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Home My WebLink About1917 FULLERTON AVE - Building Permits ,51 CITY OF COSTA MESA 4r .@ BUILDING DIVISION F A.'g. DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER 4. ,��Bd PERMIT f B03-02144 ronicso (714)7`54--5273 • Fax(714)754-4856 • www.ci.costa-mesa.tthLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1917 FULLERTON AV Status: ISSUED Suite: Applied: 12/15/2003 Vicinity: Issued: 12/16/2003 Parcel Number: 42626316 Zoning: Applicant: BROWN, RICHRAD / C Address: 1411 LINCOLN LN ISSUED BY: ` . Phone: 949-412-2686 NEWPORT BEACH,CA Zip: 92660 Owner BROWN, ORAL K Address 1411 LINCOLN LN Phone: NEWPORT BEACH,CA Zip: 92660 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch Eng:-. ., _-. Address: - Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF INSTALL 2 15LB FELT AND 20 YEAR COMP.SHINGLES FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,100.00 Permit: $83.25 Claim Valuation: $2,100.00 SMIP Res: $0.50 SMIP Corn: $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 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 244646(6/00) DECLAR4_TIONS - v 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,es required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($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# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Isnot 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.). • --T� I,as owner of the property,am EX LU VELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions `Code:The contractors License 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 ont .,-..0 . '•nse -ws.). ❑ exempt un sec. / �� Business and Professions Code for this reason: S' net - !F J.f te: /7—�� G1 '3 er ID verified by driver's lice se. -es ❑No Driv ices No.// V Expires:? //o—.0 '3 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 ❑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 0 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? 9 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,permit for such construction or modification L0 from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ....a ement. ti.t. otherol..o. 7 If a permit from the South Coast res prescribed ed Management District or dhSr airpollution ooncontrol district3 agency is required for the work which is the subject of this application,have all of the disclosures prescribed by CaliforniaCalitoHealth 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 conect. 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. Ay,,f/� lure Of Legal Owner(s) Date a And/Or Authorized- titan ate/ CODE I INSPECTIONTYPF on =aL>i sou( INSPECTION TYP[ QAIE MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final /� 208 Final Plumbing 200 Final Re-Roof /20-0(1 ( ceik 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 ` • DECLARATION OF AUTHORITY Bldg. Permit# FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS This Permit# Street Address: /Ye/) ///p /2/714_13 ,6'2L,E/7)z)A) /l %E AP Number: 1. I (we), Sr/ _ / I r I • . — , declare that I am the Owner of Title of the above referenced real property,and thatI (we)hereby authorize: \ /' / Name: "C i„,,„le„ 'stop [f/2-- 86f Telephone Numb‘ / - Street Address: l ) '/h 11 t)f77g ,t i /) City: $A ` LF4I 47-T State: (1_,/4 Zip: 9267 to obtain permits in my behalf,as owner/builder,for at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I (we)shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoingngis true and correct. Executed this /(o day of V3 E.. 6-K. 2Q' 3 ,at /Z)r'6&/r4(... . California. Print Name: Cent_ �l�i '�//d13 ,R�r tit y Signature: LC 4-CYZWZ1.-__ Date: /02 3 Note: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attomey to secure this permit in any behalf. 0779-46(rev.11/00) OWNERREVILLA, JULIAN, DATEl-n-62 JOB ADDRESS 1917 A 4 13 Fullerton Ave. BUILDING PERMIT NO. 16116 GENERAL CONTRACTOR Harmony Bld.re.r Inc.. VALUE $ 16,000.00 AP No. 118-013-17 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Duplex INSPECTIONS Signature DATE GROUP I TYPE V ZONE R2 Soil 42 • "p" SUBCONTRACTOR PERMITS ISSUED Gas L!/ .7/-GL DATE NUMBER 1' Le/ 4.R/•caL R. ,n Corn. Ref rig. 0 Air Cond. 0 .../ (� Rough Heating 44/C •d/- y,.L / i, '- > _ C -at? p, y Rough Plumbing 1441 -J1'• - -0/0/, i -- // �7- / _ Miscellaneous , 01 Pr op.Swr.Line E House Con. St.Swr. 0 1i ufvt • ( pet< ._Jr 7 G 1 ttvO r -111VSprinkling System b)�% Construction Pole Underground 0 Power C �r� Rough Wiring -4'-(oZ Cxee-, ZJ 3tki_i&tefi Trenches 0 Forms 0 Steel Rein'. 0 /9-2 a - Z _ Cr, Z Floor System ( 'lrl/ Bond Beam 0 Steel Reinforce 0 V Sheathing /VR,(!/ 3-1- /a]- - Frame and Flashing p /� 4_/q,�7. - Lathing — In � Out ❑ 4/_2y-0- Plaster, brown coat A N' , ,(.2 F`efng. 0 Air Cond. 0 lulu, p + Heating, Final PI^ nbing Fixtures, Final in- �i ,,i±) I Gas Testf( -S fCZ- Elucrric Fixtures, Final Ve•1 5 'aS(.2... / Building, Final fVffS G--1y-G2 OCCUPANCY FORM 6U4.5M — 741 HOLD FOR SPECIAL REQUiKEmENTS 10116 16116 . F E RECEIVED • JAN 5 1962 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P. O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINTBUILDING r G BUILDING ADD ESS / C�� 7 // ../._ L3 Flide°,4M COSTA MESA. CALIFORNIA For. Office Use Only RECEIPT NO. Pit{ 1 �1Qe" OWNER Julian J. Revilla /c/Y'// RHCE BY D RECEIy�r��oo Dyr�IHp HD ADDRESS5844 Temple City Rte/'j��°I�I I %L� I 1r CITY smile Cit NOAT71108 ADI DL Its j///``' / / 1 ,S %��`�� ADDRESS/ 9 l 7 491- ARCHITECT TEL• COSTA/ MESA. CALIFORNIA OR ENGINEERRPrmOny Bin l ders NO.AT79741 ADDRESS 5844 Temple Cit Blvd FIRE j p ZONE -----TYPE-------- APPROVED DATE 1 Z CONTRACTOR I _ sll• L S . •- 1 BY lll��,... ADDRESS 4844 Temple City Blvd ZONING CITY Temple City Calif. ZDNE� J�'P"LANs pI eeLDING EWp a ice k STATE TEL. LEGAL LIC.NO. NO. At 79741 DESCRIPTION / ,I Z I LGT' A P IS SIZE NO, OF BLOCS. r OF LOT 172 x 87.5 I NOW ON LOT A.P.NO. 1 / I1/-� — c 1 3 •r/ 7 USE OF YARDS EVES EXISTING BLDG 1 , - _ 1 ' APPROVED ALLOWED SETBACK LINE FROM (CENTER LINE ST.) CENTER OP STREET REAR YARD 251 FRONT I•- FT. ae- ^, IN. SIDE YARD I LEFT I RIGHT 5• R.SIDE 5 FT. QQ / IN. DESCRIPTION OF WORK L.SIDE +1 FT— TA Cw` . N. NEW I X II ALTERATION I II ADDITION I REAR o'- CFT. L— IN. REPAIR I I MOVING IIDEMOLISH BBYPROVED //I - /OJ o. DATE I -eT 1' 2-' BUILDING NO. OF HOLD FOR Stts2 R- r_ ;. SIZE 1600 ROOMS 10 STORIES 1 QUI R_ Lh .4 EXTERIOR-ALL ROOF Jam`' COVERING T V_ • 1- a COVERING ; • 1011ed e [�-L� USE OF BUILDING AND WORK TO BE PERFORMED [ fipAr - i I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. y/ VALUATION S I'F SIGNATURE OF / Y NSA A ` n i PERMIT FEE S20 / h - PERMITTEF ��ppIll f��ff!LLL✓J(((nnJJJ VVV 1 U..V �p -12 El AUTHORIZlAGENT� �kg - �� S/ �/ PLAN TOTALFEE $ / '//I �U� Org