HomeMy WebLinkAbout309 16TH PL - Building Permits •
C.
•PRGIEC1 ADDRESS: 309 16TH PL UNIT: CITY OF COSTA- MESA — BUILDING PERMIT PERM NO: BME 046485 '
OWNER'S NAME: CARP WARD .
. ADDRESS: SAME PERMIT NO: BME 046485 PLAN CHECK NO: 0312.0-90 S GOVT: N SUPP : N
CONSTRUCTION TYPE: PERMIT TYPE: ELE MEC STR - PURPOSE: REP
631--2242
• ARCH/ENGINEER: - - REG.NO.: JOB DESCRIPTION : REPAIR FIRE DAMAGE,DRY WALL & 'INSULATION SQ FT: 1 , 500
ADDRESS: UNIT: •
• CLAIM VALUE: 1 , 500 . 00 CALC—VALUE: 1 , 500 .00 GROUP OCC: R-3 /
PERMITTEE: CALIFORNIA WESTERN INS RE ( 714 ) 581-0120
ADDRESS: 23372 S . POINTEE COMMENTS :
LAGUNA HILLS CA 92653 ***�r*+ ********�r�a*********************+r*�e�r�rx***�rx***+ *�r***�r* +r�r***********xst****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON INC REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and licenseis in full force and effect. SETBACKS
cl1Y uC.: 0 S 0151 STATE sec.:p z"�"" .
Date: 3— tr)—go ( Signature: MAIN BUILDING ACCESSORY BUILDING —
WORKERS'COMPENSATION DECLARATI6N: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers'/ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance or a certified cereof(Section 3800 Lab.C). LEFT: FT IN RGHT: - FT IN LEFT: FT IN RGHT: FT IN
0&ICY NO.: 1131opym
12 4 EXP.DATE: 05/01 /90 •
oMPaxr: STATE PARKING REO PROV: PARCEL : 00000000 ZNE: REF NO:
J Certified copy is hereby furnished. ® Certified copy with the c' ilding "ion. PLANNING NOTES>
I > •
Date: SSV- e Applicant: ***************************aa***************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D E V EL OP M E••N ,.T SFR V I 'C ES REQUIREMENTS
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. ZONING APPROVED BY •
DATE: _
'Date: Signature: -
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILD I NG APPROVED BY ': - .• DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. r
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: - _ DATE:
which this permiis issued(Section 3097,CN.C). ***************************-************ **�********** **
LENDER: ************************-**if******************'**********************************
ADDRESS: - LEGALIZATION:N F E E- - S U,M M A R Y STRUCTURAL SEGMENT:•Y
•
a
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'Stale License Law for the following reason BLDG PMT PLUMBING ELECTRIC ' MECHANIC FIRE SMIP/RES GRADING '
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 35 . 00 11 , 2 5, 6 . 50 . 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 5 1.)% 25% SM.I P/NON—RES •
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN 22 . 75 '
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE15. 00 15 , 00
I, as owner of the property or my employees with wages as their sole compensation, will act the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK' ' ,, TOTAL PAID ' DUE
'-7 structure is not Intended or offered for sale(Section 7044„Business and Professional Code: The Contractors'State License Law TOTALS----> 53 , 25 30 . 00 2 2 . 7.5 106 . 00 • 106 . 00 ' ` . 00
does not apply to an owder of a property who builds or improves thereon,and who does such work himself/herself or through - '
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 106 .00 OVER/SHORT: . 00
forimpthe purpose sold 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 SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
35 . 00 26 . 25 21 .50 S 0 2 7, , 7 5
❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractors)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' FE .E1 BREAKDOWN
❑ I am exempt under Section: 8.&P.C. •• ,
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
•
•
Date: Owner SFR 1500 FIRE DAMAGE/VAL RESIDENTIAL NOZONE 1 . 00 - 1 , 500 . 00
I do hereby certify that l am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and ELE 3 FIXTURES, LIGHTING 1 ST- 20 EA. . 75 2 . 25
' 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 EL E 3 RES APPLIANCE NOT OVER r
permit
tpfor nstconstructionHOOD or modification from the Air 6ualiry Management District.Residential construction applications are exempt from
Mead MEC 1 INST Id/DUCTS FED BY' MEC EXHAUST 6 . 50 F . 50 •
END OF' FEES
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 h horize repmsen ' of this city to enter upon the ovelnentioned - . . . - \
property for inspection purposes. 1r k
Date: 3—G_ 57e2 ` Signature: \ . •
Driver's License or Social security x: •
. • 9 01 00055897-00055901 T ICE T 106.00
=\-4B White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor DATE: 03/12/90 TIME: 15:25
' .. P. & SPA - 1
1. CONSTRUCTION AND PLANNING"
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
-415 1. Temporary Electrical Service or Pole. 52. Pool & Equipment Location
2.-Soil Pipe-Undrgrnd.- - -. - 53. Steel Reinforcement
3.-Electrical Conduit Utility-Undrgrnd. 54. Forms
- 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
.'S. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings ^ 58. Electrical Conduit-Undrgrnd. .•
8. Foundation ., - • 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System • 61. APPROVAL TO DECK
11. Property Sewet Line'& House Connection 62. Backwash & Receptor-Final
12. Sewer Cap -- 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final:
14. Rough Plumbing 65. Electrical-Final
• 15. Rough Electrical-Conduit , 66. Solar System-Final
16. Rough Electric:Wiring 2....19..-ib � . Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
_ 19.. Rough Heating 84-Air Conditioning , FIRE DEPT. REQUIREMENT _ _
20. Rough Factory Fireplace . -• _, ;
_ -APPROVALS : t.Peimit# • - - -
21:-Ducts,in Structure; - - = _ _• ; r -70. Underground Hydro
22. Ducts, Ventilating , -. , .71. Product'P,iping D Gas 0 Oil
23. Gas-Pipe-Rough & Test _ '-= ,- _• _ ' -72. Underground Flush
24.-Roof Framing I - - . ` - -. 73. .Undergrnd.Storage Tank D Gas 0 Oil
25. Roof Sheathing - _. _ 74. Overhead Hydro '
26. T-Bar Ceiling (Strudturall &-Monocoat , - - - 75:_Dry Chemical 1- -
27. Frame and Flashing -- - -' -- 76. Dry Standpipe • '`' _ -
28. Lathing& Siding - _ - , - 77:_ FIXED SYSTEM-'FINA L -
29. Insulation ,-2G-9G &'4'6 78:-FIRE PREV. FINAL '
-30. Drywall_Nailing ' _ 3 2f-fo 4 fAit _ HEALTH DEPT.. REQUIREMENT
31. Plaster Brown Coat - - - • -'79. FINAL INSPECTION _
32. Electrical Power Met ,
ter-Final . 80._ FOOD CERTIFICATE ISSUED. - - -
.33EFinal Electric •: - !" t Notes: 2-_/6-4 X .0?tc£n , ,va_"',r-
• 34. Final Heating & Air,Conditioning , -1 : t- Ooo4- a,i o .
35. Final Gas Pipe-Test. .- - • _-0• its. �'�
;36. Hood or Canopy _ .4y/ .1.7-...1111,_ _ rc /Celt
37. Final Factory Fireplace ' - G.Ulb4
_. v
i
'38. Final Plumbing , , : , • -
39. Water Service-Final- . : - -
40. Gas-Service-Final - •-
.41. Solar Domestic-Final' - , , - - .
42. Backflow Preventer . ` - -' ' r- -
i 'J - - _
43. Backflow Irrigation -
,-44. Landscape Irrigation Systeni _ -
_ ' ` z L. : ?-
45: Sound Attenuation ".�.
46. Handicap Regulations :. - -
47.-FINAL STRUCTURE & BUILDING t (P /9',
`
' 48. FINAL PLANNING `;?�, ��'3 � 6C 10-4- -
49. Electric Release to Edison ` 1 - '
- 50. Ga"s Release to Southern California Gas Co ' ^ • -• _ - - • -
' 51. CERTIFICATE OF'OCCUPANCY ' - --
No. Date
l
I 4
4` 9'6CITY tS.F COMM MESA
BUILDING DIVISION
F „,• 1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT B07-00365
4tb.ron'also.4%
(714)754-5273 • Fax(714)754-4856 • w www.ci.costa_mesampkiLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 309 16TH-PL • Status: ISSUED
Suite: Applied: 03/27/2007
Vicinity: REAR HOUSE AND GARAGE Issued: 03/27/2007
Primary Occ: R3 Type of Construction: V-N
Parcel Number: 42521104 Zoning:
Applicant DALESSIO, DENNIS
Address: 19 DRIFTWOOD ST
Phone: 310-827-0818 l^
MARINA DEL REY,CA Zip: 900299 2 ISSUED BY: I\/• /)
Owner: DALESSIO,DENNIS TRUST �1�
Address 19 DRIFTWOOD ST - i
Phone: 310-827-0818
MARINA DEL REY,CA - Zip: 90292 ( j\
Contractor: OWNER-BUILDER , `/, i
Address: \_ - ^."
Phone: , .
Zip: ' " License: 000000
Arch : Eng:
Address: , Address:
•• Phone: - • Phone: •
•h ..
Zip: . License: License:
SCOPE OF PERMIT
REROOF REAR HOUSE.WORK TO INCLUDE:TEAR OFF(E)ROOF MATERIALS, INSTALL A MIN OF 2 LAYERS OF#15 FELT ON A 2:12 TO LESS 1
PITCH ROOF OR A MINIMUM OF 1 LAYER OF 30#FELT ON A 4:14 OR GREATER ROOF PITCH AND REROOF W/ASPHALT SHINGLES ON FRONT
BUILDING W/AN ATTACHED GARAGE,APPROX 2000SF.REPAIR AND REPLACE SHEATHING AS NEEDED.
- FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,000.00
Permit: $83.25 Claim Valuation: $3,000.00
SMIP Res: $0.50 _
SMIP Com: $0.00 - -
Other: $0.00
Inspection: $0.00 •
•
Total: $83.75
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 :Rear 0-0 Left , 0-0 Right 0-0
ACCESSORY Front 0-0 ,Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0. ' Required: 0 Proposed: 0 "
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 WOO)
DECLARATIONS -
WORKERS'COMPENSATION DECLARATION: 1 .7
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 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 s need not be completed i(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'
G -' compensation laws California,and agree the R�should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these r cions. " ,../`vL�
Applicant Signature: r' Date: //ZrO 77
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOUARE($100,000),IN ADDITION 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
force and effect.Lic.# Class#
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:My 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(5500).):
❑ 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 properly 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
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.). •
�l,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 p uant to the Contractors License Laws.).
❑ I am ex under sec. Business and Professions Code for this reason: /Z
T/0 /
Siggnnafure:' Peril lCl - // ate: .2 3
Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. / Explre_s: p/Z S
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).
O 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 ❑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 Calif omia 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 Safely 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 a ppermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? lI 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 California Health and Safety Code).
7 II 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 • comply with all state land city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-descri ,}��perry fo�@ction•4: I re not to occupy or allow occupancy of any building authorized by thisispermjt until fin inspection.
7 •► .,/Z 7
t SI IOwner(s)'_. [Date,
And/Or Authorized Applicant Date
$ODE II INSPECTION TYPE PAIL INTRIAL$ . CCDF F INSPECTION TYPE gdTE REIEL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final / 208 Final Plumbing
200 Final Re-Roof ("ZZ J Oq W 210 Final Electrical
201 Final Block/Retaining Wall ___ ___ TTT 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
•
CITY OF COSTA MESA
BUILDING DIVISION
Y4%1•,,___ DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER
F t
J . PERMIT B07-00364
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa ueroU°U_Dth PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 309 16TH PL. • Status: ISSUED
Suite: Applied: 03/27/2007
Vicinity: FRONT HOUSE Issued: 03/27/2007
Primary Occ: R3 Type of Construction: V-N
Parcel Number: 42521104 Zoning:
Applicant: DALESSIO, DENNIS
• Address: 19 DRIFTWOOD ST
Phone: 310-827-08181116)1
MARINA DEL REY,CA Zip: 90292 ISSUED BY:
Owner: DALESSIO,DENNIS TRUST
Address 19 DRIFTWOOD ST "
Phone: 310-827-0818
MARINA DEL REY,CA Zip: 90292
Contractor OWNER-BUILDER
Address:
Phone:
Zip: License: 000000 -
Arch : Eng:
Address: Address:
•
Phone: Phone:
Zip: License: License:
•
SCOPE OF PERMIT
REROOF FRONT HOUSE.WORK TO INCLUDE:TEAR OFF(E)ROOF MATERIALS,INSTALL A MIN OF 2 LAYERS OF#15 FELT ON A 2:12 TO LESS
PITCH ROOF OR A MINIMUM OF 1 LAYER OF 30#FELT ON A 4:14 OR GREATER ROOF PITCH AND REROOF W/ASPHALT SHINGLES ON FRONT
BUILDING,APPROX 1500SF.REPAIR AND REPLACE SHEATHING AS NEEDED.
FEE.SUMMARY
Plan Check: $0.00 Calc Valuation: $3,000.00
Permit: $83.25 Claim Valuation: $3,000.00
SMIP Res: $0.50
SMIP Com: $0.00
Other $0.00
Inspection: $0.00
•
Total: $83.75
• PLANNING &ZONING •
SETBACKS •
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 -Rear 0-0 - Left 0-0 Right 0-0
PARKING Existing: 0 " • Required: 0 Proposed: -0 ' .
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 •
WORKERS'COMPENSATION DECLARATION: { I
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:
Career: Policy Number:
((TTh:&action 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'
j -compensation lawsCalifornia,and agre hat,I should become subject to the workers'compensation provisions of Section a 700 of the abor Code,I shall forthwith
comply with these p inions. `-'14.0- . . . 2 /Z 7 //yD
ApplicantSignature: " Date: / L/ [
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($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#
Contractors 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
.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
V 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 ex pt under sec. ( -�— Business and Professions Code for this reason:
Signature: Q?444.4 49 L-6.Y2,..2' ,—Date:- -37t7 /0 7 / �1�7
c _Owner ID verified by drivers license. to-Yes 0 No DrWers License No. Expires: 9/Z 6 Amite /
\_
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,Gry 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 tiled 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 tiling 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? LJ Yes 0 No
(Section 65850.2 of the California Govemment 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, 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 ekcribed property for in tio�urpos to occupy or allow occupancy of any building authorized by thispermit yntil finalinspgction.
6((YY//ul•(di0 Z 7 D 7
Signature Of Legal Owner(s) Date
'And/OrAuthodzed-Applidant IDate—m-
;ODE t INSPECTION TYPE DATE INTRIALa CODE( INSPECTION TYPE DATE JNTrML$
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final208 Final Plumbing
200 Final Re-Roof y--/2-07 . 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
CITY OF r TA MESA N° 2 88
- -
PARK PEES
Fee Payment Receipt
QQ .I
Project Address Sol /(/ � R • lie .. Park Area
A. P. No.
11 ,7 -/023 J - }
/
Building Permit No. cF to
Owner's Name AA Mi A C-Ire
/ /J�/
Mailing Address .973 / c, roc? �y - ea////
FEE /
Single Family • No. of Units @ $455.20 =
Multiple Family •• No. of Units / @ $321.32 = j 2/. 9
Total Fee '
- ,-1
��GlpP
Planning Department Approval Date 3 7-77 By �
Applicant's Signature t/LA ' ' C
• City Ordinance 72.44
•• City Ordinance 72.45
••• City Resolution 74-124 I� 1 NI]
White-Planning;Canary-Planning;Pink-Finance;Goldenrod-Applicant CMF 0174-26 I�JI
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43998 _ ..
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MAY 18-77913 ****87_.26
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
/QI APL Af10N FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely- Use Ink Only V
RE I E D EI DATE ISSUED
ADDRESS 7
BUILDING 30G Ito+� Pt. can M� -- /r
IS
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OWNER A niNA 6-Ray A.P. NO.//7-a3//- 80 d
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ADDRESS 2-73/ E. MAR.Coast iii-V y ABDIDRESS got/
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CITY CORONA Pa NOTE.6213-024:2
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LENDER VW " `//\
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5a SIZE NO.OF BLDGS. q
L OF LOT NOW ON LOT FRONT F 91 FT.
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electric,plumbing and heating work.
Iti , REAR ,�-.[< FT, FT.
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() APPROVED
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W that the above information is correct and agree to comply with ro
L all laws regulating building construction, and I shall not employ
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I heraby'certify that I am properly licensed as a contractor under / $G. FT. /it $65
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business ir
and Professions Code,Division 3. Chapter 9. //,J, n
VALUATION�)� PERMIT FEE $ n
PLAN
Signature of `/A � ' CzA.LX/v $ )�V V TAX CHECK $ vO eno
PermitteeO 2. O� u
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43997 ma 18-77cN54OO 910* *ca**5.5O
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
AP'L l A I ION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely— Use Ink Only
REC' V O a DATE RECEIVED e .
BUILDING
ADDRESS ^309 ,4i4 pL - Il , A
AOWNER IVNA GREY A.P. NO.,/ / 023/-30 PERMIT NO.
AMAIL BUILDING 349E /6"'� P.�, ci
MAIL SSS 273/ E. zCrOASr �wy 1 ADDRESS //`` s /alta
CITY CO.�/NA Pa MAP NOTEL X73-0262 TRACT4O. J /? T ,a BLOCK
CONSTRUCTION OWNER Q NEW ADD ALTER REPAIR (MOVING D OytSH
LENDER 5(.1/I-0 ER
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OWNER sJ KcEr-'(/
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OR ENGINEER NO.
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CONTRACTOR •/ Y
ADDRESS 1 Z E NO.OF USE OF NE
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STATE CITY YARDS ED YARDS APPROVE
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W SI2E I NO.OF BLDGS. (FROM C/L STREET)
L OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
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electric,plumbing and heating work. lY/tIQREARFT. FT.
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MAIN BLOCS. ACCESS. BLDGS.DGS.G VAR.#
OU,P, W DATE
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WS, the State of California. co
I hereby certify that I am properly licensed as a contractor under SQ. FT. a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ c—wiv
and Professions Code, Division 3,Chapter 9. �/ a+
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Signature of -�, PLAN CHECK $ o
Permittee f�-wL.t"[ / " l"U/[..(.l/l _. $ TAX $ SD LL
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Authorized Agent TOTAL PAID $ S
' ' AUG 15-77PatAOO1444* ****
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4 4: i;Ii 1
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
A RECEI V DATE RECEIVED LXI /(�
�ADILDING DRESS 3o9 i�+h PLP-1L.0 / t �/ ' V I/„] 7
A.P. NO. //�` / PERMIT NO.
4WNER A>`I N/� IRA /'J
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ADDRESS30 7 E— /6/,r( �L-
ADDRESS 2., 37 E. CcASI 1 Lo I 2 q,� J
CITY Coeeta DEL. MAP NO. 1031-31 ILJ TRACT 4'Z LOT/pC BLOCK
CONSTRUCTION NEW 1ADD ALTER REPAIR f MOVING DFMOLISH
LENDER
BRANCH /fit '
Vf-OWNER 4011.409—/t✓'
ADDRESS / /_ a��./// /
ARCHITECT TEL. USE ZeL177
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ADDRESS ZONE TV'- I�r.-GROUP
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ADDRESS ZOp�� NO.OF USE OF NEW //
TEL. T!• (PLANS BUILDING ��0�47�
CITY TE 1/1.'z
F STATE CITY YARDS APPROVED YARDS APPROVED
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APPROVED
At A �
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0• all laws regulating building construction, and I shall not employ
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ZTWii the State of California. nil-
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3 I hereby certify that I am properly licensed as a contractor under L T SQ. FT. w
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FE NLY:
am exempt from the provisions of the State of California Business iO
VALUATION PERMIT FEEDC9v
and Professions Code, Division 3,Chapter 9. E / n
m
�/J ///� ///Js -}� 00 PLAN CHECK $ 11. 00 2
Signature of L '`�'_^ • `^'&'r-CA_ >44900
TAX $ S�Q
Authorized Agent \ TOTAL PAID $ 2, so a. J