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Home My WebLink About1065 VALLEJO CIR - Building Permits e . I C CITY OFCOSTA'MESA< _L . BUILDING'DIVISION DEVELOPMENT SERVICES DEPARTMENT' • PERMIT MBER PERMIT • 05-00391 (714)754-5273 • Fax.(714)754-4856 • www.cl.costa-mesa.ca.us- 77'FAIR DRIVEJ.COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1065 VALLEJO CI Status: ISSUED Suite No Applied: 04/27/2005 Vicinity: REAR OF PROPERTY Issued: 04/27/2005 Parcel Nunmber: 41205226 e Applicant: ILDEFONSO RODRIGUEZ ISSUED BY: r------1(572---_/� Address: . Phone: 714-530-7320 - - •• Zip • Owner: PICKETT, DENNIS,:. ' Address 1065 VALLEJO CIR _ - , Phone: COSTA MESA,CA Zip: 92626 Contractor: EMPIRE PLUMBING Address:- 7050 LAMPSON AV _ . Phone: 714-530-7320 GARDEN GROVE,CA Zip: 92841 License:794154 • SCOPE OF PERMIT • • NEW NC UNIT AND CHANGE OUT FURNACE: • ELECTRICAL TO INCLUDE: 1 NEW NC PACKAGE 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 $54.50 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 -. ' Misc Electrical Equipment $0.00 '0 New Res(31-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 5o•kva/kw . $0.00 0 Recept Outlets $0.00 I-- 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/C.Id ' $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(meth ride or lights) . $0.00 0 Motors to 10hp $0.00 - '0 Christmas Tree Stand • $0.00 0 Motors to 50hp $0.00 0 "Fireworks Stand - $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 , Communication drops $0.00 0 - - -Investigation Fee- $0.00 Sub panel to 200a . $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 ,NOTICE: Thework authorized by thispermitshalt comply with all applicable handicap-access requirements'under California statutes and related regulations:(Ord.No.92-28;§.1, 12-21-92) EXPIRATION: This permit shall.automatically expire.and:become-void:il.work-is not commenced within 180 days,or if work issuspended or abandoned .for a period of 180-days: ',INSPECTIONS: In-orderfor:the:work-authorized-underthis:pennit'to•be-considered-legal, such'work.must comply with-all applicable codes, and all required.Inspectionsand:fhal.approval.must baobtained:Failure to obtain inspectionaand.final:approval.wilrresult in the expiration of this permit. [,FOR-INSPECTIONS.CALL: (714)754.56261 2446-46(alae) N DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: % 4 0 •I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. - . 19—'t:have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. �My workers'comp nation Insurance carrier and policy number are: Pon ( r iffZM U1(.rc.�'}+4N "Nbmbe , Q1'KRco475-86 (This section need n t be completed i Ole permit is valued at one hundred dollars($f 00)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any preen in any manner so as to become subject to the workers' compensation lawsof California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro '"'•n c S rAp�icant.Signaturra. , _ air a/ -. Date:--, F it PklVb_ S WAHNING:&FAILURE'TO SECURE WORKERS'COMPE : • COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO C INA_ 11ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),IN ADDITION TO THE e T 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•rovisions of Chapter 9(commencing with Section 7000)of Division 3 of.the.Business a•d Professions Code,and my license Is in full I "force and effect.Lia ri=-79• #-, �Clase.0 - i 0 ,_ Contractoes'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 the 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 penally of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 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: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑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 lime 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 pre-tent or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre 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 en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 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 LI 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 01 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 alt 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. Kamp Signature Of Legal Owner(s) .• Da}e 4 ./. /L / — C •O_•.i odzed-Applicant = -'" Date - CODE I INSPECTION TYPE' ' ' ' - P9IE ' " MOM' ' CODE* INSPECTION TYPE ' PAIL MALI 1816 Fixed System Final Fire Prevention 206 Final Mechanical ' , 1266 Pool Spa Final 208 Final Plumbing •200 Final Re-Roof . - . 210 'Final Electrical 1—Z-6 201 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 . 1065 Vallejo Circle Property Line Rear Yard t 15' 30' 20' AC UNIT 4 ► a) a) C C : J ItTo HOUSE a a 2 2 a` a Front Yard Property Line Vallejo Crcle APPROVED CITY OF COSTA MESA PLANNING DIVISION SUBJECT TO BLDG. DEPT. REG. NOTE:ADDITIONS, DELETIONS, OR CORRECTIONS SHALL BE APPROVED BY THE PLANNING DIV. BY: DATE: V/Z7/6r- • CITY OF COSTA MESA BUILDING DIVISION >:j �, 'DEVELOPMENT SERVICES DEPARTMENT •PER NUMBER PERMIT ° 11.4k f 05-00231 44b4•0amst le (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1065 VALLEJO CI Status: ISSUED Suite No Applied: 04/27/2005 Issued: 04/27/2005 Vicinity: REAR OF PROPERTY / /N Parcel Number: 41205226 ISSUED BY: IL,/ Applicant: ILDEFONSO"RODRIGUEZ / Address: Phone: 714-530-7320 Zip: Owner: PICKETT, DENNIS Address: 1065 VALLEJO CIR Phone: COSTA MESA,CA Zip: 92626 Contractor: EMPIRE PLUMBING - Address: 7050 LAMPSON AV Phone: 714-530-7320 GARDEN GROVE,CA Zip: 92841 License:794154 SCOPE OF PERMIT NEW A/C UNIT AND CHANGE OUT FURNACE. MECHANICAL TO INCLUDE: 1 FAU<100K BTU AND 1 COMPRESSOR/ABSORPTION SYSTEM 3 TO 15 HP/500K BTU. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $27.15 1 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12.21.92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned ' for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work-must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. • FOR'INSPECTIONS CALL: (714)754.5626 • 2448-48(8/00) DECLARATIONS, C, 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: SCR And G IG rt41140 r Policy Number: G•31(T2 co 91 cei&A (This section need t be completed if the permit is valued at one hundred dollars($100)or less.) ❑ ' I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those pr ion • .511:72../2 /// I/ Applicant Signature: A „{{__�T//AA[[ _1 Dato: 11: .%/2 5 WARNING:FAILURE TO SECURE WORKERS' ENS/�IION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO C9yrt�.++INAL444,,,ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100.000),IN ADDITION TO THE((AASST 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 tic:n ad .e .rovislons of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,e__ndihy licen a Is in full n force and effect.Lie.a r Class 4 /�. C 0o 7 CR Hoc Contractors Signature: mini Date: 1//0 CONSTRUCTION LENDING AGENCY: L ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Coda). 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(commenting with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,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 lime during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ore 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 II an RMPP is presently required,Ria-rection 25534 of the California Health and Safety Code been fully complied with?—0 Yes 0 No .__... as Se —._on . _ ..._...._ 5 Does will the oast Air or Quality a or future building ict o from at require for the work which is the or of this U estion aPertnit for such construction or modification from the South Coast Air Ouahfy Management District or from any other air pollution control district or agency? L.1 Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). __ __ _._.___.f..asch__l_..__......Ye0 _.. 6 Will any part of the facility to be constructed under this permit be within 1000 lest 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? ❑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. SlgnatUre Of Legal Owner(s) Da f� Vg-7 5 ntl/Or Aulh xwd Applicant Date CODE 1 INSPECTION TYPE • - • 0AIE - MOW SORE( •INSPECTIONTYPE' • PAM 1616 Fixed System Final Fire Prevention • 206 Final Mechanical 7—7'-Os- 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 zsrisifit CITY OF COSTA MESA ,`y . BUILDING DIVISION f ..' i_ q ,� � DEVELOPMENT SERVICES DEPARTMENT C' 14(H. PERMIT PERMIT NT1JMBER B98-01585 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • BUILDING PERMIT Job Address: 1065 VALLEJO CI Status: ISSUED Suite: Applied: 09/01/1998 Vicinity: Issued: 09/01/1998 Parcel Nunmber: 41205226 Zoning: Applicant: BRIAN COFFEY Address: Phone: Zip: Owner: PICKETT;,DENNIS Address PICKETT,'CATHERINE R _ COSTA MESA,CA Phone: 714-966-2646 , 71065 VALLEJO CIR - ' Zip: 92626 �- - . • . i , / , . . Contractor: - THE.ROOFING SPECIALISTS Address: 2428 NEWPORT,BLVD ' - ' 5 Phone: .714-722-8846 " . COSTA MESA,CA Zip 92672 • License:': 734068 , . , . Arch/Eng: ^ - Address: //-.,a i ' .-i? "Phone:_ _ ._ . Zip: - - License: "- SCOPE OF PERMIT ;T/OFF SHEATH&REROOF 2400SF RESIDENCE W/BUILT-UP. • FEE SUMMARY ' Plan Check: • $0.00 - . - - : , .'/, -Calc Valuation: $5,605.00 • Permit: $112.25 - - ----- - - : ,' - Claim Valuation: $5,605.00 SMIP Res: $0.56 ' / SMIP Com: $0.00 =- j Other: $0.00 - Inspection: $0.00 Total: .$112.81 - -PLANNING &ZONING- ' SETBACKS MAIN STRUCTURE Front. 0-0 - ' Rear .020 ' ' • 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: • DN''tE \� N taS1 EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. . INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS • 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 Insure carder and policy number are: c (J Cartier: �'� r 7- l.) '/ < Policy Number. Z S J 3() (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 fo hich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of C la,and agree th I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall f0rbwith comply with these pr i q A7 c)Applicant Signature: C / Date: ` —r _ " WARNING:FAILURE TO SECURE WORKERS'COMPS COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOU ARE($100,000),IN ADDITION TO TH T 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 provisi�s of Chapter 9(commencing with ScdfirTin 7000)of Division 3 of the Business and Professions Code,end my license is in full force and effect.Lic.# Class# C 3 S Contractor's Signature: / Date: Ct-11j CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 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 WIII 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 greeter than a weight of 500 pounds,ore volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 ermit 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? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all 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) SDa to rAuthorized Applicant Date CODES. INSPETIQNTYPE DATE IIIDDAL,S CODE INSPECTIONTYPF DATE Ifl ALD 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Anal Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 29594 PAlU COSTA MESA BUILDING-SAFETY DEPARTMENT JAtJ -7'69LN5,�U 226 ****(i5.5( P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING For Office Use Only BUILDING ADDRESS 1065 Vallejo Circle RECEIPT NO. O. COSTA MESA. CALIFORNIA J �4 OWNER Meltzer Enterprises-Costa Mesa R[c [r AVM y[rvsj %T�lex�`,/ MAIL BUILDING /D/d/ Vali,/ 0 C.C.4.S Y ADDRESS 144 South La Brea AvenueFIRE ADDRESS /0 ��//rte T •� TEL9 ZONE .3 TYPE Z GROUPl O v clTr Los Angeles 90036 No. 36-1104 ARCHITECT T! 714 APPROVED DATE ORENGINEER Frank Gonzales Tr 1336 E. Chapman Avenue ZONING ADDRESS Orange, California 92668 SONEI NO.or USE OF NSW Res• w/ CONTRACTOR George J. lieltzer & Assoc. Rl PUNS 2 I sUILD)NGAttech.Garage LEGAL ADDRESS 144 South La Brea Avenue DESCRIPTION Lot 69, Tract 6637 CITY T,os Angeles. California 90036 AP.NO. None NOTE; NO[AVE OVERHANG SHALL BE LESS THAN uATE TEL. c..NO. 201098 NO. 936-1104 BO'TOSIDE eREAR P.L EAVES SIZE I NO.OF SLOGS. ALLOWED (U.B.C.REQUIREMENT) OF LOT NOW ON LOT 0 YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM C/L STREET/ SETBACK LINE FROM CENTER OF STREET REAR YARD 22 ' FRONT LJ�// FT. FT. SIDE YARD I LEFT 5 ' I RIGHT 16 1 R.SID[ i1 FT. FT. J / DESCRIPTION OF WORK I..SIDE 7 FT. Fr. REAR 9-YFT. FT. NEW X ALTERATION ADDITION DISTANCE BR. BET. SLOGS. REPAIR MOVING DEMOLISH MAIN BLDG$. ACCESS. BUILDING NO.OF VAR•# DATE SIZE ROOMS STORIES 1 C.U.P.# APPROVED EXTERIOR WALLROOF APPROVED / / //� ) -/ COVERING Stucco COVERING wood shingle at ',(/I/y/ /DAT! ul/� A USE OF BUILDING AND WORK TO BE PERFORMED fU// a Dwelling and Attached Garage V ' I? Plan 401CR - Lot 69 4 DV3 SQ.PT.Ig x I HEREBY ACKNOWLIDOE THAT I HAVE READ THIS APPLICATION THE AMOUNT OHO UNDER VALUATION IS FOR THE j AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. Ry? PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION ` i BUILDING CONSTRUCTION. PERMIT FEE 5 i 7 SIGNATURE OF PERMITTEE - - /n, /yL` s i l o PLAN CHECK S ,e3-....5-0 �/, 56 AUTHORIZED AGE �i / /� TOTAL FEE 5 �J `3�J 0 a� //