HomeMy WebLinkAbout1958 CHURCH ST - Building Permits I/ 7oit 2/21 /79 259.00 1L•
•
COSTA MESA BUILDING-SAFETY DEPARTMENT wi 376.1 2/21•/79 259.000KT0
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 , 3761' ' 00004467 06 ..�Q • - 1
For Applicant to Fill in Completely CAT N WOR STRUCTURAL PERMIT IOu'Ini
pp p y —Use Ink Only
RE ED V DATE RECEIVED DATE IS UED
BUILDING SG/75% /,�• &toga/
Ir 02-� 77
ADDRESS �fs C/� !'
PERMIT NO.
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MAIL BUILDING its
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CITY NO. TRACT I LOT BLOCK
CONSTRUCTION EW ADD ALTER REPAIR 'MOVING DFMOI ISH
LENDER -�,,,,////7���
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OWNER y,e SnrVS.
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ADDRESS set^���� /�/ALUE
ARCHITECT TEL. USE / lye $
OR ENGINEER NO. - " '
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS
TEL. ZONE INO.OF USE OF NEW
CITY NO. PLANS BUILDING
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
[+I SIZE NO.OF BLDGS (FROM CR_STREET)
Cr OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
C4 EXISTING BLDG. R.SIDE FL FT,
VJ
(-1
Separate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work.
G REAR FT. FT.
I.W. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
nQ MAIN BLOCS. ACCESS.BLDGS.
VAR.50 DATE
.� C.U.P.SW APPROVED
a
7 APPROVED
} _RV DATE
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I hereby acknowledge that I have read this application and state
C4 that the above information Is correct and agree to comply with m
0. all laws regulating building construction, and I shall not employ
ei
Z any person in violation of the workman's compensation laws of
IRthe State of California. .
m
SQ. FT.
I hereby certify that I am properly licensed as a contractor under av
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o
Chapter 9, and that sue enses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMITFEE ONLY:
am exempt from t Ion •f the State of California Business VALUATION PERMIT FEE $ —/w
and aturenionf ter 9. F^
CV ell
en
PLAN CHECK $ ",
Signature o
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Permitte ( �i>/
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Au rlxatl Agent TOTAL PAID $
' M - CITY OF COSTA MESA
BUILDING DIVISION
• r,,,r s _ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
tel � PERMIT
i
' , P03-00804
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1958 CHURCH ST Status: ISSUED
Suite No A Applied: 12/05/2003
• Issued: 12/05/2003
Vicinity:
Parcel Nunmber: 42626430 ISSUED BY:
Applicant: JANET SCOTT
Address:
Phone: 714-953-6300
Zip:
Owner: SMYTHE,VERNON L TR
Address 1723 E OCEAN BLVD
Phone:
BALBOA,CA Zip: 92661-1411
Contractor: CULLIGAN WATER
•
Address: ' 502 S LYON ST
Phone: 714-750-2233
SANTA ANA,CA Zip: 92701
License: 663091
Arch / Eng: .
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
WATER SOFTENER
•
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
2444346(arta)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and wille maintain workers'u an ce cassainsurance,olicyas required by section 3700 of the Labor Cade,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number/�re: ,,, 1 :T p v r7/�
Carrier: 7t Li/7.J E.. AM-P(, 4I�1N .F'Y�1�i `-'U Ot= S(_ Policy Number: ,V ol3 urn /�OG
(This section need not be completed It 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 should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions. p /
Applicant Signature: ii Date: /air p(/0 s
WARNING:FAILURE TO SECURE RKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SI-ALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OVIL FINES UP TO ONE HUNDRED
THOUSAND OOLLARE($100.000), ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under p,ro inions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full
_Corot and effect.Lac.# "r 3� / /� Class# �3
Contractor's ..Signature: �_ Z . . �Il�% I ► — Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant 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 properly 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 driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑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 lime 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? 0 Yes 0 No ,y
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 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 ❑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 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
nature f Legal Qrvn (s) Date
And/Or Authorized Applicant Date
7 INSPECTION TYPE PAIS MOM ;ODE( INSPECTION TYPE Prig MALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1286 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
A.
" ' r CITY OF COSTA MESA
F a, ��...4, BUILDING DIVISION PERMIT NUMBER
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
*IP
B99-01154
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1958 CHURCH ST Status: ISSUED
Suite: Applied: 07/27/1999
Vicinity: DWELLING 8 GARAGE Issued: 07/27/1999
Parcel Nunmber: 42626430 Zoning:
Applicant: A PLUS SERVICES INC./A PLUS ROOF,: ISSUED BY:
Address: DBA:FOUNTAIN VALLEY.ROOFING i , -
FOUNTAIN VALLEY,CA ' ' Phone: (714)775-1947 /
11237 SLATER AV" - ' Zip: 92708
Owner ,S_MYTHE,.VERNON•L TR
Address f(1808 NIODRARA DR,' _
/CV.77/ �N �-z Phone: �..� ..
/ GLENDALE CA=' Zip: 91208
i/ V N J
Contractor: FONTAIN VALLEY ROOFING "`,',:v
/„Address: 11237,SLATER AV \� � .
• /, ', 'i
/'A' Phone: - ,
N - FOUNTAIN VALLEY CA - .
'- Zip: -92708 ” H . License: 675241- ' ,
/ Arch_:, / - .. Eng: _
-r'Address: , / - Address:
, , ./ Phone: / Phone: •
1 ' \ \Zip i License: Zip: A . License:
' SCOPE OF PERMIT `
REROOF-170, INSTALL NEW 7/16"OSB BOARD, 1 LAYER OF 30#FELT AND NEW 30 YR ELK COMPOSITION
SHINGLE ROOF.
' FEE SUMMARY '
Plan Check: . $0.00 - . / .Calc Valuation: , $5,95900
• Permit: • $112.25 Claim Valuation: $5,959.00
`v SMTP Res: $0.60 ,
vvSMIP,Com: x;.'$0.00 -
Other: ' , $0.00 • - ' _ : '
`Inspection` 10.00 .
Total: ,, ' $112.85—
PLANNING'&ZONING '
SETBACKS','-A . - -
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)7545626
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: a re- ru rtn. Policy Number:
(This section need not be completed If the permit is valued at one hundred dollars(5100)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 provi ns.g��
Applicant Signature: 6 "` wo-o----- Date: COP 0 7/2 1/9 9
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 DOLLARS(3100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensedunder 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.p (p 5 — ,`2-Y/ " ' ' Class a 0 3 9 5
Contractors Signature: t J��ye...✓..oefe ct-1e.4-t:.4.#_& Date: 0 7/2. 7/9 9
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS: •
I hereby affirm that under penalty of perjury that 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 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 end 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 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.-properly 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 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 end Safety Code requires,with some exceptions,that a Business Plan be fled 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 volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 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 apermlt for such construction or modification
from the South Coast Alr 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 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 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 penally 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.
Sign ure Of Legal Owner(s) Dat
.� o -2/a9/9
And/Or Auth z Applicant Date
CODE II, I$5PECDON TYPE PATE. MEALS cgpEd INSPECTION TYPE DAZE 'MINA
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof f.t . Z 4'f 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-46
37 3v Wrnrfit, . •
PROJECT ADORE55: 1958 CHURCH ST uxlr:B CITY OF COSTA MESA — BUILDING PERMIT PERM NO; P 060611
OWNER'S NAME:SMITH VERNON •
ADDRESS: 1808 SMITH,
DR PERMIT NO: P 060611 PLAN CHECK NO; N GOVT; ' N SUPP: N
GLENDALE, CA 91208
CONSTRUCTION TYPE: PERMIT TYPE; PLU PURPOSE: OTH
ARCH/ENGINEER: '" REG.NO.: JOB DESCRIPTION ; REPLACE WATER HEATER SQ FT;
ADDRESS: UNIT:
PERMITTEE: CLAIM VALUE; . CALC—VALUE: GROUP OCC: R-3 /
ADDRESS:THE EARL 'S PLUMBING (714 ) 772-3470
1533 W. LINCOLN *OMM****4*****O *************+******D***************IEEE*************;E**************
ANANHEIM CA 92801
LICENSED CONTRACTOR DECLARs and hereby afore that I am licensed under provisionsra Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Orvision 3 of the Business and Professions Code.and my license is in full
�fo$ce6and effect SETBACKS
CITY
ate:._:005938 STATE IIC'21 657hge: �p cLAs:�,s:r_3f
Date:./3-93 therebre:// _ MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby allirm that I haver to sell-insure or a certificate of Wets' FRNT; FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
• Compensation Insurance.or a certified copy thereof(Section 3800,Lab.Cl. LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
POLICY ND.:UCC011686-92 EXP.DATE: 03/01 /93 •
COMPANY:UNICARE INS PARKING REQ• PROV; PARCEL: 42626430 ZNE: REF NO:
0 Certified copy is hereby furnished. j(] Cenilied copy is filed with the city Building Division. PLANNING NOTES>
j �� >
/a-
Date: / f3 Applicant'/�(/J / *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This sect need not be completed if the perrmt is for one hundred($10))or less). DEVELOPMENT S E R V I C E Sii R E Q U I R E M E N T S
I certify Thal 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. ZONING APPROVED BY . .4... DATE:
•
Date: Signature:
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE:
Code.you must forthwith comply vrith such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; DATE• �- ` 3
which;his permit is issued(Section 3097,Civ.C). ****************************************** ** * *************DATEM*** M DADA*
UNDER: **********************MMM*******************M*MM*******************************
ADDRESS: • LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that 1 am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,atter,improve.demolish,or PERMIT 7,00
repair any structure.prior to its issuance,also requires the applicant for such permit to tile a signed statement that he/she is licensed g SMI P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE 20.00
I. as owner 01 the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 7. 00 20. 00 0, 00 27, 00 27, 00 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through ,.•
his or her own employees.provided that such improvements are not intended or offered for sale. If,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED; 27.00 OVER/SHORT; 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 27.00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon ni
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware ****************.****** ,I,*****MM**M*it***************M*MM*****M*********M********M
that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A L'• F E E BREAKDOWN
IDam exempt under Section: B.&P.C. .7.
for this reason: TYPE QTY D E S C R I P T I O' N UNIT COST TOTAL COST
Date: Owner' PLU 1 WATER HEATER AND/OR' VENT 7. 00 7. 00
I do hereby certify that I am aware of and understand the requirements of California,Health and Safety Code Sections 25505,25533,and END- OF FEES
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 trom the Au Duality Management District.Residential construction applications are exempt front I
these provisions. ' //�o�c�`v/�
IDate:etApplicant:dsit `y G9'
hereby escertifyand that have read this application and tion that the above iteinformationis correct agree to comply with all city and county Q PI 1` yyyWWW��Iordinances and state laws relating to budding construction antl hereby authorize representatives of this city to enter upon the above-mentionedproperty for inspectioonn purposes. ,C� JAN 1 b1993Date:_`/7',._3 Signature:elOVe ' .
Driver's License or Social Security
CITY OF COSTA MESA
t641'46 White—Building;Green—Code Enforcement Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
•
CONSTRUCTION AND PLANNING POu_ di SPA
APPROVALS _ Permit# Date Inspector APPROVALS Permit # Date Inspector
i
• 1. Temporary Electrical Service or Pole, - 52. Pool & Equipment Location -
2. Soil Pipe-Undrgrnd„ ^ . I 53. Steel Reinforcement • , '
. 3.'Electrical Conduit-Ufillty-Undrgrnd. - 54. Forms
c
.x d;Electrical Condt5i4`lj idrgrnd. , 55. Electrical Bonding
•-$.•Steel Reinforcement '..i 56. Rough Plumbing& Pressure Test :_l
'.611rElectrical UFE'R G_ rnd. tr 57. APPROVAL TO COVER-GUNITE
`;X:.{ootings 58. Electrical Conduit-Undrgrnd.
-' I.
8.'"Faundation 7, - 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. , , 60. Backwash Lines,P-Trap, 0 Undrgrnd, 4
o
10. Structural Floor System i, 61. APPROVAL TO DECK •
--
11. Property Sewer Lin&& Hd'use Conrection 62. Backwash & Receptor-Final '
v •
12. Sewer Cap .. - 63. Heater & Vent-Final
13. Roof Drains c_.-: 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electricat-Conduit 66. Solar System-Final
16. Rough Electric"Wiring 67. Fencing& Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electricaj-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioninj _ FIR D-cFT. IIECWIREMENT.
20`2Rough EactoEy Fireplace ; .-. ../,.? t1 ', y _r< ' iPPRQVAY. .
:%''3'erjit# �
21 Strtctu
Dutts,in. ne - , •. .. •-1`� + 1 '.. .. `370. UnrFiun
derg ,H9 ro
22. Duffs, Ventit ti CC 't` - cs - ` ''
n!3_. t, .: J ,. •c ,r71. ProductWping O Gas O Oil I
23.-Gas Pipe-Rough &-Test n i. - ,r c _ _72. Underground Flash= r`s
24.--Root Framing' ` v ".-r . ' ? . ' `73.zUndergrnd'.Storage,Tank DDGas ❑t5i1
s .c ,.. • w _
25. Roof Sheathing . sc v •• :. ,- . r < '74COverhead Hydro f
26.7-Bar Ceiling (Stiucturall &coat - .
x 75Dry Chemical J .- - 6
27<Frameand Flashing: -_ •K . a > -c* ac 76. Dry Standpipe i- -- .- _ :T,
'-28. Lathing=& Siding::: - ..71.: 7,..a' t r F vlu z 77:-; FIXED Sya�TEM:FI�AL'�r, c
i.
29. Insulation 4...,, c. �• k �r± --r- 78SFIRE PREY. FINAL c
.. ° 1 ., -
30. Drywall Nailing1 r . • ;
4 wry.
4.....0?;) 4750 9%12/78 135.52 TL'COSTA MESA BUILDING-SAFETY DEPARTMENT Asa
/••
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 --
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely— Use Ink Only
RECEIVED BY DA EICET -E ...r E. f
ADDRESS /9r�V^ cyvre4 ST.\ , a r 9IIOOCC ////OOYY �•%(!Ap]l •i/(/•�
OWNER RIGNAR n AsT l�rscb A.P. NO. 118-0/4 -0-Z d r"r
MAIL BUILDING
ADDRESS 6515 Tee. Avco ADDRESS Ifs! CHu/lCY
TE CITY I,tbawor4 Rend\') NO.Line- -77i
TRACT LOT BLOCK
CONSTRUCTION C_. I_/. EnNEW
�Av��'1��NEW� ADD ALTER REPAIR MOVING DEMO'LSH
LENDER LJ/i`NTA_ ✓ '�/
BRANCH fWNE ken se-)
ADDRESS OWNER w/
ARCHITECT Rome y TEL ��J S VALUE$ �! �]
OR ENGINEER R,Uy/�.. pia)
NO.�G6'�� lap
, r (/(/(/
FIRE .I
ADDRESS ZONE TYPE GROUP T
CONTRACTOR
J ( ydif ��7' BVPROVED DATE
ADDRESS 2701 �9A) 62_,TELe0
`�Y USE ,I�sp'
CITY &P2'P - Dee_kJrar NO.(O/355 :._ ZONE��PLANS �/ BUILDIFNEW r~-
F�y STATE �j CITY YARDS APPROVED YARDS APPROVED
C LIC. NO. ssss 7S LIC.NO. MAIN BUILDING ACCESSORY BUILDING
w SIZE $ NO.OF BLDGS. (FROM C/L STFjE ET)
L OF LOT X /37� NOW ON LOT D FRONT �C�7c_FT. FT.
a USE OF
Ct EXISTING BLDG. R_SJDE /0 FT. 3144n1
FT.
jai I—.
Separate permits are required for L,SIDE 6 FT. FT.
welectric,plumbing and heating work. REAR �'T. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
'C DATE
♦ `, J,'}/' / y� MAIN BLOCS.
Q ACCESS. BLDGS. -f
zipie /�/ ' c�Gti 0:1 _C URP ',rya)g&784? APPROVED/D V9"�/9S
> �AP"PROVY�le re-4
DATE .2/- 7r
$$ / OLD FOR SPECIAL REOITTREMFw s
w
o I hereby acknowledge that I have read this application and state N
a that the above information is correct and agree to comply with m
$0 all laws regulating building construction, end I shall not employ
z any person in violation of the workman's compensation laws of
m
s the State of California. m
SQ. FT. N
3 ; I hereby certify that I am properly licensed as a contractor under It
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m y`
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the pr• isions of the State of California Business
VALUATION PERMIT FEE $ v
and Professions Co•-, e' isio Chapter 9. r n
PLAN CHECK $/,1,9 X11 m
Signature of /407Th
,�/s/�/./�/ QCC�� 7 U o
Permittee _ �. / /_/� $ `"'✓ TAX $ / P
Author; .: Agent ' ' ` TOTAL PAID $/ R C g2 U
Li t 7o 7 i
COSTA MESA BUILDING-SAFETY DEPARTMENT 4:. 3762 2)21/79 259.00 TL
_
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 3762 2/21/79 259.000KTO
AP'1ICATION F03iVERU 1I SPINMIT I A
For Applicant to Fill in Completely—Use Ink Only j--
y/ /n-' a l(�� REC I D '.V DATE RECEIVED DATE ISSUED
�
ADDRESS BUILDING Z9,J / (�Vcii c� ST-AFB araV-!y
PERMIT NO.
OWNER A.P.NO. �s
MAIL ADDRESS nip si4/ �Sde#}/r
ADDRESS
TEL.
CITY NO. TRACT I LOT BLOCK
CONSTRUCTION NEW ADD ALTER REPAIR IMOVING DFMOI ISM
LENDER
BRANCH
OWNER r nto'sSc---r-/
ADDRESS
VALUE
ARCHITECT TEL. USE 1 /
OR ENGINEER NO. ' -
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS ZONE INO.OF USE OF NEW
TEL. PI.AIN1S BUILDING
CITY NO.
,F—. STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
la) SIZE INO.OF BLDGS. (FROM C/L STREET)
S OF LOT NOW ON LOT FRONT FT. FT.
Q' USE OF
,a, EXISTING BLDG. R.SIDE FT. FT.
Of
(-4
Separate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work.
W
REAR FT. FT.
i.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
0 MAIN BLOCS. ACCESS.BLDGS.
',
VAR.+ DATE
C.U.P.# APPROVED
a —
APPROVED
.>.1 _BY DATE
CC
in
0a., I hereby acknowledge that I have read this application and state n
IX that the above information Is correct and agree to comply with m
L all laws regulating building construction, and I shall not employ
i
Z any person In violation of the workman's compensation laws of m
..TTW the State of California.
I hereby certify that I am properly licensed as a contractor under SQ. FT. a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY'
am exempt from pr visions of the State of California Business
VALUATION PERMIT FEE $ y
end Professio oda, ivisl 3,Chapter 9 ,.,�') M
PLAN CHECK $ / eno
0
Signature f /j' l�%%�) $ 2
Parra ltta Ti/ TAX $ a
S 114--- U
Aut r d Agent TOTAL PAID $ 2 7 �
—