HomeMy WebLinkAbout2098 VALLEY RD - Building Permits CITY OF COSTA MESA
4111/ BUILDING DIVISION 41111 r
r- , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUM ER
4 • PERMIT
,a oOP B05- 0044
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT •
Job Address: 2094 VALLEY RD Status: ISSUED
Suite: Applied: 01/12/2005
Vicinity: ROOF Issued: 01/12/2005
Parcel Number: 42233135 Zoning:
Applicant: RAFAEL LEUS _ - ISSUED BY:
M
Address: . 2016 WALLACE AV - .-;, -'• ` - - - -
UNIT B Phone: 949-642-7057
COSTA MESA;CA' Zip: 92627 ,
Owner: SMITH;DONALD L ' . - - .
Address �2094'VALLEY RD \ , - - - � �,_ • ,, ' � �
7/ r.`/- . - Phone: ,
- \ ,,� ',
,' COSTA MESA,CA �' - - Zip: 92627 - �` = �`\••C\N
Contractor: LEMUS ROOFING
Address: 2016 WALLACE'AV _
UNIT B' - - Phone: 949-642-7057
COSTA MESA,CA
' Zip: •• 92627' •' License: 826813 '
.
Arch : - - / - - Eng: - ° - � '
•
Address: ' •- Address: N. • - '
' _Phone: " ' .Phone: - '
Zip: License: License:
- - - ; - SCOPE OF PERMIT - . .
TEAR OFF EXISTING ROOF. INSTALL 30#FELT, 1/2"PLYWOOD,30 YEAR COMPOSITION SHINGLES,AND REPAIR/REPLACE SHEATHING AS
• NEEDED.25 SQUARES INCLUDES ATTACHED GARAGE. - -
FEE SUMMARY % . , '
Plan Check: $0.00Calc Valuation: 5-6,000.00'
Permit: $125.25Claim Valuation: ' $6,000.00
'-SMIP Res: $0.60 /
SMIP Corn: i $0.00 - • - �,,,
_
•
• - Other: '''$0.00 _ //'
• 'Inspection:- $0:00
v Total: $125.85 ' ' - t,.
PLANNING &ZONING- - V ;
SETBACKS v',- — - - - % d :,'
•
MAIN STRUCTURE.Front 0-0 ', Rear 0-0 - ' Left 0j0 - Right - 0-0' '7
ACCESSORY Front 0-0 Rear .6-o, Left 0:0•_', -, Right .0-0'j
PARKING Existing: 0 , Required: 0 . Proposed: •0' . • v '/
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/001
DECLARATION'S ( �l}
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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 Cade,for the performance of the work for which this permit is Issued.
C. aS.My workers'compensation Insurance carrier and policy number are:
Carrier:. `4A7- a F Or\ a ,Pol'ry.Numberi'
/( TIThsection need not be completed it the permit Is valued at one hundred dollars($100)or less.)
1
I certify that in the performance the ek for which this permito Is issued,bjec I shall not employ any npersona io in any manner so ti to becomef subject to theI haforthwith
laws of California,,and agree that if I s ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pr ns.
A�cant Sigheture:•� -- iu�G(e 3/ pit L • ( 1,— `Z-
C.—WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHAH SUBJECT AN EMPLOYE CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full
jorce.and.ettecti'i c.a = 2.-.44F?1 class fl =G— 3 G V'
CoNlractor's'Slgnatt % i/ a 1 L. vats: t — 12 —e- S
�c r
•
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.).
O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am 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:
I Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 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 flan 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? 0 Yes L-I 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.
atua Of Legal Ow r(s) Date
-<ac'eet ria r'S_ernQ 1 — 12_-OS
- nnd/Or thonzed-AWI t..` .a?rN^r..,.. x-�erc
y00E 0 INSPECTION TYPE pAlt INTRIALS COW. INSPECTION TYPE PAU elIlOAL@
1816 Fixed System Final Fire Prevention 206 Final Mechanical
1286 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof ref!p—cf" &tar 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
•
PROJECT ADDRESS: 2098 VALLEY RD . , UNIT: CITY OF COSTA MESA - BUILDING PERMIT • PERM NO:- B 059998
OWNER'S NAME: ROHRER, DANIEL H "
ADDRESS: ROHRER; MARY LOUISE PERMIT NO: B 059998 • PLAN CHECK NO: N GOVT: N SUPP: N.
• ' 2098" VALLEY RD - •
r ' COSTA MESA,CA 92627 CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ALT
j K*ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : RESHEATH,REROOF(COMP SHING)&ADD SKYLIGHT SQ FT: 3,500
ADDRESS: UNIT:
( 714 )642-5425
CLAIM VALUE: 3, 500.00 CALC-VALUE: 3, 500. 00 GROUP OCC: R-3 /M-1 ;
' PERMITTEE: MARY ROHRER
ADDRESS: 2098 VALLEY RD COMMENTS: 1 /2" CDX PLYWOOD / 40 YR "ELK" COMP / SKYLIFGT NER#216
COSTA MESA CA 92627 ******************************************************************
r`:- SMOKE °` `
LICENSED CONTRACTOR DECLARATION: hereby affirm that am licensed under provisions of Chapter 9(commencing with Section Z O N I N G R E Q U I R E M E N T
7000)of Division 3 of the Business and Professions Code, and my license is in full force and effect. SETBACKS
CITY LIC.: STATE LIC.: CUSS: p�n F
-
D
Dale: Signature:
MAIN BUILDING ACCESSORY BUIa5c1U1RE
Date: S'COMPENSATIONDECLARATION: I hereby affirm that lhave acertificate ofconsent toselbinsureoracertificate ofWorkers' FRNT: FT -INF-REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT
Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). : FT- IN;-RGHT; FT IN LEFT: FT IN RGHT; FT IN
POLICY NO.:
^.OMPOMPANr: EXP.DATE: PARKING REQ: • PROV: PARCEL: 42233136 ZNE: REF NO:
• PLANNING N TES> •
Certified copy is hereby furnished. ❑'Certified copy is filed with the city Building Division,
Dale', Applicant' ******************************************************BP,************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D• E V E. L O'P=:M E N T SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit is issued,I shall not empire/ n erson in any manner so as to become -
subject to the Worker'Compe anon Laws of California. / � � ZONING APPROVED BY 'u." : • DATE:
`, •
• Date. L� Signature. • !�- / BUILDING APPROVED BY . DATE: •
NOTICE:If.aft r making this declaration,you should become subject to a Workers'Compensation provisions of the Labor .
Code.you must forthwith comply with such provisions or this permit s II be deemed revoked. r l
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• DATE; #IF i( #iF9P
which this permit is issued(Section 3097,Civ.C). ************************ * ** ****** *** *** **************** * **
LENDER: *****************************************'**** ********************************
ADDRESS: •
LEGALIZATION:N . • F E• E S U%M- M A R Y STRUCTURAL SEGMENT:Y
•
• OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC 'MECHANIC FIRE 'I SMIP/RES GRADING '
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 63. 00 ` ' > .1 z'" r- ' 50
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed - - 'x '-''1 SMIP/NON—RES •
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business p LAN w
LL
' and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
a
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE' '�� - . . 2..-'
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL . PAID ....• DUE •
I. as owner of the property or my employees with wages as their sole compensation, wit do Inc work, and the TOTALS----> 63 . 50 0.00 - 0 .00 - 63. 50 -'• 63 . 50 . 00
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law )' _
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through !--' ` _ .l+i
•
his or her own employees.provided that such improvements are not intended or offered for sate.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: ' ; ' • 63. 50 OVER/SHORT' . 00
improvementis soldf le)hin one year of completion,the owner will have the burden of proving Ile/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC' `' FIRE SMIP/TOT: 'GRADING PLAN-CHECK •
for the purpose of sale). • , -. , 1
63. 00 . 50:' '.r -
I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business "chi e' r .1 _
❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of properly who builds or improves thereon - -' r '
t and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ******************************************************'******************,******'*
that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A L- F E -E -'B R E A K D O W,N • -
µ ,-
)- IN I am exempt under Section:B P.70 4 4 B.A P.C. j I _' L'
for this reaso ALL(JWORK BY OWNER / / TYPE QTY DESCRIPTIO N- •.j. UNIT;/„COST '' ..: TOTAL COST
Dale: �� Ig`l_Z • Owner,OWNER,"
U SFR 300 ALTER BY VALUE RESIDENTIAL NOZONE 1 :00� %. ' 300 . 00
I do hereby certify that l am aware of and understand the requirements of California Health an‘2441967a44-41-
Safety ode Sections 25505,25533,and SFR 3200 REROOF BY VALUE RESIDENTIAL NOZONE 1; 00 .t 63;, 200. 00
' 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END'.-OF FEES
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from - •
these provisions. - • 'X �^
]. r
Dale: Applicant: •,{ P I R D . ''x • . . ' .
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county s '
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned - incomplete Inspectpec •
-v
•
property for inspecr n our es. .-./'Dale: i(�f6 frig2-; _ Signature: ✓ ' / x'`"•evf/� '$e — _— .5
Drivers License or Social Security x:
1641,46 White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod-Assessor
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• •• .
XV SPA - • - -
• CONSTROST.ION AND PLANNING .
• Date -Inspector - ' ' . Date Inspector
APPROVALS Permit# APPROVALS Permit #
' .. .
1. Temporary Electrical Service or Pole ..
•52. Pool & Equipment Location
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' 2. Soil Pipe-Undrgrnd. . -- -53. Steel Reinforcement : ,-----
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---: 1-1
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▪ 5. Silielj ReinforceriirtT - i 56 Rough Plumbing•& Pressure Taeseg c"; -
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so' . 57. APPROVAL TO COVERUakcfr
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. 58. Electrical Conduit-Undrgrnd. CO .....
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4- 8,45undation c
7-'2' 59. Ga -Pipe, 0 Undrgrnd., Test --7
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9tVeater Pipe-Undrgrnd. - • ,• ...-.‘"? 60. Backwash Lines, P-Trap, 0 UndEgrnd.
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10.`Structural Floor System . ,...;
--- • .61. APPROVAL TO DECK - .
11. Property Sewer Lins& House Connection 62. Backwash & Receptor-Final ':/'
t;,'
12. SeWar Cap - ,...v ...- 63. Heater & Vent-Final
1-4 - -
•
13. Roof Drains . ' Ick - 64. Plumbing System - Final
,,,---2
14. Rough Plumbiffg 1--- 65. Electrical-Final
4 .
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' 15. Rough Electrica4-Conduit 66. Solar Systerrna
i-Fil ‘,/2 / cl
16. Rough ElectricWiring 67.. Fencing & Access-Approval -
.4-7 .
•
. -
.
17. Rough Wiring Sign - . ' 68. APPROVED FOR PLASTERING
•
18. Rough Electripl-T Bar Ceiling . -, . ., 69. POOL/SPA SYSTEMS FINAL / t -
li 19. Rough Heating & Air-Conditioning-
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21>Das1Stctut4 - H70 ?r. deg0..e-.p11--1n(C7q- Hy>7ss1 lro ' •tF•e:.
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22: Dui.is, C:4ntitetirrg 4 0S- * S tr* " it:71. ProducTPThing CI Gas aoit
231:;;GaV.Pipfr6Roligh &-lest 1 w -4:- a H.x x ,-- tr4 i t '..„acl -*
44,- x - .7,-- < 0,..: ,.4 .472. Underground Fluktro * OS --,--
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25. Rcigf Sciathing r ,* . < ctv's. pk, 74Qverhead Hydrcb- t •
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26 :T-Bar Ceiling (Smuctural) 8cVenocoat * ' i ro tr.• 73?c .?, 75T Dry Chemical -t is Hi C- <tg
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27IfFrame led Flash,4 tis ' ..2...„.:_ ..., 76"-T. er y St a niTP e 9 ' 5 '71 rc,ccz
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1....28:r1LasktinC.i& Si1ing-,X .2.: :s. 't.' :c7.13::. -:, X' -• •• "••x -4; 77 FIXED Aeil-Ei:-.9rSINAE-- .")
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79-2 F I NA L I S.SSE CT IQ N ';;; '-'- t--1' 7-pri:-115
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:;32,.rElectrical Power Metet-Finali x CC, .;" ...r. 0-4807;FOOD CERTIFICATE ISSUED
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t497Electric Release-t*sops7-4.4 ,--tt :4 .--;: t -4: -1 :a:t-,cl
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:u, 5121,..GatRellijase:to SouSheintC71Iforrti,a Gas Co ';', fdi,.*: •.5-. r-- ,---; i'. r'Ll . X.iv: .f. C.2 ...,....-: , i •
L.51. CERTIFICATE OgiCCUPANtV '',
-F: t - ••••••• r) c:115 'cc: s ?-4... .. _
co
No. Date
•
' __
y
PROJECT ADDRESS: 2098 VALLEY RD ' UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: IB 065671
OWNER'S NAME: ROHRER, DANIEL H
ADDRESS: ROHRER, MARY LOUISE PERMIT NO: IB 065671 PLAN CHECK NO: N GOVT: N SUPP: Y
2098 VALLEY RD
COSTA MESA,CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: OTH STR PURPOSE: ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : RESHEATH,REROOF(COMP SHING) &ADD SKYLIGHT SQ FT;
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /M-1
PERMITTEE: MARY ROHRER ( 714 ) 642-5425
ADDRESS: 2098 VALLEY RD COMMENTS : REISTATE EXPIRED PERMIT #B59998 FOR ROOFING & SKYLIGHT
COSTA MESA CA 92627 *************Bt+E+F******86***+F*****iF+F+E*x-******+ERE+F+r***a6*******+tkE***+E+tBE****+t*****+F>,Eae
LICENSED CONTRACTOR DECLARATION: I hereby atfam that I am licensed under provisions of Chapter 9(commencing with Section 2 ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY DC.: STATE LIC.: CLASS:
Date: Signature: MAIN BUILDING ACCESSORY BUILDING ---------
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800. Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
•OMPANY: PARKING REQ: PROV: PARCEL: 42233136 ZNE: REF NO:
J CeRified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> /
Date: Applicant: *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(SIW)or less). DEVELOPMENT SERVICES R E Q U I R E M E N )T S
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 i'
subject to the Worker Camper Qtion�jews of California. / ZONING APPROVED BY DATE:
_� Date: at�( (.] you hru: Workers'
(rs���` /Y
Code.y:If.aft r making to d larith s.you should become Subject s the mrevoked.Compensation provisions of the Labor BUILDING APPROVED BY DATE: ra
Cade.you must forthwith comply with such provisions or this permit Shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE: \ L,2 5 t.
which this permit is issued(Section 3097.Civ.C). **************************************.****** ********************* **
LENDER: *********************************************************************t**********
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT;Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES' GRADING
(Section 7031.5 Business and Professional Code- Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 30 . 00 ' n
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON•y RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE m
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID `!
structure as owner of edr or offe or my empection with usine as (Deo ssie ao eThe, ntl cto the work, nsd the D00
❑ is to
ne offered pfosale(hociuils0oiBprovessand on,Professional Code:sThe Cohcmrs'here Licensethrough Law TOTALS----> 30 , 00 0 , 00 0 , 00 30 . 00 30 , 00
does not r wn tn o pl owner. of a property who buildsmror improves e not into andewho dfere such work hi however the or tdr g or 4,
his roemntieold within provided of cmph lion.improvements are not tithe bddeoof pr for sale.If. id not bald or iimprvr REVENUE DIVISION TOTALS--> COLLECTED: 30 . 00 OVER/SHORT
forpthespurpose ofl5de)hin one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/TOT GRADING„PLAN—. 00
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
30 , 00 CHECK
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon { .
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). I am aware **********************..)E.x.**.*.*********.*.**.***.****.*****.7I•***.******.76*..N.***..N.**.**.*.***.***
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
n I am exempt under Section:B P 7 0 4 4 B.&P.C. t
for this felon: ALLY WORK BY
OWNER !/� Lo rlr
TYPE QTY DESCRIPTIO N UNIT COST 'TOTAL COST
Date: / ], fif Owner:
h
30 . 00
INS 1 BUILDING RE—INSPECTION FEE 30 , 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES ;(
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements far a
Permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize repr entatives of this city to enter upon the above-mentioned
property for infection put set
s Date: 1 �12-- 7 Signature A� U1 001`x1/12/90153586 TOT 30.00
DATE: 01/12/94 TIME: 08:47
Driver's License or Social Security a:
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
..r I
PL. .& SPA -
'e- CONSTRUCTION AND PLANNING
APPROVALS Permit# Date Inspector APPROVALS Permit #P Date Inspector
4
•
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location f
2. Soil Pipe-Undrgrnd. ter. 53. Steel Reinforcement -'i .
T'
3.,Electrical Conduit Utility-Undrgrnd. _ 54. Forms ',a -�^,
4. Electrical Conduit-Undrgrnd. J7"' 55. Electrical Bonding si'
5. $feet Reintorcentenr 56. Rough Plumbing & Pressure Test
• 8. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE
- 7-.'Fooiings 58. Electrical Conduit-Undrgrnd.
8. Foundation / 59. Gas Pipe, 0 Undrgrnd.,Test ,
9. Water Pipe-Undrgrnd. ;.1 60. Backwash Lines,P•Trap, 0 Undrgrnd. �)
10. Structural Floor System / 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 1 62. Backwash & Receptor-Final i ..•
12. Sewer Capit
63. Heater & Vent-Final ,
t
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final i
15. Rough Electrical-Conduit 66. Solar System-Final r! •
16. Rough Electric Wiring 67. Fencing & Access Approval
. i
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING'
18. Rough Electrical-T Bar Ceiling .69. POOL7SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factoey Fireplace APPROVALS- )• Permit# - ,
.
21: Duets, in Structure . .. - -- ; i.. , , `70. Underground Hydro
22. Ducts,Ventilating - - 71. Product Piping O Gas CF... Oil
23..Gaf Pipe-Rough&Test .
172. Underground Flush,. .
t.
24. Raaf Framing ' - - _ I:73:' 0 Gas ❑Oil
25. Roof Sheathing ' 74:-Overhead Hydro
26. T-bar Ceiling (Structural) & Monocoat - 75.'Dry Chemical
27- Frame and Flashing, i .• ' A 76. Dry Standpipe
• 28. Lathing& Siding77 FIXED SY TEMFINAL
29. Insulation - 7t : FIRE PREV. FINAL
1
.GO. Drywall Nailing ' -i HEALTF DEPT. REQUIREMENT
L 31. Plaster Bcosyn Coat` _ 0- :. ! I L. - 79.-FINAL IfiE$P'ECTION --
-32, Electrical PosWer Mater-Final i '• -80ir,F000 CERTIFICATE ISSUED -
-_/
. 33. Final Electric - • . Nates: , •
34. Final Heating'&(lir Conditioning -`
35. Final Ga% Pipe-Test, '` . ;
r
r , .
36. Hood or Canopy - X - -
37. Final Factory Fireplace_ ; „ 1 i
38. Final Plumbing • v -- _
39. Water Service-Final '
,;40. GuSeryjce-Final4 . „ - • - - : • • '- , -
-41. Solar Domestic-Final
I-- ' r - -
"42. Backflow Preventer
43. Backflow Irri§ation J
.44, Landscape Irrigation System. , - • -.
45.-Sound Attenuation u
'46. Handicap Regulations - -
I 47. r1NAL STRUCTURE & BUILDING AA. i
48. FINAL PLANNING - :- .
49. Electric Release to Edison - - - -
50. Gas Release to Southern California Gas Co . „ -
:51. CERTIFICATE OF.OCCUPANCY , - . , _
No. Date
•
A `
i, Y. 9 _to
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA, CALIFORNIA _
. C- 1,- t . A .. . '* 4-1A66
Figc., to Fill In Completely APPLICATION FOR PERMITG
jic
-'3I/7D TYPE OR PRINT 1C/#' 1
(BUILDING I.
BUILDING
ADDRESS 2098 Valley Road 3// CI:i U;= CGS(/♦ r'ESA
COSTAMESA. CALIFORNIA For Office Use Only
S RECEIPT NO. I PERMIT NO.
OWNER Macco Corporation / .J o3
-MAIL RECEWED BY 1 DATE RECE VED I DATE ISSUED
ADDRESS 3800 F. Coast Highway /r-+✓ �---/-6'1 RUG 2 g 299/1
.1cn 'Y Corona del Mar • No,'OR 3-422 BUILDING
I!ARCHITECT TEL.
OR ENGINEER George Wiseman Na FIRE
OR 3-422 COSTA MESA. CALIFORNIA l/��
ADDRESS - ZONE TYPE // GROUP'J9'O
CONTRACTOR*ia CCO Corporation APPROVED
BYDATE
ADDRESS 3800 E. Coast Highway ZONING
ZONE•('-)' I NO.OF /] I USE OF NE n-1.14
CITY Corona-del Marg PLANS V..G' BUILDING•I
STATE TEL. '("' OWt. 1
LIC.NO. • NO. OR 3-4220 LEGALESCRIPTIVail I A 3 n 7
SIZE G NO. OF BLDGS.
OF LOT 60 X 100 "" NOW ON LOT 0 A.P.NO.
USE OF YARDS EVES
EXISTING BLDG. APPROVED ALLOWED
SETBACK LINE FROM (CENTER LINE ST.)
CENTER OF STREET REAR YARD FRONT �-�-7FT. IN.
SIDE YARD I LEFT 51Q11 RIGHT 5'OII R.SIDE J-^FT. IN.
DESCRIPTION OF WORK •
L.SIDE 1 n1;97FT. IN.
NEW IXX II ALTERATION I II ADDITION I REAR - - 01,5---FT. IN.
REPAIR I II MOVING I I DEMOLISH I APPROVED //� DATE �—`(�40 .
SIZE
20 x 49 RNO. OF OOMS 6 STORIES 1 A- �7
EXTERIOR'WALIStUCCO I ROOF Cedar Shakes
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
till lets Construction
House Sq, Ft. 1450
Garage Sq, Ft. 420
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM-
PURPOSE OP ESTABLISHING A PERMIT PEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
SIGNATURE OF PERMIT FEE $
PERMITTEE MaCCO([firC/pgrnoz'ati�on����/ 9`�J� 3 N
\•AUTHORIZED AGE By: /'(-TL���i / (,C" I "-' $ / / /(/— PLAN CHECK $ /7"" 4F
s
TOTAL FEE $ 6--/ n