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HomeMy WebLinkAbout2637 ELDEN AVE - Building Permits . . • . . . ... EtDEli AV:71.11.TE 2437 A & B \ . ',. . 35615 - 11-1-73 L:. ? ex ':/ :c3:27.R:a. $54,700. - A 35616 - 113-1-73 ) Jaz Gar- u 5,350.; A35617 - 10-1-73 Tr:Epic:: -:/.i.r.ary.. ?„-z.• 38,100.! i' .., • . . - .2.: G ar•2..g e 611-64.23aa11 - -28-73 Plannommommaimi:(;. :t ( az) ; um, , . . 12,61082 . _ EXP.1,cic,1 7/9,4 2 i ( • . . r.. . ;..s.i . r ..., A. .t. . Vs i .5., • yr i . .:: w CITY OF COSTA MESA con M sq BUILDING'DIVISION F II g@@ 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714)754-5626 JCaL PERMIT NUMBER: B11-00055 PERMIT TYPE B_ROOF2 STATUS: ISSUED APN: 43907120 DATE ISSUED: 02/2212011 ISSUED BY: KJB JOB ADDRESS: `+2837-ECDEN"AWCM Suite/Unit: Vicinity: 5 CAR GARAr Squares: 1600 Valuation: $4,088.00 SCOPE OF WORK: TEAR OFF COMP SHINGLE ROOF.COVER WITH 30 YEAR COMP SHINGLES. ROOF PITCH IS 5:12.RE-ROOF IS FOR 5 CAR GARAGE BUILDING ONLY. NON-CONDITIONED SPACE. NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/Inspection Card OWNER: KETTNER, PHYLLIS R TR Address: P 0 BOX 10112 Unit: PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: DIAZ,LINDA Address: 1653 1/2 SUPERIOR AVE Unit: : PHONE: 949-642-7222 City/State/Zip: COSTA MESA,CA CONTRACTOR: LEE ROOFING OF COSTA MESA License No. 349686 Address: 1653 SUPERIOR AVEUnit: PHONE: 949-642-7222 City/State/Zip: COSTA MESA,CA 92627 CELL: ARCHITECT: License No. • PHONE: ENGINEER: License No. PHONE: FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $111.25 Reinspection Fee: $0.00 Bldg Std Admin Fund $1.00 TOTAL FEES $112.25 HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 -PER CMMC Sec. 13-279 Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibitied all hours-Sundays and the following Federal holidays New Years Day, Memorial Day, Independence Day, Labor Day,Thanksgiving Day and Christmas Day 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. CODE S. INSPECTION TYPE GATE INTRIALS CODES INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final /''1 208 Final Plumbing Y 200 Final Re-Roof Y 3-15-0 13u IxfCO' 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 • WORKERS'COMPENSATION DECLARATION Owner ID verified by drive i ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' ' Verific'�tion of Ownership by(type of document,i.e.-property tax bill or deed): comp nsation, as provided for by section 3700 of the Labor Code, for the e rmance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: s ion 3700 of the Labor Code, for the performance of the work for which this 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 Carrier_ S 0� TI V C - by this permit,and that no building structure,scaffdding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp resection need not be completed the benne g valued at one hundred ba9ars(5100)or less.) 2,Art 2.Sec 341,Title 5,California Administrative Code). ec—PotICINT mb ❑ As owner-builder, I will not employ anyone to do work which would ❑ I 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 issued, 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 subject t the workers' compensation provisions of Section 3700 of Applicants SignatureDate the Labor Code, s II forthwith co with these provisions. Division of Industrial Safety Permit Number: a900. v HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: (LURE 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- in full force and effect. a registration form for acutely hazardous materials? ❑Yes 0 No 1% 4lib,.dt� �4 Q o- Cl t•U W girls. 1 36j (Section 25533 of the California Health and Safety Code, with some c /�� I ( exceptions, requires registration with the Costa Mesa Fire Department by �, lJ each business which at any one time has on hand a quantity of acutely filSigna a 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)? ❑Yes 0 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 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 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? ❑Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government 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? ❑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). El 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 ❑ No thereon,and who does such work himself or herself or through his or her own 8. (If" es", attach certificate of compliance from the employees, provided that such improvements are not intended or offered fory P appropriate air pollution 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 ❑ I, 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 DI 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 authorized by this permit until final inspection. 'nal -of LegAl Ownerts) Date Signature Dale 1'] aa i f 30$7-46(0107) .7477.1^r.Mitboriied: plant a` Date EN y '. CITY OF COSTA MESA �``' � BUILDING DIVISION :116.11,7.‘k 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-0856 w www.ci. sta-mesa.ca.us it T .t.� FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER: BX08-00300 PERMIT TYPE B_MISC STATUS: ISSUED APN: 43907120 DATE ISSUED: 10/14/2008 Zoning: , ISSUED BY: BJK JOB ADDRESS: 2637 ELDEN AV CM Suite/Unit: Vicinity: UNIT B . Primary Occ: Const Type :?? ' SQ. FT: 0 - Valuation: $1,200.00 SCOPE OF WORK: - . ' PATIO DOOR CHANGE-OUT TO A NEW SLIDER W/NAILFIN, FLASH & RESTUCCO W/TECTURE.TO MATCH THE EXISTING TRI-PLEX, UNIT B. - OWNER: KETTNER, PHYLLISR TR Address:: P O BOX 10112 Unit • City/State: COSTA MESA, CA - Zip Code: 92627 Phone: APPLICANT: JANOSIK, STEVE - Address: 17032 MURPHY AVE Unit: ' City/State: IRVINE, CA - • 1 Zip Code: • 92617 Phone: 714-259-5120 CONTRACTOR: DIAL ONE WINDOW REPLACEMENT SPECIALISTS License No. 523043 Address: 17032 MURPHY AVE Unit: City/State: IRVINE, CA Zip Code: 92617 Phone 714-259-5120 Cell: ARCHITECT: - License No. ' Phone ENGINEER: - License No. Phone FEE SUMMARY • Building Plan Check: $0.00 i r '"'".,- Building Permit: . $44.85 A Electrical Permit: $0.00 Air,l°' SMIP Residential $0.00 "' SMIP Commercial • $0.00 TOTAL FEES $44.85 - -•;;� E; NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) . EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. QQQQ(,d, W$PECnON TYPE PATE INrmAL$ CODE P IN$PECTtON77PE QA-E feri 1618 Fixed System Final Fire Prevention 206 Final Mechanical • • 1268 Pool Spa Final 208 Final Plumbing . 200 Final Re-Roof 210 Final Electrical 201 Final BIocwRetaining 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 ,f 6-31--p ff ?i) t ` r WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivnse. ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: 0 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 • p ormance of the work for which this permit is issued. "' GI have and will maintain workers'compensation insurance,as required by • sec an 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 carder and policy 0 I hereby certify that no excavation fine(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized Carrier: S'E beme itj G. r by this permit,and that no building structure,scaffolding,falsework,a-demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap. 3.2,Grp (This sedan needdnpnot be mpleted tffhe permit is valued at one hundred dollars($100)or less) 2 Art 2,Sec.341,Title B,California Administrative(;Ode). Policy Number: i 6 t O o0<O t/0 o As owner-builder, I will not employ anyone to do work which would 0 I 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 issued, 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 subject to the workers'compensation provisions of Section 3700 of Applicant's Signature Date the Labo Co e,I shall forthwith comply wit r'-se provisions. /�� �. .. / '- �© // / 011 Division of Industrial Safety Permit Number: Applicant,Si. ure �!�' _ U HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE • ECURE 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 ❑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. K/1 a registration form for acutely hazardous materials? 0 Yes 0 No :l cr#- 30 Class# --.(_J _ (Section 25533 of the Califomia Health and Safety Code, with some -Q-L�� � i " '/ 2— exceptions, requires registration with the Costa Mesa Fire Department by /$7 =17-" X each business which at any one time has on hand a quantity of acutely Co les 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)? 0 Yes 0 No Lenders Address: (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. Signature Date �-\''‘ L 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: TY \' 1 Health and Safety Code been fully complied with? 0 Yes ❑No I hereby affirm that under penalty of perjury that I amcEXEMPT.FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason3Sec:it 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any cityaorrcbur{tjwhich requires'a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish,cdrzrepeir any Trstnicture, prior to its any other air pollution control district or agency? 0 Yes ❑No issuance,also requires the applicant for sucti-permifto file a signed statement .<..�.�+ (Section 65850.2 of the California Government Code requires that the requested ed that he or she is licensed'Wrsuant to th e.tiovi7000 of the Contractors information be furnished on applications for ran-residential building permits). License Law(Chapter 9ncommencing yrittESection 7000)of Division 3 of the Business and Professiohs3Coke)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 exemptionAny violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant,for a permitiubjects 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). vas o ❑ I. as',,ovmer 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 compensatlon, 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 Safely 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 js 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 certifythat 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 city ordinances regarding Hazardous Materials and Emissions. ❑ 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 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 authorized by this permit until final inspection. Sig.. j of L Own'(s) \/ Date l! 3057-45(3/07) Signature Dale /�/r, / / /D_/-'-'/ n°g An•rw.AUNonzed ' .nt Dale—; JOB SITE : 2637 ELDEN AVE . Unit "B" I I .! I I 2 - STORY 3-UNIT CODOS 6' I I I I I I I I I I I I I I P/L t i GARAGES P/L I ; I I I l I I I I I I I 1 I I K 16' 1 i _ I I —4'2 I I I I I 1 l I 1 1 1 I I I I I EM� RY I I _ KIT V 111 UV _ao..e�anr I �, ..,;_,_—I ..-� NOOKI !1l1�1� 11111 D a®m wllr 0 t nno '1t� � ,.• -1 APPROVED ANDCRSOI INSERT.WINDOW %aympVal.fsriISMS _ANOQCSCN PATIO DOOR DCTAIL - atasrvtamacq rI i Window And Door Replacement • All Windows Must Meet IBC Sect.2406 For Safety Glazing. The Following Locations Require Safety Glazing,Laminated or Tempered,To Be Etched Marked: A. Glass In Doors. Door Win. Room Size Existing Size New B. Glass In WindowsWithin 24"Of Door Jamb And Less Than 60"Above Floor. • C. Glass Within 5'Of Pool Or Spa Waters D1 NOOK 70 X 79 ALUM PDS 70 X 79 RBA PDS-TEMPERED Edge. D. Glass At Shower,Bathtub Or Stair Landing Less Than 60"Above Floor. All Construction Shall Comply With The 2007 CBC -California Building Code All Windows Are Rated With 20 lbs.Of Wind Load. All Windows Must Meet IBC Sect. 1203 For Light (8%)8 Venilation(4%) All Windows Meet 2005 Energy Code: Name STEVE & PHYLLIS KETTNER Mal_ _ Renewal -4r - • U-Factor=0.67 Or Less Adress 2637 ELDEN AVE. Unit"B" `L ;Andotsen, � - S.H.G.C.=0.40 Or Less City,Zip COSTA MESA, 92627 SMOKE ALARMS IN ALL BEDROOMS Phone 714-438-3237 17032 Murphy Avenue, Irvine, CA 92614 Egress Drawn By: Steve Janosik (949) 265-7600 All Bedrooms Must Have At Least One ALL NEW WINDOWS HAVE DUAL GLAZE, LOW E4 HP GLASS UNLESS OTHERWISE NOTED Window Or Door Opening Directly To The LEGEND: Exterior Meeting This Criteria: XX SLIDER-SLIDER XO SLIDER-FIXED GW GARDEN WINDOW CST CASEMENT PIX PICTURE WINDOW Minimum Clear Width =20" AWN AWNING WINDOW DH DOUBLE HUNG SH SINGLE HUNG PDS PATIO DOOR SLIDER Minimum Clear Height=24" RBA Renewal By Andersen Min.Area=5.7 Sq.Ft.(5.O Sq.FL For JOB:20128 mb Grade Floor Residential) SCOPE of WORK: Maximum Sill Height=44" REPLACE PATIO DOOR SLIDER WITH ANDERSEN RENEWAL PATIO DOOR SLIDER WITH NAIL FIN Outswinging Doors To Exterior Must Open FLASH AND RESTUCCO WITH TEXTURE TO MATCH Over A Laanding That Is Not More Than 1" NO MODIFICATIONS - NO HEADER CHANGES Lower Than The Interior Floor And Have A Landing As Wide A5 The Door(s)And Extend Out A Minimum Of 3'. p ' 'S.0 , CITY OF COSTA MESA , 4 BUILDING DIVISION F •, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t IPPII.ra 1 PERMIT •-- „ ,,,,.o' P07-00277 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, OSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2637 ELDEN AV Status: ISSUED Suite No Applied: 05/02/2007 Issued: 05/02/2007 Vicinity: Parcel Nunmber: 43907120 ' // Applicant: ERIC COOLEY ISSUED BY: _ �L Address: 3400 INVESTMENT BLVD • Phone: 714-614-2547 HAYWARD,CA Zip: 94545 Owner: KETTNER, PHYLLIS R.TR Address P O BOX 10112 . Phone: COSTA MESA,CA Zip: 92627 Contractor: JUST WATER HEATERS INC Address: 3400 INVESTMENT BLVD • Phone: 800-909-9483 HAYWARD,CA Zip: 94545 License: 591329 SCOPE OF PERMIT WATER HEATER CHANGE OUT 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 Bkf)ow(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 $12.30 1 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 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 ., Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0' OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) . $0.00 0 . TOTAL CALCULATED FEES: $35.80 COMMENTS /SPECIAL CONDITIONS • 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: O 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. L ''{M y orkers'compensation Insurance carrier and policy number are: "5-Y-‘,-)"‘ a1JIbyNumber- 0kt"r"Ilv0fo1"O rare"sectlon need not be completed If the permit is valued at one hundred dollars($100)or less.) r ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. dant"$gnat( uro: �- Dele. S/ z-/O- .FAILURE T• ECURE WORKERS'COMP •- • RAGE IS UNLAWFUL AND SHALL SUBJECT AN EM VENAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1 W,000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby afff r aLLern.ticensed undeyprovisions of Chapter 9(commencing with Section 7000)of Division Busliness.and Professions Code,end my license is in fullnc• and effect:Lic. S--"1 3 Z 'f ! L,''St.a Contt�agGO�Fe•SI netlire%%` -- at .. -,��2 Cr? 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 toe 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,em 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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑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(38)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 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 a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _.e ___ _. . ..tr _ _._ �_...__._...___.._._ 2 Does or will the eppllcant 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 end 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 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 Safely Code been fully complied with? ❑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 a ermil 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? 0 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. ature Of Legal Owner(s) J Z ate JrAr'-.--�--- And/Or A.-.�—Orized- plicdnt WOE f. fffVPECTION TYPE gag iNIfALS 900E1 IasflCrON TYPE PdIP IIlI 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1268 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 Flre Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy psi. F CITY OF COSTA MESA • • t BUILDING DIVISION >4:1tlC DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER iys.4. PERMIT 0509 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.n�.tLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2637 ELDEN AV Status: ISSUED Suite: Applied: 03/30/2005 Vicinity: APT C ENTRY DOOR Issued: 03/30/2005 Primary Occ: R-1 Hotels/Apts/Res>10 Occ Type of Construction: V-N Parcel Number: 43907120 Zoning: Applicant: JANOSIK, STEVE Address: 1621 E ST ANDREW PL ISSUED BY: Phone: (714)259-5120 SANTA ANA,CA Zip: 92705 Owner KETTNER, PHYLLIS R TR Address P O BOX 10112 Phone: COSTA MESA,CA Zip: 92627 Contractor: ALUMINUM ROOFING SPECIALISTS/DIAL ONE WINDOW REP Address: 1621 E ST ANDREW PL Phone: (714)259-5120 SANTA ANA,CA Zip: 92705 License: 523043 Arch : • Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REPLACEMENT OF THE ENTRY DOOR WITH AN OAK GRAINED FIBERGLASS DOOR FOR APT C. NO OTHER WORK AUTHORIZED WITH THIS PERMIT. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $1,400.00 Permit: $50.95 • Claim Valuation: $1,400.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $51.45 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-46(EV00) DECLARATIONS,, l 'O WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to sell-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. \j I have end will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code.for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: ��76Es� �L :i ; '34•IAAssF:r: Q-1 9 -2 6 1' q', : on n::.nor be completed if t e permit Is valued of one hundred dollars($f00)or fess.) "' ❑ 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,end agree that II I should be me subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr7isgs. AppGcen ' mare: �.:o., 'sate;. 3 3O O WARNNG.FA 0 SECURE WORKERS'•4, SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER' •CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND OOLIARE(S100,000),IN ADDITION • 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 egg. Professions Code,and my license is in full force and effect.Li CI 1 1—) aF, ..• oat 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 then five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to en 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 Calilomia 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). 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 It en 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 tor such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes L.)No (Section 65850.2 of the California Govemment 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? 0 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 penalty of perjury that I have read this application end 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. ;yours Of Le..I Owner(s) _ . 1 .4a� ..Ag •Who" T.pl BODE I, NISPECTION TYPE RATE INTmALS RODE s INSPECTION TYPE RATE INTITIAL6 1616 Fixed System Final Fire Prevention 206 Final Mechanical 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 L 204 Final Demolition 250 Final Building/Occupancy ' ")2—OS ' ; CITY OF COSTA MESA • 4 BUILDING DIVISION >9 ,, tic DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F ti t J PERMIT A03-00785 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2637 ELDEN AV Status: ISSUED Suite: Applied: 05/07/2003 Vicinity: LEFT PROP LINE Issued: 05/07/2003 Parcel Number: 43907120 Zoning: Applicant: TUCKER, MICHAEL ISSUED BY: Address: Phone: 714-593-3135 Zip: Owner: KETTNER, PHYLLIS R TR Address P O BOX 10112 Phone: COSTA MESA,CA Zip: 92627 Contractor: A J M CONSTRUCTION SERVICES Address: 9414 EL CAMINO AV Phone: (714)593-3135 FOUNTAIN VALLEY,CA Zip: 92708 License: 562156 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 295 LF,6'HIGH BLOCK WALL,PER CITY STANDARDS,ON THE LEFT SIDE PROPERTY LINE.INCLUDES 3,5'TO 7'RETURNS. 22'FRONT SETBACK PROVIDED. FEE SUMMARY Plan Check: $81.41 Calc Valuation: $5,900.00 Permit: $125.25 Claim Valuation: $0.00 SMIP Res: $0.59 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $207.25 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 2446-48(6/00) DECLARATIONS,v 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. rite.. 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 worker 'co pe s ti�f Insurance carrier and policy number are: 2 7 / Carrier: i7J/J9) Policy Number: /3/ b07--Oa (This section need not be completed If t . It/s valued:f one hundred dollars($100)or less.) ❑ I certify that In the perform:nce/ ark for ch is permit Is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of Car orf •:greet III ould become subject to the workers'compensation provisions of Secti 3700 the Labor Code,I shall forthwith comply with these provi ? Applicant Signature: ��� Data: / a 3 WARNING:FAILURE TO SECURE YORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PE TIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOUARE(S100.000). ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF TH LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed Cu�/r rovi i•• hap-r 9 commencing with Section 7000)of Division 3 of the Business and yrJfessio Code,and my license is in full force and effect.tic.# "'Q'�- Class A Contractor's Signature: Date: S;Z fin 4 -"i CONSTRUCTION LENDING AGENCY ❑ I hereby affirm that there is a con tructlon 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 DECLARATIOpLS. 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 driver's license. Ales 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,Mile 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 hes 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? 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 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). 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 Ten RMPP H 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 a plication appermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes u 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 fadliry to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 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 thirir 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 penalty of perjury that I have read this application and state that the information given is correct. I agree to corn. 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 pr•,. for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 4 /gj'Signature Of Legal Owner(s) t l-or - And/Or Authorized Applicant ate SOME I '•. 1•. s' PATE MALS CODEC IpSPEC1ION TYPE • QAIE IMALS 1616 Fixe.System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 7210 Final Electrical 201 Final BIocWRetaining Wall �"yl""t,7 6-414"-- 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 lo 35615 PAID ****83.33 ncr z l-7C ID COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 P IC TION FOR BUILDING PERMIT ForAp nt to Fill in Complete/ 1,Lky,Cj N RE EIV D Y DATE RECEIVED BUIeb4i7 DATE ISSUED ADDRESS9� �/1/ v i( /L et //-1,31, /�a[��Z/�ry�I. /RIO NO. �A 1 /// A.P.NO. (C/U til-4 b OWNER i`. 4 IirLC /J � / //`si MAIL Lh?(l Tcr.--�� -Q ADDRES 3 L Deft/ -Sige / Z ADDRESS r �// X/�C- W W O Lt�hC/ ' C` TEL.`(//-�(�c,yr/ TRACT 376 LOT 2Z BLOCK O.(3 CITY ( /� h.� /L N0.6 (O J`l''�)`- Z 4 CONSTRUCTION i �� a — / NEW ADD ALTER REPAIR MOVING DEMOLISH O cn LENDER (� v am ^' 4 D BRANCH ��e'UWf t1�f.�, Jamey .S']a/�e/ -JO � � OWNER Q W ADDRESS �'h AA_, i/'/(///2-�" t. 1T„�'_` tc_./ J pn �1, �I�V�ALUE C D.s� m-CO ARCHITECT •II f Ir �a� ._1C... NO. \ T o i USE1/! Lr�A � NlY'✓"1 S.') 7�a J N OR ENGINEER �.(J� /��t f� //l �I////• J,'/�f FIRE W CC ADDRESS I f?t>'1. , c(-.-'r-CP EP 7/6 ZONE TYPE ' GROUP j+ aW �] APPROVED W Z CONTRACTOR j/r,((erLA /44422:4Z1--; BY DATE 00Z Il//U�� 4 L • J cc ADDRESS I r/ et/ 709 ZONE /��l NO.OF USE OF NEW /!-J�.� r.� CI TEL. 1_` eke T_ / (_ Z I- CITYt--A ":"../C,1: NO. PLANS BUILDING V VW W O STATCITY YARDS APPROVED YARDS APPROVED i. to CC LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING D O (FROM C/LSTREET) SIZE // NO.OF BLDGS. ��//JJ ��--.. OF LOT `1 y3 b v NOW ON LOT FRONT FT. t.C, FT. USE OF1 1 A �1 / EXISTING BLDG. ^uAL, R.__SIDE a tt. FT. FT. H SIZE OF . NO.OF 5 Z NEW BLDG. J' ",.>�r ROOMS STORIES L.SIDE FT. FT. oaEXTERIOR WALL ROOF ^ o fe , _ COVERING COVERING REAR /C/ FT./5 FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. / BET.MAIN& d I, MAIN BLDGGS.. /7 ACCE . BLDGS.aact , .ztIje`j4fl74t( _ CRPE /G/7) EO APPROVEDfA � � -o I— _Q____ S ABYROVED /Arc DATE1 ..T, a Z O I UI hereby acknowledge that I have read this application and state ;•.i'EE.y' that the above information is correct and agree to comply with D FOR Sptnoi IA7 cc all laws regulating building construction, and I shall not employ VOL H any person in violation of the workman's compensation laws of Yf a ) p H the State of California. .. 5'Z p0 FT. /DYn'( /�p c z �Ufv '° I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 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 provisions of the State of California Business VALUATION and Professions Cone, Divisio -3,Chap or 9. PERMIT FEE $ to ��, N D Signature of ...���fff [//t m Permittee $� /D0 PLAN CHECK $ �i s SO E CY // / L Authorized Agent IL TOTAL FEE $ S2o f7 ;L1: 10-73EI 00 538 Fj': 159.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 PP !CATION FOR BUILDING PERMIT For Applicant to Fi$in Completely �/J V EC IV /D BY \pATE/�RECEIVEED DATE ISSUED ABUILDINGDDRESS 7 ( 777 4- 5LpL-o� JIrI1� } ( I��I J"� ]. I � �, U� J J ' 1. ` / A.P.NO. \ PIFs MsI/NlI. OWNER)f 613 IDIS /' - S- t. I ^^', //rAl,,�� ADDRE S 7 s7 VLDa)ST I 't, A MAIL 111�,r Z ADDRESS W W TEL. a O CITY NO. TRACT I LOT BLOCK Z Q CONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMf1LLSH O N LENDER -j J D BRANCH J Q ` &I 0. qq ` J co — OWNER N J a W ADDRESS r� �p p�/ VALUE CO-CO ARCHITECT TEL. USE `T Ra `�H $ OR ENGINEER NO. U Q FIRE w cc ADDRESS ZONETYP /1//E GROUP L d t#1 APPROVED I _ W Z CONTRACTOR BY VJ DATE('-10 -.1 Jp CO J Q ADDRESS W W TEL. ZONE NO.OF USE OF NEW 0 x CITY NO. PLANS BUILDING Z F W O STATE CITY YARDS APPROVED YARDS APPROVED to 2 LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING DO SIZE NO. SLOGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R SIPF FT. FT. I— SIZE OF NO.OF Z NEW BLDG. ROOMS STORIES L.SIDE FT. FT. VEXTERIOR WALL ROOF _ COVERING COVERING REAR FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& a a MAIN BLDGS. ACCESS.BLOCS. Q11( VAR.* A O P - /�pt)fr1 C. 0.P. APPROVED I— APPROVED CO ..-13Y DATE Z rizt4 0 UI hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ I` Hany person in violation of the workman's compensation laws of ?1,L7 m V y the State of California. ,o ZI hereby certify that I am properly licensed as a contractor under SQ. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force end effect,or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION /�j CE and Professions Code,Division 3,Chapter 9. S(Jif f m PERMITFEE $ N D Signature of D Permittee S-- PLAN CHECKS E l610'0 Authorized Agent U. TOTAL FEE $ • 35616 OCT 27-72a: 01239*CHSoizs9 ****16.37 - COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 /r I TION FOR BUILDING PERMIT E0 R EI D v GATE RECEIVED BUILDINS4canEitpcyppletely / ' 6( /.T� EDADDRESS ^ �j /` ^".��(�� / /DJ�� OWNER / 11 1J..D 75.0.)_ A.P.NO.1101 '1)4''70 -�(}f,.-�+O �P)ER J.7JF0.1 A MAIL ( �^ .1 U� BUILDING ADDRE Sa10.7/ /� Lbe gi Z ADDRESS i(//�z/�-/z�'1 ' OT 1-2 CITY T� I� �j[, /l 4 NO.TE � Yl l�/(/ NEW TADD T ALTER REPAIR LMOVING OFMOLLSN OZ 'CCy LENDER ^LLL'777", 1 J o- coJ D BRANCH •�/1-/, -ti w�J,• (ate z J Q • J N i— �l� OWNER %.41 JO"AJ Al /JJS`T-DFII4[.� (��] m•m ARCCHI7 CT ��C�Ll7 /CLI �t TEL. .���y�O USES—am 1 AT/Cfl4` . -2 JV J Q OR ENGINEER �nn Lege/AL N ` Za `/- • J�/ / 0/(KJ FIRE T LB cc ADDRESS 4./....) .,_„1.(„,i , .4j ZONE TYPE �GROVP l / �//J APPROVED J O CONTRACTOR f eettratal --.... C tL4f/A. BY DATE m co ADDRESS/70Q . ceitederei, W W ZONE NO.OF USE OF NEW/ 44Q.a ZF C PLANS p2` BUILDING CITY�( f / NO. W O STATE CITY YARDS APPROVED YARDS APPROVED co CC LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING DO )(30 '` (FROM C/L STREET) 6a SIZE ` 6 V NO.OF NOW ON LOT IeNT FT. FT.6a- OF LOT [P USE OF / p EXISTING BLOC. a...-c-Lj�__ 11-SIDE FL 7O FT. 1— SIZE OF J/� �j ✓NO.OF Z NEW BLDG. /o / D L �fAOOMS STORIES L,SIDE FT. 5 FT. el EXTERIOR WALL ROOF s� , l _ COVERING COVERING REAR FT. cFT.6i(,4, J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& / 13. MAIN BLDGS. p ACCESS. BLDGS. b Q IV L�-.Li(Lp S- �'K/� - DATE C U.P.# -2.....e--72-0'O APPROVED 8-ai'7a_ coo APPROVED Li) & 'r }i LJ / � DATE O ...Lot. I hereby acknowledge that I have read this application end state ('�A • D that the above information is correct and agree to comply with LU FOR SQE""' TAX cc all laws regulating building construction, and I shall not employ HO I— any person in violation of the workman's compensation laws of Z the State of California. /6 JO co co I herebycertifythat I am !/ / SO. FT, .- properly licensed as a contractor under the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5 Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: I10 [ am exempt fro a provisions of the State o California Business and Profession's Co e, Divisi n 3,Ch ter 9. VALUATION ---. ry I`\ / GU HERMIT FEE $ Signature of / t/(�U ��/-�C/ / / / 0'o m Permittee 't , 1 ��`� $, is �j 6 D PLAN CHECK $ i(, - E u. Authorized AOa t `•/J .....--.-"-----' TOTAL FEE $ 5tI� !;:i 1n-7 3ci{:00 537 cJi it*::32.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 • AP LICATION FOR BUILDING PERMIT For Applicant to Fill in Completely •n� I- �{ G ,,, \ `/�- REEl E (�Y D TE(oECE Q i-tbSS Y6 BUILDING ADDRESS 4 `r' J� t. L- , 1 N —�( WW • `-, `r/.f ��;..tt��/� _ �5mN t % R] <rNr�7 OWNER �O(-,l� A.P.NO. BUILDING (4 2 7 ' L —, L Sr MAIL ADDRESS Qi/ 11y„! Z ADDRESS W W TEL. TRACT I LOT BLOCK d U CITY NO. Z Q CONSTRUCTION l ADD l ALTFR!REPAIR.MOVING DEMOLISH O co LENDER J D BRANCH .. 11,, 11 ��\, 1. C Jto OWNEvC1tW1�J r�IV\ `, CO J ADDRESS VALUE -CO ARCHITECT TEL. USE $ 11 Q OR ENGINEER NQ, (J N FIRE WCCQ ZONE YPEjGROUP, ADDRESS // CI_ W APPROVE l io-7 J ZO CONTRACTOR BY �J DATE CO Z JCC ADDRESS W W TEL. ZONE NO.OF USE OF NEW 0= CITY NO. PLANS BUILDING Z F W O STATE CITY YARDS APPROVED YARDS APPROVED to K LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING 7 SIZE ANO.OF BLD(�5. (FROM C/L STREET) OF LOT 'NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R SIDE FT. FT. I— SIZE OF NO.OF Z NEW BLDG. ROOMS STORIES L.SIDE FT. FT. 0EXTERIOR WALL I ROOF _ COVERING COVERING REAR FT. FT. -I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 0- MAIN BLOCS. _ ACCESS. BLOCS. 0- QVAR.# DATE O k, CO&1n x-- � `�� C.U.P.# _APPROVED I— ' " „� APPROVED Z —BY _DATE O . I— L.) I hereby acknowledge that I have read this application and state �t 7 that the above information is correct and agree to comply with , ()/A bt CC all laws regulating building construction, and I shall not employ v I— any person in violation of the workman's compensation laws of CO the State of California. m Z to I hereby certify that I am properly licensed as a contractor under SQ. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5 Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a cc am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ 0'P-0and Professions Code, Division 3,Chapter 9. 2�- Si Signature of m Permittee $ ` PLAN CHECK $ E � LL `o X27 Authorized Agent TOTAL FEE $ - 35617QCT 27-7?CtiS1PAIB0012IIo* ** 6)L67 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APL ATION FOR BUILDING PERMIT For lice t to Fill i Comaletelyyyy �,, ��� )I • R ^EI E/BV —277TE CEI E7 DAT ISSUED ADDRES I 1. Q 4/'-'?/ 0-71 ADDRESS �/f,( / �/.L , PERMIT NO. OWNER \A`r--4 c tiL/J BUILDN. Ir%-obi o/�-� �'1r�;r5�/'� MAIL ADDRESS \\) D S 3 ,--') c.,2 3 ADDRESS a&,374 Et..o t, Sr LAI lliZ TRACT 374 LOT ZZ BLOCK t1 Z CITY TEL.. IIA-V/ �--1'I -I� IO•c. NO.U/ ,,,--ygig Z Q COKSTRUCTIONv 11 1 "am r NEW - ADD ALTER REPAIR MOVING IIFMOt LSH d m LENDER V t J 7 BRANCH ri—V1 rl ;�A O { n I /\•3—y�t J tn C �� /J OWNER \ /0 A/ 4 I Vsf!/V c Q W ADDRESS -A.A Li r/� I ?Coe m J - „JrVALUE s -w ARCHITECT '/ ,� TEL. USE -T/2i Pit 4/�AU sT//-a. $02[frt�� Q OR ENGINEER I/;f F1.Q ✓fI Q NO / UN �7/� wQ s FIRE cc ADDRESS �l AC+fi J ZONE TYPE GROUP�T at / W Zn APPROVED J O CONTRACTOR/ �[.//j7�it ,�1� f�/z (/(/n BV DATE ,/ m� ADDRESS ( 70 /L/O /Y�. . �PL ex VW 3�I w W [ ZONE NO.OF USE OF NEW Z F rL. PLANS BUILDING r �`�� CITY /t,f,/1/ //�_i�„ . �� TNf�i 1n.�f 1, p STATE CITY YARDS APPROVED YARDS APPROVED N 2 LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING DOSIZE ` / /� (FROM CIL/,ST EET) OF LOT �j�j �! '�,O NOW ON LOT SL/ FRONT Ip�F T. FT. USE OF 111___ q, EXISTING BLDG. `(/p d_.274012,2 ,"pet dea 4I-� R SIDE CkI ET. FT. I— SIZE OF -7 NO.OF "`. Z NEWBLOG. ( / Z ROOMS STORIES t,,sloe J FT, FT. UEXTERIOR WALL ROOF ' _ COVERING ICOVERING REAR FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& CL MAIN BLDGS. ACCESS BLDGS. 0- Q T VAR. '1 DATE �7 O f/�-( .L wy- �i/ //�, l' .�il r>�jL�G�._ C.U.P.9V+ -/�� �L7 APPRO r / _1_7 �' / Z Cr — _ ` // / - f,_ / ROVED �,co S DAT 2 . CD s t ...�.(.�� .�'l mfr l_t_1 o , / r /, A C..t� ....,,.....4.1_...n Q - . (.1 I hereby acknowledge that I have read this application and state 1�R SpE'; "1. � ce thatll the abovelan information is structi and agree to comply with n�LD ce all laws regulating building construction, and I shall not employAA. rbf 1" any person in violation of the workman's compensation laws of C/3 the State of California. Q /f 9044. 671i is I hereby certify that I am properly licensed as a contractor under (2;00SO. FT. /O��' o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR j Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a cr am exempt from the provisions of the State of California Business da Division 3,C apter 9. VALUATION and Professions n D t� PERMIT FEE $ Signature of (\\ [\',�( N. 4/690 ' �1 N Permittee �/Y ! ,\--,,,, \\ A �n $3o l� PLAN CHECK $ 62 t E / . Authorized Agent / u TOTAL FEE $ Pki _ 35i i.":11 10-735R 00 536 �,r * i 21 .00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 PP_ICATION FOR BUILDING PERMIT For Applicant to Fill in Completely _ `�'//f EC IVEDBY ATE RECEIVED ATE ISSUED `ADDRESSta 43 / cL(�L�TJsr �L-17„'Y ' to~ c_�v l3 f`1 1/ , —i--49..t � PERMIT Ng, ` BUILOWNER ( •4 ✓s r.TN�.�i A.P. NO. / /� ��Q�t MAIL ADORE S NG 4.6 -�1 ALV&-19& &ux-?5 Z _ADDRESS La NEL. Q-U TRACT LOT BLOCK Z CITY NO. F.. ZQ RCTION NEW ADD ALTER I REPAIR MOVING DEMOLISH LENDE d m NEW J 7 BRANCH JN OWNER en,,..1/4 f_) __ 0IS m J _ADDRESS {{fi�rr.�� �! r VALUE -CO ARCHITECT TEL. USES tec � t-sJo ex itaka_6� Q _OR ENGINEER NO U Q FIRE J W m _ADDRESS ZONE TVPE� GROUP [L W APPROVED W Z CONTRACTOR BVLL DATE � ' IO — J 0 — m Z J m _ADDRESS W W TEL. ZONE NO.OF USE OF NEW ZF _CITY NO. PLANS BUILDING WU STATE CITY YARDS APPROVED YARDS APPROVED co CC LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING D U SIZENO.OF BLOCS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF _EXISTING BLDG. R SIDE FT. FT. I— SIZE OF NO.OF Z _NEW BLDG. ROOMS STORIES L.SIDE FT. FT. UEXTERIOR WALL ROOF _COVERING COVERING REAR FT. FT. -J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 0- C- _ BLDGS.BLD . ACCESS. BLDGS. 3^ R 0 _ U N I1- /LN !(N fn/ ./ CUP.* APPROVED CO APPROVED CO , BY HATE �J 0 I ( v 0 I hereby acknowledge that I have read this application and state Yl�,i) 0 that the above information is correct and agree to comply with III ��_ . ¢ all laws regulating building construction, and I shall not employ F any person in violation of the workman's compensation laws of fA the State of California. m zI hereby certify that I am properly licensed as a contractor under gip, F7, 0 the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR • Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: Q am exempt from the provisions of the State of California Business VALUATIONI ,1 •••••and Professions Code,Division 3,Chapter 9. PERMIT FEE $ `r17 ••••• N D Signature of to Permittee $ PLAN CHECK $ E /�'`� w Authorized Agent LL AP TOTAL FEE $ CITY OF COSTA MESA f`y' �� BUILDING DIVISION I DEVELOPMENT SERVICES DEPARTMENT Te. NCO PERMIT PERMIT NUMBER ER (714)754-5273 • Fax(714)754-4856 BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2637 ELDEN AV Status: ISSUED Suite: Applied: 05/27/1998 Vicinity: AT REAR OF BUILDING. Issued: 05/27/1998 • Parcel Nunmber: 43907120 Zoning: Applicant: ROBERTS, WALT Address: Phone: Zip: Owner: KETTNER, PHYLLIS R TR Address P O BOX 10112 Phone: COSTA MESA,CA Zip: 92627 Contractor: LEE ROOFING OF COSTA MESA Address: 01653 SUPERIOR AV Phone: COSTA MESA CA Zip: 92627 License: 349686 Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT REROOF OVER EXISTING 1 LAYER COMP.WITH 3 TAB COMP.SHINGLES WITH 30#FELT UNDERLAYMENT AT THE REAR OF BUILDING FEE SUMMARY Plan Check: $0.00 Calc Valuation: $3500.00 Permit: $87.25 Claimed Valuation: $3,500.00 Other: $0.00 Inspection: $0.00 Total: $87.75 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: 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 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of pejury one of the following declarations: ❑ I have and will maintain a certificate of consent to sell-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 wit 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 section need not be completed li the permit is valued at 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 t ' should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith pjy.withthese Provisions. t slgnatare: Date: 5-27-1 S- ARMNG:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MD CML FINES UP TO ONE HUNDRED THOUSAND DOLIARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. • UCENSED 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 e force andeffect. atu M 7 . �— C less q i// ` \ rre ctoSI nates ursagfiDate: c-. 1 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 CONTRACTORSLICENSE 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 fore permit subjects the applicant to a civil penalty o1 not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(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.It 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 UCENSED 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 Driver's License No. Expires: Verification of Ownership by(type of document,Le.-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,wit 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,Tile 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,ore 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). 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 end Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire epartment 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 epermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes ❑No (Section 651502 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 Safely 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. a I.•ature 01 Legal Owner(s) Date � � 1��►1�. 5-Z7-9S' — / e ncrt Authorized Applicant DOW ODES I(SPFrTION TYPE LIME MEALS PODF f IbSPFCIIM TYPF DATE 9®ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof • G -'7J' q g`[O O 210 Anal 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 Anal Building/Occupancy 244846 PROJECT ADDRESS: 2637 ELDEN AV UNIT: C, E,G CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 052315 OWNER'S NAME: STEVEN KETTNER ADDRESS: 761 FAIRMONT WAY PERMIT NO: B 052319 PLAN CHECK NO: N GOVT: N SUPP: N ORANGE C 92669 CONSTRUCTION TYPE: 5—N PERMIT TYPE:' STR PURPOSE: REP AflLHIENGINEEfl: ( 714 ) 532-4806 flEG.NO.: JOB DESCRIPTION : REPAIR STAIR TREADS & RAILINGS SQ FT: 3, 400 ADDRESS: UNIT: CLAIM VALUE: 3, 400. 00 CALC—VALUE: 3, 400 .00 GROUP OCC: R-1 / PERMITTEE: JACOBS CONSTRUCTION ( 714 ) 898-2533 ADDRESS: 12861 WESTERN AV C COMMENTS: PLANS NOT NECESSARY FOR THIS REPAIR GARDEN GROVE CA 92641 **•******************* ************** ***)d**k*. ****aE*)6 +E****y6***********;, * ****x- LICENSED CONTRACTOR DECLARATION: I hereby atfirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7100)of Division 3 of the Business and Profession ode.and my license is in full force and effect. SETBACKS CITruc.: 053ff928 STATE LIC.:'7 4930 LASS: J�B�� / Date: CF—It— III //Signature: � ijEl.,. X0,22__ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby at rm that(have aceniticate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 43907120 ZNE: REF NO: N. Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> ' > Uate' Applicant: ****************************************************Y'************************** EXEMPTION FROM WORKERS'COMPENSATION DECURATIDN: (This section need not becompleted.0 the permitis for one hundred(5700)or less). DEVELOPMENT SERVICES REQUIREMENJ S I certify that in the penormance of the work for w ch this permit' issued.I shall not employ any person in any manner so as to become , scbect to the/WworkersCompensnnssation Laws California. ,n,, //, ' / �ONING APPROVED BY DATE: Date: LO � // Signature' '/�{�(✓K/l�-/.iii--/(/ = s NOTICE:II.after making this declaration,you sh d b come subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. j' r CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: # ' 13 DATE: c which this permit is issued(Section 3097.Civ.C). ****************************** ***+F+++FFf******R**** *****ir************* *** j *** LENDER: ***aE**********li******************************************fi********************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l 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.alter,improve,demolish,or PERMIT 63 . 00 . 50 repair any structure.prior to its issuance.also requires the applicant tot such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON—RES 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($500). ISSUE FEE 1. as owner of the progeny or my employees with wages as their sole compensation, win 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----> 63. 50 0 . 00 0 . 00 63 . 50 63 . 50 . 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 r improvemenr her t soled�withn onprovided ear ofat such competionr�ments ownerare wilnot have intended burden of proving he/shor tittered for sale. e did noter the build or improveiREVENUE DIVISION TOTALS--> COLLECTED: 63. 50 OVER/SHORT; 00 for the purpose 01 sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK` I.as owner of the property,am exclusively contracting vnth licensed contractors to construct the project(Section 7044,Business 63 . 00 . 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a conuactorls)license pursuant to the Contractors'State License Law).l am aware ******************************iii************************************************ that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN o I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: SFR 3400 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 3, 400 . 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 cc 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air uahty Management District.Residential construction applications are exempt from these provisions. Dale: Applicant: I hereby certify that I have read this application a 'stale that the above information is correct.I agree to comply with all city and count ordinances and state laws relating to building co action and hereby authorize representatives of this City to enter upon the above-mention n . progeny tor inspection/ purposes / `T'- •'l! -17. A' - J .2352 s•'i _ £3a.ad Date: (n—C 7 SL�� U�—,(�i^J'A "`i "'�: 7_ L'S/^1 l:r�. i%x..0 Drivers License or Social Security 1641.46 While—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING _ POO PA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line& House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping El Gas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrna.Storage Tank 0 Gas ❑Oil • 25. Roof Sheathing - 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat • 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING )./.. 61 ( 6 /,VW 48. FINAL PLANNING . 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date I ' PROJECT ADDRESS: 2637 ELDEN AV "NIT:FRONT CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 061082 OWNER'S NAME: KETTNER ADDRESS: 2637 ELDEN AV PERMIT NO: B 061082 PLAN CHECK NO; N GOVT: N SUPP: N COSTA MESA CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT ( 714 ) 438-3242 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REROOF W/COMPO 0/COMPO (TRI W/ATT GARAG) SQ FT: 4 , 900 ADDRESS: UNIT: 13.7.4..._( � CLAIM VALUE: 4 , 900 . 00 CALC—VALUE: 4, 900 . 00 GROUP OCC: ' /M-1 - PERMITTEeARMSTRONG ROOFING ( 714 ) 633-5980 ADDRESS: 1007 N. BATAVIA COMMENTS: SMOKE DETECTORS REQUIRED PER THE 1991 EDITION OF THE UBC ORANGE CA 92667 ***************** -**+E******* n-*****+E**iE*+ryE+E************+E***** ****,-***x* ***** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am Licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK S CITY LIC.:019034 STATE LIC.:27391 uss:C-39 •----- Date:2.--1 344 Signature: atz_ �(�—'�— MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sol re or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN insure Compensationmwrgy,nc2g.ppr cegiifi copy thereof(Section 3B00,Lab,CL. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY N0.:6 tSL9tl�—yL EXP.GATE: 0 /01 /93 COMPANY:STATE FUND PARKING REQ: PROV; PARCEL; 43907120 ZNE; REF NO: El Certified copy is hereby furnished. ® Certified copy is filed with the city Building Division. PLANNING NOTES> • xa.s A > —.•••• Date:11, y V c S Applicant:' 0 ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is r one hundred(3100)or less). DEVELOPMENT SERVICES REQUIREMENTS 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. ZONING APPROVED BY . DATE: • Date: Signature: NOTICE:If.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: Code.you must forthwith comply with 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 B Y: DATE- which this permit is issued(Section 3097.Civ.C). *.*********************-***.f**** * * * *** * - re***************************** LENDER: ****************************************** *********************************** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM I P/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 72 , 00 . 50 repair any structure,prior to its issuance.also requires tie applicant for such permit to life a signed statement Cal he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 0l the Business • $MIP/NON-R E$ and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My 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(S5(q). ISSUE FEE • I. as owner of the properly or my employees with wages as their sole compensation, will do the wane, 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————> 72 , 50 0 . 00 0 . 00 72 , 50 72 . 50 , 00 does not apply to an owner of a properly 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 sate.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 72 . 50 OVER/SHORT• . 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 72 . 00 . 50 I.as owner of tee propel.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business - ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors State License Law).l am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.B P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST - TOTAL COST Dale: Meer: SFR 4900 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4 , 900. 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safely Code Sections 25505,25533,and END OF FEES 25534 and that I or any luture building occupant will/will not(circle one)need to comply with said stale codes and the requirements for a permit lot construction or modification tram the An Duality Management District.Residential construction applications are exempt from j' these provisions. iiiii A• Dere: Applicant: EXPIRED I hereby certify that I have read this application and state that the above information is correct.I agree to comp ith all city and county Incomplete I(1SPt(OT15 Siordinances and state laws relating to budding construction and hereby authorize representatives of this city to en in the above- tioned - property for inspection purposes. / / . �� bete _ -- g ___--�a-- --� Dale:..(_'' Signature: _ r /i. _ .. /. ' . - 1 1641-46 White—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue:Goldenrod—Assessor • 'j I te f CONSTRUCTION AND PLANNING POOL& SPA APPROVALS Permit�`r Date Inspector APPROVALS Permit i Date Inspector 1. TemporaryElectrical Service or Pole 52. Pool & Equipment Location I I 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement - ' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms -- ! -I 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing& Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GU'. T£ j t :' 7. Footings 58. Electrical Conduit•Undrgrnd. 8. Foundation59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 1 60. Backwash Lines,P-Trap, 0 Undrgrnd. I 10. Structural Floor System 1 61. APPROVAL TO DECK i 11. Property Sewer Line& HouseConnection 62. Backwash & Receptor-Final - 1 12. Sewer Cap 63. Heater & Vent-Final -1 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical•Final 15. Rough Electrical-Conduit 66. Solar System-Final 1 16. Rough Electric Wiring •. • 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 1 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT' - 20. Rough Factory Fireplace APPROVALS Permit 21. Ducts,in Structure 70. Underground Hydro t 22. Ducts, Ventilating 71. Product Piping ElGas 0 On 1 -t 23. Gas Pipe-Rough& Test 1 72. Underground Flush , 24. Roof Framing 73. Undergrnd.Storage Tank C Gas C O•l 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 1 77. FIXED SYSTEM FINAL 29. Insulation I 78. FIRE PREV. FINAL I 30. Drywall Nailing { HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �- 33. Final Electric Notes: ?-f //?(73 0 ie_ Go ,60, oU ,z_p 1- 34. Final Heating& Air Conditioning l • 35. Final Gas Pipe-Test 36. Hood or Canopy -` 37. Final Factory Fireplace ` - 1 11 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final I i 41. Solar Domestic-Final 42. Backflow Preventer ( i 1 43. Backflow Irrigation I 44. Landscape Irrigation System f i 45. Sound Attenuation I ~ E-X-P-I-R-E-D -j 46. Handicap Regulations • Incom Incomplete . p Inspections 47. FINAL STRUCTURE & BUILDING Oete -7/9-9 -fig ,65--_ 48. FINAL PLANNING 49. Electric Release to Edison I i 50. Gas Release to Southern California Gas Co f 51. CERTIFICATE OF OCCUPANCY No. Date