HomeMy WebLinkAbout2568 ELDEN AVE - Building Permits ELDEN AVENUE 2568
40228 - County Add Stge. to gar. 700. .
4022 - County Sdd Patio 360.
2305 7-28-6t Elec. NC (Meter)
6930 - 6-22-76 Plbg. NC (Nater Piping)
43875 - 6-26-78 Residence v/att. gar. 62,550.
43876 6-26-78 6 Unit Apt. Bldg- 190,800.
800.
44169 - 6-23-77 Demo Res. & Car. 500.
i ti22 - 7-28-27 gTkves .
.&Tr.Encl. 6, '..
45105 - 88-2-7889 Fire Yard Line 1,950.
74565 - 9-6-78 Plbg. NC (Softener)
. 78032 -)7444 Plbg. NC (W.H.)
I — —
I
i
870791
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CITY OF COSTA MESA
BUILDING DIVISION
F, I� 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
". fl . FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: BX07-00025
PERMIT TYPE B_MISC STATUS: ISSUED
DATE ISSUED: 07/17/2007
ISSUED BY: BJK
JOB ADDRESS: 2568 ELDEN AV CM • Suite/Unit:
Vicinity: PrimaryOcc: Const Type:??
SQ. FT: 0 ' Valuation: $16,000.00
SCOPE OF WORK: REPLACE 30%OF THE FASCIA BOARDS AND SPOT ROOF REPLACEMENT ON THE SINGLE-STORY
PORTION OF AN EXISTING APARTMENT BLDG. WORK TO INCLUDE ELEC FOR LIGHTS
AND CONDUIT.
OWNER: TAMURA,NOBUYOSHI P Address: 2568 ELDEN AVE Unit:
•
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: LUGO,RICARDO Address: LUGOS ELECTRIC Unit:ANAHEIM,CA
PHONE: - 714-996-4398 City/State/zZip: 3106 E ORANGETHORPE UNIT C
CONTRACTOR: OWNER-BUILDERLicense No. 000000
Address: Unit: , PHONE:
City/State: ZipCode: CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
MISCELLANEOUS PERMIT FEE SUMMARY . .
Building Plan Check: . . $0.00
Building Permit: $265.25
Electrical Permit: . $45.00 •
Other Fee: $0.00 •
SMIP Residential '$0.00 :
SMIP Commercial $0:00 '
TOTAL FEES $310.25
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.
coots INSPECTIONTYPE 128.18 1NTn1ALS gODEf INSPECTION TYPE IM IN1111ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical /04/0
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 M////7
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the i ,.._.ang declarations:
❑ 1 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.
❑ 1 have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(rhe section nectlnot be completed d Ne permi a vahxd at one hundttd cWars (St 00) a IessJ
Policy Number:
I certify that in the performance of the work for which this permit is
ssued, I shall not employ any person in any manner so as to become subject
to the workers' compennsatioof California, and agree that if I should
become subject rsp nsation provisions of Secti 3700 of
the Labo e, I shall fort I with these provisio
7 0
p want s Signature pri
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. #
Class #
Contractor's Signature Date
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency fon the
performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Signature Data
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 Codb) 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 penally 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
d'dnot 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.).
❑ lam exempt under sec.
Business and Professions Cod o this reason:
�_l7_ o
SiBrtature _ Date
305746 (107)
r
Owner ID verified by driv Ise. Y s ❑ No
Driver's License Expires: 02__Q_0.9
Verification of Ovmers? - property tax bill or deed):
t
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, falsewfirk, of demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safely, as noted above, unless
such person has a permit to do such work from the division.
Applicant's Signature Date
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be 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).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air 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 cion -residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(if 'yes . the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No,
8. (If yes", attach certificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
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 finalcoon.
i ature of Legal tamer Date
Maroc u ooze Date
(714) 754-5273 • Fax (714) 7644856 • www.ci.costa-mesa.gL4"LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
2568 ELDEN AV
Suite:
. B
Vicinity:
ROOF
Primary Occ:
R
Parcel Number:
- 43916117
Applicant:
BRIAN WOLSKY
Address:
P O BOX 771
SMIP Res:
HUNTINGTON BEACH, CA
Owner:
TAMURA, NOBUYOSHI P
Address
2568 ELDEN AVE
Inspection:
COSTA MESA, CA
Contractor:
TOM BYER ROOFING
Address:
P 0 BOX 771
HUNTINGTON BEACH, CA
Zip:
92647 "
Arch
Address:
Phone:
Zip:
License:
Type of Construction: V -N
Zoning:
Phone: 714-847-9332
Zip: 92647
Phone:
Zip: 92626
Phone: 714-847-9332
License: 575002
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 08/21/2006
Issued: 08/21/2006
Phone:
License:
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) 7545626
2446-46 (6100)
SCOPE OF PERMIT
TEAR OFF EXISTING
ROOF. INSTALL 1 LAYER OF 15# FELT, 4:12 PITCH AND 1:12 FOR FLAT, 50 YEAR CERTAINTEED COMPOSITION
SHINGLES, REPAIR/REPLACE SHEATHING AS NEEDED, APPLY COLD PROCESS ROLLED ROOFING. 6,500 S.F. FOR SLOPE AND 1,000 S.F.
FOR FLAT INCLUDES
ATTACHED GARAGES. BLDG B, UNITS B001-8006.
FEE SUMMARY
Plan Check:
$0.00 Calc Valuation: $25,000.00
Permit:
$391.25 Claim Valuation: $25,000.00
SMIP Res:
$2.50
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$393.75
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
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned
for a period of 180 days. - ,.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2446-46 (6100)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION: j
I hereby affirm under penalty of perjury one of the following declarations: .�
❑ 1 have and will maintain a certificate of consent to sell -Insure for workers' compensatl-k,'as provided for by section 3700 of the Labor Code, for the performance of the
�— rk for which this permit is issued.
k __4 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued.
My workers' corn enation Insurance carder and policy number are:
Cot r:✓ - �� icy Number:
is section need not a completed i/ the permit is valued at one hundred dollars ($100) or less.) 'P�` ----`
❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 700 of the Labor Code, I shall forthwith
comply with these provisio
ApppplicaM.519nature: Datie-
WCljbll O?P/1ILURE TO SECUREWMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMP OV�CRIMINAL PENALTIE4 AND CAVIL PINES UP TO ME HUNDRED
THOUSAND DOLLARE($100,O1)o), IN A9DPPeftTO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby.affirm.thafl 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
'f cor a and effect Llc It - �� �- Class- N�—��-' 3
-
GontraclorsBlgnature X ii, o�
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that 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 o1 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.).
❑ 1, 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ 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 B, 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 WIII the applicant or present or future building Occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any One time during a repand 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).
.........._..........................._...............................___._............................ildi................___...............___............................._.......................___............................................................. —
..............__._.......
__....._..._
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous matenals7 ❑Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials aqua 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.
_...............................................................r*equ. i'r..........._....._......t'i'o....................................._.........i'a'-...................................t-y"'.............................._._........................................................................._..............
..........
.........
._.........
........
_............
4 ...........FanRMPP is presently required, has Section 25534 of the California Heelth andSafety Code been fully complied withl [Yes ❑ 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 a ertnit for such construction or modification
Irom the South Coast Air Quality Management District or from any other air pollution control district or agency?Ves � Na
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
._.......................__._............................._—__....................._....................._.... ........................................__........._._............___.
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
...... . ......................_...................................._......_._... _.......................................... _._......................._............................._.......................... ___......................................................................... ............... _.......... __..........
_.
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No I
........._............................_...................................._........_...............................___............................._............................_............................_.................................._..__.__.__.__..............................._..................._._.................._..................._
B (ll 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 infornetlon 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.
ignalure Of LegalOwner - Da j
r`A'_or-Appllcant— ,--=•=•—^ rpate"
CODE x. INSPECTIONTYPE grljj INTMALS CODE INSPECTION TYPE Ii!!TE i INTITELS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 9 d O 208 Final Plumbing
200 Final Re -Roof 7 210 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
(714) 754-5273 • Fax (714) 7544856 • www.ci.costa-mesaBUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2568 ELDENAV
Suite: A
Vicinity:
Parcel Number:
43916117
Zoning:
Applicant:
WOLSKY, BRIAN
$195.25 Claim Valuation: $10,455.00
Address:
17662 METZLER LN
SMIP Com:
$0.00
Other:
Phone: (714) 847-9332
Inspection:
HUNTINGTON BEACH, CA
Zip: 92647
Owner:
TAMURA, NOBUYOSHI P
Address
2568 ELDEN AVE
Phone:
COSTA MESA, CA
Zip: 92626
Contractor: TOM BYER ROOFING
Address: 17662 METZLER LN
Arch :
Address:
Phone: (714) 847-9332
HUNTINGTON BEACH, CA
Zip: 92647 License: 575002
Phone:
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 11/07/2002
Issued: 11/07/2002
Phone:
Zip: License: License:
SCOPE OF PERMIT
REMOVE EXISTING ROOF, APPLY SHEATHING, APPLY 50 YEAR COMP TO SLOPE AREA. APPLY HOT ASPHALT B.U.R TO PATIO.
Total: $196.30
SETBACKS
MAIN STRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existing: 0
NOTES:
Rear 0-0
Rear 0-0
Required: 0
PLANNING & ZONING
Left 0-0
Left 0-0
Proposed: 0
Right 0-0
Right 0-0
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) 7545626
244 6(NW)
FEE SUMMARY
Plan Check:
$0.00 Calc Valuation: $10,455.00
Permit:
$195.25 Claim Valuation: $10,455.00
SMIP Res:
$1.05
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total: $196.30
SETBACKS
MAIN STRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existing: 0
NOTES:
Rear 0-0
Rear 0-0
Required: 0
PLANNING & ZONING
Left 0-0
Left 0-0
Proposed: 0
Right 0-0
Right 0-0
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) 7545626
244 6(NW)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affinn 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.
1Eq\_1_bavG and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carder and policy number are: • • s
Carder: Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this pernit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California gf4Sthat if I should become subject to the workers' compensation provisions of Sectionj3700 of he Labor Code, I shall forthwith
comply with these ' i I I I O
Applicant Signature:" Date: I
WARNING: FAILURE TO SECURE WORKER OMP 'N COVERAGE IS UNL WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE AI IES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE($100,000), IN ADDITI THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 906 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions ter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lic. # Class if
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): 1
❑ 1, 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.).
❑ 1, 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. ❑ yes ❑ 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:
❑ 1 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 W ill the applicant of present or future building occupant need to lite and cantly a Business Plan ter emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section which of the California Health and Safety Code requires, with some exceptions, that a Business Plan than
filed with the Costa Mesa Fire Department by every
business which has at any one time during a rd temp year a quantity of hazardous materials equal to or greeter than a weight of 500 pounds, or a volume'of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves [I 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 2DO, cubic feel 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, cerI ication 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 en RMPP is presently required, has Section 25534 of the California Health and Safety 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 p2plication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No I
(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 feel from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
............................................................................................................................................................................................................................................................................................................................................................................................
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
.............................................................ate...........................................,..............................................11ut................trol...................................................................................................................................................................:...............................
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 AITIHORIZAT1ON 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.
Ignalure Of Legal O I I t`Dald�
And/ uthonzed App11 nt —I UDataa
CODE., INSPECTION TYPE PETE INTMA CODES INSPECTION TYPE 2&U tIfunnilu;
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final �!f 208 Final Plumbing
200 Final Re -Roof 1 HOZ 210 Final Electrical
201 Final Block/Retaining Well 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
PROJECT AODflE55: 2 5 6 8 ELD EN AV UNIT:
OWNEWSNAME: TAMURA KIMIO TR
ADDRESS: 2566 ELDER] AVE
►. COSTA MESA,CA 92627
S I,
ARCHIENGINEEfl: flEG.NO.:
ADDRESS: UNIT:
PERMITTEE: KIMIO TA14URA (714)645-9061
ADDRESS: 2568 ELDEN AV
COSTA MESA CA 92626
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
CITY LIC.: STATE LIC.: CLASS: EXP-
Date:
XP:Date: Signature:
WORKERS' COMPENSATION DECLARATION: 1 hereby affirm that I have a certificate of consent to self -insure or a certificale of Workers'
Compensation Insurance. or a certified copy thereof (Section 3800, Lab, C).
POLICY NO.: EXP. DATE:
COMPANY:
❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division.
Date: Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($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 Wor/kgrs/' Compensation Laws of California _ 7
Date'. v/ ' 1777r Signature:
NOTICE: If, after making this declaration, you shoul become subject to the Workers' Compensation provisions of the Labor
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
which this permit is issued (Section 3097, Civ. C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code Any city of 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/she is licensed
pursuant to the provisions of the ContractorsState License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
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 (Section 71944, Business and Professional Code: The Contractors' State License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through
his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or
improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve
for the purpose of sale).
I.as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Code: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractions) license pursuant to the Contractors' State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section: B. S P. C.
for this ra on:
Date: / Ownar/
1 do hereby edify hall am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and
25534 and that I or any future building occupant wilVWII not (circle one) need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from
these provisions.
Date: Applicant
I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county
ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above mentioned
property for inspe lion purposes. Y/
Date: / C Signature:
Drivers Li ense or Social Security
164146 While—Building: Green—Code Enforcement Canary—Applicant: Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 070791
PERMIT NO; B 070791 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: SIR PURPOSE: OTH
JOB DESCRIPTION REROOF W/COMP SHINGLES SQ FT: 5,900
CLAIM VALUE: 5,900.00 CALL—VALUE; 5,900.00 GROUP OCC; R-3 /
COMMENTS: REROOF SOOOSF RESIDENCE W/COMP, SMOKE DETECTORS $819�LfHC^T/1p
M MM MMM M MM M MM M M M M M MMMM M MMMMM MMM MM M MM M M MMM M MM MM Miert M MM MMM MM M e i �l
ZONING S E RT EB QA UC IK RSEMENTS REQUIRED
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING RE • PROV: PARCEL: 43916117 ZNE: REF NO:
PLANNING N TES>
>
M M M MMM M M M M M M M M M M MM M MM M MM MM M MMMM M MM M M M M MMMM M MM M M MM M M Miert M M MMM M M M M M MM M M MMM M MMMM MM M
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY
DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: DATE:
M MMMMMMMMMMMMMMMMMMMMM MMMMMMMMMM MM
M MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 81,00 ,59
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS ---- > 81,59 0,00 0.00 81,59 81.59 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 81.59 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
81,00 ,59
MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 5900 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 5,900.00
END OF FEES
EXPIB.QD
DATE /i Lf jIj
01 001 75n2 -1-0017F-229 TOT 31.54
"'ATE: C1 19i9`. TIME. jt�61
�
CONSTRUCTION AND PLANNING
APPROVALS Permit # Date
Inspector
- .
POOL PA
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-Undrgmd.
55, Electrical Bonding
5. Slee! Reinforcement;!
56. Rough Plumbing & Pressure Test
5. Electrical UFER G'rnd.
57. APPROVAL TO COVER-GUNITE
7. Footings ..
58. Electrical Condwt-Undrgrnd.
8: Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, ❑ 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. Poor Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
55. 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. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Perniit #T
20. Rough Factory Fireplace ,-
21. Ducts, in Structure -
70. Underground Hydro '
22. Ducfs, Ventilating • ' -
-
71. Product Piping 0 Gas coil
23. Gas Pipe -.Sough & Test
72. Underground Flush"
24. Root Framing,
"73. Undergrnd. Storage Tank 0 Gas 0 Oil
25. Roof'Sheathmg -
_
-
-
74. Overhead Hydro
O
26. T -Bar Ceiling (Structural) & Monocoat-
..
75.' bry Chemical
- -
27. Frame and Flashing'
.•,, -
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM,fINAL -
4
7
29. Insulation .,
78. FIRE PREY. FINAL
30. Drywall'Nailing
- HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coai'
'
79. FINAL INSPECTION
32. Electrical Power Meter=Final
80. FOOD CERTIFICATE ISSUED
I 33, Final Electric
34, Final Heating & Air Conditioning
Notes: 1cpo¢ LO�%1/[F%
35. Final Gas Pipe=Test '
36. Hood or Canopy -'
37. Final.Factory Fireplace
i
- '
38. Final Plumbing
-
39. Water Service -Final
-�
,40. Gas Service -Final::
41. Solar Domestic -Final
42. Backflow Prevent&
r
'
43. Backflow Irrigation
.44. Landscape Irrigation System u-
45. Sound Attenuation,
46. Handicap.Regulations
47. FINAL STRUCTURE &•BUILDING
,
48. FINAL PLANNING
49. Electric Release toaEoison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF..O000PANCY
No. '' Date
COUNTY OF ORANGE
BUILDING DEPT.
636 No. Broadway
Santa Ana, California
Phone: KI 2-6211
i. OWNER'S
`J
Application for Building Permit
AND FOR A
Certificate of Use and Occupancy
MAILING ADDRESS...._!!.:. 5.6.6.:-...
Name--------------------------------------------- ---------------_
(Architect or Engineer)
Address
City
State
Lic. No.....---------------------------- Phone ---------- ------.----- .--------
PROPOSED USE
City ------- -
State
Lic. No------------
Permit No--- 21.-2n 9.
-------------- PHONE: ..................................
CITY---- -' - .......
(Contractor)
2. OB LOCATION ........_...- �%f-r---------
J -------------------- / v�- _------..
(House No.) (Name of Street) (Town or School District)
3. LEGAL DESCRIPTION:Lot_ -1...2-Z,#...._.732-----------Block ... ._----------------- -------- ------ Tract...,3.7_-,�---------------._.----
(Metes and Bounds Description—Use reverse sideyof form)
i. CORNER LOeeT ( ) INTERIOR LOT ( ) THROUGH LOT ( () SLOPE OF LOT ( )
3. SIZE OF BLDG.:--' ..U.--4--�---- AREA:_,l- P0.............SIZE OF LOT:...7.A.-----3.. _-?.0-.AREA:3yj)---61--------
6. HEIGHT OF BLDG.:. ..........._------...._------------...CEILING HEIGHT:.................................NO. OF STORIES
7. NO. FAMILIES ----------------- - -----------Size of Smallest Bedroom: ------------- --_------------- Size of Kitchen
S. EXTERIOR WALL CONSTRUCTION: ------------------------------------ .-_...INTERIOR WALL COVERING ............................................
(Frame, Stucco, Etc.) / (Plaster -Drywall, Etc.)
9. SETBACKS: Front Yard From Gestate- T+ao ^` Street------ ..g -.f �. .
Nearest Side Yard ------_S�!..Rear Yard_&42,0_7.±-..Distance in Feet Between Bldgs. on Same Lot ----- 1/2... - /�7f7.......
10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH.
I 15Z/
11. For (a) Footing: Width.....-...�. .�� i' `...........Depth in Grotmd_.'-.I L -"__-Width of Wall---- . A...Y..........
Accessory
Bldgs. and b Size of Studs: ---
....... Spacing ----- --G............... CC Material of Floor ..... _1
Similar
" ---- -- - =----
Structures:
(c) Size of Floor joists: ----------------- `-----'---------------- Spacing -------------------------------------------- CC
(d) Size of Rafters: ..-�..AY--------------------------_-- Spacing ----- --_c. ..CC
12. VALUATION OF PROPOSED WORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and
sewage disposal $...r .r%..i1..2--------------------------
13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO.
._.
Signed: ----YY-..�-'/`� ---...!v...s?-` ---- ------------
t -
(Owner)
Plans Filed:.. - �—� � .�..............
BY`----------------------------------------------_-- --...---- -_----------------------------- -
(Authorized Agent)
FOR DEPARTMENTAL USE ONLY
FEES: r ��ING BY
Bldg. Permit - $..-:., .Q�% GROUP ._...,.Z\... APPLICATIO /�'. HEALTH ............................
Plan Check $-... '' G+-----..... TYPE ..................__.. FIRE
ZONING---- rl
Total ' $... -' " DIST. MARSHAL---------------------
--- -
�j -- ----------- PLANS AND
MAP t No. P./c- 'L ..15;/..' ...... P------------- ----"'`----
pSPEC'S---------------------------- STATE ----------------....------
Paid to SHEET NO --------- t�-------- CORRECTIONS ENGINEER
Date.............................>..� ---------------------------------------------------- V ,.a,-„-->. CAL...--------------------------------
DATE .......
��—. _.
5 M -e-51
PERMIT
CY^
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o.
COUN'T'Y OF ORANGE R '- •
636 N INTG DEPT. for
No.,K y.9....
adway
Santa Ana, California Application for Building Permit
Phone: KI 2-6211 AND FOR A
Certificate of Use and Occupancy
OWNER'S NAME..--- ... .......... - .... �..�..g-.�'�..............
,...p.------------------------------ PHONE: ..................................
MAILING ADDRESS...... _ -- -....... - L ----- C%�i`. _ ----- --- CITY .----`
Name....................--------.............---`..---------------------------------- Name.....................---......................................................................
(Architect or Engineer) (Contractor)
Address----------------- ..................---------------------------------------._----- Address .---'
City------------------------------ -------------------------------------------------- ----- ------ City ................. .-------------------------------- --...............................................
State State
Lic. No ....................................... Phone------------------------------------- . Lic. No ------------------------ ------.............. Phone_._ ---------------........-------'-
!17
PROPOSED USE: .... ..-------- l�..............---------�--------------------............. - ....._................-.....-----------------------
.......... - - - .......
N -. GtO�...... .�trc .---- -.---- - _
� JOB LOCATION_.....,F-..S...�..�!
(House No.) (Name of Street) (Town or School District)
i ])
3. LEGAL DESCRIPTION: Lot..--S.1nt
...................... ........ - -------------- Tract ..3.�............................
(Metes and Bounds Description—Use revers side of form)
4. CORNER LOT( [) INTERIOR LOT ( ) THROUGH LOT ( ) SLOPE OF LOT ( )
i. SIZE OF BLDG.:_I„L..ff.:1k.a...AREA:.... _)k_'B............. SIZE OF LOT:7 2_x3 J.0......AREA:)�773 % 6D -------------
G. HEIGHT OF BLDG.: .......................................... CEILING HEIGHT: --- NO. OF STORIES ----------------- ..............
7. NO. FAMILIES .................................. Size of Smallest Bedroom: ----------------_--_--------_....... Size of Kitchen ....................................
8. EXTERIOR WALL CONSTRUCTION: ........................................ ... INTERIOR WALL COVERING ............................................
(Frame, Stucco, Etc.) (PlasterDrywall, Etc.) '
1. SETBACKS: Front Yard From-GawteL.I..iae of Street ..... 9_0_11
....................
f /�,� . 3 C7
Nearest Side Yard ---3--------------- Rear Yard... _C.C.....Distance in Between Bldgs. on Same Lot....................--......................
10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURE'S AND USE OF EACH.
11. For (a) Footing: Width..... ---------------------- ..Depth in Ground .
--- ....... .------------- Width of Wall .............
Accessory
Bldgs. and
Similar (b) Size of Studs: ............................ Spacing .............................. CC Material of
Structures:
(c) Size of Floor joists: .......................................... Spacing ---...---------------------............:'CC
(d) Size of
"CC
12. VALUATION OF P O OODOV�ORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and
sewage disposal $----.- ....................................
13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS CORRECT 'AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE, THERETO.
Plans Filed: --------- /-------- ?...
....
PEES:
Bldg. Permit
Plan Check
Total - -
Receipt No. RIC—
Paid to
Date.....................
By: ............. .. -..................... -----------
(Authorized Agent)
FOR DEPARTMENTAL USE ONLY
O GROUP ..... S/. ...... ..
TYPE.......--.............
/........... DIST.
MAP.....(w... ................
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DATE......... _ . ...... L/
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COSTA MESA BUILDING -SAFETY DEPARTMENT
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USE OF BUILDING AND WORK TO BE PERFORMED
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MAIN BLDGS. ACCESS. SLOGS.
VAR. DATE
/
C.U.P. yJE APPROVED
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OLD FOR SPECIAL REQUIREMENTS
I hereby acknowledge that I have read this application and state
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the State of California.
(�
SO. FT.
I hereby certify that I am properly licensed as a contractor under
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and affect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
VALUATION
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end Professions Code, Division 3, Chapter 9.
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COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
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RECEIV DATE RECEIVED D TE ED
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COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
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electric, plumbing and healing work.
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USE OF BUILDING AND WORK TO BE PERFORMED
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VAR. 9W
DATE
C.U.P.46
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the State of California.
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SQ. FT.
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the State of California Business and Professions Coda, Division 3,
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THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
VALUATION
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and Profetslons Code, Division 3, Chapter 9.
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P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
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APPLICATION FOR STRUCTURAL PERMIT
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RECEL
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Separate permits are required for
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electric, plumbing and heating work.
REAR FT.
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USE OF BUILDING AND WORK TO BE PERFORMED
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VAR.+
C.U.P. +
DATE
APPROVED
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BY
I hereby acknowledge that I have read this application and state
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all laws regulating building construction, and I shell not employ
any person In violation of the workman's compensation laws of
the State of California.
1 hereby certify that I em properly licensed as a contractor under
SO. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
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
PERMIT FEE b Q
antl Professions Code, Division 3, Chapter 9.
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COSTA MESA BUILDING -SAFETY DEPARTMENT
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VAR.# DATE
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the State of California.
I hereby certify that I am properly licensed as a contractor under
SQ. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE O
am exempt from the provisions of the State of California Business
VALUATION43
PERMIT FEE E
antl Profession. C da, Division 3, Chapter 9.
C�LAN
Signature of
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COSTA MESA BUILDING -SAFETY DEPARTMENT
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USE OF
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USE OF BUILDING AND WORK TO BE PERFORMED
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(P �j
VAR. .+ DATE
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any person In violation of the workman's compensation laws of
the State of California.
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SQ. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Cod., Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE O
am exempt from the provisions of the State of California Business
antl Professions C de 01 INon 3, Chapter 9.
VALUATION
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Signature of
Permittee
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Q'U
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TAX E
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TOTAL PAID $
• COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
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BUILDING _ _ . — r/ ; A � /-
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APPLICATION FOR STRUCTURAL PERMIT
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Separate permits are required for
L. SI F
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electric, plumbing and heating work.
1,f
REAR F
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
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A
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ACCESS. BLDGS.
-'
VAR.+
DATE
I hereby acknowledge that I have read this application and state
that the above Information Is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any parson in violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and affect, or I
am exempt from the provisl0ns of the State of California Business
and Professions C//d , Division 3, Chapter 9.
Signature of (I / _ I /
Authorized Agent
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THE AMOUNT SHOWN UNDER VALUATION IS FOR
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COSTA MESA BUILDING -SAFETY DEPARTMENT
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FT.
USE OF
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FT
Separate permits are required for
L SIDE FT.
FT.
REAR FT.
FT.
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
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MAIN BLDGS.
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F/ r% o— G—V rl tI
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1 hereby acknowledge that I have read this application and state
that the above Information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
SO. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
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
and Professions Code, Division 3, Chapter 9.
VALUATION
PERMIT FEE f
Signature of
�.�,
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PLAN CHECK f
TAX f
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TOTALPAID f 03 0