
MAIL r� / BUILDING `1
ADDRESS 532- C6niTFit ST . ADDRESS 1
Z /^ N-��tI TEL.
a.. U CITY COS74 r54 NO. TRACT ? LOT , /rr
BLOCK
Z
CONSTRUCTION tyOME N WEALTER REPAIR MOVINGOFMOLLSH
ON LENDER 'C u`/
0- m
J 7 BRANCH
----
_IUD OWNER .(/- Y✓I / AA.{X/
m J ADDRESS /ER /Y//)0.-[2.42--4-/ �( ``y\
J m ARCHITECT TEL. USE s^fir'WF{/� Q''L ! $..( Lf'6rlri
Q OR ENGINEER NO f/
_ FIRE
W CC ADDRESS ZONE't3 TYPE GROUP re?
C'W /� APPROVED J,(J'///r
WZ CONTRACTOR /-rT-HS l-7UI�vr25 BY t, A117 pJQ
CO Z e , t
JK ADDRESS /2-432.f�/'rtu Po Jo- (&L✓.' . Jt/"
ZOI CITY a,Sri Het SL TNOLJ45.5544% ZO PLANS '�/BUILDING EW�
ill
STATE n '�'f ei /L' LIC.CITN O. • YMAIDS N BUILDING YARDS ACCESSORY APPROVED .
N CL LIC.NO. L / 4 9BUILDING
=U SIZE 7- Li 7k C 'LI rNO.OF BLDGS. /15
(FROM C7REET)
OF LOT J NOW ON LOT Z FRONT -l/n FT. FT.
USE OF //--�_' ��
EXISTING BLDG. CbM&' 2C, - L - R.SIDE /[FT. FT.
Z NIZE OF EW BLDG.1-- TZ ROOMS I STORIES L.SIDE 2V FT. FT.
a EXTERIOR WALL ROOF
U COVERING S7✓nco COVERING ASUO�aLI REAR T. tet-{ FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. / BET.MAIN&
0-
0_ go v'fl it d rug a.y , MAIN BLDGS. ACCESS.BLDGS.
Q VAR.#'7 7 // AATE /`
O C.U.P.# 0b// 'O� APPROVED IQ -6 ~6
I—
APPROVED// / ,t
I;n ABY DATE DATE Ill //11 (/
6j eil
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VI hereby acknowledge that I have read this application and state
D that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
IA
_the State of California. //-��ss o
/O SO.-/ m
m
? �
I hereby certify that I am properly licensed as a contractor under J'� . FT.
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR j
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ¢m
am exempt from e provision of the State of California Business VALUATION ',
and Profession •e/a ivisio C apter 9. CX O �� m
PERMIT FEE $ w
Signature o - D
7 fy, A '1 at
Permittee f , .4 S�-Y �,� '� PLAN CHECK $ /Q . AS E
L/I ^ o
Authorized Agent
CJad
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TOTAL FEE