HomeMy WebLinkAbout2184 PACIFIC AVE - Building Permits • _ Applicant to fill in all spaces except those within heavy border lines and.sign all appropriate declarations. 3583 4/2' nib . ...
CITY OF COSTA MEA NST UCTIgNIERMIT - PERM{�NO`���� TRACT NO. LOT NO. UNIT NO. '
•
Project Address Ale-4 aoi rK tn/L •' , llyy dd11 ff I - _,
Applicant's Mailing Adyr • TYPE OF CONSTRUCTION LJ NEW ❑ ADD U ALTERATION 4riREPAIRt
Owner's Name Phone SI ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# - Zone
/�-Ot J DESCRIPTION OF WORK/USE OF BLDG.
Address v(' S Main Building: Accessory Building:
Arch/Eng. License No. - • TYPE OF PERMIT 0 GRADING r_i❑ OUNDATION LI STRUCTURAL E Front i 0
Address p��%} /1/� ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear - N
Contractor's Nam
/Li_ 1 . Al i I c.hone is (it"X)5" ❑ 'OTHER C Right N
1 PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Addresslmailing) (, y7 , / f K G
3/ CON ST RUCTION TYPE VALUATION$ S Left
City License No. CCCII • ZONE GRADI NG CU.YDS. ACRES E
LICENSED CONTRACTOR DECLARATION - Ping. Ref.# Parking Req./Provided
Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M
with section 7000) of Division 3 of the Business and Professions code, and T
my license is in ell o ce and effect. n • fftny ((ff6C`
License lass •_� _/ ' e se • •. V S1 FCEiVE� •`r• iJUL • $
Date - mold ignature A'IL_I i / ./Jk L PLUMBING FEES PPECEiVJ. APp
WORKERS'COMP -NSATION DECLARATION • Bar Sink Showers MGI. EL I PR Mb FEES
I hereby al firm that I have a certificate of consent to self-Insure or a certificate
of Workers' Compe r ce, or a certified cop h (S ction
3800, Lab. c) ��1-Q�j�� � r�- P L( "� Backflow Preventer Service Sink Automatic Washer Transformer 0 15-50 KW ,
PolicyNo. QJ ?7 /7•'iu 7) Company7�- liz� Backflow Irrigation Sewer Cap0 50+KW
TND: g )Construction Pole Sub.
rtifietl copy Is hereby furnished. _
cert'•w�n-q y fi d with the city 20 •iv i.,s / / Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date •-/ Applicant pi/ �/A -A �a.i. �-_
`—
EXEMPTION FROM WORKERS'CO ' NSATION DECLARATION _ Clarifiers Solar Collectors Dishwasher . Meter Dover 100 amps - -
(This section need not be completed if the permit is for one hundred ($100) or Dishwasher
less). ( Solar Piping Dryers ❑Gas DElectric Sub Panel ,
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 tolthe Drinking Fountains Solar Tank Fan •
Workers' Compensation Laws of California. Motors 00.1 HP 01%-8
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar❑g-15 HP 016-15+
'NOTICE: If,after making this declaration, you should become subject to the ___ __ __
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply•with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service : Outlets Water Closet - - Device Boxes • '
I hereby affirm that there is a construction lending agency for the performance - Pole Light
of the work for which this permit is Issued (Section 3097 Civ. C.) • Interceptors Water Heater - Outlets Range
Lender's Name -
•
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION ,
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - Auto-Wash • ' GarbageDisposal
following reason (Section 7031.5 Business and Professional Code: Any city or P Standing Sections
l county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator ❑0.5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant fpr such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of • Roof Drains
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
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
enalty of not more than five hundred dollars($500). •
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee • $ 3
compensation, will do the work,and the structure Is not intended or offered _ Reinspection Fee ` $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's • -MECHANICAL FEES
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 his or her own . DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II 0 Zoning Approved By ^ Date
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). ('a- Building Approved By, / s` Ddte
(/I�'
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date (kite)--eb
tractors to construct the project (Section 7044,Business and Professions Code: i„
The Contractor.'s License Law does not apply to an owner of property who Duct-Ventilating - - 00.100,000 BTU 0100,000 BTU
builds or improves thereon,and who contracts for such projects with a con- SUMMARY OF FEES
tractor(s) license pursuant to the Contractor's License Law). I am aware,thatExhaust System ❑ Multiple 0 System Repair/Alteration ' BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. •
PLAN CHECK $ PERMIT
•
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. IC8O# Fire Dampers PLUMBING $ ‘4) 00 ISSUANCE $
Date Owner _ Heating System&Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above ❑o-100,000 BTU 0100,0008Th GRADING $
information is correct. I agree to'comply with all city and county ordinances • • - ELECTRICAL ' $
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city to enter upon the above-mentioned property for 0 v
inspection os�51 ��OOOp + MECHANICAL $ TOTAL FEE $
DSrivers'
Ai Date �- Reinspection Fee $15. Issue Fee $ 3 PLAN CHECK 25% $
Drivers' License or SST/ — s
CMF 0865-46,rev. 10/84 White - Building: Canary - Applicant; Pink -Accounting;Goldenrod -Assessor
CONSTRUCTION AND PLANNING POOL & SPA
Date Inspector Date Inspector
• APPROVALS Permit# APPROVALS Permit#
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
5. 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 Sewer 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 67. Fencing & Access Approval
171 *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 •
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing •
74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. .Dry Chemical
27. Frame 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 Notes:
roy/firo .m11 1/472
34. Final Heating & Air Conditioning
47/5141)1.7"5/
rr ens71 / 14, IM//J R X71:7 f/
35. Final Gas Pipe-Test -
36. Hood or Canopy
37. Final Factory Fireplace
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38. Final Plumbing 7-tt-bt CE0
39. Water Service-Final
i J
40. Gas Service-Final f r'
f a , •
41. Solar Domestic-Final -
42. Backflow Preventer - ) •Iii
43. Backflow Irrigation ,r .
44. Landscape Irrigation System ._
45. Sound Attenuation --a- '-
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 't=,
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY
No. Date
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR.STRUCTUR9AL PERMIT 45075 TI.
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ����/By--�-��
RECEV / PERMIT N2 49884
For Applicant to Fill in Completely — Use InkOnly
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.. ADDRESS L Q 7 �fi/iI td WV'C 7 j /�
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4i's :;. 'OENANTOR /f/�/�✓ 4 a. ADDRESS �6G.//Q/J� Gee,JISG UNIT OR • 1
MAILING fete ,_ / SPACE NO.
ADDRESS �/a/z i a - /V��DDS t � //J�/./(
CITY ��� J/i1i/ _ , _NOL T •
NEW ADD AOT REPAIR MOVING DEMOLISH
CONSTRUCTION __��•"'���-
LENDER //JJ�� ���� � � � /(/��� � )///ffful
BRANCH I�•?L4 4 s aal VI• ,
ADDRESSOWNE�Rr /1 /�
ARCHITECT TEL. USE Al. A/!ri - VALUE$ !_ 600
OR ENGINEER NO f "✓`�� (�Q
ADDRESS ZONETYPE V GROUP H
APPROVED J/q
CONTRACTOR �� (�J BY � DATE J/LS�
ADDRESS ///
TEL.
CITY NO.
STATE CITY APPROVEDIETBAFS` (/D
LIC.NO. LIC.NO. tel
W SIZE NO.OF BLDGS. (FROM C/ STRE T)
O. OF LOT NOW ON LOT FRONT FT.
Q USE OF
g EXISTING BLDG. R SIDE FT.
h
(-1
Separate permits are required for L.SIDE FT.
electric,plumbing and heating work: RE FT.
F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
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AAPPR
APPROVED
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14' raL,aA APP OVEp /r�� DATE Srtrn
Ed
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O 1 hereby acknowledge that I have read this application and state n
a. that the above information is correct and agree to comply with
as all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of a
xthe State of California. N FT.
I hereby certify that I am properly licensed as a contractor under SQ. N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ro
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m
am exempt from t.- provision . the State of California Business VALUATION PERMIT FEE $ �/_ Y
and Professio - .PCe, • i Ch.-ter 9. Bt7 m
�j pPLAN CHECK $ /�t,.L SS" "I
Perm' a •f // v .� � � / lu.
Perm' e: •/ .���1%` '� - .% $ 'g &eo TAX $ �•2o . U
3 ® 1.0
Authorized Agent Date TOTAL PAID S
re'4112Zt> CITY OF COSTA MESA !'
�..�,� BUILDING DIVISION
t: DEVELOPMENT SERVICES DEPARTMENT
P PERMIT PE MIT NUMBER®
B98-01753
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT •
Job Address: 2184 PACIFIC AV Status: ISSUED
Suite: Applied: 09(29(1998
Vicinity: Issued: 09/29/1998
Parcel Nunmber: 42204114 Zoning:
Applicant: GINGRICH, DAVID
Address:
Phone:
Zip:
Owner: ZONE, STANLEY TR
Address 17112 BERLIN LN'
Phone: 714-846-2665
HUNTINGTON BEACH,CA Zip: 92649
Contractor DAVID GINGRICH ROOFING
Address: 17351 chapparal In
Phone: 714-455
H.B., CA. Zip: • 92649
License: 746906
Arch/Eng:
Address: -
Phone:
Zip:
License:
SCOPE OF PERMIT
TEAR OFF&REROOF 4000SF WITH 20 YEAR COMP.SHINGLES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $5,000.00
Permit: $99.75 Claim Valuation: $5,000.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other $0.00
Inspection: $0.00
•
Total: $100.25
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
NOTES:
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
\ .
DECLARATIONS
ti
WOggKERS'1OMPENSATION DECLARATION: if
I hobby 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 i 0 performa e 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'
compensati• laws of Califomi; and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply wi these provisions. ,
__ -
Applicant Signatu :. • _ _ Date: q 2i — c Pi
WARNING:FAILURE TO SECURE WORKERS'•• .-4••-f.srr.,c(. jP UNLAWFUL MD SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MD CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOUARE($100,O00),IN ADDITION TO ' t, 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 Businesssnd I rofe sions Code,and my license is in full
force and effect.Lic.# 1quit)le. Class# C .S
Contractor's Signet bin . _ _� _ Date: 9—'2 q — 4 td
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 toe civil penalty of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend, will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 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 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 appemit 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 LI No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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
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 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-property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
,SIgnatu a Legal Owner(s) /� Date
Cts --7_,P - ciR
uth 'zed Ap Date
=LEA INSPECTION TYPE BIDIISl9 CODEI IBSPFf•.TnN TYPE QA1E UMW
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final208 Final Plumbing
200 Final Re-Roof 'a L'9$ 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