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Home My WebLink About1278 LOGAN AVE - Building Permits A- i * ItJSk- CITY OF COSTA MESA M i) BI/ILDL G DIVISION PERMIT NUMBER DEVELOPMENT SERVICES DEPARTMENT PERMIT F 99-00409 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • PLUMBING PERMIT Job Address: 1278 LOGAN AV Status: ISSUED Suite No Applied: 07/16/1999 Issued: 07/16/1999 Vicinity: IN FRONT OF BUILDING n ' Parcel Nunmber: 14120121 ISSUED BY: K�`-� ' Applicant: KNIPSCHEER, ROBERT Address: 5436 WAMEDA AVE. - - CA . , ,, Phone: (323)257-7850 LOS ANGELES. Zip: 90041 . . .. owner,% WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: Carrier: - Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in 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 these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 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 COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F 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.tic.k Class if Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: 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 exem.t un.:r se . Business and Professions Code for this reason: Signature: v /t/ilei/ - Expires: /--"--/Z-194Verification 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,Califomia 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 ❑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 ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 ❑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 Califomia 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-describe. property for ips. I .osesl agree no to occupy or allow occupancy of any building authorized by this permit until final inspection. Signet.re• Leg- Owner(s) Date And/Or Authorized Applicant Date coDE I INSPECTION TYPE DAL INTRIALS IOU INSPECTION TYPE DATE INTRIALS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical po 1266 Pool Spa Final 208 Final Plumbing I' p L f 1 61.,�/ 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, 2446-46 DECLARATION OF UTHORITY Bldg. Permit # FOR AGENTS OF PROPERTY OWNER This Permit # fieoO zLoq TO APPLY FOR PERMITS /a- 7 1 ,L o<CA %-r/'t Street Address AP Number e), /3/4//(/ e�Ll�,f/ (J�/C , declare that I am the Owner of Title of the above referenced real property, and that I (we) hereby authorize: ,40'43Fier kkt?set1e (7,-) 67- 7fro Name elephone No. 67/36 WAM -0s 4f•. Street Address LDS 4,45-EG6244 r00.414/ City State Zip to obtain permits in my behalf, as owner/builder, for (d1.5774t477C& DC' j4-CK FLl2cr-, at the above referenced property. ,DRE//E.ri7?M !1/414--1/E 2. Should any person become an employee engaged in the improvement of the property, I (we) shall im- mediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correct. Executed this re day of wLy 19_1r_, at/{cryr 4 ME 4,.California. /4/1 Ay aGin) tJA(cW 7— Printed Name Date // Signature NOTE: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. 077948(Rev.2191) I • 1'02 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT 1/--.9V-5-7 (� P.O.BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT. ` fOR APPLICANT TO JILL IN COMPLETELY APPIefffkl ,P6094bMEIS&RMIT TYPE OR PRINT BUILDING BUILDING / i77, /D tee �(�c- ADDRESS COOOOSTAMESSA. CALIFORNIA > ..1177 � // IFO I ) fOR OFFICE USE ONLY OWNER Liam., Y yak,/ /�ry(C/IL,/ I RECEIPT NO. PERMIT NO.y 1l MAIL Ian �J /�,I./ n /�// / RECEIVE DATE NECEIV p pAT IBS ply ADDRESS /I� J0 2 aRj,416GN / It! /r/`et 4 hT�E / Y -,j CITY a) y'T�Mf TNO�A,f-c-4- ADD EISS ARCHITECT / OR ENGINEER NO .LIC. COSTA MESA, CALIFORNIA FIRE / ADDRESS ZONE TYP y GROUP �'2- L�nr/f'f STATE APPROVED I },-'/lI CONTRACTOR#t6O S '1 LIC.NO.g a.ts BY DATE /y/Y/v ADDRESS ']7((/ �{�{�,.��fj/�/�,/`J . '.v i cr . ZONING LEGAL LOT 1.5674 �f/I /, I yc4 kONE I NO.OF USE OF NEW , DESCRIPTION I NO. VVV ��- L•CK. TRACT >/` `I PLANS BUILDING I/ J//KKff�� A.P.NO. tate/ � F al �....�. "IINI BVPROVED f / DATE /fl�4( {,,)� SIZE 75 A" t4 I YARDS NOWYON LOT/LOW REQUIRED AEVES LLOWED p `�J'� OF LOT /� Y'7 USE OF (CENTER(CENTER LINE ST.) � EXISTING BLDG. Ai FRONT /.5." Fri - d IN. i1 SETBACK LINE FROM l, f!4724 "<�.r✓ i, CENTER OF STREET `'� REAR YARD ✓�y R.SIDE `r/ --/'J FT. I(/7/ " 'V IN. SIDE YARD (LEFT S` RIGHT L.SIDE ,AS315. 0 FT. 4/10-'- IN. DESCRIPTION OF WORK S`r4 REAR ,J FT. IN. NEW I(�J/(ALTERATION I II ADDITION I Yd - F JN x t� ;'F / 4 REPAIR - MOVING wsN I ti--.04( i f BUILDING.R�X�a NO.ROOMS OF f STORIES / 40417 �0B p 4 1P SIZE 77 EXTERIOR WALIO ROOF COVERING %L:aICOVERING 7nt r US F BUILDING AND WORK TOB ERFORMED di'SQ/'G ";e1tret) op$' �� _ . r , , eG• . 0 : / - 4% r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- 'THE AMOUNT SHOWN U'DER VALUATION IS FOR HE PLY miffALL CITY ORDINANCE Po STATE LAWS REG ATING PURPOSE OF ESTABLISHING A PERMIT FEE •NLY. BUILDING CONSTRyE'tl��/ VALUATION//,, O'�/ T FEE $ SIGNATURE �/�/ i/a $ (�/ /'fO0 �y' PLANICHECK $ �� / SERMITTEE //f�p��^^"CC%%/ /� ! (J /` �\ ¢e60 Oats o,CST � 2d, 21ZED AGENT TOTAL FEES 33 .--