HomeMy WebLinkAbout3102 MACE AVE - Building Permits f •
os—if MF CITY OF COSTA MESA
441
. BUILDING DIVISION
F• „, DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER
PERMIT
J in 4p`� des
B01-00130
(714)754-52730 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 3102 MACE AV Status: ISSUED
Suite: C Applied: 01513-8/29.0.1-
. Vicinity:
15 3 0/2 0 0i-
Vicinity: C Issued: 01/30/2001
Parcel Number: 13955110 Zoning: R3 R3
Applicant: PRIDY, ALLISON ISSUED BY: 0)%k—
Address: 2750 SIGNAL PARKWAY
Phone: (562)528-8000
SIGNAL HILL CA. Zip: 90806
Owner: OHLAND, ROBERT CHARLES TR
Address /1886 TAHITI DR
k Phone:
COSTA MESA,CA Zip: 92626
Contractor: HAR-BRO INC:
'Address: 2750 SIGNAL PARKWAY
Phone:. (562)528-8000
SIGNAL HILL CA.
Zip: 90806 'License: 258441
Arch : Eng:
Address_: Address:
Phone: Phone:
Zip: License: License:
•
SCOPE OF PERMIT
REPAIR DUE TO FIRE DAMAGE BY ROOF PATCHING, DRYWALLS, STUCCO PATCH ARROUND WINDOWS,AND NEW DOOR. ,
FEE SUMMARY
Plan.Check: . $0.00 Calc Valuation: $9,000.00
'Permit: . $167.25 • Claim Valuation: • ' $s,o0o.00
,SMIP Re's: $0.90
SMIP Com: $0.00 /
Other $0.00
'Inspection: $0.00
•
Total: $168.15 .
\vC• • r"i ,
PLANNING-&ZONING
SETBACKS., (/ /,
MAIN STRUCTURE,Front '0-0 , Rear 0-0 • ' . Left. - 0-0 Right . 0-•
ACCESSORY Front . 0-0 Rear" 0-0 Left 0-0 . Right ' '6-0
PARKING Existing: 0 - - Required: 0 Proposed: 0 -
/
-
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration,of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446.46(6100)
e 1
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.
O 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�' °mpensatlon Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars($100)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 C.Ifomla,and agree that If I should become subject to the workers'compensation provisions of Sec on 3700 of the Labor Code,I shall forthwith
comply with these pros.
Applicant Signature: Date: ( O/O/
WARNING:FAILURE TO SECUREERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDRION 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.it /` CC"4 V . Class it
Contractor's Signature: /v\ Date: ( 73 w
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 is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. _ Business and Professions Code for this reason:
Signature: . Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,An 2,Sec.
341,Title B,Califomia Administrative Code).
O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 yes 0 No
(Section 25533 of the 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 application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency'? Lj Yes u No
(Section 65850.2 of the Califomia 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 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 Califomia 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 cenify 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.
— Sign f Legal Owner(s) Date
( — 30at al
And/Or Authori Applicant Date
goDE I INSPECTION TYPE Qug" INTmALS CODE! INSPECTION TYPE DAM INTTALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Flre Prevention
202 Final Factory Fire Place - 220 Final Planning Approval •
203 Final Sign 222 Final Site �/
204 Final Demolition 250 Final Building/Occupancy 5-L 7'-4' [pv("_
4101 M CITY OF COSTA MESA
44, 9 BUILDING DIVISION
e
)lirtiP71121193/.•" DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
l;t 1P4k PERMIT
R'� E01-00112
S._ 0,4*r • . •
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
•
• Job Address: 3102 ' MACE AV Status: ISSUED
Suite No C Applied: 02/07/2001
Vicinity: UNIT C Issued: 02/07/2001
Parcel Nunmber: 13955110
Applicant: PRIDY, ALLISON ISSUED BY:
Address: 26406 CITYLIGHT CT
Phone: (818)681-0888
•
SANTA CLARITA, CA Zip: 91351
Owner: OHLAND, ROBERT CHARLES TR
Address 1886 TAHITI DR
Phone:
COSTA MESA, CA Zip: 92626
Contractor: DOTY ELECTRIC
Address: 26406 CITYLIGHT CT
Phone: (818)681-0888
SANTA CLARITA,CA Zip: 91351
License: 745302
SCOPE OF PERMIT
ELECTRICAL PERMIT FOR FIRE DAMAGE REPAIR OF EXISTING APARTMENT BUILDING. INSTALL 3
LIGHTS,4 RECEPTACLE OUTLETS,2 SWITCHES,&3 SMOKE DETECTORS.
REF: B01-00130
•
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res. a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $3.30 3 up to 50 kva/kw $0.00 0 _
Recept Outlets $7.70 7 up to 100 kva/kw $0.00 0 -
Switches $2.20 2 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 - "
Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 -
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $36.70
Intermed Pole $0.00 0
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:7
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.
MY
o and will maintain Insurance
compensation carrier a d police,u required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My work rs'compensation Insurance carrier end policy number are: _
CCerrier:> �'I/}"T¢_ Policy Number:: ) ' ' 4 L )-- Ut
_(Thls-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 f 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 visions.
Applicant Signature: ____7 '3 Date: %O.---Al /a
WARNING:FAILURE TO E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($104000),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 1 am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of.the Business ag4 Professions Code,and my license is in full
torte and effect.Lie.k S"I "4 5 5%-)--
1 Class#. — t O
i____.--
Contractors Signature:� - 1 Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Coda: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 properly,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 properly who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 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)?
p 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 Cale 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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? D 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 prescnbed 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.
Ignature Of Legal Owner(s) Date
9-- -1 - 01
•Or AuetlApplicant ( Date r)
CODE 1 INSPECTION TYPE PATE =AL/ ODE E INSPECTION TYPE all Its
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing p
200 Final Re-Roof 210 Final Electrical •-.5/7/0/7Jb / tS/�14.0
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
oaf MF CITY OF COSTA MESA
441_9 BUILDING DIVISION
Ft ��' � r''gel . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
A PERMIT //
044
/P01-00101
Ni
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
•
PLUMBING PERMIT
Job Address: 3102 MACE AV Status: ISSUED
Suite No C Applied: 02/20/2001
Issued: 02/20/2001
•
Vicinity: UNIT C
Parcel Nunmber: 13955110 ISSUED BY: .P.------
Applicant: PRIDY, ALLISON
Address: 2750 SIGNAL PARKWAY
Phone: (562)528-8000
SIGNAL HILL CA. Zip: 90806
Owner: OHLAND, ROBERT CHARLES TR
Address 1886 TAHITI DR
Phone:
COSTA MESA, CA Zip: 92626 .
Contractor: HAR-BRO INC.
Address: 2750 SIGNAL PARKWAY
' Phone: (562)528-8000
SIGNAL HILL CA. Zip: 90806
License: 258441
Arch / Eng :
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
INSTALL NEW GAS LINE(UNIT C).
REF: B01-00130 -
•
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
CGMM9WT6 I€PCCIAL COIIDITIONC
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(WOO)
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:
Carrier: T Cs "iear–T r l Policy Number: D 0 - Y(e
(Tis section need not be completed i/the permit is valued at one hundred dollars($100)or less.) l
❑ I certify that in the pert rmance 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 alifomia,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 pr sions. C�
-�CU ADPIIran(S�lure: � v r-Deter_ � — o� Cl--
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 OOLLARE($100,000),IN AODmON 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 affirrnhal la licensed der provisions of Chapter 9(commencing with Section 7000)of Division 3 ofthe-Business and rofessions Code,and my license Is in full
force and effect.Lic.#I g y'-(/ Class A I
Co 1rector's Signature: y— /Data: ' a — e ^(l
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 for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ 1,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.). -
❑ 1 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.-properly tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file end certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑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 lime 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 en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or wit 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 LJ 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 ❑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 ❑No
B (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws end 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.
/ 1 Signature Date
/v1 - ao — a �
AndtOf Authodzed'Appllcaam- ( Date
COPE# INSPECTION TYPE MTh ICAO CODE! INSPECTION TYPE RALE l'tTMLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical /1 �A�
1266 Pool Spa Final 208 Final Plumbing A'tW�(-
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
Building Safety Department CERTIFICATE OF OCCUPANCY N? 2613
P. 0. Box 317
Costa Mesa, California
The Building located at 3102 Mace Avenue. A-D-•
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group 1 w r? Occupancy.
Use of Building 1 Unit Art. Building with atttached garages and laundry
Legal Description Ott 62602 t 3
(See reverse side for Metes and Bounds)
Building Permit No. 29617 Electrical Permit No. 2ra08 Plumbing Permit No. 34'67
Floor Load Signs have been installed as Room Capacity Signs have been instated as
required under Sec. 2308 U. B. C. required under Sec. 3301 (1) U. B. C.
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied
until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obtained whenever there is a change in:
1) Occupancy classification of a building or portion thereof
2) The number of apartments or guest rooms
3) Ownership
If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California
Administrative Code, Title 8, Chapter 9, Article 8.
Number of apartments 4 and/or guest rooms
ISSUED TO: Building Offi/ci 1 / •
R:PJR KOVACU by !A- ✓ ��`I��-f/
•
Date July 30,. 1969
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed
except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Form Bu34-3M-11-63—S_13 P
29617 PAIS , �{t�
JAN -6-69C1i<.00 127 715.7:
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92020
yFor Applicant to Fill In Comple ly APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING 3/ea? 01r4(e //vim For Office Use Only
ADDRESS vt
RECEIPT NO. PERMICt� t 7
COSTA MESA.
C�A; IFORNIA/ -� G�.`�J
ECEIVED TE
OWNER 11 111 _ Ii :, ' RECE f7/ ja--7_,7-Ii� 7g -; -6E
ADDRESS 114"I t , (-Pt IS r ADDRESS \3/D� / *z-w a/I/C / ✓FIRE
CITY FN 644-019 NO. ZONE �� TYPE I/ GROUP /of
_ I APPROVED
~ ^NGIPIEHf!-V Ohn UJI NO. BY DATE
7. S3� zo63
ADDRESS 70 LV • nor4 Ji• Ia 110(n.:1 ZONING
7 ZONE I NO.OF I BUEOFNEW 4 plex w/
.•}j µ/., / PLANS BYILDING
CONTRACTORO IQLJ C,c Ir LLL,tn1 brie I? 3 -2 aFt S rat- gar
n I LEGALEGCRIPnON tot c4F Tr HGF(]
ADDRESS � 442- O QX ICI
CITY 1 YL(1iCr4-0q A.P.NO. none
,yr{ ,I(/� ,�+
NOTE: NO IBM OVERHANG SHALL BE LESS THAN
LIC..NO. IJ "" i 0l 7' 4I NO V I 9 233 3r TO SIDE B REAR P.L
VES
SIZE NO.O���B� ALLOWED (U.B.C.REQUIREMENT) _.
OF LOT 1 3 k /14) 1 NOW 4 N WT�'4�,
YARDS APPROVED YARDS APPROVED
USE OF wt.ay P MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET)
SETBACK LINE FROM G /0
FRONT ,17 FT. PT.
CENTER OF STREET 5 REAR YARD
SIDE YARD LEFT Q
j('J - R.SIDE / FT. FT.
O I RIGHT 7
DESCRIPTION OF WORK L.SIDE 0 FT. PT.
i
t ALTERATIOp N ADDITION REAR /Pa RT. FT.
DISTANCE BET. BET..MAIN Q
MAIN BLDGS, ACCESS.SLOGS.
REPAIR """"��/� MCIING ,.DEMOLISH
BUILDING itd'�a 0 NO.OF /y, �77 VAR•S �- DATE
SIZE ROOMS rfi/VJ ST$RIES �" C.U.P.{t APPROVED
E. (�•��•�J���' ^-r ofr TIES
R Ott . APPROVE x/ 4-45. -�6
EXTERIOR WA�_�I IROO y,
COVERING LD COVERING // _ B7 Lf�� DATE /
USE OF BU ILD INS AND WORK TO BE PERFORMED 0.
C9
g/C1�6 -, -ce4.. a -;.41 rev c� y 9 ;
nt
w ill laect)SQ.
REST AC T THE E THAT
IS NAVECORRRANT IS APPLICATIONAGRETO COM. NP ESTABLISHINGUNDEVALUATION
A�MON FEE ONLY.
THE
I AC ABOVEOWLEOGTNAT I NAVE READ THIS THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION 0
BUILDING CONSTRUCTION. PERMIT FEE S /V5.5a k
SIGNATURE OF1
PERMITTER / Pa 7/ -� �+
� k
� 93/ '— PLAN CHECK S (! 7
AUTHORIZED AGENT 47 --)--,-" r"
_ /i/5.�'5
TOTAL FEE $a' J