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HomeMy WebLinkAbout1763 ANAHEIM AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1763 ANAHEIMAV Status: ISSUED Suite: Applied: 07/29/2002 Vicinity: Issued: 07/29/2002 Parcel Number: 42426326 Zoning: $125.25 SMIP Res: $0.55 Applicant: PROSERVE ROOFING Other: $0.00 ISSUED BY: 4/— Address: P.O. BOX 25307 - - �, ," - "I ' - � SETBACKS-`, „iii _ -Phone: (714) 772-7485 - Front 0-0 PARKING Existing: 0 ANAHEIM, CA--, - Zip: 92825 Owner: WESTBAY PROPERTIES NO.7 Address X136 ROCHESTER 3T Phone: ' /COSTA MESA, CA - Zip: 92627-3009 - Contractor: 'P,ROSERVEROOFING Address: P.O: BOX 25307 i Phone: %(714)772-7485 " ANAHEIM, CA �•i - Zip: 92825" ' License: =489090 - - Arch: �:.!'- - Eng: Address: Address: - '� Phone: Phone: i \i•' Zip: License: License: TEAR OFF COMP, INSTALL 30 YEAR ,1 LAYERS OF 1 Plan Check: $0.00 Permit: $125.25 SMIP Res: $0.55 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 � Total: $125.80 SETBACKS-`, MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 NOTES: ILB FELT-. FEE SUMMARY Calc Valuation: -$5,500.00 Claim Valuation: $5,500.00 Rear 0-0 Left 0-0 Right 0-0 . Rear 0-0 Left 0-0 Right 0-0 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 became void If 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 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) 7545626 :wasp tawr s DECLARATIONS WORRS' COMPENSATION DECLARATION: I her effirtn under penally of perjury one of the following declarations: 0/ 1 have and will maintain a cortlfinate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the Ki,Wowork 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 coo W compensation Insurance Cartier and policy number are: , I ,,. /, rn Mas UCL (Tt. Policy Number: buy-?-7%LS,�4' Y Zi need not be completed if the Permit is valued a one hundred dollars ($100) or IsSSQ ❑ 1 certify that in the performance of the work for wh�his permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensallo laws of California,..-88III)d agree thatllf I s bold become subject to the workers' compensation provisions of Section 3700 o1 the Labor Code, I shall forthwith c I' - t se provisi �^ �� _ c .nature: I Dale: WAR TO SECUR WORKERSCOMPENSATION CCYVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOME HUNDRED THOUSAND DOLURE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affi at I a licensed under pr visions of Chapter 9 (commencing with Section 7000) of Dlvisio Business antl Professions Code, and my license Is in full force effect. Llc. x O Cla x �— �9 Co nature: e: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this pernit 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 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 .r 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 appy 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.). ❑ 1 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 .f Ownership by (type of document, I.e. - property tax bill or dead): 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 B, 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 pernil 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? ❑ Yes ❑ 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 filo a registration form for acutely hazardous materiels? ❑Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Masa 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 cowc feet of compressed gas at standard temperature and pressure). 3 sr will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for ecutetyaza hrdous materials)? 0 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 me Fire Department. ...................... ................................... _._..................................................................._...__............................._......................................................................... I .................................................. .............._........—._......._.............._. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................................._................................................._........_..—...................................._..................hii:'._...................................................pli-c............._.........__..._..__.............._._...._ 5 Does he will the applicant or present or future building occupant require for the work which is the Subject c this ,�e�pppllcatlon e6p No for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes LJ NO (Section 65650.2 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 ❑ No (It 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 Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ NO B (If yes', emacs 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 cityordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1 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. Ign ure OfAegal Owner(s)Date --/_�-02 nd/Or Authorize plicanl Date COOS x INSPECTION TYPE iNTrnALS CODE r INSPECTIONTYPE 2AjL Its 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 7�—'7T 206 Final Plumbing .. 200 Final Re -Roof L b 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 ORANGE COUNTY BUILDING DEPARTMENT i 636 NortF - 'wdway ' SANTA ANA, JFORNIA APPLICATION FOR PERMIT FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN I RECEIVED BY RECEIPT NO. GATE RECD. PERMIT NO. GATE ISSI�ED BUILDING 1/76,1 ADDRESS SCHOOL DIST. /0� _yq� OR TOWN //S��"l4G/Q� I1/� / _ /��/©� �\ / CROSSNEAREST �" Gi , ,\�I OWNER B�JILDING ADDRESSMAIL. �v/s ADDRESS I /�,y y cl SCHOOL DIIb�.y-� S\ OR TOWN ��61 I CITY 1 ,&zzlL NO` NEAREST " CROSS ST.V\ ARCHITECT OR LIC. ENGINEER NO. ZON/ PLAIDS TYPE-- �--GF A ADDRESS APPROVEDrTR1� •�� , '% 7 BY_O~AT.E LIC. I // V 1/ C_OR WTIOLEGAL CONTRACTOR /A, NO. / ADDRESS I � t LO ( 7,, DESCRIPTION NOT O� BL TRACT j G(/ !ATTACH METEri BOUNDS NO. OF BLDGS. SIZE OF LOT•y/ NOW ON LOT _ USE OFLI I I EXISTING BLDG. / _ FMILIEE ROOMS SETBACK LINE FROM: y REARYARD o2. - - - 0 CENTER OF STREET / SIOE YARD _T DESCRIPTION OF WORK NEW I I ALTERATION I ADDITION I� - D r REPAIR I MOVING I I DEMOLISH I BUILDING O. OF I O / SIZE MS STORIES EXTERIOR WA R OF COVERING COVERING y USE OF NEW BUILDING APP OVALS FOUNDATION: LOCATION ! NSPECTOR DATE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORMSALS ,PINN NG •/ Q APPLICATION AND STATE THAT THE ABOVE IS CORRECT FRAME: FIRE STOPS. BRACING. BOLTS �l AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. LATH, INT. LATH, EXT. SIGNATURE OF PERMITTE _ PLASTER. INT. PLASTER. EXT. AUTHORIZED AGT. /oU �pJ PERMIT FEE E p MASONRY REINFORCED VALUATION $ J S J PLAN CHECK BOND BEAM TOTAL FEE FINAL • (I P .;•'P ' n PLOT PLAN Show location and distances from property lineond.between buildings: t A. 1 I � I PLOT PLAN Show location and distances from property lineond.between buildings: t A. 1 . \.. ... PLOT PLAN Show location and distances from property lineond.between buildings: t A. 1 PROJECT ADDRESS: 1763 ANAHEIM AV OWNER'S NAME: STAN KOSTECKI ADDRESS: 1763 ANAHEIM AV COSTA MESA CA 92627 ARCHIENGINEER: ADDRESS: UNIT: REG.NO.: UNIT: PERMITTEE: CHEYENNE PROPERTY SERVICE (714)693-9171 ADORESS:19841 FUTURA DR YORBA LINDA CA 92686 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions Of Chapter 9 (commencing with Section 7000) of On, f he Business and Professions Code, and my license is in full force and effect. CITY LIC% STATE LIC.6 4 2 0 13 LASS: C-1 0 Dale: Z _ Signature: WORKERS' COMPENSA ION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab, C). POLICY 11296342-92 1 DATE: 04 /01 /93 COMPANY:STATE FUND I Certified copy is hereby furnished. IKI Certified copy is filed wl the city /Building �Division. Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($10D) 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 WorkersCompensation Laws of California. Date: Signature: NOTICE: ll, alter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of 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/She is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or that he/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 penally of not more than five hundred dollars (5500). 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 (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner Of a property who builds or improves thereon, and who does such work himsell/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building Or r 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 purpose of sale). ,as owner of the property, am exclusively contracting with licensed contractors to Construct the project (Section 7074, Business Eland Professions Code. The Contractors' State License Law does not apply to an owner of propetly who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' Slate License Law). I am aware that proof UI their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B_ S P. C. Lor this reason: Date: Owner: I do hereby cemfy that I am aware of and understand the requirements of California Health and Safety Code Sections 25505. 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 for construction or modification from the Air Ouality Management District. Residential construction applications are exempt from (nese provisions. Dale: Applicant: I hereby Cerlily 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 slate laws relating to blinding construction and hereby authoriz epresentatives of this city to enter upon the above-mentioned property for intrepid 1, @j"'poses. Signature: Driver's License of Social Security a: 164146 While—Building: Grea,Code Enforcement: Canary—Applicant, Pink—Revenuo: Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO; E 061144 PERMIT NO: E 061144 PLAN CHECK NO: N GOVT; N SUPP: N CONSTRUCTION TYPE: 5-N PERMIT TYPE: ELE PURPOSE: OTH JOB DESCRIPTION : ELECTRICAL SERVICE CHANGE OUT SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 / COMMENTS: INCLUDES UPGRADE ON SUB-PANEL Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REqq• PROV; PARCEL: 42426225 ZNE: REF NO; PLANNING NiSTES> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 29.50 15,00 0.00 > .00 REVENUE DIVISION TOTALS--> COLLECTED; 44.50 OVER/SHORT; .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING D E V E L O P M E N TR V I C E S R E Q U I R E M E N T S ZONING APPROVED BY I N D I V I D U A L F E E B R E A K D O W N DATE: BUILDING APPROVED BY DATE: APPLICATION ISSUED BY: DATE• LEGALIZATION:N FSE E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 29,50 508 SMIP/NON-RES PLAN ISSUE FEE 15.00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 29.50 15,00 0.00 44.50 44,50 .00 REVENUE DIVISION TOTALS--> COLLECTED; 44.50 OVER/SHORT; .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 44.50 I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 1 SERVICES BELOW 600 V & BELOW 201 AMP 18.50 18,50 ELE 1 SUB -PANEL 11,00 11,00 END OF FEES CONSTRUCTION AND PLANNING APPROVALS Permit # Date _ Inspector POC SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Seevice or Pole 52. Pool & Equipment Location t 2. Soil Pipe-Undrgrnd. i '- 53. Steel Reinforcement 3. Electrical Conduit lhdrtyUndfgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. ; •, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13, 'Roof Drains 64, Plumbing System -Final - 14. Rough Plumbing 65. Electrical -Final 15.' Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical•T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19. Rough Heating TA,, Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit #` 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas 0 Oil 23. Gas Pipe:Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank L7 Gas ❑ 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 (n 79. FINAL INSPECTION 32. Electrical Power Meter -Final' / ,/ �(/ 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning , 35. Final Gas Pipe -Test 36. Hood or Canopy I. 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final , 42. Backflow Preventer , 1 43. Backflow Irrigation 44. Landscape Irriqation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 1 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date