HomeMy WebLinkAbout1600 IOWA ST - Building Permits • 4
057 NAY -6-71cne 00 246* ***22950
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA.CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely gECEI D D TE RECEIVED
BUILDING 9� DATE ISSUED
ADDRESS 1600 ABCD Iowa Street
�� 'J! 3�r .�jk�—�6'7�
OWNER Modular Technology, Inc. A.P. NO. PC1.Jr0,�"7
BUILDING
MAIL ADDRESS 1600 ARCD Iowa Street
Z ADDRESS 1104 E. 17th St.
TRACT 6614 LOT 43 BLOCK
M U CITY Santa Ana NO. 547-9673 NEW ADD ALTER REPAIR MOVING DEMOI ISH
O4 CONSTRUCTION LENDER 'rile Tr 1{.tpe.s of Mortgage '
in
a. BRANCH Trust of America X
JIn OWNER Modular Technology, Inc.
m Lu ADDRESS 141 Battery St. , San Francisco a 'VALUE✓�J, SdD. "
J Q ARCHITECT Kermit Dorius TEL'644-7111 u s• 5 q
N OR ENGINEER NO. //
U FIRE f�
Z
W ADDRESS 3111 2nd Ave., Corona Del Mar _ZONE TYPE tr GROUP/044
APPROVED
wO CONTRACTOR Owner BY DATE
m Z
J cc ADDRESS
Wuj
NO.OF USE OF NEW
Ifrti
ZM CITY NO. -aP PLAN$ 0---BUILDING ( Q.�r
U STATE CITY YARDS APPROVED YARDS APPROVED
LU
cn cc LIC. NO. P52549 B-1 LIC.NO. 1690 MAIN BUILDING ACCESSORY BUILD! G_
SIZE NO.OF BUGS. (FROM C/L/S/T/BEET) // `
OF LOT I NOW ON LOT FRONT ?LOFT. (p 4 FT.
USE OF
EXISTING BLDG. -- R SIDE C2 KT. FT.
1- SIZE OF NO.OF /
ZZ NEW BLDG. 4188 ROOMS 2O STORIES 2 L.SIDE ( FT. FT.
EXTERIOR WALL ROOF
V
__ COVERING Stucco COVERING Built-Up REAR /0 FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
1
CL MAIN BLOCS. ACCESS.BLOCS.
0 Construct 4 condominium units with VAR.
u P w 3S =f D DROVED II- -7 D
H APPROVED I,r/L
N attached garages. RY DATE ) /chi/
Z a'VW /1 C-
0
UI hereby acknowledge that I have read this application and state
D that the above information is correct and agree to comply with
all laws regulating building construction, and I Shannot employ
I- any Person In violation of the workman's compensation laws of HOLD FOR SPECIA, REQUIREMENTS
Nthe State of California. /] 0
L
Z I hereby certify that I am properly licensed as a contractor under
3h''S SD. FT � V?
0
the State of California Business end Professions Code, Division 3, THE AMOUNT SHOWN UNDeR VALUATION IS FOR s
Chapter 9, and that sulicenses are in force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a
am exempt from th- ••a••visions of the to of California Business
and Professions Co, •• ivisio 3 h ter VALUATION / rc
S1 c:-. m
PERMIT FEE $ :•J r'
signature of m
Permittee , (,d O(�/, $ r..'�� , u PLAN CHECK $ �/J ��� LL
Authorized Agent /Y 1/!) TOTAL FEE $ a^w 4) O o
OWNER MODULAR Technology, Inc. DATE 5-6-71
JOB ADDRESS 1600 Iowa Stree• Jnits A-D E )ING PERMIT NO. x33057
GENERAL CONTRACTOR Same DESCRIPTION of WORK 4 Plex w/att/garages
AP No. . LOT 43 TRACT 6614 FIRE ZONE . VALUE $ 50,700.00
INSPECTIONS Si na uJ Date GROUP H & J TYPE V ZONE R4—CP
SOIL j�t -/,/�/ PERMITS ISSUED
GAS /' SUBCONTRACTOR
Date [ Number I Signature
WATER Plum ng
ROUGH PLUMBING l / �� �Q.7f �J ., / fJ Aa.- �� �/ 0734
PROP. SWR. LINE Yisa, H/OUSE CON. lJN "1"7-0 �1• '7"%7J `���">1einilfra. / 7?-'7, '7yy
SPRINKLING SYSTEM
MISCELLANEOUS ry
ROUGH HEATING AND AIR CONDITIONING c9-1/...,/,c9-1/...,/, 0�`7`/
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER 0 _
ROUGH WIRING (�!�/ a A , H-atin. and Vent.
TRENCHES 7. FORMS El STEEL RE INF. % ' rAsa r , r(� ,
FLOOR SYSTEM -Y.WSCrit Y / ite.Mt_4p-
BOND BEAM n STEEL REINFORCE E
SHEATHINGME �� r/� 7
FRAME AND FLASHING `/;roy
LATHING - IN Fr DUT ' /'/
PLASTER, BROWN COAT /V C/r4
STRUCTURAL, FINAL '
HEATING, VENT., REFRIG AND A.C., FINAL f - 7 , ,. 'e i , -/7-7/ •
PLUMBING, FINAL AND GAS TEST [4. k �:`(�r17//
ELECTRIC, FINAL f
It
•
• f COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATIOOFORSTRUCTURALPERMIT 5e50 TL
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RECEIV BY 'PERMIT N0 - 4 9 7 7 -
For Applicant to Fill in yyCompletely.— Use Ink Only �y �1�
BUILDING (6oD t ..J_Liw,'%- Cr A.P.NO. 13-1--(5"' \^'OI
BUILDING
OWNER OR d , �N T cq V__,�te� ADDRESS f oo a Sr
TENANT ATL `Aw
UNIT OR
ADDRESSMAILING I2-t /r ///
1/
LO��s-N) SPCE TRANO NO LOT 33 BLK.
CITY (4,S/ � #2,$!t NOL ` / Y b D NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
•--- /w/et •
LENDER Y
BRANCH �^ OWNER A-/.46/ T. SC-44.,....M-L-6 4
_
ADDRESS APPl- VALUE
USE $
n;OARCHITECT -.----
TEL. •
OR
ENGINEER NO.
ADDRESS 4.,.--_ ZONE yyJJCfS ITYPq GROUP A
--1
APPROVED fCONTRACTOR O lLY-`- YDATE 3- 7-p
3
---
ADDRESS
TEL.
CITY NO. •
(-0APPROVEDCITY APPROVED SETBACKS
�Sy UC.NO. '� LIC.NO. r �A J
(FROM C/L STREET)
Isl S12E NO.OF BLOCS_ a�Q' ^
G. OF LOT NOW ON LOT FRONT F /r10 p ` ./ j
F I Tt�TJ�-✓
Q USE OF 10 _/� /
„N„ EXISTING BLDG. _13 SIDE S•. /
I-
FSeparate permits are required for L.SIDE F ,`A�-�
Cr electric,plumbing and heating work: REAR FT.4.1
�J"
US OFB�yyILDING AND WOO TO BE PERFORMED PLANNING ACTION
o ?aNnos.,- W nds,1,t/
/ere)? '&o I/ I DATE
APPROVED VED
Q ROVEDjVADATE S•-.1
��)-• BY ieJ ,
Cd
Ira
0 I hereby acknowledge that I have read this application and state N
lye that the above Information is correct and agree to comply with
R. all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of 2
W the State of California. c-
3 I hereby certify that I am properly licensed as a contractor under SO. FT. � �' �' or
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR w
Chapter 9, and that 5 Kansas are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from t - pro slons of the State of California Business
and Professions C de, D islon 3,Chapt. 9. VALUATION PERMIT FEE $ .5 m
i ) / PLAN CHECK $ r- n
Signature of i o
Permoo`ttee / h �� $ 25-
L_ TAX $ Q SQ u
Authorized Agent Data
TOTAL PAID S .56-1 ,S 0
.a COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RECEIVED BY 'PERMIT
For Applicant to Fill in Completely — Use Ink Only tel
2 A I N� 4 9 7 7 0
BUILDING 1Hnc ' X74 r A.P.NO. Y'�'�O�t�t ' O1
ADDRESS J•� �j!f J
BUILDING ♦ , `� �0 OWNER OR ADDRESS / GOn cir7 ..---
BUILDING
SrS .
TENANT irk J r S66ter/.'F-LBE
UNIT OR �)
MAILING i / p SPACE NO. `/
ADDRESS /'ZrJ LOt'TAIJ
t ^- COTR.NO./Q/_ �J. LOT ,1 BLK.
TE CITY Ce,$I� /Zl/`5/4 NO. G7/no `�(l'I 1 K5
CONSTRUCTION Q NEW ADD- ALTER REPAIR MOVING DEMOLISH
LENDER ^— � ' �t (///t T Sok,'
BRANCH OWNER /y-[�4-rd b• , e1(�TW/¢L.BE
ADDRESS
�"
�p� VALUE
ARCHITECT TEL. USE EZ S O^•••-
OR ENGINEER NO �. ,Q
ADDRESS ZONE yJ 1•�/rG3F tt
TYPEV-N GROUP - I
APPROVED 13 _7_p1_
CONTRACTOR �''/ / BY DATEa V
ADDRESS
TEL.
CITY NO. __-
I- STATE CITY APPROVED SETBACKS
LIC.NO. LIC.NO.
IP
I+1 SIZE r NO.OF BLDGS. (FROM C/L STREET/ D
6• OF LOT NOW ON LOT ^ FRONT FT. ,/ _
Q USE OF 01
„�„ EXISTING BLDG. R SIDE i�./� ( j _
I-1
Separate permits are required for L.SIDE ••4i . _
C electric,plumbing and heating work: REAR FT. Jv1 tie
W USE OF B ILDING AND WORK TO BE PERFORMED PLANNING ACTION _
A ,— _,Lo-,,...__ .
a 8 it _I . K 36 rr DATE
APPROVED
>" APPROVED CRY1� DATE . .-7-80
.]
IX
FR
QI hereby acknowledge that I have read this application and state r,
IK that the above information is correct end agree to comply with
L all laws regulating building construction, and I shall not employ ti
Z any person in violation of the workman's compensation laws of u
[s7 the State of California. 25-0.7n
7 _ OP -
3 I hereby certify that I am properly licensed as a contractor under SO2,5. FT. t7. ` 70 n
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR fa
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt fro • i provisions of e State of California Business VALUATION PERMIT FEE Y
end Professlo•• •••e, DIvI� heptar 9. E S - 5
m
Signet re! �� PLAN CHECK E �_ ie
_ o
P armitt=e/ / It♦r $ Aso,-- TAX E o•SO
Authorized Agent e,tt� /7-/e ° �O(� _ U TOTAL PAID E SlS O /
Tr
ELT ADDRESS: 1600 IOWA ST uRn: ABCD CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 047769
OWNER'S NAME: FRANC ISA WANDEN '
....• 'ADDRESS: MESA VERDA ASSOC , .PERMIT NO: B 047769 PLAN CHECK NO: N GOVT: N SUPP : N
7400 CENTER AV„ 8205
HUNTINGTON BEACH, 92647 CONSTRUCTION TYPE: PERMIT TYPE: SIR PURPOSE: ALT
714 /557-9975
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REROOF SQ FT: 3 , 500
ADDRESS: UNIT:
. CLAIM VALUE: 3, 500 . 00 CALL—VALUE: 3, 500 . 00 GROUP OCC: R-3 / •
PERMIME: PETERSON ROOFING ( 714 ) 720-0812
ADDRESS: 2816 PCH COMMENTS:
CORONA DEL MAR CA 92625 ***sr*+E**********************************+E**+r************sE***+rsrsE+e*+s*********+r***
UCENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my bi ne fs In hJB force and effect. SETBACKS
cmuc.: 045445 . STATEuc.:468553 r c 'milk -39
Date:,±,— — `1a Signature: 2- MAIN BUILDING ACCESSORY BUILDING
'(ERS'COMPENSATION DECLARATION: I hereby affirm that)have acerdlicate of •nsent toselt.insure or acerlifieate of Workers' FRNT: FT IN REAR; FT IN FRNT; FT IN REAR: FT IN
enation Insurance,ora certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
, aCY ND.: 1021355 °P.m': 04 /01 /91
COMPANY: STATE PARKING REQ: PROV: PARCEL : 00000000 ZNE: REF NO:
U Certified copy is hereby furnished. [2 Certified copy is filed with the ' Building Division. PLANNING N TES>
.ni_ >
Date:--r lam— C/ C Applicant: Yom' /� ,---�>. ********************************************************************* *********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Ibis section need not be competed it the writ B for ore huna ed(510))or less). DEVELOPMENT S E R V I C E S R E Q U I R E M E N .T S •
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 Caiiforma. ZONING APPROVED BYDATE: '
•
Date: Signature:
NOTICE:IL alar maid ng this detlaratlon,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE:
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. /
CONSTRUCTION URGING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; DATE: TG /�s)
which this permit is issued(Section 3097.Civ.C). *************************************** ************************* **
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,Improve,demolish,or PERMIT 63 . 00
repair any structure,prior to its Issuance.also requires the applicant for such permit to the a signal statement that he/she is licensed 5 0
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE '
I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ' ISSUE PLAN—CHECK TOTAL PAID DUE
structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS--——> 63':50 0 . 00 0 . 00 63 . 50 63 . 50 , 00
does not appy to an owner of a property who builds or Improves thereon,and who does such work himseli/hersell or through
his
provement own employees,
lprovidednthat
completion,theowner�wiB have the burden ofpoving he/sr sale he did oteou eorriimprove
REVENUE DIVISION TOTALS--> COLLECTED : 63 , 50 OVER/SHORT: 00
for the purposeofsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63 . 00 . 50
U and Professions Code: The Contractors'State License Law does not appy to an owner of property who builds or improves thereon
' and wile Cgnracts for suchprojettscath atontraCtor(s)IICCrg.pursuant to the ConUactora' tale License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
0 I am exempt under Section: B.6 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 3500 REROOF BY VALUE RESIDENIAL NOZONE 1 . 00 3, 500 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533.and END OF FEES
•
25534 and that I or any future building occupant will/mill not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from their Dality Management District.Residential construction applications are exempt from •
these provisions.
bate:' Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state taws relating to building construction and hereby authorize r;pmematlres of this city to enter upon the above-mentioned
properly for inspection purposes, } (`J` l ' C\C\ '''4:\
bate: 5 —i .—CLO Signature: 4—C.._ "� .ice.,
ce. 01 _
Driver's License or Social Security N: I� DATE: 06/15/9LTOf3293 T1nE: L2:01 '
1441 White—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
I
•
CONSTRUCTION AND PLANK )OL & SPA
APPROVALS Permit# - _ Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. . ••
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. • 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement i 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
•16. Rough Electric Wiring • 67. Fencing & Access Approval
'
17. Rough Wiring Sign 68. APPROVED FORPLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating-84 Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test • 72. Underground Flush
24. Roof Framing • 73. Undergrnd.Storage Tank ❑Gas ❑00.
' 25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical •
27. Frame and Flashing - 76. Dry Standpipe -
28. Lathing & Siding 77. FIXED SYSTEM'FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test l .
36. Hood or Canopy -
37. Final Factory Fireplace
38. Final,Plumbing - .. ,
39. Water Service-Final -
40. Gas Service-Final
'41. Solar Domestic-Final •
42. Backflow Preventer -
43. Backflow Irrigation
44. Landscape Irrigation System . . '
45. Sound Attenuation
46. Handicap Regulations "yy��r
47. FINAL STRUCTURE & BUILDING 5/i,1/
48. FINAL PLANNING -�-c
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co Y •
51. CERTIFICATE OF OCCUPANCY ' '
No. Date
CITY OF COSTA MESA
o ' "'F, BUILDING DIVISION
Ft ,)1 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
a. AI. FOR INSPECTIONS CALL: (714)754-5626
`bonro PERMIT NUMBER: B09-00235
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: TPN980105 DATE ISSUED: 10/22/2009
ISSUED BY: BJK
JOB ADDRESS: 1600 IOWA ST CM Suite/Unit:
Vicinity: REROOF CONDO BLDG
Squares: 2500 Valuation: $10,000.00
SCOPE OF WORK: REROOF 1600 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.
OOE t. INSPECTION TYPE OATS 'MALS CODEX INSPECTION TYPF OAI IN111fALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final E 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
r
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. 0 Yes 0 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 tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
perfor nce 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compenSallon Insurance carrier and policy
number are: 5 ❑ 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
�( f v 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 sedan need nof becomplerled,✓the permt is valued of one hundred dollars($100)or less) 2,Art 2,Sec.341,Title B,Califomia Administrative Code).
C. %//
Policy Number: G/ , eC /
❑ 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 person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compel f .' California, a r agree that if I should
become subjec • e ;• pensatio . ,visions of Section 3700 of
the Labor •. • -. comptg ese provisions. Applicant's Signature Date
/G--Pc-D-0'J Division of Industrial Safety Permit Number:
Appliranignature / Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILUR 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? ❑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 in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No
Lic.# d C-. # � 39 (Section 25533 of the Califomia Health and Safety Code, with some
/64 ^ al7 exceptions, requires registration
with the Costa Mesa Fire Department by
( 7 �{/ each business which at anyone time has on hand a quantityof acutely
-nor -gnature Dale 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ f hereby affirm that there is a construction fending 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)? ❑Yes DINo
(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? ❑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? ❑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 ❑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 appy 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
❑ 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 agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Si nal c Date
Signature Date M
3057-05(3/07)
An ulhon -•Applicant Date
CITY OF COSTA MESA
,74 BUILDING DIVISION
> •:j r- .r DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER
I � ll ( PERMIT
J., B01-00520
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1600 IOWA ST Status: ISSUED
Suite: Applied: 04/17/2001
Vicinity: Issued: 04/17/2001
Parcel Number: 93207069. Zoning: ,, ^
Applicant: CALIFORNIA PACIFIC ISSUED BY: (/
Address: 5396 RANCH GATE RODE V
Phone: 800-810-7288
ALTA LOMA,CA.. Zip: 91701 - "
Owner: BEJERANO, LAURA KAY TR _
Address 2860-ALTA VISTA DR< .--_ _ . ' -._\
/'7 /2\
\ Phone: '‘:\\-N�
/ `'',/ NEWPORT B -
EACH,CA - Zip: 92660 A
.�i \�<
H
Contractor CALIFORNIAPACIFIC
'Address:2 5396 RANCH GATE RODE �\
`
/ / _/ /� /' Phone 2'800-810-7288 7
ii r/ 'ALTAtOMA,CA - A�; A A'� \
' Zip 7' 91701/ .License: `519073 - - i ) \\-). A\
.Arch - Eng: N , - VC
Address: / • Address:' - _ 'c''
- - Phone: Phone:
- ,
-Zip: , License: License:
SCOPE OF PERMIT - i
` TEAR OFF,30LBS FELT INSTALL LIGHT STEEL-TILE NER 423,-1.5PSF. 1: - - -, ,,,,1-1,
FEE SUMMARY j
Plan(Check . , $0.00 _ Calc Valuation , $6,800 0o f
'Permit. $139.25 ,. Claim Valuation V!, ' $6,80600
N'SMTP Res: ,',, $0.68
SMTP Com:, . $0.00
'�, \� Other $0.00 �; JJ
Inspection:' $0.00 „-/� `Lb / ,j /
Vy`'v. -- -- ", /,,,,/
\, Total: $139 93` 1/ /("'
? .,l
Jr'
Vv�• / ,� o o ,PLANNING&ZONING „-:2:-,27 /ij\- /07
SETBACKS :\ � �\� jj'/%,</ 0�l/
MAIN STRUCTUREXFront 0-0 , Rear 0`0 - ,,. .Left0-0_ Right';) 0'-07/ /.V
V /y \-..,:-.:// - , - - VVI is ,,/ l�
ACCESSORY Front c-0 0 -1,-.-",//,Ream - 0-0 Left 0 0 --. , A Right t 01 0 :l
PARKING Existing 0 \-Required 0, Proposed: ' 0i, '
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
fora 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
244646(6/00)
DECLARATIONS �� `
WORKERS'COMPENSATION DECLARATION: ,..� t'
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.
43 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: I Z�^�
Carrier: Policy Number:
(This section need not be completed U the permit Is valued at one hundred dollars($100)or less.)
9 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 p ision . I ' A
AppllcantSigneture*. pO sate,
�=_=pa)_ y 44 (
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm at.I;em lice eq,under p ovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business repressions Code,and my license is in full
force andeffect.Lic.N O/ Class.#
Contractors Signature:' 6.K . LAW ��Date:>> /$ O(
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 bull 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 Safely 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? ❑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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�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? ❑Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
—it
—
/ alai r Of egal Owner(s) /( �
�AndlOrAuthoriiddApplicanT_> -(/_ D e
COVE E INSPECTION TYPE PATE' INTRIALS CODE! INSPECTION TYPE ME IIIIM61.8
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof e 3–0( • (O.C4A– 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