HomeMy WebLinkAbout1269 BAKER ST - Building Permits L' CITY OF COSTA MESA
t ►\CC BUILDING DIVISION
Fr..� DEVELOPMENT&EF'VtES DEPARTMENT PERMIT NUMBER
4 PERMIT
B02-00884
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1269 BAKER ST Status: ISSUED
Suite: Applied: 06/19/2002
Vicinity: Issued: 06/19/2002
Parcel Number: 14120104 Zoning: R3 R3
Applicant: FAUBERT, BRAD ISSUED BY:
Address: 8902 SAILPORT DR
Phone: 714-926-2203
HUNTINGTON BEACH,CA - - Zip: 92646 •
Owner: MARTINEZ, MARIA J -
Address 26972 BANDERAS
Phone: ' ,
/MISSION VIEJO,CA Zip: 92691-6011 Ari[ r
Contractor: STAR COURSE ROOFING CO.
Address: 8902 SAILPORT DR
Phone: (800)854-0011
HUNTINGTON BEACH,CA
Zip: 92646-2664 License:" 532778
•
Arch. : - Eng:
Address: Address:
- Phone: - Phone:
Zip: License: License:
- ,• ; ,. SCOPE OF PERMIT . _
TEAR OFF EXISTING ROOF.COVER WITH BUILT-UP.PROJECT IS A FOUR PLEX.ONE BUILDING,TWO STORIES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $2,190.00
Permit: • $83.25 Claim Valuation: $2,190.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75 •
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)754-5626
244648(WOO)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: - r
I hereby affirm under penalty of perjury one of the following declarations: t-•
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 performance of the
11 work/ for which this permit is issued.
eve 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.
�7 My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed At : ,. it is value. : • e hundred dollars($100)or less.)
❑ I certify that in the perform:Ar•: - • for w•':. this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws• I omia,and a• -: -. If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with the . • •visions. /y�1 r'�
Applicant Signa . Date: (p--I 1 - Vtm
WARNING:F =-• RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,003),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 DEC , .
I hereby affirm that I am lice.-=d ander roNsions of •,•er 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.4 / Class 4
Contractors Signa • e: / Date: Co
CONSTRU ION • G/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,CMI Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
6-a.'.
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 ajpermit.to.sconstruct,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 licensdd!pureuant 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 o(shl�isazempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant tda dvil penalty of not more than five hundred dollars($500).): •
❑ I,as owner of the property,or my employeas'with.wages es their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contrectors 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,end 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 driver's 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,felsework,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 and pressure).
._ .._ ... ean RMP ._ ._.t.._
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 0 No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ❑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? ❑Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 stat: • • • •: ces relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for in •: on purposes.I agree not t• • upy or allow occupancy of any building authorized by this permit until final inspection.
Signature O eg wner(s) /_ ( q — c5)1
/—
. 'nd/Or Authorized Applicant t0 Date
CODE t :1:19 1•. IPATE INTIf1AL5 CODE! INSPECTION TYPE BATE POW&
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final T j )�., 208 Final Plumbing
200 Final Re-Roof "••90I' 13K) (M✓l 210 Final Electrical
201 Final Block/Retaining Wall 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
l ' CITY OF COSTA MESA
` . BUILDING DIVISION
>:
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 Ls issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
(3V-certify that in the pertgqrr00n1ance 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 Colifomla,and agree thRt if I sho Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these
Applicant Signature: ° )Wia\/ 1 Date: I i-G(-V
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THrx ICAND DOLLARE(SICO,000),IN ADDrAICN 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 and Professions Code,and my license is In full
force and effect.Lie.# )QLL,lyyl�71�JO Class# Cc2O
Contractors Signature: 'f'a rit,,(_A d4.111JLC-'LC Date: /I--o24-0 I
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 per+'
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 puisuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's 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,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? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mosa 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 in 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 end 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.
_.. ........_ti.. _t__....._... __....__......_...__.....___.._...—.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑Na
._......_ _... __. _._ .._ ..._.thi........_.____...._..._.._._
5 Does or coo the oast Air or DualityiManagement n building occupant at y otherefor the work ontch is thesubject this a Yestion eggeNnli for such construction or modification
from the South Coast Air District or from any air pollution control district or agency? �Yes LJ No
(Section 65850.2 of the Califomia 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 to 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).
._..___...._.i._..._._ __ __.._... _......_...._ _ _ -_.._ -
7 Ifa a permit from the South Coast res Descry ed by CaliforniaiHealthal or other eCodeeion control districtbn agency is required for the work which Is me subject of this
application,have all of me disclosures prescribed by Celoia and Safety Section 42303 been made? 0 Yes ❑No
_ of
6 (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
QpJurrpos�es.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Ig
nd/Or Authorized Applicant Date
CODE t Impaction TYPE PATE INTIT1AL5 CODE, INSPECTION TYPE DAM \
1616 Fixed System Final Fire Prevention 206 Final Mechanical 7' 9-(>q
1266 Pool Spa Final 208 Final Plumbing /
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention •
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
)204 Final Demolition 250 Final Building/Occupancy
CITY OF COSTA MESA
� BUILDING DIVISION
>44l nnaul1111 Vitt ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
�
't �s PERMIT
.• .. .. ,. P03-00247
(714)754-5273 • Fax(714)754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1269 BAKER ST Status: ISSUED
Suite No A Applied: 04/16/2003
Issued: 04/16/2003
Vicinity:
1110 _
Parcel Nunmber: 14120104 ISSUED BY: .4110.
Applicant: ROMERO, JOE
Address: 24881 ALICIA PKWY .
SUITE E312 Phone: 949-770-6411
LAGUNA HILLS,CA Zip: 92653
Owner: MARTINEZ, MARIA J
Address 26972 BANDERAS
Phone:
MISSION VIEJO,CA Zip: 92691-6011
•
Contractor: AMERICA'S PLUMBING
Address: 24881 ALICIA PKWY
SUITE E312 Phone: 949-770-6411
LAGUNA HILLS,CA Zip: 92653
License: 784091
Arch / Eng: .
Address:
Phone: .
Zip:
License:
SCOPE OF PERMIT
PLUMBING TO INCLUDE:REPLACE 1 GAS(1-4)OUTLETS FOR UNIT A.
FEE SUMMARY
AMT QTY AMT -QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 •- Sump Pump $0.00 0
Backflow irrigation. $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 . Wash Basin $0.00 0
Dishwasher $0.00 0 . Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0. Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial - $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
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:
Cartier. Policy Number.
(This s /on need not be completed if the permit is valued et one hundred dollars($700)or less.)
1 certify that In the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pro, Ions. /�
` A 01,<b 63
Applicant Signature: I_ •.,iv/ a- .r .-. Date:
WARNING:FMLURE TO SE• �r W'� '( '• TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI IES AND CIVIL FINES UP TO ONE HUNDRED
11-101/SAND DOLI.ARE(51ADDITION TO E 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 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.Uc.4 ! ii a Class
Contractors Signature: dJr4It? 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,CMI 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 cMI 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 end 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 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 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 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 Cade 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 Duality Management District or from any other air pollution control district or agency? 0 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
(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 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 COMPUANCE 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 end 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.
Signa9luLrs)
re Of nt • e
CODES N•, $• DdIF MA45 LODE! INSPECTIONTYPE RAIL Mal/��/-'�/v��.�
1616 Fixed pSa tem Final Fire Prevention 206 Final Plumbing
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
•
, _ _
TOWNER RUBIN HOWARD P. DATE 9 8 9 _
JOB ADDRESS 126• W Bake_ St eet -- ' .i Y-ANN 2. ..ig..r BUILDING PERMIT NO. 10 2
GENERAL CONTRACTOR Richard A. Huff— VALUE $ h1,386.00 ' _
AP. No. LOT2q 2 4 TRACT 3377 FIRE ZONE DESCRIPTION OF WORK 14-plex w/att.gar.
I ECTIONS 0_,"4-* DATE I GROUP H & J TYPE V ZONE R-2
L. erground Soil'/ U.G. Water 9-/4--6=1 PERMITS ISSUED
Underground Gas SUBCONTRACTOR DATE NUMBER
Overhead Water and Gas
Rough Heating Ails' '0' -'-a'9 •4-$7 _ 9: �g o2 69( /
Rough Plumbing /l¢/5 ro-/H-S-p �,�- _' .A., y,pe, of 9-/!,1-5'9 .2 no ' s.
Miscellaneous X3,0164-le dao /0--070-. _a/9 �hir K'`
�
Prop. SwrCLine�House Con. St. Swr, • /y'C ,„....6- Jj„S.T'� ?/1--t Li) r' D`S' • iffy'
Sprinkling System yr 4 i e
Heating, Final kg/ &cc- r
rr -
Plumbing Fixtures /,e k/ yffr'l
Final Gas Test 1KXn, ,La/ ' -1 - / 17 -
Construction Pole
-
Underground Power -
Rough Wiring 24t.'t (OL4-CC/ D--j/ . ti .7:A.;.. 9/o -r9 //1/// /
-
Trenches Forms Steel f-t-E Y -'/OSJ
� i
Floor System Y'-/r 1 I '
Steel Reinforce Chimney Re-Rod
Bond Beam -
"'-cathing , (0 -/4^-J 'I
Ame and Flashing 9,- /0 "%./ -6?
Lathing, In Out 6t,A; e ;7 ' .$19 - :V _
Plaster, brown coat Z.---"&"if /I-/Z'•-%/
Plumbing Fixtures, Final (.g'/
Electric Fixtures, Final !y/ ..�.
Building, Final ` f. }_ r
OCCUPANCY / , i 17,,-7-7.37 - _
Form 210-3M-4-59 / UNIT A
OWNER RUBIN, HOWARD P. DATE 9/8/59
JOB ADDRESS 1269 W. Baker St. BUILDING PERMIT NO. 10323
GENERAL CONTRACTOR VALUE $
AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK
I' ECTIONS o,-the-a DATE GROUP TYPE ZONE
Ur...erground Soil p/.e{ U.G. Water44,Sg-/.S;a. PERMITS ISSUED
Underground Gas SUBCONTRACTOR DATE NUMBER
Overhead Water and Gas
Rough Heating ,4d-ç4-2-1 ST
Rough Plumbing /L/}-S/a-Y•,.5v 42cLcbai ,Ci_li J, 9-/4-S , _ ,e e '
di
Miscellaneous
Prop. Swr. Line House Con. St. Swr. '
Sprinkling System 1i
Heating, Final '1-- N/ /,�-Q 12
Plumbing Fixtures (.(/ arl' _ }1'
Final Gas Test I W 0-i— 4
Construction Pole
Underground Power ,
Rough Wiring ike-2��ss////%/'Su ', ' .d - 9-to -c y /o/i'7 ------
Trenches
Trenches Forms Steel d—�r✓`C ..-/.b_t
`
Floor System Y -//S`O'
Steel Reinforce Chimney Re-Rod
Bond Beam
-`eathing yoyy�,yyC�'' /O-/�"��
ime and Flashing Y/gYi( /q —, 4-3`V / _
Lathing, In Out -d /-1'.V(1 -,')1
Plaster, brown coat 4.4rr /1-0.:',1"9
Plumbing Fixtures, Final P
Electric Fixures, Finalfr,• 4/4,,
•
Building, Final
OCCUPANCY 44/11).7--SI
Form 210-3M-4-59 UNIT B
OWNER RUBIN, HOWARD P. ' DATE 9/R/59
JOB ADDRESS 1269 W. Baker St. BUILDING PERMIT NO. 11)323
GENERAL CONTRACTOR _ VALUE $
AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK
II iCTIONS ray-G4' DATE GROUP TYPE ZONE
Unuerground Soil/Sic U.G. Water ,t46f-/s-5 PERMITS ISSUED
Underground Gas SUBCONTRACTOR DATE NUMBER
Overhead Water and Gas
Rough Heating 5 /p -23-0
Rough Numbing /147‘5 `0-/cfr-y-r/,i ___ rf-m-s-y ,. ;
Miscellaneous P
Prop. Swr. Line House Con. St. Swr. ,
Sprinkling System 1 f. ,$
Heating, Final • % '1
Numbing Fixtures S .
•
Final Gas Test /,C' / 4 iJ' _ —,.�
Construction Pole
Underground Power
Rough Wiring ,,ii /a'1/-7v _ ,,,,.,� LO Y-/c s-9 6/
Trenches Forms Steel- '
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
lathing
acne and Flashing ,5� �w✓ ii ^'k-c'Y r
Lathing, In Out 41-1 le -so ".fir,
Plaster, brown coat 4 t-* //-/2--:1 r
Plumbing Fixtures, Final fQj EIA-M9
Electric Fixtures, Final
/ ;I 'r5/�777
Building, Final pf1C{/,� 7�/'S
OCCUPANCY X9a, /]..-}2.'/17
Form 210-3M-4-59 UNIT C
• OWNER RUBIN, HOWARD P. •
DATE 9/8/59
JOB ADDRESS 1269 W, Baker St.. BUILDING PERMIT NO. 1 23__
GENERAL CONTRACTOR VALUE $
AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK
I ECTIONS GyL/- 9 DATE GROUP TYPE ZONE
L....erground Soil /y.{.S U.G. Water44 54—/S- et PERMITS ISSUED
Underground Gas SUBCONTRACTOR DATE NUMBER
Overhead Water and Gas
Rough Heating fritt.c /0-3-_3-3, •
Rough Plumbing /yyC 10-70-1V Xze/d pl lV -ni/• 9-/4f-r9 . O ; ' ' i
Miscellaneous
Prop. Swr. Line House Con. St. Swr.
Sprinkling System nil
Heating, Final • a W. OP-,3t7
Plumbing Tst Fixtures frw�`-- te: -0- y
Final Gas Test /d 4. 9•� - �`
Construction Pole
Underground Power
Rough Wiring 4r6 (l-/-w ,,,. t-/J.,• T 9-/0 -c? /01/ 9
Trenches Forms Steel
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
-"eathin•
1 ame and Flashing ,w':r. /6 -,2(e--j7
Lathing, In Out ,� 'ea..Ro- 4Y-
Plaster, brown coat A/- . /1 -'/2
Plumbing Fixtures, Final A_u.,a4-41
Electric Fixtures, Final
Building, Final J
OCCUPANCY Q(1<12.-2a--Il y
Form 210.-3M-4-59 / UNIT n
OWNER RUBIN, HOWARD P. ' _ _ DATE 9/8/59
JOB ADDRESS 1269 W. Baker St.. _ ` - - ' BUILDING PERMIT NO. 10329 —
GENERAL CONTRACTOR VALUE $
AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK
'ECTIONS q ,',' -9 DATE I GROUP TYPE ZONE
L_aerground Soil)fr.}S U.G. Water,44� /S- SUBCONTRACTOR PERMITS ISSUED
Underground Gas DATE NUMBER
Overhead Water and Gas
Rough Heating /Ws /J-1;-577
Rough Plumbing /14/S ro w-S'y
Miscellaneous
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating, Final ' fes _ 1
Plumbing Fixtures 3fy� Y, I ��
Final Gas Test J,J, GIStV � i0,--,2 ,n.j7 iA '
.. •
Construction Pole d
Underground Power • r •
Rough Wiring �'t /O2/fv7 i/.,A , (_ ,,,,-- r.,:- 9-/6-r9 e :JVD/ • '
Trenches Forms Steel 9 -r6
Floor System -_-_1_ 9/ 3
Steel Reinforce Chimney Re-Rod
Bond Beam
Theathing
nine and Flashing ,2 4tiv,•-s
Lathing, In Out Er-t1'& ✓o •. PIC K7
Plaster, brown coat
Plumbing Fixtures, Final / , Sir
Electric Fixtures, Final
L./).P,/�"'/�i
Building, Final
OCCUPANCY C- )a-u-- ry
Form 210 -3M-4-59 / LAUNDRY
10323
''
COSTA MESA BUILDING-SAFETY DEPARTMENT V4! V ,, r
P.O.BOX 317 COSTA MESA. CALIFORNIA � a �`'I i
„Pt r-INANCF DFPI-
fOR APPLICANT TO fill /N COMPLETELY? orAPPLICATION hFO,R,,.PERMIT
TYPE OR PRINT •BUILDING
NG
ADDREBUILDSS 1a Lic 1..Atra_\��c- 'SA,, •
COSTA MESA, CALIFORNIA TOR Off/CE USE ONLY ���...111
O I .RECEIPT NO. PI`_NO.
OWNER r �� 'S elin
MAIL \ RECEI VM -DyFRECEIVED DATE ISSUED
ADDRESS �`i5 .c A..12a .9S_- <I
TEL
BUILDING
CITY��-tx.S X�A\\�a _ NO.0 r ADDRESS )2 4-9 4) Settic
--et/
ARCHITECT LIC.OR ENGINEER NO. COSTA MESA. CALIFORNIA -
FIRE
ADDRESS ZONE TYP GROUP 4191
J 9
1
STATE. BYPROVEDt .� DATE Q/ .25.-
CONTRACTOR LCNO\ \ "�
ADDRESSy9 5. yC`'a CLaka\k)LS, ONING
. .
LEGAL LOT2 _ I I '(lam\Q1 ZONE 1 ) �NO.OF USE OF NEW p7..r/M/-L/
. DESCRIPTION NO. BLOCK TRAY"
/07 PLAN$ �I'BUILDINO J/T "
APPROVE /o ,,,111 V
' A.P.NO. BY �I a !�' a ATE ^ 4•1-57
SIZE t 1 \ \I NO.OF BLOCS. �l YARDS ' �Ev6
a OF LOTs7,7S A,\OS' -*5T1•2S AAS NOW ON LOT ll REQUIRED ALLOWED
USE OF _ (CENTER LINE ST.) /'� •
EXISTING BLDG. FRONT St FT. IN.
SETBACK LINE FROM I '\
CENTER OF STREET 5 REAR YARD'? V R.SIDE 1('" FT. IN.
SIDE YARD I LEFT �\ I RIGHT ` ,',�� L.SIDE ,
fT`, LL FT. IN.
DESCRIPTION OF WORK
REAR �FT. IN.
• NEW I'S.II ALTERATION I II ADDITION I 4!V7. ((//q ,RT7, 4 L* \II] Aril n1 _.
REPAIR I II MOVING I II DEMOLISH I /1t L1 II d � j.\I Ut, I�
SIBZE
NO.OF
ROOMS STORIES T!�. r i� 1 T AI♦ 0 (
EXTERIOR WALL I ROOF 111. :I . `a\- IJ 4 as JL./ ' e
' COVERING COVERING /) '/
USE OF BUILDING AND WOR TO BE PERFORME• I /
• o / . �h. / r
- ‘..' r- _ aha.- 1 /L -- "_�
•
'I "A I-
/} S VAR Nn O, ,11PPRnVVD 54y^.s
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION �'
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO C _ THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGUL I PURPOSE OP ESTABLISHING' A PERMIT FEE ONLY.
BUILDING CONSTRUCTION.�� /1 1 \p1 VALUATION / '1
SIGNATURE FCC......_ PERMIT�.�/ I`� , \; PERMIT FEE $ (�/A U C
PERMITTEE ��\�� l `R'N1 $ 9? 310
d{
d !F p
PLAN CHECK $ 4�(/-A \} L
AUTHORIZED AGENT TOTAL FEE S 9/✓•.) 0