HomeMy WebLinkAbout1391 BAKER ST - Building Permits , • • r
CITY OF COSTA MESA
,ba . BUILDING DIVISION •
1Fv •l. 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca...p77
-4. � FOR INSPECTIONS CALL: (714)754-5626
•
PERMIT NUMBER:- 'BC07-00341
•
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 11/01/2007
ISSUED BY: BJK
• JOB ADDRESS: 1391 C BAKER ST CM Suite/Unit: C •
• APN: 14119103Zoning:R3, , , , ..
Vicinity: UNIT C Primary Occ:
Const Type: V-N . SO. FT: 0 - .• Valuation:• $4,000.00
SCOPE OF WORK: CHANGE-OUT OF 7 WINDOWS(RETROFIT) IN UNIT C OF A TRIPLEX. ELEC: 3 OUTDOOR LIGHTS, 1
FLUORESCENT KITCHEN LIGHT,'12 UTLETS, 13 SWITCHES. PLUMBING: CHANGE-OUT 2 BATHROOM SINKS 1 KITCHEN SINK
OWNER: HARRIMAN,ERIK D Address: 300 35TH ST • ' Unit:
Phone: 949.887-6447 • • City/State/Zip:'. NEWPORT BEACH,CA • . • - . • -
APPLICANT: HARRIMAN,ERIK D - Address: 300 35TH ST - Unit: :
Phone: 949-887-6447 - City/State/zZip: NEWPORT BEACH,CA
CONTRACTOR: OWNER-BUILDER License No. 000000
Phone: Address: Unit: - -
Cell: City/State: "ZipCode
ARCHITECT: • - – License No. - - PHONE:• ;
ENGINEER: • License No. _ •e 'PHONE:•
COMBINTATION PERMIT FEE SUMMARY
Building Plan Check: $0.00
Building Fees:% • $97.25 , -
Electrical Fees:( $55.40
Mechanical Fees: $0.00 .
Plumbing Fees( - $52.90 •
SMIP Residential: . $0.50
SMIP Commercial: $0.00 '
TOTAL FEES: $206.05
**Refer to fee receipts for all fees paid for project
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
CODER INSPECTION TYPE pATE IN1TPALS CODE II INSPECTION TYPE fag INTIML¢
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbin atitzg /1 0
200 Final Re-Roof 210 Final Electrical dttelud /1 9/cl' '•- :7„ /
201 Final Block/Retaining Wall 212. Final Fire Prevention 4
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign - _ 222 Final Site
��—µ�/�,•,,'��/�/�,'',
204 . Final Demolition • 250 Final Building/Occupancy,}2t AfJ //Q/,91 [�1 V
l
WORKERS'COMPENSATION DECLARATION Owner ID verified by dr, .a. 4� es ❑No /�
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. (' Expires: a—ZC5-- /"
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: •
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: 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
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(Thissedbn need not be completed(the pen7 is valued at one hundred dollars(3100)orless.)
2.Mt 2Sec.341,Title 8,California Administrative Code).
Policy Number:
❑ As owner-builder, I will not employ anyone to do work which would
PI certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
ssued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become �5ybject to the workers'compensation provisions of Section 3700 of
0 0 ,I shall forthwith comply with these provisions. Applicant's Signature Date
���'717171''///"MM""111��rrrr///// iii 07 Division of Industrial Safety Permit Number:
Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds.or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect, a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.# Class# (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
Contractor's Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? CIYes ❑No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 255314 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes El No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8 (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer). •
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty-of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
IDI, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044.Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction,and authorize representatives of ,
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
4 ?...j, authps,o izzedby tthh�is permit until final inspection.L /) _ / — O7 yapt re of Legal Ownerlsnr� 1 Date
Signature Date M1/ /I I _ 0 2
3057-0e(3/07)
A d/or Authorized Applicant Date
MF CITY OF COSTA MESA
49 BUILDING DIVISION
____ r DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
41 PERMIT
, � B03-01767
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ctue, NG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDIJob Address: 1391 BAKER ST Status: ISSUED
Suite: Applied: 10/10/2003
Vicinity: ROOF Issued: 10/10/2003
Parcel Number: 14119103 Zoning: R3 R3
Applicant: ERIC STICKNEY ISSUED BY:
Address: 370 MOLINO AV
' Phone: 562-438-0757
LONG BEACH;CA ` - Zip: 90814
Owner: MILBERT, ALLEN J
Address 3179 CORTE PORTOFINO
i
Phone:
NEWPORT BEACH,CA' Zip: 92660
Contractor: CDS CONSTRUCTION
Address: 370 MOLINO AV
Phone: " 562-438-0757
LONG BEACH,CA
Zip: 90814 License: 768490
Arch : - Eng:
Address: - Address:
. Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 15#FELT,30 YEAR COMPOSITION SHINGLES(TIMBERLINE)AND REMOVE AND REPLACE 20 LF OF
FRONT OVERHANG,NEW SHEATHING.23 SQUARES FOR RESIDENCE ONLY.
FEE SUMMARY
Plan Check: $72.31 _ - Calc Valuation: $4,850.00
Permit: $111.25 Claim Valuation: $4,850.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $184.06 • •
N
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 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 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:
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 workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued et 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 that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these previs' ns.
Applicant Signature: i .? -> �'— Date: /0-/0- 0 3
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($1DD,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION erw OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
1 hereby affirm that I am licensed under 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.# 261410 410 Class#
Contractors Signature: ` —' Date: /O-!O- 6 3
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax 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,Califomia 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? ❑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 a'standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 1:1 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 ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes S 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 ❑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.
jihnature Of Legal Owner(s) Date
70- 0-0 3
And/Or Authorized Applicant Date
CODE# INSPECTION TYPE PAIS INTIMAL$ CODE it INSPECTIONTYPE PATE =ALA
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final208 Final Plumbing
200 Final Re-Roof /-7-49:1-973 210 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 J
jr
BUILDING DIVISION
> g..a.yiehrb, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
+ so JB02-01356
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1391 BAKER ST •
Status: ISSUED
Suite: Applied: 08/23/2002
•
Vicinity: ROOF Issued: 08/23/2002
Parcel Number: 14119103 Zoning: R3 R3
•
Applicant: MAUPIN, ANDREW ISSUED BY:
Address: 923 N LOGAN ST
Phone: 714-558-3707
SANTA ANA CA Zip: 92702
Owner: MILBERT, ALLEN J
Address 3179 CORTE PORTOFINO
Phone:
NEWPORT BEACH,CA Zip: 92660
Contractor: SANTA ANA ROOFING &WEATHERPROOFING INC
Address: 923 N LOGAN ST
Phone: 714-558-3707
SANTA ANA CA
Zip: 92702 License: 463596
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROCK ROOF.INSTALL 1 LAYER,30#FELT,25 YR COMPOSITION SHINGLES.900 S.F.FOR
2ND STORY PORTION ONLY OF DUPLEX.DOES NOT INCLUDE GARAGE.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $1,500.00
Permit: $54.00 Claim Valuation: $1,500.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $54.50
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 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
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12.21.92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work is suspended or abandoned
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)75456226
244S41(aoo)
DECLARATIONS t 0
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have end will maintain a certificate of consent to self-Insure for workers'compensation,as provided far by section 3700 of the Labor Code,for the performance of the
1 work for which this permit is Issued.
NCI—I)lave 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.
I
-My workers'compensation Insurefn carder and policy number are: L n q
Cartier.) STs E ' ts 0 Policy NumberJ 1b(1r�3 /
•,(This section need not be completed l r milt is valued at one hundred dollars($100)or less.)
�n: .: 11
❑ I certifympthat in the poamen',. .work for witch s to permito L5 issued,I shallhnot employ any on In any manner a as to becomef t subject to the I shall forthwith
laws of Calif•�• t � •agree U:t I I should become subject to the workers compensation provisions of Section 3700 of U r Code,I shall forthwith
comply_with these pro
{ . pi`m.s pnewre� / r {Dat'a t��Z 3 a Z
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION E IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000).IN ADDmON To THE COST OF TION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
).hereby:afflrn'thot l em.11cense. der provslo s of Chapter 9(commencing with Section 7000)of Division 3 ol-the.Business end gjof ssions Code,and my license is In full
force entailed.L ure I JL Class q
.Contractors actor gnature -di. •L I ' '- Dere:-._., A� a o 'J
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that 1 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 U 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 for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the properly,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 properly,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 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,An 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 d'Mslon.
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 end 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 feel 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 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).
__...._ —' _._..Pogc�—.�_
3 Does sr will the applicant cur 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 Safely 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 Celifomia Health and Safety Code beenen fully complied with? 0 Yes ❑No
5 Does or will the applicant Or present or future building occupant require for the work which is the subject of this application agemut for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No
(Section 85R50.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
cefo.._...__ Yes----0—No
Will any part of the facility to he 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 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? 0 Yes ❑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 Materiels 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 compl with ell sta laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described propee ei "for inspecti purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. .
(/
`/ , SI matYr 0 Legal Owner(s) — a� �j
I OP (AhdlOr A Applcant> /( ate >
;ODE I INSPECTION TYPE PATE IMA.LS ;DDE if QISPECBON TYPE Q61 MOM
1616 . Fixed System Final Fire Prevention 206 Final Mechanical
1268 Pool Spa Final . 208 Final Plumbing
200 Final Re-Roof 1j-*0'az- arit 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
89)73 FESECEWED
COSTA MESA BUILDING-SAFETY DEPARTMENT ���d C1 DI-PT•
P.O.BOX 317 COSTA MESA. CALIFORNIA tt
CITY OF COSTA MESA
FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
ADDILESS 1391 ABC Baker St. e�
COSTA MESA. CALIFORNIA FOR OFFICE (/SE ONLY
I RECEIPT NO. I PERMIT
OWNER Kendon Homes, Inc.
MAIL RECEIVED BY I TE RECEIVED ,D`TEJ8SUE1}
ADDRESS 1555 Placentia Newport Beach -/y/^,-,A Jnr,•
PI Li, (��((// J 77
BUILDING
ra 6-3227 TEL. aP
CITY NO. ADDRESS
•
'
ARCHITECT LTO.
OR ENGINEER Same NO. COSTA MESA. CALIFORNIA
ADDRESS • Same FIRE type �'OUp
--`i ��{{ Co. ZONE ���rrr
CONT ACTTOR Cons t. CLC No. 61195 APPROVED
BY DATE
ADDRESS 'same ZONING
LEGAL rcel 11V1f I 16[4 ZONE ^ /T NO.OF I USE OF NEW
DESCRIPTION NO. BLOCK TRA IyP(11T/•PLANS/ l� BUILDING
A.P.NO. APPROVED-/� y . // l /.;--'7,"
r DATE
IY-6-1/47
BY G dl's L\!
SIZE 50 x 130 I NO.of SLOGS. 0 YARDS EVES
OF LOT NOW ON LOT REQUIRED • ALLOWED
USE OF (CENTER LINE ST.)
EXISTING BLDG. FRONT FT. IN.
SETBACK LINE FROM
CENTER OF STREET 631'211 REAR YARD 5 R.SIDE ...—j FT. IN.
SIDE YARD I LEFT 5 I RIGHT L.SIDE ST. IN.
DESCRIPTION OF WORK c.
REAR �✓ FT. IN.
NEW I X II ALTERATION I II ADDITION I
REPAIR I -II MOVING I II DEMOLISH I
SIZE BUILDING 2710 NO.OF ROOMS 12 STORIES 2
EXTERIOR WALL,. ROOF
COVERING S1,11CCC ICOVERING hot-mopped
USE OF BUILDING AND WORK TO BE PERFORMED
Tri nl ex resi Bence and_ PPS a e
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CDM.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING ucrlorv. 1 VALUATION
PIGNATOR=••- - /Y A._ / PERMIT FEE $ 43.00
PERMITTEE , ! 2�-I
$ 23, 21
060.00 PLAN CHECK $ .50
AUTHOR •• AGENT TOTAL FEE $ 64.50