Loading...
HomeMy WebLinkAbout113 23RD ST - Building Permits O� CITY OF COSTA MESA _ / , 4, q BUILDING DIVISION ./7 ---- PERMIT DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBERi� PERMIT f v .4° B01-00121 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cca.us UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BJob Address: 113 23RD ST Status: ISSUED Suite: Applied: 01/29/2001 Vicinity: RESIDENCE ONLY Issued: 01/29/2001 Parcel Number: 42605404 Zoning: R2 R2 Applicant: MIRANDA, FRANK ISSUED BY: _a______ Address: 18193 MUIRWOOD CT Phone: (714)557-6516 FOUNTAIN VALLEY,CA Zip: 92708 Owner: KUCHINSKI, ROBERT G Address 10012 JON DAY.DR i, Phone: - HUNTINGTON BEACH,CA Zip: 92646 . Contractor: ISLAND PACIFIC ROOFING Address: 18193 MUIRWOOD CT Phone: (714)557-6516 FOUNTAIN VALLEY,CA Zip: , 92708 License: 631472 • Arch : - Eng: Address: Address: Phone: Phone: Zip: License: License: / ,.. SCOPE OF PERMIT . REROOF RESIDENCE:T/O EXISTING COMP SHINGLES, REPAIR SHTG AS NEEDED, 1 LAYER 15#ASTM FELT,APPLY 25-YEAR COMP SHINGLES.7 SQUARES • FEE SUMMARY Plan-Check:‘ $0.00 Calc Valuation: - $1,400.00 -Permit: $50.95 Claim Valuation: 51,400.00 SMTP Res: . $0.50 SMIP Corn: $0.00 v' Other: $0.00 , Inspection: - $0.00 Total: $51.45 • ,-•- . . • . . . N / 77 PLANNING &ZONING SETBACKS\ N ' - ' MAIN STRUCTURE Front 0.0 - Rear 0-0 Left 0-0 Right - 0-0 i� ACCESSORY Front 0-0 Rear 0-0 Left " 0-0 Right 0-,0 PARKING Existing: 0' . Required: 0 Proposed: 0 NOTES: • 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(8/00) DECLARATIONS , I il 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 ork 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 i1 the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of ork for w•ich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws o Califo •'_ th ! I should becom' ubject to the workers'compensation provisions oftion of the Labor Code,I shall forthwith comply withensati t =rep •v alif-r .- � Applicant Signature: _r�i4.....1-04/./77,-i. Date: lam/ WARNING:FAILURE TO S C - DRIERS CO - AT/ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO C MINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(51 r 4.1.r),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 unp: provisio of Ch.pier 9(commencing with Section 7000)of Division 3 of the Business and Prete sions Code,and my license is in full force and effect.Lic.II /, Class N — Contractor's Signature:I. M/S) �AI%��tte� Date: CONSTRUCTION LEN• NG 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 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 B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia 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 Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or 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 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 Wilt any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No B (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 AUTHORIZATON.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%� e� property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ....V �lie gal,• ner(s) //z9,/b/ Date I U And/Or Authonzed Applicant Date CODE r INSPECTION TYPE RAIL' INTRIALS CODE! INSPECTION TYPE PATE INTRIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof C' "OZ ( 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 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PE IT NO TRACT Na LOT NO. UNIT NO. CITY OF COSTA MESA2CONST,i[RUsC�TIION PERMIT�(s _ 3t� ©t f 2 A.P.# Zone 1 Project Andress J4 113 0p•�(S7 Fn.P �n�nr¢r7 S Main Building: Accessory Building: Applicant's Mailing Address 0 r� fl STan-S 1R t1tA•-?BCE• TYPE OF CONSTRUCTION ❑ NEW LI ADD X ALTERATION U REPAIR E Front Z it Owner's Name 'tl KUC JJJ,, �1 Phone 64/42- ❑ CONVERSION ❑ DEMOLISH ❑ OTHER�� TB N ' DESCRIPTION OF WORK/USE OF BLDG. _SE> � A Rear — _ I Address is ..tom• • xa- • 1�.. i . ___ Arch/Eng. - License No. •^ TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL C • Right G Address �� ❑ TENANT XIELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left R 0 ❑ OTHER Ping. Ref.# Parking Req./Provided E Contractor's Name Phone PROJECT DESCRIPTION SQ. FT. OCCUPAN v /'�I Planning Notes: M Address Imailin9l ��' eOVt[• CONSTRUCTION TYPE VALUATION$ • T �a s T City License No. ZONE GRADING CU.YDS. ACRES S.LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: i with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ELECTRICAL FEES License Class License No. Date Signature PLUMBING I FEES Automatic Washer Transformer 0 15.50 KW WORKERS'COMPENSATION DECLARATIONBar Sink Showers I Construction Pole Sub. • 0 50+ KW I hereby affirm that I have a certificate of consent to self-insure or a certificate • - Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter pup to 100 amps 10, Lab. C.) /y Iicy No. Company Backflow Irrigation Sewer Cap I Dishwasher / Meter ,over 100 amps /O Sb U Certified copy Is hereby furnished. Dryers ❑Gas DElectric Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Date Applicant . Fan Motors ❑0-1 HP ❑1%-8 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors (This section need not be completed if the permit is for one hundred ($100)or Dishwasher Solar Piping F.A.U. Inc.Solar 09-15 HP 016-15+ less). I certify that in the performance of the work for which this permit is Issued, I Fixtures shall not employ any person in any mann r o as o becom object to the Drinking Fountains Solar Tank Microwave Workers' Compenjyon Laws of Califor / • Date Workers' by Signature ,/ �/ Floor Drains Swimming Pool w/Spa Device Boxes Pole Light NOTI If,alter aking this decla ion, u should b come subject to the - Workers' Compensation provision of the Labor Code, you must forthwith Floor Sinks Urinal - Outlets Range comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections Lender's Name Lender's Address Kitchen Sink Water Service Generator 00.5 KW 05-15 KW Trash Compactor •OWNER BUILDER DECLARATION 'I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays any structure, prior to its issuance, also requires the applicant for such permit �a to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains aJ Do the Contractor's License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee , $15 Issue Fee $ tAerefrom and the basis for the alleged exemption. Any violation of Section °5;33 5 by any applicant for a permit subjects the applicant to a civil arty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: 'Al, 3 Ias owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee Zoning Approved By Date pensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEESBuilding Approved By Date License Law does not apply to an owner of a property who builds or improves _ ® s' thereon, and who does such work himself/herself or through his or her own Application Issued By Dat: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II 0 SUMMARY OF FEES pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). BUILDING PERMIT $ SMIP $ 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $ builds or improves thereon.and who contracts for such oroiects with a con- __ tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's Compensation Insurance should be provided to me. �+ ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG* Fire Dampers •� ELECTRICAL $ J•�•.��1., GRADING $ — PLAN CHECK 50% $ MICROFILM $ Date tat27• by Owne - - - / Heating System& Ducting Registers - MECHANICAL $ TOTAL FEE $ 33..5 o I hereby certify that I have re.• this .pp Ica ion and st. e that the above 00-100,000 BTU 0100,000 BTU 25% information is correct. I agree to comply with all city and county ordinances PLAN CHECK $ and state laws relating to building construction,and hereby authorize repre- sentatives of this cl y to eater upon [ -•ove-mentioned property for inspection purposes / • rfi� - _ Signature _i Date ZZ C 1 U 7M'Lc:- GC:b1CU TOT Drivers' Licen ' or S5 .- Fee $15 Issue Fee $ 3 ;,'r.T5-.1 06.i21,39 I?fiE .15::12 0865-46,rev.5/88 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor . I CONSTRUCTION AND PLANNING POOL ?A Date Inspector ' Date Inspector APPROVALS Permit# APPROVALS Permit# 1.e'femporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil.Pipe-Undrgrnd. 53. Steel Reinforcement t 3.'Electrical Conduit Utility-Undrgrnd. 54. Forms - ! 4: Electrical Cond jpUndrgrnd. 55. Electrical Bonding S:,Steep Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE r; 7. Footings / f 58. Electrical Conduit-Undrgrnd. • 8i-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 Sewer Line & House Connection 62. Backwash & Receptor-Final - 12.rSevier cap' 63. Heater & Vent-Final 13: Roof,Drains 64. Plumbing System - Final r' 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final ,16. Rough Electric Wiring 67. 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 & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil P3. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing i-- 73. Undergrnd.Storage Tank 0 Gas 0 Oil "/5. Roof Sheathing •- ! 74. Overhead Hydro 26. T-Bar'Ceiling (Structural) & Monocoat 75. Dry Chemical 27.TFrame,and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation _ ^ 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric t ^////aq AAA Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48.E Special Requirements Completed 49. Electric Release to Edison , • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • No. Date I t _