HomeMy WebLinkAbout1953 MEYER PL - Building Permits "c
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CITY OF COSTA MESA = lit'
4 � BUILDING DIVISION
F i T.
77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
Y. �ta . FOR INSPECTIONS CALL: (714)754-5626
etgii-osirwPERMIT NUMBE8-00136
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 42224101 DATE ISSUED: 04/23/2008
;ISSUED BY: RMD
JOB ADDRESS: 1953 MEYER F L? CM ,`Suite/Unit -
Vicinity: HOUSE AND GARAGE ROOF+ . ,
Squares: 0
+/ I -
SCOPE OF WORK: TEAR OFF:(E) ROOF MATERIALS, INSTALL 2 LAYERS OF 15#FELT'ONiA2:12 PITCHED ROOF AND REROOF
WITH 30 YEAR COMP SHINGLESIAP.PROX'18`SQUARES(ATTACHED HOUSE AND GARAGE)'AND,INSTALL 1,25#
BASE, 2-11#FIBERGALSS AND;1 LAYER OF=72#CAP SHEET ON 5 SQUARES OF FLAT ROOF. REPAIR AND, ti'.
REPLACE SHEATHING AS NEEDED..,Tn `rr a Wttx ,, :.';
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OWNER: DUGAS,WILLIAM A ET AL s_ `-r--Address: ,1953 MEYER PL`.' . • _ Unit:
PHONE: r- ' ' _ City/State/Zip: COSTAMESA,CA
{ Ii t"f. -
APPLICANT: BURR STEVE a )//__ .7, Address: 711 WEELO DR s--;r., Unit:
PHONE: 949-548-2965£ - L City/State/Zip: COSTA MESA,CA r .. ....
•
CONTRACTOR: STEVE'S ROOFING • $ License No 302157
Address: 711 WEELO DRUnn. _PHONE. 949-548 2965
City/State/Zip: COSTA MESA CA 4.r 92627 - -. -- - • T:_CELL - -
r
ARCHITECT: t'` .�<,- License No. PHONE ��
is
ENGINEER: License No. PHONE:
FEE SUMMARY
Reroof Plan Check: l''''.$ •0.00';•,,, ' '
Reroof Permit Fee: $97.-25 ',y
Reinspection Fee: $0.00
TOTAL FEES $97.25
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.
CODE P. INSPECTION TYPE DATE INTITIALS CODE9 INSPECTION TYPE, DATE INTII1ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final ' 208 Final Plumbing
200 Final Re-Roof (IA_ .W 10 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'COMPVNSATION DECLARATIO Owner ID verified by dri ,c. ❑Yes 0 No
I hereby affirm under penal of perjury one of the °flowing declarations:
Driver's License No. Expires: -i•
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tall bill or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation InsurancA carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
r-n—umber are: E person is required to descend, will be made in connection with work authorized
�-Camer. t/fv by this permit,and that no building structure,scaffdding,falsework,or demolition
or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This seaun need not be completed tithe permd is valued at one hundred dollars MOO)or less)
2,Art 2,Sec.341,Title B,California Administrative Code).
Policy Number:
0 As owner-builder, I will not employ anyone to do work which would
O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of Califomia, and agree that if I should
become subje t to the workers' compensation provisions of Section 3700 of
Applicant's signature Date
the Labo Co hall fcomply with these provisions.
r - 23-0 V Division of Industrial Safety Permit Number:
Applicant's Signature Dale HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the Califomia Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. q a registration form for acutely hazardous materials? 0 Yes 0 No
Lica.#' y �Z / Class# C 3 1 (Section 25533 of the California Health and Safety Code, with some
3 4g1 exceptions, requires registration with the Costa Mesa Fire Department by
3 each business which at any one time has on hand a quantity of acutely
U-t contractor's Signature •"Date hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No
issuance,also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors (Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'Yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
O I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
thereon,and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer). •
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). .'information given above is correct. I'agree•to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions. .
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and • -
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
El I am exempt under sec. _ the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
pnature o! er(s) '/ Date �/
Signature Date `] 23'61
305746(3/07)
And/or Authonzed Applicant Date
I -. E - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PERMIT NO. • _ TRACT NO. LOT NO. • UNIT NO. r' _F _
CITY OF COSTA/ MESAlCONSTRUCTION PERMIT 1 O S�
ProjedP.Yddress A 7 3 - rL ,a� ' J
TYPE OF CONSTRUCTION ❑ NEW I ADD ALTERATION H REPAIR 1 • - "AU C g inn A
Applicant's Maili❑p�-}gddress _ �7 ❑ CONVERSION- ❑ DEMOLISH OTHER q.p,# Zone
Owners Name r� - Phone C' - _ •I A.
DESCRIPTION OF W /USE OF �Gp��'q�/ JJf-' h ��C
Address - I : ¢.o • Li - 6A - E Main Building: - -AckIYw'1
T�i MESA r • Z
Arch/Eng: - License No140 i41 J/ TYPE OF PERMIT GRADING FOUN TION ❑ STRUCTURAL T Front _ 1 H" O
Address - ,,/ • - - • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING- ❑ MECHANICAL B Rear - l
Contractor's Nam "� 1� -PhOne�y'S I LFI - El OTHER q IN
mo T7 y- , PROJECT DESCRIPTION SQ. FT.• a O OCCUPANCY C Right • • _ G
Address(marling) -r�J 1 qN ��J K
CONSTRUCTION TYPE • VALUATION rt O 0• g Left' • I r < R
/l City License No. ZONE GRADING CU.YDS: - ACRES I _ E
soLICENSED.CONTRACTOR DECLARATION . ' Ping. Ref. # 1 Parking,Req./Provided • l - .
I I herebyaffirm that I am licensed underprovisions of Charter 9 commencing 0
1 ( Remarks: I Planning,Notes: M
with section 7000) of Division 3 of the Business and Professions Code,and ' _ _ T
`' my license is i• u ford and effe i l , •I I •
_1 License Class I 'cen :��J '��/ - r ;
'` Date ' • Signature •.�• • PLUMBING FEES 1
YORKERS' COMPENSATION DECLARATION . • " • - ' '
hereby affirm that I have a certificate of consent to self-insure or a certificate • Bei Sink Showers l • ELECTRICAL I 1 FEES ,
of'Workers''Compensation-Insurance, or a certified copy thereof-(Section--.- • Backflo• w Preventer -', Service Sinkl -- ' - - - - - - 0 15=50 KW -;
_ "
3800, Lab. C.) - 1J I
L '7 Automatic Washer - (Transformer
Policy No. �-9af�1/2u11i I Qompany Backflow Irrigation Sewer Cap0 50+KW
- Construction Pole Sub.
8 Certified copy is hereby furnished. •
Certified copy is filed with the city Builtll ivi o�r�r 4 Bathtubs Sewer Connection Cooking Unit • Meter Dup to 100 amps
Date (Si Applicant 1�•--s"-r `• - - _ - - - 1
'EXEM PTI N'F FROM WORKERS'COMPENSATION DECLARATION• Clarifiers _ _ -y Solar COII¢Ctors Dishwasher Meter Dover 100 ampsr
(This section need not be completed if the permit is for one hundred ($100) or ' -
less). I l ' Dishwasher _ Solar Piping Dryers ❑Gas' ❑Electric Sub Panel I '
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 gas to become subject to the ' . Drinking Fountains , Solar Tank Fan Motors 00-1 HP 01Y:-8
Workers' Compensation Laws of California. '
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar.09-15 HP ❑16-15+
NOTICE:IL after making this declaration,you should become subject to the - {
Workers' Compensation provisions of the Labor-Code, you must forthwith - , Floor Sinks -' -"'- - ' - . Urinal" - '- - - - ' -- - " Fixtures • •-' "" �- - .. -r ' -'
comply 'with such provisions or.Jthisrrpermit'snail be deemed revoked. l Microwave
CONSTRUCTION•LENDING.AGENCYt .0 ' . i - Gas Service 1 Outlets' " Water Closet - 1 • ' '
• •
I hereby affirm that there is a.construction •
lending agency for the performance •" I ` Device Boxes ' Pole Light
of the work •for which this permit is issued-,(Section. 3097 Civ. C:) Interceptors' . • Water Heater • Outlets • ' Range I
Lender's! Name -
Lender'sAddress ' 1.. - Kitchen Sink _ Water Service, - 1 _, Switches . Sign
OWNER BUILDER DECLARATION - - _ , . - •
I hereby affirm that I am exempt from the Contractor's License taw for the Lavatories I •
Garbage Disposal 'Standing Sections
following reason(Section 7031.5'Business and Professional Code: Any city or - _ _ - -
county which requires a permit to construct,alter,improve,demolish or repair , P-Trap -. It . - a Generator 00.5 KW 05-15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit - - _
'o file a signed statement that he/she Is licensed pursuant to-the provisions of Roof Drains; • .. •
-
ae Contractor's License Law (Chapter,9 (commencing with Section 7000) of - - '
ivision 3 of the Business and Professions Code)-or that he/she is exempt - r I I I • •• r
herefrom 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 • I ' I - I - - ,
LIenalty of-not more than five hundred dollars ($500)., - $'37
I, as owner of the property or'my employees with wages as their sole 1 Reinspection'Fee ' i I $15 ' ' Issue Fee • I - 1 -
compensation, will do the work,and the'structure isnot intended or offered - -- Reinspection Fee I $15 Issue Fee • $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
-
License,Law does not apply to an owner of a property who builds or improves - - - - DEVELOPMENT SERVICES REQUIREMENTS: I
thereon, and who does such work himself/herself or through his orlher own ' Hood or, Type I ❑ t 1 '
employees, provided that such improvements are not intended or offered for Boiler ' . �- ,
sale. If,,however, the building'or improvement is sold within one year of com- Canopy• Type II ❑ Zoning Approved By Date
pletion, the owner will have the burden Of proving he/she did not build or im- Duct--Under Ground ' 1 i Building Approved By - Date
rove for the purpose of sale). II, aslowner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System i Application Issued Bye Y'- Date 8'
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an'owner of property who - Duct-Ventilating - ,- 00-100,000 BTU .0.100,000 BTU •SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con- - -
tractor(s) license pursuaqf to the Contractor's License Law). I am aware that ' BUILDING PERMIT $ 20.CO • 'SMTP $ ••SO
proof of their Worker's Compensation insurance should be provided to me.• l Exhaust System 0 Multipl¢0 System Repair/Alteration -
PLAN CHECK $ PERMIT ,
C I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBO# • - PLUMBING $ ISSUANCE $
Date '_ Owner - ' Heating System& Ducting - PLAN CHECK '25% $ .ENERGY,P.C.' $
I hereby certify that I have read this application and state that the above • 0o-100,000 BTU D100,000BT , • ELECTRICAL $ "GRADING $
information is correct. agree to comply with all city and county ordinances - •
and state laws relating to building construction, and hereby authorize repre- I PLAN CHECK :50% $ MICROFILM $
sentatives of this' city to enter upon the above-mentioned property for •
Inspection purposes. 1..F n n F/_L/7 •
MECHANICAL $ TOTAL FEE • $ Z0.cJ�C
Signature J(
Reinspection Fee $15. Issue Fee • - $ 3 PLAN CHECK 25% $
CMF 0865-46.rev.4/84 White-Building; Canary-Applicant;Pink-Accounting;Goldenrod -Assessor
CONSTRUCTION AND PLANNING FG .SPA -
- ARPROVALS Permit _ Date Inspector APPROVALS Permit# Date Inspector
r •
4 1. temporary Electrical-Service or Pole - • ' 52. Pool & Equipment Location ,
2. ail Pipe-Undrgrnd. , . 53. Steel Reinforcement
3. Electrical Conduit-Utility-Undrgrnd. 54. Forms -• - - - . , '
4. Electrical,Conduit;Undrgrnd. , - - 55. Electrical Bonding •- ,
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test - _.
6,- Electrical UF ER Grnd. N 57. APPROVAL TO COVER-GUNITE ,
7. Footings + • - . 58. Electrical Conduit-Undrgrnd.. - •
, 8. Foundation 59..Gas Pipe, 0 Undrgrnd.,Test •
9. Water Pipe-Undrgrnd. • - 60. Backwash Lines;•P-Trap, 0 Undrgrnd. - . •
10. Structural Floor System - . • , 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection • 62. Backwash & Receptor-Final •
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing - - -'65: Electrical-Final ' ;
15. Rough Electrical-Conduit - - - - - - - 66. Solar System-Final ' '- - - -
16. Rough Electric Wiring - - - 67. Fencing & Access Approval • , - • - - - -
17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL • ' •
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT •
20. Rough Factory Fireplace . ' ' APPROVALS Permit#
• 21. Ducts,in Structure . ' 70. Underground Hydro
22. Ducts, Ventilating • , 71. Product Piping0Gas 0Oil , •i
23. Gas Pipe-Rough &Test . •. 72. Underground Flush- '
24. rot Framing ,r 73.'Undergrnd.Storage Tank O Gas .0 Oil
25. Roof Sheathing • Vielt,g_ e- tif _ 74. Overhead Hydro -
26. T-Bar Ceiling (Structural).& Monocoat . ' 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe • -
28. Lathing & Siding 77.4 FIXED SYSTEM FINAL '
29. Insulation - - 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT ,
31. Plaster Brown Coat 79. FINAL INSPECTION -
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
'
33. Final Electric Notes: •
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test ,
36. Hood or Canopy - - - -
37. Final Factory Fireplace - . . - -
38. Final Plumbing I - - •
39. Water Service-Final .
40. Gas Service-Final . • •
41. Solar Domestic-Final ' . - .
42. Backflow Preventer
'43. Backflow.Irrigation ,. , - - • -
44. ,Landscape Irrigation System - -
45. Sound Attenuation '
. 46.46. Handicap Regulations . -
47. FINAL STRUCTURE & BUILDING 9��,/$�G , •
•
48. Special Requirements Completed / ' - •
•
' 49. Electric Release to Edison' - - - - -
50. Gas Release to Southern California Gas O i
51. CERTIFICATEOF'OCCUPANCY _ _ - ,
No. - - Date --
-
s' .'-' tApplicant to fill in all_spaces except those within heavy border lines and sign all appropriate declarations. - - _ -r - -
s4 r I PER IT NO TRACT NO. ' .LOT NO. UNIT N6. _ �_eQO, TL
;,-
GIT OSL.4:MES�, CONSTRUCTION PERMIT I I :• r 1 1
IRS MeyE2 �I IACCa 1 r (a5 c'� 3845 1.2!11 /84
. project Address ' - ,r
Applica• nts Mailing Address -\SR IY1.1= ' TYPE OF CONSTRUCTION" , ' L I NEW"Li ADD_L ALTERATION LI REPAIR -
Owner's Na •
me-� ).r I t I a N. .VUt; h 9 •- Phone Sc}8• "^9/a Sp ❑ CONVERSION _❑ DEMOLISH j❑ OTHER I - _ A.P.# r. Zone -
•
-DESCRIPTION OF WORK/USE OF BLDG. - - .
Address' 1 ci S3 Mel P-9.- r C1 l4e' P- (nSTa Me Sf} - - • _ , _ S Main Building: •_ Accessory - •
Arch/Eng -• License No. , i TYPE OF PERMIT ;❑.G RARING ❑ FOUNDATION ❑-STRUCTURAL , T: Front i , , ' t - - • - Q
Address - - I - ' ❑ TENANT •.❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL • - B Rear - . N I
Contractor's Name l Phone '❑ OTHER - `- i • A - • ' -
'I _ P,ROJECT DESCRIPTION SQ. FT.' - -' OCCUPANCY C Right C = G
Address(mailing) • K• Left - I
I I i ' CONSTRUCTION TYPE • - VALUATION$ • ' - S - . . '
City License NO. _ t ZONE •- GRADING CU.YDS. ACRES ' - - E
LICENSED CONTRACTOR DECLARATION - Ping. Ref.# , Parking Req./Provided r
i-hereby affirm that I am licensed under provi ons of Charter 9 (commencing Remarks: . ' - ._ Planning,Notes: I M
. with section 7000) of Division 3 of theme us' es and Professions Code, and - ' '
. my license is in full force andleffect. `/' \) I I , • - . ' ' -. - - T
License Class _ c se No.' I , -• S
-
Date " - ' Signature ! • PLUMBING FEES 1 I ,
-' WORKERS'COMPENSATION DECLARATION 1
t%i hereby affirm that I have a certificate of consent to self-insure or a certificate - , Bar Sink , Showers ' , ' ' ELECTRICAL - •• • 'FEES ( I
41-of Workers' Compensation-Insurance, or a certified•copy thereof (Section , .. Backflow Preventer - ' Service SinkT' ' - ' '
-3800, Lib. C.) 1 , Automatic Washer Transformer ❑ 15-50 KW 1
•
•Policy No. Company I Backflow Irrigation i• Sewer CapD 50+ KW 1
- R Certified copy is hereby furnished. Construction Pole Sub. • .
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection •
Cooking Unit IMeter ❑lip to 100'amp5
•
Date ' I Applicant . - 1
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION. Clarifiers ' Solar Collectors ' I _ Dishwasher '' _ y Meter _❑Over 100 amps - '_
'(This section need not be completed'if the permit is for one hundred ($100) or - . - -
less): Dishwasher I Solar Piping Dryers ❑Gas ❑Electric - Sub Panel
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 . Drinking Fountains Solar Tank Fan ' '
/ N Workers' Compensation Laws of Cal''4fo� nia' , - ' Motors ❑0-1 HP ❑1K-8
. Date IA-int-& Signature U if fi ..n-q dQ' rCt.L.1 Floor Drains Swimming• Pool ape I , •
y P F.A.U. Inc.Solar109-15 HP ❑1 6-15+
'NOTICE:If,after making this declaration,you should becom object to the _
Workers.'Compensation provisions of the Labor Code, you.must forthwith Floor Sinks -- -Urinal - - -- Fixtures - -- -' - - _
comply with such provisions or this permit shall be deemed revoked. - Microwave ! I
CONSTRUCTION LENDING AGENCY -, 1 - ' ' • Gas Service ' cOutlets. . Water Closet Device Boxes-
• -
I hereby affirm that there is a-construction lending agency for the performance ' - - - 'Pole Light '
of the work for. which this permit is issued (Section .309] Civ. C.) v. Interceptors I - Water Heater ' Z',� Outlets Range ' -
•
Lender's Name' - l
Lender's Address - • - ' _ ' ' - Kitchen'Sink l' ' ' . I -,Water Service , ' ' - - Switches Sign '
OWNER BUILDER DECLARATION -- _ 1 •
I hereby affirm-that I am exempt from the Contractor's License Law for the Lavatories,. ' l . - ' -
following reason'(Section 7031.5 Business and Professional Code: Any city or . Auto-Wash - ,, Garbage Disposal Standing Sections i
county which requires a permit to construct,alter,improve,demolish or repair , P-Trap- - Laundry Trays. Generator ❑0-5 KW❑5-15 KW Trash Compactor ' -
any structure; prior to Its•isauance, also requires the suant an or such permit _ i
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains '
'he Contractor's License Law(Chapter .(eommde) g with Section 7000)of " ..
evision-3 of the Business and Professions Code) or that he/she is exempt _ - �- ,
merefrom and the basis for the alleged exemption:Any violation of Section - - �.
.1031.5 by any applicant for a permit subjects the applicant-.to a civil - -
•
LJenalty of not more than five hundred dollars($500).' I .
I, as,owner of the property or my:employees with wages as their sole "Reinspection Fee • I $15, Issue Fee - - $ 3 - '
compensation, will do the work,and the structure is not intended or offered ' ' 1111 - .Reinspection Fee I $15 Issue Fee j $ 3 •
for sale (Section 7044, Business and Professional Code: The Contractor's • y n MECHANICAL . 1 FEES •
License Law does not apply to an owner of a property who builds or improves 1 - - ,
thereon,.and who.does such'work'himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS:. -
employees, provided that such.improvements are not'intended or offered for Boiler Hood or Type I ❑ i
, sale. If, however, the building or improvement is:sold within one year of com- . - Canopy . Type II'' 0 Zoning Approved By Date_ -
• pletion, the owner will have the burden of proving he/she did not build or im- . Duct-Under Ground I I • Building Approved By - Date I
prove for the purpose of sale). ' - , - -
•
❑ I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By 4 4.4111Dat= '
tractors to construct the project (Section 7044,Business and Professions Code: i
The Contractor's License Law does not apply to an owner of property who . Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES `
builds or improves thereon,'and who contracts'for such projects with a con-- _ -' — . -- —_, ,
' tractares) license pursuant to the Contractor's License Law). I am aware that - BUILDING PERMIT , $ ' i SMIP• $ ,
• proof of their Workers Compensation insurance should be provided to me.• Exhaust System 0 Multiple 0 System ,
0 1 am exempt under Section B.&P.C.for this reason Firepl/Fact.Bit. ICBG# ' Fire Dampers--- '
PLAN CHECK : $ PERMIT •
1 PLUMBING $ �•C� yI ISSUANCE $ ) I
X Date )Z-II- &V owner -` ._- A�1 � Heating System&Ducting [ Registers PLAN CHECK 25% ' $ ENERGY P.C. ' •
I hereby certify.that-I,have read this application-and state that V a above ❑0-100,000'BTU ❑100,000BTL• - - • - • - - - - - ( • GRADING ,$ '
information is correct. I agree to comply with all city and county rdinances ELECTRICAL $ - ,
and-state laws relating to building construction, and hereby authorize repre- MICROFILM '$ ' •
sentatives of'this'city to enter upon the above-mentioned property for • i t J PLAN CHECK 50% $ ! ' _ 1
, Inspection purpo e3. " 1 i
,5 )�_ )/- I i MECHANICAL $ • TOTAL FEE $ �'
Signature�!J 1Ly-k.LYYt- Date
Drivers' License or SS ke
� Reinspection Fee I $15 Issue Fee i $ 3 PLAN CHECK 25% ' $ !
MF 0865-46,rev,10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
•
If _ ,CONSTRUCTION%ND PLANNING ' - - - - _ .P9 & SPA
11 APPROVALS Permit# - •Date Inspector - - APPROVALS Permit# - Date Inspector
.Temporary Electrical Service or_Pole - .52. Pool &`Equipment Location -
Soil Pi a-Undr rnd..
' P g - • 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. - 54. Forms _ -..."4. Electrical Conduit-Undrgrnd._ i 55. Electrical Bonding , •
- 5. Steel Reinforcernent ' r - 56. Rough Plumbing & Pressure Test . - '
' 6. Electrical UFER Grnd. - - 57. APPROVAL TO COVER-GUNITE
7. Footings - - . -• 58. Electrical Conduit-Undrgrnd. _
8. Foundation c - - 59. Gas Pipe, 0 Undrgrnd:,Test • ' •
(9. Water Pipe-Undrgrnd. - '60: Backwash Lines;P-Trap, 0 Undrgrnd..
10. Structural Floor System - - - 61. APPROVAL TO DECK _ -
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final '
112. Sewer Cap - - -63: Heater & Vent-Final -
13. Roof Drains - • 64. Plumbing System - Final .
• 14. Rough Plumbing • - 65.-Electrical-Final • •
-15. ;Rough Electrical-Conduit- - - , - 66.-Sola-System-Final - -
- 16.,Rough Electric Wiring - - ,67. Fencing & Access Approval - - - " _ - - -
17: Rough Wiring Sign . - . 68. APPROVED FOR PLASTERING ' - '
. 18. Rough Electrical-T Bar Ceiling : - 69. POOL/SPA SYSTEMS FINAL •
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT . •
20. -Rough Factory Fireplace APPROVALS Permit# '
21. Ducts, in Structure .70., Underground Hydro
22. Ducts,Ventilating -71. Product Piping LI 0Oil -•
23. Gas Pipe-Rough & Test ' 72. Underground Flush ' -
24. 'Roof Framing- . 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro - •
26. T-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical --
27. Frame and Flashing 76. Dry Standpipe i
28. Lathing& Siding ,77. FIXED SYSTEM FINAL
29. tlnsulation • . - 78. FIRE PREY. FINAL
30. Drywall Nailing • .HEALTH DEPT. REQUIREMENT
•-31. Plaster Brown Coat 79.. FINAL INSPECTION
32. Electrical Power Meter-Final . 804 FOOD CERTIFICATE ISSUED
• 33. Final Electric • Notes:
- 34. Final Heating &Air Conditioning' •
35. Final Gas Pipe-Test i _ _ _ ,
36. Hood or Canopy . - i -_• -
37. Final Factory Fireplace' -
38. Final Plumbing J4% /.0 .//-/if? I
39. Water Service-Final
40. Gas Service-Final i •
41. Solar Domestic-Final - - _ _ -_ _ _ •-. _ _
-
42. Backflow Preventer . •
43. Backflow Irrigation • - ' - .
44. Landscape Irrigation System
45. Sound Attenuation - -
.
46. Handicap Regulations _ . i; - - _
47. FINAL STRUCTURE & BUILDING - t
48. Special Requirements Completed' i . I ' ', . - - •-`
•
49. Electric Release to Edison - - - - '•- I • •
•
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY �_ .. i_ ;. -. !_
INo. 1 Date_ - I ! - , - -
.., C
CITY OF COSTA MESA •
• BUILDING DIVISION
OWNER-BUILDER VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shallattach to such t;
notice, and, as a condition precedent to issuing a building permit, require the completion and require
the return of, an owner-builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be
issued until this verification is received.
I personally plan to providp,the major labor and materials for construction of the proposed •
Qproperty improvement, j Yes 0 No
I (have/have not) 'V\P t -' signed an application for a building permit for the
proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name ft'n. AS n h.-e-t-Q_a_
Address City
(14.---&-t".• %✓✓tx-�
Phone ( ) a cif-- °/3_3—O Contractor's Lic. No.
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address City
Phone ( ) Contractor's Lic. No
5 I will provide some of the work but I have contracted (hired) the following persons to provide
the work indicated:
Name Address Phone Type of Work
•
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the
State of California Health and Safety Code and have completed the above information to the best of my
personal knowledge, in compliance with this State law.
Signed: 1:04.-“c4.,_,..__, /XSlic,yc„v ) - &a ga. 4p t I a— ( - � Y
Name: . ft-kiL1vc, /4 A tlUSffR- c.O
(Printed or Typed)
C.D.L. #or S.S. #
CMF 1042-46 754-5273
•
'' _ CO FO. RM, rD COPT
• �, ' ��''� Not Compared with Original
RECORDED IN OFFICIAL RECORDS
'8407 09107/F4 • 4.00 I OF ORANGE COUNTY,CALIFORNIA 9
101 8407 9/07/84 : 4.000ATL -1
Sam -Sio PM SEP 7'84
P407. 09/07/84 5.000ATO ClQ
c e� //�� COUNTY
t C( `/tJ�.t.c L RECORDER
9407 09/07/84 1 .000ACG J •
ISPA(I AROVt THIS LINE FOR RECORDERS USE/
101 PhD7 9%07/84 2
POWER OF ATTORNEY •
SPECIAL
VV
KNOW ALL MEN BY THESE PRESENTS: That t, W;L-la Am AR 1—idC c
the undersigned
(jointly and sqyacally it more than onn27h reinatter collective}y/' rincipal"). hereby make, constitute and
appoint nit/Lid P CO t' i4— /"fY7N. S/44'6V
principal's true and lawful attorney to act for principal and in principal's name, place and stead and for
principal's use and benefit:
(a) To ,b1.47vU Lc 4- AAATl K i c2..4'1 b
or
Ltt ( AA 5 r /c_ PII/� -t L� .
Principal hereby grants to said attorney in fact full power and authority to do and perform each and every act
and thing which may be necessary, or convenient, in connection with any of the foregoing, as fully, to all
intents and purposes, as principal might or could do it personally present, hereby ratifying and confirming
all that our said attorney in fact shall lawfully do or cause to be done by authority hereof. •
Wherever the context so rssquires, the singular number includes the plural.
WITNESS my hand this 7a day ofA" / 2 / .
Ann
STATE OF CALIFORNIA
/� 55.
COUNTY OF._SJmante
On this 7t day of .rf�r 4 P in the year 19.W..before me,the undersigned.a Notary Public in
and for said State.personally appeared (✓.� r�... /�}}�iur d4 401
personally known to me tor proved to me on the basis of satisfactory evidence)to be the person. "whose name-_.,-/1 _subscribed
to the within instrument. and acknowledged to me that _he_executed it.
WITNESS my han and official seal.
,/ — •
i I
Notary Public in and for said State.
L..
POWER OF ATTORNEY-SPECIAL lbs mandate)Ipm It mlended tat IM typal mann anwuntered m ea lWM R am tion.bEat yea Wilt read
WOLCOTIS FORM 1406—Rav 1St (Wm W M 3) a,no In all Wanks.and make.NIMW LIMn9as WO appbpryR and'medlar/Y IOW PanC"nanMtlYf roll WN a
:•IR1t WOLCOTIs.INC. Yeo 11 rad doubt ow term's Wass Ip your Oradell and use
f
.. Costa Mesa Building Department V APPLICATION FOR PERMIT
111 EAST 20th STREET ,712
COSTA MESA, CALI FORNI 143 ^�-�'-�'��- --"'-'�,
FOR APPLICANT TO FILL IN E FOR OFFICE UONLY. 1
' I Receipt No. Permit!No.
Building n ; ; c i '/'
Address 1953 Meyer Place - i r //54/1_<" `
_
Receiv by, Date Recd. Date Issued I
Costa Mesa, California 1
Nearest I ! 6 —�f7 Ss 6- /e -S ,1
Cross St. 79th Street Building I i
Address I 1
Owner lieirbor Estates ',• i Costa Mesa, California 1 I
Mail 1 East 17th Street
Address 4 9 ', Nearest
Tel @ Cross St. j . i 1
City Costa Mesa NoLi.8-1159 ,' zone; I No.of Type I Group
Architect or Carlson cc Il_idUiebrgk1c
i�/.� 4I Plans � I { T�
Engineer No. : Approved tt
by I I Date
Address Garden Grove ! i CO i ONS
ContractorDikeNo.
Colegrove-& City Lic.1301•
♦ I
Address 419 East 17th Street f �` 1l
1
Legal Lot - ___ - f I
Description I No. 59 Block Tract1986 - —
p I at 1 6 1955
(Attach Metes and Bounds) i - I
No.of Bldgs.
Size of Lot 60 x 110 I Now on Lot none - -—
Exist ng Bldg. none I Families No.of 1 I Roof 2 — CI� A
�.6
Setback Line from - 501 Rear Yard I —''- - "-`"T-' -_,__---_Z
Center of Street Side Yard
DESCRIPTION OF WORK m5 __ , ,.-„ l , r
New I x I Alteration I I Addition I
Repair 1 I Moving I Demolish I
"i Building 1
Size 971 5q• • No.Rooms of 52 Stories
Exterior Wall I Roof
Covering Stucco Covering Comp. APPROVALS
Use of Now Single family residence
Building Foundation Location Inspector Date
Forms, Materials,
and garage Under-Pinning
J .. Frame: Fire Stops,
/ ,' G Bracing, Bolts
I hereby acknowledge that I have read this Application Lath. Int. .
and state that the above is correct and agree to comply i Lath. Ext.
with all City Ordinances and State Laws regulating
building construction.
Signature of Dike & Colegrove Plaster, Int.
Permittee -
Plaster, Ext.
Authorized Agt. '.- /
,.,, ,.: - , . ,_„ �.- Masonry Reinforced
$Valuation , Permit Fee a. . c 0
Plan Check $ _d, v o Bond Beam
$ roc 7- Total -
,NJ 4 Fee -$ es1-3 . °O FINAL
form 208 G-H 1M 12.5
. tP -♦ _ _
. t-at'T ? '
•
J v c
C. . . +
a` •
- a ' JllP� 16 5513Ddesd_Ili 3T. =*.a23.Q0
.i' .
. . ._.. . .
Street.
t] ., - ., l
PLOT PLAN . . - . _ ,
Show location and distances from
property line and between buildings.
._ , ..7• •: .. ..
•
` - ,: - - ?'.; CO3...;
.._. _ . JJ ..-. .
•
•• c
. ..
. . . )_- :11 ..
Ir Y:
OWNER HARBOR ESTATES ✓ ' - 6-16-55
JOB ADDRESS 1953 Meyer Plade BUILDING PERMIT NO. 1115
GENERAL CONTRACTOR Dike & Colegrove VALUE $ 8,000.00
LOT 59 BLOCK TRACT19S6 Residence & Garage1 (Single)
GROUP I TYPE V ZONE MI FIRE DISTRICT 1432
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
/ DATE NUMBER
&
Footing Trench - S'G 7-12-C
Foundation Forms and Grade to Garager;
Rough Framing 8_` �y�o(,t4 8 k-sj .
Plumbing,Rough to Slalf il , ya yri�
V _ Z
Plumbing,Rough Complete a,.y � 4c;f i „;-o-co„ c1_23-ff ,.L trio ✓
Temporary Pole
Wiring,Rough VC°z'`" ep'/2-ti 214,,,,,,,,,,,,t, c-
co,ac - 25--r?-,SS- /a6>/
Heating,Rough - n
Heating,Final Asea .S • • ! 6a 'i" , 9-a3-.r 2 2,Y`
Sewer, House / y Sewer,St. X� /JJa:le- -) R-1,-cr ,4I-1N/ ✓
Septic Tank or Cesspool
Lathing, In Out �y� 3,-, -
Plastering 4t44 9-,2o• 4
Plumbing,Final,Fixtures Com I te/«t 1 4-
Plumbing,Final Gas Test/�� , ;(i �f /(�. 1' \ / % � �f .-
Plumbing,
Wiring, Final II•• $./ IC-.7-5 k'-..J Cr _ /-�
Occupancy t.-- fd epi-
Form 210 G-H 1500 1-55 . .