HomeMy WebLinkAbout1946 FULLERTON AVE - Building Permits t, - . CITY OF COSTA MESA -
y ,:.%, BUILDING DIVISION
1.1 .�--' '1 DEVELOPMENT SERVICES DEPARTMENT "P98-00474
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• PERMIT `v/PERMIT NUMBER
(714)754-5273 • Fax(714)754-4856 PLUMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1946 FULLERTON AV Status: ISSUED 64U
Suite No Applied: 06/15/1998 �J
Issued: 06/15/1998
Vicinity:
•
Parcel Nunmber: 42603219
Applicant: KRESOTSKY, DANIEL
Address:
Phone:
Zip:
Owner KRESOFSKY, DANIEL .
Address KRESOFSKY,MARILYN , -
LONG BEACH,CA Phone:
126 ORIZABA AVE Zip: 90803
Contractor.
Address:
Phone:
Zip:
License:
Arch/Eng:
Address:
Phone: ,
Zip:
License:
•SCOPE OF PERMIT
INST W.H. •
FEE SUMMARY.
AMT QTY AMT QTY AMT QTY
ISSUE FEE $22.00 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 Bkftow(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 $11.00 1
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: $33.00
COMMENTS/SPECIAL CONDITIONS
LX?1 ED
nATE to 20 G.
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 18 days,or if work Is suspended or abandoned
for a period of 180 days.
i
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 Car
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have end will maintain a certificate of consent to sell-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:
Cartier: • Policy Number:
(This section need not be completed if the permit Is valued of 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 CML RIVES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100A03),IN ADDrON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby ether 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.Lie.a Class 4
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).
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 to a civil penalty of not more than five hundred dollars($500).):
.t=1 c 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 end 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 derUsec. • '� Business and Professions Code for this reason: //''
Signature: ` : Date: Y l�S -
Owner ID verified by drivers license. -,i Y: 0 No Driver's License No. Expires:
Verification of Ownership by(type of docu . ,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,end that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more then thirty-six(36)feet high.(Chap.3.2,Gm 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,es 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 greeter than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature end 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 et standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare en 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 appermit 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 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? ❑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 penally of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described pro inspection pungni"...egrt occupy or allow occupancy of any building authorized by this permit until final inspection.
1/ ordinance
Of Legal•'� _ Date
And/Or Authoriz:. ;•plicant Date
COPE L INSPECTION TYPE PAIS 111110565 C=OEI INSPECTIONTYPE DAZE ILLtT19AL$
1616 Fixed System Final Fire Prevention 208 Final Mechanical 11
1266 Pool Spa Final 208 Final Plumbing I�'z'C9 U1''!F
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
2446-46
{' a _L__ • CITY OF COSTA MESA
410
Fr `I BUILDING DIVISION
i DEVELOPMENT SERVICES DEPARTMENT /M98-00239
vq PERMIT -�/J PERMIT NUMBER
4•0caw
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
• MECHANICAL PERMIT �1
Job Address: 1946 FULLERTON AV Status: ISSUED �v
Suite No Applied: 06/15/1998
Issued: 06/15/1998
Vicinity:
Parcel Nunmber: 42603219
Applicant: KRESOTSKY, DANIEL
Address:
" Phone:
Zip:
Owner KRESOFSKY, DANIEL '
Address: KRESOFSKY,MARILYN
LONG BEACH,CA _ Phone:
126 ORIZABA AVE Zip: 90803 c
•
Contractor. .
Address:
Phone:. '
Zip:
License: -
Arch/Eng:
Address:
- Phone:
Zip:
License:
SCOPE OF PERMIT
){MOVE VENT FROM WINDOW.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $22.00 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $0.00 - Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 Ventillatioh System $0.00 0
•Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator . $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00, 0
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU . $0.00 0
Hood w/Meth Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 r 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU .$0.00 0
Appliance $0.00 0 Boilers. .
Fire Dampers $0.00 0 C Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $9.50 1 15 to 30 hp $0.00 0 -
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 . Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES\$31.50
COMMENTS/SPECIAL CONDITIONS $43n e
J
• 9ptg
EXPIRATION: This pemiit 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. 4
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 ( ) ( ) “-
WORKERS'COMPENSATION DECLARATION: . R
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation insurance canier and policy number are:
Cartier: 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.8 Class II
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).
Lenders 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
\ sub'ects 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 properly who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is
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 exam un er sec. Business and Professions Code for this reason: /r-/S _..._c.•
ignature: Date: (lO
Owner ID verified by driver's liven . Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type ocument,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 feat 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? ❑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 appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 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-descc'bed property for i 'action p,/roses.I agre:not to occupy or allow occupancy of any building authorized by this part until final inspection.
(` S c atur.!
•
)3-1• 1"4,„ CITY OF COSTA MESA
;;+ t, BUILDING DIVISION
.i �•""� ' DEVELOPMENT SERVICES DEPARTMENT B98-01039 •
Te.w-* PERMIT PERMIT NUMBER
(714)754-5273 • Fax(714)754-4856 BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1946 FULLERTON AV Status: ISSUED
90
Suite: Applied: 06/15/1998
Vicinity: Issued: 06/15/1998
Parcel Nunmber: 42603219 Zoning:
Applicant: KRESOTSKY,DANIEL
Address:
Phone: 714-722-6795
Zip:
Owner: KRESOFSKY, DANIEL
Address KRESOFSKY,MARILYN
LONG BEACH,CA Phone:
126 ORIZABA AVE Zip: 90803
Contractor:
Address:
Phone:
Zip:
License:
Arch/Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
SEE DESCRIPTION.INST GURADRAILS LEADING TO LOFT,SEE CODE ENF. LETTER ATTACHED.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $200.00
Permit: $21.00 Claimed Valuation: $200.00
SMIP Res: $0.50
SMIP Com: $0.00
• Other: $0.00
Inspection: $0.00
Total: $21.50
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:
trp,0444,
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 -r
WORKERS'COMPENSATION DECLARATION: .N
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 wit maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is iealed.
My workers'compensation Insurance carrier and policy number are:
Cartier: 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 it 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 ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST.AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full
force and effect.Lic.M Class it
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,CMI 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 Cade)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
subje a 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 properly who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement Is
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 exempla sec. Business and Professions Code for this reason:LAli /1
-,
Expires:
Verification of Ownership by(type of docu ant,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,1 will not employ anyone to do work which would require a permit from the DMsion of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safely Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Flre 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 Califomia 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 epplication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Di 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? ❑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 es 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 penally 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 pro for inspectio rooses, a e not occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature OIL al ner(s) Q % 5----9Date
And/Or Authorized Applicant - Date
GORE L INSPECTION TYPE PA¢ MAL& QOM I INSPFCTION TYPF DATE PM=
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1286 Pool Spa Final 208 Final Plumbing
200 Anal 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
2448-48
4 7-
't 4.,,,,S,
IT CITY OF COSTA MESA
•
yam,) BUILDING DIVISION (,/�v/>
h
DEVELOPMENT SERVICES DEPARTMENT .898-00505
TA.ItbePtuano#4
PERMIT (PERMIT NUMBE
(714)754-5273 • Fax(714)754-4856 BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1946 FULLERTON AV Status: ISSUED
Suite: Applied: 04/14/1998
Vicinity: Issued: 04/14/1998
Parcel Nunmber: 42603219 Zoning:
Applicant: KRESOSKY, MARK
Address:
Phone:
Zip:
•
Owner KRESOFSKY, DANIEL
Address KRESOFSKY,MARILYN
LONG BEACH,CA i Phone:
126 ORIZABA AVE Zip: 90803 -
Contractor: -
Address:
Phone:
Zip:
Licenser
Arch/Eng: -
Address: '
Phone: -
Zip:
License:
SCOPE OF PERMIT
REPAIRS AS REQUIRED PER H&S 17920.3&UHC. 1001. '
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: Sono
Permit: $21.00 Claimed Valuation: $500.00
SMIP Res: $0.50
SMIP Com: $0.00 '
Other: $0.00 .
Inspection: $0.00
Total: $21.50
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
fo
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 workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number
(This section need not be completed it the permit/s valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($l00,003),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,MD ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is in full
force and effect.Lic.4 Class N
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: 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 fore permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
`raj' 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 sate.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 o1 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.).
qI am exempt er sec. Business and Professions Code for this reason:
Ownerure: .0 %���
Owner ID verified by drivers license. s 0 No Driver's License No. /� Expires:
Verification of Ownership by(type of docum nt,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:
❑Msion 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 en 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 Safely 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 aggernit for such construction or modification
from the South Coast Air Ouallty 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 Alr 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 es 0 No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penally of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials end 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 end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described roperfyfor inspect urpose I agree not to occupy or allow occupancy of any building authorized by this permit untilfina_122`s3Qecti
Yr e
C!� Signature Of ner(s) Date
pp
And/Or Authort ed Applicant Date
CODE L INSPECTION TYPE DAG =ALS CODE 4 INSPECTIONDPP DATE BM=
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 20B Final Plumbing
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
2446-46
/
OWNER GRAVES, MINNIE R. DATE 1/27/64
kJOB ADDRESS 1946 Fullerton Ave. BUILDING PERMIT NO.21492
GENERAL CONTRACTOR Doyle E. Smith VALUE § 325.00
AP No. 118-052-37 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK Reroof Res.
pic.ECTIONS Signature DATE GROUP I TYPE V ZONE R2
csiz' - PERMITS ISSUED
Gas SUBCONTRACTOR DATE NUMBER
Water
Rough Corn. Refrig. ❑ Air Cond. 0
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line 0 House Con. ❑ St. Swr. ❑
Sprinkling System
Construction Pole
Underground 0 Power 0
Rough Wiring
Trenches 0 Forms 0 Steel Reinf. ❑
Floor System
Bond Beam ❑ Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing— In ❑ Out ❑
Plaster, brown coat
F'; x. 0 Air Con. 0 Final
hcsiNg, Final
Plumbing Fixtures, Final
• Final Gas Test
Electric Fixtures, Final
Building, Final *ire 7--Z 49
OCCUPANCY .
Form BU4-6M-3-63—S-B P
em hM
214.92 FEE RECEIVED
! JAN 2 7 1964
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P.O.BOX 917 COSTA MESA,CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING For Office Use Only
•
ADDRESS COSTA MESA. CALIFORNIA'/LI _
®
OWNER/AIAIII R Vf1CCY_ftS '
BUILDING
MAIL • ADDRESS
ADDRESS
FIRE
AA,�
Ste` NO. ZONE TYPE I/ GROUP
CITY /7 S �A /"'
APPROVED
ARCHITECT TEL. BY DATE
OR ENGINEER 110.
ZONING
ADDRESS . ��
ION` NO.OF USE OFNEW�
/ \ it PLANS U BUILDING
CONTRACTOR AP / , A I/
LEGAL �1 I�,1
• DESCRIPTION Q V I 1/!%
-
CITY Is .� . i .
STATE ,R _ TELk, �zr4 r - OVERHANG SHALL
LIC.NO..„9/, 77 'T d NO. ..
SIZE ,------ EAVES
NO.OP SLOGS. REQUIREMENT/
OF LOTNOW ON LOTS- YARDS APPROVED
USE OF MAIN BU I LDI NG ACCESSORY BUILD I NG
EXISTING BLDG.LOA,fAL/27/4/04.6b.fy -OM C/L-
SETBACK LINE FROM FRONT _
CENTER OF STREET REAR YARD_
SIDE YARD LEFT RIGHT
DESCRIPTION OF WORK
REAR FT FT.
NEW ALTERATION ADDITION
DISTANCE BET. BET.MAIN&
MAIN SLOGS. ACCESS.BLDGS.
REPAIR _MOVING DEMOLISH
BUILDING NO.OF
SIZE ROOMS STORIES1 APPROVED
EXTERIOR WALL I ROOFAPPROVED
COVERING COVERING
COVERING - .
USE OF A7-19 tee A BUILDING
aN.,WORK TOE PERFORMEDSAL/•
AI _�I�,
A
80.PT.
0
7.
I HEREBY ACKNOWLEDGE THAT I HAVE READ IS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE _
AND STATE THAT THE ABOVE IS CORRECT AN CAREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. G
PLY WITH ALL CITY INANCES AND STATE S RHODU T VALUATION p
BUILDING CONSTR
/ •`•
/ 3
�, li PERMIT FEE $ S
SIGNATURE OF r A/
PERMITTEE
S ir
0
AUTHORIZED AGH' 3 ___.
b.
TOTAL FEE