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Home My WebLink About1612 ORANGE AVE - Building Permits 511111 CITY OF COSTA MESA BUILDING DIVISION f . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT / B01-01045 bc •� (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.usING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDJob Address: 1612 ORANGE AV Status: ISSUED Suite: Applied: 07/09/2001 Vicinity: Issued: 07/09/2001 Parcel Number: 42520102 Zoning: Applicant: LEWIS, KYLE ISSUED BY: Address: Phone: 714-632-3800 Zip: Owner: SHANNON, CAROLYN J Address 930 COASTLINE DR Phone: SEAL BEACH, CA Zip: 90740 Contractor: LEWIS & SONS CONSTRUCTION Address: 4071 E LA PALMA SUITE K Phone: 714-632-3800 ANAHEIM,CA Zip: 92807 License: 416525 Arch : - Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT • TEAR OFF,COVER WITH 20 YEAR CLASS A COMP SHINGLE. DUPLEX INCLUDES 1612 AND 1614 ORANGE.ONE STRUCTURE. FEE SUMMARY Plan Check: $0.00 - Calc Valuation: $2,800.00 Permit: $83.25 Claim Valuation: $2,800.00 SMIP Res: $0.50 • - SMIP Com: $0.00 - Other: $0.00 - Inspection: $0.00 Total: $83.75 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: • 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(6ro%) DECLARATIONS n fl WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I.have and will maintain a certificate of con-, t to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the for which this permit Is issued. I have and will=item workers'compen - ion 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! do In. rat . •:r and policy number are: I ; % ! 7 0 Ii 3^ Carrier: ILS Policy Number:r (/ l (This section need not be completed if t :pe/it is valued at one hundred dollars($100)or less.) ❑ I certify that in the performanc• • thelArk 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 Car o I:,and,.gree that ii 1 should become subject to the workers'compensation provisions of Sectio 3700 of fyyhe Labor Code,I shall forthwith comply with these provisl, 7 � /O W RALA Applicant Signature: . �. Date: �(NAL WARNING:FAILURE TO SECUR • ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P TIES AND CIVIL NES UP TO ONE HUNDRED THOUSAND DOLLARE($100,•••,IN ADDfT10N TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DEC "A r ON: I hereby affirm that I em licensed r L n f tp'a commencin with Section 7000)of Division 3 of the Business and Professions Code.anQyly licyr6e�is in full force and es Signature:Lic. I W f7� g Class x 1%�/ Contractor's .. 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: ❑ 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 Califomia 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 lime 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 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. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Coda 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 apEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes Li 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 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 11 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 end Emissions. Signature: Date: CERTIFICATE • COW'LIANCE 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 a r-: •co y ly 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-de••.. prof; y for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / Signature Of Legal Owner(s) -7/ q/0 I Date /q/ Iia And/Or Authorized Applicant Date CDDE I INSPECTION TYPE PATE UiDIBLS CODEC INSPECTION TYPE PBTE INTftALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 7�•-•ra( 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 0 OWNER JACKSON; -ADFT.TNE M. DATE 2-15-57 . JOB ADDRESS 1 2 .Cranpe Aya. BUILDING PERMIT NO. #43611 GENERAL CONTRACTOR Owner B]f3Y. VALUE $ 12,6h0.00 AP117-151-18 AS PER U. B. C. LOT 53 BLOCK TRACT Na,, Hgts. Dup. w/att. gar. GROUP I & J TYPE V ZONE Rh FIRE DISTRICT h372 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Footing Trench : A./F V X _ Foundation Forms and Grade to Gara•eg'/ .1' .,Q - ?7 Rough Framing p' .4-. ' •" /7 - ' ��• .gg+`,,�p J, , Plumbing, Rough to Sla• ,._1s'�j.� - i -yl-Y 0 rrJt__'!�lmstrim � , a a- 1 7 9.5 3 Plumbing, Rough Complete If vi -S' e l � .. ct -, _ (J-6-7 7 95---9 — Temporary Pole Wiring, Rough MAR 7 1951 V ' L ' , ;3-7-$ -Sio 7T 7a.— Heating,Rough ea 3. - 7 !p, • !. a - 7 95- 3 — Heating,Final /fryht S, f-&- 5-7 b.-Sewer, House Sewer,Ste MA) 4A/L-S7 - - '9-1,5--3-7 del 90 -- Sep is Tank or Cesspool J Lathing, In /. Out A 2, %.r7S - 7 Plastering - t That."57 Plumbing,Final,Fixtures CompleteMILS -S-ST ///_ Plumbing,Final Gas Test/3-/S jj HS -- ; -S- i 4 -- -414 /f/L�� S!t e / Wiring,Final toy 1 g 1957 VCI _ Occupancy WM 1 : 1957 VCb _in-- - 1,'1A1i . 43'72 C' C ��0 0 n CO&TA MESA BUILDING DEPARTMENT I I1 ` S'7 ` P.O. BOX 317 COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT ADDRESS///� cent c pv0 BUILDING ADDRESS / //1 COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY �peZ/,/L iPI . jAC��O /r RECEIPT NO. VPq T OWNER MAIL �/ /�� f� RECEIVED�. BYY DATE RECEIVED 0.7-A---47 ADDRESS fre/ . Il . /Ik.N///}��oeTA1.) . O.170 .,2—i/-S 7 o7-A--S •,7 �'I 'TEL. q / BUILDING CITY He yy Dog I Re,nC4 N ! .g/O3(p ADDRESS a,,,�.,, ARCHITECT r LIC. L' OR ENGINEER NO. COSTA MESA. CALIFORNIA FIRE ADDRESS ZONE e/�yl�i ;Ia. ZONE NO.OF Si/� TYPE GROUP{ yOR CITY LIC. _ PLANS V j/j �� CONTRACTOR NO. TEL. APPROVED .4 \\ �j��ja { > ADDRESS NO. BY f'-1. S] •DATE 0-I E fi/ LEGAL • LOT // pp DESCRIPTION NO, Ca BLOCK NO,:„ 4 • Aplit `!� A.P.NO. ';;IIS 1/ 7— 15 1-- l 8' «((//// Y [Y{l Y4 I. SIZE 7 NO. OF BLDGS. CITY 01- COS I A MESA OF LOT • )C 90 NOW ON LOT PLANNING DFPT USE OF SUBJECT TO 7. DEPT, REG. EXISTING BLDG. /^ SETBACK LINE FROM A� G • Y /j /1 CENTER OP STREET / REAR YARD pP / /• �_5/ L —// 7 �.� 111777• V DATE rT 8Y SIDE YARD RIGHT �~ / LEFT S / PLAN TiCI __ DESCRIPTION OF WORK NEW 11ALTERATION ADDITION ILII��' 1 REPAIR DMOVING DEMOLISH BUILDING//.V I NO.OF SIZE (e f- 6.3 ROOMS A STORIES / EXTERIOR WALL.,/OCGO ROCOVERING n,,,in f / ( l F v COVERING USE OFEW J� ss A BUILDINGN �).(J /'k eX 4,77 4 n /$!0Q As .j '2 U, A . C I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND • STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC. Tion. SIGNATURE / 1 / VALUATION SIGNATURE OF PERMIT FEE 5 30 ///) PERMITTEE Lam' A (� 1///P�_ ' .- / I 1�4 $ 47 / Ve PLAN CHECK S /U Lrbd�/�. 1 "Pt �YF c fp 4....._ , AUTHORIZED AGENT V 1, P. Stay, TOTAL FEE $ 44C