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Home My WebLink About1553 ORANGE AVE - Building Permits DECLARATION OF AUTHORITY Bldg. Permit# E02- b053d FOR AGENTS OF PROPERTY OWNER This Permit# TO APPLY FOR PERMITS Street Address: /S-S?r Cr- LSI Cr—LSI "—Zee-7C AP Number: 1. I (we), S / 7 ' /c.,./7/ 7.-----e , declare that I am the Owner of Title of the above referenced real property, and that I (we) hereby authorize: iiie Name: )lephone Number: Street Address: / 7 7a� City: 47, State: Zip: ��7 to obtain permits in my behalf,as owner/builder, for \cJ EFT re/rv ___ at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I (we) shall immediately provide Workers Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that th foregoing is and correct. . Executed this O,2 day of 20 O 2,-at 'i�%a,California. Print Name: J , yr `V` Signature: Date: 412-1 Jo 2... Note: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. 077946(rev.11/00) • p , •,P CITY OF COSTA MESA . 4 BUILDING DIVISION F ,4. DEVELOPMENT SERVICES DEPARTMENT PERM NUMBER PERMIT ro �,. 02-00580 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1553 ORANGE AV Status: ISSUED Suite: Applied: 04/29/2002 Vicinity: DUPLEX 1553 AND 1555 ORANGE Issued: 04/29/2002 Parcel Number: 42534129 Zoning: Applicant: SWEETLAND, TIM ISSUED BY: Address: 17722 METZLER LN Phone: 714-376-6434 - HUNTINGTON BEACH,CA • Zip: 92647 Owner BUTCHER:JEFF . , Address -1555 ORANGE AVE - _ _ Phone: - COSTA MESA,CA Zip: 92627-3718 Contractor: - Address: - - Phone: Zip: License:-: - Arch : Dig: Address: , Address: Phone: - Phone: Zip: License: License: SCOPE OF, PERMIT. _ . ' TEAR OFF SHAKES,RE-SHEATH,COVER WITH 30 yEAR CQMP., _, - i-' '' • , - FEE SUMMARY ' , Plan Check: $0.00 , , . Calc Valuation: $6,000.00 •Permit: $125.25 - Claim Valuation: $6,000.00 SMIP Res: $0.60 SMIP Corn: $0.00 Other: $0.00 - Inspection: $0.00 Total: . $125.85 PLANNING &ZONING SETBACKS- - MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ./ ACCESSORY Front 0-0 ., Rear 0-0 Left 0-0 Right , 0-0 - - PARKING Existing: 0- - Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL:-(714)754-5626 2446-46(6/00) • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,es prrvided 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 wo�for which this permit is issued. My workers'compensationIInsnce card rens policy number are: n Carrier:hcolofed it ev //'I� Policy Number: .11h his section need not be o tared i/the pe itis value. . • a hundred dollars($100)or less.) ertify the '•_i: •-rf.mance of the work for - his:ermiit I _;it•,I shall not employ any person in any manner so as to become subject to the workers' compensation laws o .•lifornia, : r,•r.-#T . : • : '. . ::-••-• . •rovislons of Section 3700 pr'the Later Cade,I shall forthwith comply with these provii+al s. 4 Q/7/ Applicant Signature: = i ../41.....a. ...410. Date: Z '02 i WARNING:FAILURE TO SECU-E WORK?' .-COMPENSATION COVERAGE IS UNLA FUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL IES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE Cf1ST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lie.# Class# 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).): ❑ 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. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 8 No (Section 65850.2 of the California Govemment 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 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 and state that the information given is correct. I agree to comply with all state law -nd city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection.•rp• es.I agree not cupy or allow occu•anc of:• • 'I.in.authorized by this permit until final inspection. i/ 4'pa4f 4Feej e •nd/Or Authorized Applicant Date ;ODE• INSPECTION ME QAIE INTITIAL$ CODES INSPECTION TYPE QATE MOM 1616 Fixed System Final Fire Prevention • 206 Final Mechanical 1266 Pool Spa Final Al208 Final Plumbing -. 200 Final Re-Roof sag- IV' 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 • COSTA MESA BUILDING DEPARTMENT FEE RECEI JED p / P.0. 31L , f f'"? J • \ __ COSTA MESA,A, CALIFORNIA F ANCE DEPT. FOR APPLICANT TO FILL IN A FiffilLICifAMVIMESAR PERMIT BUILDING 553_55 g BUILDING ADDRESS 1 Orange Ave. COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. IT P OWNER Fred Coury RECEIVED BY DATE RECEIVED DATE ISSUE ADDRESS 1531 Orange Ave. Costa Mesa ------7-L-77' //--�7 `/G�/ - 7 CITY Costa Mesa ;Elam 87BUILDING 079 ADDRESS ARCHITECT LIC. ENGINEER HITINTER IC. COSTA MESA. CALIFORNIA FIRE ADDRESS ZONE ZONE/� ff NO.NS TYPE GROUP� / CONTRACTOR Hickory Homes`ITY LID.Da 4963 • / , // PLA NB V 0 ADDRESS 2156 Newport Blvd N4.i 82271 BByPROVED .4,- -a., 4—no...:4-1DESCL LOT ��r.,(ipI�jI$1L DESCRIPTION NO. 35 4 BLOCK TRACT 27 tlYQ'yY�'1r,` T +yL`Jap A.P. NO. l /7 — /3 e> _ CITY Cr COSTA MESA SIZE OF LOT !}9.11} x 125 NOW ON LOTB. none PLANNING DEPT. USE OF 5U81ECT,TO BL• •,.DEP i, REI, EXISTING BLDG. ' SETBACK LINE FROM �� CENTER OF STREET 50' REAR YARD -err- " .. ,r I . , At-/_ Pr oen er ae a = PLAN TECH., SIDE YARD RIGHT 0.6 ■ LEFT $ DESCRIPTION OF WORK NEW X ALTERATION ADDITION REPAIR IVpI MOVING DEMOLISH SIZEDING 159V p ROOMS V STORIES 1 EXTERIOR `yALL. Wood ROOF COVERING& sturCO COVERING Shake USE OF NEW BUILDING ' dwellings with attached garages ( Z 0p t, ii, X ) /5-- 5- 3. f F-/ sti As P,t& / n— (/I 4.6, e/ ,7o0 x ;-- I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. Hickory Homes VALUATION _ SIGNATURE OF PERMIT FEE S (/ PERMITTEE _ r,,, PLAN CHECK 5 /S AUTHORIZED AGENT A TOTAL FEE 5 SL S BMF OWNER - COURY. FRED - DATE 4-16-57 JOB ADDRESS 1553-55 Orange Ave. BUILDING PERMIT NO. #4849 GENERAL CONTRACTOR Hickory Homes VALUE $ 12,830.00 AP117-130-24 AS PER U. B. C. LOT 35 BLOCK TRACT 427 Dup. w/att. gars. GROUP I & J TYPE V ZONE R4 FIRE DISTRICT 4863 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Footing Trench irk t+' FS 4- '2-.I7 Foundation Forms and Grade to Garage W-..* -5 1 _.,-e,. „e ...." ` Rough Framing .'6./-a .5'2 j-J �s v Plumbing, Rough to SlabS.f M /.1•S 6--3-S7 ;.. I,'r' Sig. -i 3t 9//8 Plumbing,Rough Complete ' /14 4/ S 5-_/g_5-7 Temporary Pole SA Wiring, Rough MAY 21 1957 VC6 art/L/7r,/� S'-/6--.5-7 5�40970,e '" Heating,Rough /4/L- S -/?-r7 •:.a. V4 !I A9-,2,37-3-7 9// Or ,..- Heating, Final /4/&-4 74:1�S'7 ,-Sewer, Housewer, St.a G//41e7 , ,t J,4vt,.. (1, ,,,,t 4 —17--57 9 (;• ep lc Tank or Cesspool!p7 ,,/ J Lathing, In _.4d / Out 4- ,-ll/3-.f, Plastering 0- 7j /Ar.7 j Plumbing,Final,Fixtures Complete`4 . 1$ •3•-,S' /„ � Plumbing,Final Gas Test j8 /S7/`p✓l es -1...34.7 1/G< ..� 11, cl /.�4,2 WGWising,Final d �� '- - r.-- . li.>> - Occupancy 71 ?.f' -,2i / FORM 210 3M 10-55 4849