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Home My WebLink About432 17TH ST - Building Permits�� Costa Mesa Building Department —�� APPLICATION FOR PERMIT ''� 111 EAST 20th STREET 'i-'!�� B U I L D l N G � � COSTA MESA, CALIFORNIA �+ � � FOR OFFICE USE ONLY �� FOIi� APPLICANT TO FILI. IN Receipt No. Permk /No. Addreu9 "7',3 �2. � ��'..�LC/1�.lx/ ' I I �� /o Costa Mesa, �i&�OPII18� Received by I Date Rec'd. /D/ate Issuec Nearest " � Cross St. / ,cyj � Bullding � � Address Owner Costa Mesa, Cie�IlfOPl11& Mail Addresa Clty Architect or �ontractor(y�J�r/y1p�v t Addrew Legal I Lot Description No. (Attach Metea and Bounde) /, � Size oi Lot QL Use oT Existina Blda. a� - oav � fldfny jb, e .erior Wall_ Alte�atlan Moving .� ; , JVo. of I hereby acknowiedge and state that the abo wlth all Clty O�{na buflding construction. Signature of �.. Permittee � Authorfzed Agt. Valuation � s o2�S S Q.� FORM 2�4 G•H 2M 9•5O Lic. —Ovl Plana I l� I No. Approved b Date ,,,.__ , ,_ CORRECTIONS �7-3�2.0. . of Bldga � w on Loi Addition � /� Demolish I Stories O c// • �+�" �� Brecing.Bolts that I have read this Applicatlon Lath. Int ve is cro�tect and agree to comply Lath. Ext nces and St�e�� regulating _ �/ `o�..w.. �..� 0 o eo�a s � � FINAL --� _ O a � 2 D r APPROVAIAS rl '. ' ♦ � • 1 • . ._ . � .. ,. tL' . . t - r." . Street ' r � - _ � � . ' ' �... ' __ • PLOT PLAN : . . � . Show�focatlon �and distanees fromf . . �,,,. . ' r.,' . property line and between bufldings . . ,. ; �.. .._ __, __ _ . ,. _ l�' J (;C7i:�CY:S�1'�,�iC"1 , . ' ' ^ � ; _ : __ " - ,-. _ _..,'�-�u °''._y.C;cr�:�..-� Fo ' _' ' ' . ;; �J . , _ �J'�7C 1 e� :.Y`.0 SLa'L8 ' InsuranCe? , '' - � . . ,�:;; �r'_.c ` : �rY emP�oYe4 ' j at:t L7; C." , n .� 1 - _ , _., � �. r;, ; f O . . _ . . ,L:, j1 ,y r T, � �� :,� • .t ' i `1 yabo `'� ...-��i, 1'a '. a � to be 11=��'`� n�a'�i� � Work�an� � `• �e'.. /• Signed. • " ;• • . ` 12�19 CdSTA MsSA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 C06TA MEBA. CALIFORNIA For Applicanf io Fill In Compleiely TYPE OR PRINT ■ MAIL COSTA MESA. CALIFORNIA C 61 x 300 ■ BETBACK LINB RROH FEE RECEIUED � fn/� 7 /�r. O `� `� � �• FINANCE DEPT. % CITY Of COSTA MESA 3> �G APPLICATION FOR PERMIT _ 4� � „ BUILDING � � For Oifke Use Onl y 3 y AECEIPT NO. �EHMIT NO. � T ar nGreYecerv � I � Yesu a �4 �. in � �— .�i o; COSTA FIRE ZONE APPROVED BY iONE�I NO. OP l� PLANB LEOAL D88CRIPlION OF BIDOB. ON LOT O p, p, NO. YARDS APPROVED tc¢rmn uNs eT.1 YARD FRONT 1 DESCRIPTION OF WORK APPROVED WALL IROOF 118E OP NHW BUIIDINO EVES G 1 HER¢BY ACKNOWLEDOB THAT I HAVB RCAD THIe APPLIGTION THE AMOUNT 6HOWN UNDER VALUATION 19 FOR TH8 AND BTATe THAT TH8 ABOVB IB GORNBCT ANO AOR88 TO COM- pUPP096 OF E6TABLIBHINO A PERMIT FEE ONLY. PLY WIiH �LL CItY OPOINANCEe AND BTAT¢ L.�W6 ReOVUTING BUILDINO CONBTRUClION. VALUATION � SIGNATURE OF PERMIT FEE $ PERMITTE ',(-� $ 450�� PLAN CNECK $ f AUTHORIZED AGENT � � /�'�V! � j BUILDING PERMIT Job Address: 432 E 177H $T Suite: Vicinity: Status: ISSUED Applied: 01/21/2005 Issued: Ot/21/2005 Parcel Number: 11732128 Zoning: Applicant GALLA RINI,DAVESE - _, _ ISSUED BY: � Address� 346 E MEADOWBROOK� --/� �'� � � � � " � �i�� ' �'Phone: (714)974-6424 - . ORANGE, CA� �� - " - • Zip: 92668 � � - i�v.'� , , �' _ . �%,, �� , , - � . . , , _ �\ r. Owner. LIPSCOMB, JOSEPH K` � ' � " Address iTR i' % � -. - �_ , . .. �. �� 1� ' � ��" NEWPORT BEACH, CA "-. = " " - - Phone:� �� '�'�� " � � \'� � � , ' -. P O BOX 1079, ; � Zlp: 92659 - ,\� � . � � �; - �_ , ; __.. _ '��,_ �, , '� .. . Contraoior. GALLA RINI, MILES � - � � - Address: 346 E ME4DOWBROOK � � � ,- , � � . ' .. Phone:, Q14)974-6424 ��'' � � i � ORANGE, CA _ � � � Zip: 92668 . � License: � 663983 , . � � � - ' ' " Arch : Address: � Eng: - ' ` " � - � - � Address:� ` Phone: N _�� , , � . .Phone: . , � Zip: � - , � License: � � , License: � � �' � � --� : � �} . -. SCOPE OF PERMIT , � ,, T/OFF EXISTING HOT MOP INSTALL 1.LAYER OF, 25LB.FIBERGLASS SHEET AND TORCH DOWN. � � Plan Check: Permit: SMIP Res: `�SMIP"Com: � � Other:�� inspection: Total: $0.00 $125.25 $0.59 $0.00 " $0.00 � �, $0.00 ` ,$125:84 . i,� SETBACKS � �� , MAIN STRUCTURE. Front 0- 0 \� ACCESSORY �Front � 0- 0 � PARKING existinq: o NOTES: FEE SUMMARY ., . i; �. � . �,'� ;_� - � ;<<.:, ' . Galc Valuation: Clsim Valuation: :_�`: _ 0 � � PLANNING & ZONING !�/ ' . �,, , . .. �`/ : ;�i ' , � ' %, _ ��Rear'0�0 �_ - � Left '0-0'�". -'�Right ��0 0�, i� "��, ._ . ' - . _ _ �. ..<_. . � Rear�- 0-0 � � Left- �0-0 . Right �,0-0-��% ��' � `1 � � ' � � _ Requl2d: � 0 ' � Proposed:• 0 � . � � - - .� . �. � ��: -, � "`�-``' ��.� _�; i-��- '" — . � $5,933.00 $5,933.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-g2) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or If work is suspended or abandoned for a period of 180 days. . INSPECTIONS: In order tor ihe Work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetlone and final approval must be obtained. Failure to obtain inspections and final approval will result in tha ezpiration of this permit. FOR INSPECTIONS CALL• (714) 7545626 I zanobn �aw� i WORKERS'COMPENSATONDECLAFiAnON: � � + � I hereby eHirtn under penelry at perjury one of t�e following daclarations: ❑ I have and will meintain e certHicate of consent to self-Insure for workers' compensation, es provided for by sedion 3700 oi �he Lebor Code, for the pertorRiancaef,{he �work for w�ich Ihls pertnit is issuetl. I have and will main�aln workers' compensetlon Insurance, as required by sectlon 3700 ot the Lebor Code, tor the perfortnance of ihe work for which this permlt Is issued. \ y workers' compe etion Insurance carrier end policy number are: �/, Cerder. �Cr�l�b Poli Number: O v��0�3 ectiar need nof be completed i/ Me permit 75 velued at one hundred dollars ($f00) or less.) T ❑ I certify that in the p o ence of the work for which ihis permit Is Issued, I shall not employ any person in any manner so es to become subject to the workers' tlon lews f C ifomie, and agrae ihet tl I shoultl become sub�ect to Ne workere' compensatlon provislons of Sectlon 3700 of ihe Lebor Code, I shall forthwlth hase ro ons. � Iicent Signetu : � — Da : � �' �� WM . URE TO SECURE WORKERS' COMPE COVEMGE IS UNLAWFUL PND SHALL SUBJECT AN EMP R TO CFIMINAL PENALTES AND pVl� FlNES UP TOONE NUNDRE� i1qUSAND DOLLNRE (5100,000�, IN ADDITIIXJ TO THE C0.ST Of COMPENSATION, DAMAGES AS PROVIDED WR IN SECTION 3]Ofi OF THE UBOR CAOE, IMEREST, AN� ATTORNEI"S FEES. LICENSED CONTRACTORS DECLAHATON: i �m licensed �nd� pr>r'o� on8s oJ, h p er 9(commencing wlth Section 7000) of Divlsion e Business end Professions Code, end my license is in full 5 �"� c•35_ �s r gna re: � � <Date. � �/i /i �� LENDING AGENCY: ❑ I hereby attirm thet t�ere Is e construction lending egency tor the pedormance ot the work for which this permit is issued. (Sec. 3097, Civil Cotle). Lenders Neme: Lentlers Address: Signeture: Date: OWNER-BUILDER DECLABATIONS> �: � � I hereby ettirtn thet under penalry af perjury thet I em E%EMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Buslness and Pratesslons Cotle: Any ciry or county.which requiras e permit to construct, alter, improve, demolish, or repelr eny siructure, pnor to its issuance, elso requires the epplicant (or such permit to file e signed statement thet he or she is Ilcensetl pursuant to the provisions of the Conirectors License Lew (Chepter 8(commencing with Sectlon 7000) of Dlvision 3 of the Business and Professlons Cotle) or that he or she is exempt therefrom and Ihe basis for tha elleged exemption. Any vlolation oi Sectlon 7031.5 by eny epplicant for e permlt subjecls iha applicant to e civil penalry of not more ihen five hundred dollers ($500).): ❑ I, as o'wner ot the proparry, or my employees with weges as iheir sole compensation, WILL DO THE WORK, end ihe struqure Is not intended or oHered for sale (Sec. 7044, Business end Protessfons Code: The Contradore License Lew does not apply to an owner of property who builds or improves ihereon, end who tloes such work himself or herself or through his ar her own employees, pmvided that such improvemenis ere not Intentletl or oNerad for sale. N, however, ihe building or improvement is sold within one year o� completion, the owner-builder will have ihe burden oi proving ihat he or sha did no� builtl or improve for purpose ot sele.). ' ❑ I, as owner of Ihe proDerty, am E%CLUSIVELV CONTRAC7ING WITH LICENSED CONTRACTORS to construd Iha project (Sec. 7044, Business end Protessions Cotle: The conirectors Llcense Law does not epply to an owner ot property who builds or Improves ihereon, and who contracts for such pro�act with e conirector(s) . license pursuant to the Contradors License Laws.). ❑ I am exempt under sec. SigneNre: Owner ID verifietl by tlriver's license. ❑ Yes ❑ No Buslness and Professions Code for ihis reason: VenTcatlon of Ownership by (type of document, i.e. - D�operry ta�c bill or tleetl): DIVISION OF INDUSTAIAL SAFETY PERMIT CERTIFICATON: Drivels License No. Dete: Eapires: ❑ I hereby cerlify that no excavation five (5) or more faet in depth into which a person is requi�ed to descend, will ba me0e In connection with work euthonzed by this permi�, and ihat no 6uilding simcWre, sceXolding, falsework, or demolition or dismantling thereot, will be more Ihan �hir�y-siz (36) feet high. (Chap. 32, Gry 2, Atl 2, Sec. 341, Title 8, Cellfomla Adminisiretive Code). ❑ As owner-bulltler, I will not employ enyone to tlo work which would require e permit trom the Division ot Industnal Sefery, es noted above, unless such person hes e permit to do such work from the division. Signeture: Date: Divislon of Industnal Safety Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORRATON OF ENTRY: I certity under penalty of perjury that I have read this epplication antl state thet the information given Is cortect. e to comply wiih ell state laws end ciry ortlinances releting to building construction, and authonza representatives of the Ciry of Coste Mesa ro enter upon Ihe ebov escribed properry tor inspection purposes. I egree not to occupy or allow occupancy ot eny building authorized by this permit until fnal inspection. COUEI, INSPECTIONtYPE 1676 1266 �2 202 203 o�re It�E6@ Fixetl System Final Fire Prevention Paal Spe Final Finel Re-fioof �� 7 � I % "0� �� Finel BIocWRetelning Well Final Factory Fire Place Final Sign 204 Final Demoli�ion eooe� ixsvernoxTrve 206 Final Mechanical 208 Final Plumbing 210 Final Eledncal 212 Finel Fire Preventlon 220 Finel Planning Approval 222 Final Site 250 FinalBuilding/Occupancy P� It�dLH