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HomeMy WebLinkAbout2153 MAPLE ST - Building Permits I 4 CITY OF COSTA MESA i . S. BUILDING DIVISION $: DECLARATIONS WORKERS'COMPENS'i TION 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 /�'�rk for which this permit Is Issued. 1 " My.w and ywill maintainst arrer a policy as required by section 3700 of the Labor Cade,for the performance of the work for which this permit Is issued. iy.'ice�qp g¢m nsatlo sure carrier and policy number are: ` (Carded need aty,�-� ipoliOy Numbei:'1 �VV4.414. (This"section need of be completed if the permit Is valued at one hundred dollars(POO)or less.) ❑ I certify that in the performance of the work lot 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 1 should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EM OVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1013.003).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed u ravi h Chapter 9 commencing with Section 7000)of Division 3 of the Business an P fessions Code,and my license Is in full lorce'eftd efect.Linc_ COCK Class ft, (Contractors Signature: ,S .Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirmbhat under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:An9'city'ordounty,which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of DMsion 3 of the Business and Profe$sions'Code)or,Rlat 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 cMl penally of not more than five hundred dollars($500).): El 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 Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(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 DMsion 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). a._.. _._ to f __.... 2 Does or will the applicant or present or future building occupant need to lila a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 Of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 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 II an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a pliication aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 U 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 slate 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�I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of a( ? ^ / 15„ 'And/0 orized'Appllca -, to CODE s. I SPECt1ON1YPt gall M5U CODES ISSPECTIONTYPE g6IE gffiMALU 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place • 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Bullding/Occupency -• y ..- CITY OF COSTA MESA ).`e- BUILDING DIVISION ' DEVELOPMENT SERVICES DEPARTMENT P98-00548 - r k PERMIT PERMIT NUMBER 4. (714)754-5273•"+0��;• Fax(714)754-4856 PLUMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2153 MAPLE ST Status: ISSUED Suite No G Applied: 07/06/1998 Issued: 07/06/1998 Vicinity: Parcel Nunmber. 42220111 Applicant FLORENCE, DELLA Address: Phone: 949-645-3389 . Zip - _ Owner KELLY!THOMAS A //' / / , - N ,,SANTA ANA,CA, - - Phone ':;\.:_c;'------;('''-- : /'' v'"�`v , 2626 W BORCHARD-AVE Zip: 92704 \� � ' A��� VNN' N , Contractor. , `�, y,, ' Address: t- • Phones Zip: - i 1 " r -License Arch l Eng: -• Address: , \ - Phone: � . '•License:' • .', SCOPE OF PERMIT • ! - INST WASHER AND DRYER. tit, ,,,-- -, - - - =%„•e. - ' .. �_ , - FEE SUMMARY 7 AMT Y -'A OTMT,' QTY - AMT- QTY ISSUE FEE $22.00 Laundry Tub/Washer -$8.75 'c- 1 Sump Pump',', $0.00 0 Backflow irrigation , $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator, ' $0.00 0 Urinal-- , $0.00 0 Clarifier System $0.00 . 0 Process Piping(per_10 ft), - $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 .- 0Receptors, ; $o, o, 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units - $0.00 ' '0," Septic Tank - -> • - -40.00 '' 0' = Wash Basin $0.00 0 Dishwasher $0.00 , 0 , ."Sewer.Cap for Demo., '" $0.00 0: ' - Wash Basin Set I $0.00 0 Drain,Floor $0.00 0 -. *-:Sewer Connect . '•' ,$0.00 ;.01,? - , .' Waste and Vent System $0.00 0 Drain,Rainwater $0.00 , 0' : Sewer-Private Line ' `$0.00 -0 - ' - Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 - Shower - - $0.00 0 ' - Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 . 0' , 'Sink,commercial $0.00 0 ' . Water Re-pipe $0.00 0 . Gas Earthquake Valve $0.00 - ' 0 Sink,Floor ' • $0.00 0 Water Service $0.00 0 ' Gas(1-4 outlets) $5.50 1 Sink,kitchen $0.00 0- ' Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop ' $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 - Spa(private) .. _ $0.00 -0 ' ' VIOLATION $0.00 Gas Service $0.00 0 Spa(public) - - $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $36.25 COMMENTS/SPECIAL CONDITIONS • 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 "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 U 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.) ❑ 1 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 shell forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100.000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37030f THE LABOR WOE.INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em licensed under provisions of Chapter 9(commencing with Section 7000)01 Division 3 of the Business end Professions Code,and my license is in full force and effect.Uc.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects th licant to a civil penalty of not more than five hundred dollars($500).): 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 pursue I to the Contractors License Laws.). I am exam. 'r Business and Professions Code for this reason: �J,i�/'g nature: I _i F, a7�1 .� 1 te:/ -Co rY Owner ID verif ed•y driver's license. ❑Yes ❑No Drivers License No. Expires: Hy. Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: ' Division of Industrial Safety Permit Number: - HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gag 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? 0 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 fadlity 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: CERTI CATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is core• gra*t• 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 abort: operty for i SS cti•• u ••ses.I agree not to occupy or allow occupancy of any building author' ed by this permit until final inspection. gnature• Legal Owner(s) Dae And/Or Authorized Applicant Date CODE I INSPECTION TYPF DATE =E64 CDDE1 INcPECTInx TYPF DAIS iAi,S 1616 Fixed System Final Fire Prevention 206 Final Mechanical �_ 1266 Pool Spa Final 208 Final Plumbing eig g 200 Final Re-Roof - 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 Bullding/Occupancy 2446-46 ADDRESS OFau OM 2153 MAPLE ST LINT: CITY OF COSTA MESA — BUILDING PERMIT GNERSNAMEIFQOiN: KELLY, THOMAS A PERM NO: B 079493 ADDRESS: KELLY, ANN R 2626 W BORCHARD AVE PERMIT NO: B 079493 PLAN CHECK NO: N OVT: Y SUPP : N SANTA ANA, CA 92704646-6871 APDL.MAILING ADORES& CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH ARCHITECT OR ENGINEER: UC NO.: JOB DESCRIPTION : CHANGE OUT 8 WINDOWS 6 ONE 2 SLD . DOORS SQ FT: 8, 500 ARCH.OR EMI ADDRESS: °M` CLAIM VALUE: 8, 500 . 00 CALC—VALUE: 8, 500 . 00 GROUP OCC : R-1 / CONRIACTORSNAl1E FOUST CONSTRUCTION ( 714 ) 675-7337 Cp4RACTORS MAIM 308 ANADE AVE. COMMENTS : THE "ACOUSTICAL INSULATION MITIGATION PROGRAM" /4WINDOW/2 SLD DOOR Awmm NEWPORT BEACH CA moo, 621989 **+E*•***********ft*****x•ft* Eft***xSrSr*SE*********+t*+E*SESt*iE*iE****x*x*+t****ill**SE*ill****Sr*ill 92661 UM: Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby ell under penalty of perjury that I am themed under provisions of Chanter 9 SETBACKS (cons. Ong with Section 7000)d Divisim 3 d the Business end Professions Code.and my Scenes Is In full ores end effect. cN0.: 067559 uc.CLASS: B uc.No.: 21989 EXP: 05/97 MAIN BUILDING ACCESSORY BUILDING FT IN REAR: FT IN FRNT: FT IN REAR: FT IN /r: : L?-g(o cmhea« LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN ER BUILDER DECLARATION:I hereby affirm under pawky a patsy they 1 am exempt hon the Contractors license Law for the FRNT: • ason on and a county Meth requires ame "'��'-t'ao".�or repair ystuucttre.ppior to asiauaannoe.�rea�u�mtthhe°`apppcant for such penult tofiteeeeigned"" nthaaat he orae PARKING REQ: NOTES> PROV: PARCEL : 42220111 ZNE: REF NO: ° pursuant to the provisions a the Contractor°Lica.,Law[chapter 9(commencing wish Section 1000)of Dweion 3 of the and Professions Code]or that he or the is exempt therefrom and the basis w the alleged exemption.My violation of Sean, > 7031.5bysay applicant Iota permit subjects the applicant to a dot penally of not more than the hundred doles[5500D. ********************************************************************'*********** ❑ L as owner a the properly«my employees with wages as Us*sole mmpemmnn,ora do the work.and the structure a not intended DEVELOPMENT SERVICES R E Q U I R E M E N•`•'T S or offered for sale(Section 1044,Business end Profession Code:The Contractors License Law does it appy than owner a propend i who bads or thermos thereon.and who does such work himself or Mesa or through his or her own employees.provided OW such • imtxovememe are not intended«altered ter sale.fl,however the leiMinp«knpavemaa seas wkNn oneyeerof completion,the ZONING APPROVED BYDATE: ' ow°erbuaer will have the burden o proving he or the did net build or improve for the propose a We). ❑ I.oowheatMprogty.amexdudw,enactignabFmmedmaroaaemmmaualtMpgea(Sne nMM,Basin.ond BUILDING APPROVED BY : DATE: Pmlessons Code:The Contractors License law does not apply to an owns a property who balls or imposes thereat and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). ^ /l ❑ Iamexempt under Section: B.AP.C..wthsrenal: APPLICATION ISSUED BY: DATE: - 1. - 4 Date: OtherLEGALIZATION:N F E E SUMMARY STRUCTURAL SE MENT:Y I do hereby certify that I am aware a end understand the requirements a Lanni.Heath and Safety Code Sections 25505.35533.end 35534.and thIaanyfturebuildingonamN occupant amply said etBLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING aprovisions.construction m uctionorodithation homthe As( Management(Dusky Donna.Residential construction apphmtiaeare exempt born these PERMIT 149 , 75n . 85 Date: Appfcea: ' r SMIP/NON—RES PLAN WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty d pejn one of the blowing deaaatnm: ISSUE FEE ❑ Ihandwawffwaw mantainaeeteemwumeww« to m n' mpehmm. itesProidedfobSeda,3l00athe BUILDING—DIV—> PERMIT ISSUE PLAN aw —CHECK TOTAL PAID DUE r Code,f«the p.dmh performance ame work f« ba with this permit is issued. TOTALS----> 0 . 00 0 . 00 ' 0 . 00 0 . 00 . 00 . 00 0I have end w mai tain wcompensationke 'compensationinsurance.asrequired by Section e,for n 3703 of Labor Codthe performance a the l sr wort,for which this°«mh'issued.Myworkers' S1�ATFY(�Nard°wYaprheare. EXPIRES REVENUE DIVISION TOTALS— > COLLECTED : . 00 OVER/SHORT: . 00 Pd'ry Number 14211di— b 02 /01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (The Acton need nor be completed l the pant e Sr one hundred doors MOW or lots) ❑ 1 oeIly that in the performance of the work for with this permit is bored,I shall net empny any person in any manner so as to become'shied to the wanks~.'coweensMiom laws of California.end styes mw it I should bane tubed to the waters' ******************************************************************************* ompemawh provisions a sedan 3703 a the Later Code.Iora,comply with mote provisions...e- I N D I V I D U A L F E E B R E A K D O W N �1P/'7-tar A PES t: /re f/ F+�I/5/ sifting Failure to secure wotkea'oorrymesdon awsereweUnaWA4.icdstSlSuAsd,n employerrocMMtW IP dna TYPE QTY DESCRIPTION UNIT COST TOTAL COST gra ntse tp to one hundred thousand dollars(Sioq OA lo atter)to M roaror cottpenesrb4 drains as provided for In secton3)aotthe Labor Cods,ImeLattorneys fees SFR 8500 ALTER BY VALUE RESIDENTIAL NOZONE 1 , 00 • 8, 500 . 00 CONSTRUCTION LENDING AGENCY:I hereby Mum under penalty a perjury that nee is a construction lending agency w the END OF FEES performance of the work for which the pmol is issued(Section 3097,Cb.C). LENDER'S NAME: LENDER'S ADDRESS: f rwi I certify they I have read this application and date that the above information dnation is conl agree to comply with all ay end county d county aeh end state laws Stang to buidi,9 aasedin end hereby eaherbe representatives al this city to enteron eters-mentioned upthe ebrttto ed property 6 for inspection purposes. •1 BARRY FOUST Print /7—t ls ✓ DAT01 EEO:209/17/95 TIME: 5:05 •• .00 aesl� r Date: sig =Tl aoened ...,A.. -Try (515116.WP) White-Baling A Safety:Gs°°-Fie:Carney-Awlratl:Pok-Revenue:Ocldenm6-Asxm CONSTRUCTION AND PLANNING pOr ' SPA APPROVALS Permit # ` Date Inspector APPROVALS Permit #� Date Inspector r 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location '2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement, 3. Electrical Conduit UtilityUndrgrn8. 54. Forms 4. Electrical Conduit-Undrgrnd. .i 55. Electrical Bonding - • .131 • v, 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE ' 7. Footings - - 58. Electrical Conduit•Undrgrnd. r i 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 K 14. Rough Plumbing 65. Electrical-Final ' • 15. Rough Electrical-Conduit. - 66. Solar System-Final ' r ' \ 16. Rough Electric Wiring 67. Fencing & Access Approval ' 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING -- 18. Rough Electricah Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace - 7 . APPROVALS Permit# - 21. Ducts, in Structure 70" Underground Hydro 22. Ducts, Ventilating _ • 71. Product Piping O Gas ❑Oil 23. Gas Pipe-Rough & Test . 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 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 PREV. 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: 715-1-4_ fre.,o7/ v_.eady 34. Final Heating& Air.Conditioning �r.�� 35. Final Gas Pipe-Test - 36. Hood or Canopy . `. • 37. Final Factory Fireplace, - 38. Final Plumbing t -- - 39. Water Service-Final - 40. Gas Service-Final - ' 41. Solar Domestic-Final i • • 42. Backf low Preventer . 43. Bacfcflow Irrigation l 44. Landscape Irrigation System - 45. Sund Attenuation 46.'Handicap Regulations ` 'C4. FINAL STRUCTURE & BUILDING tJQ,5. l)6 awe ` - 48. FINAL PLANNING / y� 49. Electric Release to Edison - • ' 50. Gas Release to Southern California Gas Co _-. • 51. CERTIFICATE OF OCCUPANCY No Date 1 PROJECT ADDRESS: 2153 MAPLE ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 064634 OWNER'S NAME: KELLY, THOMAS A ADDRESS; KELLY _ , ANN R PERMIT NO: B 064634 PLAN CHECK NO: N GOVT: N SUPP ; N 2626 W BORCHARD AVE SANTA ANA,CA 92704 CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ALT ARCH/ENGINEER: RUM.: ' ADDRESS: UNIT: JOB DESCRIPTION : T/O ROCK REROOF W/BUILT-UP SQFT: 1 , 600 CLAIM VALUE: 1 , 600 . 00 CALC-VALUE: 1 , 600 . 00 GROUP OCC: R-1 /M-1 'i PERMITTEE: ALL-COAST ROOFING ( 714 ) 650-2244 ADDRESS: 2107 WALLACE AV COMMENTS: SMOKE DETECTORS REQUIRED PER 91 UBC, REROOF 1100SF TRIPLEX COSTA MESA CA, 92 . 27 #######################±F##tr#x-#######*##########+r#####################* LICENSED CONTRACTOR DECLARATION: hereby affirm that I am licensed under provisions of 'ter 9(commencing with Section Z ON INC R EQU IR E M E N PETEToo � ©,## 7000)of Division 3 of the Business and Professions Code,andlicense is in full forceand SETBACK S SMOKE 71 Date UC.: h19a�sTATE LID' 598440 C^S�C39 n Date:_ f (J��_ Signature: 0a=1►L MAIN BUILDING ACCESSOF�(311 ll WORKERS'Co PENSA ION DECLARATION: I hereby affirm that Ihaveace hate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT Iti of FT IN Compensation Insurance.or a certified copy thereof(Section 3800,Lab.Cl. LEFT; FT IN RGHT: FT IN LEFT; FT • IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ• PROV; PARCEL: 42220111 ZNE; REF NO: . ❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES>- ' > Date: Applicant /� ##############iFfF##########)t#############jE##################1f#######jf1E###iE####df# EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be co I ted lc r t is for hundred($100)or less). D E V E.'L OP MEN T SERVICES R EQUIR EMENTS I certify that in the performance of the work for which this permit/it issued.I shall note y afy rso in any manner so as to become subject to the W rkers' cation Laws of California. ZONING APPROVED BY •Dater L� . Signature: -----54.--- NOTICE: _ • DATE: NOTICE:II.after aking this declaration.you should become subject t the Workers'Compensation provisions of the Labor BUILDING APPROVED B YDATE; i Code.you must forthwith comply with such provisions or this permit s all be deemed revoked. : • CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY : / ���.. DATE; 7 0 which this permit is issued(Section 3097.Civ.C) ############################################### ################TE' *# LENDER: #############*#####################################################'############ ADDRESS: LEGALIZATIONiN F E E SUMMARY STRUCTURAL SEGMENT :Y OWNER BUILDER DECLARATION: I hereby affirm that I 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 3 7 , 0 0 repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed . 50 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SHIP/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penally of not mare than five hundred dollars($500). ISSUE FEE I. as owner of the properly or my employees with wages as their sole compensation, wit do the work, and the BUILDING D1 V' > 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----> 37 . 50 0 , 00 0 . 00 37 , 50 37 . 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 37 , 50 OVER/SHORT; 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/TOT GRADING PLAN-CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 37 . 00 , 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors State License Law).I am aware ##y.####.lf#N.if,#,N,####,.lE#ie###ieie,lEilIE,IE#######16'X1!###################1E#+F##+f####if####ff iE 1E#F iE# that wool of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B.8 P.C. I N D I V I D U A L F E E BREAKDOWN for mis reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 1600 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 600 . 00 25534 and that I or any future building occupant wilt/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that e above information is co gree to comply with all city and county Ordinances and state laws relating to building construction and hl 1-by authorize rep sentaC - • .city to enter upon the above-mentioned property for in5p Iron pur oses. 1 1 cliDate:��— Signature: W 01 00149585-00149586 Ti�T 37.50 Nu DATE: 50/26/93 TIME: 16:04 Driver's Licens or Social Security a: 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant Pink—Revenue:Goldenrod—Assessor CONS-Valle-11N AND PLANNING POOL ,PA APPROVALS Permit# Date Inspector APPROVALS Permit + Date Inspector If.' 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 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Condtnt-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 FOR PLASTERING 18. Rough Electrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & 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 0 Gas 0 Oil I 25. Roof Sheathing !�a 'Y ,ererg74. Overhead Hydro 26. T-Bar Ceiling tStructurap & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. 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 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final • 40. Gas Service=Final 41. Solar Domestic-Final e 42. Backflow Preventer 43. Backflow Irrigation ,; , Y • 44. Landscape Irrigation Sv{temrr' 45. Sound Attenuation v _ mss 46. Handicap Regulations: ' t ---. ilyry�47. FINALSTRUCTUREr&'fSW✓6DING 9 ' 48. FINAL PLANNING ` l..t 49. Electric Release to Edr'son 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No, Date • 41 �a4 "AR -2-76Pntu00 085* ***151.28 nlcr COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 P ICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely - Use Ink Only R E ED V TE E 1 ED DATE ISSUED ADDRESSG 2153 -MAPL S`[ : C /t-�/'���" 6 .5 Imo✓-4 / A.P.NO. IIS��� 1 �—07 PERMIT NO. OWNER Ti�HE- S L,C.I E.(C-L� MAIL /. • ADIDRE 52153 MAS ADDRESS /7 S 5 / A •�[ y4/A� CITY G4AdCiff G-�msr NO d37-. T/3 '" �OT33 BLOCK CONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMOI ISH LENDER / I BRANCH OWN AAter'? 00 r%1 G le ADDRESSARCHC l///sss�ppp VALUE �-�s ,'` OR ENGINEER ECT S'/CI C.t'_/�j Btif�� NO.9CA-7P4I TEL.lide S uNl/7 7 E /1/V `� p / / / �s FIRE , �•yI T ADDRESS/p y 72 "fjdcyL #h. - 41 /]t ZONE VPE GROUP (� APPROVE .,-- f,..., ..--7/ CONTRACTOR Owtent BY DATE LJ 1 '- — / A. ADDRESS//S v K/H GC/R EL. ZON �j NO.OF USE OF NEW 4 V N IT- Act / NO C► PLAN BUILDING tau/APrt•. GAR Ca.tdE.v (ltKda✓r~ fo;S'•s 9l•� nx STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING W SIZE NO.OF BLOCS. (FROM C/L STREET) 0. OF LOT/LC Z /5/- 1 j - )NOW ON LOT /..4../C, FRONT 50 FT. FT. Q USE OF q EXISTING BLDG. R._SIDE I Z FT. FT. rn IN F Separate permits are required for L.SIDE SG FT. C.— FT. electric,plumbing and heating work. r WREAR FT. FT. 1 i.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE B BET.MAIN& M Q ..11 - y y� MAIN BLOCS. �7/ /� ACCESS. BLDGGJS. I /+�` Q 7_ 9,'t .//ti/r/f W t t n" (' s) G.YGT C URP.#ZE_.-76._,,,a /b�I•l� APPDATROVED J I'�Ip )�>d�r� j/ in 31-• ABY APPROVECau fri DATE S- / 2 �C I� W HOLD FOR PTCI L RE UIR O I hereby acknowledge that I have read this application and state tl sin L that the above Information Is correct and 'agree to comply with to all laws regulating building construction, and I shall not employ >: Z any person In violation of the workman's compensation lows of o the State of California. 7 _ - I hereby certify that I am properly licensed as a contractor under ���/ SO. FT. e. I a ry the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 0 Chapter 9, and that such licenses are in full force and effect,dVi THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: to am exempt from the provisions of the State of California Business VALUATION PERMIT FEE E a and Professions Code,Division 3,Chapter 9 V..07.3 / in SIS V PLAN CHECK S lit �� m Signature of /�� ` ' m Permittee �....�[O��nI -, 'foto TAX E 5.7 0 2 U. U Authorized ABB ) TOTAL PAID $ / . 27 If i ,y 1 13 76—PAIS 00 614# ***331.75 • COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ACITION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely —Use Ink Only s� RE I E BY DATE RECEIVED DATE ISSUED BUILDING .rI .3 Imo( /t L C -,s 13_7.6 ADDRESS t J f �-1 i" \ I 1� -� PERMIT NO. OWNER ,,.4 CC-1 Yt�gt(4A.' A.P.NO. f MAIL ADDRESS 21 57 Ni , �t ADDRESS TEL. TRACT I CITY NO. LOT BLOCK CONSTRUCTION NEW IADD IALTER REPAIR MOVING OFMOUSH LENDER I`/X_` BRANCH • ' OWNER \ {rM� 1 S Lk It.-aCLC ADDRESS ARCHITECT TEL. VALUE r VALUE` . OR ENGINEER NO. FIRE ' 14 G j ADDRESS - ZONE TYPE / GROUP 4-.] ��jj J�-// /J APPROVED CONTRACTOR O I/3 ,Q-P/I. / BY DATE _ ADDRESS J '/ ZONE INO.OF USE OF NEW TEL. PLANS BUILDING CITY NO. FL STATE CITY YARDS APPROVED YARDS APPROVED LIC,NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING Is SIZE NO.OF BLDGS. (FROM C/L STREET) • Cr OF LOT NOW ON LOT FRONT FT. FT. _ Q USE OF Ca EXISTING BLDG. R.$IDE FT. FT. _ (a Separate permits are required for L.SIDE FT. FT. electric,plumbing and heating work. W - REAR FT. _ FT. t'.• USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& G MAIN BLOCS. ACCESS.BLOCS. VAR.5 DATE 17:1C.U.P.916 APPROVED Q - APPROVED )1•Ll , _BY DATE a 14 Q I hereby acknowledge that I have read this application and state n Ln C4 . that the above Information is correct and agree to comply with , m G all laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation laws of F. the State of California. 3 I hereby certify that I am properly licensed as a contractor under SQ. FT. N the State of California Business and Professions Code, Division 3; THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business r 'o VALUATION PERMIT FEE $ v and Professions Code, Division 3,Chapter 9. t -1 ti -PLAN CHECK $ sr 1.4 3,-3,4"2 Signature of � 2 Permittee $------0....- TAX $ Li U Authorized Agent TOTAL PAID SA -A i•1