HomeMy WebLinkAbout2673 SANTA ANA AVE - Building Permits OWNER FINKE, R. L. DATE 4-10-75
.` JOB ADDRESS 2673 Santa Ana Avenue BUILDING PERMIT NO. 39833
GENERAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK Demolish one unit
\i AP No. 114-164-11 LOT TRACT FIRE ZONE VALUE $ 5,000.00
INSPECTIONS Signature Dote TYPE y GROUP I ZONE Rl
SOIL PERMITS ISSUED
GAS SUBCONTRACTOR
Date I Number I Signature
WATER PI umbinq
ROUGH PLUMBING ;-/ 41-/0-76-
/D- t
PROP. SWR. LINE ❑ HOUSE CON. �i✓.?��
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING .
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER 0
ROUGH WIRING Heating and Vent.
TRENCHES fl FORMS fl STEEL REINF. n
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n
PLASTER, BROWN COAT
STRUCTURAL, FINAL Electric
HEATING, VENT., REFRIG. AND A.C., FINAL I
PLUMBING, FINAL AND GAS TEST ❑ f .O 30-15
ELECTRIC, FINAL � .
RNILDING. FINAL Q0 k��`r yyS
39833
COSTA MESA BUILDING-SAFETY DEPARTMENT 7 c,l, 365.r y:::tr"3�—
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
ForApplican(t��toFill in Completely PP I ?TION FOR BUILDINGJPERMITE
D
to 73 el Lin.(_a_, �C�}-� RE E Y DfyfEjDECEJI[�p 1 D 7 /Q 7r
BUILDING 1/1 `J 1
`X?DDR ESS P rye ,f
?OWNER ¶. 1'�-Nx. 2 A.P,NO. l ''.1t..01---• p PERIv�I§ 33
!!!•••MAIL 111p BUILDING 2673 (n /i-�} /�/
MAILESSq ..2y //7A G'NO L/q- SJ ADDRESS 37
Jpp -��y��/r//Yj f�G
2 CIT'r?o.STA /IJe SA ?U7y NOLWo72-.?5.9%.) TRACT J /�I f LOT �O BLOCK
Z
CONSTRUCTION NEW IADD ALTER REPAIR MOVING F[) hY1LISN
O a. m LENDER ✓\x�\
JD BRANCH _
cr) — OWNER F A/KC
m J Ur ADDRESS O VALUEL W
-CO ARCHITECT TEL. USE $
Q OR ENGINEER NO
Z Q FIRE
0: ADDRESS ZONE /I/t TYPE GROUP
6.W I AU APPROV // /yj J[,_/Q _7C
J O CONTRACTOR 0 W Al el r�rt/��'�(•, BY 'lV ///[/l.� DATE-J
CO Z
J Q ADDRESS
W W TEL. ZON I NO.OF USE OF NE ■�
O= CITY NO. 1 PLANS BUILDING W.�CMO
Z —
STATE CITY YARDS APPROVED YARDS APPROVED
cd Q LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
D OSIZE NO.OF SLOGS.
(FROM C/L STREET)
OF LOT NOW ON LOT FRONT FT. FT.
USE OF
EXISTING BLDG. &SIDE FT FT.
I— SIZE OF NO.OF
Z Q NEW BLDG. ROOMS STORIES L.SIDE F ���.//// FT.
Ci EXTERIOR WALL ROOF
_ COVERING .COVERING _REAR FT. FT. so
—I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
CL
d MAIN BLOCS. ACCESS.BLOCS.
Q .� VAR.# DATE
O X DE- 070 A/SN 0 NC. OA/, / , C.U.P.# APPROVED
N _FLY EC✓,. 1( / DATE '/ r
Z (N V 7'/0 _75—
STATE
I- 1 hereby acknowledge that I have read this application and state0 144
D that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ r
✓ any person in violation of the workman's compensation laws of TAX /
(r) the State of California. ' ta
I hereby certify that I am properly licensed as a contractor under SO. FT. O
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR •
Chapter 9. and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: R
am exempt from the provisions of the State of California Business VALUATION
and Professions Code,Division 3,Chapter 9. �� o m
/, P qI,sini PERMIT FEE $ N
Signature Permittee o/'f/s",-^� /1 i ��-Lr $ /UL%D f PLAN CHECK $ E
Authorized Agent (N �,s o
TOTAL FEE $
!J/ u.
DTT TMAN & DTTTMA2
ZNJOB ADDRESS 2673 Santa Ana Avenue BUILDING PERMIT NO. 41740
,.GENERAL CONTRACTOR Jim Willman DESCRIPTION of WORK Req w/arr r.
'\AP No. 119-164-11 LOT TRACT FIRE ZONE VALUE $ 36,600.00
INSPECTIONS
?immure Date TYPE V GROUP I & 1 ZONE R-1
SOIL ' /jam b .22—74 PERMITS ISSUED
GAS t SUBCONTRACTOR
�.�`�•(� /j.$ 4. /Jr.X/ Date Number I Signature
WATER__ ,�, L ?L. S P�m�bi J•, �� � )� ` y`
ROUGH PLUMB Gam' -e .17• MATOL�/l ifffai•YL.7Il�'1(.i./i—
PROP. SWR. LIN U HOUSE CON. Id y , (itIJJennrar /'Tim
SPRINKLING SYST”. ; e/,! %rclIFIP:4. K'1T..F---
MISCELLANEOUS / igelr 'IG emirs?nt
ROUGH HEATING AND AIR CONDITIONING Lei . -
inn
TEMPORARY SERVICE OR POLE ___ 'y
UNDERGROUND ❑ POWER 0
ROUGH WIRING \L,. tee,- eatin•. •nd Y.nt. _
TRENCHES FORMS • STEEL REINF. 0 �r.>/�7:4 4/ N�7 , A
FLOOR SYSTEM /L i , a(/ ,.....----
BOND SEAM 0 STEEL REINFORCE
SHEATHING 491.111
FRAME AND FLASHING ./...,'� r S.--G
LATHING — IN fl OUT M La-rI /en
PLASTER. BROWN COAT
STRUCTURAL. FINAL FIycp Ic
HEATING, VENT., REFRIG. AND A.C.,�FINAL �.y� Dtcfl0}/,8 .. 6-17-74 yo77 --
PLUMBING, FINAL AND GAS TEST I� %$ ova!cutlet. G. Ara- G-4 -n` Ye7fp.
ELECTRIC, FINAL ,QL low- . L ^���
BUILDING. FINAL - f/p p.. e?A 'SJ t V
SPECIAL REQUIREMENTS .t2 Iri.._7'c'-^J„
- 41.74D PAIL`
APR ?8-76cMz,001550.* ****76.56
- . • COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
4 £F2Y
P LI ATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only pJhf_—
''1 -7 C- 11,4
�}� )/� DA E Erl D E ISSUED
ARDIDRES---S---'���'i9 I3 So.11 4 AV is • .IL/ 7.
�/ 1 "f144%. tIJII IbbYK1.J I9 r& y-// PERMIT NO.
OWNER A.P. NO.
MAIL ^"� �[ BUILDING j'I
ADDRESS 311 1.l�ta'I/�)✓t ADORESS�(G ��/ � Ii�JQ t/e
00.11-74 )) TEL.. / TRACT 6 STK /0 BLOCK
CITY l�L(.(% ! i'a NO.6CM-9Oi-y _ 7 [
CONSTRUCTION ,„ , L NEW ADD ALTER REPAIR MOVING DEMOI ISH
LENDER wI OV;r�r VS .5 r .
BRANCH )) r \ i
ADDRESS 1 +h �- DO ../ p �Z OWNER ��ssI IL•LLM. AN y#�,q//�DIILLe14/l(��64ki
ARCHITECT Gin /1 TE USE5414E /CM s"J / �- V'l^ -' S f0� ,
OR ENGINEER We)
4 A I YV✓1c0 NO n / �,
ADDRESS UIY' F_ 34/kW. 8�.JCL � ,�_J�I� ZONE TYPE 7" GROUP
/27 APPROVE // .- I
CONTRACTOR c.. ry..� i Ilt.WWI t... BY `� DATE 6J
ADDRESS,3 I f LA)A iti,/4—
/�,� TEL., ZO/N..g� NO.OF //II USE OF NEW ///
CITY Co;j 7-Y jail /.yam NO. L/,J y p� ,/ 1� I PLANS BUILDING ,...a".#
� Y-/�Gt�
F STATE CITY YARDS APPROVED YARDS APPROVED!!!��'
LIC.NO. L3 05 J Lf LIC.NO. MAIN BUILDING ACCESSORY BUILDING
iU SIZE `_ v NO.OF BLDGS. (FROM C/ +BtEET�
O. OF LOT SJ )( / D / NOW ON LOT FRONT S/FT.`y� 50 / 61/4-9-eZ
a USE OF ��''
.�., EXISTING BLDG. V 4-C .1.--.1 _fl-SIDE ..5 . FT.
z
F L
Separate permits are required for .SIDE /C/�
kf. FT.
electric,plumbing and heating work. _ REAfl
_� � T. FT. •
4d USE OF BUILDING AND WORK TO BE PERFORMED
QF DISTANCEBLD BET. BET.MAIN&
/fit, / / MAIN BLDGS. ACCESS,BLOCS.
ATE
'--1 [ r/NSN✓GY'/ J..1 /t, /r VAR.* APR
Q D (a S'j�� j �y C.U.P,yIs APPROVED
�f L.�P///� {/ r ^ / APPROVED /�� /"[/��p/
AA, ( 3 De,C s' Thal. .2 enteli r)C.�B_Y �fr./� /\ / DATE
IU ._..277.‘
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0 I hereby acknowledge that I have read this application and stateo.
_ 4UIREMENTS m
O4 that the above information is correct and agree to comply with
aa,
all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of e
Sthe State of California. J(��j..�s�1 �- - /fir,r a
I hereby certify that I am properly licensed as a contractor under // " - SQ. FT. : /LfL/y/ tv
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ro
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business 'p
VALUATION PERMIT FEE $ v
end Professions Code, Division 3,Chapter 9. ut
gni PLAN CHECK E + -tr/r o
Signature of ! I
Permittee '{�r}'w-�� � $3/ fl TAX $ 5 U
AuthorizatlXgent / Iv TOTAL PAID E5'�1'
4 / #0nitl -2-76�N°00 082RC4***148 CC
I j COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Co pletely — Use Ink Only
RECEIVED BY DATE RECEIVED DATE ISSUW
BUILDING �t47t } / ,.2_jG
ADDRESS L^T/ /Jo( PERMITVN
OWNER A.P. NO.
MAILBUILDING� ���
ADDRESS ADDRESS
TEL. TRACT LOT BLOCK
CITY NO.
CONSTRUCTION NEJM ADDISH
!ALTER I REPAIR MOVING OFMOL
LENDER X I11
BRANCH
OWNEiticAa .
ADDRESS
/�.,, VALUE
......43__-- i
ARCHITECT TEL. USE +/�
OR ENGINEER NO.
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR 0 BV DATE
ADDRESS
TEL. ZONE NO.OF USE OF NEW
PLANS BUILDING
CITY NO.
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE NO.OF BLOCS. (FROM C/L STREET)
O. OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF .
EXISTING BLDG. R.SIDE FT. FT.
(a
F Separate permits are required for L.SIDE FT. FT.
C electric,plumbing and heating work. REAR FT. FT.
ly USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. BET.MAIN&
GMAINAIN BLDGS. ACCESS.BLOCS.
.11 VAR.+ DATE
C.V.P.�s APPROVED
Q
APPROVED
}.1
. _EY DATE
IX
W
A.
I hereby acknowledge that I have read this application and state
N
e.
CC that the above Information is correct and agree to comply with
m
all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of 2
LUthe State of California.
3 I hereby certify that I am properly licensed as a contractor under SQ. FT. a
the State of California Business and Professions Coda, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ta
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FE ONLY:
am exempt from the provisions of the State of California Business ("1---y
VALUATION PERMIT FEE Si
and Professions Code,Division 3,Chapter 9. n
PLAN CHECK $ "l
Signature of o
Permittee $ TAX $ ILIL
Sin
U
Authorized Agent TOTAL PAID Si
( UWNtn OTTS, Lee. UMI t 12=6:17_6 •. rvtc 1:.,ur.rVlcit
JOB ADDRESS 2673 Santa Ma Avenue BUILDING PERMIT NO. 43140 • '• —
c,GENERAL CONTRACTOR Berge Pools DESCRIPTION of WORK " pvr stia_~ _ _
AP No. 119-164-11 LOT TRACT FIRE ZONE VALUE $3,000.00 _
'INSPECTIONS - Signature Date GROUP J TYPE III ZONE R-1
? Pool Location AC- )1Y5.-16, SUBCONTRACTOR PERMITS ISSUED
Date I Number 1-Signature
Forms
Main Drain
Steel Reinforce
Elec. Bondc . Electric ,P /� . --.�:;
Approval to Cover )QG ib$-76 '- 0 fasa (A'4 tts iii(oa3 .
Underground Electric ;a. 3-1`•». ._ 0
Gas Piping Test Plumbing
Filtering System Lines QT-SC- 1 V ` /4_ i a.4.7‘70743 074'"'3 -'-^z....,
Backwash Lines and Recep.
Electrical Final C , C C.,-11-741
Heater and Vent Final - 6 _
Filter System Final
Backwash and Recep. Final "
Fencing Final (
•
•
•
•
/ • ' 43140 �C —6-76PfI.0Q 266" ****36.50
i
• COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92926
For Applicant to Fill in Completely— Use Ink Only C TION FOR STRUCTURAL,/ PERMIT
y n -/ r�• ,�Q RE BY g4TEjiEGEWED� Do—el //q E ISS,Etl
ADDRESS BUILDING zF !3 fa el- 6/41-0L H✓t • _/ �('yJ�Ap 9 // -t/ // •4 7�
OWNER Lr'e 04'' �/ 4-0I-
TE
[/J� A ""^ I11 16, i I P
ADDRESS
J� Ze 7.4 o4 kjei- /.MAIL
• ADDRES �GQT.) ,fie
CITY 4'534 /f1•C�yr NO. f ea9di TRACT 57/ BLOCK
CONSTRUCTION NEW ADD I AITFR REPAIR MOVING ❑FMOI SH
LENDER >4.-'
,�1
BRANCH /
OWNER _ GTGC rQ
ADDRESS
ARCHITECTS / TEL. PT QPM VALUE -
OR ENGINEER A-C.• •44y1{mac NO 539 �/
Afro
[[ // / FIRE �js�
ADDRESS /zysj Afroezike n' /a 66 ZONE TY GROU/Pt tri Rr
p APPROVED (/
CONTRACTOR .ebre�6+e�J�paa IS BY DATE/G r-
ADDRESS 9/d/ J • /frn' . •
//
TEL ZO NO.OF USE OF NEW
CITY -./t JrGI4 NO. i9s(r� aPLAN$__ :UILDING
h STATE CITY YARDS APPROVED YARDS:s. ROVED
LIC.NO. 8 D !G53 LIC.NO. MAIN BUILDING _
(FROM WI-STREET) ACCESSOR BUILDING
SIZE �� NO.OF BLOCS.- f/
L OF LOT NOW ON LOT FRONT FT. C/E^,/y�, rh e/.
Q USE OF �J
Fa EXISTING BLDG. rfT.
- R SIDE FT. S
us
F Separate permits are required for L.SIDE FT. /QT. —
d electric,plumbing and heating work. REAR FT. / FT.
tra USE OF BUILDING AND WORK TO BE PERFORMED
F ^ DISTANCE BET. BET.MAIN&
O MAIN BLOGS. ACCESS.BLDGS.
I.:1
f/Cys VAR.# DATE
r �'a/ 4 Aa C.U.P.#/�/ / 1 APPROVED
^/
..l APPROt{ECt/�Jr t oATE ! a,6
CC C/���///VVV
W
0 I hereby acknowledge that I have reed this application and state n
gg that the above information is correct and agree to comply with m
0. all laws regulating building construction, and I shall not employ
W 4
any parson In violation of the workman's compensation laws of
y„ the State of California.
3 I hereby certify that I am properly licensed as a contractor under SQ. FT. a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force end affect,or I THE PURPOSE OF ESrABLSHING A PERMIT FEE MI. 0
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ J
and Professions Code, Division 3,Chapter VI
m
Signature of etti-/ ,/'1 PLAN CHECK $ o
Permittee /`y zY r l�Llt� $ f"�/1�l/I TAX $ '51) 11
Authorized Agent .�/•f`�_Jf_/ . V U
TOTAL PAID $ 3(P• �])
OWNER OTIS; L. R. DATE 4-21-78
JOB ADDRESS 2673 Santa Ana Avenue BUILDING PERMIT NO. 45869
GENERAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK Comp.Spa. started under' 40
AP No. 119-364-11LOT TRACT FIRE ZONE VALUE $ 500.00
INSPECTIONS Signature Date GROUP J TYPE In ZONE Rl
Pool Location •
SUBCONTRACTOR PERMITS ISSUED
Date Number Signature
Forms
Main Drain •
Steel Reinforce • _
Elec. Bond E ectric �j/�� �� /
Approval to Cover L`GU//Lj'hi-��LI I 4-11-72 �g7 J
•
Underground Electric
Gas Piping Test /.Plumbing 1 ry �/ g
Filtering System Lines f an•- A 41 At/"�h Ma/
Backwash Lines and Recep. /
Electrical Final
Heater and Vent Final _
Filter System Final
Backwash and Recep. Final
Fencing Final
5869 9645 4/21 /78 5.50 TL
1 •
• •j COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely —Use Ink Only
A //t RECEIVED BY DATE RECEIVED D E S y�r-�yy
BUILDING .2 /„ 73 /tr_ _ 6j./ �. ,O
ADDRESS , ([/ d� "`"^"°sem 4t-
,// r C��� /�—// y// tei.. .dradeetrae PERMIT NO.
OWNER i/\_�'`( A.P.DIN (Q/7-MAIL , BUILDING I)•
_ADDRESS
ADDRESS Z
TEL. TRACT LOT BLOCK
CITY NO.
CONSTRUCTION NEW (ADD ALTER REPAIR (MOVING DEMOLISH
LENDER ^
BRANCH
OWNER �/L /t '
tta
ADDRESS VALUE ,q�tT/
ARCHITECT TEL. USE $O'"
OR ENGINEER NO.
IRE
ADDRESS [/��//�e, / •NE n TYPE i GROUP//
CONTRACTOR ���$F�P�T�/� f�f�j{/ • By `DYED y / DATE 47 OM,
ADDRESS 7`
TEL. ZON / NO.LAN$OF USE OF NEW •
CITY NO. BUILDING
(-1 STATE CITY YARDS APPR• ED YAR APPROVED
LIC. NO. LIC.NO. MAIN BUILD( ACCESSORY BUILDING
W SI2E • NO.OF BLDGS. (FROM C/L STREET)
0. OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
•-• EXISTING BLDG. R.SIDE FT. FT.
CO
I-.
Separate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work.
O - REAR FT. FT.
124
[..i USE OF BUILDING AND WORK TO
B/B EE}PERFORMED DISTANCE BET. BET.MAI &
0 �� I '� 'i l MAIN BLOW. DATE B s•e.,
0 VAR..W DATE
/I x �{.-A C.U.P.qW APPROVED
> cpc4.2rE(J 0 4 Y3/Vo _APPROVED DATE
(J I
a
w
a. I hereby acknowledge that I have read this application and state its
Coo.
athat the above Information Is correct and agree to comply with a
all laws regulating building construction, and I shall not employ
Z any person In violation of the workman's compensation laws of o
xW the State of California.
3 I hereby certify that I amproperly licensed as a contractor under SQ. FT. w
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: _
t from the provisions of the State of California Business �O
am exempt p VALUATION PERMIT FEE $ S OO n
and Professions Code, Dlvisl hap 9.
PLAN CHECK $ t o
Signature of $
Permittee TAX $ 6-02
/� U
J
Authorized Agent TOTAL PAID $ • re
CITY OF COSTA MESA
4
r BUILDING DIVISION
• rthairrini• DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
te. !ti PERMIT
4itbk,e ,a' B04-77
(714)754-5273 • Fax(714)754-4856 • www.cLcosta-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2673 SANTA ANA AV Status: ISSUED
Suite: Applied: 12/21/2004
Vicinity: ROOF Issued: 12/21/2004
Parcel Number: 43920212 Zoning:
2az--
Applicant: CHRISTY WALKER ISSUED BY:
Address: 20081 SW CYPRESS ST
Phone: 949-500-3648
NEWPORT BEACH,CA Zip: 92660
Owner: POWELL, CHARLES AND KIM
Address 2673 SANTA ANA AVE
Phone:
COSTA MESA,CA Zip: 92627-4638
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 000000
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF.INSTALL 1 LAYER OF 30#FELT, 1 1/2 X 1 1/2 NEW PERIMETER METAL,30 YEAR GAF DIMESIONAL BLACK
COMPOSITION,AND REPAIR/REPLACE SHEATHING AS NEEDED.25 SQUARES INCLUDES ATTACHED GARAGE.
FEE SUMMARY
Plan Check: $0.00 - Calc Valuation: $6,700.00
Permit: $139.25 Claim Valuation: $6,700.00
SMIP Res: $0.67
SMIP Corn: $0.00 _
Other: $0.00
Inspection: $0.00
Total: $139.92 - -
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
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
•
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: f r,
I hereby affirm under penalty of perjury one of the following declarations: A -
❑ 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'compensation 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.)
gigWify 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 the r.•,.•viw -.�
.. ..: n • yI / / «! Date ph .
Ire•NG:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS($1110,000),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 em 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.# 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 end Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant toe civil penalty of not more than five hundred dollars($500).):
O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 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).
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3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the 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 apermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? LJ 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? ❑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? ❑Yes ❑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:
CERTFICATE 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
corect. 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.
S gnaWr f Legal Owners) 12 I VT Date
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CODE t INSPECTION TYPE V-� OATS 1NTRIAL9��. CODES INSPECTION TYPE UATE INTRIALS
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 Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy