HomeMy WebLinkAbout1649 IOWA ST - Building Permits •
OWNER MODULAR Technology, Inc. DATE 5-6-71
JOB ADDRESS 1649 Iowa Street, Units A-D BUILDING PERMIT NO. 33030
GENERAL CONTRACTOR Same DESCRIPTION of WORK 4 Plex w/att-garages
AP No. LOT 9 TRACT 6614 FIRE ZONE VALUE $50,700.00
INSPECTIONS ���Sig1n)tu p Date GROUP H & J TYPE V ZONE R4-CP
SOIL 4C 6. J/ SUBCONTRACTOR PERMITS ISSUED
GAS Date I Number I Signature
WATER r//�'' / Plumbyiing� (� �f
PROP. PLUMBING eZiee .r.2r7/1`Q-tSS- j7 1 a1›7 .S-JO
PROP. SWR. LINE HOUSE CON. `� M /0�.� V ��`in-i- e i /�7�0 Q iK4��ij7/ 07ae
SPRINKLING SYSTEM /
MISCELLANEOUS r'
ROUGH HEATING AND AIR CONDITIONING /X G:z7•�/
TEMPORARY SERVICE OR POLE /
UNDERGROUND fl POWER 0
ROUGH WIRING WG„,71 / Heatin• and V •t.
TRENCHES FORMS 2' STEEL REINF. 7 a °F-Ka- 2/QI
•
FLOOR SYSTEM4 (/
BOND BEAM n STEEL REINFORCE �� �Z' �/4 " •-a-7/ X/s
SHEATHING Q-2q -tt
FRAME AND FLASHING
666 ! +/-�
LATHING - IN [i] OUT [q I' �;•r•Il
PLASTER, BROWNCOAT
STRUCTURAL, FINAL
HEATING. VENT., REFRIG. AND A.C., FINAL F�zaar��/, Sflffl4f , 9/.v.7/ rag/
PLUMBING, FINAL AND GAS TEST r� r?- '����I J1
ELECTRIC, FINAL ts:+. ''1' , /
RIIII.nING FINGI 4 G 1.f>_ a
CITY OF COSTA MESA
t MF BUILDING DIVISION
F1
77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
�. n FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: B09-00310
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: TPN009026 DATE ISSUED: 12/15/2009
ISSUED BY: KJB
JOB ADDRESS: 1649 IOWA ST CM Suite/Unit:
Vicinity: AT MESA VERDE VILLAS
Squares: 25 Valuation: $10,000.00
SCOPE OF WORK: REROOF CONDO BLDG AT AT MESA VERDE VILLAS.TEAR OFF EXISTING ROOF AND REPLACE WITH BASE,
MODIFIED 2-PLY AND ROCK.25 SQUARES •
OWNER: MESA VERDE VILLS HOA Address: 1604 IOWA ST Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: PRICE,ROBERT E III Address: Unit: :
PHONE: City/State/Zip:
CONTRACTOR: PREMIER ROOFING AND BUILDING CO INC License No. 634404
Address: 17501 NORWOOD PARK PLUnit: PHONE: 714-573-0155
City/State/Zip: TUSTIN,CA 92780 CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. 'PHONE:
FEE SUMMARY •
Reroof Plan Check: $0.00
Reroof Permit Fee: $181.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES $182.25
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
BODE E. INSPECTION TYPE DATE INTn1ALE CODES INSPECTION TYPE DATE INITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final ✓1 d� / /^ 208 Final Plumbing
4-14-
200 Final Re-Roof /D by {] ) 210 Final Electrical
201 Final BIOCk/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
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive.0 license. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' �—
Verifica[ion of Ownership by(type of document.i.e.-property tax bill or deed):
compenetion, asiprovidetl for by section 3700 of the Labor Code, for the
perfor ance of the work for which this permit is issued.
have and will maintain workers'compensation insurance, as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. workers' comp�rn�ssaa Ion Insurance carrier and policy ❑ I hereby certifrot hat no excavation flue(5)or more feet in depth into which a
number are: / /
person
this is mqund t no buil ng tr mae, in conneg, wish work demolition
,fir D/ by this permit,and that no building structure,scaffolding,falsework,or demolition
Carrier:• or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
\----(This se n need not be completed rl the permit is valued at one hundred dollars(5100)or less) 2,Art 2,Sec.341,Title 8,California Administrative Code).
Policy Number: 6.1--a/G/z7.-A e,
r���'��
El As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any perso. ' any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compe i•.. of Californi- -nd agree that if I should
become subject �✓�ir•i"compens. '• provisions of Section 3700 of Applicant's Signature Date
the Labor Co. yF` with corn. ' th these pro ���
`/ . � Division of Intlustrial Safety Permit Number:
.• Signawre \.Dale HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions. that a Business Plan be filed with the Costa Mesa Fire
ATTORNEYS FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is' full force and effect. a registration form for acutely hazardous materials? ❑Yes CINo
Lic:#---, // j Class# ` If (Section 25533 of the California Health and Safety Code, with some
/S' f exceptions, requires registration with the Costa Mesa Fire Department by
�'� Gj each business which at any one time has on hand a quantity of acutely
on +rsSt. .re Date 1 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
CON TRUC •N LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature - Dale 4, If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish. or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑ No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No
thereon,and who does such work himself or herself or through his or her own
8. (If"yes",attach certificate of compliance from the appropriate air pollution
employees. provided that such improvements are not intended or offered for control officer).
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 CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction ' -uthorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter e above-described property for
inspection purposes.I agree Jo.: . cl is allow occ =: cy of any building
authorized by this permit i inal,.....di ..ir ton.
Signa 40- 1• ele /62Z
Signature Date _
305746(3/07)
•ndlor Authorized Applicant ` Date
A 1 t 'L
�@ 9 - CITY OF COSTA MESA
BUILDING DIVISION
f • „„• �) DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
4 PERMIT /
, � / 601-00923
o
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.usNG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDIJob Address: 1649 IOWA ST Status: ISSUED
Suite: Applied: 06/19/2001
Vicinity: MESA VERDE VILLAS HOA Issued: 06/19/2001
Parcel Number: TPN980105 Zoning:
Applicant: SESLER, MARK ISSUED BY:
Address: 5396 RANCH GATE RODE
Phone: 800-810-7288
ALTA LOMA,CA Zip: 91701
Owner MESA VERDE VILLAS HOA
Address
Phone:
COSTA MESA,CA Zip: 92626
Contractor: CALIFORNIA PACIFIC
Address: 5396 RANCH GATE RODE
Phone: 800-810-7288
ALTA LOMA,CA
Zip: 91701 License: 519073
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF:T/O EXISTING SHAKE ROOF, 1 LAYER30#FELT,REROOF WITH"GERARD”LIGHT STEEL TILES(NER-423)
1.5 PSF
1700 SQ FT
FEE SUMMARY,
Plan Check: $0.00 Calc Valuation: $6,800.00
Permit: $139.25 Claim Valuation: $6,800.00
SMIP Res: $0.68
• SMIP Com: $0.00 ,
Other:- $0.00
Inspection: $0.00
Total: $139.93
�N '• '
%i' PLANNING &ZONING- `- i '
SETBACKS
MAIN STRUCTURE Front , 0-0 N Rear 0-0 Left 0-0 Right 6-o
ACCESSORY Front 0-0 - Rear 0-0 Left 0-0 ' Right 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(WOO)
DECLARATIONS C.)
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.
1 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 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 Call rnla,a d agree t t if I should become subject to the workers'compensation provisions of Sectio 700 the Labor Code,I shall forthwith
comply with these pro i s. //� 4G77����
Applicant Signature: 4 Date: ( 'i 0(
WARNING:FAILURE TO SEC E ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTIE AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100000) N 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 and r pro ions o Cha er 9(commencing with Section 7000)of Division 3 of the Business and Proles ions Code,and my license is in full
force and effeLic.ct. N Class#
Contractors Signature: Date:
L 701
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
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 drivers license. ❑Yes 0 No Drivers 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 end certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and 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 agermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ci Yes L-I 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 ❑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 COMPIJANCE 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.nspecfon purpos .I agree not to occupy or allow occupancy of any building authorized by this permit//runtil final inspection.
Sign ur Of gal Owner(s) ` /,7^/Date
r An Or Authorized Applicant �j(/ G(JDate
CODE t INSPECTION TYPE DAIS INTmALE CODES INSPECTION TYPE QeIE INITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof '27"0 210 Final Electrical
201 Final Block/Retaining Well 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
a.....„---(Arm.., CITY OF COSTA MESA '
4 A = BUILDING DIVISION
> DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
'I. ' i PERMIT
°c B01-01384
(714)754-5273 • Fax(714)7544856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1649 IOWA ST Status: ISSUED
Suite: D Applied: 09/06/2001
Vicinity: Issued: 09/06/2001
Parcel Number: 93207092 Zoning:
Applicant: MC CASLAND, ANNE ISSUED BY:
Address: 1649 IOWA ST APT D .- - "
' - -.Phone: 714-751-4330 - -
COSTA MESA;CA / Zip: 92626
Owner: MC-CASLAND,ANNE "
Address 1649 IOWA ST APT D -- ��
�- Phone:
,,
" COSTA MESA,CA' • - Zip: 92626 - _ -
V .
Contractor: , , V "
Address: '
. - . Phone:. .
Zip: - • License:
Arch : -- Eng: '
Address: , - - Address:-
. ' Phone: - v Phone: '
Zip: - License: License:
SCOPE OF PERMIT
" REMOVE EXIST SLIDING DOOR AND REPLACE WITH A BAY WINDOW ALSO REMOVE SIDE WINDOW.NO CHANGE IN SIZE
FOR BOTH INSTALLATIONS. - . ' ' " - . '
FEE SUMMARY
' Plan Check: $54.11 • • ' - - Calc Valuation: $2,700.00.
Permit: $83.25 Claim Valuation: $2,700.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other $0.00
Inspection: $0.00
Total: $137.86
' - - PLANNING & ZONING ,
SETBACKS
MAIN STRUCTURE Front 0-0 Rear. 0-0 ' Left 0-0 Right 0-0.
ACCESSORY Front - 0-0 'N. , ' Rear 0-0 Left 0-0 Right 0-0" -
PARKING Existing: '-0 ReQuired: 0 Proposed: 0
NOTES: - ,
VO I
I I
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
244648(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 carder 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: Dale:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THrx(RAND DOLLARE(5100.000).IN ADDrnON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3700 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.U0.it Class q
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,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 pert
sub cts 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.
044,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.).
❑ t,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.).
t under s0c. Business and Professions Code for this reason: L ,/
Aigiss
- - a verified by drivers license. es ❑No Drive/ .. :IOW •
Verification of Ownership by(type of d ment,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation live(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: „ _ Date:
Division of industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and 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 compiled with? 0 Yes 0 No
the
ape_.__.._
5 Does or will the o st Air or present or future building occupant at requirer for the work which is the subject age of this application aEEeNNt 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 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? ❑Yes ❑No
8 (If"yes",attach certificate of compliance from the appropriaateeair 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: ` i /''..;mate: ..a a
CERTIFICATE OF COMPLIANCE ANI AUTHORIZATION OF ENYRYA certify under penally of p0hury that',nave reed this appliCation'`end stater that the information given is
correct. I :!ree to comply with al rd ty ordinances;relating to building constructions and authorize representatives oo the City of Costa Mesa to enter upon the
above-, 'bed propsqy qfo^r hip-. i�:gree'not to occupy ori Ilow occupancy of an)�building authorized bylhis�nmt ntil final inspection.
��
�(y t Sig •re Of Legal Own: (s) U ate
And/Or Autho zed Applicant Date
CODE t• I65PECf1ON TYPE OATF QmnALS VODFt INSPECTION TYPE PATE MH
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1286 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final BlocloRetaining 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
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. I G DATE /2 — y1I
IAT NO. --
ADDRESS /649 0 • .-li¢-t.<YQ Jig-
The developer of the above entitled. tract desires to sell the above se,t
forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
(he-she-they) p (was or were) jjni2J advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the City
at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from
any claim resulting in damage or personal injury to the undersigned by reason
of the aforementioned uncompleted condition.
OPurchaser
GEv <�
ROP'00 EPt. BY
otpNN,��'0 Developer and/or`uthorized
191 representative
aM
0C- ' 5‘6 BY
NIA
g,N,�R�k
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO.
Q46 / V DATE �a -1 / & -2 /
LOT NO. /
ADDRESS // l. 4/9 C ��p-�c.�2sjfr
.
ClettZL-291.-eoa-
The developer of the above entitled tract desires to sell the above set
forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
(he-she-they) (was or were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the City
at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from
any claim resulting in damage or personal injury to the undersigned by reason
of the aforementioned uncompleted condition.
: 't
/
Pd chase
S aA
SSP 4 Developer audio authorized
G�VpaO �1� 0 representative
�Q� BY
Q ti
GC header--
1'
g?tet 11127
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. 44.741-- DATE 12 -22 - 7 /
LOT NO, Z
ADDRESS / (4 ? C� ) rien /rr Agi
The developer of the above entitled tract desires to sell the above set
forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
(he-she-they) (was or were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the City
at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from
any claim resulting in damage or personal injury to the undersigned by reason
of the aforementioned uncompleted condition. I
BY l/� LCih1� 1 7a4
Purchaser
13a
RECEIVED Developer and/or uth ized
representative
CITY OF COSTA MESA
PLANNING DEPT.
Lender
C E C 2 1971
AM am
71819.104 =,1, 2.11415,6
A
10 0
PAID
MAY -6-71cns700 216-'} ***229.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely RECE D V D E RECEIVED DATE ISSUED
BUILDING �3.-7� -.4::‘,-- 7/
ADDRESS 1649 ABCD Iowa Street 'a
PERMIIT Naqq--)
OWNER Modular Technology, Inc. A.P.NO. •:•JUJLJ
MAIL BUILDING
ADDRESS 1104 E. 17th St. ADDRESS 1649 ABCD Iowa Street
w 6614 I LOT 9 BLOCK
O.0 CITY NOL'547_9673 TRACT
Z Santa Ana
z< CONSTRUCTION NEW ADD ALTER I REPAIR IMOVINr: DEMOI tSH
I-
o LENDER The Trustees of Mortgage I
111
Q. co Trust of America X
J co BRANCH
J U) Ow ER,s Mod ar Technology, Inc.
m w ADDRESS 141 Battery St. San Francisco /%1 i a,/ i� - VALUE fuer//.•
-m ARCHITECT TEL. USE . • = S',Y ,t�o�
J .,:c
OR ENGINEER Kermit Dorius NQ. 644-7111 -
UQ FIRE '/ /Air wD: ADDRESS 3111 aid Ave. , Corona Del Mar ZONE TYPE / GROUP /b'- v
a w APPROVED i/
J Z CONTRACTOR Owner BY DATE
z if
.Jw cc ADDRESS FT( /f OF /
ZrCITY NOL ? `(�C el PLANS BUILDING EWII i �(/�
I
-0 STATE CITY YARDS APPROVED YARDS APPROVE
to EC LIC.NO. 252549 B-1 LIC. NO. 1690 MAIN BUILDING ACCESSORY BUIL NG
SIZE I NO.OF BLDGS. (FROM C/DEET)
OF LOT INOW ON LOT FRONT FT. FT.
USE OF (y
EXISTING BLDG. -- R.SIDE I I FT. FT,
I- SIZE OF NO.OF q
Z NEW BLDG. 4188 ROOMS 20 STORIES 2 L.SIDE / FT. FT.
EXTERIOR WALL ROOF
C.1 COVERING StUCco I
Built-Up REAR 1 OFT. FT.
-1 USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
1
a MAIN BLDGS. ACCESS. BLOCS.
Q VAR.# DATE
0 Construct 4 condominum units C.U.P.#760...2--7v APPROVED 44-b-7
I-
with attached garages. _BYROVED� ATE S ,
Z0 1 ��
VI hereby acknowledge that I have read this application end state
0 that the above information is correct and agree to comply with
all laws regulating building construction, and I shell not employ
I-any person in violation of the workman's compensation laws of HOLD FOR SPE IAL REQUIREMENTS
fn the State of California. �/�� y� p' m
!lXI hereby certify that I am properly licensed as a contractor under SQ. FT. 0
the State of California Business end Professions Code, Division 3, THE AMOUNT SHOWN UNDIR VALUATION IS FOR 5
Chapter 9, and that such I'•.nses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: Q
am exempt from the Pr•. _ons of the State of California Business
and Professions Code, • sion 3,Cha ter 9. VALUATION /53 ,00 N
It PERMIT FEE $ D
Signature of D m
Permittee Lw,,,i/�( Q.c $��Q PLAN CHECK $ 71e S4' o
Authorized Agent /� �f LL
TOTAL FEE $ 7d ._
5-G1