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HomeMy WebLinkAbout1641 LABRADOR DR - Building Permits 4. clar' ' CITY OF COSTA MESA 4 ► BUILDING DIVISION Y• e ..�i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER V. �`�`"'a t PERMIT / I o-"wi P07-00384 ROO (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaI9 MBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1641 LABRADOR DR Status: ISSUED Suite No Applied: 05/30/2007 Issued: 05/30/2007 Vicinity: SIDE YARD FACING BAKER Parcel Nunmber: 13918147 • Applicant MALROS, JOHN ISSUED • Address: 1525 MAC ARTHUR BL. • Phone: 714-641-1545 COSTA MESA,CA Zip: 92626 Owner: RIOS, MANUEL G Address 1641 LABRADOR DR Phone: COSTA MESA,CA - Zip: 92626 Contractor: C AND R DRAINS INC Address: 1525 MAC ARTHUR BL. Phone: 714-641-1545 • COSTA MESA,CA Zip: 92626 License: 531746 • • SCOPE OF PERMIT PARTIAL UNDERGROUND GAS LINE AT SIDE YARD(FACING BAKER)OF SFD. • FEE SUMMARY AMT QTY AMT QTY , AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0. Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 -Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 '0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 _ 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0,. . , . 'Sink,service/mop $0.00 , '0 - OTHER $0.00 Gas Repipe $9.80 1 . . Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 - Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) '$0.00 0 - REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 • 0 TOTAL CALCULATED FEES: $33.30 . • COMMENTS/SPECIAL CONDITIONS • 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(6/00) DECLARATIONS 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 worke 'compensation Insurance carrier and policy number are: /' Qi 'Gamier: .te es „! \ _•z. �� i� ! bar: 4)7792 3 - rethls section need no be c•mpleted if the permit is valued at one h -. ed dol ars(:100)or les,:---- 0 ess ❑ 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 law-•f California,and agree that If I should become sub'.-t to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the'= •rovi '•ns. A�PyplicragLSignetur: tA4 / i.a Date: S 3 O— 7 WaR-[JPJG:FAI r O SECURE WORKERS'COMPENSA ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLO ER TO PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND••• -E($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37C6 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 'Business and Professio s Code,and my license is in full force:erldreffect-tio,. _ / lass itC -7C ^ 64 Sri'"' /� �� Contractor's�Slgnatur : �c res • — Data—��.--.1- Q—a 7 CONSTRUCTIO ENDING 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 1 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.). ' ❑ .1,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 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 ❑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 ❑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 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 Califomia 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 akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 (Ii"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 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. T Signature Of Legal er(s) Date-0 u—e- f � � - o nsl/. r-Authorized Applicant-z .r,.r,,,.„ lem� • CODE I INSPECTION TYPE. PAM INITIALS CODEC INSPECTIONTYPE PATE INTDIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 5-31-67 RN 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 bF 9 CITY OF COSTA MESA • BUILDING DIVISION f 1 `I DEVELOPMENT SERVICES DEPARTMENT PERMIT�N�U ER J PERMIT P05-66276 ee (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1641 LABRADOR DR Status: ISSUED Suite No Applied: 04/19/2005 Issued: 04/19/2005 Vicinity: &ior...._ Parcel Nunmber: 13918147 ISSUED BY: Applicant: JOHN MELROSE Address: 1525 MAC ARTHUR BL. Phone: (714)641-1545 COSTA MESA,CA Zip: 92626 Owner: RIOS, MANUEL G Address 1641 LABRADOR DR Phone: COSTA MESA,CA Zip: 92626 Contractor: C AND R DRAINS INC Address: 1525 MAC ARTHUR BL. Phone: (714)641-1545 COSTA MESA,CA Zip: 92626 License: 531746 SCOPE OF PERMIT 1 LAUNDRY TUB WASHER. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkftow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $33.30 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 244640(WOO) DECLARATIONS 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. .end 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 ork 'compensation Insurance carrier and policy numberumare: Carrier: Ca-C:— ) O o ( /e s( ''- 77J Carrier: r C-.9-7---� //f/A tC� = ' Nu S. . len n no a completed if the permi is valued et 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 subje ..the workers'compensation provisions of Section 3700 of the Labor CodeJ.chall forthwith cram I ' these p sloes. �// '�� • nt•Signature• !� Date: WAR NG-FA RE T CURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND 00 to (5100000),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 aff•e. '. .m 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.•d-e - �L p— 4 3 A G — 6 Contra.•rS Signatur:. (� , i( i —s. —L____ a:02 /` zrY1" l i 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).): O 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 ❑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: o I herepy 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 Cale). ❑ 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 then a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas al standard temperature and pressure). w.ill.theappl._._._.._ 2 Does or will thea applicant orpresent or future buildingoccu and need to file a registration form for acutelyhazardous materials? pp peg' 0Ves 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 al 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 of will the applicant or present or future building occupant require for the work which Is the subject of this(Application a_oermit 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 Safely 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 road 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. Sign:Lure Of L:gal Owner(s) time a. i i_� .— / And/Or A orize• •pplicant \ D. : Ohs I IaSPTCDONTYPE MAZE IPITRIA16 00EI InSPEQioa lift DM5 INIIBAI& 1616 Fixed System Final Fire Prevention 206 Final Mechanical �/ 1266 Pool Spa Final 208 Final Plumbing N—za C— % Qiti 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 • • - CITY OF COSTA MESA °4yl BUILDING DIVISION PERMIT NUMBER f' `^ a— ' DEVELOPMENT SERVICES DEPARTMENT rirallt PERMIT a"a+mo;". 00-00659 • (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1641 LABRADOR DR Status: ISSUED Suite: Applied: 05/09/2000 Vicinity: HOUSE&GARAGE Issued: 05/09/2000 • Parcel Number: 13918147 Zoning: R1 R1 y � Applicant: JOE SHULMAN ISSUED BY: f r / Address: 7821 SEAGLEN DR - / Phone: (714)536-5116 HUNINGTON BEACH, CA Zip: 92648 Owner: RIOS, MANUEL G Address 1641 LABRADOR DR Phone: COSTA MESA,CA Zip: 92626 Contractor: SHULMAN ROOFING Address: 7821 SEAGLEN DR Phone: (714)536-5116 HUNINGTON BEACH,CA Zip: 92648 License: 690617 Arch : Eng: Address: _ Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF-T/O, INSTALL 2 LAYERS OF 15#FELT AND NEW 25 YEAR COMPOSITION SHINGLE ROOF. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $4,000.00 Permit: $97.25 Claim Valuation: $4,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • Total: $97.75 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 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 notcommenced'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 o WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: go- 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Coda,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 worrkkers'compensation Insurance and policy number are: . _ /� Carrier: IV�SN Ibr -!/F4-T1n Lt Ak Policy Number: l in- 7?05OY 4 (This section nee not be completed it the permit is valued at one hundred dollars($700)or less.) O 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 Calif ia,and agree th I if I s uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provis' S-70 ,Z)CD Applicant Signature: Date: WARNING:FAILURE TO SEC 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 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under prov}}i io s 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.# (O- / I Class# C-.^x.75 Contractors Signature: I(..! ,1 Date: 4 -AO--co t 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: Lenders 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($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. ❑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 Salary 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? ❑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 apermlt for such construction or modification from the South Coast Alr Duality Management District or from any other air pollution control district or agency? Yes 0 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. Si ure Of eget Owner(s) A Date /6-ce And/Or Authorized Applicant Date CODE/ INSPECTION TYPF 09IE UITOIALS ;ODE 4 INSPECTION TYPE Oa INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof .5/C?T//D1 210 Final Electrical 201 Final Block/Retaining Wall 1 212 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 PROJECT ADDRESS: 1,641 LAB DR UNIT: -- CITY OF COSTA MESA — BUILDING PERMIT PERM NO: BE 4045647 OWNER'S NAME: MxAIRUEY RIO • ADDRESS: SAME PERMIT NO: BE, 045647 • 'PLAN CHECK NO: 02216-90 S GOVT: N SUPP : N r. CONSTRUCTION TYPE: PERMIT- TYPE: ELE STR ,PURPOSE: ADD 714 ) 641--1773 • ' . ARCH/ENGINEER: • REO.xO.: JOB 'DESCRIPTION : ' PATIO COVER & PORTABLE SPA •- • SQ FT: . 171 ADDRESS: UNIT: • ' CLAIM VALUE: . 200 . 00 CALC—VALUE: 2, 359 . 80 GROUP OCC: R-3 / . PERMITTEE: MANUEL RIOS ( 714 ) 641-1773 - • , ADDRESS: 1641 LABORADOR COMMENTS: PATIO COVER & SPA CM CA 92626 **seal*ateF�FifaF*riot*year*ar**ar**********atiEst*�F* +FaEataf*******�FitN•xaFP***+titSt�t******�FaF�t+t�FaF�t�tit* UCENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commenting with Section ZONING REQUIREMENTS 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: ' • Date: Signature: • — MAIN BUILDING -- ACCESSORY BUILDING — • ( "NIERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or acenificate of Workers' FRNT: FT IN REAR: 25 FT IN FRNT: FT IN REAR: FT IN ensation Insurance,ora certified copy thereof(Section 3800,Lab.C). LEFT: 7 FT 6 IN RGHT: FT IN LEFT: FT . IN RGHT: FT IN • ACT NO.: EXP.DATE: PARKING REQ:Q: PROV; PARCEL: 13918147 ZNE: R1 . REF NO: ❑ Cemredcopyisherebyfumished. 0 Certified copy is fled withthetilyBuildingDivision. PLANNING NOTES> TO LEGALIZE AN EXISTING PATIO COVER, ONLY. • > Date: Applicant ***********************************'*it'at***************'************at************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This sect 1 not be°omelet, a permit'. .r one hundred(5180)or less). • D E V E L O P M E N T S -E •$,.V I C E S R E Q U T R E M E N T S I certify that in the performance of the work for which this permit is iss ,I shall not empl• y per y manner so as to become �^ 6 ' subject to the Workers'Compensation Laws California. - _ ZONING APPROVED ABY. - • `-- '• DATE: ( ^ —90 Date: t— Sl— 9 Signature: �(� •• - - - . . - - NOTICE:If,after making this declaration.you should beco subject to the Waiters'Compensaf.' provisions of the Labor (6U I LD I NG APPROVED BY : •• ;DATE: _ Code,you must forthwith comply with such provisions or Iris permit shall be deemed revoked. ' s - ' • CONSTRUCTION LENDING AGENCY: Thereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B `��— DATE: (---- 6 "1 0 ' which this permit is issued(Section 3097,Civ.C). - ********************** - ^ f - *************** ***at LENDER: *********************** ******* '*********************************************'* ADDRESS: LEGALIZATION:N • .E E SUMMARY STRUCTURAL SEGMENT: Y • OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMB I'•G ELECTRIC'S 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 - • 54 . 00 75^ , 5 0 '' 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 Business5 0 ESMIP/NON—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 PIAN 35 . 10- - - ^v applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). - ISSUE FEE 15 . 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV--> PERMIT ISSUE PLAN—CHECK TOTAL PAID : . DUE ' structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS——--> ' 55 ..25 ' 15 . 00 —,35.40 105 . 35 105 . 35 . .,r . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through ty,_ : • 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: 105 :35 OVER/SHORT: . 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve for the purpose of sale). 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 54 . 0 0 1 5 . 7 5 5 0 35 . 10 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon - - andwhocontractsforsuchprojectswithacontractor(s)license pursuant to the Contractors'State License Law).l am aware ***********************************************************************•*pit****** i 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 BREAKDOWN ,❑ I am exempt under Section: • B.& i*neriAAÄ &!' ' tor this reason: / TYPE QTY DESCRIPTION ' UNIT COST TOTAL COST Date: ( - �— C SFR i 171 ' RES—PATIO COVER—POST & TRELLIS 13. 80 . 2, 359 . 80 I do hereby certify that I am aware of and understand the requirements of Californ'. eatth and Safely Code Sections 25505,25533•and ELE 1 REC EPT/OUTLET 1/ST 2 0 EA. ' . 75 ' . 75 1 -25534 and that I or any future building occupant will/will not(circle one)need to c• ply with said state codes and.the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from ' ND-'OF, FEES these provisions. ' I Date: Applicant: • EXPIRE D I hereby certify that I have read this application and state that the abov lunation is correct.I to comply with an city and court Incomplete Inspections ordinances and state laws relating Co building con ruction and hereby a representatives of ryto a .�•. the above-mention • -_ app\ • property for inspection purposes. ,/� S ` • Date —Sf—`3 signature: �7% �/ /���` • O1 00051361-0005 1364 TOT Driver's License orSocial Security x: {, • � DATE: 01/08/90 TIME: 15:35 1841-48 White—Building;Green—Code Enforcement;Canary—Aoolicant:Pink—Revenue;Goldenrod—Assessor [� - - - CONSTRUCTION AND PLANN, IOL & SPA • APPROVALS Permit # - Date Inspector , APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole . 52..Pool & Equipment Location • 2., Soil Pipe-Undrgrnd.- 53. Steel Reinforcement ,•:N.SElectrical Conduit=Utility-Undrgrnd. 54. Forms • -";4. Electrical ConduirUndrgrnd. 55. Electrical Bonding c'i5. Steel Reinforcement 56. Rough Plumbing & Pressure Test • rtt ^'(6. Electrical UFER:Grnd.Mk 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 v63. Heater & Vent-Final 13. Roof Drains „ _ i 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 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electridil-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19.--Rough Heating & Air Conditioning • _ _ _ rFIRE^DEPT. REQUIREMENT _ 20.Though Factory Fireplace C. , - ;APPROVALS=�Permlt# 21bDucts, in Structure* •• --_ v H4 f 170. Underground Hydro 22�Ducis, Ventilating;:. • x v� ;i -,-k v: _;71. Product-Piping 0 Gas 0.Oil 23.•Gas-Pipe-Rough & Test " s - ;i ,r a; _ -+72. UndergrouiJ *1nd Flush' '•- v 24.=Roof Framing tIlt :, * J -r x '73 Undergrnd.Storage*Tank,O Gas 0 DT r: 25. Roof Sheathing a' . lc. • _• _ a. , 74,^. Overhead Hydro,->-' ` , 26.T-Bar Ceiling (Structural) &'-MBnocoat „ ` '=,'t• 75�-Dry Chemical F, - ' .73= ] 27,Frame and Flashing - - •- g :, m c x 76. Dry Standpipe t-=- * _'28. Lathing'& Siding,'; -' -'`t= ' < •' •)x : r q, „r 1. Ct" Y; , ;,,_�, ; 77;_ FIXED SYSTEMiFINAI:- , ^29. Insulation cu`: ^ _ -•.-i - , i i :4 7e;FIRE PREV. FINAL * = ". C. '30. Drywall Naii ng "i'..:4; , r. � _ P,I ) •- * x NEALTHDEPT REQUIREMENT i r-31. Plaster Brown Coate S "?' ^ # ;l! 1," X; 979. FINAL INSPECTION. * - v rt __. . a __ -32 ElectricaI Power Meter-Final. I I ik � "80r'FOOD CERTIFICATE ISSUED_ • Y: ' t h • :J33'=Final Electric �: ter., ..:;:i7; go .I Notes: - "• -re , - J Ir r. - ` 34`�' Hea Final ting& Air Conditioning• x r I • a x , p//i iceac• /'�/ (t O `- cAvat, • N i 35'.=Final Gas Pipe Tesy -r " :x i a .0.' -'811- -'Da w36. Hod or Canopy -~ -rt `] v;< t r ; 1 i (g ^ C1-4 r c _ o _ r. . x- t.K z. r-i ... r I?7 x a .-c ,,. m o. --37.:.Final Factory Fireplace;. -- .. -� ,: - cJ �-38r=FiHAI Plumbing v _ .1 " " s '-' t"39=Water Service;Fina( _- [�: * t I : r • ' Z]•• r '40. Gas-Service-Final - `^ • t, - I is :* ij•'.: '-]r•' * 41 Solar Domestic-Final` ••� .r I !X i r•_- • - 42. Backflow Preventer< -.> - I� * Y. r 5 H - F C tt * G:S S er I fi: --r e_e t L. 43. Backflow Irrigation; ., * r is -h '44. Landscape Ii?igatidn System-^r� ``^ * - , C• C t-_/* S: 1%; r! _ r .. `1 E C. C..:'i: A 1 ..T., 0 t S n -45.,Sound Attenuation, - .. x tri rt; litsi:i: - - • kr. ;. A :46.-Handicap Regulations * w .Sr y`I'ti' S t t, .,47rFIfdAL STRUCTUBE & BUILDING F 1 lie r-�7 p1e InsWi tiofft - 46�FINALPLANNING l ''F T ^� 4942-Electric-Release to.'Edison x. I ;X r. 71 < 2.,` • 7.50`Gas]Release to Southern California Gas Co x i aj .�. '-' ' ^ r' is < W. [ #'. -- �, pf _ -51. CERTIFICATEOF'OCCUPANCY -P I, " -c• ` ,' No. Date 8222 ,IdLI6lttiu 'v 1�L COSTA MESA BUILDING DEPARTMENT AC 9 ffl3 1i" P.O. BOX 317 r jrJ CE DEPT. COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING 1641 Labrador Dr. BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. PERMIT NO OWNER Mesa Verde Estates •l'Q- -)— MAIL RECEIVED BY DATE RECEIVED DATE ISSUED ADDRESS 1701 (Sisal er St. C 'yt( - )'3J. /�--9-52' /J-`9-SP BUILDING CITY Costa Mesa TEL 5 NO. KJ —1751 • ADDRESS ARCHITECT y LNIC OR ENGINEER Y. R. Shelley D. C-2170 COSTA MESA. CALIFORNIA - ADDRESS Long Beach Ge 9-0908 ZONE ZONE NO.OF TYPE GROUP CONTRACTOR L.G.Robinson CITY NOO. 1123 / PLANS -. 4- -1 C} L A _ADDRESS 1701 Gisler TND. Xi 5-1751 BPPROVED DATE `EGA` 1. CORRECTIONS DESCRIPTION NOT 124 BLOCK TRACT 311$ A.P.NO. SIZE SV ..k. 'I&X f7 NO OF SLOGS. OF LOT 700 Now oN LOT none USE OF EXISTING BLDG. SETBACK LINE FROM /� CENTER OF STREET 50tp1us REAR YARD 20 plug _ SIDE YARD RIGHT58plus LEFT 5'plus DESCRIPTION OF WORK NEW % ALTERATION ADDITION REPAIR . DEMOLISH • BUILDING �/ NO.OMS OF SIZE )60 Sq.Ft. RO6 STORIES 1 • EXTERIOR COVERING WALLS tucco ROOF COVERING Asphalt & Rock USE OF NEW BUILDING Tpc1a pnr.A & Attached aarag: I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS/PP CATION AND STATE THAT THE ABOVE IS CORRECT,AND AGREE TO CO LY WITH ALL CITY ORDINANCES AND STATE L NS REGULATING QUI TNG CONSTRUC• TION. V VALUATION d% SIGNATURE OF / PERMIT FEE $ SS: PERMITTEE ÷ / OCY� '�- L/� e 0 PLAN CHECK $ / J 5_% AUTHORIZED AGENT TOTAL FEE $ 5 . 't .J3 V°Mi