HomeMy WebLinkAbout1952 MEYER PL - Building PermitsCITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.cams
�. FOR INSPECTIONS CALL: (714) 754-5626
�ro �
PERMIT NUMBER: P08-00163
PERMIT TYPE PLUM STATUS: ISSUED
APN: 42214231 DATE ISSUED: 07/01/2008
ISSUED BY: YH
JOB ADDRESS: .;1952 MEYER PL -`CM ter. Suite/Unit
Vicinity:
v
SCOPE OF WORK: REPLACE, WATER HEATER.
OWNER: SCHUDA, STANLEY W TR .'" Address: : PO BOX 3859 ,
PHONE:_ _ City/State/Zip: COSTA MESA, CA -
APPLICANT: MIROSLAV=P BARNYASHEV - . Address:
PHONE:City/State/zZlp. =
I _ 1�'•)
CONTRACTOR: CALIFORNIA DELTA- MECHANICAL INC License No. - 811114 ...
Address: 1235 GRAND AVENUE " ..:.. -. - - -PHONE: _ .800.898-0008
City/Stale: SPRING VALLEY, CA ZipCode:' 91977 .. CELL: -
ARCHITECT: - - License No. - PHONE..
ENGINEER:License NoJ - - '- -PHONE:"
URIhTd-]10[Mil :1:1JAI 1fi;Iq*Y1ltTihrd_L'al
PLAN CHECK FEE: $0.00
PERMIT FEE $35.80.
,r
TOTAL FEES:,,., $
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/. INSPECTION TYPE DATE 110TIAL CODE N INSPECTION TYPE DATE I.iii
S
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing X / / 1 ' I _
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECD .ON:
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.
[9]' 1 have and will maintain workefs' 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: c5 �
Carrier: L'
/itis neaten need rpf Wow d the dennR d; valued at are hundred obtWrs(S 100) or leu)
Policy Number: �`r' —1
❑ 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' com nsation la of California, and agree that if I should
beco ubject to arorkers' rmpensation provisions of Section 3700 of
the b Code. II forthaAth nmply with these provisions.
^/-0,?
Applicant's Signature Date
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
($100,010), 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. /'
Lia # I (� Class iP—.?
Contirlaefor's Signatunq Date
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).
Lender's Name:
Lender's Address:
Signature Date
OWNER -BUILDER DECLARATIONS:
I hereby affirm [ at under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORENSE. LAW for:t following reason (Sec. 7031.5,
Business antl:Profe 'ons Code: -Any, ci� or count' which requires a permit to
construct, all r, im v0'demolishl5i ;reD-,ai any structure, prior [o its
..
issuance, also requi litlappfcapkfor-Su It to file a signed statement
that he or she is-pursu[_to'� " visions of the Contractors
License Law (Ch r-8.(colm�senci09,w1ttionZ7000) of Division 3 of the
Business and Pr s3rrti+Cod�ry oi!ilia or She is exempt therefrom and
the basis for the le ed exempticura - solation of Section 7031.5 by any
applicc��t��forfa pe n sects tfie'applica to a civil penalty of not more than
five hdMdreQ'�tl" Dtiliiiri
❑ 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 ofprovingthat he or she
Cid 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 contractors) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signature
3057J6 (3/07)
Owner ID verifib. .y drivb.., dcense. ❑ 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:
❑ 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, a 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, 1 aril] 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.
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 filed with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ 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 Safely 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 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
8. (if "yes", attach certificate of compliance from the appropriate air pollution
control officer). - - .. .
CERTIFICATE OF COMPLIANCE: 1 -certify that under penalty of perjury the
information given above is correct. 1 agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
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 agr)k not to occupy or allow occupancy of any building
authorized by this permit ntil final inspefltlon. -
SignaWr agal O«negsl / Date
7 %- 0�
And/or Authorized Applicant Date
4 CITY OF COSTA MESA
BUILDING DIVISION
_ DEVELOPMENT SERVICES DEPARTMENT
J
•,� - � PERMIT PERM UMBEq
B98-01540
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
i
Job Address: 1952 MEYER PL
Suite:
Vicinity:
Parcel Nunmber: 42214231
Applicant: CRANK, JIM
Address:
BUILDING PERMIT
Zoning:
Status: ISSUED
Applied: 08/25/1998
Issued: 08/25/1998
�./'P66ne:=949-548-5569 -
Zip. ..
i r
Owner: SCHUDA STANLEY_
Address 2187 EWIN DR--
/����-Phone',
/,PRESSCOTT,AZ J '� Zip: 86301
Contractor:i CRANK. BROTHERS ROOFING CO
Address: 00726 COMMERCIAL WY
I
Phone: 949-546-5569
s;! /
�!COSTA'MESA Cq Zip: 92627
A.
--
License:: 408677
EEE.SUMMARY!
Plan Check.
$0.00
r " t r
Arch / Eng
-$6,000.00
�Permit:
'.'1112.25
.,
,., •'
� � T
Claim Valuation:'; `
_'
's6 000,00
' Address.:�,.��
r �
•' i r �
�'-.
Phone:.,
SMTP Com:.-,
Zip:
Zip:
-, ,Other:
$0.00
License:
Inspection:
.
SCOPE OF PERMIT
yTEAR OFF, RE -ROOF WITH 20 YEAR COMP: ONE -DUPLEX,, ONEESINGLE FAMILY DWELLING, " -
JNCLUDES GARAGES` ROOFCOVER CERT'ON.FILE.
_.. ,._ ...... ..
1.
,
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
A.
EEE.SUMMARY!
Plan Check.
$0.00
r " t r
-1=Calc Valuation.
-$6,000.00
�Permit:
'.'1112.25
Claim Valuation:'; `
_'
's6 000,00
SMIP Resp
$0.60
-
SMTP Com:.-,
',x`$0.00
-, ,Other:
$0.00
Inspection:
$0;00
Total:
$112.85.'
.PLA
NNINGI&'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, ; 07"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
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carrier and policy number are:
Cartier: Policy Number
Is section need not be completed i/ the permit is valued at
me hundred dollars ($100) or less.)
I certify that in the Affrisirmance of the work for pl is permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation lawsLlf C {ifomia, and agree t s E Id become subject to the workers' compensation provisions of Se i n 3700 of the Labor Code, I shall forthwith
comply with these p ons. n /� (�
Applicant Signature: Date: lL `'�J
WARNING: FAILURE S E WORKERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL NALTIES D CAVIL FINES UP TO ONE HUNDRED
THOUSAND E ,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 li n ed under provisions f Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full
orce and effect. Lia # Class #
ontractor's Signature Date: qV
CONSTRUCTI ENDING AGENCY:
❑ I hereby affirm that them is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby afflrn 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, 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. 11, 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's 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:
❑ 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 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 Q No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
............................................... _...................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ 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).
...................................................................................................................................e'a'..............('Ris.........................................................r-am.......................................................
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management antl 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 a plication a22ernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Government Cade requires that the requested information be tumished on applications for non-residential building permits).
........................................................................................................................................................................................................... ..................................................................
6 Wi11 any pert 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 mulred 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? ❑ as ❑ 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- ribed property for inspection purposes. ree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
gna LOwner's)
And/Or Authorized Applicant Date
�adbli t. INSPECTION TYPE PATE INTrRALS CODED INSPECTION TYPE gAt9 U�A�
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof ,9-iy-�9 '�^"� 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
241616
APPLIr AON FOR A BUILDING PERMIT
Tract
Block
Lot
BUILDING PERMIT NO.
�J
,/ V
Electrical
Permit No.
BuildingV
Re Address e,<, �/
Plumbing
Permit No.
Cross
Mechanical
Area Street
Permit No.
/
Owner Lp SC 1 J ,rI
Type Pf project: ❑ New ❑ Alter ❑ Addition
Address
❑ epair ❑ Convert ❑ Demo ❑ Occupancy Pmt.
City Zip Phone
A- .
Sup. Dist./
Insp. Area
Architect/
Designer License No.
one
Spl. Pmt. No.
Address
tbacks
P/L Front
C/L St.
Street Width
rds01.
left
Rig
ear
City Zip Phone
e
9
Engineer License No.
Parking Spaces
etl
Provide
overe
Address
Struct
No
of
No.of
City Zip Phone
Height
St
ries
Family
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed tinder provisions of Chapter g
Park Fees Yes
Required No
C.
Fee
Receipt
_
Zoning Approved BY:
Date
(commencing with Section 7000 of Division 3 of the Business and
Professions Code, and my license is in full force and eff
License Chas License Number is��rfi6.5
Date—Co ntra toorr k� _L ��S(�-
Misc.
Proposed Use
of Structure
`
Address /✓ L� f`� /C .'-�
City and Zip �.cc,�c-c��!�' ,���Phone ✓�
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,
Civ. C.).
Dec.
Class 11
Type
Const.
Code
Veer
1
USE CCUPANCY
SIZE SO. FT.
Lender's Name
Lender's Address
1
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason:
❑ I, as owner of the property, or my employees with wages as their
2.
sole compensation, will do the work, and the structure is not
intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with
3
4
licensed contractors to construct the project.
ElI am exempt under Sec. , B&PC for this reason
Date__ Owner
WORKERS' COMPENSATION DECLARATION
Total Valuation
Encroachment Permit Require ❑ Yes ❑ No
1 hereby affirm that 1 have a certificate of consent to self -insure,
or a certificate of Workers' Compensation Insurance, or a certified
copy thereof, 4 y' a l
Policy No YZP_6O/_/-JCompanvZ*1eA` '�' `�^�
Gratling Pmt.
Required ❑Yes No
Grading
Pmt. No.
❑ Certified copy is hereby furnished.
❑ Certified copy is tiled with Orange County, EMA.
Rough Grading
Approved by:
Date
Date Applicant
CERTIFICATE OF EXEMPTION
FROM WORKERS'COMPENSATION INSURANCE
(This section need not be completed if permit is for $100 or less).
1 certify that in the performance of the work for which this permit is
PERMIT FEE
issued, 1 shall not employ any person in any manner so as to become
subject to the Workers' Compensation Lewsof California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of
Structural $
Pla Check $
Exemption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with such
provisions Or this permit shell be deemed revoked.
Electrical $
5 ecial
vest. $
plumbing $
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTH-
ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON
Mechanical $
Pre -Grade
Inspection $
THE ABOVE ME IONED PROPERTY FOR INSPECTION PUR.
POS S r
4�0
Signature of PPlicant or Agent or Agent Date
Pre. -Grade $
Ree. No.
Permit $
Issue
Print Applicant's/Agent's Name
All spaces within this box must be complete to process
P ,
Plan
Check By:
Issuance
Approved:
CMF 0335-46 (BU -28) rev. 6/80
W
JOBADDRESS 1952-511 Meyer Place' .n BUILDING PERMIT NO. 109:7
GENERAL CONTRACTOR Owner -Builder VALUE $11+)872.00
LOT AP# 115-322-37 BLOCK TRACT Duplex
GROUP I TYPE Q ZONE R+1 FIRE DISTRICT 1108
INSPECTIONS
DATE
'S'
SUBCONTRACTOR
PERMITS ISSUED
DATE
NUMBER
Footing Trench ��� G�
1 j
t G%4.
Foundation Forms and Grade to Garage
Framing
_Rough
bing, Rough to Slab
P
. bing, Rough Complet ri (.� 5
,/
S=/,� ��j
i 33
Temporary Pole
Wiring, Rough
Heating, Rough
Heating, Final
Sewer, House Sewer, St.(' 511{
��
G
Septic Tank or Cesspool
Lathing, In lyOut _
Plastering 'LL
Plumbing, Final, Fixtures Com ete;7-1)-
—oZ J _
Plumbing,
Plumbing, Final Gas Test/S «3
7—,2? --;J
q G
J
Wiring, Final
Occupancy
Form 210 G -H 15001-55
Costa Mesa Building Department /f APPLICATION FOR PERMIT
111 EAST 20th S' -T ✓ -1-1.08 BU ') I N G
77 COSTA MESA, CAL NIA
FOR OFFICE USE ONLY
FOR APPLICANT TO Fq111N._Receipt No.. — Permlt N
[ 5"aceiv by Date Recd. Date Issu
Costa Mesa, Californf�arest / 7 3 -,3/
)as St. / dingess
nerCosta Mesa, California
T n
or
Contractor C LU
Lie.
■ New
Alteration
Cross St.
Zone /,
)RA
Addition
Building �S ✓ �� (�/'NO. of ,C,
Size '7 x Rooms Storiesl%<
Exterior Wall
CoveringkG24- Covering �/iirswriX
Use of New
Building — n Ll n /% _
Materials,
Pinning
Ire Stops,
L hereby acknowledge that I have read this Application Lath. Int.
and state that the above is correct and agree to comply
with allCity prnance and a ws regulating Lath. Ext.
building constrtt¢fioh.
Signatu re of i� � � � Plaster, int. �
Permittee
Plaster, Ext.
Authorized Agt.
Masonry Reinforced
Valuation ��� d 4 Permit Fee $
Plan Check $� v o Bond Beam
$ j Total
Jq Fee $ ,3%. ��. FINAL
FnaM 204 g -H 2M 5-54
ALS
(�t
Lotht
�5
n
No.))
Blo((ck
Metes an4ounds)
'%J-3
FAcbdrewve
No: of E
ot ��Y�/te
Now on
<✓No.of
Bldg.
Familie
Line from
�
Rear
f Street
Side
■ New
Alteration
Cross St.
Zone /,
)RA
Addition
Building �S ✓ �� (�/'NO. of ,C,
Size '7 x Rooms Storiesl%<
Exterior Wall
CoveringkG24- Covering �/iirswriX
Use of New
Building — n Ll n /% _
Materials,
Pinning
Ire Stops,
L hereby acknowledge that I have read this Application Lath. Int.
and state that the above is correct and agree to comply
with allCity prnance and a ws regulating Lath. Ext.
building constrtt¢fioh.
Signatu re of i� � � � Plaster, int. �
Permittee
Plaster, Ext.
Authorized Agt.
Masonry Reinforced
Valuation ��� d 4 Permit Fee $
Plan Check $� v o Bond Beam
$ j Total
Jq Fee $ ,3%. ��. FINAL
FnaM 204 g -H 2M 5-54
ALS
_ 19250
'COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 917 COSTA MESA, CALIFORNIA
ps:�7
cant to Fill In Completely
TYPE OR PRINT
MESA, 'CALIFORNIA
A/ v f= G
rp Z�� �%•TEL.
i !' • Y- NO.
ARCHITECT TEL.
OR ENGINEER 514/0,'LL/ /_ NO. /2% hd
ADDRESS 2./[ILL/<7 o* -7 4541/G
v 0 Ki
OF
SETBACK LINE FROM
CENTER OF STREET `� REAR YARD
SIDEYARDI LEFT RIGHT
DESCRIPTION OF WORK
ALTERA
DDITION
NEW I MOVINGTION DEMOL SI
REPAIR
BUILDING NO. OFL
SIZE /7 • /- .ROOMS 7. STORI
EXTERIOR WALL- ROOF
COVERING . %4'CC23 COVERING U G
USE OF BU ILDINC AND WORK TO BE PERFORMED
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION.
SIGNATURE OF
PERMITTEE •*—✓�.�/�I,�. �N /17T7�
AUTHORIZED AGENT 1
F` c RECEIVED
} AOR 4 1963
FINANCE DEPT.
APPLICATION FQJA�PERIAIT;OSTA MESA
BUILDING
For Office Use Only
RECEIPT NO.
ERMIT NO .�
8C61V DBY
THRECEIVED
ATE SUEDE'J�D�
�% —�o
BUILDING
ADDRESS
FIRE
ZONE TYPE ROUP
APPRO D q�/ 4S'O 4Tv5
BY DATE
ZONING
ZON
NO. OF _
USE OF NEW
PLANH OJT
BUILDING
LEGAL
DEeCRIFTION
A. P. NO.
NOTE: NO EAV E OVERHANG SHALL BE LESS THAN
SO• TO SIDE 8 REAR P. L.
EAVES
ALLOWED (U.B.C.REQUIREMENT)
YARDSAPPROVED
YARDS APPROVED
MAIN BUILDING
ACCESSORY BUILDING
( FROMC/L STREET)
FRONT OPT.
FT.
R. SIDE
FT.
L. SIDE GFT.
FT.
REAR FT.
, FT.
DISTANCE BET.
BET. MAIN Q
MAIN SLOGS.
ACCESS. SLOGS.
VAR. # DC7
DATE
C.U.P.#
/
APPROVED
I ' /�
APPRVY y 1//
BY IiA� / lY lDATE
V SQ. FT.
THE AMOUNT SHOWN UNDER VALUATION IB FOR THE
PURPOSE OF ESTABLISHING A' PERMIT FEE ONLY.
VALUATION
7
PERMIT FEE $ ✓%rD �
PLAN CHECK
TOTAL FEE / ✓
OWNER
JOB ADDR&
L GENERAL C
J AP No. 115-
INSPECTION
1
S�
VELLI, John
Shoreline Construction Co.
TRACT FIRE ZONE
DATE "9-63
BUILDING PERMIT NO. 19250
11
VALUE $ 2060.00
DESCRIPTION OF WORK Residence
S Signature
DATE
GROUP I TYPE v ZONE R-2
Soil -
-
SUBCONTRACTOR
PERMITS ISSUED
Gas 4
DATE
NUMBER
Water --A3- - -
Rough Com. e£rig. ❑ Air Cond. ❑
Hough Heating 12✓I�
Rough Plumbing S
-//,�3
-QJ 'fi3
_
�..
, .
7-i0-43
,�a 3 -
led?
Miscellaneous
Prop. Swr. Line House Con. St. Swr. ❑ /-. /
T
f� /. G,j
s�
Sprinkling System
f-truction Pole
rground ❑ Power ❑
h-agh Wiring
_
Trenches ❑ Fo=s ❑ Steel Reinf: ❑
/
Floor System
Bond Beam ❑ Steel Reinforce ❑
Sheathing
Frame and Flashi
Lathing — In Out
7i
Plaster, brown coat
7�
Refrig. ❑ Air Cond. ❑ Final
Heating, Final
Q
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final
Building, Final (/jbZ _,iJy/G,+,Q.� 6 �,(� /!/L[.�
/0 • �(';
OCCUPANCY
FORM But - 5M - 7.61
IO0gn
s
r
3.
'COSTA MESA BUILDf�,�.`vm
g��AFETV DEPARTMENT
P.O. BOX 1200 COSTA INE SA, CALIFORNIA 92626
4118 10/02%80 3_6.50 !TU
APPLICAT "FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
RECEI V,EG'.y.� PERMIT �0 0 ^
L�f �) fV!
ADDRESS /90 y /Ne ?O/ �N�%
^
ADID RESS s �
TTOWNER ENANTOR //���. '/ c,4(J J _,
_5 c,4(1C/�'
VNITR SO
SPACE NO.^ / '7't
/1CGK�% (�"—
MAILING
ADD RESS
LOT t
�y.N ®��0� L.
BLK.
/' �• �/JTR.NOt
CITY TE
C D.�7/ /i/BJ�/4' TEL.
NEWADD JALTER
REPAIR
I MOVING
DEMOLISH
CONSTRUCTION
LENDER
BRANCH
T'
OWNER
ADDRESS
cA^ VALUE 7�
USE C7�'lf A A a0D
ARCHITECT TEL.
OR ENGINEER N
ZONE TYPE GROUP
ADDRESS
..��
AI.S%1
CON T RACTO,R/
BVPROV ED DATE
/eJ��/f/l-�P
]e ST.
ADDRESS/,J �dJro 1"Ip
CITY �P.s p4irs NEOL
s773
STATE/
/n
LIC. NO. �' ��� .7 LI CVNO. (�28�
APPROVED SETBACKS
SIZE NO. OF BLOCS.
OF LOT NOW ON LOT
(FROM C/L STREET)
RONT FT.
USE OF
EXISTING BLDG.
R. SIDE FT
Separate permits are required for
electric, plumbing and heating work:
L. SIDE FT.
REAR FT.
USE OF B LDING AND WORK TO BE PERFORMED
PLANNING ACTION
p
DATE
APPROVED
QATP
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 person In violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed ass contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
am exempt from the rov1s'ons of the State of California Business -
and Professions Code, ivi I 3, C r 9.
Signature of �
Permittee — "
SQ. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT ONLY:
VALUATION
$ aj..-700
^FEE
PERMIT FEE $ tx --
PLAN CHECK $
TAX $ �
O
or
Authorized Agent 91,
TOTAL PAID $