HomeMy WebLinkAbout2559 ELDEN AVE - Building Permits C 1 .
4, 4 CITY OF COSTA MESA- , '`
BUILDING DIVISION
> •�' , ,i a DEVELOPMENT SERVICES DEPARTMENT PE T NUMBER
ft t
PERMIT• /
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B04-01895
•
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2559 ELDEN AV Status: ISSUED
Suite: Applied: 11/08/2004
Vicinity: BLDG WITH UNITS A&B Issued: 11/08/2004
Parcel Number: TPN00416 Zoning:
'
•
��
Applicant: HARTMAN, HEIDI ISSUED BY: /!///
Address: 2626 NEWPORT BL -
Phone: (949)548-1645
COSTA MESA,CA- Zip: 92627
Owner: ELDEN MANOR HOA
Address 2559 ELDEN AV -
Phone: _
/, COSTA COSTA MESA,CA , - _ Zip: 92627
Contractor: 'PETRONELLA-ROOFING ,
Address: 2626 NEWPORT BL
Phone: (949)548-1645 .
COSTA MESA,CA "
Zip: 92627 License: 460707 ,
Arch : Eng: •
Address: Address: •
- . Phone: . : - Phone:
Zip: License: License:
' SCOPE OF PERMIT
CONDO BLDG WITH UNITS A&B:T/O EXISTING COMP SHINGLES,REPAIR/REPLACE SHTG AS NEEDED, 1 LAYER FELT UNDERLAYMENT,
INSTALL"GAF TIMBERLINE ULTRA SHINGLES."2500 SQ FT
' FEE SUMMARY
Plan Check: $0.00 - , ' -- Calc Valuation: $7,000.00 .
Permit: $139.25 - -_- '' Claim Valuation: 4 $7,000.00
SMIP Res: $0.70
SMIP Corn: . $0.00
Other:, $0.00 .
. Inspection: $0.00
Total: $139.95
�- - ' PLANNING 8 ZONING
SETBACKS -
MAIN STRUCTURE Front 0;0. N - Rear. 0-0 ,Left 0-0 - 'Right `0-0 , - '
ACCESSORY Front- 0-0 , Rear, '0-0 Left 0-0 Right 0-0
PARKING Existing: --0 Required: „. 0 . -' Proposed: -0 -
•
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 it work Is not commenced within 180 days,or it 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 cafes, 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
244848(6/00) .
DECLARATIONS 6,
WORKERS''COMPENSATION DECLARATION: •
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My wo em'compensqtion Insurance carrier and policy num,ib r are: �f
Cartier. ZIZ'TC CAM PEnls.*io' AIM INS MD Policy Number:! /6"Q 1-E/ d S
(This section need not be completed it 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 Califo la,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 provlsi � �L / T/ —_
Applicant Signature: d.� Date: 7 ,tLa N6ce2 9y 2c¢
WARNING:FAILURE TO SE RE WORKERS'COMP 6ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($103,0:0).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed nder provislone 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.Lic.x `) - 070 class p 11 C 39
Contractors Signature: .r ' Date: �OiVEiStget
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: 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 fore permit
subjects the applicant to a civil penalty of not mord 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,em 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 em 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,lalsework,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? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No
(Section 25533 of the California Health and Safely 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).
_._ .-.._ ___..__ _..._...f_r_..__.._
3 Does it;will the appplicont or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutelyhazardous 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 Califomia 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 appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ Yes U 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 toDe constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 Ifa a permit athe South Coast s prescri ed by Califo District or Sr airpollution coon 4l 3istragency is required for the work which is the eubject 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 Oily 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.
/ Slim :Of Le r(s) Date
And/Or Aut ortzed Applicant Dare
SOOE/ INSPECTION TYPE [MTh 1E11211 COQE( INSPECTION . PATE =AA
1618 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root /77/'.,r thief'
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
PROJECT ADDRESS: 2559 ELDEN AV • UNIT:A CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 061264
OWNERS NAME:MICHAEL FOX -
ADORESS:P•O. BOX 117 PERMIT NO: B 061264 PLAN CHECK NO: N GOVT: N SUPP: N
FALLBROOK
CA 92028 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE; DEM
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : RESTORE CONV' TD ATTIC SPACE TO ORIGINAL SQ FT:
. ADDRESS: UNIT:
•
CLAIM VALUE: 1 , 000 . 00 CALC—VALUE: 1 , 000 ,00 GROUP OCC; R-3 /
i PERMITTEE:MICHAEL FOX ( 619 ) 723-1495
ADDRESS: 2559 ELDEN AV A COMMENTS• FOR DEMO ONLY, NOT FOR CONSTRUCTION
COSTA MESA CA 92626 **�F*�P+rRF�r �rsr*****�FRF*****sr+F �E*****x�r** ****** *4** *******************************IF >E
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions or Chaplet 9(commencing with Section Z ONING REQUIREMENTS
7000)0l Division 3 0l the Business and Professions Code,and my license is in lull torte and eltect. SETBACKS
CITY LIC.: STATE LIC.: CUSS:
Dale: signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR ; FT IN
Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ1 PROV: PARCEL; 00000000 ZNE: REF NO;
❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division.
> PLANNING NOTES>> •
Jate: Applicant: *************************************************************************3e***ie*
EXEMPTION FROM WORKERS'COMPENSATION OECLARATION: Olds sec' ed not be cmnpen s eted if the pefor one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENS
I cemly that in the penormance of the work for which this permit is is d shall not employ any person in any manner so as to become
subject to theWorkers'Compensation Laws of California. ZONING APPROVED BY •• DATE: =
Date: 3e 4 3 Signature: BUILDING APPROVED BY
NOTICE:y:If.alter making this declaration.you shouldo become s Dl be deemedrevoked.Compensation provisions of the Labor L t�Av�F f .�-�s3 )(\* R DATE: _:
Code.you must forthwith comply with such provisions or this permit shall be deemed ��JJ((��
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE
which this permit is issued(Section 3097.Civ.C). ************************* * ***** •** **** *************** - t **
UNDER: ********************************************* •********************de***********
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor 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 25 . 00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed • SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN '
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by /_ . 50
any applicant for a permit subjects the applicant to a civil penalty 01 not more than five hundred dollars($500). ISSUE FEE / •
I. as owner of the progeny or my employees with wages as their sole compensation, will 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—--—> 25 . 50 0, 00 _„ 0 , 00 25. 50 25 . 50 , 00
' does not apply to an owner of a properly 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 sate,If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 25, 50 OVER/SHORT• . 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
for the purposeol sale). BLDG5 PMTT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOO GRADING PLAN—CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon .-
and
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *******************************************************************************
that prool of their Worker's Compensation insurance should be provided to me. INDIVIDUAL', FEE BREAKDOWN
lam exempt under Section:B P 70 4 4 B.8 P.C. '•"a
mrthis reason: NOT A CONSTR PERMIT TYPE QTY D E S C R I P T I O, N UNIT COST TOTAL COST
Date: 4 clA� Owner: NO FEES WERE SELECTED FOR THIS PERMIT
I do hereby certify that I am aware 01 and understand the requirements of California H£etycodeseations25500,25533,and
' 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a - •
permit lot construction or modification!tom the Air Quality Management District.Residential construction applications are exempt from —
the5e provisions.
Dale' Applicant.
I hereby cenily 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 elaws relating to building construction and hereby authorize re epallVeS of this Pty to enter upon the above-mentioned Oishiii
property for inspection purposes./ T
Date:___=NLI, -[ Signature: - - _
Drivers License or Social Security Gm— —
1641-46 White—Building;Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL 'A
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. Steal Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical OF 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. .z. 60. Backwash Lines,P-Trap,D Undrgrnd.
10. Structural Floor System 1 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final '1
12. Sewer Cap 63. Heater & Vent-Final
11 Roof Drains 64. Plumbing System - Final f,
�y II
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-T 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 DGas DOil
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 I 78. FIRE PREV. FINAL
30. Drywall Nailing ) HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final I i 80. FOOD CE� TIFIC�rrA��nTE ISSUFQ n A
33. Final Electric Notes: S �r71 //jj �//>
` l[1
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 I
42. Backflow Preventer I
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 3/473 i2-e-
48.
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
-
a!S 1t.` CITY OF COSTA MESA
' '• '• BUILDING DIVISION -
>:l - DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
PERMIT
B04-01896
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2559 ELDEN AV Status: ISSUED
Suite: Applied: 11/08/2004
Vicinity: CONDO BLDG WITH UNITS C&D Issued: 11/08/2004
Parcel Number: TPN00416 Zoning:
-
Applicant: HARTMAN, HEIDI ISSUED BY: ./�A
Address: 2626 NEWPORT BL - __
• Phone: :(949y548-1645 .
COSTA MESA,CA Zip: 92627 " - ,
. - <- 1.
•
Owner: ELDEN'MANOR HOA • �I '
Address 2559 ELDEN AV. , - • _' • `�. - �,
�-COSTA MESA,CA - Zip: 92627 - _i
Contractor:' PETRONELLA ROOFING
Address: 2626 NEWPORT BL ' - '
Phone: (949)548-1645
COSTA MESA,CA 1 , '
Zip: 92627 License: 460707 „,
Arch _ . ::Eng:
Address: Address: •
-
,
*Phone:
Zip: - License: - / v License:
/
SCOPE OF PERMIT '
CONDO BLDG WITH UNITS C&0:T/O EXISTING COMP SHINGLES,REPAIR_/REPLA_CE SH TG_ AS NEEDED, 1 LAYER FELT UNDERLAYMENT,
II , INSTALL"GAF TIMBERLINE ULTRASHINGLES:"'2500 SQ FT , ' L
FEE SUMMARY - -
Plan-Check: . - $0.00 - Calc Valuation: ' $7,000.00 .
Permit: ' $139.25 :_- ` . ./%'_ ,"._Claim Valuation: - $7,000.00,
SMIP Res: $0.70
r
'.SMTP Corn: , $0.00 • ,4/ /.
Other ,$0.00 ' -. !�
Inspection:`. .,>;$0.00 /
= .
Total: $139,95 q/ ,
'. -/' /
/ PLANNING &-ZONING " _ • /
SETBACKS i �� .
MAIN STRUCTURE-.Front 00,`- ::Rear,,,0 0- '-'Left, ,0-0 "Right S0-0 ',:i . /
/
ACCESSORY \Front , 0-0 / a Rear ' 0 0.. - -Left0.. - -Left Ot 0 ` Right '0-b ' , /
PARKING Exishnq:. 0 - • Required .,0 - "Proposed: - 0 '
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)
•
DECLARAPONS V.-.± ",o a'
WORKERS'COMPENSATION DECLARATION: : +.,,
I hereby affirm under penalty of perjury one of the following declarations:
0 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,fort the performance of the
e.awork for which this permit is issued. ,
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'compensatton Insurance carrier end policy number are: ^ / /� 1162CCarrier: -STRq
Carrier:
Tc LAMf°E/'' O.1 Mac ..C.W D PolicyNumber: 3
"(This section need not be completed if the permit Is valued of one hundred dollars($100)or less.).
•
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree tha if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shell forthwith
comply with these prow i s.
Applicant Signature: Date: /l,2✓F-�T�ae 9412_4;o-1-
WARNING:FAILURE TO S URE WORKERS' PENSATION 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 that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business annrof�siops Code!and my license is In full
force and effect.Lic.# O Class#
' '3 Cgi
Contractor's Signature: - Date: /1/G✓IGM3fsR- B; 2 ¢
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: - Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:YJC.y*.
I hereby affirm that under penalty of perj ry 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•puisuanito 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'exerript 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).):
0 I,as owner of the progeny,or my employees wllh.weges 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.wlth 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 ❑No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions.that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature end 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 a plication appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 1101 Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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.
� u�re Ot I Owner(s) Doty.,
�/.Y'Gti
SJ �O ✓S M B�vlL 2600 SL
And/Or Authorized Applicant Date" I .
;ODE t INSPECTION TYPE DATE INTRIALS CODE r INSPECTION TYPE • QAIE MIN&
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final JJJ208 Final Plumbing
200 Final Re-Roof ! 4 a ,fes 210 Final Electrical
•
201 Final Block/Retaining Wall - �.1 P . �� _-� ` 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
40 ir
)a!, k , CITY OF COSTA MESA •
BUILDING DIVISION -
>:/ ..,1 DEVELOPMENT SERVICES DEPARTMENT PE NUMBER
F twowis • PERMIT
s •# 04-01897 Pawn
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2559 ELDEN AV Status: ISSUED
Suite: Applied: 11/08/2004
Vicinity: CONDO BLDG WITH UNITS E&F Issued: 11/08/2004
Parcel Number: TPN00416 Zoning:
Applicant: HARTMAN, HEIDI ISSUED BY:
Address: 2626 NEWPORT BL - _
Phone: (949)548-1645
COSTA MESA,CA• ' -;,C2c ". Zip: 92627 - _
Owner: ELDEN MANOR HOA - 1
ilt
Address 2559 ELDEN AV - i Yc .I i
•
i Phone:
�' COSTA MESA,CA - Zip: 92627 - - _ \
Contractor "PETRONELLA ROOFING .
Address: '2626 NEWPORT BL -
-, . .
Phone: (949)548-1645 -
' COSTA MESA,CA
Zip: 92627 . License:. 460707
.
Arch : ;, ' -Eng:
Address: 'Address: - , , _
. - Phone: ' - Phone: ,_
Zip: License: / License: _
SCOPE OF PERMIT
f CONDO BLDG WITH UNITS E 8 F:T/O EXISTING COMP SHINGLES,REPAIR/REPLACE SHTG AS NEEDED, 1 LAYER FELT UNDERLAYMENT,
INSTALL"GAF TIMBERLINE ULTRA SHINGLES."2500 SQ FTS,' .._ - ,, -
' • FEE SUMMARY
`, Plan Check:'. . ... $0.00 .. . _ L Calc Valuation: $7,000.00
Permit: $139.25 _=_- \ " . _ Claim Valuation: - $7,000.00
SMIP Res: $0.70
SMIP Com: , $0.00 ij /, ,
Other:- ' , $0.00 - - -
Inspection: ' ' $0.00
\ ,Total: $139.95 -,"P • „ -
''
, ; -/2 . ,PLANNING &ZONING �,
SETBACKS , 7
MAIN STRUCTURE Front 020� :Rear 0-0
ACCESSORY vFront- 0-0-• - ' '? 'Rear 0-0 Left 0 0- Right• .- 0-0 ,
PARKING Existing: - 0-- ,Required: ,0 ,:Proposed:, 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days. ,
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
•
244648 lane) .
DECLARAtivi kS Li % , `-''
WORKERS'COMPENSATION DECLARATION: ,
I hereby affirm under penalty of perjury one of the following declarations:
0 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 pertormance of the
9 work for which this permit is issued.
have and wille maintain workers'ante compensation Insurance,u required ntl by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensationJJl��surance carrier and policy are:number� C
Carrier: Snore compensation
'sAnou et% N✓Nt. Policy Number:' /S- 41-6.2 3
(This section need not be complefad 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 the1workers'
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�-rovi�_sioff7s. A.10
11 ddthr I
Applicant Signature: C� .Date: NO✓EMB£2 S, 200 51-
,
WARNING:FAILURE TO S URE WORKERS' PENSATION 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 3706OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed nder 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.Lic.# toO Class# - G 3 4
Contractor's Signature: tat • Date: ,. 4o✓BM ale& 9 %200 -
7
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: Lender's Address:
Signature: Date:
r f..
OWNER-BUILDER DECLARATI6 O�
I hereby affirm that under penalty of perjury an 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 Conetiuct,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 end Professions Code)or that he or she is ekenipt 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).):
MA
❑ I,as owner of the property,or my employees wlih•weges 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
❑ 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,end who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
in I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑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
❑ 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.
I
Signature: Date: r
Division of Industrial Safety Permit Number:
•
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I
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,ora 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? ❑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 11 an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑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? 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? ❑Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). i
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 Iron 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 andi 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. '
Sig to Lega
c� l s) Date
e - ' of AL vert 36-2 8 .2 00!¢
nd/Or Authorized Applicant Date
CODE I INSPECTION TYPE 2A3 MEW LODEI INSPECTIONTYPE ZEE PTTTIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final /� . - 208 Final Plumbing.
•
200 Final Re-Roof �/-7�7�a_� . . ♦/�I 210 Final Electrical
201 Final Block/Retaining Wall ISA . _ ..L....1:—.*!!I 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
v
1511 8/21/79 8.50 TL
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATIO OR STRUCTURAL PERMIT
•�P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RE IV D8 PERMIT N� 48 -
For Applicant to Fill
lll ininCompletelyj8
•
�— Use Ink Only 6b
BUILDING
ADDRESS �7 J I EL t/ AB .No./
/jil-�^p �; 429.--,
TO NANTOR G UCTCt,-I'�C^ V L-sP/ i is ADDRESS -z f / s e_C' N
)
UNIT OR
• MAILING 3y-v f3') FR0+�1 1 SPACE NO.
-ADDRESS�J V� E. J
�t '` j TR.NO. LOT BLK.
• CI N.Bct-ao (SL/ANO NO. 70135
_ NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
ENDERCTION &IC"SI_.4re-6-o
BRANCH Die. pp
A10 b-\
OWNER L/ /- OC".N//tom
ADDRESS A )•^7 VALUE op
OR ENGINEER
N INEE •- / . A l e) NOL&3.2 7.
• _ `-LT ` USE D6YY�C/ $ co CrZ�
OR ENGINEER�P YI' t
ADDRESS 30 C14 51,17e. /3 ZONE TYPE t/ GROUP
APPROVED Of
CONTRACTOR OCA )to (3C BY _ DATE 8. 21•7
ADDRESS
TEL.
CITY NO.
I^ STATE CITY APPROVED SETBACKS
LIC. NO. LIC.NO.
WSIZE rr__ • NO.OF BLOCS. (FRO C/L REE i
O. OF LOT LC./d X 7305' NOW ON LOT I RO FT
Q USE OF J
EXISTING BLDG. f+OJin
lir a
FSeparate permits are required for —
c electric,plumbing and heating work. REAR FT.
iW. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
Q •
DATE
mac= inn S/NGLE r4/1/L • /,QIP[//} APPROVED� 7
.rl /.4us G/�/C/�GC SRC/'' ' �[ _ DATa7 7
lY
lz] •
OI hereby acknowledge that I have read this application and state . n
a, that the above Information Is correct and agree to comply with
Cu ell laws regulating building construction, and I shall not employ
Z any person In violation of the workman's compensation laws of e
IR - the State of California.I
voosr...-----
SQ. FT. mcv
I hereby certify that I am properly licensed as a contractor under
• 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: n
am exempt from the provisions of the State of California Business
VALUATION PERMIT FEE $ 6, 072, n
and Professions Co e,Division 3,Chapter 9.
Signature of PLAN CHECK $ 2
/y 0
Permittee -L4.-4 LQ $Boo• w TAX $ , CO F
Or Authorized Age //A Date g^ I , 79 TOTAL PAID $ grs—a U
4
COSTA MESA BUILDING-SAFETY DEPARTMENT APPL CATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ,p/
rJ' ' REC• , BY PERMIT {+/ . '-'DU (1(t `ib 56 It
For Applicant to Fill in Completely —Usetlnk Only N° 4 9 9 S 5
BUILDING �A:P. NO. 9'J
ADDRESSBUILDING
S. �. .• ,G.Lbeta,��, .v . / 7 - `' �-'Q 'a7-. ,
TOENANT R G \. L 12 t C ADDRESS a 5 c 9 �_L1)e�
MAILING. ?� I_' p�\' _ n UNIT OR - \•
sv 'Ni. t%
ADDRESS ✓'�i, E 1 cB . Ingo I SPACE NO. k
/� /� "ill /'7 �l p TR.NO. LOT BLK.
CITY%ALBO �s, , NOL.(07S7i85 /o7
NEWS ADD ALTER REPAIR MOVING DEMOLISH
CONSTRULENDERCT
ION VALe oc 1 IA BP'aqC
V/
BRANCH x \I% •
s�
ADDRESS \•D _ r� �T '11 OWNER a� Il��ss
OR ENGINEERITECT �,l-I- C41 A m Le) a�737Lnp USE 1b ' ALUE ' �
ARCHITECT (tel J TE
ADDRESS 4�.5 3O A A N 13, ZONEYPE 1 GROUP /
CONTRACTOR 5P1vtta AS Ow(4 ewe. BYPROVED V ` DATE 40040 _
ADDRESS ��// r
TEL.
CITY NO.
•-• STATE �(�T�t�] CITY APPROVED SETBACKS
LIC.NO. 31R-(V l 4 LIC.NO.
itj SIZE NO.OF BLD (FROM C/L STREET)
G. OF LOT 3Q J it lob I f;s NOW ON LOT Q FRONT FT.
a USE OF
„&� D /� R,
EXISTING BLDG, 1 SIDE FT,
r&/) _
E
Separate permits are required for L,SIDE FT.
C electric,plumbing and heating work. REAR FT.
W USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
a 13 OC (L W AL1_
• DATE
APPROVED
7 APPROVED*
>' __AY DATF
...I -1 litlIM
w
oI hereby acknowledge that I have rood this application and state 0
Q$ that the above Information is correct and agree to comply with
Q. all laws regulating building construction, and I shall not employ i
Z any person In violation of the workman's compensation laws of _ °
x the State of California.
of
SQ. FT.
I hereby certify that I am properly licensed as a contractor under N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ro
Chapter 9, and that such licenses are in full force and effect,or I THE PURPCBE OF ESTABLISHING A PERMIT FEE ONLY: m
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ Y
0 G
m
and Professions Co , Division 3,Chapter 9
PLAN CHECK S. Z2 s pQ
Signature of ` , enV_
Permittee / T $ �,B TAX 5 O % U
Authorized Agent Date . • TOTAL PAID $66, 6
IP
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COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION P9ftglINctyytAL PERMITI39e73 TL
�••• P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
REC BY PERMIT
For Applicant to Fill in Completely — Use Ink Only Ng 4 8 5 4 3
BUILDING • .., A.P.NO. Ar-• Ar -a2.9- c2 a
ADDRESS ��•1r.aS r _la k. �'Q ...—���/►►►
OWNER OR V� i I 1 I I/ ADDRESSBUILDING " Z`r`a — 't A48
TENANT
UNIT OR
AMAILINGDDRESS 4ti9 .L -H 4 `3 SPACE NO. '2'
` t I., / - TR.NO.
S.
LOT BLK.
CITY N�� CC� P-4 I, NO.(�73 1• NEW ✓ADD (ALTER REPAIR IMOVINGIDEMOLISH
CONSTRUCTION { r1 ��)) �- -
LENDER
BRANCH
OWNER •
ADDRESS eatARCHITECT ��yy /� ��//��,,,,�1 r1�� /�• ��� VALUEdr $ 03 �
OR ENGINEER. IGff( •�lI-1 ' L Y NO.In USE 2
ADDRESSTYPE GROUP\/7L
475 �t�l 4-f'� N, I .. ZONE J
� /I���
p APPROVED
CONTRACTOR �j\VNe� BY DATE
ADDRESS �p,(t[ll;
TEL.
CITY NO.
I-.
STATE CITY APPROVED SETBA21C /,/
gLIC.NO. LIC.NO. ` It fox) ( UirQA
61 SIZE (�^I X �I NO.OF BLOCS. (FROM C/L STRFT. �i £(ctn
S OF LOT 2- ) NOW ON LOT z OM FT. C..�
•
USE OF r
-7 /5' eV
EXISTING BLDG. M_.5 R.SIDE /F11 /
%1 !r
FSeparate permits are required for L.SIDE 3—FTC J
C electric,plumbing and heating work. REAR /7 f F.0 r/
F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING re
a t 1/ �/`l `1ATE
(�
Q ��C/1`YJ���"�IlUI l � _ 77-40 APPROVEA,Z= .
11NIT C.oNI7OMINUri BYR J1#/ . ( DATE Cr/ `
ce
w
aI hereby acknowledge that I have reed this application and state• ..
p( that the above Information is correct and agree to comply with now Fox small, /rr.s..
a. all laws regulating building construction, and I shell not employ �Q�REMEN$'^ >
Z any person in violation of the workmen's compensation laws of >I l �r`I {
W the State of California. Id Lk 4 -�
I m
3 I �f SO.FT. (��- N Q
co
I hereby certify that I am properly licensed as a contractor under N/
the State of California Business end Professions Code, Division 3, THE AMOUNT SHOWN U DER VALUATION IS FOR B
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ,o
am exempt from the provisions• a State of ,lifornia Business VALUATION Y
and Professions Code,Divislo • Choer 9. PERMIT FEE S n
Signature of� is I �OQ PLAN CHECK $ en
r�3.J \V
Permittee • • Se 03 Z 3 kicit
TAX E J
or 2 - s
Authorized Ae - ate ' a' / TOTAL •PAID s s 3
CA
•
' COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RECEIVED PERMIF r (• 26) 00 it
For Applicant to Fill in Completely— Use Ink Only �' JV V0
BUILDING 2559 E`be _/ A.P.NO.VVV
ADDRESS e647:L I H�,r� o•2SSy egn Q
BUILDING
OWNER OR ADDRESS -
TENANT - UNIT OR /1 6
MAILING J.?lie. a""'1":.7� SPACE NO. H LOT BLK.
ADDRESS L' /� (�
Lia
lie. TEL. `/N('�/{"'y�O
CITY ` NEW ADD ALTER MOVING DEMOLISH
CONSTRUCTION
LENDER v r ��O C16'7a8r
BRANCH OWNER 4.1//0A)/ic
ADDRESS (/'+ I� ./ VALUE
OR ENGINEEPN- �r Ir /'Y1' Nt t�•TS�IO USE OZ ���, $ `
�sADDRESS cki ZONE Q an YPE V GROUP
/bulicie-I APPROVED /t/�� �'-�_
CONTRACTOR BY DATE T`! (/s.//
ADDRESS
TEL.
CITY NO.
(" STATE CITY APPROVED SETBACKS
LIC.NO. LIC.NO.
ga 512E it ^ I / NO.OF BLOG �s (FROM C/L STREET)
a �"�OF LOT h $3C.,1„...
Q. I S.NOW ON LOT op- _F_3ONT FT. .
Q USE OF
ice, EXISTING BLDG. .RCS. R SIDE FT.
to --- i
FSeparate permits are required for L.SIDE FT.
O electric,plumbing and heating work: - _REAR FT.
(W. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
Q •
O
CI \ ^C,s DATE
aC ODPPRPROVED
APPROVED
j• _BY DATE
..1
ce
ILI
0.
I hereby acknowledge that I have read this application and state
ao that the above Information is correct and agree to comply with
0. all laws regulating building construction, end I shall not employ i
Z any person In violation of the workman's compensation laws of x
Sthe State of California. -
I hereby certify that I am properly licensed as a contractor under �—SQ. FT. co
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: e
am exempt from the provisions of the State of California Business
VALUATION PERMIT FEE E j 61.00 y
and Professions C e,Division 3,Chapter 9.
^ PLAN CHECK $ C
Signature of *Cote
/ 9J
U.
Permittee �/��j//I S l TAX $ �• f
Authorized Age Date / !!r l 'e TOTAL PAID E U
' 9)80 '�Z12%79
UNITS 'c .t D , rrr'� \ I °.70/�—
COSTA MESA BUILDING-SAFETY DEPARTMENT • •
APPLI ATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 .
/
REG BYPERMIT
- -- For Applicant to Fill in Completely—Use Ink` O'my ' N° 4 8 5 47 5
- — L DI NG For Z 9 I �, Jt�l A.P.NO. 3� 7/-2-1:9 p�
OWNER OR r �� IV (, IMEE �—'�7 _ s1 ____i V
TENANT I K
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ADDRESS V I(� _
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NEW A•D ALTER REPAIR MOVING DEMOLISH •
CONSTRUCTION ,
LENDER
BRANCH
OWNER
•
-Th ADDRESS
_ARCHITECT v TEL. USE GI a
OR•ENGINEE- .......4 ` •
ADDRESS G � n41 IN
•7 � TypE GROUP
APPROVED
CONTRACTOR S'r_x\/NF- —• - BY — DATE
ADDRESS sI }I V - ` ._ . _
TEL. •
CITY NO.
F STATE CITY APPROV�{1 SETBACVC�
LIC.NO. LIC.NO. , (./n( rem
NO.OF BLDGS. (FROM C/L STREET) I
fid
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a USE OFF / I /'t 4
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Separate permits are required for L.SIDE 5 /FTG /7
G electric,plumbing and heating work: REAR � FT. .ir
n24
FW^ ' USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
DATE
a t C�oN y or -z ENR c/__t�ll/T�l. 1`7--7(b?PPAPPROVED/L (V 7�,
} APP. — DAT/// •
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e, that the above information Is correct and agree to comply with - - -rs'. - �.
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4 all laws regulating building construction, and I shall not employ � (� i
Z any person In violation of the workman's compensation laws of / /
S the State of California. 3 � Z m
�j SO. FT. N
• I hereby certify that I am properly licensed as a contractor under I // 2 N IN
the State of California Business and Professions Code, Division 3, TH AMOUNT SHOWN ND VALUATION IS FOR m Q
Chapter 9, and that such lice. :re in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the prov on of : State of California Business y N.
and Professions Code,D 1 VALUATION PERMIT FEE $
��� / PLAN CHECK $ `3 Z,S—o o
Signature of v
Permitter _ �al-' LL
a, 03 TAX $ 6,L f
or r
Authoriz.• A.i i 1 r TOTAL PAID $!3 — T ;
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a COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RECEIVED V PERMIT ^ /
`1 For Applicant to Fill in Completely—Use Ink Only '4/12 I�Cr
n^r �j G n,,.�I LI• • t on
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AODRESS c:;06-75.i..
'�S 1 f�i-b C/V A.P. NO. z. 2E ••oo
BUILDING 25.61
aos -4*6
OWNER OR 15 / I��N I'C ADDRESS
RE5S
TENANT G l�
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NO. LOT BLK.
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CONSTRRUUCTI—ON
LENDER
BRANCH
l !-+T/ 10Pt. ItADRESSn /� VALUE �'`/� - Q QbQ 3 ` SOR EN (NEE r 1/s N 3 ' � � t
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ADDRESS y a�zs��s�a�N, ,/�J�, PE GROUP /^ /D
CONTRACTOR ctspvy ' a(,s.WGI APPROVED
DATE /�e/VO
AODRESS ttt LLL
TEL.
CITY NO.
FSTATE CITY APPROVED SETBACKS
CLIC.NO. LIC. NO.
W SIZE tL NO.OF BLOCS. (FROM Cil_STREET)
L OF LOT ^� T 3(555,
� I NOW ON LOT FRONT FT. —
USE OF
'N EXISTING BLDG 41s R.SIOF FT.
V)
HSeparate permits are required for L.SIDE FT.
electric,plumbing and heating work.
D REAR FT.
Lsl
F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
Q
Q 00.34 • es? Ulur - Cal*$ - DATE
APPROVED
7 APPROVED
>. saY DATE
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0 I hereby acknowledge that I have read this application and state e`
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that the above information Is correct and agree to comply with
ti
a. all laws regulating building construction, and I shall not employ
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Sthe 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: ' e
am exempt from the provisions of the State of California Business VALUATION
and Professions Co e, Division 3,Chapter 9. PERMIT FEE E � , n
^
SSI nature of 46 PLAN CHECK S
/ 0
-
PeY ofKae at /ikk $ TAX E (//f
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Authorized Age De TOTAL PAID E -a)
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COTMESAIILDIIG- FTYDEPARTMENT
APPLI ATIONRTRyCTURAI.PERMIJ 39a73
BOX TLoq SACALIFORNIANIA T6E6 '
f REG V Y PERMIT
For Applicant to Fill in Completelyle — Use
Ink Only
lnly N. 4 8 5 6
ABUDIDLRDEISNSG
rz e I 4 I�1/[ A.P.N04/3�J_/�7/L 02?
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ApDRESSGt5 '' ',21-1 I� Hr I`/• ZONE/..2 TYPE GROUP
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CONTRACTOR rwrire BY DATE
ADDRESS &NMg.
TEL.
CITY NO.
F STATE CITY APPROVE ETBACK$
LIC.NO, LIC.NO.94 SIZE I � Cp
(FROM /LSTR ET/
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Cn Q USE OF �ga5. R S / FLC/ //
EXISTING BLDG. _ fiJ
vz f/7 i/
5 Separate permits are required for L,SIDE c FT.CJ
electric,plumbing and heating work. C,/ //
' �J 5
C REARFlO
IW.
., USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
g 2 - .
I / DATE
.Si: 'V rd. ✓ /� APPROVE. s
ARPPy Q DATIL./5---5-0
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0 I hereby acknowledge that I have read this application and state
n
that the above information is correct and agree to comply with C
L all laws regulating building construction, and I shall not employ FIOLD FOR SPECIAL REQUIREMENT:
i
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W the State of California. r�7 f� to
:I SO.FT. • /' _ CV
I Hereby certify that I am early licensed as a contractor under I ' ` F m
the State of California : nd Professlo s Code, Division 3, THE MOUNT SHOWN UN ER VALUATION IS FOR m Q
Chapter 9, and that • - - /ace and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: r,
am exempt from •• prov' ns If he State :f Ca ornia Business
VALUATION PERMIT FEE S ,q
end Professio a Div;,f•n 3, s apter 9.
Signature • / D® O�PNV
LAN CHECK S 73 CO 2 N
Perm? , $a % O?� TAX $
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Authorized ?gent ' e TOTAL PAID $ /3 fin ��►fTTT...
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COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RECEI PERMITQ-
For Applicant to Fill in Completely—Use Ink Only c'cn '7! /Q'S-� T_ e00 TL
BUILDING n`51 ( A.P.N
ADDRESS �f. 7 f.,N - /
BUILDING ^SS9 E`beJ
OWNER OR! 1` 1 I ADDRESS �/ 1
TENANT �J r
MAILING I 1 UNIT ''
SPACE NN O. ' F
ADDRESS
O ����/,Q y�J TR NO LOT BLK.
CITY `T'z�/� s+' NiE674 D ALT01 ER REPAIR MOVING DEMOLISH
CONSTRUCTION
LENDER
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OWNER Li k7pod I/c
ADDRESS • VALUE
400R' y ^ USE �Q0
$�
OR ENGINEE7Y1 NNY !] r9I�
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ADDRESS 45 35411 11 J N S.
ZONE 14 TYPE y/ GROUPAP4t/t4
CONTRACTOR , e , ay
NBYPROV ED
/fie. DATE tG/'tO
ADDRESS awe.
TEL.
CITY NO.
iw STATE CITY APPROVED SETBACKS
LIC.NO. LIC.NO.
Ly SIZE X / NO.OF BLDG& (FROM C/L STREET)
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a USE OF ///'''���
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(9P -SIO
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rn t )= O
F Separate permits are required for L.SIDE FT.
C electric,plumbing and heating work: REAR FT.
xt
USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
a
o
( /S
a ‘1,1r11/4Y1/1) _ I APPROVED
›' -- �� APPROVED
>'. _gY ftATF
.4
CL
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QI hereby acknowledge that I have read this application and state N
that the above information is correct and agree to comply with
Cr all laws regulating building construction, and I shall not employ i.
Z any person in violation of the workman's compensation laws of m
•`WL' the State of California. i:
ry
SQ. FT.
I hereby certify that I am properly licensed as a contractor undern
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR a
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: w
am exempt from the provisions of the State of California Business a
VALUATION PERMIT FEE $ �6/ ,Qp
and Professions Co e,Division 3,Chapter 9. w
n
//t PLAN CHECK $ G
Signature of • �i $ � TAX iz
Or
Permittee �11GGAuthoried Ag Datelc# ��/� TOTAL PAID $,o76,7roc) U /
77-.4561i ENCL. • 8191782 8/02/79 8.50 T_L
• COSTA MESA BUILDING-SAFETY DEPARTMENT APPLI •TIONIFOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626•
_
RECEI i' • • (PERMIT NB 48547
For Applic
ant to Fill�� in Completely — Use Ink,Only X71 V(y
ADDRESS 7 1 7 57 &fl W A.P.NO. 413/9—/ 7/,+�-sS 9
BUILDING 25� �, ,�M
OWNER OR G ADDRESS uj f y
TENANT �101� LIMN' I IC
MAILING I '
UNIT OR C
ADDRESS g.. �/1TH{ # SPACE NO. 1
sal i�� 1, TR.f4 �y� LOT / jBLK.
TEL. (J// n
CITY NO(•,7?t-'I57C, EW AD ALTER REPAIR I MOVING(DEMOLISH
CONSTRUCTION Ill
LENDER ✓
BRANCH t�
OWNER 1 1 1\
ADDRESS / .3„� VALUE
ARCHITECT r�! /` TEL. �-t USE /Ltgf, $
OR ENGINEER� i r l/I- � NO,f�.�I��-I"J IQ _
ADDRESS 4Z T.1-1 t IN•�f"• ZONE g'2 PE GROUP p�
CONTRACTOR O\ ri
APPROVED , DATE ��a/r o
ADDRESS �+ '� !!.//
/ •
TEL.
CITY NO.
t'^ STATE CITY APPROVED SETBACKS
LIC.NO. LIC.NO.
(FROM
il
is SIZE (��-+C^J X V�^ t NO.OF BLDGS /ill `/ J
O• OF LOT S NOW ON LOT FRONT FT.
G USE OF
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rn
I-1
Separate permits are required for L.SIDEFT.
electric,plumbing and heating work.
WREAR
USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
r 'iri'
Je.(l1YJer}--1 1ti11G1 l L.- I jaj'1-1 DATE
APPROVE
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a (NC I qzor-r7 - "'I lY. Rr JL DATE .� ,
m
aB-
I hereby acknowledge that I have read this application and state I-
C that the above information is correct and agree to comply with
B. all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of
the State of California.
m
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 ' en are In full orce and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: -
am exempt from the • •vi ions•f he State •f California Business
and Proles'•- • •, VALUATION PERMIT FEE $ • BO q
/ / QPLAN CHECK $
Sign• ure of r1eelto
Pero TAX S F rtes $ 00 ,Sb V
Author :d A.-n r..to TOTAL PAID $ 8, rel
f
. ' COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
• P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
REC V PERMIT - (1
For Applicant to Fill in Completely —Use Ink Only N2 5 Q 188
BUILDING r A.P.NO. I) �/U"v I 3, 50 IL
ADDRESS
255—/ �LD�tr �C�`Q /—,�� a
OWNER OR /=u�. f e oc L itgo I'✓ ADDRESS aa'VJs / � � y,
TENANT L+ (� [� F�
MAILING } / /���r- UNIT OR
ADDRESS 7O, E. Foy j !i SPACE NO.
'/� 'p��1 15 ! TE
L/ •7 TR.NO. LOT BLK.
CITY 10�}'LC�I/"'t ',t NO(iJ(S7 NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
UCTION VA.Li-6e_Letel b - 3�4 I LE /�/1�Gar Si �/
BRANCH 6-04 -I OIxs �N PPNW/\_t ' • ' pnOWNERADDRESS/ 23S M ��llll`4Et7c)GAill) r't/GhA•Iti VALUE• OARCHITECTR ENINEER Je Fr eL ACti4Cey NOL60737 /QUSE�� NDp� $� 1�
ADDRESS VPwPo, -r /3C ZONE TYPE GROUP
CONTRACTOR S ,J J . L ( %/Ole/[t . BVPROVeu) / DATE 6���
ADDRESS S o l 6 _ 34✓r4ou1/ H
(lTEL. ^^�� ��tt pp
CITY /7i.4L. 1 S. NO4/c2285 _
F STATE r� CITV APPROVED SETBACKS
LIC.NO. 9-6 L�CP Li LIC.NO.
W SIZE �/ / r� NO.OF BLDGS. (FROM C/L STREET)
. OF LOT 30 S /t bD NOW ON LOT 0 FRONT FT.
Q • USE OF
CA EXISTING BLDG. 14/4 DR.SIP* ET,
to
E-•
Separate permits are required for L.SIDE FT.
O electric,plumbing and heating work. REAR FT.
F USE OF BUILDING AND WORK
KKyTOO/BE PERFORMED PLANNING ACTION
Q I Illy c Q "Boer ' 'TE -
J //!/
APPROVED
APPROVED
} —ELY DATE
.d
W
C I hereby acknowledge that I have read this application and state N
ad that the above information is correct and agree to comply with
L all laws regulating building construction, and I shall not employ
i
Z any person in violation of the workman's compensation laws of m
= the State of California.
N
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: n
am exernpt from the provisions of the State of California Business
VALUATION PERMIT FEE $ //77b7�
and Professions Code,Division 3,Chapter 9. .6/`� m
Signature of / 7/�j/A /��/1/�/,rt00 PLAN CHECK S. 45 Oo a
Permittee Mr;�� Aa $�W✓ TAX $ ! St)
LL
or �� ` /La7� v
Authorized Agen Date s TOTAL PAID $3 ..b
41
CITY,F COSTA MESA ='
linik BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT I P MIT NUMBER
4. ; PERMIT B05-01340
SP
asartm
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.S.U1LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2559 ELDEN AV Status: ISSUED
Suite: C Applied: 08/08/2005
Vicinity: BLDG WITH UNITS A&B Issued: 08/08/2005
Primary Occ: R-3 Dwellings/Gong Res<10 Type of Construction: V-N
Parcel Number: Zoning:
Applicant: GARY ROGERS
Address: 2626 NEWPORT BL /��/�/'��
Phone: (949)548-1645 ISSUED BY: //
COSTA MESA,CA Zip: 92627 l
Owner:
Address _ `"`
. Phone ra
1,Zip: t 5
Contractor: PETRONELLA ROOFING �` ,
Address 2626 NEWPORT--BL v" '' '-
y "
Phone: (949)54&1645
COSTA-MESA,CA >,..
3a ,
,Zip:' 92627' „3 ' License: 460707
Arch • � ` Eng:
Address:d Address:
Phone:
r"Zip
G,�`yf9- SCOPE OF PERMIT" z,� ,,
CONDO,BLDG WITH UNITS 2AN,a l/O EXISTING COMP SHINGLES,REPAIR/REPLACE SHTG AS NEEDED,'1 LAYER`FELT 23200 SQ FT
Plan Check: $0 00 ¢ ` " :' Calc Valuation:( . sio,o 0 oo
Permit: r X2$181.25- ' P .._.. ClaimA Valuation $10 000.00
SMIP Res: $1.00—
SMIP Com $0.00,4, '
Inspection t;:':$0:00$ ' '" ' :fix x.fes._ • ,,,& ' .,. • .....r s` an.. ,,.f 5%
Total $182.25
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0 0 Lefty 0:014'4- Right • 0-0
ACCESSORY ;k',. Front 0 0 1-1,1- ' Rear 0 0 " " Left-'" 0 0 Right '0-0
° aui `.Proposet 0- -1;, r -
PARKING ''Exishnq 0 . _ Reowred� 0, �3 . d
-. _: Yom.,
•
•
` {
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) .
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: II -
I hereby affirm under penally 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,fahe 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 performancetof 5 yrerrt tor whicherthis permit is issued.
My wor S' ompen;ption Insurtince carrier and policy number are: Il 9(11 fpY 3
Carrier: 71 -1..vmA Policy Number.
giCiciron need not be completed ll the permit is valued at one hundred dollars($100)or less.)
I coni 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'
pensatio aws o elitomia,er agree that ii I should become subject to the workers'compensation ns of Sept1I 700 of the tabor Code,I shell forthwith
comply wit ese pr /'q�oonnss���p�( 1-�� �� �,(y(�//
Appli nature: ✓R UN/'"V Da — V
WARNING FAILURE TO SECURE WORKS Si COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS(5100,000).IN ADDM TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereb�yu .tic: se'u,d:r pr. , ions of Chapter 9(commencing with Section 7000)of Divi •• - ,-: :gland ' •esslons Code,and my license Is in full
•.".. 1 Cla. ` -T
C•T.: • s Sign: riff I •. rla�Wain"
I a
I
CONSTRUCTION LENDING AGEN Y:
❑ 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: 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 end 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 fora 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 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(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:
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 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 flung 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 a,permit for such construction or modification
from the South Coast kr Quality Management District or from any other air pollution control district or agency? U Yes P No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 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.
Of Leal Owner(s) + . •' e Miribiar-
O
An 1,•r • t orized App •nt •ate
CGDE(, INSPECTION TYPE PATE gWIT8L CODE. INSPECTION TYPE P.E1 EMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final � 208 Final Plumbing
200 Final Re-Roof 8—3t..' t/As _y`` 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
4
9 BUILDING DIVISION
F
eta-„, , DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
J11.14.44 : PERMIT • BO5-01341
•
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.d.I1RLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2559 ELDEN AV _ • Status: ISSUED
Suite: E Applied: 08/08/2005
Vicinity: BLDG WITH UNIT E&F Issued: 08/08/2005
Primary Occ: R-3 Dwellings/Gong Res<10 Type of Construction: V-N
Parcel Number: TPN00416 Zoning:
Applicant: HARTMAN, HEIDI
Address: 2626 NEWPORT BL 0/AK Phone: (949)548-1645 ISSUED BY:
COSTA MESA,CA Zip: 92627
Owner ELDEN MANOR HOA
Address 2559 ELDEN AV
Phone
COSTA MESA,CA • s • Zip 92627 .
Contractor PETRONELLA ROOFING n": •
Address: 42626 NEWPORT BL .< .� - ,
. . Phone: (949)548-1645
COSTA MESA,CA ,
Zip: 92627 ' License: 460707 '
Arch :- Eng: ,
Address:" - , - Address: `
Phone: - - - Phone:
•
Zip: License:, . " License:- "
•
SCOPE OF PERMIT
CONDO-BLDG WITH UNITS E AND F T/O EXISTING COMP SHINGLES,REPAIR/REPLACE SHTG AS NEEDED, 1'LAYER-FELT UNDERLAYMENT,
INSTALL"GAF TIMBERLINE ULTRA SHINGLES."3200 SQ
FEE SUMMARY
Plan Check $0.00 < • Calc Valuation $10,666.00
Permit $181.25 " • Claim Valuation $10000:00
SMIPRes $1.00 :
SMIP Com 'x$0.00 m
Other '$0.00 •r
r�
Inspection: `$0 00 -- "
•
• $182.25
• •
,/PLANNING=&ZONING -
SETBACKS w-.
MAIN STRUCTURE Front 0 0 • Rear 0-0 Left• p0 0 • y h 'Right -0-0
ACCESSORY .;..Front ,•0-0Rear 0-0 Left` 0-Opgss-. - ;Right- 0-0' -
PARKING -Existing '0 Required '0 Proposed.: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21.92)
EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
244648 WOO)
DECLARATIONS '
WORKERS'COMPENSATION DECLARATION:
I hereby affirm eider 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 workforwhich this permit is issued.
wo r^'mpe tion Insupnce artier and policy number are: _ I S�I I 6�P 05
Cartier 1 'o�-+•i'`vV1 mbar:
' section sad not be plefed 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 Cal mia,and agr a that If I should become subject to the workers'compensation provisions of Sec on 3700 of the Labor Code,I shall forthwith
rase provisl MP - 5 S-
/
: .•I•:nt Signature: •W\-1AY, •�- Data 6 a(/
WAR 0:FAILUR •SECURE WORKERS'COVENS/010N COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOU • •.. RE($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I here t I am Ilcens d u der provisions of Chapter 9(commencing with Section 7000)of Divisi���of-7vNb,Business and P fe ions Code,and my license is In full
force an .Lie.N ��jQ�ly l -
Contr t lure: 9/}-�v /ill lay 1 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: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more then five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,I.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure). _
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Cale,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 Cale 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 a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 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 El 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.
a
Signature Of Le•- • ner(s) f `' Date
ofd 1 4 i
r An-'Or Authorized • '. e
61E I yN TYPE e ion 1tlJ117A45 CODE Finan ec nMALI
1616 Fixed System Final Fire Preva Ion 206 Final Mechanical
1268 Pool Spa Final -- 208 Final Plumbing
Tref—
e f- -"
200 Final Re-Roof 1(4 444
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