HomeMy WebLinkAbout1618 IOWA ST - Building Permits •
CITY OF COSTA MESA
FFL BUILDING DIVISION
• F 1 t 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714)754.5626
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PERMIT NUMBER: B09-00260
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: TPN980105 DATE ISSUED: 11105/2009
ISSUED BY: RMD
JOB ADDRESS: 1618 IOWA ST CM . Suite/Unit:
Vicinity: REROOF CONDO BLDG '
Squares: 2500 Valuation: $10,000.00
SCOPE OF WORK: REROOF 1618 IOWA CONDO BLDG:T/O EXISTING B.U.R.REPLACE WITH BASE,MODIFIED,2-PLY AND ROCK.
25 SQUARES
OWNER: MESA VERDE VILLAS HOA Address: 1604 IOWA ST Unit:
PHONE: City/State/Zip: COSTA MESA,CA
•
APPLICANT: PRICE, BOB ' Address: 17501 NORWOOD PARK PL Unit: :
PHONE: 714-573-0155 City/State/Zip: TUSTIN,CA
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,
COPE, INSPECnoNN1Y E DATE INTInALS CODED INSPECTION TYPE QA IN701Al.
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof I 014 210 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
4111, III
•
a
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
0 I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property lax bill or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued.: M workers' compensation Insurance carrier and policy 0 I srebyreq certifyt thatno excavation read nnl in depth work
into which a
number are: 4„.7y7[//o Y-J/ C'/// person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffdding,falsework,or demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This soave/need noi be con�oletteedelthe ppeemle¢valueevl one
hieelimlSaes($100)afes.) 2,Art 2,Sec.341,Title 8,California Administrative Code).
(i[
Policy Number: :C.(//7/62/9,0
❑ As owner-builder, I will not employ anyone ID do work which would
❑ I certify that in the performanc' - t•- 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 •�•.r In - manner so - to become subject such person has a permit to do such work from the division.
to the workers' compen •"cos • California, -•• agree that if I should
become subject t• ' ere' • pensatio . ovisions of Section 3700 of
the Labor C•• �� forthvn o�ro. i ese provisio/� Applicant's8110
Signature Date
// 477 Division of Industrial Safety Permit Number:
r-Appy• •' 'r• .lure/ -Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILUREX O SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL A' 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
ATTORNEY'S 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 iryNl�•.rce9nd e -cr. //�q a registration form for acutely hazardous materials? 0 Yes 0 No
Lit.# (/l/� �G!/_w/0 Class# (// / (Section 25533 of the California Health and Safety Code, with some
-cr..... /�// //-TiG/!. /— p exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely• t Date 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
CONST-•CTION LENDING temperature and pressure).
O I ereby 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 fa 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 Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 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? 0 Yes 0 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? ❑Yes 0 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).
O 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
sale. If. however, the building or improvement is sold within one year of control officer).
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 Dale
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
❑ 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, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I a•r-- •s% occupy or allow occupancy of any building
authorized by this p- u• ' inal in •.ction.
•e of Legal• er(s) //Date
3037-46(3107) Signature Date
'J/
^ �G !•
An• - •ulh•.- .Applicant / Date l
33052 HAY -6-71Pn1BOO 240* ***
COSTA MESA BUILDING-SAFETY DEPARTMENT CNSF 22o50
,
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
REC;VEDB DATE RECEIVED
ADDRESS �j o
BUILDING/// Q ff`/A'8�D Iowa St. _, ,h, 3 +•7 OWNER Modular Technology, Inc. lin.
BUILDINGlligNa
/44��',A A n
MAIL ADDRESS /7 l- Iowa St.
Z ADDRESS 1104 E. 17th St. /- /
TEL.
aTRACT 661 LOT 38 BLOCK
CITY Santa Ana NO.547-9673 rQ
ZQ CONSTRUCTION NEW App(ALTER FAIR MOYIN(i DFMOLISH
I-
OLENDER
0. %
J 7 BRANCH '
N OWNER Mod lar Technology, `Inc.
m LU ADDRESS VALUE SO .2.9p,"
m ARCHITECTTEL. S_ •„4-. s , 140,1„,,,..„ $ .-==ie1+
J Q OR ENGINEER Kermit Dorius,AIA ND, 675-116 -
OW FIRE / F
w CC ADDRESS 3111 2nd Ave.. Corona Del Mar ZONE TYPE GROUP
O. W APPROVED
W Z CONTRACTOR Owner BY DATE
J Q
m Z
J Lu ADDRESS Same
W NO.OF SE OF NEW
Z r -- TEL. -- 7�pt f��EJ(� PLANS BUILDING �y / /
CITY NO. I \ I y�n df:ie '
!] STATE CITY YARDS APPROVED YARDS AQPROVEO
to Ir LIC.NO. 252549 B-1 LIC. NO. 1690 MAIN BUILDING ACCESSORY BUILDING
D O (FROM C/ STVET)
SIZENO.OF BLOCS. (/
OF LOT 72 x 108 I NOW ON LOT - FRONT FT. FT.
USE OF
EXISTING BLDG. -- R.SIDE / d FT. FT,
I- SIZE OF NO.OF / 3 II
Z NEW BLDG.2RIOR p0�94 S.F. ROOMS IO STORIES 2 L.SIDE / FT. 10 FT.
ROOF
C.) COVEXTERING tieL d.Shakes COVERING Built-Up REAR /`� FT.. FT.
-I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
1 MAIN SLOGS. ACCESS. BLDGS.
a DATE
/
Construct residential d with CURPG.3.S— APPROVED 'y —(qw
0
• F-
attached garages at front of lot. APPROVED (� DATE 5 —5^-7
z int
0
UI hereby acknowledge that I have read this application and state
D that the above information is correct and agree to comply with HOLD FOR 5"CCTA F2QUIR.6 vlhN 15
K all laws regulating building construction, and I shall not employ
r any person in violation of the workman's compensation laws of
Zthe State of California. d�( CDco
I hereby certify that I am properly licensed as a contractor under J SQ. FT. 0 0
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDE ALUATION IS FOR ,
Chapter 9, and that sue ' enses are in full force and effect,or I THE PURPOSE OF ESTABLISHIN PERMIT FEE ONLY: a
am exempt from the •., Bions of the State of California Business
and Professions Cod 'vision 3 C-apter •. VALUATIONCC
i^,rt' J"� co
PERMIT FEE $ ✓
3
Signature of •�/y •
< O to
Perm Ittee L/e Ari _ // $ PLAN CHECK $ I t J E
/n O� LL
Authorized Agent / 5oJ �y TOTAL FEE $ e ."v Sib
OWNER MODULAR Technology, Inc. DATE 5-6-71
JOB ADDRESS 1618 Iowa Street, Units A-D BUILDING PERMIT NO. 33052
GENERAL CONTRACTOR & DESCRIPTION of WORK 4 Plex w/att.garages
AP No. LOT 38 TRACT 6614 FIRE ZONE VALUE $50,700.00
INSPECTIONS Sign tturr Date GROUPH & J TYPE V( ZONE R4-CP
SOIL i>V ft .552/'t/7 SUBCONTRACTOR PERMITS ISSUED
GAS Date Number I Signature
WATER �+ Plumbing
ROUGH PLUMBING / fJfl ��/-7/ 7fe. //5/�y ,����/1��i ‘,/,91/7/ �r.///.�J7;,
PROP. SWR. LINE OUSE CON. 2--- /!1% O-/tqf /Wee 1OV 7/ ^�1VJA
SPRINKLING SYSTEM _/
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING '22Y WZA`
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER 9 +�
ROUGH WIRING "MIEN ,r7 H-atin. and V nt.
TRENCHES in' FORMS I" STEEL RE INF. M g���•�"i�,/�S- �/. / a
FLOOR SYSTEM -//nz r s//�/nfrarira.MaillrgniEnt
BOND BEAM 9 STEEL REINFORCE 9
SHEATHING j4a27,42,/
FRAME AND FLASHING
FLASHING er� y/
LATHING - IN r410--I "" [ 1��/��/ /
PLASTER, BROWN COAT R /61Y-17/
STRUCTURAL,
HEATING, VENT., REFRIG. AND A.C., FINALWill/
.1/ T. Nati/
t. O.I rI �Y
7y
PLUMBING, FINAL AND GAS TEST WH--
,
ELECTRIC, FINAL J
////
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. G b i `-l" DATE /19-30---2)
IAT NO. 3R 2
ADDRESS ,/e. i n 6_3
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.
If / • / 010
BY . 6.
Purchaser t
RECEIVEDate
CITY OF COSTA MESA BY ,;
PLANNING DEPT, Developer and/or =utho zed
representative
NOV 2 1971
AM Dpi Lender
718,9,11bt 441112,11,4,516
A
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. 4 /V DATE //a a - .7if
LOT NO. Jf '-• /
ADDRESS /( /p -�� �nlJ4I A
`7y) •
The developer ofthe 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) L0-4-0 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 �`'
C EJ Vm Purchaser
R E a COS1 PI`D DEPS
?`01N1 N BY De
C 2 1 OFA Developer and/or a orized
�Srepresentative
St 11 BY
Lender
i.. \.
,
'-7 MF 9 CITY OF COSTA MESA
BUILDING DIVISION
>:l,,,,, i. -. DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER
1 �� PERMIT
4. 1.11.4 601-00600
(714)754.5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1618 IOWA ST Status: ISSUED
Suite: Applied: 05/01/2001
Vicinity: 4-UNIT RESIDENCE ONLY Issued: 05/01/2001
Parcel Number: TPN980105 Zoning: /
OfIr.4,00,
Applicant: SESLER, MARK - - - ISSUED BY: Ate./L
Address: 5396 RANCH GATE RODE - -
Phone: 800-810-7288
ALTA LOMA,CA Zip: 91701
Owner: MESA VERDE VILLAS HOA
Address 1604 IOWA ST
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:
2 ' N " / ;` SCOPE OF.PERMIT_. '.
REROOF:'T/O EXISTING SHAKE-ROOF`1 t!AYERI304EFELT,REROOF WITH"GERARD"LIGHT STEEL TILES , - . 2 f 2• ,
. _ Y.`/ _
1700 SQ FT - A 1 li
`FEE S_ UMMARY.;--_ -. - ._-
Plan Check: $0.00 ---' .-/,' / Calc Valuation: r, - $6,800.00
Permit $139.25 • , Claim Valuation,.'7 $6,800.00
SMIP Res: $0.68 -__ 'r- ,
SMIP Corn: $0.00
Other:- $0.00 °�/ ,
Inspection: $0.00> --„ - /j
=Z ..'. (1,4;
Total: $139.93\ V', ' t , / /�
A ,.
`�\ ///,,1 � _ V /PLANNING &ZONINGS/ --\j; "�/ '7/
SETBACKS \
// A . i> / %//
MAIN STRUCTURE Front. '0�0 \‘ '/ Rear ' -0-0 Left 0 0--2' -. \ Right: 0-.02-,
ACCESSORY Front 0-0 \ Rear 0-0 , ' "'Left 0-0' Right, 'O-0
PARKING Existing: 0 Required:_ 0 Proposed'y,--,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(6/00)
WORKERS'COMPENSATION DECLARATIL...
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.
)2'1 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 Calmia,end agree that If I should become subject to the workers'compensation provisions of Sectl n 3700 of the Labor Code,I shall forthwith
comply with these provJahs. /
Applicant Signature: !/w11(1!� � �� Date: l t`-1 C.WARNING:FAILURE TO SECURE ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PE TIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DOLARE(SS00,0001,IN ADDITION TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF 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.Lie.# Class#—/--{
Contractors Signature: "I Q t .S cc 1(f Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to tile 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. 0 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,laiseworx,or demolition or dismantling thereof,will be more than thirty-six(38)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:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Caffomia 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 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 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 Califomla 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.
JSign: • -Of egal Owner(s) S 1 t Io( Date
. . 6/
And/.r Authorized Applicant Date
CODE r I•. I USE INTRIALS ;ODE( INSPECTION TYPE PATE JNTTALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof S^ 7 �( ,'2*'# 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 REQUEST FOR OCCUPANCY
TRACT NO. C'E. / `T DATE /7— 2 -71
LOT NO. 2E (4- )
ADDRESS /6 /R (!T) ) 40_,c, (9/11.
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. /�
BY ���<�J l/iS-7'�L5Ac.--/
Purchaser
BY a-- dr V" a
Developer and/or :utho." ed
representative
Lender