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Home My WebLink About2123 FEDERAL AVE - Building Permits j��L=1'k,,. CITY OF COSTA MESA 4 aBUILDING DIVISION >: DECLARATIONS 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 for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I hav 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. orkers' mp ✓a rerRSe canVz3bar are: ""• L2 �•arrier Poli Nus �( ` 5 is section need not be completed lithe permft Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for I h•perm .ued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo• and:gre�4fiaN1� d• ubject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi•Iia 1�' � _. oilmiv ': - r Date: WA- INO:FAILURE TO SECURE WORKERS'•• - NSATION COVERAGE -UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1WADDITION ,COD),W TO THE COST OF COMP COVERAGE, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION:�a,� I hereb affirm that I am licensed PdEL f$,f,..• ., r,..ter B(commencing with Section 7000)of Division 3 ill e.Buslness and (fess s,i ode,and my license is In full Q"i�•leffect: .ft `K— I. C� dT.(o 4/01r 1=PI CONSTRUCTION LENDING AGENCY: In 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: 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 U 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. 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.faisework,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 Safely,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 greeter than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or VI the applicant-WIpresent or future building—occupant require for the work which Is the subject of this application epereit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 pennit be within 1000 feet from the outer boundaries of e school? 0 Yes 1:1--No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 a ppatrotram the South Coast Air Descry ed Management eal or other airpollution control district3or agency is required for the work which ci the subject of this application,have all of the disclosures prescribed by Californiala Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I aaaggrrreen not to occupy or allow occupancy of any building authorized by this permit until final inspection. 09r/toe, - ,^{)ateO/AujAlmatant�, 9 QTte `;ODE F thIPECTNIN TYPE '.r EM1161.1 1:OQE1 INSPECTION TYPE PAM g1IIDAtS 1616 Fixed System Final Fire Prevention 208 Final Mechanical �/ 2 1266 Pool Spa Final 208 Final Plumbing 1-1 ✓cc "RC" 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well , 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 • APPLICATION FOR PERMIT - 636• NoFORy B U I L D B N G 1 SANTATA ANAA,, CALIFORNIALI FOR APPLICANT TO FILL IN "FOR—OFFICE-USE ONLY _ RECEIPT NO. PERMIT NO. BUILDINGV / `4372 ADDRESS 2123 Federal ([I /r/ SCHOOL DIST. OR TOWN RECEIVED BY DATE RECD. DATE ISSUED NEAREST I �, 6 --. �J / 2-.it.) CROSS ST. Vi rtnri n St • J (o BUILDING . 2- / 2 J � n OWNER O$AGE HOMES. INC. ADDRESS /CIjJ.,lre MAIL 9363 WILSHIRE BLVD. SCHOOL DIST. /! . �.-� �J�. . ADDRESS • do-(LL' 5 )'7 .(. Q/��+ OR TOWN • TEL. _ CITY BEVERLY HILLS NO. CR. 54361 NEAREST ' y ARCHITECT OR LIC. CROSS ST.. �(/( -'✓sALi ENGINEER ZOryC O. OF TYPE GROUP (.AIN & MEKERRACHER No. Sr.SYX4841 //A / I PLANS I i /�� ADDRESSP/R/ V ` Z11O E. WALNUT Sr. ,STPASADENA APPROVED JTRACTOR NEWPORT VISTA CD.No. CR. 5.4361 BYI , DATE ADDRESStS CORRECTIONS 9161 WI LSHI WILSHIRERE BLVD. , BEV•AYlL3 LEGALLOT DESCRIPTION I NO. 59 I BLOCK I TRACT 1713 • •ATTACH METES & BOUNDS) NO.OF BLDGS. - ' SIZE OF LOT 70 x 110 I NOW ON LOT 0 USE OF I NO. OF NO. OF EXISTING BLDG. a. FAMILIES I RQO C�^ya , SETBACCENTERKOFINE STREETM SS f 1,* SIDE YARDREAR 111 6r l—ic DESCRIPTION OF WORK p 6 NEW I X I ALTERATION I I ADDITION I Z y REPAIR I I MOVING I I DEMOLISH I F BUILDING NO. OF .- -�- ) SIZE 1034 SO.FT.ROOMS 5 STORIES 1 , EXTERIOR WALL I ROOF COMPO COVERING STUCCO <..I-•1'1 713':'1as �., _. _..�. •„•- -- COVERING " ,�' NGGLEES 7 OF NEw RES IDENCE¢ NN�fC'et APPROVALS FOUNDATION: LOCATION IN$EECTOR DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS UNDER- MATERIALS, // i-, CJ -�I APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNDER-PINNING �S AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS. ^/) BRACING, BOLTS t' 61/� AND STATE LAWS REGULATING BUILDING CONSTRUCTION. // / /, _ LATH. INT. L.,f/G77! S .. IJ-, R SIGNATURE OF NEWPORT CO. LATH. EXT. ;. • //S'CR PERMITTEE O PLASTER. INT. L� J (/{4L'75-3 AUTHORIZED AG6• C% • 1/7 --aL.•1 r I(/ -h- Ti p• 1rrEes / PLASTER, EXT. _I'• 4 VALUATION $ 4°30.00 y MASONRY REINFORCED PLAN CHECK S / BOND BEAM TEEALn /� - ;�7a3 FEE s FINAL '�J Jf'' !" EM 3.30.53 • W \- W ..`2 ' r - . 0 O 0 O - • _ -a (:.3::o`: 2E470 • M. S.11P7_l,: f Y •T. \'1 11 _ r. ' : . J r.S -•• V T ocrrs': - r r . • Off ,. STREET- . . X • PLOT PLAN • - • Show- location and distances from - -- - - -- _ - propertylineandbetweenbuildings.. - rc�..a� - - '•oe , :;�f. - 023;.:1•7: - - - - - “'• •••.t . 11 7"=r l ,-7::•1 • • • • T.10'.\-f - • • G:. • •